Nerdy comics

This site is awesome. I've spent the last hour looking at the comics. Fits my inner nerdiness.

http://xkcd.com/304/

Patient Rights

Informed consent. It's a long history, but informed consent came about when patients started asking for more autonomy in their patient care and the term "patient rights" came into being. I'm all for patient rights and autonomy and it's definitely the right direction for patients to go towards. Of course, there has to be a limit to what a doctor can or has to do, and this article does an excellent summary of listing and explaining common myths about informed consent:

http://archinte.ama-assn.org/cgi/content/abstract/156/22/2521

Let me summarize.

Myth 1: A signed consent form is informed consent. Just because somebody signs a piece of paper saying they understand all the risks and potential complications of a procedure doesn't mean that they understood everything you tried to tell them, or everything that's on that piece of paper. Some of those consent forms are pages and pages long and full of jargon, so that could actually confuse someone more than it helps.

Myth 2: Informed consent is a medical miranda warning. There's more to informed consent then tell patients all the risks of a particular procedure or action. You also need to tell patients about options, potential outcomes, etc.

Myth 3: Informed consent requires that physicians operate a medical cafeteria. For a given problem, there might be 20 different ways of going about treating it or solving it. A doctor doesn't actually need to present all 20 ways - in fact, this usually confuses the patient! The doctor only needs to (and should) present a couple of the methods (usually what the doctor thinks is best) to the patient and information about the different methods. And physicians can still give advice - the goal is just to not be paternalistic. In fact, patients often ask for advice ("what would you do if you were me") in addition to the information and welcome it. Doctors don't have to just sit back and let the patient choose out of all the options with only factual information.

Myth 4: Patients must be told everything about the treatment. This is certainly not legally required, and if doctors did this, it could take hours. Ethically and legally, a doctor should tell a patient everything a "normal" patient would want to know, and then of course, ask if the patient has any questions. A doctor cannot and should not be sued or deemed a bad doctor because he failed to disclose an aspect of the treatment that is very rare or that the common patient wouldn't care to know at the beginning.

Myth 5: Patients need full disclosure about treatment only if they consent. Theoretically, patients need to know about important things before they consent if they are trying to choose between options.

Myth 6: Patients cannot give informed consent because they cannot understand complex medical information. While a patient might not be able to remember or recall everything that was explained in the office, during that office visit, they will probably understand everything well enough to make a decision. Secondly, things need to be simplified in a way that patients can understand things. If a patient is incapacitated or incompetent in a way that makes them unable to make decisions for themselves, then there needs to be a surrogate decision maker.

Myth 7: Patients must be given information whether they want it or not. It is certainly within a patient's right to not participate in decisions affecting their health care - they may leave it up to a family member, or even their doctor. The doctor shouldn't force a patient to listen to them if the patient truly wants to give up this right.

Myth 8: Information may be withheld if it will cause the patient to refuse treatment. In no instance is it right to withhold health information from the patient about him or herself.

I think this article is great, because often doctors feel they have to tell the patient too much, or there are doctors not telling patients enough. Conversely, there are patients who expect things that doctors aren't obligated to give. Of course if they ask, it is usually given, but just because a doctor doesn't give it, doesn't mean they're a bad doctor. The article basically explains to both doctors and patients what is expected of them during an office visit, and that's been a relatively murky issue for quite a while - at least in my mind.

Accumulation of Wealth

This came up in a previous post. How come we have sooo much crap?

Not only did I already own a lot of crap, but when I moved in with my fiance, we doubled our crap and neither of us is willing to give up much. When I moved here, I brought my clothes, my car, and some pots and pans. I went to Ikea the very next day and bought a mattress, a TV and a chair. That's what I had for 3-4 months, and that worked pretty well! Now we have 2 TV's, 2 DVD players, 2 stereo systems, a futon (we actually sold our two couches - only because they didn't fit), three tables, one desk, one desk chair, three easy chairs, one rocking chair, 6 wooden chairs for the dinner and breakfast tables, 4 huge bookcases and 2 smaller ones, 3 chests of drawers, 3 air conditioners in various conditions, pots and pans galore, one bed and mattress, a huge number of towels, a couple hundred books, countless wall hangings/posters/art, and probably some other furniture and stuff I can't remember. It's crazy!

And now that we're getting married, people keep pushing us to get more stuff - my people, I mean the culture. Not everyone is going to want to give us cash for getting married, so we had to register for all this stuff we don't need and may have to move from apartment to apartment. And going to the store, all the salespeople are pushing us to register for tons and tons of stuff - even things we don't need. And somehow sometimes it works and I feel like we need it. And then they say "well you just throw out the old stuff." I think that's also a load of crap. But we really don't need it and our stuff doesn't have to be the best out there in the market.

I think I'm just saying I don't like this material culture even though I am 100% a part of it and play into it.

