Pros and Cons of Becoming an Emergency Room (ER) Doctor: Should You Become an Emergency Room (ER) Doctor?

Globally, there is a shortage of doctors including emergency room (ER) doctors, so the need is there. If you are considering becoming an ER doctor, this kind of career choice offers a unique, professional challenge. A hospital ER is an excellent, learning-teaching environment.

Doctors are acutely aware of the pros and cons of working in hospital emergency room (ER) settings. Many of them enjoy the excitement of the ongoing activity, even though sometimes, it can prove to be quite chaotic. This kind of a setting, invariably gives doctors front-line experience that they may not obtain elsewhere. This is true of ERs in extremely busy, city hospitals, as well as those located in remote regions.

Other pros and cons may include the following, depending upon the country, location and size of the hospital.

Hospital ERs are a place where doctors and nurses continually deal with emergency, medical situations. Here, doctors carry out medical assessments, as well as offer diagnosis and treatment options, in conjunction with nursing care administered with the assistance of registered nurses and other health care professionals and non-professionals.

Hospital ERs serve their communities in other capacities, often functioning as a place where patients can obtain pre-scheduled minor surgery. They can be temporary clinical settings for doctors who are already in or en route to the hospital. In times of community medical crises, they may become a central, designated center for the medical-surgical treatment of large numbers of patients, who need care simultaneously. ER doctors play a major role in organizing this kind of a scenario.

ER doctors may function in other capacities working inside the hospital or in their own practices and clinical settings. At times, there may be only one doctor in a hospital ER, but there may be more than one, depending upon the population in a certain area, the needs of a community or the demands made by a hospital. Other doctors may come and go from ER departments, depending upon patient needs. The patient turnover in ER departments can be extremely high, relatively diverse in terms of race or culture and complex with respect to medical-surgical demands.

ER doctors need to be intuitive and able to assess patients quickly, quietly and accurately. Being well organized is important. They must work well with registered nurses and other health care professionals and non-professionals, on a one-to-one basis or as teams.

ER doctors must be able to act quickly in any kind of an emergency. They need a high level of medical-surgical skills, as well as those related to specialty areas like cardiology, pediatrics, obstetrics, psychiatry, oncology,  and gerontology. ER doctors draw from all of their previous training and experience and should have advanced training in CPR, first aid, intravenous therapy, medication administration, cast care, wound care and sutures.

Hospital ERs demand a great deal of paperwork from ER doctors, depending upon the patient volume and status. ER doctors have to be familiar with hospital procedures and policies.

Previous medical records for patients may not be easily accessible, particularly on evening or night shifts, holidays and weekends, when the ER is busy. Specialists may not be available, so there may be times when an ER doctor has to make a learned, medical decision or a judgment call. It may not always be possible to have the essential lab work, x-rays or other tests done, immediately. Calling technicians at home, may be necessary during off hours.

There may not be sufficient beds to accommodate the patients in need of hospitalization. Transferring patients to other medical facilities may be necessary. The stabilization of patients is an important aspect of their care, prior to transfer via ambulance or air ambulance. For example, a child in medical distress may need transfer to a children's hospital for immediate cardiac surgery.

In the ER, critical medical situations occur without a moment's notice. This can include cardiac or respiratory arrests, hemorrhaging or the unexpected birth of infants. At times, the ER may be been alerted to patients who have suffered trauma from motor vehicle accidents and fires, but not always. Doctors may have to contend with a constant flow of police officers, fire fighters, emergency response team members, ministers and priests, as well as patients, family members, friends and others.

Patients may arrive by ambulance semi-conscious, unconscious or deceased. They may be well oriented or disoriented. Many patients may appear confused because of head injuries, illness like diabetes or psychiatric problems. Patient's complaints may not always appear to be well founded.

Patients may show up alone or accompanied by others. Many ERs function as walk-in clinics and numerous patients arrive, expecting to seen, diagnosed and treated by a doctor, immediately. Many times, they have to wait. Crisis scenarios must be dealt with first. Numerous crises can happen simultaneously, in an ER setting.

Life and death is a daily, ongoing struggle in hospital ERs. Some patients are struggling to stay alive. Others may have attempted suicide or are knowingly or unknowingly hurting, harming or killing themselves and others, through the abuse of tobacco, drugs and alcohol. There may be a high level of knife and gunshot wounds related to violence.

Good patient assessment, diagnosis and treatment skills are vital for ER doctors. Effective communication and conflict management skills, interpersonal relationship and counseling skills are essential.

The ER doctor functions as a teacher for registered nurses and other health care professionals, as well as patients and their families. Each patient must be educated in some way, regarding diagnosis and treatment, as many may not have follow-up care. Often patients require hospital admission by ER doctors.

