By Genevieve Yates One reason why I chose to do medicine was that I didn’t always trust doctors – another being access to an endless supply of jelly beans. My mistrust stemmed from my family’s unfortunate collection of medical misadventures: Grandpa’s misdiagnosed and ultimately fatal cryptococcal meningitis, my brother’s missed L4/L5 fracture, Dad’s iatrogenic brachial plexus injury and the stuffing-up of my radius and ulna fractures, to name a few. I had this naïve idea that my becoming a doctor would allow me to be more in charge of the health of myself and my family. When I discovered that doctors were actively discouraged from treating themselves, their loved ones and their mothers-in-law, and that a medical degree did not come with a lifetime supply of free jelly beans, I felt cheated. I got over the jelly bean disappointment quickly – after all, the allure of artificially coloured and flavoured gelatinous sugar lumps was far less strong at age 25 than it was at age 5 – but the Medical Board’s position regarding self-treatment took a lot longer to swallow. Over the years I’ve come to understand why guidelines exist regarding treating oneself and one’s family, as well as close colleagues, staff and friends. Lack of objectivity is not the only problem. Often these types of consults occur in informal settings and do not involve adequate history taking, examination or note-making. They can start innocently enough but have the potential to run into serious ethical and legal minefields. I’ve come to realise that, like having an affair with your boss or lending your unreliable friend thousands of dollars to buy a car, treating family, friends and staff is a pitfall best avoided. Although we’ve all heard that “A physician who heals himself has an idiot for a doctor and a fool for a patient”, large numbers of us still self-treat. I recently conducted a self-care session with about thirty very experienced GP supervisors whose average age was around fifty. When asked for a show of hands as to how many had his/her own doctor, about half the group confidently raised their hands. I then asked these to lower their hands if their nominated doctor was a spouse, parent, practice partner or themselves. At least half the hands went down. When asked if they’d seek medical attention if they were significantly unwell, several of the remainder said, “I don’t get sick,” and one said, “Of course I’d see a doctor – I’d look in the mirror.” Us girls are a bit more likely to seek medical assistance than the blokes (after all, it is pretty difficult to do your own PAP smear – believe me, I’ve tried), but neither gender group can be held up as a shining example of responsible, compliant patients. It seems very much a case of “Do as I say, not do as I do”. I wonder how much of this is due to the rigorous “breed ’em tough” campaigns we’ve been endured from the earliest days of our medical careers. I recall when one of my fellow interns asked to finish her DEM shift twenty minutes early so that she could go to the doctor. Her supervising senior registrar refused her request and told her, “Routine appointments need to be made outside shift hours. If you are sick enough to be off work, you should be here as a patient.” My friend explained that this was neither routine, nor a life-threatening emergency, but that she thought she had a urinary tract infection. She was instructed to cancel her appointment, dipstick her own urine, take some antibiotics out of the DEM supply cupboard and get back to work. “You’re a doctor now; get your priorities right and start acting like one” was the parting message. Through my work in medical education, I’ve had the opportunity to talk to several groups of junior doctors about self-care issues and the reasons for imposing boundaries on whom they treat, hopefully encouraging to them to establish good habits while they are young and impressionable. I try to practise what I preach: I see my doctor semi-regularly and have a I’d-like-to-help-you-but-I’m-not-in-a-position-to-do-so mantra down pat. I’ve used this speech many times to my advantage, such as when I’ve been asked to look at great-aunt Betty’s ulcerated toe at the family Christmas get-together, and to write a medical certificate and antibiotic script for a whingey boyfriend with a man-cold. The message is usually understood but the reasons behind it aren’t always so. My niece once announced knowledgably, “Doctors don’t treat family because it’s too hard to make them pay the proper fee.” This young lady wants to be a doctor when she grows up, but must have different reasons than I did at her age. She doesn’t even like jelly beans! Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/
Dr Genevieve Yates
over 6 years ago
This study was conducted to better define the pathophysiology, risk factors, and therapeutic approach to exercise-associated hyponatremia. Medical records from all participants in the 1998 Suzuki Rock ‘N’ Roll Marathon® who presented to 14 Emergency Departments (EDs) were retrospectively reviewed to identify risk factors for the development of hyponatremia. Hyponatremic patients were compared to other runners with regard to race time and to other marathon participants seen in the ED with regard to gender, clinical signs of dehydration, and use of nonsteroidal anti-inflammatory drugs (NSAIDs). An original treatment algorithm incorporating the early use of hypertonic saline (HTS) was evaluated prospectively in our own ED for participants in the 1999 marathon to evaluate improvements in sodium correction rate and incidence of complications. A total of 26 patients from the 1998 and 1999 marathons were hyponatremic [serum sodium (SNa) ≤135 mEq/L] including 15 with severe hyponatremia (SNa ≤ 125 mEq/L). Three developed seizures and required intubation and admission to an intensive care unit. Hyponatremic patients were more likely to be female, use NSAIDS, and have slower finishing times. Hyponatremic runners reported drinking “as much as possible” during and after the race and were less likely to have clinical signs of dehydration. An inverse relationship between initial SNa and time of presentation was observed, with late presentation predicting lower SNa values. The use of HTS in selected 1999 patients resulted in faster SNa correction times and fewer complications than observed for 1998 patients. It is concluded that the development of exercise-associated hyponatremia is associated with excessive fluid consumption during and after extreme athletic events. Additional risk factors include female gender, slower race times, and NSAID use. The use of HTS in selected patients seems to be safe and efficacious.
