Juan Gervás Open Letter to a medical student:
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Transcript taken from: http://medicocritico.blogspot.com/
Gérvas strikes again: Open Letter to a first year student of medicine.
((The letter, in its natural habitat, in this link))
WHY BE THERE IF YOU HAVE MEDICAL INTERNET?
OPEN LETTER TO A STUDENT OF FIRST
MEDICINA1
Juan Gérvas
General Practitioner, Team CESCA, Professor Emeritus Department of Public Health, Universidad Autónoma de Madrid
jgervasc@meditex.es www.equipocesca.org
seekers Internet provide access to diagnosis and treatment much of the ailments that afflict us. By typing the signs and symptoms is obtained an approach that can be more certain that we offer a doctor of "flesh and blood."
"About therefore doctors?
try to show you, dear student, no, that doctors would be needed even if artificial intelligence could surpass the Turing test. By the way, go online and read about Alan Turing, his life and his "proof." Turing died in some way for being gay, in a period after the Second World War in which doctors we defined homosexuality as a disease. A sample of medical abuse its serious impact on the lives of patients and societies. Homosexuality is still crime punishable by death in some countries it is a sin in many others, is a disease in a number and "deviation from normal" in many. Doctors are no strangers to this nonsense that continue in other ways, the sex and sexual activity are a source of income for many pimps (read, that will interest you, the book by Ray Moynihan and Barbara Mitze "Sex, lies and pharmaceuticals. How Drug companies plan to profit from female sexual dysfunction ").
believe in technology as a solution to suffering and fear of death is foolish. The only technologies help from the stethoscope to anesthesia, from vaccines to morphine, since the best form of organization to improve the transmission of knowledge. But no solution to the burden of living, there is no scientific answer to the fear of death. Religion can offer eternal life or captivity, no medicine. The pain is always with us, the suffering is part of life. He said the classic "Is he dead? No, over that at birth began to die. " Technologies can not deliver neither compassion nor sympathy, nor pity that it can give a doctor hands full scientific and human, the "healer" who we were and should be.
Human Complexity
We have a brain that we do not deserve. When you study it, dear students, do not forget to marvel at its complexity. Be amazed, for example, the study of vision. Ranging from embryology to the anatomy of the eye and optic nerve (with its sheltered position in the skull and face) and its function, with the retina as "extension" of the brain itself that faces the outside and that it "interprets" radiation in the visible spectrum. Do not forget that neither the visual cortex or in any part of the brain is a "screen" or representation of holograms. Yet see!
govern the human brain is complex. Perhaps why drugs are part of all cultures. In our legal drugs are a lot of caffeine, protein, nicotine, ethanol, tranquilizers, sleeping pills, tranquilizers, codeine and others. We survived them and socially acceptable rites in common use (weddings, parties, gatherings, celebrations, desktops, etc..) Or alone ("no sleep, doctor, and this pill helps me sleep, not like the drug addicts, who want for nothing, is that I need, you know? "). However, at the end arises jealousy, frustration, the anguish of living, the frustration, regret, unpleasant memories, envy and a hundred other feelings that make us unhappy, even amid the opulence of developed countries.
We move between Eros and Thanatos, both related to the night, both related to the dark unfortunately. We spent the poop, ass, fart, piss "to" cock, pussy, dust "and return to start in old age. Is a brief that the matter requires us to form our bodies ("born, grow, reproduce and die.") And we do not know how it changes as intelligence or kindness. The dissection of the brain certainly does not help discover the soul but not love. And we all love, and few are the lucky in love who we want. No one can promise to "love" the human species. Neither "health."
health can be promoted, you can look, can be protected, but health is an asset that nobody can guarantee. The Iron Law of Epidemiology is always true, and everyone who is born dies. We can prevent some diseases can delay some deaths, but every disease and every death is different depending on the individual they affect you. Not you, dear student, "idealist." I know "empiricist." The diseases are poorly defined and changing states each patient lives personally. "There are no diseases but sick people is a key theme for the physician. And it's a really good job of explaining scientific empiricism, not idealism. The empiricist believes in what he sees in patients, not diseases.
much human suffering has its origin (the cause of the cause ") on the determinants of health, particularly in the unjust distribution of wealth. Thus, there are many examples showing that "a spit blood for others to live better." Serve the case of cotton, whose subsidies in the U.S. (for less than twenty thousand farmer-entrepreneurs) unfair competition involving the best quality cotton in poor countries like Mali, consequently, are losing crops, displace populations and die a lot.
understand human complexity requires the doctor "medical leave" and walk through the worlds of economics, anthropology and sociology, which I recommend you do as part of your training ("the doctor knows only medicine, or medicine knows"). Social complexity
If human beings are complex, what about our society!. During the visit of a Martian perhaps more attention would be called the language. Probably end up studying the Martian language to try to understand humans. In some ways it seems that we are "beings for the language" as you study genetics, dear student, it will seem that our destiny is to be complex "carriers genes. " The language allows us to establish classifications and codes. The language is an interpretation of the world while facilitating human relationships and undermines our global vision. We think what we are capable of expressing. What we do not express affects the limbic system, dear student will study a still misunderstood marvel, a wonder that the world affects your emotions, so connected to the olfactory system.