Doctors must act professionally at all times, while they attempt to meet the mental, emotional, spiritual and physical needs of patients. Integrity is always important, as is strict attention to detail.

Doctors must demonstrate high levels of concern and compassion, as well as insist on high quality patient care, as legal action or malpractice suits can occur, unexpectedly. The doctor assumes the responsibility for patients in the ER, in conjunction with registered nurses involved in patient care.

There is a high level of risk of infection for doctors, registered nurses and others working in hospital ERs, particularly when there is a global concern, like the current spread of the H1N1 virus. Infection control is always an important aspect of any doctor's work.

On a global level, hospital ERs may be short staffed, particularly in busy hospitals or remote areas. This means that the ER doctor may have to work extra hours, particularly on weekends and holidays. It may entail missed meals and breaks. Family and home life may suffer.

Essential medication or medical supplies may not always be immediately available. Doctors often have to make do with what is available at the hospital or try to obtain the needed medicine or medical supplies for patients, through local pharmacies or hospital supply places. Sometimes, an ER doctor may have sample medications, but at other times, patients have to wait.

ER doctors demonstrate a great deal of patience with other health care professionals and non-professionals, as well as patients and their families, who may become frustrated, angry and upset. Many patients and their families, as well as others, do not comprehend the seriousness or the reality of what happens in hospital ER settings and thus, they may become demanding, abusive or aggressive towards the ER doctor and others.

There are many times, when working in the ER can appear to be a thankless job, but ER doctors are instrumental in saving many people's lives. Sometimes, they only treat teens or children with sports injuries, by applying casts or suturing cuts. Sometimes, those who they have to treat are members of their own families.

Should you become an ER doctor?

Ultimately, the decision is going to be yours, but if you are thinking seriously about it, begin to do some online research, visit some hospital ERs and talk with other ER doctors. Inquire about available courses at your local medical school or university.

Do not be surprised if other doctors raise an eyebrow, when you tell them that you want to become an ER doctor, because they know that you will have your work cut out, if you go that route. They may smile as well, because they know you will probably enjoy it, too.

Pros and Cons of Assessing Patient Pain Levels Through 1 to 10 Scales

The Fifth Vital Sign: Pain, quantity and quality

"Pain scores are sometimes regarded as the Fifth Vital Sign." (1)

Monitoring vital signs are important in patient assessment and evaluation, diagnosis and treatment, but it is difficult to assess a patient's pain level. Accurate assessment is necessary, because pain management is an essential part of a patient's medical treatment and nursing care. In pain management, there have been numerous attempts to measure pain or the degree of pain that a person experiences, using pain scales. There are pros and cons to using these.

What is a pain scale?

"A pain scale measures a patient's pain intensity or other features. Pain scales are based upon self-report, observational (behavioral), or physiological data. Self-report is considered primary and should be obtained if possible. Pain scales are available for neonates, infants, children, adolescents, adults, senior, and persons whose communication is impaired." (2)

Self-reporting pain means that a patient can assess his or own pain subjectively and report it, based on a scale of 1 to 10. This has limitations, but remains the primary mode of pain assessment and evaluation. Where communication on a subjective level in not possible, observation (behavioral) or physiological data must suffice.

Is it a matter or either one or the other?

In 1968, Margo McCaffery, suggested that "Pain is whatever the experiencing person says it is, existing wherever he says it does," (3)

This is assessing pain subjectively or as a patient would perceive it, himself. It opens a door which allows the 

patient to use a subjective pain scale (from 1 to 10), to report his or her level of pain to nurses and doctors, which does have some merit.

There are some drawbacks. Using only a pain scale of 1 to 10 or reporting pain based strictly on numbers, in conjunction with this definition, does not include the reporting of pain by those who have limited communication skills or by those who may not understand how to use a pain scale.

For example, a person who is mentally disabled may not be able to state that he has a pain level of 5 or 8. An infant or small child would not be able to express his or her pain in terms of actual numbers, either. Nor does it allow for those who are restricted by their lack of communication skills or inability to communicate, for instance, someone who is semi-conscious.

The International Association for the Study of Pain (IASP) defines pain from a scientific and clinical perspective, stating pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage." (4)

A subjective analysis of a patient's own pain might include only that which is an unpleasant sensory and emotional experience. Unfortunately, using only a subjective numeric pain scale to report pain may not include the potential tissue damage that is occurring or an appropriate description by the patient, even when it describes an unpleasant sensory or emotional experience. .

