Blowing my Own Horn

Behind the scenes in Dr. Couz's head-- here is the interview that I did for Dr. Nick Genes at Blogborygmi in honour of hosting Grand Rounds a couple of weeks ago. It's on Medscape, so you may need to register to view it.

Is a "Well-Rounded Physician" an Oxymoron?

Not Quite The News

I have a love-hate relationship with the media. I love it in the sense that I have an addiction to information. I want to know what's going on. I read newspapers, watch the news on TV and listen to it on my car radio during my endless commute. I hate it when it comes to medical news. It is usually sensationalist and can pretty much be counted on to distort whatever new study has been deemed 'newsworthy' by some guy in an editing booth. It's frustrating.

And today is no exception. This news article describes the story of a woman who died after spending 3 days under observation in the hospital. The article goes on to describe the concept of the 'orphaned patient', and goes on to blame the fact that the doctors who take responsibility for orphaned patients have a maximum quota of 5 patients per day. Then Kevin, MD jumps on the bandwagon by posting the link to the article with his parting shot... "no wonder there's an access shortage up there".

Please. The issue of orphaned patients in GP-run hospitals is a little more complex than that. A bit of background for the lay-folk-- in many community hospitals, when patients are admitted it's their family doctor who assumes responsibility for their day-to-day care. If a patient is admitted who doesn't have a family doctor (or whose family doctor doesn't have privileges at the hospital admitting the patient) the patient is assigned a family doctor-- either a family doctor who takes on the care of these 'orphaned' patients, or a hospitalist, whose sole job is to manage the care of a large number of orphaned inpatients.

Family doctors have it tough when it comes to the care of inpatients in the hospital. It doesn't pay terribly well, and it's a difficult responsibility to balance with a full day of office. At my practice, a typical day has me coming in at 8am to begin rounding in the hospital. If I know we have more than 3-4 patients in at any time I'll come in earlier. If we had the misfortune of getting hit with an orphaned patient overnight, I was often faced with rounding on our inpatients as well as sorting out an often complex medical history and medication list for a patient I've never laid eyes on before. No easy task. One orphaned patient admission could easily take 45 minutes. Add that to the usual rota of patients in the hospital at any given time and rounding in the morning could stretch to 2 hours, starting the day's clinic 45-60 minutes late.

Last year our call group made the decision to stop accepting the assignment of orphaned patients. The workload had become unreasonable, and was only getting bigger as more physicians removed themselves from orphaned patient coverage. The hospital kept promising to hire hospitalists to help shoulder the load but none were forthcoming. So our group bailed.

Caring for inpatients means more than just stopping by to say hello on the way to clinic every morning. The five patient quota would still be a full house when you consider the time to round, write orders, put out fires, liaise with specialists and field phone calls throughout the day relating to the usual odds and ends that come up. And this is on top of the full day's office, minor procedures, house calls and paperwork that fill the typical family doctor's day.

Who is the Ottawa Sun (or Kevin MD, for that matter) to suggest that family doctors who limit their 'quota' to five patients are somehow slacking and shirking their responsibility to the health care system? Would it somehow be better for family doctors to double their inpatient quotas and cut their office hours in half? Family doctors are already putting in 12 hour days on any given workday-- something has to give.

All By Myself...

HowManyOfMe.com

There is: 1 person with my name in the U.S.A. How many have your name?

How fun is this?

Funny that I'm so unique in the U.S. In Canada, not so much. In fact, there was another girl with the exact same name as me who shared my childhood pediatrician. They always mixed up our files-- she had asthma.

People in Ontario frequently comment on the 'uniqueness' of my maiden name. I tell them that in Quebec, my name is the equivalent of 'Smith'.

And that end's this evening's deep thoughts.

Evidence 1, Fear 1... It's a Tie!

So way back when, I discussed elective cesarean section as a reasonable birthing alternative. In women who are adequately informed regarding the risks and benefits of both vaginal and cesarean, elective c-section should be perceived as no less valid a choice than home birth, drug-free birth, unassisted home birth, birthing centre birth, or any other option currently available to pregnant women. Then, in a seeming 180, I posted a few months later regarding my interest in being delivered by a midwife in a hospital setting. Again, all of this remains hypothetical since as far as I know, I remain fetus-free. But it never hurts to be prepared.

