Wednesday, February 28, 2007

Top 10 List: Gimmicks Pre-Meds Use to Stand Out

After a few years in the game you start to hear more and more stories of what to do and what not to do.

In case you're having trouble deciding which of the following strategies to adopt (or regret not adopting), I've conveniently ranked each gimmick with a patented, easy-to-understand ranking system (in lieu of the customary "top 10" ranking).

  • Submitting cookies with their application
    They better be peanut-free.
    Rating: 3 dozen batches of shame out of 12.

  • Submitting their application on scented paper
    Are you kidding me?!
    Rating: 2 garage-sale antique perfume bottles with the little puffer balls (atomizers, I think they were called) out of 29.

  • Showing up 15 minutes late for the interview, while the interviewer waits for them to show up.
    I actually saw this happen, and I heard the interviewer ask, "Why were you late?" The response? "Oh, I thought my interview was at 11:45." I can't decide whether this applicant was extremely honourable for being honest or extremely stupid for not at least making up a better excuse.
    Rating: 4 white lies out of 11.

  • Drawing a cartoon of Mickey Mouse instead of writing an application essay.
    Even worse: Labeling your cartoon "This is what I think of the admissions process."
    Rating: 99 spots on the Hollywood Walk of Lame out of 100 (because this is a true story).

  • Answering the "Why do you want to be a doctor?" interview question with a one-sentence response.
    These are the kinds of people that a) have limited common sense and b) the interviews are designed to weed out.
    Rating: 56 times having to listen to "Because I Like Science and Helping People" as the lyrics of a polka song, out of 941.

  • Not following simple directions regarding the application, resulting in their first and last name ending up in the "First Name" box.
    Pathetic, though unintentional, I assume.
    Rating: 65 misread directions out of 143.

  • Including a spelling error in the first sentence of my application essay
    Uh... oops.... well, it got me an interview...
    Rating: 10 honest mistakes out of 10.

  • Writing their admissions essay from the perspective of the applicant's pencil.
    Not a bad idea. I wish I thought of it.
    Rating: 49 well-deserved spots in medical school out of 50.

  • Wearing a The Simpsons tie to their interview.
    I saw this one done by a guy who interviewed at the same time I did last year.

    He's not in my class.
    Rating: 1 desperate, unsuccessful plea for attention out of 64.

  • Showing up at the admissions office wearing a Tarzan leopard-skin outfit and singing Portuguese love songs to the dean
    I don't think this one has been attempted yet, so give me credit for the idea if you use it. I guarantee you will stand out.
    Rating: Negative 16 rock-bottom shameless sells out of 612.

This list came about after a conversation with my school's director of admissions as we were killing time and chatting up a storm during interview weekend (I was helping out). She told me that giving gifts to the admissions office simply doesn't work. First of all, the dean of admissions doesn't dictate who gets in and who doesn't; it's a committee decision, based on the accreditation policy. Secondly, gifts aren't accepted by the department; they're either given away, or in the case of larger gifts, sent back.

My advice? Instead of using a gimmick, try being a great person with a stellar personality. But hopefully you didn't need to hear that if you're indeed applying to medicine.

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Monday, February 26, 2007

Vitum Medicinus: An epic announcement...

It's a turning point in the history of Vitum Medicinus.

Update your links!

Vitum Medicinus now has its own place on the web!

The URL for Vitum Medicinus has now changed to:

E-mail can now be directed to vitum at VitumMedicinus dot com.

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Sunday, February 25, 2007

Premedasaurus extinctus

When I started my undergrad, I wanted to become a doctor, so I simply signed up for the "pre-med" major at my university. I didn't realize that I was jumping on to the last glimmers of a dying wave.

Musings of a Dinosaur is hosting Grand Rounds v3.23, and in an attempt to fit with the theme and thus get listed, I'm writing about the one thing that, this early in my medical career, I know about which has gone the way of the dinosaur: the "pre-med" degree.

Most "pre-med" students are aware that "pre-med" degrees don't actually exist anymore. My degree program wasn't even technically that; it was a B.Sc. in Biology, Pre-Med stream, or simply a collection of courses in and extraneous to the Biology degree requirements which happened to be common prerequisites for medical school. As a matter of fact, it was discontinued in my second year or so, leaving me slightly embarrassed and feeling without compass or sense of direc.... no, actually, I didn't really even notice.