Tissue damage can often occur without any awareness of pain. A patient can also experience a relatively low level of pain and be unaware that there is tissue damage occurring. For example, an elderly diabetic may do damage to his or her feet by wearing improper footwear and may not be aware of it, until significant pain is experienced.

There are instances when the patient is aware of damage that is happening, but is unable to report it, because of the limitations of reporting pain on a scale of 1 to 10, which does not express anything other than a numeric level of pain. It excludes the patient's observations about the extent of tissue damage that is taking place. By the time a patient experiences severe pain and expresses it as a 10, it may be too late, as the damage may already be permanent.

Note this quotation with reference to quantity of pain.

"Many attempts have been made to create a pain scale that can be used to quantify pain for instance on a numeric scale that ranges from 0 to 10 points. In this scale, zero would be no pain at all and ten would be the worst pain imaginable." (5)

The difficulty lies in the reality that this is limited to quantity of pain and does not address the quality of pain experienced by a patient. At the same time, the numeric pain scale does serve a purpose.

"The purpose of these scales is to monitor an individual's pain over time, allowing caregivers to see how a patient responds to therapy for example. Accurate quantification can allow researchers to compare results between groups of patients." (6)

In other words, if a patient states that he has a pain level of 8 after treatment with an appropriate pain medication, he might report a pain level of 3. The pain management has been effective, at least for a time.

There are tests that make allowances for the use of subjective numeric pain scales, as well as include a descriptive interpretation of pain.

For example, "the McGill Pain questionnaire consists primarily of 3 major classes of word descriptors - sensory, affective and evaluative - that are used by patients to specify subjective pain experience." (7)

Pain assessment and subsequent pain management has to include both the quantity and quality of pain. It is not sufficient just to assign an arbitrary number, as a subjective designation of the patient's level of pain. The quality of pain is important, too. Other definitions of pain may enable pain assessment, in other ways.

Objectifying the patient's pain, allows doctors, nurses and other health care professionals to assess, evaluate, diagnose and treat their patient's pain more effectively. Pain management with quantity and quality, extends beyond the level that medical personal are able to achieve for patients who only interpret their own pain subjectively and numerically.

For effective pain management, observational (behavioral) or physiological data must be included. For example, an infant's facial grimace gives evidence of pain. So does a small child's reluctance to move a fractured limb.

In other words, nurses and doctor must always assess patients objectively and physiologically for pain, even when a patient is using a subjective pain scale from 0 to 10 for his or her pain management.

(1) http://en.wikipedia.org/wiki/Pain_scale

(2) Ibid.

(3) http://en.wikipedia.org/wiki/Pain

(4) Ibid.

(5) http://en.wikipedia.org/wiki/Pain#The_Dimensions_of_Pain

(6) Ibid.

(7) Melzack, Ronald, The McGill Pain Questionnaire: Major properties and scoring methods, Volume 1, Issue 3, September, 1975, p277-299

Methods Used by Medical Professionals to Put IV Lines in Patients With Poor Veins

Understanding intravenous therapy

Many patients require intravenous (IV) therapy and thus, the methods used by medical professionals to put in IV lines in patients with poor veins are important, in order to avoid unnecessary trauma to the patient and the risk of infection.

What is intravenous therapy?

"Intravenous therapy or IV therapy is the giving of liquid substances directly into a vein." (1)

Many hospitals have special IV teams with medical personnel trained in advanced skills for intravenous therapy. Even for them, there may be times when it appears almost impossible to establish an IV line in a patient who has poor veins.

What are veins?

"In the circulatory system, veins (from the Latin vena) are the blood vessels that carry blood toward the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood." (2)

What is a poor vein?

When a patient becomes dehydrated, his or her peripheral veins may collapse. At times, in the sick or the elderly, these veins may be fragile. In infants and children veins can be tiny and sometimes, almost impossible to find. Veins used too frequently for medication administration, may no longer be appropriate for intravenous therapy. Sometimes, patients just do not have good veins and thus, are said to have poor veins.

It may take a well-trained doctor or nurse to find an appropriate vein that will function for ongoing intravenous therapy. 

The veins most commonly used for intravenous therapy are the veins that are located in the arms and hands or legs and feet. Starting intravenous lines properly requires practice. Every patient scenario is unique as his or her veins can be different. Medical personnel may use various techniques for starting intravenous lines, depending upon how and where they train. Some doctors and nurses may find it easier to insert IVs than others do.

A doctor prescribes intravenous therapy for his or her patient. He or she advises the registered nurse of the appropriate intravenous treatment which consists of the administration of fluids, electrolytes and/or medication.

The location of the IV line is important. Being aware of which vein to use, as well as which vein is the most appropriate to use for a patient, is also important. Sometimes the veins in one part of the body are better suited for some kinds of intravenous therapy than the veins in another part of the body.