My personal views on the subject are pretty predictable to anyone who has been reading my blog for awhile-- as long as women are informed regarding the risks and benefits to both mother and baby, they should be allowed to make the decision that is best for them. As I mentioned before, my only problem with this situation are the increased costs to the health care system if one opts for an elective c-section. But for simplicity, I'm going to overlook that little detail for the purposes of this particular discussion.

I am no stranger to obstetrics. I completed one rotation as a medical student in a relatively small academic centre. My next two month block was also spent in an academic centre, although in a much larger city. During my time in family medicine over the past two years, uncomplicated obstetrics has been a big part of my practice-- I have followed many women through from their initial positive pregnancy tests through to their deliveries and beyond. Now that I'm nearing the end of my 8 months of full-time family practice, I'm seeing several women whose babies I delivered coming back with positive pregnancy tests once again. Sharing such an incredible moment in a family's life still feels like such an honour. And as much as I complain about the effect it has on my free time, I still love the fact that my family practice has such a significant obstetrics component.

From my end, though, I'm still torn. I have seen so many of the worst-case-scenarios it seems like a normal vaginal delivery with good outcomes for both mom and baby are the exception to the rule. I am very aware that my perceptions are heavily influenced by my experiences in high risk obstetrics. I had hoped that my experiences in uncomplicated obstetrics through my family practice would help to give me a more balanced viewpoint when it came time to make birthing choices for myself.

I am uncomfortable with uncertainty. Aside from the odd sports injury, I have never experienced pain. And as one of my friends at work put it, I have an 'internal locus of control'-- I think that's a nice way of saying that I'm a control freak. What scares me about giving birth is the unpredictability of it all. I can plan and prepare for a vaginal birth all I want but may still end up with an emergency c-section. Vaginal births are sometimes uncomplicated and beautiful, but other times-- forceps, tearing, incontinence, sexual dysfunction, uterine prolapse... and that's just the maternal outcomes. The number of things that could potentially go wrong with baby is staggering.

I'm not sure when I started to think this way, but I began to view elective c-sections as a way of maintaining some degree of control and predictability over the whole birthing process. Although the concept of entirely elective c-sections hasn't been completely accepted by the medical community (let alone society in general) it's not something I've talked about very much. But there is plenty of evidence to support the idea. Although none of the data is completely undisputed, studies have suggested that elective c-section may reduce the risk of post-partum urinary incontinence, fecal incontinence, uterine prolapse and sexual dysfunction.* And that's just on mom's end. From the baby's side, studies suggest a reduced risk of unexplained stillbirth, chorioamnionitis and cord prolapse. These possible benefits must be weighed with the increased risks, particularly those associated with post-operative complications for mom and increased incidence of breathing difficulties in newborns.

Unfortunately, the decision to opt for primary elective c-section over vaginal delivery isn't so straightforward as just weighing the risks and benefits of each option. If it were so simple, I'd be first in line for for my uncomplicated, low intervention vaginal delivery. But no one can guarantee anybody that their planned vaginal delivery won't evolve into more-- operative vaginal deliveries (meaning a vaginal delivery that is vacuum or forceps-assisted) increase the risk of complications to mom and baby considerably. If an emergency c-section is required, the risks are increased even more. Each of these scenarios carries a greater risk than if an elective c-section had been undertaken initially.

And that's where I'm stuck. I want one of two scenarios-- a low intervention vaginal birth attended by a midwife in the secure environment of the hospital, or a planned, controlled, elective c-section. Ideally, the former plan would be the ideal one. But again, there is no guarantee that plan won't evolve into something more risky. And that's what scares me, because that's the part I have very little control over.

I am a primip, so by definition I have an 'untested' pelvis. I don't know if I'll be able to give birth vaginally, and I won't know until I try. I am healthy, which is in my favour. I am older than ideal, although still a couple of years away from being considered 'advanced maternal age'. My mother gave birth to three children vaginally with no major complications. But it's still that uncertainty that makes me unwilling to completely discount the elective section option.

A month ago I would have said that my plan would have been to have a midwife-assisted delivery in a hospital. And then the Canadian Medical Association Journal published Maternal Mortality and Severe Morbidity Associated with Low Risk Planned Caesarean Delivery Versus Planned Vaginal Delivery at Term. It wasn't a perfect study, but added more information to the information already out there. And now I'm undecided yet again. And around here, midwives book up fast. So if I want to have a midwife-assisted delivery as an option, I'd better make the decision before I even pee on a stick.

Bah. With my luck, mini-Couz will end up breech and the decision will be made for me.

