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Psych wk 3: day 12 tired. i could sleep forever. ...
i've fallen in LOVE!!!! meet my sweet!!
Psych wk 3 day 11 i interviewed a pt with my atte...
had brunch with v and christian. then, they left b...
Psych wk 2: day 10 medical student asked a reside...
finished my call at midnight. was at CPEP, which i...
Psych wk2 day 9 imagine, if you will: seminar led...
aha! i'm able to get a quick little break. so, yo...
ok, so i'm not asleep yet. sue me, brian. too many...
Psych wk 2: Day 8 went in LATE. missed morning ro...
Psych wk 3, day 13:
first ever ethical dilemma faced on the floor, for me:
i ran into the family of a patient who we think has Alzheimer's disease. the family wanted to know what was up, i didn't know how much i should tell. my general policy is to be honest and just tell as much as they can understand. the problem was, the daughter of the patient was a physician, and thus had an idea of what a diagnosis of Alzheimer's might mean for all the children of the patient, including her.
naturally, she wanted to know the results of the genetic testing for her father, and if positive, she wanted to know for herself.
another problem was, should we do the panel on genetic markers for Alzheimer's or not?
there are several issues at stake:
1) there is no definitive method to diagnosis Alzheimer's for sure, except post mortem. thus, even if the panel were to be positive, we might be scaring a lot of ppl, unnecessarily.
2) the thing about Alzheimer's is, you can't reverse the damage. there is a progressive memory loss and dementia. what we CAN do, is give cholinesterase inhibitors, and try to slow the damage.
my personal opinion was that the panel should be done for our patient, and if +, also for his children. we're going to give the cholinesterase inhibitors for the patient, no matter what (it won't hurt him, and may slow the deterioration). but if the patient's children are also positive for the genetic markers, at least they will be alert and ready to slow the progression early on, instead of slowing it after there has already been a lot of loss.
3) the third, and most important issue, is this: if the children (now adults) know that they are positive, they will be living life with a sense of impending doom. Alzheimer's can be slowed, but it can't be stopped. How would you feel, knowing that you are going to deteriorate, lose your memory, etc? it's scary. i don't know what to do. gotta discuss with our treatment team (me, resident and attending)
*****
finished moving to my new room. it's 3 ft longer. makes a world of diff...
****
i'm sitting in my room now, doing my long, multiple page write up on one of my patients that i have to turn in to the attending tomorrow. i'm suffering...
yakob at 2:04 AM
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first ever ethical dilemma faced on the floor, for me:
i ran into the family of a patient who we think has Alzheimer's disease. the family wanted to know what was up, i didn't know how much i should tell. my general policy is to be honest and just tell as much as they can understand. the problem was, the daughter of the patient was a physician, and thus had an idea of what a diagnosis of Alzheimer's might mean for all the children of the patient, including her.
naturally, she wanted to know the results of the genetic testing for her father, and if positive, she wanted to know for herself.
another problem was, should we do the panel on genetic markers for Alzheimer's or not?
there are several issues at stake:
1) there is no definitive method to diagnosis Alzheimer's for sure, except post mortem. thus, even if the panel were to be positive, we might be scaring a lot of ppl, unnecessarily.
2) the thing about Alzheimer's is, you can't reverse the damage. there is a progressive memory loss and dementia. what we CAN do, is give cholinesterase inhibitors, and try to slow the damage.
my personal opinion was that the panel should be done for our patient, and if +, also for his children. we're going to give the cholinesterase inhibitors for the patient, no matter what (it won't hurt him, and may slow the deterioration). but if the patient's children are also positive for the genetic markers, at least they will be alert and ready to slow the progression early on, instead of slowing it after there has already been a lot of loss.
3) the third, and most important issue, is this: if the children (now adults) know that they are positive, they will be living life with a sense of impending doom. Alzheimer's can be slowed, but it can't be stopped. How would you feel, knowing that you are going to deteriorate, lose your memory, etc? it's scary. i don't know what to do. gotta discuss with our treatment team (me, resident and attending)
*****
finished moving to my new room. it's 3 ft longer. makes a world of diff...
****
i'm sitting in my room now, doing my long, multiple page write up on one of my patients that i have to turn in to the attending tomorrow. i'm suffering...
yakob at 2:04 AM