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Archive for the tag “medical practice”

Drastic and devastating

Drastic and devastating

The title of this post presents two important words from the medical dictionary. “drastic” can be first seen in the homeostasis introduction to medical physiology course. It emphasizes the lack of adaptive and accommodative responses to sudden and strong changes in the environment. In such conditions the outcome can be quite damaging or even fatal. The word “devastating” can be found in the pathology essays such as those changes due to severe infections and it usually concerns a local pathological change, e.g. necrosis. Though the two words may originally concern natural events in the environment, they may provide clues to medical care and case evaluation.

In medical practice the care-giver should avoid harsh interventions in terms of course and dose. The treatment may be better doing when it is decent and incremental (opposite to drastic). That view in the medical care – in some situations – entails ‘partial correction’ of the concerned disorder as”rapid*” ‘full correction’ may bring about quite unwanted or even fatal hazard. It is always wise to have an overall vision of the medical case with top-to-bottom estimate so that such extreme flip-flops can be better appreciated and avoided. The treatment should be both problem- and patient-tailored. As the body’s reserves to accommodate changes (temperature, water, food, etc.) is limited and varying from time to time one should be careful not to be too rush or too slow.

By the way, the medical opposite of devastating can be ‘mild’ or ‘trivial’.

Take-home massage:

1- Be decent, systematic, and incremental.

2- Observe well.

3- Be open-minded, generous and evolution-ready.

4- Make your expectations as modest and small as you can.

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* Suggested steps of management could be:

1- Reverse the current event.

2- Restore/establish base line.

3- Treat residual illness.

 

Must know facts in medicine

Are there any facts in medicine? This question may come to medical students because of the many situations where a certain finding or outcome cannot be stated clearly or absolutely and not to forget the usual gap between academic study and the real daily practice. In this essay I would like to try to give a reasonable answer to this question if there could be any solid basis (evidence-based facts) for medical practice.
On one extreme of the scale, the human body should be regarded as a mere machine, a living machine, only in order to objectify and modularize the medical facts that we are looking for.
I. Generalities:
1- Doctor’s collegial conduct.
2- A well defined and openly made medical service fee (physician and other costs) is the only most effective statement to guarantee a responsible conduct of service giver and taker.
3- A substantial number of people’s morbidity or death is caused directly by medical staff dehiscence and faults.
4- Human body function and health is amenable to study and predict by mathematical methods such as probability estimation.
5- Patient’s misery for doctor but doctor’s ‘revelation’ for patient.
II. Functionalities:
1- Spatiotemporal connection.
2- No price for an absent goat. No single organ can replace or cover the absence of another organ.
3- Once born is done. The new born is completely made person that will change almost only in shape and size (genetic and social constitution).
4- Consolidation rule.
5- Life is neither gifted nor robbed.
III. System operation:
1- A human is an open system organo-heterotroph.
2- Self and nonself (immune system).
3- Flow and stagnation (in- and outflow).
4- True- and malposition (body positioning).
5- Juvenility and aging.
IV. Pathognomonic criteria:
1- Vital data (temperature, blood pressure, heart rate).
2- Inspection and light transmission.
3- Palpation, percussion and auscultation.
4- Reflex arches.
5- Biochemical and radiologic tests.
V. Remedies:
1- Social manipulation.
2- Life style.
3- Antibiotics.
4- Medical remedies.
5- Anesthesia and surgery.

Life and medicine, reflections

life and medicine, reflections

The common divisor for life and medicine is that they are both ‘easy’.

The problem exists only when we make things complicated while they should not be so. But, on the contrary, a smooth and self-assembled and harmonized cascade of success should be there when we manage – even after quite long time – to lay such noise and artifact aside. You could be a famous and impactful physician because you show the readiness and willingness (sometimes fondness and passion); notice that many people do not show any of that all.

Do not be taken too far by those thick medical books full of ink and texts. These could be written by more than one person and/ or over long times, could be useful and interesting, or they may not contain an answer for your past, present or future curiosity and questions. You are, in every case, not meant to read every paper you find or to understand each word you may have ever heard – though it would be great if you were to do that –. Because, going from the easiness of medicine, you should (or very politely: must) stick to the basics of medicine (or life). This can be the line of demarcation between a trustful and artful physician and those who either dampen in their hesitancy or float in illusions of details and thoroughness: the true basics and ethics.