*Interestingly, more recent studies have actually found no difference in urinary incontinence between c-sections and vaginal births. And they've found that method of delivery is not a significant predictor of sexual dysfunction one year after delivery. So even the 'evidence' isn't set in stone.

Another Week Down

It's been a long week.

Big dog managed to impale himself on a stick while we were playing fetch in the off-leash park last weekend. One sleepless night and an early morning trip to the vet later he was diagnosed with a wound infection. Since the vet had to sedate him to explore the wound, I actually called in sick to spend the day looking after him. I blame Mr. Couz, who was still visiting his family, for not coming home early to be with our poor injured dog. When I suggested this to him, he called me a crazy dog lady.

The next day the snow started to fall. I got in the car to make the 1 hour commute to my family practice, and made it all of 8 blocks before turning around and coming home. Good call, since by the time the snow stopped falling about 60cm had fallen on my town. More had fallen on the town where I practice. It was not a good day for commuting. I stayed home and studied for my board exams.

The day after that I didn't even make it out of the house. It was a Snow Day-- capital "S", capital "D". People were being told to stay off the streets, and even the malls were closed down. I stayed home another day, leaving the comfort of my couch only to join my husband in shoveling out our front path, our sidewalk and our cars. Considering that I live in a part of Canada where this kind of weather is really not the norm, this was an event. The fact that the snowbanks are as tall as I am brings me back to my childhood faster than a Raffi song.

The next morning I woke up, ready and willing to go to work. Well, maybe not entirely willing... my throat was scratchy, I was coughing, and my head hurt. I am *not* impressed. A month after getting over URTI #1, URTI #2 hits. Ugh. I guess I should be happy it's not a gastro. But how I managed to get sick the one week I wasn't in contact with patients (unless I caught it from a dog) is beyond me. But I couldn't very well take another day off when I had already missed more than half the week, so I dragged my germ-y butt into work and saw a steady stream of patients with the same symptoms as I had. Seriously... if there was a cure for the cold, don't you think I would have used it on myself?

And in spite of the copious amounts of time I've had to sit around with my laptop and a cup of green tea, readers may have noticed a lack of blog postings recently. I've been hit with... The Block. It must be a midwinter blah thing. I can't come up with anything worth talking about, and when I try to force it I manage to create posts that ramble on for pages without actually making a point. So I stopped trying.

So that's it for my random thoughts from this week. At least I made it until the weekend. Hopefully this week will be better-- my last week in my community family practice. Sigh.

What Bugs Me Today II

I couldn't believe it when I stumbled across this British medical student's shameless plea for donations. I'll give you the recap so that you don't need to click on it and drive up this loser's hit count-- he's a 4th year medical student in Manchester, U.K. (over there it's a 5 year program) and he's nearly 30,000 British pounds in debt. He's begging randomly to the internet community to send him donations because he doesn't want to 'graduate in debt'.

Please. Call the whaaaaa-mbulance. In Canada, since deregulation of medical school tuition in the mid-1990's a student would be unbelievably lucky to finish medical school with only 60K in debt (assuming the very rough conversion of 1:2 for British pounds to Canadian dollars). Not to mention the fact that we then have to make payments on this debt as we complete anywhere from 2-6 years of residency at which time our pay starts at $45K yearly. In fact, if you divide the weekly salary by the average number of hours a medical resident works in a week, we almost make minimum wage.

I admit, my debt is on the high end of normal. I didn't have a family to support, so I don't have that excuse, but I did put myself through a master's degree and a second undergraduate degree before medical school without outside assistance. And until the government student loan program wakes up and realizes that the max allowance of 10K a year is ridiculous for a medical student (whose yearly tuition and fees nearly doubles that and it's not like we have the flexibility in our schedules to work-part time through school), the bulk of my debt is with the bank. I could sell my first, second and third born to the bank and I'd still end up owing them in the end.

I don't usually feel sorry for myself when it comes to my financial situation. I don't begrudge the loan system-- without it, medical school wouldn't have been an option for me. I don't even resent the amount of tuition that we're expected to pay-- even my $16K yearly tuition is heavily subsidized by the Canadian taxpayers. But it's difficult to keep your head above water for the first few years making payments that eat up 50% of your take-home salary.

On one hand, I think it deters people from primary care (family medicine, pediatrics) where salaries are traditionally lower and overhead traditionally higher. But on the other hand, I wonder how my specialist colleagues in 5 and 6 year residencies can manage with the high debt and low salary for even longer than I have to.