That didn't keep me from shamelessly using "I'm in Pre-Med" to try and pick up members of the female gender. Surprisingly, this was so unsuccessful that I abandoned it in favour of pursuing getting struck by lighting while holding a winning lottery ticket and getting mugged by Chuck Norris at the same time. I figured my chances were better for the latter, and hey, who needs a girlfriend when they can say they were mugged by Chuck Norris, anyways?

In actual fact, I soon lost all enjoyment in introducing myself as a "pre-med." I found that common responses to this declaration were:

  • "Oh, so you're going to be a doctor?"
  • "You must be smart!"
  • [pointing and shouting] "Hey, look, Mom, a nerd!"

These were combined with that which anybody in pre-med has had to deal with... the one thing that dominates every action you as a pre-med do: the thought of "getting in." Almost every pre-med wonders about everything they do, "Will this help me get in?" (ie. regarding a summer job) or worse, "Oh no, will I still be able to get in now?" (ie. regarding getting busted for what you thought was a harmless prank and then finding out that your high school's administration has less of a sense of humour than you first expected... uh, fictional situation, of course). It ends up being in the back of your mind all the time and soon gets pretty annoying.

Take that and add a bit of humility (ok, fine, insecurity), a bit more not wanting to let down people who thought you were smart, and a a lot of realistic awareness regarding the admissions process and the brutal odds that are involved, and you soon find that you'd much rather not tell people that you're 'pre-med.' By my second year of undergrad I told everyone that I was taking a Biology major. I hadn't even realized that by this time my university had pretty much phased out the 'Pre-Med' stream.

Clearly, though, Vitum avoiding the term 'Pre-Med' didn't drive it into extinction. So why isn't it offered any more, and what's the alternative now? Well, I'll take this opportunity to answer a question from Carrot Juice, who took the time to get in touch with me via e-mail and ask for advice about applying for medicine. I'll start here and continue to address this question in a few other posts.

Med schools are more and more in favour of diversity these days. People with diverse backgrounds make a better medical school class, so the story goes. This, in fact, is the driving factor behind allowing 43-year-olds to begin medical school, something which a lot of people are a little confused about because after all, there's a good chance they won't have many years to practice after they graduate. So now you can have a math major who becomes a surgeon, or a economist who becomes a general practitioner. Our class has engineers, a nurse, a paramedic, a school teacher, an Olympic athlete, an entrepreneur, a city councillor; we've also got PhDs alongside students who didn't even finish undergrad. In fact, the first semester of our curriculum is in a sense a compressed physiology undergrad degree, to catch up everyone to the same science level despite their diverse backgrounds.

Thus, no longer can you get through with your basic 'pre-med' combo of biology, biochem, organic chem and expect to be an A-1 applicant. Nowadays it's all about standing out. What else would you expect, though? With Canadian med school acceptance odds of something like 1 in 11, that's what has to be your focus; making your admissions essay, your interview, your application stand out from the other 1000-3000 applicants (depending on where you apply).

It's all about diversity; being one more 'pre-med' in a pile of 3000 'pre-meds' doesn't cut it anymore. And so, as can be expected, the 'pre-med' degree ended up where most of those bland, un-unique applications end up: in the 'gone forever' pile.

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Thursday, February 22, 2007

Talking with an autistic person... who can't speak

How can an autistic person be described as "brilliant" and having "a great sense of humour" if they can't even put together sounds that resemble words, let alone use language?!

"I find it very interesting that failure to learn your language is seen as a defecit, while failure to learn my language is seen as natural," says Amanda Baggs, a 26-year old woman with autism, with the aid of a computer keyboard and a voice modulator. "The thinking of people like me is only taken seriously if we learn your language."

Amanda has a language and way of seeing the world that is entirely her own. Watching the videos and reading Amanda's story on CNN's website has entirely fascinated me, blown me away, and forever changed the way I view people with autism. Click on the video link, "Watch Amanda communicate in her own way."

I value my abilities to communicate and think rationally so highly that I figure being in a situation like this would torment me. Similarly, I have an insecurity as well as a tendency to avoid people with autism based upon my ignorance and limited interactions with autistic persons. I'm sure I'm not the only one who feels this way, but I'll admit that I do...albeit ashamedly.

I guess the biggest surprise for me was, "Wow, just because she can't speak our language, doesn't mean she can't understand it." The interviewer was asking her questions in perfectly normal English and she was processing and answering them as quickly as any 'normal' person would. Again, I haven't really ever been 'taught' or learned how to interact with autistic people, so this was a new thing for me; but I now know not to 'talk down to' a person with autism, or to speak to them as if they think 'slower' than I do.