You deserved it because you knew it in advance; you got its essence and made it in the centre of your consciousness. What, when, why, how and where? It is (or should be) more easy than anyone can believe. As a physician you don’t fix machines but peoples’ health and life, you do not sell books or household goods but convey knowledge and culture, you do not stamp money or create gold but help everybody better appreciate their life and life as a whole.

A physician is a person who goes in life brilliantly and successfully in the best possible satisfaction through the honest practicing of medicine.

The physician’s guide

the physician's guide

The physician’s guide is an indispensible tool to summarize basic medical and clinical knowledge and experiences. It should be concise, easily demonstrable, regularly updated and greatly physician-specified (self made).

Here is a personal view of such important medical tool.

The Hippocratic Oath

Section 1: normal values (pediatrics: growth milestones or curves, caloric and fluid requirements and calculations; CBC; hemoglobin electrophoresis; plasma electrophoresis; liver function; kidney function; urine; stools; semen; hormones; electrolytes; arterial boold gases; and ECG findings).

Section 2: preparation-oriented drug index (topical formulas: skin, eye, ear, and nose; tonics and food supplements; antimicrobials: antiseptic, antibiotic, antifungal, antiprotozoal, and antihelimenthics; analgesics and antipyretics; antihistaminics; corticosteroids; skeletal muscle relaxants; antispasmodics; antihypertensives and cardiac agents; hemostatics, hypoglycemics; neuropsychiatric agents (sedatives and hypnotics, anticonvulsants, brain stimulants, antidepressants, antiparkinsonians); and beauty preparations (shampoos, cosmetics, soaps, etc.).

Sections 3: natural foods and herbs – sorted alphabetically – and their uses (basilica, chamomile, garlic, green tea, onion, thyme, etc.).

Section 4: medicines’ doses and instructions tables (neonate, child, and adult).

Section 5: crude models of medical prescriptions (orthopedic, eye, ear, nasopharyngeal, dermal, gynecologic, oral, cardiac, digestive, liver, renal, respiratory, and neuropsychiatry).

Section 6: medical algorithms (pediatrics: infant of diabetic mother, muconial aspiration, low birth weight, prematurity, neonatal jaundice, respiratory distress, etc.; adults: HTN, DM, bronchial asthma, cardiac asthma, DVT, diabetic ketoacidosis, hypoglycemia, stroke, etc.).

My physician is a human

my physician is a human.

It is nice to meet and know good people in a quite formal context, when customs and ethics are well applied and respected. You will like a smile, praise a shape or figure and admire a character. And so as a habit you will find somebody to like and almost find an excuse for possible light mistakes or a triviality. Sometimes, it is even more exciting to know about your idol something, but not so formal this time, as I would like to tell now about my amazing super physician. In one word I would like to shape out my physician as a mere human. A human who may have much cares about himself and about other people as well; who can make mistakes and suffer these terrible pains of conscience and self-criticism, and who may have chronic disease or very special health provisions.

And what a delicate human! My physician should train himself regularly how to help the sick so kindly and friendly without raising the least doubt or suspicion of any shortage as for medical proficiency and personal balance. Doctor’s work must be almost perfect. My physician does not like to work as much like a machine. The dehumanization technique, though logically important, is not absolutely working because my physician thinks that sharing the sick some of the pain is quite good for a guérison. My physician would experience and live inside some medical cases in a time to become quite exhausted and can’t see more cases. That is why a regular moral washout and physical and mental refreshment are very important. Not only concerned with bodily diseases, fighting infections, curing debilities, and ameliorating pains, but also and vey often sympathizing financially and engaged personally and socially.

My physician is very proud to convey a particularly beneficent message to the needy and sick people and insists to practice this job with much love and sincerity. As a mere human my physician can’t be blamed or insulted, but – on the contrary – should be honored and respected. My physician may succumb to any moral, physical or psychic concerns and devotes a whole life and resources to help fix or tame those defects or phenomena. That’s why my physician is deservedly described as mere human.

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