The following questions must be taken into consideration.

How long will the patient receive intravenous therapy? What fluid or medication has the doctor prescribed? What is the volume of the IV infusion going to be? Is an IV treatment prescribed as a single administration of medication or will it be ongoing therapy, over a period of days? Is the size of the needle appropriate for the size of the vein and/or the medication?

The nurse should have the IV equipment ready, prior to searching or probing for any veins. Normally, there can only be three attempts by one medical person to establish an IV line. If the attempts are not successful, it is advisable to seek the assistance of another medical person who has more experience or expertise, in order to prevent unnecessary trauma to the patient.

Veins are blue in appearance and may be openly visible on a patient's hand or a foot. Palpation of an area may help to locate a deeper vein or one that is more appropriate, for instance, on the inner aspect of the elbow. Lowering an arm or hand will cause the blood to flow downward and the vein will become more evident. Applying a warm, moist towel over the area may help. Using a rubber tourniquet on a limb is sufficient to cause the vein to bulge enough to insert a needle for an intravenous line. One must always use caution regarding the length of time that a tourniquet is allowed to restrict blood flow in a limb.

With infants and children or others who may be frightened, it is important to have another person present when the IV is started. Encourage a parent or other health care professional to assist by holding, positioning and helping the patient to understand what is happening. It should not be a frightening experience for him or her. Having the patient look away or occupying the patient's attention in another way, may make it easier for him or her. The pain experienced should be minimal.

Sometimes, massaging the area, milking the vein or tapping on the vein gently, will cause it to become more prominent. Fully extending an arm will bring the vein forward on the inner aspect of the elbow.

Proper skin preparation is always important to prevent infection.

Once the needle is in the vein, dark red, venous blood should be evident. Immediately, start the flow of intravenous fluid to keep the vein open. Place tape over the needle to prevent it from slipping out of the vein. Appropriate pressure applied on the IV insertion site, will any prevent unnecessary bleeding. An IV line, held in place by tape or an appropriate bandage, is not likely to fall out.

Calculating the drip flow correctly and maintaining it continually is important to prevent having to restart the IV. Good observation skills are vital. Always record the location of the intravenous line and document any problems encountered.

Care, concern and compassion are always vital aspects of nursing care in respect to intravenous therapy, because IVs can be painful for patents. An intravenous line can give them a feeling of helplessness. Encouraging the patient to walk about with the use of an IV pole is a good idea.

Be aware that the administration of some medications can be painful, even if does not cause pain initially. An IV not inserted correctly can cause unnecessary swelling, particularly when the IV goes interstitial. There may be excessive bleeding or bruising. At times, the IV may not flow at all. The use of an ice pack will help to reduce swelling.

The use of a splint or correct positioning of a hand or arm can be beneficial in terms of keeping an IV running. At times, restraints may be necessary to prevent a patient from pulling out an IV.

Constant monitoring and maintaining an accurate record regarding the patient's IV therapy are always important. An intravenous line should not be allowed to run dry.

Make certain that the patient receives proper age, orientation and education appropriate directives and instructions regarding his or her IV. He or she should be encouraged not touch or attempt to remove the intravenous line and should report any evidence of blood backing up in the tubing, bleeding around the IV site or any excessive bruising.

Many patients take pride in helping to monitor their intravenous lines. So should intravenous team members who are able to establish and maintain effective intravenous lines, particularly in patients with poor veins.

(1) http://en.wikipedia.org/wiki/Intravenous

(2) http://en.wikipedia.org/wiki/Vein

Should Doctors Talk About Religion With Patients?

Healing, health and happiness: Doctors, patients and religion

Should doctors talk about religion with patients? Every patient expects his or her doctor to be able to talk to him or her about the possibility of healing, as well as with respect to his or her general health and happiness.

Is it ever possible to separate a patient's healing, health and happiness from the realm of religion? Healing, health and happiness are important to everyone, as well as some of the most important and central concepts found in religion.

In order for a patient to be truly whole, his or her medical and health care must touch upon and include every possible dimension of his or her personhood. Healing, health and happiness, as different aspects of personhood cannot be confined, restricted or limited to just the realm of physical care. Total patient care includes the spiritual, as well as the mental, emotional and physical realms.

If one limits or restricts what doctors should talk to their patients about over time, some important aspects of their medical and health care will be missing. In other words, if a doctor is not able to or is prohibited from speaking to a patient about religion, the part of patient's medical and health care that pertains to the patient's spiritual realm, will be absent also. This in turn, will affect the mental and emotional realms of his or her health and general well-being. Ultimately, it may also affect the physical realm, in an adverse manner.