Watching these videos and reading the article have helped me realize that my insecurity is entirely unfounded. Just because someone isn't capable of speaking to me, it doesn't mean there's something wrong with them or they're anything less than me.

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Tuesday, February 20, 2007

Heart in my Hands for Valentine's... literally...

This week we studied congenital heart defects. For our case-based learning assignments, we were to look up heart murmurs and congenital heart defects. "That's easy," I thought. "Murmurs... whatever, there's probably 1 or 2 types, and congenital defects, I've heard about that before. Hole in the heart. Good as done."

I was in for a surprise.

The list I ended up with had over twenty separate congenital heart defects that presented with murmurs. Apparently anything and everything about them can go wrong; thickening of the blood vessels (aorta, pulmonary artery); hole in the atrial septum; hole in the ventricular septum; valve issues; the vessels get switched around; portions get enlarged; or combinations of the above. The list goes on.
It turned out to be one of those things that you think you understand, but never really put much thought into, and then you realize there's way more to it than you ever imagined.

I ended up feeling like I learned a whole lot just from lecture this week (a rare feeling; usually I have to sit down and start going over stuff myself). After our five or so weeks of microbiology, infections diseases and the like, a block that was poorly organized and not so motivating, it's nice to finally feel like we're learning something applicable and medical (I think I've said that a couple times over the year but it's getting better and better).

The climax of the week ended up on Friday afternoon. Everyone was bitter because up until now we'd had Friday afternoons off, so nobody was impressed that we had to go across town to the teaching hospital to do a pathology 'lab' in the small group rooms there. While there was a bit of variability in the groups (and 3 of the groups had tutors who were on call and thus did not show up), it turned out it was actually really interesting. Each group was given six pathological specimens of human hearts taken from infants that had died in their first few weeks of life (aww, yea it was a bit sad but babies do die and I suppose this is a way that they can help others in a huge way even though nobody was able to help them). Each heart had a congenital defect, and given the specimen we donned gloves and went through the chambers of the heart looking for it.

For me, it was neat enough to be given specimens in formalin in glass jars and being allowed to actually handle them. Most times when you see things in glass jars they're not to be touched. I felt special.

Besides that though, which I'm not entirely sure I should've admitted, it was really neat being able to investigate and problem-solve in a way that was applicable and solidified the content we'd learned that week. Being a visual learner, as well, seeing the defects in front of me, and being able to put in a probe into the vessels to see where it came out made a lot more sense for me than the description we'd had in lecture.

For those who are as nerdy as I am, here's a bit more. We had one specimen that displayed a congenital defect called Transposition of the Great Vessels, where the major vessel leading from the heart to the body (the aorta) is switched with the major vessel to the lungs (you might remember that the left of the heart pumps the blood to the body and the right side pumps it to the lungs). I figured the best way to repair this surgically would be to switch these vessels; but supposedly that's too tough when the hearts are small, so instead they do a Mustard procedure, where they put in a baffle, a piece of synthetic material that switches the inputs of the heart rather than the outputs. That way these people's hearts end up backwards; the right side pumps blood to the body, and vice versa. It was interesting to see how this little heart had compensated for the change; instead of the left ventricular wall being thick and muscular, the right side had this morphology. Fascinating. Seeing these hearts with surgical repairs and synthetic materials sutured in definitely gave us an appreciation for the minute surgical procedures that are involved in fetal surgery, and for the remarkable way in which surgical interventions can be a lot like rewiring a car engine.

It was all kindof solidified when a lecturer did something that doesn't happen often enough in our classes. The prof brought in a former patient who was born with transposition of the great vessels, and who had had the mustard procedure done when he was a kid, and interviewed him in front of the class. Other than shortness of breath for a few days if he exerts himself too much, he lives a normal life and owns a successful company and has a few kids. Nice to see a human face rather than just being lectured about a condition.

I'm still in awe at how much they're teaching us, and it seems like every week I find out a whole other pile of things that doctors know that I'll have to learn as well. What I thought was just one possibility for heart defects quickly turned into 20+, each with a different pathophysiology, set of signs and symptoms, treatment and prognosis. Not only am I learning medicine, I'm learning a lot about medicine, and how much there is to know, and that it doesn't necessarily line up with what my expectations were in every way. Fortunately, though, finding this out is more exciting for me than anything. So far.

