A Medical Career

A talk on Medicine as a Career was recently requested.  Feeling stumped by my own thoughts, I begged off.  One always wants to ask WHY? when a young person plans for a life in this job.  Too many times, I'm made to feel old by their frank response.  A talk from someone like myself may scare them away.

Its not that the personal costs are too high in Medicine.  Careers are like all other things in life– best when in moderation.  The Greek concept of hubris applies.

Wondering if what doctors do seems difficult to most outsiders…  I thought I had a pretty good idea of this life as a student but, as it turns out, its a role assumed like most others- adult status, married life, parenthood.  After years of training, experience, & discipline, the most complex clinical situations take on the properties of a time-delimited puzzle, a "best fit" challenge to a prepared mind.

One simply does what one has to do, and the modifier is how well we do it.

Grief

I think that I'm tired and my defenses are down because of it.

Just lost 4 patients in 10 days.  None of these deaths came as a surprise, but they happened to people I've known for a few years.  Long, drawn-out declines in fairly young people with advanced disease.  That they all went in what feels like one fell swoop seems intolerable to me just now. 

Surprise, surprise…after all these years, this job can still deliver a shock of grief after all.

New Cancer Treatment Options

Archimedes having his best bath.

Its an ambivalent relief when they confirm the significant activity of targeted therapy for a specific cancer. A lot of publicity is involved, and that's only right. The companies have a flurry of educational seminars and lunches to pound in what you already know, if you had half a brain. That's appropriate too, given the multimillion dollar investments involved.

What's horrid is the small number of patients who can actually afford these new treatments. My ulcers act up each time that unguarded look of despair flashes from across the table when costs are discussed (in my gentlest tones).  Although it always elicits my own guilt, budget must be nailed at the first encounter with a patient, especially where no corporate insurance is involved.   When a quick size-up hints that budget may be severely limited, I zip through the expensive options anyway in the hopes that I'm mistaken, but confine myself to 2-3 loaded sentences.  Thereafter, the minutiae of costly treatments are presented on a computer screen only when specifically requested.   As in, 

• "Your breast surgery has taken out all visible cancer but you are at risk for relapse & require chemotherapy at about 10 thou per dose given every 21 days for 6 times– and you must have at least that." – said slowly in ALL CAPS fashion.  Then, almost as a brisk aside, "Newer chemo drugs can give you better control and less risk of relapse at an additional 45 thou per dose, with another 30 thou held in reserve for supportive medications. Moreover, your specific breast tumor profile shows that you can potentially reduce relapse rates by half with targeted therapy, each dose to be given intravenously every 3 weeks for 1 year (later, maybe two, depending upon current trial results) at an approximate cost of 70-120 thou per dose depending upon your size — this, in addition to chemo and, perhaps, further hormonal therapy later on, if it applies."  

Whew.   A long pause follows, after which, this particular patient population usually tries to bid down the original 10 thou quote for 1 cancer treatment. 

In a third world country, what is the optimal way to bring down costs of cancer care?  Prevention and early diagnosis, one suspects.   Education, of course!  I wish the government would step up their programs.