One must also ask whether anyone can legitimately deny freedom of speech, either to doctors or to patients. In every part of the world, freedom of speech is a basic human right. Everyone should be able to speak freely about religion to anyone, at any time, without fear of retaliation from anyone. Unfortunately, in many parts of the world, there is still no freedom of speech. For many reasons, freedom of speech, particularly as it pertains to religion, is often severely restricted. Invariably, at the root of this, lies fear.

"Perfect love casts out fear." 1 John 4:18

"God is love." 1 John 4:16

Those verses from the Bible speak from a Christian perspective. Of course, doctors and patients have differing religious beliefs. Diversity is a global norm and something that everyone should expect to see and learn to understand, particularly since the world is becoming increasingly global in its perspective on medical and health care issues. The diversity should be something that is accepted and appreciated for what it is and signifies for humankind.

Religion often proves to be an area of controversy, concern and conflict. This may result in difficult, non-effective communication or no communication between doctors and patients, but globally, there is one uniting factor in every religion and that is love. Doctors and other health care professionals seek to help and assist patients because of the care, compassion and concern or the ultimate expression of love that they have for their fellow human beings.

Love is central in any true religion, east or west, north or south. This has been true right from the beginning of time up to our present, contemporary era. Globally, there is a multiplicity, complexity and diversity of expressions of love, realized in a wide range of religious beliefs systems.

One might also ask, if there can ever be medical and health care morals or ethics without religion and love. Moral-ethical concerns, issues and questions are invariably a vital part of doctor-patient communications and interactions, as well as their medical and heath care. Without religion, moral-ethical concerns have no basic grounding or guiding principles.

Are doctors able to talk to patients about religion? That might be a better question to ask, because while some doctors may be comfortable talking to patients about religion, other doctors might prefer not to enter into that realm of discourse, as they find it difficult. Some patients may wish their doctors would talk to them about religion, while others prefer not to have doctors talk about religion, at any time. Religion can be or become a controversial topic. It can also be a prohibitive topic with regard to other cultures that have different, belief systems.

Another important aspect of the question of doctors talking to patients about religion has to do with the topic of death and dying. Doctors deal with these issues on a daily basis. When patients are confronted with the question of life and death, it is often unexpected and sudden. Religion is important to patients at that time, but it is important at all times whether patients understand that or not.

Doctors should have the freedom to decide whether to talk to their patients about religion. Invariably, they seek to do what they know is going to be the most beneficial for their patients.

Educating doctors, as well as patients, about religion will help to eliminate a lot of fear about doctors speaking to patients about religion.

Religion is far more important than the majority of patients realize. Yes, doctors should talk to patients about religion. Patients should speak to doctors about religion, too.

Do you have questions about religion that you would like to discuss with your doctor? Doctors are quite approachable. If they are not able to answer your questions about religion, they will certainly be able to help you to find someone who can answer them for you.

How Ethical Dilemmas are Best Resolved in Health Care Issues

Resolving ethical dilemmas with commitment, care, compassion and concern

Ethical dilemmas are best resolved in health care issues, through the continuing commitment, care, compassion and concern of medical and health care professionals, whose moral and ethical standards are rooted or grounded in the love of God and humankind.

It is seldom only one voice that speaks, if or when, there are health care issues of concern. If or when there is just one voice, there is no dilemma. That single voice is the one that speaks to all concerned. That voice has the final authority in terms of ethical dilemma resolution. Right or wrong, that voice takes precedence.

Many times, it is a good thing that more than one voice that speaks out on behalf of humankind with regard to health care issues. This is one way of protecting human beings from what may ultimately prove to be unethical, one-sided or unorthodox decisions. Ethical dilemmas in health care tend to affect or involve more than one person. They are not just issues that relate to only one doctor and/or patient. If they were, that would simply their resolution to some extent.

Ethical dilemmas in health care issues can involve, as well as affect, the lives of many people. These kinds of issues often include numerous medical and health care professionals like other doctors, registered nurses, non-professional caregivers, as well as a patient's family members and friends.

Many times, there may be many other people involved from various levels of society. These include employers, teachers, co-workers, neighbors, students and friends who all must be taken into consideration, particularly when the ethical dilemma concerns them directly or even indirectly. For example, when there is an outbreak of an infection like the H1N1 virus, it can affect the lives of everyone, in some way.

Ethical dilemmas are not always simple health care issues that need to be resolved. For example, when there is a global economic crisis, obtaining the funding for health care becomes a complex scenario. Health care issues may not be just ethical dilemmas either. There may also be moral or legal aspects to consider in the decision-making process, as well as in the ultimate resolution of any health care issue. This may not be immediately apparent, at the time. In other words, many health care issues can be or become moral-ethical issues or moral-ethical-legal issues, rather than just ethical issues.