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Saturday, February 17, 2007

The Politics and Red Tape of Paramedics

Riding along with the paramedics was indeed thrilling, though at about 11:00 am on the day of my ridealong, that would've been a hard sell.

"My friends think this job is all blood and guts," said Jim, the paramedic I was shadowing. It was funny because we were in our second hour of waiting around at a hospital. If there are no beds in the emergency ward for the patients that paramedics bring, then there is no nursing coverage for those patients, so the paramedics are required to stand around and wait at the hospital. "At some hospitals, there will be an ambulance crew standing around for entire shifts." This pulls ambulances off the roads, and if someone needs help, the nearest ambulance is then called in. "Nearest" is used loosely - the next community over may be fifty kilometers away.

I got another glimpse into the red tape tangle that is the ambulance service. While there are transfer ambulances, glorified taxicabs dedicated specifically to transfer patients who can't get a ride on their own to get simple tests done, (ie. patients in nursing homes and the like), there aren't enough of those cars, so the load invariably spills over into the lap of the paramedics who are trained to save lives. Some provinces / regions have private transfer ambulances but apparently we don't. This means that instead of being able to respond to a call within minutes, the paramedics are taking Papa to his stomach ultrasound. Well, I shouldn't make generalizations; it's not all old people that are transferred. One of the people we transferred was a young man of about 35. He was involved in a car accident years ago, and had no family or insurance to really take care of him. So, he spends his days in a nursing home surrounded by geriatrics, paralyzed, unable to get out of bed on his own or do anything for himself. My heart went out to him.

At one point the paramedics told me, "When you're a doctor, don't order an ambulance for people who clearly don't need it." Doctors apparently have this power. The paramedics were getting pretty frustrated taking this old woman home from the ER who clearly could have just gone in a cab. I could see their annoyance... they could've been out doing a real call instead of playing cabbie. "I thought taxicabs were supposed to be yellow," I joked.

The best example of red tape, which had the paramedics I was shadowing hopping mad, was the time we dropped off a patient at a hospital for a test. When we pulled in, there were 4 other ambulances plus a supervisor car. "Is there something going at St. Sickkus Hospital that we should know about?" radioed in the driver. Turns out the hospital was closing down the ward, so they brought a bunch of ambulances to bring the patients out. Eight paramedics and a supervisor milling about waiting to be told which patients they would take. It turned out there were only eight patients in that ward. "They could've just double-stretchered and gotten the transfers done in one trip."

The politics don't end at paramedics, though; I've got some good times to look forward to, apparently. My friend shadowed in the ER the other day and told me that they had a patient who was bleeding from his rectum after his surgery. The ER docs called surgery, who sent down their first-year resident - a doctor of, oh, perhaps six months - to deal with the problem. Surprise surprise, he had no idea. He suggested they call GI. "Not my problem," said the GI doc, and wouldn't show up. "Call internal" somebody suggested - no dice. Frantic, they called trauma surgery as a last resort, and pretty much got laughed at as they tried to advocate for the patient and explain how this could be considered trauma. The ER doctor ended up having to deal with the situation on his own.

But I suppose every job is like that. I interned in an office where you couldn't go elsewhere for your graphic design needs because everything had to have a uniform look, but then again, the graphic design department there took weeks to get even a simple invitation or notice done. People caught wind of my knack for composition and I started getting a lot of requests to help other departments with their design needs. The funniest part was having to be discreet about it. Can't let the designers catch on. Don't want to get a talking-to.

You think I would have learned my lesson working in one office... perhaps I haven't. In a feeble attempt to figure out what I want to do this summer, I put in an application this week to work for the national medical association as an intern. I have a funny feeling that such a job just might end up being laden with politics as well.

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"Please do not frighten the applicants."

Interview weekend is fast approaching and I've offered to help out in a few areas.

I particularly enjoyed the guidelines we were given.

We keener helpers have been specifically instructed to "not frighten the applicants."

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Thursday, February 15, 2007

Medical Breakthrough: Effects of Chronic Masturbation

The things we learn in med school...

Well, this actually wasn't covered in class. It was passed on to me by a fellow classmate. Nonetheless, I found it just too... unique... to not post immediately.

Chronic penile oedema secondary to chronic masturbation. Int J STD AIDS. 2004. Jul;15(7):489-90.

