25 June 2007

White Coat Ceremony

During orientation week at my medical school, the last night of the week is reserved for the White Coat Ceremony. This ceremony is where the incoming medical student has a physician place their white coat, shake their hand and where they are officially welcome into the practice of medicine. This ceremony marks their first taking of the Hippocratic Oath (with a re-take for the practicing physicians).

There is usually a nationally recognized speaker - for my year is was Benjamin Carson, M.D., chief of pediatric neurosurgery at Johns Hopkins- who sets the tone of the entire program. I have heard White Coat Ceremony speeches by Former Surgeon General Jocelyn Elders and other nationally known physicians. Every time I attend one of these White Coat Ceremonies, I am reminded of why I went into medicine in the first place and the "humanism" of my practice.

Even today, in 2007, the infant mortality in Mississippi is higher than in many third-world countries. In New Orleans, many patients with chronic diseases such as hypertension and diabetes face an uphill battle to find adequate primary medical care for simple maintenance of their conditions after Hurricane Katrina wiped out many clinics in the poorer neighborhoods. In Appalachia, the complications from untreated hypertension have left many without renal function who have to rely on hemodialysis three times each week.

We still have a health care system in this country that shuts out large populations who either do not have jobs that provide health insurance or jobs with health insurance benefits that are woefully inadequate. Many of these people avoid seeing a physician when early intervention could likely make the difference between remaining healthy or progressing to a chronic state of illness that will be life-changing.

Obesity is rampant in all segments of our population yet the morbidly obese face discrimination and ridicule by hospital staff, physicians and large segments of society who see them as lazy and responsible for their condition. In most cases, morbid obesity comes from lack of access to foods that are lower in fat and higher in nutrition because of cost or lack of knowledge. After gaining a large amount of weight, even walking around the block becomes more than many of these people are able to achieve.

When I think about attending the White Coat Ceremony at my medical school this year, my focus will be on how we can raise the quality of delivery of health care across all segments of our society. It is my belief that preventive medicine needs to be practiced more than interventional medicine. The poor, the morbidly obese, and those who lack knowledge are among the most difficult patients that any physician will ever treat.

The morbidly obese are a rapidly growing segment of our collective patient populations with problems such as non-healing venous stasis ulcers, lymphatic dysfunction, obstructive sleep apnea, early congestive heart failure, depression, Type II diabetes of the young and predisposition to thromboembolism. Even a relatively minor surgical procedure such as an appendectomy becomes a major undertaking in a person who weighs more than 300 pounds let alone 400 - 500 pounds. I have watched my colleagues deliberately avoid treating morbidly obese patients who have sought their care because they didn't want to deal with the possible complications.

Morbid obesity is showing up in middle school, junior high and high school with some individuals weighing so much, they become unable to attend school. In the cases where these morbidly obese individuals are able to attend schools, many physical education classes are unable to accommodate these children who desperately need to learn how to exercise and eat properly in order to undo 200-300 pounds of weight. In most cases, these children do not need to be subjected to gastric bypass surgery but need simple education and good food choices along with making aerobic exercise a regular activity.

With every patient, we as physicians, need to look toward preventive medicine and patient education. To do otherwise, keeps us on a path where health care costs will continue to sky rocket and soon, too costly for most people to be able to afford. It is up to us, as physicians, to lead this country back to basic good health for every segment of our population.

1 comment:

David P said...

Very insightful post.

It's a shame that preventive medicine is not really emphasized at schools.