A friend recently described to me how horrified she was watching her two and a half year old son play with a group of children at a local fast food restaurant. Her concern was over the fact that he was being exposed to all kinds of germs that could potentially make him sick.
My friend is correct in her observation that her son was coming in contact with all kinds of bacteria and viruses many of which his immune system had never before encountered. A minor illness may indeed be the result. I tried to reassure her. Most current immunology research would have us believe that challenges to our immune system when we are young may lessen our chances of developing certain diseases when we are older.
These conditions are called autoimmune diseases. Examples such as type 1 diabetes, Crohn's disease, and rheumatoid arthritis occur when the body's own defense cells that are suppose to attack infectious invaders such as bacteria and viruses attack the body itself. There have been several studies showing our twenty first century fetish with cleanliness could be hurting us and increasing the risk of developing such illnesses. It may also be producing guerrilla pathogens like methylcillin resistant staphylococcus auerus, a bacteria resistant to most common types of antibiotics.
Reflecting on all this, I began to think about "social sanitation" and how it hurts us as well. By social sanitation I am referring to practices which keep us isolated in groups of people who look, act and think as we do. Growing up in what I call Small Town Texas, my friends and I were cautioned by our parents to avoid those different from ourselves. Not only were all my friends Caucasian, they were Protestant, mostly Southern Baptist, and all our parents with only a rare exception were employed by the oil industry.
There is a certain security in similarity but in the twenty first century where our world is shrinking to the point that diverse cultures are required to come together to solve our common problems this behavior is much like the avoidance of common germs. If our only contact with people who have different beliefs and behaviors is in an effort to convert them to ours, how can we truly understand each other.
Living in a more cosmopolitan area than I growning up has given my children advantages that I did not have. Their friends are from many different backgrounds. They understand different religions, political view points and different lifestyles not because they read about them or watched a television show but because of experiences with their friends.
Yes, these exposers to different lifestyles often result in my sons questioning of many of my beliefs and some of our family practices. Yet I am hopeful that from their experience of a wider world my sons have been protected from many of the prejudices that weaken my own generation.
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Musings of a physician in private practice for 24 years, now teaching in a residency program and working as an ob-gyn hospitalist in a large metropolitan hospital.
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The Local MD
Having now been a physician in private practice for twenty-one years, twenty-six days and about an hour and twenty minutes, it occurs to me that I have become what in medical school was often a derogatory term, the local MD.The presentation on rounds often went something like: "This 45 year old Caucasian male was seen last week by his LMD, and diagnosed with a viral upper respiratory infection..." At that point everyone knew that the LMD had missed the diagnosis. Otherwise the poor patient would not have ended up in a tertiary medical center with three consulting specialist, a fellow, a resident and four medical students at his bedside.What we, the medical students, the resident, the fellow and even the attending hospital physicians did not realize is that we would never know John Smith as well as the LMD. We would never speak to his wife using her first name. We would never be able to recall the names of all his children and know where they were in the world. We would never remember his favorite hobby let alone joke with him about it. Nor would we shed a heart felt tear when we gave him the diagnosis of the aggressive small cell carcinoma of the lung that had landed him in our midst and would kill him in less than three months despite our aggressive treatment that was the best medical science has to offer.At that point in my life I was very proud to be even the lowest ranking person on the team that was on the cutting edge of the diagnosis and the treatment of the gravest of conditions that plagued mankind. I felt so very lucky that I was being initiated in to this sacred fraternity. That I would soon be able to write "MD" after my name. I am still proud of my vocation yet I believe there is a wisdom that has only come with those twenty-years of practice.Today I realize what people want most of their physician is that he or she is someone who cares.Yes, we all want "everything medical science has to offer." Yet, what most of patients need is someone who will listen with their heart as well as with their head. Physician eyes are important, not only for seeing signs of disease in the body but for making contact with the patient's eyes where we are often allowed to see into their soul. All of the technology in the world will not replace a warm clasp of the hand or sitting at the bedside to share a few moments of the day along with the test results.So, I have created this blog. In large part it is a place for me to put my feelings. My hope is that at least some of these posts will resonate with others out there. Not just physicians, but others in caregiving vocations and even those for whom we care. If we are not here for each other then why are we here?
1 comment:
Very well tied together! Love you mom.
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