*Added 15 Feb in response to comment:
Oedema, more commonly spelled edema, is swelling of tissues due to excessive fluid accumulation.

Thank goodness it's only two pages.

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Sunday, February 11, 2007

10,000 Hits to Vitum Medicinus

So Vitum Medicinus has hit a bit of a milestone - 10,000 hits!

Thanks so much to everyone who reads this blog - my friends, family, and the 'regulars.'

And special thanks to everyone who posts comments!

- vm

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Top 10 list: Things I learned by watching House, M.D.

Special thanks to Comrade for his joint authorship of this post.

1. Things will only go wrong when the doctor is in the room (unless it's before the patient enters the hospital).

2. X-ray, MRI, CT scan, and ultrasound technicians don't exist. Attractive, high-profile doctors do all the work.

3. Real hospitals don't have nurses, unless the doctor is making a snappy remark to them, or they are extras walking around in the background.

4. Patients are rarely ugly.

5. House doesn't need a mask in the OR, he has sterile breath.

6. There is entertaining music every time a doctor thinks up a correct diagnosis.

7. Harassment and manipulaiton aren't inappropriate; rather, they are funny.

8. If you want to do a procedure on a patient and they or their family says no, you simply aren't smart enough to get them to change their mind. There is a way, figure it out.

9. The smartest doctors use vicodin.

10. Everyone lies.

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Saturday, February 10, 2007

"Congratulations, Vitum, you started his heart again."

I couldn't believe it.

We had been having a thrilling morning (no, they wouldn't let me drive). After sitting the first two hours of the shift in the ambulance shooting the breeze and watching the Saturday morning news and discovering new ways to be annoyed by whomever was reading the headlines / sports / weather, we got our first call of the day - a motor vehicle accident. We left a guy having chest pain who refused to go to the hospital, took a guy having neck pain who tried to refuse having to lay on the spine board, and proceeded to wait at the hospital for two and a half hours once we took them there (it's all politics... post on that stuff will be on here soon).

And then it happened.

The dispatcher's calm voice came over the radio. Sixty-seven bravo, Code 3, cardiac arrest, 22416 Church Hill Road, file 3026702.

The attending paramedic (as opposed to the driving paramedic) wrote down the details on the little white pad attached to the dashboard, and the driver hit the four switches on the console to activate as many as possible of the flashing red and white lights stuck to the white box we were driving. He turned the knob under those switches from "OFF" to "WAIL." Off we went.

It's funny, albeit a bit sad, watching drivers with a screaming ambulance on their tail. Most have a general idea to let the ambulance through and pull over to the left or right. Some people stop dead in the middle of the road. Paramedics are required to stop briefly before going through any intersections where the light was red, and in doing so, one oncoming driver (this is not the place for gender generalizations or debate on who drives better so I'll omit her gender) thought that meant she/he could complete her left turn in front of the ambulance, almost plowing into us when we started moving again.

Despite the numerous other vehicles that were apparently working hard to oppose us, we made it to the call scene. The advanced care paramedics were just walking in, and the firefighters were already inside. We grabbed our stretcher and bags of supplies and went inside the group home.

In the fairly spacious common area / tv lounge right through the doorway, there was an sixty-something gentleman laying with his back on the floor. His lips were blue, like nothing I'd ever seen before. He was mostly bald but the hair he did have was neatly trimmed. The firefighters were pumping on his chest and stopped for just a second to let the advanced care paramedics cut off the patient's shirt. I was surprised at how deep into his chest they were going, and how the patient's huge bloated stomach ballooned up with every pulse.

I was amazed at the efficiency and controlled environment in the midst of the fact that a man was laying dying. It was like a well-choreographed dance. One firefighter was getting information from the home staff, another was timing out two-minute intervals for CPR - "switch, whether or not you feel tired." One of the advanced care paramedics had defibrillator leads on his chest within seconds and were seeing if his heart rhythm was shockable or not, and while another was putting a breathing tube down his throat, one of the regular paramedics was starting an IV in the patient's right arm. As soon as they had the IV line, the advanced paramedics started whipping out bottles of epinephrine and atropine, popping off the tops with their thumbs, and plunging the drugs into the man's arm.

I stood as far away from the situation as I could while still having a good view. Not only did I not want to get in the way, but it had been made pretty clear to me that except for the times when the paramedics called upon me 'to assist as a bystander,' I was forbidden to touch anything, and would be held liable for anything I did touch.

