The more things change...

Submitted by Wajid Sayeed on April 18, 2012 - 14:33

My name is Wajid Sayeed. I graduated from UWO medical school in 2010, and started a Neurology residency program at the University of Manitoba shortly thereafter. When I was approached about writing for the Open Medicine blog, I was on vacation, said I'd think about it, and then fully intended to dally an hour or two away watching YouTube videos.

I actually wound up watching Dr. Bryan Young's EM London Grand Rounds on basilar artery stroke, and in YouTube's creepily insightful sidebar (its degree of insight, I suppose, is an indicator of just how much time I waste on it) this documentary from the 1960's popped up:

A few things have changed when I compare my first year of residency to that of Dr. Mulder. We aren't required to work 36 hour shifts with 8 hour gaps. Indeed, there is a strong push globally to start limiting resident work hours to a maximum of 16-hour shifts – a move that is actually opposed by a significant minority of residents for reasons that aren't surprising if you know how residency programs are accredited. With the advent of tomographic imaging, we don't do lumbar punctures willy-nilly as they were apparently done at Bellevue. By the same token, you don't see many interns who would report papilledema as part of their physical exam. We treat acute MI's and PE's differently. The nurses don't all wear the same uniform. We don't all smoke. Some genius invented colours.

Beyond those details, though, it was far more striking to reflect on how much has not changed. While the aesthetics of the equipment have changed, not much of its actual function has. The "electrocardioscope" isn't called that anymore, and it's got a few extra bells and whistles but it`s essentially the same device. The non-rebreather mask is now transparent plastic, but it's also no different in principle. In 50 years, our hi-tech equipment will almost certainly look quaint.

While today we stand a better chance of finding a definitive diagnosis for what caused the first patient's brainstem findings, we don`t really stand a better chance of improving his outcome; that patient, presenting in that condition, to an emergency room in 2012 would be just as dead as he was in 1960.

Perhaps more substantially, the great invention of the last two decades in patient relations - "patient-centred care" does not seem to have made all that much of an impact. Looking at the way Dr. Mulder and his colleagues and superiors interacted with patients, I can't see a substantial difference in the way my colleagues and superiors deal with ours. I and my classmates had, and continue to have, the same 'Surgery vs. Medicine' conversation. Even in the absence of "Evidence-Based Medicine", Dr. Mulder seems to have known the importance of treating high blood pressure.

I write this not to belittle the advances we have made in the past 50 years, but rather to encourage the development of some healthy skepticism regarding attempts by various parties to pat themselves on the back and deride the way things were done in the "bad old days." The day may come when our practices too are deemed barbaric, and our professional progeny will wonder how our terrible habits were permitted in a hospital, and how much better they are at understanding people.

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