I don't love being my age (i.e. not a spring chicken) still having to rent. There is so much travelling I want to do but unless it involves camping and is accessible by car it's unlikely to happen any time soon. Even having a baby may strain the finances more than I care to think about. But as long as I manage to make ends meet until I'm making real money, I know the debt will be manageable. It just means our first house will be small, we'll make due with our car until it dies a natural death, we won't be taking any vacations and we won't be contributing to RRSP's until we're in our late 30's. But that's not so bad, right? Um... right?

I guess that's why people like this guy irk me so much. What makes HIM so special that he deserves to graduate debt-free? Why shouldn't he have the same concerns as the rest of us who chose a life in medicine regardless of a distinct lack of rich relatives? I don't begrudge the people who had a hand in getting through school-- but I don't think I would have asked it of my parents even if they COULD afford it.

I just wish people would stop assuming that Mr. Couz and I are on easy street because of my title. Trust me... right now, it's no financial windfall.

(Thanks to Kevin, M.D. whose post brought this wing-nut to my attention)

Grand Rounds 3.20

The People Behind the Medicine

More than most other professions, medicine has the ability to devour all it touches. Those who enter the world of medicine as patients soon find it difficult to identify themselves beyond the confines of their label-- at least within the walls of the hospital. Those who enter into it as a career soon discover just how far-reaching a life in medicine is. Interests and relationships that once defined us as people too often take a backseat to the demands of medicine. Too easily we find that we lose sight of ourselves. We advise patients to rest, exercise, eat right, deal with stress, develop good coping mechanisms... and then we go home, order out, catch up on paperwork and try to fit in a few moments with our loved ones before catching a few hours of sleep.

Although I appreciate that not everyone enjoys 'themed' Grand Rounds, I thought it was about time that we acknowledged the people behind medicine for more than just their clinical expertise. Here are 30 submission that I thought conveyed that message in some way, regardless of how they chose to accomplish it.

The Medical Professional as a Professional

It is often a judgment call whether or not it can be therapeutic to let the line between professional and person blur in front of patients and their families. Joy, from My Own Private Soapbox examines the pros and cons of letting patients see past the professional veneer. It's not always pretty under there, and sometimes even the patients prefer to stay distant from the realities of medicine. Not so in the case of Susan Palwick, a volunteer hospital chaplain at 'Rickety Contrivances of Doing Good'. She blogs about the fact that she freely shares pieces of her own medical history to make a connection with the patients she counsels. Vitamin K also reminds us that when we take our work home with us, sometimes it's for the greater good.

Sandra Miller from 'A Shot in the Dark' recounts the tale of a particularly difficult experience with the health care system and how she believes that a little less 'professionalism' from the people involved might have made it a little more bearable. One woman (and frequent patient) from 'Tales of my Thirties' finds herself wondering how the doctors in her life end up in the specialties they choose.

Dr. Scott at Just Practicing reflects on why he chose to keep his blogging persona anonymous, and maintain that imaginary line between the person and the physician he plays at work.

Rita at MSSPNexus Blog talks about her favorite boss and what qualities made her special.

The Medical Professional as Patient

The quickest way to see our world from the other side of the fence is to be forced to experience it firsthand. Over at Protect The Airway, an RN wonders what is bringing on his runs of symptomatic PVC's. Dr. Dork tells a tale of some unseemly side effects experienced when the doctor becomes the patient. More on the subject of the professional as patient comes from Diabetes Mine in the form of an interview with Gary Scheiner, an accomplished diabetes educator and long-time diabetic. Kim at Emergiblog takes it one step further with memories of a time when she straddled the line between nurse and patient (or rather, patient's mom) until someone gave her permission NOT to be a nurse this time.

The Medical Professional as Parent

Role strain is almost inevitable when the health professional becomes a parent. Caring for others as a profession often takes on a whole new dimension when you're trying to balance it with caring for a child. Geena at 'Code Blog: Tales of a Nurse' lets us in on her inner struggle to find balance between her identity as a nurse and her new role as a mom. In a similar post by MSG at 'Creating the Godcomplex', he attends a c-section that brings back powerful memories of his own daughter's birth. Moreena at 'The Wait and Wonder' shares a moving story about caring for her daughter under the watch of the untouchable PICU nurse-- until the strain pushes them both to emotional breakdown.