There is true ethics, as well as ethics that may prove to be pseudo-ethics or not true ethics at all. Similarly, there are true morals, as well as morals that may be pseudo-morals or not true morals.

Discernment is extremely important in the decision making process, particularly when it tends toward moral or legal process involvement. For example, ethical decisions may involve the norm of numbers, not morals or morality. In other words, if a large number of people are involved, the number of people may be what is considered, rather than the reality that what is happening may or may not be morally right.

Ideally, in the process of ethical resolution of health care issues, true morals set principles, guidelines and help to establish criteria for mandates of the future.

There are also earlier precedents established in terms of medical and health care issues. Those who are involved in the resolution of ethical dilemmas often have to consider any number of previous ethical resolutions, regarding issues of concern. There must also be some way to justify similar, subsequent acts of resolution that in turn, will have to be justified, at some time in the future.

Ethical dilemmas regarding health care issues are normally extremely complex and often multi-faceted. Many times, there are no simple answers and thus, they can involve many different or unique levels of professional concern. Right and wrong are not always immediately discernible, even to medical and health care professionals, when it comes to ethical dilemmas in health care. At the same time, the likelihood of medical and health care professionals being able to discern right or wrong is higher for them, than for other non-professionals, because that is their area of expertise.

The question of right or wrong is not always something that a patient and his or her family can discern immediately, either. This is often part of the dilemma too. Who or what is right may become a central question. Who has ultimate authority?

Ethical dilemmas in health care frequently involve life and death scenarios. There may be a question of quantity of life versus quality of life. Often for these kinds of situations there are no easy answers.

It is the ongoing commitment, care, compassion and concern of health care professionals that ultimately leads to effective moral-ethical and legal resolutions.

In every country of the world, human beings love one another. That in itself is an amazing reality. How can that be possible? That question, one may not be able to answer, but we can rest assured knowing that it is true. Tragically, there is the opposite or the non-love of others that is evident, as well.

A measure of the degree of love that human beings have for one another, is evident when there are ethical dilemmas in health care that are effectively resolved by medical and health care professionals. This often leads to future mandates in health care that prove to benefit humankind on a global scale.

For those who are involved in personal or family ethical dilemmas in health care, it is always a good idea to seek advice from your own doctor first. He or she will be able to refer you to other medical or health care professionals or others, as necessary.

Education about health care dilemmas is important for everyone who is involved and thus, it is a good idea to research any area of legitimate concern. Many times, there are plausible solutions that can lead to effective ethical, as well as appropriate moral and legal resolution.

You and others can help to find answers, even though at times, they may not be easy to find. Ask yourself if there is ongoing commitment, care, compassion and concern evident in the resolution of any health care issues that you or your family members are involved in because this is extremely important. Remember that your health care, as well as that of others, including your family and friends, is at stake, too. What happens in your scenario may affect the lives of others in the future, as well.

Become a pro-active advocate of ethical decisions in health care, but always remember to include the moral and legal aspects of the decision making process as guidelines. Teach others to do the same.

Doctors and Empathy: Treating Patients Effectively

Should doctors have empathy? Yes, of course, doctors should have empathy, especially when it involves treating their patients. It is the only way that doctors can treat their patients effectively.

What is empathy?

In its literal translation as “in feeling”, (1) empathy is understood as the “capability to share and understand another's emotions and feelings.”(2)

We expect doctors to have that capability. In fact, we go to them with that expectation, otherwise we would not be seeking medical advice and/or treatment from them. The doctors we visit are medical professionals, who can and will understand what we are trying to convey to them about our medical or health-related concerns.

For example, a male patient visits a doctor to have sutures removed following a bout of surgery. He knows that this doctor will understand what he tells him about the status of his incision. He assumes the doctor will then do whatever is required with regard to effective treatment.

Taking the definition of empathy further, it is the ability to "put oneself in another's shoes." (3)

But, if you have you ever tried to wear someone else's shoes, you soon realize that no matter how hard you try, those shoes won't fit your feet properly. They may be too large, small, wide or narrow. In fact, they may hurt or damage your feet, when you try to wear them. Blisters from wearing someone else's shoes are certainly not much fun. Ask any child, who has had to wear his or her older brother or sister's shoes and then, walk a mile to school in them. Problems arise when you try to wear other people's shoes because you are a different person, as well as being someone unique, who has different feet than the other person whose shoes you are trying to wear.

"Walk a mile in my shoes?"