almost 6 years ago
Gender and Country of Primary Medical Qualification does affect Performance in Postgraduate Examinations
Poster Presentation at AMEE 2009
over 10 years ago
Identifying and Treating All Aspects of Fibromyalgia: A New Look Into a Painful Syndrome - Deconstructing the Syndrome of Fibromyalgia
In this podcast, Drs. Andrew Cutler and Stephen M. Stahl discuss the syndrome of fibromyalgia at the neurobiological level. Current diagnostic guidelines are addressed, as well as providing recent information regarding the underlying causes of this painful syndrome. Gender differences in presentation are also discussed.
Neuroscience Education Institute
almost 10 years ago
The epidemic of substance abuse continues to pose a significant challenge to clinicians nationwide. Although there is a tendency to simply associate drug abuse with poverty, the problem affects every social stratum gender and race; and pregnant women are no exception. Caring for pregnant, substance-using women and their infants presents complex legal and ethical issues. Debate is ongoing about whether criminal penalties should be imposed on women based solely on their use of alcohol and other drugs during pregnancy. Furthermore, controversies persist about the rights and wishes of pregnant women versus the interests of their fetuses. For health professionals, conflict arises when the pregnant woman chooses behaviors that have the potential to harm the developing fetus. The ethical dilemma arises from competing autonomy-based and beneficence-based obligations to the maternal-fetal dyad. This chapter explores the ethics-based conflicts in the delivery of health care to drug abusing pregnant women.
almost 5 years ago
Maternal preconception and gender selection has long been a controversial topic. Are you more likely to conceive a boy if you eat red meat, and a girl if you make love under a full moon? Oldwives tales and fantasies exploring sexual position, diet, and dominance circulate the Internet however how can we logically distinguish between fact and fiction? The topic has widespread cultural implications. Sex-related abortions are on the increase in China and India where local customs and religious virtues appear to strongly correlate with the systematic elimination of girls. In an effort to challenge the dogma of chance fertilization two main research streams have explored variations in maternal condition and gender conception. The ‘Maternal Dominance’ hypothesis has suggested trait dominance, underpinned by serum testosterone, correlates with increased male conception rates. The second, ‘Maternal condition’ hypothesis relates to pre-conceptual maternal diet, investigating variations in both quantity and quality of diet and effects on sex ratios. However such assumptions have been difficult to replicate and more recent evidence has suggested changes in maternal condition may have a stronger influence Maternal adaptations in behavior appear to closely correlate with biased gender ratios and can have wider connotations on sex-linked disease inheritance. However unless we can identify molecular mechanisms influencing the intrauterine environment and follicular development, hypothesis will remain mere assumptions.
about 9 years ago
Peripheral vascular disease (PVD) is due to atherosclerosis of arteries in the limbs. The level of arterial occlusion present is proportional to the symptoms. The pathogenesis and risk factors are the same as for coronary artery disease (CAD), and include: Hypertension Dyslipidaemia High LDL and low LDL levels Diabetes Obesity FH of arterial disease Smoking Age Male gender Epidemiology
almostadoctor.com - free medical student revision notes
over 6 years ago
Research into mice and people with multiple sclerosis (MS) says a key difference in male and female brains may explain why more women get the disease than men.
about 6 years ago
The guidance for abortion providers in England has been clarified to reinforce the fact that terminating a pregnancy on the grounds of gender alone is illegal.
about 6 years ago
67th Health Assembly guest speakers – First Lady of Zambia (WHO Goodwill Ambassador against gender-based violence) and Melinda Gates, co-Chair of the Bill and Melinda Gates Foundation – deplore the prevalence of violence against women and girls.
about 6 years ago
Doctors say they are inundated with young patients hoping to start gender transitions, but are 13-year-olds capable of making such big decisions?
over 5 years ago
Age- and gender-related normal left ventricular deformation assessed by cardiovascular magnetic resonance feature tracking Via PubMed
J Cardiovasc Magn Reson. 2015 Mar 10;17(1):25. doi: 10.1186/s12968-015-0123-3.
about 5 years ago
Disclaimer: Although the cases I discuss are true, to protect the identity of my patients and myself certain details may be changed. Examples of items that may be changed include a person's gender, age, gravidy and parity, and so on.
almost 5 years ago
New Stroke Risk Factors for Those with Atrial Fibrillation (AF): Female Gender, Heart Disease, and Age
New stroke risk factors for those with atrial fibrillation (afib) include being a woman, having heart disease, and age 65 or greater
almost 5 years ago
Susan Nolen-Hoeksema (May 22, 1959 – January 2, 2013) was an American Professor of Psychology at Yale University. Her research explored how mood regulation strategies could correlate to a person's vulnerability to depression, with special focus on a construct she called rumination as well as gender differences.
over 4 years ago
This video describes the pros and cons of this test (sometimes called “noninvasive prenatal screening” or “the gender test”). It also explains what condition...
almost 4 years ago
Purpose: The number of women physicians is increasing in Japan. The authors investigated gender diff
about 6 years ago