A friend gave me feedback a few days ago, "Some people say you are arrogant, but I tell them ‘No—he is just self-confident.’" He followed, "We need that in a doctor, but, you know, there is a fine line between those two characteristics."
Uff da! That threw me for a bit. After thinking about it, I took it as an honest comment and a chance for me to improve myself. A physician/philosopher once said: "A true friend will help you grow by pointing out your warts. Instead of getting angry, one should take it as an opportunity to get better."
What is arrogance? The dictionary’s definition is harsh: "An offensive display of superiority or self-importance; overbearing pride." I see it in people who treat others poorly, especially those who are lower on some hierarchal level. Examples would include an employer who expects sexual favors of some kind, a prison guard who harasses a prisoner hatefully, a teacher or parent who supervises a student or child unjustly, or, to make the point, a doctor who treats a nurse or patient poorly. I believe nothing indicates the true color of an individual more than how he/she treats someone who may be lower on the totem pole.
I have seen examples of physicians acting this way: when a surgeon threw a scalpel across the room; when a specialist spoke negatively to the patient about a primary care physician; and when a surgical resident treated a young inner-city woman, infected by gonorrhea, with disdain and contempt. I am not proud that my profession probably deserves some of its reputation for being arrogant. On the other hand, part of the value provided by a physician comes from the sense that she or he is competent and knowledgeable. A humble physician is one thing, but an unsure and uncertain doctor is another.
Perhaps sometimes I have come off as a know-it-all. I need to work on that because I do not know it all. In fact, it seems the more I do know, the more I realize my inadequacies. My folks came from humble backgrounds, and I was drilled on the Golden Rule. The last thing I want to do is to portray myself as a physician who thinks he is more important than anyone else. Rather, I would like to be known as someone who is both competent and cares.
Richard P. Holm, MD
As part of our Prairie Doc volunteer work to spread science-based public health information, we have assembled a group of pre-professional college women and men to help us out. Almost every Thursday night at 7 PM (6 mountain time), these young “Prairie Doc Assistants”, or PDAs, answer telephone call-in questions for our TV show on PBS. This changing group, initiated by our friend and advisor Mr. Judge Kelley, has been helping us for more than four years.
These kids not only help answer phone calls during live shows, but they help research medical topics, and even help others during medical mission trips. In return, we give them the opportunity to meet our medical guests for 30 minutes before the show, and we help them find shadowing experiences with physicians. They need to experience a taste of what it would be like in med school and in the real world after starting practice, before they commit to it.
My first two years of medical school, back in the 70’s, required putting my nose into books, memorizing how the normal human body works, and understanding what can happen when illness strikes. The second two years, and the internship and residency that followed, were spent learning from an older and experienced master who taught by example. This mentor-based teaching style is a lot like the medieval way of learning, like being an apprentice to a silversmith who knows what he’s doing, and who guides you in making your first silver tea service. In medicine, I think the hands-on, one-on-one, mentoring experience is what matters the most, but the book-learning part is still necessary. Now, med schools are mixing together the book-learning and the mentoring throughout the four years of education, which is a better deal in my opinion.
During my life of medical practice, I have mentored many apprentice nurse practitioner students, P.A. students, medical students, and medical residents; all while I was caring for patients. I asked the patient permission first and very rarely had anyone say “no" to having a student in the room. How else are they to learn how to listen, examine, and think in their quest to become a high-quality care giver? Besides, having a student watching can only make a doctor try harder and be better.
Now, I find myself encouraging college students into the glorious and rewarding field of medicine. Indeed, what an honor it has been to have a treasure chest of knowledge that can be used to help others!
By Richard P. Holm, MD
In 1966, a ten-year-old boy from Hamlin County, South Dakota was sleeping out with his buddies when a skunk crawled into his sleeping bag and bit the boy aggressively near the face. Despite providing the child with old-style vaccinations, the boy succumbed to rabies within a month. Even with present day technology, once rabies gets to the nerves it is at least 96% fatal in humans. rabies is believed to kill more than 55,000 people every year in Africa and Asia alone—most of them after a bite from a rabid dog. By comparison, in the U.S., rabies kills only about two or three people per year.
Over the last 50 years, effective vaccination programs for domestic dogs and cats, along with improved rabies post-exposure prevention (PEP) treatment, has significantly reduced the number of rabies-related deaths in the United States. Domestic animal vaccination has been quite successful in containing rabies exposure to humans, but minimally affects the risk of rabies in wild animals and thus they remain a reservoir for the disease. This and the newer PEP, which is easier to take and more effective, has also helped radically reduce human rabies.
We still have plenty of animal rabies, however. In SD, over the last ten years, we tested 6,500 animals suspected of rabies, since they were seen in unnatural hours acting sluggish or aggressive. They found five percent tested positive. Specifically, 195 skunks, 48 bats, 47 cows, 22 cats, 16 dogs, eight horses, three goats, and two raccoons were rabid. Please take note that none of the 16 infected dogs had been vaccinated, giving credibility to the value of vaccination. Of all the bats tested, only three percent were positive, while 48% of the skunks tested were rabid. These were selected due to bizarre behavior and thus the percentage affected is artificially high. Still, this gives another reason, besides bad odor, to avoid skunks.
Just last week a Sioux Falls man was walking his dog late in the evening near many evergreens, when he noted something was crawling on his forearm. When home in the light, he noted tiny double bite marks, highly suspicious for bat bites. Since SD bats are usually bug eaters, not arm chewers, this incident was worrisome. The doctor recommended rabies PEP.
Bottom line: Vaccinate your pets, avoid messing with wild animal, and seek immediate medical care whenever bitten by any animal.
By Richard P. Holm, MD
In the U.S. there are almost five million people with mild to moderate dementia. Studies show that about 70% of these people are at home, either alone or with a caregiver (often a spouse). If more people with mild to moderate dementia could stay home safely, this would save Medicare and Medicaid a great deal of taxpayer money. More importantly, this would provide those affected by dementia with their preferred environment. Indeed, it is important to allow all people the chance to stay at home whenever possible.
Recent Johns Hopkins research studied more than 250 people with dementia and found that 99% of the demented and 97% of their care givers had at least one unmet need. The foremost unmet need was safety issues which increased risk of falling, such as poor lighting in walkways. Other unmet needs included not performing regular exercise, poor follow-up with health care providers, not having prepared legal and estate planning, and not receiving needed help with medications and daily living activities. Researchers found that individuals with lower income, with depression, and/or with borderline—rather than severe—dysfunction, had significantly more unmet needs.
When there were at-home caregivers for these folks with early dementia, the caregivers were often not aware of these deficiencies. Add to all of this, the needs of the caregivers were often ignored or unrecognized. Remarkably, at-home caregiver stress and depression was one of the strongest predictors for an earlier move of the person, with dementia, to the nursing home.
Methods to enhance a person’s chance of staying at home are not difficult. Preparation for legal issues and estate planning should be done early and BEFORE memory loss. Other methods include providing raised toilet seats, grab bars in the bath and bedroom, properly tacked down carpets, adequate night-time lighting, and proper day and night time footwear. Researchers also strongly advise providing enhanced support for caregivers, such as educating them about support services available, like social services, occupational therapy, and caregiver support groups. In addition, screening for and treatment of any caregivers’ depression should be provided. This would go a long way in helping people stay at home as they age.
Bottom line: most of us (and our families) are not prepared for the possibility of dementia as we age. If we prepare, we greatly improve our chances for staying at home.