The theory of addiction

I'm sure this is a subject that has been explored many many times, but the other night I got into a debate that eventually involved the definition of addiction. Here is the definition according to Webster:

ad·dic·tion
Pronunciation: \ə-ˈdik-shən, a-\
Function: noun
Date: 1599

1: the quality or state of being addicted <addiction to reading>
2: compulsive need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal; broadly : persistent compulsive use of a substance known by the user to be harmful

And then the definition of addicted:

¹ad·dict
Pronunciation: \ə-ˈdikt\
Function: transitive verb
Etymology: Latin addictus, past participle of addicere to favor, from ad- + dicere to say — more at diction
Date: 1534

1 : to devote or surrender (oneself) to something habitually or obsessively <addicted to gambling>
2 : to cause addiction to a substance in (a person or animal)

The first definition is what I would argue at first thought - that there is a biological basis for addiction. Not only are the physiologic rewards of using the substance, but there is tolerance of the substance (i.e. as someone uses the substance over time, it takes larger amounts of the substance to get the same high) and if you take it away, there are symptoms of withdrawal. Now the first thing this made me think was that substances that many people think are not addictive, probably are actually addictive by this definition. For example, drugs like marijuana, acid, and mushrooms are not thought of as biologically addictive, however, I think if you use these substances often enough, there are definitely symptoms of withdrawal, although they might not be as severe as some other substances. So are these substances than addictive? I think so - which is a change from how I used to think.

This leads into my second thought - that the "addictiveness" (how fast you can get addicted to a substance, or how long it takes) and symptoms of withdrawal are very different depending on the drug. Some drugs people can take once (e.g. cocaine, meth) and get immediately addicted whereas others it seems that you can use for a while before getting physiologically addicted (e.g. tobacco). Of course, this depends on the user as well, as there are genetic and environmental issues that are involved. Likewise, some withdrawal symptoms are mild, but some can even cause death, so clearly, the drugs are different. Does this translate into different levels of addiction? As an immediate answer, I think so... Clearly, if you can get addicted faster to a substance - that should mean it's more addictive. If your withdrawal symptoms are worse for a particular substance, probably you would do more desperate things to get the drug. For example, in the news you hear of crack addicts or heroin addicts robbing people, even the occasional murder to get the drug or get money to buy the drug. You don't hear that much for things like marijuana or mushrooms. Acid I have no idea. I guess I don't pay that much attention. I think this is very interesting because clearly some addictive things are legal - e.g. tobacco and alcohol. Legalizing some substances, like crack, cocaine, heroine, meth, seems like it would be impossible, and probably ethically wrong, because they are relatively easy to get addicted to and the withdrawal symptoms are horrible, not to mention the health issues of taking those drugs in the first place. However, if something is not that addictive, and symptoms of withdrawal are not that bad, does that mean that it's okay to be legal? Clearly the government thinks alcohol and tobacco are of a low enough addictiveness to be legal.

Finally, the last thing this made me think was that perhaps this definition was a bit restrictive. People have been known to engage in other behaviors that are harmful to themselves and are termed addiction - for example, an addiction to gambling or shopping. Although there are no withdrawal symptoms, people have a compulsion to do these things which are potentially (and usually) harmful to themselves. Myself - I have a potato chip addiction (especially ones with fake cheese). You could argue that maybe there is a biological basis for these people's behavior - maybe gambling gives them a natural rush, maybe a low-level state of excitement that they crave while gambling somewhat similar in nature to the adrenaline rush that adventure-seekers or sports-players seek. But that's a little murkier and far-fetched. I'm not saying impossible, but it's definitely in the realm of the unknown at this point.

I think this is a very interesting topic and deserves a lot more thought than I have time to give. Maybe when I'm retired.

Escalation

So it's interesting... when I first moved to Philly, I must have had nothing to do. I mean, sure I was probably kept busy for a bit, getting situated, moving things into my new apartment, and starting med school. Actually, I remember it took me quite a while to get more furniture... For a while, all I had was a mattress, a TV, and a chair that sat in front of the TV. I eventually found what I was looking for either on the street, or at Ikea but it definitely took me 3 or 4 months. I even had people over dinner - I made them sit on boxes and on the floor!

ANYWAYS, the point of this blog is that everything in my life seems to have escalated. I had barely any social life back then. I moved, and I knew nobody in Philly. I probably went out once a week, and med school-related events, and went to watch football games with pseudo-friends, some of whom I would become really good friends with, and some whom I have no desire ever to be friendly with again. Maybe I was studying (although most who know me would probably laugh), but I think I found other ways to occupy my time, and for the life of me, I can't think of what that was back then. Now my social life is so busy, it's a little crazy. Not only do I have friends from med school and ultimate frisbee now, which keeps me busy enough, but I have a significant other to interact and live with, and since his whole family lives on the east coast, and his whole friend base is also here, we have some sort of family function about every 2 weeks, which can often take up an entire weekend! And we're also big hosters and cookers - we love hosting people for parties, dinners, you name it. So we're definitely busy.

Other things have escalated too... I came with what fit into a very small two-door car. Basically my clothes, a TV, some pots and pans. Now we have a two-bedroom apartment, plenty of storage, and we are crammed with stuff. Granted we moved in together so there's two people's stuff crammed into one apartment, but I think more than half of it is mine! And we have tons of stuff in storage space too that we don't even use but don't want to throw away. It's ridiculous.

Maybe moving to a new city will be good - it'll be scary but it's a new beginning, and that's pretty exciting. :)