Fast Medicine

Around the turn of the century, Y2K was ushering in a doomsday scenario. I, on the

other hand, as a young physician-scientist, was quite excited. You see, I was quite confident that knowledge of our genetic heritage would be the panacea that the world was seeking. I think the lure of genes and genomes was merely an obsession for me. However, once I realized that, on a global scale, sustainable health for kids was not going to come from the deciphering of genetic codes, I had to switch my trajectory.

First came the awareness that I could no longer be an indefinite graduate student. That realization was made all the more potent when Ayesha, my wife, threatened to enroll in graduate school for English Literature in lieu of her relatively better compensated psychiatry residency. In order to determine what I wanted to do, clinically and academically, I remember asking myself a few hard-hitting questions. The most crucial was: “Where can I make the most difference or have the most impact with the least effort?”

The Emergency Room, being the answer to the above question, was not all that apparent initially. Swapping a cerebral field like medical genetics with an adrenalin-driven ER setting required a bit of a leap of faith. I was exchanging a group of untreatable rare disorders with readily-treatable, frequently- encountered pediatric illnesses. Being able to do something for the kids being seen in the ER was a significant motivator for continuing with that line of work.

Working in an ER in a major metropolitan area provides a fascinating view of humanity. The ER is a microcosm that is a reflection of the real world outside. People bring their presumably sick children to be fixed; in their minds, my stethoscope becomes the proverbial magic wand, as potent as Harry Potter’s. Just like their other problems, medical ones should be tackled instantly and gratification achieved…yes, instantly. For now, I often ask myself whether I have the ability to be a true healer or am I just doling out quick, albeit temporary, fixes to medical ailments of children that for the most part would eventually self-resolve. I have also figured over the past few years that more than the sick child, the overly anxious parent (usually the mother) requires much more placation.

As a medical professional educated in the ‘developing’ world, but practicing medicine in the ‘developed’ world, I question those labels. There are pockets of underdeveloped, underserved and developing communities in the developed world. It is likely that an ER doctor in a poor rural county hospital of the U.S. faces much the same issues as an ER doctor in a big city of a developing nation - both settings have limited access to resources and thus have to deal with absurd expectations of large numbers of patients as well as hospital administrations.

Let me give you an ER doctor-in-practice-for-a-few-years’ perspective. Parental complaints about the medical team intermittently reach the hospital administration. In the ER the parents are extremely anxious, and rightly so. So is the medical team when the patients have overrun the capacity of the ER. The parents, for the most part, do not grasp the medical triage system in the ER, or in other words, the idea that the most sick will get seen first. For them, their child is the sickest of the lot. Hence, if something like a blood transfusion for anemia or morphine for pain has not been administered in a timely fashion the parents may perceive that as medical neglect. They demand that things must be done ‘STAT’. But what they cannot understand is that the medical system has limitations. They stop being patient and tolerant. They then get angry and lodge formal complaints against the medical personnel.

In the U.S. one would hope that there isn't any physical violence against the medical team. But, I would speculate that aggression against the medical facility and team is likely the norm in less developed parts of the world. Just imagine you are an ER doctor at a facility where the patient to be seen next is entirely determined by his ability to pay versus the severity of illness. Would you tell some VIP that he will not be seen first because he is not dying - whereas, the poor old guy next to him having a heart attack must be seen first?

I would also speculate that there is a higher likelihood of medical error and negligence in under-developed regions of the world. Although doctors, being humans, can make medical blunders, there really should be more transparency and accountability. Hospitals in the developing world must have systems with checks and balances that minimize medical errors and thus ensure more meticulous patient safety.

At the end of the day, there are significant limitations that the medical infrastructure faces no matter where you are in today’s world. The doctors’ honesty about what medicine can and cannot achieve should be matched by the public’s patience with and realism about their ‘healers’.

Health generates passion and interest in experts and non-experts alike. And so it should. If one’s mind and body are unhealthy then we are unlikely to be productive members of society. Unhealthy minds and bodies cannot be educated. This does raise an interesting chicken vs. the egg paradox: is a healthy mind and body needed prior to any hope of education, or is an educated mind needed prior to a healthy state being achieved? In either situation, I feel that education drives targeting the community about health and disease, can be a move towards sustainably improving health, and not just merely ‘fixing’ diseases in ER and hospital settings.

Finally, encouraging love for one’s doctor, per the insightful lyrics of a famous song, might also generate good outcomes.

“Doctor, doctor, gimme the news I got a bad case of lovin' you No pill's gonna cure my ill I got a bad case of lovin' you...”

[from Health & Disease]

Acknowledgments: This article was first published in the Houston Inner Looper Newspaper (Feb 2013). A condensed version appeared in the Aga Khan University Alumni Newsletter, AKUNAMA. Photography by Riaz Khan.