Much of your learning time will be devoted to the acquisition of medical language, the domain of medical jargon. This language will help you connect with your peers, to be part of a tribe, the tribe in which we integrate the "healers." Used that language for the patient, not against it (in fact, the council should be general, "you never against a patient.") On the other hand, do not let them get vaccinated with the tongue against the "escepticemia (escepticemia is a disease of low infectivity against which the vaccine to students in medical schools).
societies standards are endowed to us more than "institutions" general agreements that respect. For example, we feel bad for all the doctors bag and baggage delivered to industries so that they are the interests of shareholders, and not the needs of patients and society, to guide medical decisions. There are organizations that seek to promote relations transparent, proportionate and independent industries. In Spain, "Nogracias", and the world HealthySkepticism. Students are not oblivious to these movements, and well it shows in Spain to develop students Pharmacriticxs by IFMSA and in some countries the implementation of the movement "transparent medical schools" promoted by the declaration of interests and commitments to industries of all teachers, and the eradication of promotional material in the classroom and teaching areas. In practical, for example, when you go to ask my dear student oncology doctors for their economic return "participation in clinical trials of their patients."
in Georgia has discovered a prehistoric skull with denture wear. Without teeth could not live in those times there was not the art of cooking or simply boiling. This skull shows the care he received his master, care and compassion of those who were his contemporaries. Over time, developed societies have organized a health and social benefits that facilitate the exercise of their love and care as part of justice (not charity). In all developed countries, with the notable exception of the USA, there is a public health system providing care according to need, not according to ability to pay. Public, dear student, means "public funding". The English health system is an anomaly among public health systems worldwide. No one else has these armies of doctors employed in hospitals and health centers (only seen in Finland, Portugal and Sweden). The most common (from Canada to New Zealand from Austria to Norway, from Italy to Japan) is the doctor as a freelancer, which means that the patient does not have to pay for their services.
In Spain, moreover, the public health system is little public almost covers the private as 30% of total health expenditure. In practice, this explains that the mouths of the rich can clearly distinguish from that of the poor because dentistry is poorly covered in Spain. Poverty is a determinant of health ("due cause"), and it is for healthcare access and provision of care after entering them.
is important to understand the organization of the health system, funding and policies supporting the various options. Nothing is casual, and be a doctor in a given culture and social context that should understand.
response to pain and suffering
The doctor first was the shaman, the shaman of the tribe, the individual can offer comfort to the sufferer. Spiritual comfort through spells and rituals and physical comfort through the use of drugs and other techniques, as an arrangement of fractures and dislocations, amputations and more. This individual was probably the first member of the tribe who managed not to have to hunt for food, as others did for him in payment for his services. Some argue that it did, and may be the source of the doctors, the midwife, the woman who attended at the birth of the others, who knew how to choose abortion when they wanted. This interpretation is more block to the politically correct, but I fear that we are heirs to the "ready" for the tribe that the midwife.
Over the years shows the doctor of hosts and serving the poor, both paid for wages, while doctors of the "free" were paid by the act. In Spain, Alfonso X El Sabio already established that the "physical" test their training and it was accepted by the other's physical location, as a way to recognize their worth and ability. This physique was a general practitioner, surgeon and dentist, and even pharmaceuticals. In Spain, unions developed in the Middle Ages capitation payment (the "equals", a Therefore each member of the guild, to ensure care for the disabled, widows and orphans).
late nineteenth century, the development of chemical sciences, physical and biological and capitalism made possible the flowering of the specialties, some physicians are dedicated to very specific fields such as pediatrics or gynecology and there was a middle and upper classes who could pay for their services. Specialization has grown inexorably and the XXI century has come to ignore that "the whole is greater than the sum of its parts," very true of people. Specialists are increasingly one-eyed Cyclops; eye so no longer need magnifying glass or microscope óptico sino microscopio electrónico, peligroso cuando se aplica fuera de su área de conocimiento. De ahí la necesidad de combinar saberes de médicos generales y de médicos especialistas.
