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Seuss was a Doctor

Welcome, oh welcome to the world of reform,Where truth is elusive, confusion the norm! Where thinking comes only in partisan form, And people, we're just at the start of the storm!

So hear me divulge the sad story of woe. I wish I could tell you it just isn't so, But trouble's aplenty where foe faces foe Behavior starts slipping and standards get low.

In one corner stands the old party so grand The party of Lincoln who once saved our land Their numbers depleted, an overthrown band See them in the chambers as they make their stand!

A plan that is public creates great distress, Just growing the government won't fix this mess! Absolute power just leads to excess! (But what's their alternative's anyone's guess)

Determined they stand with a look in their eye That says they would hell and high water defy And right in the face of that president guy Their spokesman will utter: "you lie,sir, you lie!"

Opposing them is the great Jefferson's crew Who feel that their moment is long overdue Their numbers once meager just suddenly grew From liberal Yankees to dogs that are blue.

With such a great army they should be victorious And stand at the summit with splendor so glorious But fighting themselves is their modus notorious And keeping together extremely laborious.

Their leader is suave and a speaker so gifted And when from their task their attention has drifted Or if without warning positions have shifted He soothes and he strokes 'till their party's un-rifted

So in their committees they lobby and fight To save our great land from its medical plight They often use words that are hardly polite They wrestle and wrangle deep into the night

When every last partisan word has been said When rules long held sacred are turned on their head They offer the thing that the people all dread A bill wide and sweeping that nobody's read

And from this confusing and uncivil mess Come speeches proclaiming a certain success All quickly devoured by a clamoring press But actual outcomes one only can guess

And far from the demagogues' loud proclamations Away from champions of grand obfuscations Who speak to the cameras with brilliant orations And bow at the altar of public relations

Spread over the reaches of this tired nation Are havens of healing where doctors meet patients Who carry burden of  mounting frustrations And end being listed as sad "complications "

With all of the money the leaders are spending The obvious message to us they are sending It's totally clear, there is only one ending: It's their own agendas to which they are tending

The patients are now in the poorest condition We've put them all into this dreadful position Ignoring the help of those greedy physicians And trusting their health to those smart politicians



Fever and Global Warming

Does fever cause global warming? Does global warming cause fever? No, that's not what this post is about.

I was listening to a podcast about global warming this morning and it struck me how the debate was very similar to one that happens in the doctor's office.

A Parent brings her child in. It is a 3 week-old with a reported temperature of 102 degrees at home.

Doctor: "This may seem alarmist, but it is our protocol to hospitalize all children under 1 month of age. Children this age have higher rates of meningitis and blood infections, and they don't show signs of the illness that older people show."

Parent: "But doctor, my baby looks great. My other kids had a cold with a fever. Don't you think that this could just be a virus?"

Doctor: "Sure. I think that it is most likely that your child has a virus, but there is no way to know if it is meningitis, so we just can't take that kind of risk."

Parent: "Don't you have to do a spinal tap to rule out meningitis? I don't want you to do a spinal tap on my baby when you think that it is most likely just a virus."

So, to summarize:

  • There are symptoms of a potentially serious problem
  • There is still the possibility that it is not a serious problem
  • The consequences of being wrong are severe
  • There needs to be rapid and fairly dramatic steps to assess and possibly treat the problem

I don't know if global warming is happening, but a lot of experts feel the signs are there. They may be wrong - and I hope they are, but if we do not work to diagnose and treat, the consequences could be horrible. Like when an infant has a fever, under-reaction is far worse than overreaction.

When one of my patients comes into my office with significant worry about a serious problem, it is my job to rule this out. If I can do it simply by taking a history and examining them, then often they are reassured. If after examining them, however, I have not reasonably ruled out the problem, it is incumbent on me to do what I can to rule this out.

If a patient is worried about a lump on their breast, and my exam does not rule out this being a malignancy, it is my job to act on it and do what is needed to determine if this lump is cancerous.

Here are the possible scenarios:

  1. I work up cancer and it comes out there was cancer present. This means she gets care sooner and has a better outcome than if I had waited.
  2. I work up cancer and it is not found. This is the best-case scenario. We want to rule it out.
  3. I don't work up cancer and it is not cancer. This may seem OK, but I am leaving my patient to worry and myself vulnerable to missing an important diagnosis. I am not doing my job.
  4. I don't work up cancer and it is cancer. This is the worst-case scenario. I have delayed diagnosis and treatment and so put the patient at a much larger risk for dying from cancer.

I am generally not political on this blog, but even those who don't think global warming is real should understand this parallel. Overreacting to the possibility of global warming is not nearly as big of a risk as not reacting soon enough.

As much as I hate sticking a needle in a baby's back when they have a virus, it is far preferable than an infant dying when I had it in my power to save them.