Doc in Training Learn Medicine with a Medical Student

The Inaugural Post

In the face of uncontrolled medical costs and unprecedented technology, where does a doctor's responsibilities lie? Is it solely to the patient or also to society at large? A doctor can provide the best (and expensive) treatment for the patient with minimal chance of efficacy, but if all doctors subscribe to this practice, medical practice nationwide is weakened.

In this inaugural post, I want to describe an experience that motivated me to create this blog to chronicle my medical education.

In our summer MDPhD course, William Hahn, a cancer biologist and oncologist at Dana Farber, discussed a paper for the drug cetuximab,  an antibody therapy for colon cancer. Cetuximab was shown to be more likely to be effective in patients without a certain mutation in their cancer cells. This is an expensive therapy, costing about $30,000 for an 8-week course. Furthermore, they show only a modest increase in stopping the disease, roughly two months, during which quality of life suffers from side effects and intravenous administration.

It therefore seems wise to screen patients for the lack of this mutation to determine if the treatment is likely to be successful, and indeed this is standard practice. It's not so simple, though. A low percentage of patients with the mutation also respond to treatment. In this case, it was one patient (1.2% of those without the mutation).

A patient nearing the end of life and the supporting family will often do anything to extend that lifetime. I certainly would try for myself and anyone I cared about. Even if there was just a 1.2% or a .01% chance that the treatment might give a few months of extra life, I would take that chance, even though the science overwhelmingly discourages it. After all, that patient could just be that lucky one out of a thousand.

And so the dilemma surfaces. As a doctor, I want to do everything I can to help the patient, even in the most unlikely of scenarios. I would expect the same of my own doctor. Yet if all doctors felt this way and supported treatments that were very unlikely to work, healthcare costs rise uncontrollably, and the medical institution as a whole suffers.

So with whom do our responsibilities lie?

I don't know the answers to these questions, but I aim to figure them out for myself over many years in the future.

My mission in this blog is to discuss questions like these. I want to describe my medical education, to be frank about my fears and hesitations, and to share the lighter parts of becoming a doctor. I hope that it reveals insight into how your doctors become who they are and what issues we constantly grapple with while we practice.

It's going to be an exciting ride.

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