Los médicos contamos con el fervor de la sociedad, como se demuestra de continuo en las encuestas donde, por cierto, los políticos salen siempre despreciados socialmente. Son un ejemplo a no imitar. Lo que importa, pues, es la meritocracia, el valor de lo que los médicos saben y hacen. Ello lleva a los pacientes a nuestras consultas y a entregarse en cuerpo y alma en la esperanza de la curación o del alivio a sus males. Los médicos traspasamos casi sin darnos cuenta las barreras de la piel y del alma y conviene que no abusemos de that power. Sexual abuse is rare in the consultations, for example, but there, do not forget dear student serves as an indicator of abuse frequently breaking the duty of medical confidentiality and the right to patient confidentiality.
Physicians have limited power, finite. There is almost magic in our consultations (eg on mine when a local anesthetic cream can be removed painlessly me a nevus, or when an adhesive allows me to "sew" a wound without using points, or where a medication can eliminate the pain in a terminal patient), but we are not magicians but mere healers. Nor are scientists, but use science to discern the true from the false (and philosophy to distinguish the important from the irrelevant.) Do not be a magician, dear student, but not scientifically false. For example, never believe that statistics is science or that "saved lives." Do not think in the "CPR" (is simple "resuscitation").
Physicians only prolong lives. Again, everyone who is born dies. When we fight today of death by disease vaccines can kill ironically morning hunger. It is therefore important to question the quality of life than does the extension of it. Critical question in these Western societies in ever-growing death by suicide.
not enough to "save lives." Care about the quality of life that will follow our actions. Life is not "the supreme good." Sometimes life is worse than death, as well evidenced by the opinions of parents of some children from "low birthweight", who believe that health outcome after the years has been worse than death. Talking about life and the consequences of medical acts is also talk of euthanasia and of the abortion. There can be negative or "conscientious objection" indiscriminately, but the human response, pious and scientific. All abortion, voluntary or spontaneous, caused a stir in women. All voluntary abortion is a health and educational failure, a failure in avoiding unwanted pregnancies.
The voluntary abortion is often discussed in its legalization, but little is discussed about the "boatman's syndrome" which retains its implementation in clinics, gynecologists, and often with surgical methods. Nearest methods and human, drug and at home, there for decades but are still an exception. The "boatman's syndrome" explains that there are opportunities to use technology to achieve the "highest quality, minimum quantity, appropriate technology and as close to the patient as possible." The technology has its literary parallel in the ring "Lord of the Rings" possession blind physicians and the power that is used for personal gain.
Be understanding and compassionate with patients, put in place, admit they are. Do not become her friend, doctor and do not be your friends or your family. Respects the beliefs of your patients, whether Escriva believe in Shiva or the Devil, also respects their experiences, whether drug or addicted to work or sex, or gambling addicts, without more, appreciated the Mohammedan and the Jew, the Protestant and the agnostic. Patients are fragile as people feel threatened in their life journey, many may not know how to re-organize their lives or how to deal with the disability and death. Ask the patient how he wants to be treated, if you or you, if you like Dona Francisca, or Ms. Garcia, or without further Pepita. Find out what you want to know about their disease and offers exquisite and careful compliance to their wishes.
Being a doctor in the XXI century
Nobody who was in the talk that generated this text (September 14, 2010) will reach the end of the century. However, developed societies believe they can fulfill the desire of Gilgamesh, and gain access to the source of eternal youth. Blinded by the magic of medicine as Gilgamesh ignore the advice of Siduri, the tavern of the Sea of \u200b\u200bDeath, and prefer to look today uncertain future good embittering the right way today. The bitter with the "pornoprevención," that excessive desire to avoid harm, all suffering, all pain and death. We have the healthiest populations and aging of the entire history of mankind, is a medical and social success to have achieved such health capital. But the practical consequence is the fear of loss of health, fear of aging anxiety, the fear of death. Thus, there is a paradox that becomes sick to healthy, just by practicing prevention has become dangerous on a test basis, indications and drugs. No wonder that in U.S. medical activity is the third leading cause death.
Much of your activity as a doctor of XXI century, dear student, you must engage in "quaternary prevention." That is, to prevent damage caused by medical activity. Especially to avoid unnecessary medical activity, since all medical activity (necessary or unnecessary) adverse effects to damage. Only some medical activities offer more benefits than harm. Some activities clearly offer more harm than good, such as check-ups (gynecological, healthy child, labor, elderly, and others).
quaternary prevention is in the twenty-first century expression of the old principle of medicine "Primum non nocere (first do no harm, first not to further complicate things). Of course, physicians do much good, great good, but sometimes we do avoidable harm. Sometimes we hurt unnecessarily, sometimes it dominates the "health malice." It is essential, dear student, who failed to do much more good than bad, that when you retire you can say that the good definitely made up for the wrong you caused. Practice, then, the quaternary prevention.