"Have you ever seen a cardiac arrest before?" was a question I got a few times as well. For that one, the answer was no - I'd seen one (though it was a Do Not Resuscitate) while volunteering five or six years ago.

As soon as the patient's heart started to do something that resembled beating, they worked together to scoop him up and in a few seconds we were outside, somebody bagging the patient (breathing for them), somebody pumping on his chest, a few people steering the stretcher. "One of you drive," said the advanced paramedics to the ones I was shadowing. "Okay - We have a medical student with us today," they replied. "Sure," said the advanced paramedics, looking at me. "Hop in."

We were on our way to the hospital a few seconds after that. Even though we were in a hurry, nothing seemed frantic, disorganized, or really even that rushed. It takes experience to keep a level head when you know that valuable seconds are ticking by. "So, Vitum, can you bag the patient for us?" they asked. "Press in the bag about one third of the way every three seconds or so." I was happy to help. I was doing something and felt significant for a change.

In the car his heart rhythm decided to go down the tubes again and the paramedics started CPR and pumping more drugs into him. From my view at the head of the patient I was watching two people that were keeping this man alive, and I was playing a role too!

SNAP went a rib or two while the paramedic kept pumping on the patient's chest. When the car swayed around a corner or screetched to a stop at an intersection, CPR form was sacrificed for balance and I watched a neat little ditty they must call 'one-handed CPR' while the paramedic's other hand held onto the bars on the walls or roof. They didn't teach me that one in CPR class.

Fortunately they taught me plenty in CPR class, though, and when the paramedics turned to me and said "want to do CPR?" I was able to jump right in there, not missing a beat, and soon I was pumping this man's heart for him. SNAP went another rib. I pumped away.

"Have you ever done CPR before?" the paramedics asked. "No, only on a dummy in class..." I replied. "Oh come on," replied the paramedic. "I know the patient is from a group home, but you don't have to call him a dummy..."

He was making a joke. I know and completely understand the stress of a job where you're surrounded by death and dying, and that black humour is a common coping mechanism (I have read The House of God, after all). I was a little caught up in the situation, though, and I didn't find it funny. But I was suddenly aware that my not laughing made the paramedic obviously uncomfortable and I felt bad for that. He leaned towards the unconscious patient's head and said, "Sorry, pal."

After about a minute or two of pumping, they asked me to stop so they could check the rhythm. "He's got a heart beat! Congratulations, Vitum, you started his heart again."

I had saved a life.

Maybe it was beginner's luck. Maybe it was the immediate actions and CPR of the care home nurses, the expertise of the firefighters, the cool organization of the first responders, the quick IV placement, the copious amounts of epinephrine and atropine administered, the rapid on-the-scene intubation by the advanced care paramedics, the continuous CPR given to the patient by somebody from every department listed above. Okay, so I played a small part. And I didn't necessarily save his life - he still had a long way to go. I just happened to be helping out right when the combined efforts of everybody who attended started paying off.

It still feels incredible, though. I know not every day as a doctor is like this, and that getting a heartbeat back after CPR isn't usually the way things go... but still, it was a good seeing what paramedics do before patients arrive at the hospital, and I have a huge new level of respect for paramedics now.

And I had a blast.

I think I might enjoy doing this medicine thing for a living.

- Postlogue -

The patient kept his heartbeat for the rest of the ride to the hospital, and there I learned a good lesson about one of the huge disadvantages of being a paramedic - as soon as we had relayed the information, and the doctors took over, the paramedics left the room. I lingered but soon I had to leave too.

I still don't know if he made it or not.

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Tuesday, February 06, 2007

Grand Rounds v3.20

Grand Rounds v3.20 - It's a gooder this time, even though they misspelled my name as "Victum Medicinus."

Actually, that's kindof funny. I wish I'd thought of that.

That's all there is to this post! Too bad I can't get the stupid "Read more..." thing to go away when I don't want it there...

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Friday, February 02, 2007

Fumbling with the Tools of the Trade: Empathetic Statements

"... So I pulled out this empathy comment in front of a patient at my Family Practice class on Wednesday. I figured I hadn't used one in a while. I tried hard to mean it but I guess I didn't really, and so soon after I started saying it I began hoping the patient wouldn't catch me. It was slightly misplaced, and a little bit out of context. I felt really phony and I hated myself for it for a brief few seconds..."

I sometimes feel a little awkward using my new set of tools of the trade.