The Medical Professional as an Emotional Being

Yup-- they have feelings too. Nick Jacobs from 'Hospital Impact' waxes philosophic on the subject of emotional attachment-- something that we, as medical professionals, occasionally take too lightly. Wyatt at 'Foggy Bottom Lantern' explores playing favorites among the patients have touched him throughout his career. Nurse Ratched recalls a patient who touched her life almost as much as she touched his-- and reminded her in many ways why she became a nurse in the first place.

The Medical Professional With Outside Interests

The quest to find balance in a life dominated by medicine lead me to unearth some interesting hobbies and interests in my fellow medical bloggers. At 'Universal Health', N=1 talks about one of his (her?) non-medical obsessions-- along with a nice reminder that we shouldn't take ourselves too seriously. This is GirlVet's strategy too-- at 'Madness: Takes of an Emergency Nurse' she claims that it's her warped sense of humor that keeps her coming back to the ER. And she's not the only one-- it seems that finding humor in bizarre situations is a common thread among those of us drawn to the ER (GruntDoc being a good example).

For those of us without the warped funny bone, George finds solace outside of the OR with his travels and for those of us living vicariously through the travels of others, provides many photos. Liana from Med Valley High discovers that not only does climbing make her well-rounded, the skills she learns while climbing aren't that different from the ones she learns in medicine. Don't worry, Liana-- I haven't started my CCFP review yet either!


The Medical Professional as a Spiritual Being

Big Mama Doc reminds us over at 'Fat Doctor' that a few moments in patient-lead prayer might be more therapeutic than any other intervention we have to offer. While many of us might be uncomfortable with the idea, it only takes minimal effort on our part to ask about our patient's spiritual needs-- particularly in the face of serious illness or major surgery. Dr. Wes has also had a recent lesson in link between medicine and divine intervention that might have made him just a little more of a believer. Even if you don't consider yourself religious, these posts are food for thought.

The Soon-to-be-Medical-Professionals

The next generation of medical professionals are still trying to figure out if they can avoid allowing medicine to overtake them. Topher at 'The Rumors Were True' acknowledges that while he's striving to find balance as a medical student, at times he fails miserably. Over at 'FIFE-me', A Girl looks with wonder at her accomplished medical school classmates and wonders how long she'll be able to juggle all of the balls she has in the air. On a lighter note, Clerk at 'A Cure for Hiccups' explains why the desire to settle down and find a wife isn't just on the minds of the men in her class. Finally one of my new favorite bloggers, Vitum Medicinus, reminds us all that tact and empathy really can't be taught-- particularly to medical students.

This week's Editor's Pick goes to TC at Donorcycle-- she gives a heartbreaking minute-by-minute account of what transpires when a child dies. She managed to tell a terrible story in an incredibly sensitive manner and reminded me that no matter how 'professional' I become, I don't ever want to lose the ability to cry.

Thank you to everyone who took the time to submit. Have a great week!

Why Can't We All Just Get Along?

As far as doctors go, I consider myself fairly knowledgeable when it comes to alternative therapies. Other doctors consider me somewhat left-wing in my practices and policies although in a generally right-wing profession such as medicine I guess that really doesn't say much. I regularly recommend that my patients try chiropractic, massage therapy, acupuncture, or naturopathic medicine. I am a huge breastfeeding advocate, and support mothers who can breastfeed their babies beyond infancy. I am very anti-circumcision. I appreciate the benefits of such 'crunchy' parenting beliefs as co-sleeping, baby-wearing, and attachment parenting in general.

So because I know few people in real life who think the way I do (not to mention the very real problem of not really having the time to make any friends in the city I've been living in since starting residency), I often rely on the internet for information and to find people with common interests. In particular, I am a fan of message boards. One such message board that I won't mention (it's not my intent to start a war) seemed to be exactly what I was looking for-- there were reviews of cloth diapers, vegetarian and vegan recipes, information on natural health and healing and all kind of great information probably considered 'off the beaten path'. Just one problem.

They hated me.

Well, maybe it wasn't 'me' they hated. After all, I hadn't contributed anything at that point. It was more a matter of hating what I (voluntarily or not) represent. I first realized this when I ventured into a forum on vaccination. Vaccines weren't something I had spent much time thinking about through my medical training-- in emergency medicine, the only vaccine that had a role in the emergency room was the Td booster, which we offered to everyone who came in requiring sutures who hadn't received the vaccine in the past 10 years. I didn't really concern myself with people who refused it-- just explained the indication and documented that it was offered and declined.