Taken literally, that may not be a good idea. This also suggests that according to this particular definition of empathy, something may and probably will be lacking. In this case, what is lacking is the perfect fit. 

Certainly, doctors and patients often share the patient's medical concerns. Doctors appear to understand patient's emotions and feelings, at least to some extent. Be aware that this is always going to be imperfect at best too, because the shoes do not ever fit perfectly. The shoes may almost fit, but that is not sufficient. In other words, at best, the doctor understands the patient only in part or objectively, rather than subjectively. He is merely the outsider, looking into the patient's medical or health care scenario.

For example, the male patient reporting to his doctor about his post-operative surgical incision informs the doctor that he is still experiencing some numbness, in the surgical area. The doctor knows what numbness in the surgical area means or signifies, even though he cannot feel it himself. He still lacks the total patient experience, even though he may be quite astute in his understanding of what numbness is and how it feels.

Take this one definition one step further, by looking at the Greek word "empatheia" (4), which is understood to mean "physical affection, passion and partiality" (5) or a combination of the Greek words "en pathos" (6) signifying "in feeling" (7).

Theodore Lipps created the German expression, we now understand as "feeling into". (8) By this definition, the doctor is essentially seeking to understand, explore or objectively "feeling into" what the patient is stating, reporting or experiencing. Remember that the patient always has the subjective experience and not the doctor. The doctor's experience is purely objective. The doctor is in a position of trying to comprehend the patient's actual experience or reality, from an outsider's perspective.

The doctor still may have high regard, affection or love for his patient. The doctor may be passionate about his work as a doctor and show distinct partiality towards his patient, at times. But, at best, he is only able to delve into the matter at hand, to the extent that an outsider can touch upon another person's actual experience.

For example, if the doctor could feel the patient's lack of sensation or numbness in the post-op surgical area, he would know the exact extent of it immediately. Because he is not the patient, he has to ask the patient where the numbness is, as well as how extensive it is, at that particular moment in time. Then, he can decide whether this is something that he should be seriously concerned about.

For example, when the patient who has just had back surgery, states that there is numbness around the immediate area of the incision, that is not going to trigger an alarm in his mind. Patients often experience numbness around a surgical incision. If the patient states that the numbness extends down to his feet, then there is reason for the doctor to be concerned. There may be back and nerve problems that require further investigation, diagnosis and treatment.

The ancient Greek word, "alexithymia" (9) meaning "without words for emotions", (10) sheds more light on the meaning of the word empathy, as it signifies "a state of deficiency in understanding, processing, or describing emotions in oneself." (11)

From this perspective, one can begin to see the reality of the true meaning of empathy in terms of the role of the doctor. Empathy distances the doctor from the patient, at least to some extent. The patient's medical scenario would consume or devastate the doctor, if this was not so. That could render him impotent to help the patient or make him ineffective, in terms treating him effectively.

For example, the patient in the doctor's office screams in pain, when he tries to move his legs, as the doctor examines him. The doctor does not resort to screaming in pain, too. The doctor does not experience either the pain or the same emotions that the patient is experiencing, at that exact moment, even though he might be concerned or become alarmed by the screaming.

Thus, in this kind of a situation, the doctor demonstrates a lack of words for emotions. His understanding, 

processing or describing the same pain and emotions as being his own, are lacking or deficient. Only the patient can do that. This allows the doctor to distance himself, far enough away from the patient to be able to treat him effectively for his pain. He goes on to prescribe pain medication for the patient and suggests that physiotherapy will help him to become increasingly mobile again.

Yes, doctors should have empathy. It is a good thing. In fact, doctors need empathy in order to treat patients effectively.

1. http://en.wikipedia.org/wiki/Empathy

2. Ibid.

3. Ibid.

4. Ibid.

5. Ibid.

6. Ibid.

7. Ibid.

8. Ibid.

9. Ibid.

10. Ibid.

11. Ibid.

Assessing Trends to Remove Adenoids in Young Children: Infection, Adenoids and the Immune System of Young Children

In the past, a large percentage of children have had the surgical removal of their tonsils and adenoids, early in life. Over the years, removing the adenoids in young children has come under severe scrutiny and the merit of such surgery has become more and more questionable.

Medical opinions tend to change over time and previous medical-surgical trends give way to current medical-surgical theory and practice. Nowadays, there are very few young children who are having their tonsils and adenoids removed. Why is this so? What has happened, historically? In order to understand this transition of thought more fully, consider the anatomy and physiology of adenoids.

What are adenoids?

"Adenoids (or pharyngeal tonsils, or nasopharyngeal tonsils) are a mass of lymphoid tissue situated at the very back of the nose, in the roof of the nasopharynx, where the nose blends with the mouth. Normally, in children, they make a soft mound in the roof and posterior wall of the nasopharynx, just above and behind the uvula." (1)

What is an adenoidectomy?

