My Worries: Obesity, Breasts and Budgets

I can feel the way I think changing. Whilst watching The Fellowship with my housemates last night, we had a fairly lengthy interlude during Weathertop to discuss exactly where Frodo was stabbed, which vessels had been missed and how lucky he was. Also, why didn’t the Witch King Angmar have better stabbing aim!? Or during my recent sci-fi indulgences, I’m not thinking ‘wow, that’s a lot of blood coming out of that person’s mouth’ but ‘hmm is that blood from the stomach or from the lungs or both? How would I work that out and treat it quickly in an emergency setting?’

My Stethoscope

My first stethoscope

As well as spending enormous amounts of time watching shit (or excellent) TV with my housemates, I’ve got to know them very well in ways most people don’t usually know their friends. For example, Leo has a slow, steady and easily palpable (feel-able) pulse. Maisy’s pulse is somewhat erratic and difficult to find, the vessels in her arms are difficult to access. Lewis and Leo have both had the pleasure of finding my apex heartbeat, which for a woman involves having fingers sunk into the bottom, left part of the boob.

As well as feeling the way I think change, in the last month I’ve had many more opportunities to interact with patients. And to be honest, the biggest difference between practicing a cardiac clinical exam on my friends versus doing it on patients is that the patients are often fat. I didn’t really realise just how much you need a patient to extend their neck to find a carotid pulse when they are severely obese, or just how difficult it can be to orientate yourself with regard to their organs.

Obesity is a truly devastating problem, especially here in Wales. It breaks my heart (metaphorically)  – and eventually breaks theirs (literally) – to see patients struggling so much to maintain a healthy weight. 10% of the NHS budget is spent on type 2 diabetes; a disorder that correlates highly with obesity. And these patients are often coming in with multiple other things wrong with them, either all caused or complicated by their obesity. It is such a great shame, and to be honest I have no idea how it can be solved. Surely there must be a better way to help these patients.

I think most of us, smoking, drinking, eating what we fancy, don’t know it will affect us 40 or 50 years from now. If a patient could see their future after smoking 20 fags a day for 15 years, where they’re incapable of walking 50 metres in one go, would they stop?

So much of our healthcare demands these days fit into one of two categories:

FUCK, DO I HAVE CANCER?

and,

please give me antibiotics

Some could argue that our preoccupation with cancer is a good thing, knowledge of our own physiology can surely only help us identify things early. But it worries me how much anxiety this is causing patients without having a real impact on altering behaviour. I know from my own experience that I am terrified of getting cancer, and yet I almost never examine my own breasts because I find it too frightening. My boobs are so lumpy anyway, how could I possibly notice something? And yet I also know logically that a simple self-examination once a month in a stress-free manner might be achievable. I guess I’ll work towards it.

The antibiotics thing is a whole other rant, for another day. But I’ll just quickly note that a 2015 survey by WHO found that 76% of people think that antibiotic resistance is when your body becomes resistant to antibiotics. This is not what antibiotic resistance is. This is terrifying.

Another change this month is my tolerance for phenomena that some may find revolting is rapidly increasing. Bit off poo flung towards you? That’s fine. A child’s snot on your leg? Just brush it off. An atrophied (dead) leg passed along to you? Examine it carefully and learn what you can.

There’s beauty and a huge amount of diagnostic value in this stuff.

I hope that as I move through my medical career I can help find better ways to communicate to people how they can best manage their healthcare. I find that humans are intrinsically interested in the way their own bodies work, and are delighted to learn more especially if you can link it to evolutionary and embryological science. I hope that over the next few years, more people turn around and examine their shit before they flush it, feel their breasts or testicles, over-think injuries in films and re-examine their own lifestyle choices. Practice with your friends and lovers if that helps.

And if anyone has any idea how I can help affect this change, I’m all ears.

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