The thyroid. Parathyroid. Bilateral axillary. Breasts and the areolas. Almost the entirety of the abdomen – stomach, liver, spleen, intestines, and pancreas. Rectus & tranversus abdominis. External & internal obliques. Linea alba & umbilicus. Inguine. Rectum & anus. All of these within my domain and scope of practice. I am a general surgeon, FACS; qualified in bariatrics, robot assisted and minimally invasive surgery (MIS), and primary care with emphasis on underserved rural communities. I have also been on-call for ER surgical, and served as alternate house physician for a large, privately run, Independent & Assisted Living/Skilled Nursing retirement facility. I have practiced medicine for almost 17 years, including surgical residency. With the exceptions of two teenaged food service jobs and one (mercifully brief) stint as a rental car call center rep (“Try Harder”? Whatta crock!); medicine is what I know.
The uterus. Cervix. Fallopian tubes. Ovaries. Babies, intra and post partum. Colpus, internal and external. The kidneys. Ureters. Bladder. Testes. Urethra. My wife is also a physician; her scope of practice is just as vast, yet in very different areas. She is a dual specialised medical surgeon, trained and served at the behest of state and private medical agencies. She has been sent to many places in Eastern Europe and Asia, including cities in her ancestrally native Ukraine, Belarus, Russia (she was born in Kamchatka in Russia), and Chechnya, for medical missions (some of them in declared zones of conflict), and has practiced for a little over 13 years. Her childhood dream was to be a professional ballerina to see the world, and has worked entirely in the medical field. She was also the captain of her chess team during her medical training, and was a champion level competitor (a rather sore winner, she is; and, an exceptionally sore loser, to boot). Her father, a high ranking military officer, specifically encouraged her to study medicine as a way to serve her country without military enlistment.
The job of a physician is very simple: To diagnose and treat disease. Simple, yet so very complex. Made even more complex by the very people we strive to help, and often worsened by those ostensibly charged to help them on their behalf, moreso those in the public sector, but the private sector can be just as frustrating. What we hope to accomplish in this series is to pull back the curtain and give you an idea of what we do and our respective points of view with regard to practice and overall ethos that informs our respective approaches to care.
For example, I am of the firm belief that medical care is not an inherent, plenary, human right. Period. Full Stop. End of Story. I own my skills totally, and determine who and who does not receive them. This is, of course, subject to contract at the pleasure of an employer and/or third party payer, though I will inform them upfront that there are certain non-negotiable lines that simply won’t be crossed.
My wife, who for now shall be referred to as Zhena Groovova (Жена Грувова – literally, “wife of Groovus”), her views were and are informed by the fact she has witnessed the dissolution of the Soviet Union, The Orange Revolution in 1991 (Ukraine’s Independence), and, most recently, The Maidan Revolution and subsequent Donbass Invasion in 2014 (we had the poor fortune to witness that one firsthand in Donetsk, and will most likely include medical experiences from that time). She received almost all her training in Ukraine post-independence, as when it was part of the Soviet Union, the job of the country was to make planes and tanks, grow wheat, and educate doctors and train nurses (Soviet Command Economy). She believes that basic medical care access is an inherent, plenary, human right, though the physician determines the limits of his or her labour by right of education and station.
Suffice it to say, we do believe that, regardless of system, payment scheme, and even patient demands, we own our education and skills – there are ethical and personal lines we simply will not cross. Many of our anecdotes and reflections will stem directly from these competing philosophies.
That said, the types of things we’ll cover in Medical Mondays and Супер Среда (Super Wednesdays) are:
1. The lighter things, such as humorous patient anecdotes, medical education bloopers and blunders, and intra-office pranks (Of which there are legion; ever put SuperGlue on the Med Students’ pens and clipboards, or saran wrap the Charge Nurse’s desk?);
2. “A Day in The Life,” and other fly on the wall vignettes, providing answers to the oft wondered, “Why is everything taking so long,” “Do you ever go to the bathroom,” “With all the gross stuff you see, how do you even have a sex life?” “Are your kids your personal lab rats?” “How do you get along with other doctors?” “How much sex and sleaze goes on in a hospital?”;
3. More contemporary issues with regard to medical freedom, such as: records privacy in the digital age, licensure, billing, Charity Care, the roles of rising adjuncts like ARNPs, PAs, and Allied Health (like respiratory therapists, pharmacists, medical technologists, and paramedics/EMS), scope of practice, continuity of care, tele-medicine, robotics and autonomous bots, regulations, DNA and heredity, charting and dictation, “know-it-all-WebMD patients,” and other unique stressors for us that patients don’t ever see, and so much more from the doctor’s perspective;
4. The much more serious side of medicine, such as how we deal with: patient deaths; stillborn births; preemies; birth defects; performing a surgical abortion; going to jail for freedom of conscience and religion; assessing possible sexual assault & completing a rape kit; industry drug abuse; being sued; the worst and most gruesome ER cases; war injuries, crimes, and pathologies; when to remove, and removal of, life support; attending patient’s funerals; having the Jonathan Kent/”Superman” moment (“All these powers, why couldn’t we save them?”) and other extremely emotionally draining, personally destructive, and unpleasant aspects of medicine, where no one asks what we feel or think, how it affects us and our psyches, or has never even given it a first thought, forget a second one. “Prick us, do we not bleed”?
5) Solutions to the current medical care delivery woes, and how both technology and human conditions can improve it; conversely, addressing legal liability costs and concerns in this almost literal, Post Mendelian, “Brave New World.”
What we don’t want is some run of the mill malady/cure column extolling the virtues of folk remedies (though many work, actually), nor throwing abstracts in your face a la Pub Med Ninjas. The InnerToobz is already bursting at the seams with advice columns; if you are hoping for a column on which is better, Vick’s Vap-o-Rub v. Lamisil, for toe fungus, BORING! (FTR, Vick’s is cheaper, no side effects, OTC, and takes not much longer than Lamisil. Wash and dry your feet, apply Vick’s to the cuticle for about three weeks. Trim nails as needed. Works wonders for thick, cracking toenails, too. OK, we may throw in a few tips…)
The other thing we ask: Be respectful to us. We hope many of you will like us, some find us an absolute scream, know others will find us about the level of watching paint dry, know some will (and do already) hate us, and know most hate the systems as they are. If we see such comments such as, “PERMISSION SLIP!”, “CARTEL!”, “GUILD MAN!”, and other stuff we already know grinds your gears, we’re out, and we will take down our posts and comments with them.
OMWC and SP, and The Founders here, gave us this forum out of the goodness of their hearts to entertain and educate, not be punching bags and pinatas. We get enough legit abuse to last many lifetimes over. We are here for you, but won’t hesitate for a second to keep you at arm’s length – the time we spend with you, is the time we could be spending treating paying patients, making filthy doctor lucre, and spending time with our three children…
Our greatest fear, at this moment, is failing to meet your expectations.
*Hangs Up “Out” Shingles*