Remember the two goals of medicine summarizing the Hastings Report: avoiding medically preventable suffering and help to die with dignity. To do prevent disease, helping to heal, always consoled and seek rehabilitation if it is disabled. To do this we look at the patient terminal so you dont have any pain or distress, or insomnia, or ascites, or edema, or constipation, or vomiting, or other signs and symptoms that prevent die in peace and dignity. Avoided, especially premature and unnecessary deaths medically preventable, such as appendicitis or death from tetanus. As possible, avoid the deaths of medical cause, such as those caused by the advice of "sleep upside down" babies in the eighties and nineties of last century, or those caused by hormones given to women climacteric or consequences to overuse of radiology.
Heal yourself. Luke records it, the doctor evangelist, about the rejection of Jesus of Nazareth by his countrymen. "There is no prophet in his own country, also said on that occasion. What of "doctor heal thyself" aplicártelo you, dear student, is the broad sense of taking care of yourself, to know yourself, to analyze yourself to yourself, to look at what you have to apply to patients of being human and compassionate with you first so that it can be with your colleagues and patients. That includes ethical considerations to help you choose the best possible course of action in each patient and situation.
Study, study hard, studied as a gross but do not stop reading poetry, trying to be happy, movies, dancing, sports and observe and analyze social drift, political and economic in your society do not forget to enjoy the love, family, sex, friends and life in general.
A doctor is a highly qualified professional that requires study and training throughout life, able to make quick decisions and generally accurate in situations of great uncertainty. You'll become a doctor without realizing it, based on study hard and practice a healthy skepticism (hopefully you have caught my "escepticemia!). Doubt, doubt that even you read. Documéntate if possible with the original studies Initial and form your own opinion. Never be cynical, do not admit "the culture of complaint" do not complain, act. Tolerates clinical uncertainty, but do not be reckless. Do not accept "the tyranny of diagnosis", not because you insist on diagnosing the diagnosis is only an aid to the decision and may decide not diagnosed and successfully.
Be optimistic, there are thousands of reasons. Remember
any English university is among the best in the world (or the group of the top ten, nor in that of the hundred best, or that of the hundred best). Visit, if you can, other top universities, such as the Maastricht (Netherlands) where the first medical student mentor and guide is the first day to a general practitioner and go to the hospital and faculty to complete their training. Or the University of Tampere (Finland), or that of York (UK) or the Ottawa (Canada) or Queensland (Australia).
Travel is a way to mature.
Today Internet is a window on the world, peek at it. Contacts who can help, is part of "invisible colleges" to share knowledge and recognition.
In short, avoid preventable deaths and promotes quality lives, do not do that Quevedo is right in his sonnet:
PHYSICIAN FOR EVIL NO QUITA,
RECETA MUCHOS2
La losa en sortijón pronosticada
y por boca una sala de viuda,
la habla entre ventosas y entre ayuda,
con el “Denle a cenar poquito o nada”.
La mula, en el zaguán, tumba enfrenada;
y por julio un “Arrópenle si suda;
no beba vino; menos agua cruda;
la hembra, ni por sueños, ni pintada.
Haz la cuenta conmigo, dotorcillo:
para quitarme un mal, ¿me das mil males?
¿Estudias Medicina o Peralvillo?
¿De esta cura me pides ocho reales?
Yo quiero hembra, vino y tabardillo,
y gasten tu salud los hospitales.
IMPORTANT NOTE
This text is distributed under Creative Commons by-nc-sa 3.0, therefore can be freely distributed and re-developing the condition include the author, not for commercial use and maintain the product under the same type subsequent license (full license).
NOTE TO MY DEAR STUDENT
Read more on this subject and author of publications on www.equipocesca.org where Gilgamesh ("False promises of eternal youth in the XXI century. Gilgamesh revived") and the idealism / empiricism (" Illness: Science and Fiction "), for example. Especially
complement the text "unknown territories of our mind" (above for medical reasons) http://www.equipocesca.org/wp-content/uploads/2009/10/por-que-ser-medico-2009-final.pdf and "Patient information about your physician" http: / / www.equipocesca.org/wp-content/uploads/2009/03/triptico-consulta-gervas.pdf
occasionally Relay this text and complement it and add and correct what is appropriate to build your own ideas , creed or utopia.
1This paper summarizes the lecture to medical students in first at the Autonomous University of Madrid, on 14 September 2010. It was organized by IFMSA-SPAIN of the region (AIME-UAM). IFMSA is the International Federation of Medical Students Associations. 2The
doctors used to wear ostentatious jewelry ("sortijón"), were well harnessed mules who left at the entrance of the house (porch) of the patient and prescribed suckers and "help" (laxatives). Peralvillo town in La Mancha is where you meet death sentence cruel saetazos. Tabardillo is messy joy, and such person.
