Archive for September 6th, 2009

Why’d you go and make things so complicated

I love my evidence based medicine (EBM), (maybe i should get a t-shirt with that on it…) i love my journals, and studies and audits.

They simplify medicine for me. I  love reading through characteristics of certain classes of patients and their symtoms and findings and test results. And how if you put enough of this together that you can then figure out what their disease is.

And then once you’ve figured out what their disease is you can provide an intervention and hopefully make them better. The science behind all this is great.

However. There exists a bit of a gulf between the numbers, between the audits and the papers and the list of characteristics, between all these and the patient sitting in front of me.

You see the patient sitting in front of me doesn’t care about any of this. They care because they’re short of short of breath or whatever. They care about getting out of here and going back to vegetating in front of the TV eating twinkies or getting back to the farm to get the cattle in. They care not for evidence based medicine. They hurt my feelings.

Perhaps patients are irreducibly complex in an equation. EBM makes them reducible – and saves lives as a result. However it makes me dehumanise them a bit to get there. Is that too strong? Perhaps so.

Patients are the most wonderful, annoying, fascinating, frustrating bunch of people to work with.

They do not tell you about pure pathology, about the narrowing in their coronary arteries. They tell you about this funny “tightness” that they get. And they won’t tell you that it’s exertional, they’ll tell you that sometimes they get it when they watch TV, sometimes they get it on tuesdays.

Patients are too complicated. They do not have typical symptoms. They will have their chest pain while feeling suicidal. They will have classic symptoms of a pulmonary embolism while at the same time having classic symptoms of pyelonephritis.

They quite clearly haven’t read the script.

Perhaps this is why I love evidence based medicine and logistic regression analysis and Bayes theorem (I’m not sure about the last two, I have only a vague understanding) so much. Because it makes life simpler. Honestly it does.

To do this I must ignore their love for twinkies and the need to get the cattle in. I must ignore all their glorious complex humanity.

As much as I love you dear patient you must become a collection of symtpoms, signs and test results if you want to live through the night.

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August and everything after

So as summer comes to an end with a cold, damp, miserable thump (what a surprise) it’s time to review some of what i’ve been up to over august.

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I was at a wedding in a castle in Edinburgh (though not edinburgh castle) where they had the most wonderful humanist wedding ceremony. (I think we need more humanist wedding ceremonies, but that’s another blog.)

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There was great food, good wine and even some dancing – of which i did not partake i must confess. Even the Bon Jovi.

I picked up the guitar and grew some balls and played my songs in a wee cafe in Portadown. And after the first 4 songs i even started enjoying it.

And in a fit of musical enthusiasm I picked up the old electric again and played with the old band in church. Lamenting my dying guitar amp and how rusty I’ve got at playing the electric guitar.

I await my new valves in earnest in the hope i can resurrect the Hot Rod deluxe to do another 10 years of loyal service.

On a more positive not the new Pod X3 rocks. While a little on the complicated side to set up and run it does sound pretty sweet. These are the days i wish i hadn’t sold my strat to Woodsy.

In between I have actually enjoyed my work. Which is kind of new for me. I have found myself too often pisssed off and frustrated in work so it’s nice to have a wee bit more enthusiasm and positivity about the whole thing. being there less helps. Which i know sounds weird – “I love my job as long as I’m not there…” – but when I do less hours I sleep better and am more sane than usual. This has got to be a good thing.

I look forward to dropping a day a week in the middle of september and going back to cutting up dead bodies with the students.

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And then most recently was Jonny and Lynne’s wedding. Dear Jonny, whom I’ve known since I was 6 when he arrived in P2 and stole my lego. Not that I’m bitter. Dear Jonny, who I shard houses with and tears and joy with and made 9 platiunum selling albums with in the Turf Brothers. Good times.

Great wedding, though running around doing musical stuff all day. Including the first ever live turf brother’s performance.

And it was mighty craic playing in Nice Guy Eddie again (my old wedding band) and even nicer to move from dance floor to band and back to dance floor again getting to play just the songs that i remembered.

There was dancing. There was me dancing. There was me enjoying dancing.  But i blame Transfarmer for that. I blame her for everything really.

But above all else what made the wedding was the fact that we didn’t have to drive the 1 1/2 hours back from the Killyhevlin at midnight. Instead we sat about the hotel till 0130 and then dandered back to our little chalets at the riverside for a cup of tea and a nice kip.

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And so began our little two day holiday in damp fermanagh. Like the donegal trip simply transplanted to a pre-fab chalet on the bank of the river.

I took the good ship pudge out on my own for the first time but was slightly annoyed that the brisk wind meant that i couldn’t get the thing turned and embarassingly had to reverse the canoe to shore just to turn it.

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Everyone else seemed to enjoy their trip too. No one got wet anyhow.

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We visited an ice-cream shop, just for the adventure of getting lost in the Fermanagh countryside. Sat-Nav is great and all that but only if you tell it to go to the right place.

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Extended weekends rock. And it’s still only sunday morning.


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