In family medicine, however, they became more routine. But still, I hadn't thought much about them. They were routinely given at 2, 4, 6, 12 and 18 months. Only once did a patient take me up on my quick "do you have any questions or concerns about the vaccinations scheduled for today?". He was concerned about the mercury in vaccines. I assured him that vaccines in Canada no longer contained thimerosal with the exception of the flu shot, and he was happy with that. At his next visit, the same father asked about the use of formaldehyde in vaccines. I told him that I didn't know, but that I'd be happy to look into it for him. We delayed his son's vaccinations that day.

The 'Vaccination' forum would have been much more appropriately named the 'Anti-Vaccination' forum. A few clicks was all it took to realize that the nature of the forum went far beyond having evaluated the literature and deciding that the risks of vaccination outweighed the risks of contracting vaccine-preventable diseases. That, I can respect. But instead these people have decided that the entire medical profession is, at best, a bunch of ignorant and obedient pharma shills. At worst, we are voluntary conspirators pushing dangerous interventions on people to benefit our own pockets.

I have to admit that when it comes to something as seemingly benign and beneficial as vaccination, we're probably not as critical as we should be. We know what we've been taught-- and that is that vaccines have been proven safe and effective, that adverse effects are rare, and that the benefits of vaccines far outweigh the risks. It's not 'dogma', it's not a belief system, it's simply presented in the same way as every other one of a million other pieces of medical information that we, as physicians, are expected to know. And as with anything else, we should be prepared to discuss it intelligently with our patients rather than simply shutting down at the suggestion that there may be more to it.

But the anti-medical sentiment runs far deeper than the vaccination forum. Among the opinions presented as fact are:

• Well baby visits are simply an opportunity to push vaccinations and berate parents who choose not to vaccinate.
• Well baby visits exist solely for the financial benefit of physicians
• Physicians receive kickbacks from pharmaceutical companies for prescribing their products
• Physicians make up statistics to coerce patients to agree to certain interventions
• Physicians are "unethical liars telling women rubbish to suit their own purposes" in regards to childbirth
• Obstetricians are "knife-wielding surgeons who are bound and determined to slice you open no matter what your wishes"

It actually makes my stomach hurt. Poll a thousand medical school applicants and I can bet you that not one of them mention the desire to have people accept their word without question or perceive them as superhuman among their reasons for pursuing a career in medicine. But many of them will talk of a desire to feel like they're helping people, and working to better patient's lives. During medical school we are never taught trade names for drugs-- we refer to all medications by their generic names and discuss only broad categories rather than specific therapies (i.e. "use a beta blocker for this condition" rather than "use metoprolol" and certainly never "use Lopresor") and have no contact with the influence of drug companies. Again, unless things are dramatically different in the U.S. the ideas expressed on this board are ridiculous.

But it's a sentiment that goes both ways. Allopathic medicine is slow to accept, let alone endorse, many branches of 'alternative' or 'complementary' medicine. It took years for acupuncture to finally be endorsed by the medical community in spite of years of evidence in support of its benefits. Recently, when my family medicine group discussed a case where a woman came into my colleagues office asking about her opinion on the naturopathic remedies that had cured her condition, my colleague had to admit that she had no idea what to say or how to handle the situation. I suggested having a naturopath come in to speak to our group about some of the principles of naturopathic medicine and alternative healing-- it's something I've always wanted to learn more about and clearly it was an area of weakness for my colleagues as well. Instead my suggestion was met with uncomfortable silence. Instead it was decided by the group that we'll be having an MD give us a talk on alternative medicine. Um... right. Talk about defeating the purpose.

The attitude that practitioners of alternative medicine have against physicians and the attitude that physicians have towards much of alternative medicine is only hurting the patient in the long run. A recent study showed that 63% of patients over the age of 50 were using some form of complementary or alternative medicine, and nearly 70% of these had not discussed it with their doctor. Many of these women on the anti-vaccination board were advising each other to lie when asked if their child was up to date on their vaccinations to avoid questioning and condemnation. That can't be good for anyone.

Traditional allopathic medicine has much to learn from the world of naturopathic and alternative therapies-- we should be keeping an open mind and ensuring that we have (at minimum) a basic knowledge of the therapies and techniques available. Alternative medicine would gain more acceptance by traditional medicine by shelving the adversarial attitude and through more rigorous scientific testing of their therapies.

It's too bad that each side has to feel so darned threatened by the other.