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Steven Goldberg – In Memorium

Last week Steven Goldberg (no relation), a former student of mine at the University of Miami School of Medicine, passed away of lymphoma at the age of 42.  After 25 years of my teaching at the U of M, his name stands out in my mind, not because of similarity of name, but because of his brilliance and character.  He was a true mensch.

Steve was born with transposition of the arteries, which required surgical correction.  When he advanced in medicine, his goal was to become a pediatric cardiac surgeon and offer to other children what had been provided to him.  He did just that, training at the same institution that had operated upon him as a child.  He specialized in difficult cardiac procedures in children, including the kind of congenital defect that he had, as well as cardiac transplantation.

You can gain a better glimpse of his character through the YouTube video he prepared for LeBonheur Children’s Hospital last year. Within only a few days of his passing, there were hundreds of facebook postings by people whose lives he had touched.

Steve was also a skilled artist who illustrated significant parts of my books on Clinical Physiology Made Ridiculously Simple and Med’Toons. Here are three of my favorite cartoons that he drew:

Emphysema in wolves

From Med’Toons, by Stephen Goldberg, Medmaster

Immune-picture

T-helper cell function in the immune system.
From Clinical Physiology Made Ridiculously Simple, by Stephen Goldberg, Medmaster

Steve will be greatly missed.  He was the personification of the ideal physician.

Drawing The Patient Into the Decision-Making Process

From Med'Toons, by S. Goldberg, MedMaster

From Med’Toons, by S. Goldberg, MedMaster

Should the patient and family participate in the decision-making process as to whether or not to pursue an aggressive course of therapy?

Of course, there are those patients who say “Whatever you think would be best doc.”  And there are others who are so mentally incapacitated as to not be able to render an intelligent decision.

But what if a patient wants to help decide on the course of therapy? There are two points of view.  There are physicians who feel that patients and family should not participate in decision-making in aggressive treatments, such as surgery, radiation, and chemotherapy, as they are too emotionally involved and may not think rationally.  I feel otherwise.  Apart from the patient having the right to agree or not agree to a particular treatment, there are situations in which the patient may be in a better position than the physician to decide.  For instance, say a patient has a tumor of the arm and the statistics indicate that there is a 90% chance of survival if the entire limb is removed, but only a 70% chance of survival if the tumor is removed locally, but leaving the function of the arm intact if successful.  What should one do?  Leave the decision up to the physician, or seek the patient’s opinion?  The physician may opt to remove the arm to improve the chances of survival but the patient may want to take the gamble, in order to keep a functioning limb. The patient’s choice may well be the better one; it suits the patient’s individual needs.  The patient and family may be willing to gamble, while the physician may not.

If the patient and family are well-informed of the facts, the therapist should encourage their participating in the decision-making. The patient and family not only have the right to do so, but their input may be helpful, even invaluable, in making the right decision.

The Importance Of Patient Followup

The spontaneous cure has kept many a healer in practice.

In the busy pace of medical practice, whether in-hospital or outpatient, it is common to lose track of what happens to the patient after discharge.  There are two good reasons to try to follow up, when possible, on how the patient fared after leaving the hospital or outpatient office:

1. Calling a patient is important psychologically to the patient.  Your call lets the patient know that you care by taking the time to follow up.

2.  It is important to your own education.  Once the patient leaves the hospital or office, if you don’t hear back is it because the patient improved and doesn’t feel the need to return? Or perhaps the patient’s condition has not improved and the patient may have sought care elsewhere or otherwise feels hesitant to return.  This is an important source of learning that can help you in treating future patients.  You wouldn’t want to continue a treatment that doesn’t work, but you would want to emphasize one that does.

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The Healing Power Of Just Sitting Down

We enter medical school full of humanitarian goals. Somehow, though, something seems to happen all too frequently in the clinical 3rd and 4th years and beyond.  There is less focus on the patient as an individual and more emphasis on lab tests and presenting on rounds.

Perhaps it is the busy schedule, where so much time has to be spent with performing, ordering and reviewing lab tests, making rounds, writing notes, and preparing for presentation to interns, residents and attendings.  Perhaps it would be too draining to become emotionally involved with the patient’s illness, as would be the case for a family member.  But the opposite extreme, of overlooking the patient’s emotions, is not good either;  there needs to be a happy medium.

When I was a student, I noticed that the internal medicine interns and residents who were considered the best knew their medicine and were up on their lab tests.  But there was little evidence that they really knew who their patients were as people.  The chief resident, who had the most status, had even gotten an article published in the prestigious New England Journal of Medicine.  He was very much involved in the lab tests, but I doubt if he knew anything about who his patients were as individuals.

With such a busy schedule, there is a simple change on rounds that can make a difference.  That is sitting down with the patient, rather than standing and quickly passing through.

Sitting down briefly doesn’t take much time.  But it gives the patient the feeling that s/he is not just a statistic, and the physician truly cares; it relieves some of the patient’s mental stress, which is part of any illness.  It also gives the physician a little insight into the patient as an individual.  We call this bedside manner.  It is practiced much better by certain practitioners of questionable areas of “alternative” medicine.  There is no reason why it can not be done in all areas of medicine.