Opinion

A PIECE OF MY MIND Ellen D. Feld, MD Physician Assistant Department, Drexel University College of Nursing and Health Professions, Philadelphia, Pennsylvania.

Corresponding Author: Ellen D. Feld, MD ([email protected] .edu). Section Editor: Roxanne K. Young, Associate Senior Editor.

Time to Get Over It When questioned about his plan to donate his body to science, my father (who was not a physician, but a physicist) would answer, “Why not? I won’t need it anymore.” I so admired his attitude, and I always wished I could emulate it. It has taken me decades, however, to come even close. It was not until last month that I finally said yes when I was asked, while renewing my driver’s license, to be an organ donor. That it took me so long is embarrassing: as a medical student, I participated in organ transplant operations; I am well aware of the life-saving role donated organs play, and of the tremendous organ shortage in the United States. As a friend of a person with lupus who is on her second transplanted kidney, I have seen the immeasurable difference the transplants made in her life, and I am forever grateful to the donors who’ve given me 34 years of friendship with her. Why did it take me so long? Were my reasons the same as the 55% of US adults who are not registered as organ donors? I doubt it. I am not, as 50% of individuals in a 2009 survey1 were, afraid that physicians will not try as hard to save my life if they know I’m an organ donor. I do not fear that my organs might be sold on the black market (as 44% of those individuals believed). Nor do I question whether brain death is irreversible (as did 57% of that population). No, my reasons were, I’m ashamed to admit, even less rational than those mentioned above. They relate to being a physician and to the trauma of medical training. “Trauma” may sound like hyperbole. But however you describe it, medical education is stressful, exhausting, and eye-opening, and most of us emerge from it changed in crucial ways. After taking part in countless “codes,” for example, many of my fellow residents and I vowed never to allow that ribbreaking violence to be inflicted upon our loved ones or ourselves (we joked about getting “Do Not Resuscitate” tattooed on our chests). When I was a third-year medical student, my first rotation was surgery. On the transplant service we were on call 24/7: if a kidney came in, we came in. During my first week on the service, I was called into the hospital on 5 consecutive nights. When the hospital operator called me on the fifth night, I tried to convince her that she had reached the wrong person. I have vivid memories of our team and the eye team, a flock of hurried vultures, descending on the operating room for the organ recoveries. Of a kind nurse swabbing my face and neck with ice water as I struggled to stay awake holding retractors during the fourth or fifth nighttime recovery that week. Of the huge abdominal incisions (who would ever see them?) that I closed, sloppy from fatigue and hurry, with thick black sutures. My memories of that time are not of

learning, but of surviving. The experience felt brutal, and I emerged from it exhausted, relieved it was over, and wanting never to repeat it. Consciously, it convinced me that I was neither interested in nor “cut out” for a surgical career. Unconsciously, I suspect, it made me unwilling, even after death, to go back to that OR. Interestingly, my memories of the transplant operations themselves are gone, washed away with those of scores of other operations that focused on improving the lives of the individuals operated on. The painful dissonance of the organ recoveries, where meticulous care is taken to preserve the life of an organ, but not of its owner (who is completely beyond help), must have helped earn those procedures permanent spots on the cluttered shelves of my memories. A 2009 study of US medical students and surgeons demonstrated that only 53% of the attending surgeons surveyed were willing to donate their organs. 2 While arrangements for organ donation, including approaching families of potential donors, are now accomplished by third parties (organ procurement organizations) in the United States, physicians undoubtedly still play an important role. Families interact with and rely on the physicians caring for their loved ones, and those physicians’ attitudes toward organ donation are no doubt transmitted to these families, even if only unintentionally. We also have the potentially important role of educating the public (our patients) on the subject of organ donation, yet we rarely do: a survey of primary care physicians revealed that while 30% of them reported discussing end-of-life care with their patients, fewer than 4% of them discussed organ donation.3 In a 2005 Gallup poll, only 28.5% of the US public identified medical professionals as an important source of information about organ donation— physicians ranked behind the Department of Motor Vehicles and roadside billboards.4 Fortunately for me, my opportunity to donate organs has not yet arisen; I’ve had 30 years to get over my medical school experience, and my driver’s license now has the proper notation on it. Who knows, though, how many patient-education opportunities I missed during those 3 decades. My experience was not unique: in the above-mentioned study, experience on the transplant service influenced 21% of the physicians refusing to donate (with more than 80% of that group specifying the recovery procedure as the most important factor).2 Whatever the reasons for our dismal statistics as donors and educators, we must do better. Residency reforms have made medical training experiences less grueling, and this should have had a positive effect on younger practitioners. But recovery procedures have

jama.com

JAMA January 22/29, 2014 Volume 311, Number 4

Copyright 2014 American Medical Association. All rights reserved.

Downloaded From: http://jama.jamanetwork.com/ by a Ndsu Library Periodicals User on 05/17/2015

359

Opinion A Piece of My Mind

also become longer and more complex; they are no doubt still stressful and exhausting. Even in the (comparatively recent) 2009 study, only 61% of medical residents were willing to donate.2 Targeted educational programs, tailored to practitioners’ experience levels, would likely help; even brief educational interventions aimed at emergency physicians were shown in the past to increase family discussions and tissue donation rates from patients who died in emergency departments.5 Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for the Disclosure of Potential Conflicts of Interest and none were reported. 1. Donate Life America. While the majority of Americans express interest in organ and tissue donation, too few take steps to register as donors—survey reveals misperceptions about donation are common [press release]. April 2009. http://donatelife.net/ama/. Accessed August 21, 2013.

360

Any traumatic experience can have lasting psychological effects, and medical education is no exception. But these effects can be overcome. It is possible to “get over it,” and we owe it to the thousands of patients on transplant lists to help our students and colleagues do so, to educate patients and families about organ donation, and to step up and agree to be donors ourselves—even if it means going back into that OR one last time.

2. Hobeika MJ, Simon R, Malik R, et al. US surgeon and medical student attitudes toward organ donation. J Trauma. 2009;67(2):372-375.

Rockville, MD: US Dept of Health and Human Services, Health Resources & Services Administration; 2005.

3. Thornton JD, Curtis JR, Allen MD. Primary care physicians’ attitudes and practices regarding discussing organ donation with their patients. J Natl Med Assoc. 2010;102(1):52-58.

5. Riker RR, White BW. The effect of physician education on the rates of donation request and tissue donation. Transplantation. 1995;59(6):880-884.

4. Gallup Organization. National Survey of Organ and Tissue Donation Attitudes and Behaviors.

JAMA January 22/29, 2014 Volume 311, Number 4

Copyright 2014 American Medical Association. All rights reserved.

Downloaded From: http://jama.jamanetwork.com/ by a Ndsu Library Periodicals User on 05/17/2015

jama.com

A piece of my mind. Time to get over it.

A piece of my mind. Time to get over it. - PDF Download Free
44KB Sizes 2 Downloads 0 Views