Composthaste’s Weblog

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Today, I went from “local lecturer” to “World Speaker”.  This is not to be confused with “world narrator”…you know the type; they read all the building signs as you drive by, comment on everything they see.  This is not to be confused with “low talker”…you know the type; they sit too close to you at a party and comment on everything in a running monologue, right into your tympanic membrane, despite the conversation you are in the middle of with someone else.

Nope.  Today, I gave my first lecture outside of my own little microcosm of residents.  I flew out of the nest.  I left the farm for the first time.  I left the hive behind and buzzed out into the world.  It’s important here not to confuse “world speaker” with “international renown”.  More accurately, I am like Celine Dion, working out the kinks in my performance overseas before I bring it back to the US.

So, standing in front of a room full of Argentine physicians, I dazzled them with my brilliance.  I also learned a few things.  For example, despite the simultaneous translation, jokes don’t really translate well.  During the talk, a paparazzi-esque photographer kept snapping photos of me while I droned on about metabolic diseases in infants.  Angeline Jolie?  Yeah, I feel her pain. After the morning session, the woman organizing the event planned a “meet and greet” lunch.  This was my favorite part of the day.  Sitting in a circle and discussing the various pleasures and problems we found with medicine in our respective cultures.  Their socialized medicine structure appears very much intact and I couldn’t tell at times whether they are behind us or our future.

If you’re ever planning a little lunch for people who speak different languages allow me to suggest getting an official interpreter.  I speak Spanish a little bit.   Essentially, I understand 8-9 out of every 10 words people say.  This means that I can carry on a conversation without difficulty at times and that I can also completely miss the point.  For example “We’re so excited to have you here sharing your ideas of emergency medicine” can also be “We’re so excited to have you here sharing your diseases in our emergency department”.  Despite my imperfections though, I think I would have done a better job than the interpreter we had.  The organizer, a completely lovely and enthusiastic woman, made the most lovely introductory speech that went something along the lines of “On behalf of the physicians here, we would like to extend a warm welcome to our American colleagues.  We are so excited that you travelled all the way to Buenos Aires to speak with us and to sit with us here to share ideas.  I would like this time to be about asking each other questions about the way medicine works in our very different systems.”  The interpreter then “translated” this to be “She welcomes you to Buenos Aires, if you have questions for each other, ask.”

Really, it appears that their issues are similar to ours.  How do you do research in a busy clinical practice, how do you keep patients happy when there are so many inefficiencies and waits, and how do you practice medicine for 30 years without becoming burnt out.  One of my colleagues addressed the last question with the basis of academic medicine in the US.  You can avoid burn out by staying in an academic setting and decreasing slightly the number of clinical hours you work by pursuing loftier goals: research, advocacy, administration, etc.  They were all nodding their heads until he stated “….and this way, you’re not seeing patients for 40 hours per week”.  At that point, we lost them.  The woman next to me, coyly remarked that she works 12-15 hour days at three different jobs.  It turns out the “part time” physician here works 36 hours per week and that is only because her husband works more and makes enough to support them.  I’m no health care czar but I think that if you went to most American physicians and said “Look, good job and everything on your eight years of graduate studies and 5 years of residency.   You’re now going to need to take a second job to make ends meet.  Maybe a third…it’s hard to say right now”….you would have a riot on your hands.  Not a violent one, more of a conservative physician, sulking in the corner type of riot….holding signs that said “we don’t want to play anymore” and “I’m taking my stethoscope and my pen and I’m going home”.

12-15 hours per day.   That is unreal!  Now, I’m sure they don’t have the same stringent rules about documentation.  I’m sure their nurses don’t spend 2/3 of their time writing in charts as opposed to taking care of patients.  And, you don’t hear a lot about big payout Argentine malpractice suits.  So, maybe medicine here is actually fun to practice.  Maybe they spend the majority of their time making decisions based on medical necessity and not patient satisfaction scores.  If I didn’t have to coach my patients to say that they received “excellent” care today when they were phone surveyed a month from now, after they recovered their health and received their $1000 bill, maybe, I wouldn’t mind working 12 hours a day.   Doctors in the US used to practice this way.  Round at the “public hospitals” before you went to see their patients in your clinics.  So I really couldn’t tell if these fine and brilliant physicians were behind us or if this will be our future.


Written by composthaste

May 21, 2010 at 1:48 pm

Posted in Uncategorized

One Response

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  1. Nice to hear about your trip..I’ve enjoyed Marks pictures and now your blog. Are you finished with speeches? or do you have more work to do. Harry is doing great. Looking forward to having you home at the other end of the phone.


    May 21, 2010 at 2:00 pm

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