Medical Residents and Type 1 Diabetes: You Can’t Help, But Please Do No Harm

Over the past 41 years of living with Type 1 Diabetes, I have met a lot of medical Residents: doctors who have completed their initial training, but are now doing further study on the road to becoming specialists – basically, newly-minted GPs with aspirations of greater things. Because my medical team has always been situated in or associated with teaching hospitals, Residents are part of the territory.

I try to maintain an open mind and a positive attitude whenever I am told that a Resident is studying with my team and asked if I would mind if he or she either sat in on my appointment, or saw me in advance of my meeting with my Endo. After all, if we don’t allow these people to deal with real patients while they are under the supervision of a specialist, how will they learn to do it properly? I would much rather meet them in the structured environment of their education than after they hang out their specialist shingle. So I have participated in the training of many, many Residents in the course of my many years of living with T1D.

Some of them have been wonderful. More of them have been arrogant, [...] continue the story

When It Doesn’t Make Sense

May 16, 2012

As doctors in training, we learn to think in patterns of symptoms and can often use “clinical judgement” to fit a patient’s presenting symptoms into a diagnosis. This generally works well, until we are presented with an unfamiliar pattern. For example, in the early 80’s I saw a 60 year old shoe salesman with fatigue and a low grade fever. He had general malaise and some muscle weakness. His exam and initial blood work was unrevealing except he was mildly anemic and his sed rate was elevated. A search for cancer and infection unrevealing. So my next thought was polymyalgia rheumatica, an autoimmune illness associated with inflammation of medium sized arteries. I sent him to a surgeon for a temporal artery biopsy which was negative.

About this time he started to get a cough and the chest X-Ray showed a hazy pattern of change. I knew the symptoms yet had not yet encountered HIV. He was one of the first cases in our State, but likely we had all missed the boat with similar patients. Our pattern thinking generally works clinically, but it isn’t a very good way to ferret out a new or unexpected disease. I never thought [...] continue the story

Schwartz Center Compassionate Caregiver of the Year Dr. Amy Ship

In accepting the award, Ship spoke of the importance of small gestures in the doctor-patient relationship – specifically, the art of listening with both eyes and ears. “Returning the (patient’s) gaze is one of those powerful small gestures,” she said. “It encapsulates empathy and compassion – being present, fully present, to another human being: pausing to look back. To say with our eyes that we are listening, that we hear.”

It’s a lesson she teaches medical students who rotate through Healthcare Associates. “I’m proud to be a primary care doctor,” she said. “Primary care is focused on continuity, of knowing one’s patients through all their illnesses and the complexity of their lives. And primary care is focused on prevention – on protecting you from the consequences of untreated but silent diseases and from unnecessary tests or hospitalization. That’s care we all need and deserve.

“I look out tonight at a room filled with people who have the minds, energy and position to change medicine, and I want to make it clear that primary care needs saving. Those who practice it need to be given the time to do it right. Primary care can literally save lives, but it can not be done [...] continue the story

TEDxMaastricht – Bas Bloem – “From God to Guide”

Professor Bas Bloem ( @basbloem ) is a consultant neurologist at the Department of Neurology, Radboud University Nijmegen Medical Centre, the Netherlands. He received his M.D. degree (with honour) at Leiden University Medical Centre in 1993. In 1994, he obtained his PhD degree in Leiden, based on a thesis entitled “Postural reflexes in Parkinson’s disease”. He was trained as a neurologist between 1994 and 2000, also at Leiden University Medical Centre. In 2002, he founded and became Medical Director of the Parkinson Centre Nijmegen (ParC), which was recognised from 2005 onwards as centre of excellence for Parkinson’s disease. Together with Dr. Marten Munneke, he also developed ParkinsonNet, an innovative healthcare concept that now consists of 64 professional networks for Parkinson patients covering all of the Netherlands (www.parkinsonnet.nl).