Category Archives: Medicine

Fun Ebola Facts #1 and #2

It’s been years since I’ve blogged, but I might as well start up again now. I don’t feel like watching TV tonight, so why not kill some time correcting some of the misperceptions regarding Ebola and the US response that I keep seeing on Facebook?

I have to say that this is also an interest of mine, which is why I’m happy to share my opinions on the topic. I spent several years working on emergency preparedness at the federal level. I was surprised by the legal constraints on the federal government, That’s part of what led me to law school. (I will also say that I was very impressed by the thoughtfulness of the really smart people who have spent entire careers thinking about preparing for emergencies much, much worse than Ebola.)*

Fun Ebola Fact #1

Misperception: We should shut down the borders to travelers from West Africa.

FACT: That won’t work. For several reasons.

First off, people travel all around the world. The gentleman who died of Ebola in Texas flew to the US from Brussels. I believe he flew on a connecting flight, so we might have known where his trip originated. But suppose he traveled by car to Egypt, then flew to Istanbul, then thru Paris to the U.S. Would we know that? I doubt it. Especially if he crossed a border illegally somewhere and wasn’t registered by the immigration services.

Second, people ignore those types of orders and find ways around them.  For instance, a few years ago there was a US citizen who flew to Italy who had been diagnosed with XDR TB (extensively drug resistant tuberculosis). While the government was working to bring him back to the US safely, he ignored instructions and flew commercial flight to Canada and then drove across the US border. You can read about that here.

Fun Ebola Fact #2

Misperception: The failure of the CDC to enforce infection control procedures in Dallas are why the two nurses got infected.

FACT:  It’s not the CDC’s role to enforce infection control procedures in hospitals.

We live in a federalist system, which means the federal government only has the powers granted to it in the Constitution. The remaining powers (such as the “police powers” — the power to protect the health and safety of citizens) are powers reserved to the states by the Tenth Amendment. While the CDC has had protocols for health care workers posted on the web, it is the states’ responsibility to manage health and public health within their state.

The CDC doesn’t even have the power to go in and quarantine individuals. As explained here, the CDC only has authority to isolate or quarantine individuals trying to enter the US or moving between states.

What Should You Do?

There are a few things you can do:

  1. Get a flu shot. You’re much more likely to die from the flu. Depending on the severity of the flu season, over 40,000 people die each year from influenza. Only one person has died from Ebola in the United States ever!
  2. Wash your hands. Always good advice.
  3. Call your Congressman and ask if they supported the President’s funding request for responding to Ebola in West Africa. The best chance at preventing further spread to the US is to help the international community contain it in West Africa by supporting the health and public health systems there.
  4. Stop using Ebola as a political topic. You can be a better person than that.  While I don’t think we have any need to panic, this is a serious disease that is likely to kill a lot more people around the world before it is brought under control and has nothing to do with which political party is in charge.

Next Fun Ebola Facts?

Have a question or concern about Ebola or the US response? Post it in the comments and I’ll see if I have any facts or opinions that I can use for the next post.

* Now that I no longer have to think about these things, I sleep A LOT better at night.

Disclaimer:  Obviously, these are just my opinions, except for the parts that are facts.

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My Last Day in a Medical Clinic

Going Back to Clinic

About a year after I moved to DC, I started having a regular clinic, again. (It took them that long to process my credentialing paperwork.) So, since late 2007 or early 2008, I’ve been going to the VA hospital most Friday mornings to see patients. Overall, I’ve enjoyed it. Most of the patients have been nice, and I know I’ve helped a few of them. Some of the patients have been a bit more challenging. And they’re the ones that come in more frequently. The staff have always been great. Without them, it wouldn’t have been possible to do clinic one half-day per week and maintain my other jobs.

But, as I thought about going back to school, I was worried that it was just one more responsibility I’d have to juggle. It’s not like my regular job reduced my workload by 10% since I was out of the office 10% of the time. And with classes 4 nights a week, I can’t afford to work late, so need to keep my schedule as close to 40 hours a week as possible.

I also started studying for my Internal Medicine board recertification exam. Every ten years, we have to take this exam, along with several online self-education modules. As I was studying for the test (which I did pass, btw), I realized that I had forgotten a lot of medicine that I used to know. When you don’t do rheumatology or cancer care, it’s hard to keep up with the new tests and treatments.

Both of those factors helped me decide that it was time to give up clinic.

Leaving Clinic

About 3 months ago, I told the clinic staff, who were all saddened to see me leave. And we started telling patients. Several of them didn’t seem to care. They were just stoic that this is what happens in the clinic. Staff come and go. Residents rotate out every three years. Most of the patients said they were very sad that I was leaving. One patient asked me to come back just every three months so that I could still be their doctor for their regular appointment.

This past Friday was my last day in clinic. It was bittersweet. I’m excited to be taking one more step towards simplifying my life as school’s about to start. But, I will miss the staff, and most of the patients. It’s also a little sad because I’m not sure I’m a “real” doctor, anymore. I even gave my stethoscope away to one of the staff.

They had a going-away party and breakfast for me before clinic started. It was supposed to be a surprise, but it ended up getting included in some general clinic announcements I was cc’d on. There was lots of tasty food in the conference room.

Toiletry BagThey even got me gifts. I got a beautiful red leather toiletry bag, which means I can use my old one for the gym instead of going to buy a new one for the gym. (One item checked off my To Do list.) I also got a card with lots of nice comments, a box of chocolates, a plaque thanking me for my service, and a box of Pop-tarts (my secret indulgence).

Before the gifts, the clinic director made a brief speech, which was very kind. She talked about how they often assigned me patients that were having conflicts with their other doctor because they knew I could handle them in a kind way. It reminded me that so much of medicine isn’t about the science of medicine. It’s the ability to listen — to connect — with a patient. I will miss that.

I will probably be back in clinic next week. First off, there’s a fair chance I’ll forget I don’t have clinic. I’ll just wake up like any Friday and drive there. Even if I remember, I probably need to go in and do some paperwork. Friday morning, I realized that I hadn’t told anyone in administration that I was leaving. I stopped by Friday after my clinic was done. (None of my patients showed up!) The guy who handles that paperwork was on vacation. It’s my own fault. About 3 months ago, when I made the decision, I realized I needed to tell them, but figured I’d wait and do it about 4 weeks before I was done. Then, I forgot.

I worked with some really great people there and I will them all much more than I miss the patients. I will also miss a few of the patients.

But, I guess I can always go back to clinic. I am Board Certified until 2021, now.