I'm not talking about the otoscope, or the opthalmascope, or the stethoscope, or the rectoscope (I can't wait!), or the tongue blade (apparently the technical term for 'tongue depressor'; the public caught on and started using the medical term 'tongue depressor,' so 'they' had to change the medical term to something more scientific and dangerous sounding. "Tongue blade should suffice," said the men in the white coats in the dimly-lit strategic medical equipment naming room.) Yeah, I'm all thumbs with all those tools still (as is my classmate who inflicted great pain on me whilst using one of the above scopes in a Clinical Skills learning session), but those aren't exactly the tools I'm referring to.

The 'tools' I'm referring to are the tools we learned during Communications Skills class, or "We Have A Past History Of Taking Crap for Our Graduates Being Socially Awkward And Insensitive To Patients So We Will Mandate That All Of Our Medical Students Take This Class On How To Talk To Patients Without a) Them Thinking The Doctor Hates Them, b) Them Thinking That They Will Sue The Doctor, Or Worse Still, c) That They Should Stop Donating Money To The Medical School From Which The Doctor Graduated." (That's the course title. Look it up.)

These 'Tools' are the Sit Down, the Get Consent or Die a Painful Immediate Death, and the most difficult to master secret ancient ninja maneuver, the Empathetic Statement.

The first two are pretty easy. "Sit down to create the impression of spending more time with the patient," we were told. Funny, I figured I'd just create that impression by spending more time with my patients. Shows how much I know. Moving on.

The second tool, Get Consent or Die a Painful Immediate Death, is pretty self explanatory and consists of making sure that the patient is willing to be interviewed by me. I have to get permission to talk to the people and I still don't even examine them on my own yet. Even if I screw this one up, my Medical School has covered their legal bases by layering - the patients are told when they book their appointment that medical students will be there, there is a "This Doctor is Teaching Medical Students" slash "Go Easy on the Medical Students, We Can't Have Them Quit On Us This Far In" certificate in the waiting room, the doctor asks them if it's OK to be questioned by a rookie, and finally I, the Medical Student of whom the patients have heard so much and are by now wondering why they have to be so sure they want to talk to me, ask them if it's OK.

(On a bit of a side note, in case there aren't enough side notes already, there are patients who decline to have their appointment on Wednesday afternoon once they find out that there are medical students in the office then. I'm collecting names so that I can decline to treat them or their children in the future. Just kidding, there are still some things that I don't mind putting off seeing in real patients until I've had a chance to be trained with standardized patients. You may recall what I'm referring to.)

Back to the tools. While the first two could be mastered by any layman, the final one, the Empathetic Statement, has pretty much become one of those things that haunts you even when you've punched your clock and have left work. It's awkward to wield, and takes a while to master, and at times you just close your eyes and hope it's working and you're not just embarrassing yourself, but when it is effective, man is it a deadly blow. It's kindof a secret weapon of new doctors, too, so don't tell anyone I told you this, we're sworn to confidentiality (which is why I'm sworn to anonymity)... I'll tell you, but I just don't want you, in your next doctor's appointment, to start wondering if a doctor is genuinely nice, or they have had to receive training on being nice to patients and are whipping out a full blown Empathetic Statement assault on you. Assume the former.

So I pulled out this empathy comment in front of a patient at my Family Practice class on Wednesday. I figured I hadn't used one in a while so I should get some more experience. I tried hard to mean it but I guess I didn't really, and so soon after I started saying it I began hoping the patient wouldn't catch me. I was interviewing this patient about her painful urination, now on my list of afflictions that I hope to treat rarely and acquire never, and I then chose to pull out an Empathetic Statement. It was slightly misplaced, and a little bit out of context. I felt really phony and I hated myself for it for a brief few seconds. If she wasn't so busy trying to make sense of my questions while I asked her to describe her pain in terms of its location, intensity, nature, character, mood, demeanor and favourite food and color, she might have noticed that my Empathetic Statement, "That must've been difficult," isn't exactly the most ideal interviewer response to "But the pain got better when I drank cranberry juice."

Okay, it wasn't actually that bad. I think what actually happened was that she told me that the pain was worse than ever before and I said that it must have been difficult. But I still felt phony saying it. This is what I'm talking about when I say that work stays with you even after you punch out. You see, it's rough when I do say something like "That must've been really frustrating!" spontaneously, even in normal conversations, because I feel like people - especially if the conversation is with someone in my class - they think I'm just pulling that out of my ass(ignment book for Communications Skills class). We joke around enough with FIFE (ie. Classmate approaches me and tells me they locked their keys in their car; I respond, "Awwww, how is this affecting your functioning? What are your fears?") so it's logical for them to think that I'm pulling out an Empathetic Statement because we were taught to, and not because I actually mean it.