"Adenoidectomy is the surgical removal of the adenoids". (2)

Why is it that children have routinely had their adenoids removed surgically so frequently, in the past?

"Adenoidectomy has been advocated for the treatment of middle ear effusion as an isolated procedure or in combination with tonsillectomy, or with myringotomy and insertion of tympanostomy tubes. This procedure is most often chosen when nasal obstruction, nasal discharge, snoring, and mouth breathing are present." (3)

For many generations, adenoidectomy for almost all children seemed to be the preferred method of treatment for numerous childhood problems, including the prevention of infection.

"Maw (1983) noted that, historically, adenoidectomy has been recommended when the eustachian tubes are occluded by hypertrophic adenoidal tissue, compromising middle ear ventilation or when the adenoids appeared to be a focus of ascending eustachian tube infection." (4)

Where the Eustachian tubes of the ears were involved, adenoidectomy appeared to be effective, but then further investigation made it apparent that for very young children, adenoidectomy was not the best answer.

"For patients whose adenoids obstruct the nasopharynx, adenoidectomy has the immediate benefit of relief of mouth breathing and snoring. Gates, Avery, Cooper, et al. (1989) reported a direct benefit to children 4 years or older, both in reducing morbidity from otitis media with effusion and in reducing the number of recurrences. On the basis of these results, adenoidectomy is a clinical option for treatment of bilateral otitis media with effusion lasting 3 months or longer in a child age 4 years or older. (5)

Is there another reason why the medical opinion on the merit of removing adenoids from young children has changed?

The focus of medicine in general, has now shifted towards a direct emphasis on attempting to build up or to strengthen the immune system of the human body, as opposed to surgical intervention.

What are the current recommendations for the adenoid removal in young children?

"Adenoidectomy is not recommended for treatment of otitis media with effusion in a child age 1 through 3 years in the absence of specific adenoid pathology." (6)

This suggests that currently, the practice of adenoidectomies in very young children is not advised. Are there times when the surgical excision of the adenoids is justifiable?

"They may be removed for several reasons, including impaired breathing through the nose and chronic infections or earaches." (7)

While the benefits of removing the adenoids still remains controversial to some extent, there is a rapidly growing trend towards not removing adenoids in the majority of young children.

"Adenoidectomy is not often performed on children aged 1-6, as adenoids help the body's immune system. Adenoids become vestigial organs in adults. Adenoidectomy is not always beneficial in the long-term as adenoids may return." (8)

Medical professionals are still assessing the human immune system and its role with regard to the prevention of infection. No one has all of the answers yet.

"The relationship between enlarged adenoids and recurrent ear infections is controversial. We know that chronic nasal blockage can contribute to increased rates of ear infections and persistence of fluid in the middle ear area, but there are no definitive studies to support the removal of adenoids in all children with recurrent ear infections. Practically speaking, experts agree that in a child with recurrent ear infections removal of enlarged and obstructing adenoids may help reduce the number of ear infections." (9)

In conclusion, one must suggest that while surgical intervention remains so controversial, if a parent or guardian is considering the possible removal of the adenoids as a treatment option for his or her young child, he or she should consult a family physician first, who may recommend seeking a second opinion from a specialist.

It is generally wise to consider the following factors before making a decision about the removal of adenoids from young children.

Having an adenoidectomy could adversely affect or compromise a young child's immune system. This could render the child more prone to infections, rather than preventing or protecting the child from possible infections, in the future. Adenoids, surgically removed in young children, may grow back. An adenoidectomy for a young child can prove to be unjustifiable surgery, during or after which he or she may suffer unnecessary trauma. An adenoidectomy may not prove to be an effective cure or even an appropriate treatment for very young children who have symptoms of otitis media. There may be other potential medical-surgical dangers, including cardiac arrest or hemorrhaging, that may occur during or after adenoid surgery.

Normally, parents will not place their children in any danger or allow them to experience unnecessary trauma. They love their children and seek to protect them from anything that might endanger their lives; so do pediatric medical professionals.

The bottom line is that when there is a question about medical treatment with regard to the removal of the adenoids of a young child, it is generally advisable to rule out all other possible treatment options first, before considering the possibility of surgical intervention

1. http://en.wikipedia.org/wiki/Adenoids

2. http://en.wikipedia.org/wiki/Adenoidectomy

3. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.section.23612

4. Ibid.

5. Ibid.

6. Ibid.

7. Op. cit., Adenoidectomy

8. Ibid.

9. http://www.drpaul.com/library/08OCT1999.html