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A Horse of Course and a Life Lesson

Medicine is complex. The body of medical information doubles approximately every 72 days. Surgical procedures now routinely performed in community hospitals were unthinkable outside a specialty center even a few years ago. And the certification process to maintain one’s medical license is likewise bewilderingly complicated.

Why should you care if your doctor is certified? Or if your nurse practitioner has requalified for licensing? Let me explain.

The Board of Medical Examiners in most states is responsible for monitoring the behavior of healthcare professionals and assuring the public that the practitioners they see in their neighborhood medical clinic or medical center are qualified to practice within their scope of expertise.

One of these requirements is CME, continuing medical education. Another term is CPD, continuous professional development. A baseline requirement to maintain a license is to accumulate X number of hours or credits over a certain period of time. For example, in Minnesota, we healthcare providers are expected to accumulate 75 credits, usually on an hourly basis over three years. Our license might expire if these baseline requirements are not met.

To get our hours of refresher courses in, we might attend a series of lectures over five days, sometimes six to eight hours a day. So by the end of the week, we might accumulate 25 hours in learning about new techniques and cutting-edge information about treatment, drugs, and research studies in our field of expertise.

Well, COVID changed this too. During lockdowns, some of these hourly requirements were loosened. In the post COVID era, face-to-face meetings as well as virtual methods are being used so we practitioners can maintain our licenses.

But now for an educational experience I did not anticipate.

In order to accumulate my hours, I participated in a general medical meeting. During these programs there is often a nonmedical speaker and in this case it was a gentleman animal rights advocate with whom I had communicated but had never met.

After his noontime presentation, we exchanged the usual pleasantries at the refreshment center, and then I was taken aback by a question: “You know anything about the gallbladder?” I honestly thought for a moment that this was the start of a humorous story but it was not funny at all.

I explained I had some rudimentary knowledge of this organ, as an internal medicine physician, and we left the venue for a small meeting room where his story unfolded. Our guest speaker had developed typical symptoms of gallstones with nausea and vomiting and punishing abdominal pain. His family practice provider performed all the usual studies confirming his clinical impression and referred the patient to a general surgeon in the community.

In most circumstances, a general surgeon has had four to five years of general surgical experience and then enters into a practice with a focus on particular conditions such as breast cancer, colon cancer, hernia repair, and other fairly routine surgical disorders.

The general surgeon commented about the appropriateness and safety of a laparoscopic gallbladder removal. With the patient under general anesthesia, the surgeon makes about four incisions in the abdomen through which instruments are inserted to visualize the gallbladder in conjunction with mechanical devices to remove the organ. This surgical approach looks like something out of Star Wars, but these robotics have become routine.

In general, the procedure is safe, most patients are dismissed on the day of surgery, and in fact in some instances, this is essentially an outpatient procedure.

The other approach commonly discussed is the open cholecystectomy—the medical term for removing the gallbladder, typically an abdominal surgical incision. With this more intense surgery, patients are often hospitalized for about three days.

I explained this to my new friend the animal activist who works with abandoned horses and other larger animals and reassured him that the laparoscopic procedure under experienced hands is a reasonable approach.

His situation for some obscure reason did not go smoothly. Instead of an outpatient procedure, he remained in the hospital for several days with severe abdominal pain as well as nausea, vomiting, and loss of appetite and a deterioration in his overall sense of well-being.

These symptoms plagued him for several months. Because of his work at an animal rescue site, he did not have the luxury of sitting behind a computer but was required to have hands-on care for these animals entrusted to him After approximately four months of misery and multiple visits to medical providers, his symptoms did improve but he was not yet back to baseline.

What are the lessons for each of us? These are obvious and we need to pay attention:

  • There really is no such thing as a minor or straightforward surgery. There are always risks from any procedure.

  • We as patients need to have an understanding of the pros, the cons, the risks, the options, and the expected complications of any procedure.

  • We as patients need to respectfully ask the medical team what are the expected complications and do each of us as individuals have any risk factors. What are the alternatives to the proposed approach?

  • We need to share with the team who we are, what we do, and important lifestyle issues we have. The recuperative requirements for a behind-the-desk professional such as a CPA are very different from that of a construction worker.

  • The activist explained to me that his position did not allow a casual recovery and had he been aware of these potential complications, he would have modified his schedule, would have brought on board additional help for the animals, and would have blocked out his calendar for administrative responsibilities. He just assumed that his case was straightforward and did not plan for a delayed recovery.

And so, my story started out talking about continuing education for healthcare providers like myself, and I found a better story during one of these sessions. A story for empowered patients.

After all, at the end of the day, no one has a greater stake in your health and well-being than you do.

I mage from Unsplash.

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