Fortunately it doesn't usually go that bad. I have never actually gotten in trouble or accused of brash falsehood when I have used an empathetic statement, genuine or not. But I still hope this will stop being so awkward soon, and that when I actually do mean the statement, or even on those rare times that I don't and am just trying hard to be a bit more human, that my efforts will be appreciated nonetheless.

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"Aboriginals and Preferential Treatment in the Med School Admissions Process"

This is a response that I posted to a forum post entitled "Aboriginals and Preferential Treatment in the Med School Admissions Process," which can be found here.

This issue is one that just five or six months ago, I wouldn't have had a single idea about. In fact, back when I was naïve to the condition and many aspects of the history of Aboriginal peoples, I wondered a lot of the same things that were posted in the initial post. I was raised in a religiously sheltered home and had never had the chance to get to know personally people in the gay/lesbian/bisexual/transvestite community, people of other racial descent, or people of other religious beliefs, Aboriginals included.

Now that I am in a medical school class I have been blessed to get to know some people of Aboriginal descent. I have only begun to address some of the misconceptions I had.

Everyone has a basic understanding about the "we're on their land" concept. However, poor treatment of Aboriginals has occurred more recently than you might think. Lack of the most basic human needs (ie. clean water) on Canadian reserves has happened only a few months ago, with the Canadian government directly to blame. But most people know about that too. One of these things that I had no idea about just a few months ago concerns the residential school system. In the last few months I have been horrifed to learn about this despicable part of Canadian history. A description can be found at CBC Archives or on Wikipedia. I have heard stories of Aboriginal students abused in every way, from being forced to use only the English language, to being forced to sleep in human excrement under outhouses. I began to realize that for these horrors, any amount of money in the world wouldn't fix or help having to grow up with parents or grandparents who suffered through this and are still emotionally scarred by it. Then I found out that people I know were old enough to have gone to these schools. The last one closed in 1996, during your lifetime. I didn't realize that 'benefits' for Aboriginal people weren't just for things that happened hundreds of years ago.

Another misconception I had was about the medical school admissions standards for Aboriginal applicants. I've been in your position, so you might be surprised - as I was - to hear that Aboriginal applicants don't 'have it made' as much as I thought they did. Yes, while some medical schools have different requirements or admissions subcommittees for Aboriginals, still a huge percentage of declared Aboriginal applicants are turned away each year. I can't find the exact numbers, but unlike how I first thought it was, being of Aboriginal descent isn't a 'free pass' into medicine. Therefore, I believe that anyone who thinks that Aboriginal students might use their 'status' to 'abuse the system' or 'skip the queue' needs to realize that this isn't easy to do. Aboriginal applicants will be interviewed on ethics and integrity just like every other medical applicant there is, and don't try to tell me that there are no other medical applicants who have ruined other peoples thesis experiments, misconstrued themselves, or told a lie just to get into medicine. Admissions offices have filters for these bad seeds, and they come from every background.

One of my most memorable classes to date was held in an Aboriginal longhouse. We had an Aboriginal physician and speakers from the Aboriginal community talk to us about Aboriginal health issues. We learned some basic things like the medicine wheel, which relates to the four directions of life (more on that at
here). Good health, according to Aboriginal tradition, can be achieved by finding balance between the four areas. Knowing things like this, they told us, will help us relate to our Aboriginal patients even better in the future.

I felt honoured a few weeks later when my Aboriginal friend's father was telling me about a man of whom he thought very highly. "He's very balanced," he told me. I knew exactly where he was coming from. I couldn't help but smile and realize that I had finally learned something of real meaning in my medical school class.
You're not the only person who doesn't understand these things fully. I didn't. I still don't. One of my Aboriginal friends has even told me that she has had people ask her to her face, "Why do you people get it so good? Why don't you have to pay taxes, etc." and the pain that a misinformed question like this causes is horrible, and could be avoided if we simply overcame our misunderstandings. I still have a long way to go, and am hoping that I didn't say something ignorant or offensive even in this post. But give me credit for trying to increase my awareness, and while you may have offended some people in the way you phrased your comments, I hope you're going down that path as well.

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