Tuesday, April 24, 2007

You thought the pharmaceutical industry was slimy before reading this post?

You're a drug rep selling psych meds (hey, had to make the post fit this week's Grand Rounds somehow!), and you have to meet your quota. The family doc whose office you're walking up to right now, though, is 100% hardass.

You can bet that you won't even get the chance to have any face time with him - even though his secretary always cleans out your briefcase full of samples (this doc's one of the "sample-grabbers" you heard about in training), this doc will only see you if it's by accident, and even then, pretend you don't exist.

Which of the following best describes your attitude?

a) Scared stiff.
There's no way you can up sales if you can't even see the doctor.
b) Pretty nervous.
What if he's behind the counter when you come in and he yells at you?
c) Pissed off.
This is going to be a waste of an appointment.
d) Thrilled.
You know you can accomplish your objectives - probably even better - even if you only talk to the secretary.

If you answered D, you're a slimy lizard, and you'll make an ideal drug rep.

In fact, you'd make an even better one if you believe that there's a "d) thrilled" answer for every single type of doctor - from those who prefer competing drugs, to the skeptical, to the high-prescribers, to the friendly and outgoing, to the ones who won't even meet with drug reps.

That is, after all, how the drug companies train their reps to think.

Thanks to a new journal article out called "Following the Script: How Drug Reps Make Friends and Infl uence Doctors," available to anyone here at the PLoS online peer-reviewed journal, you can get an eye-opening glimpse into the mind of a pharmaceutical drug rep.

The article concludes, "Physicians must rely on information on drugs from unconflicted sources, and seek friends among those who are not paid to be friends."

I'll admit, reading this made me a heck of a lot more wary. Even just a few months into medical school, I've already seen drug reps in action at the family practice clinic I go to for class an afternoon a week. I've seen everything including pens, patient chart notes, and Kleenex boxes supplied by drug companies, with their logo stamped thereupon (though I honestly can't remember any of those sponsoring companies...then again I haven't been prescribing very much yet). I've also gotten a couple free meals thanks to drug companies, and there are students in my class (who instill much jealousy within me) that have clinic at a group family practice office and a different drug rep each week brings lunch for all the docs and staff there.

I strongly encourage you to take a look at the article, even if it's just to browse the fascinating table explaining how a drug rep approaches each of the doctor types listed above. If, like me, you had little to no idea what's going on - or, if you're routinely visited by these reps - you need to at least give this article a glimpse.

By the way, I proceeded to write about this again - link to Version 2, here.

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Sunday, April 22, 2007

Cancer Survivor, Children's Book Author, and only 14 years old

"I have Hope, Faith and Courage on my side
and Love standing guard at my back.
No Dragon in the world is a match for all that."

Somebody told me about Matthew Epp in an e-mail to our class, and I was incredibly touched by the story and had to share it with you.

When Matthew was only two years old, he was diagnosed with a rare form of cancer known as Wilm's tumor. With three recurrences throughout this life, nobody expected Matthew to survive, let alone be a thriving, energetic and inspirational 14 year old.

Matthew has overcome overwhelming adversity with the help of Hope, Faith, Courage and Love, and he has also done some incredible things in his life. He has been selected as the child representative for the Canadian Cancer Society, Saskatchewan's Children's Health and Hospital Foundation 2004 Champion Child, has met the Prime Minister, worked with the Chldren's Miracle Network telethon.

Now, he has written a children's book offering a touching story of a young boy who must undergo surgery who dreams of a magical land, and pictures himself in a fight against a viscious dragon, representing cancer.

You don't have to
buy the book to be touched by the story. If you do choose to, however, and I highly recommend it, regardless of your age I can assure that you will benefit from the breathtaking story that this young man has to offer. A portion of sales goes to help fund cancer research.

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Saturday, April 21, 2007

"Hit the patient" . . . ?!, and, My Dashing Clinic Partner

Doctor, to my clinic partner: "Go take the patient's pulse. And he's being uncooperative today, so if he objects, just... just... smack him."

My family practice preceptor has been described as "an odd duck."

The description, I believe, is accurate.

Fortunately, I have had the pleasure of being accompanied to clinic by my breathtakingly beautiful and stunningly intelligent clinic partner (whom I'll refer to as "Kristine," for her privacy), who is in fact the sole reason I look forward so much to the 35-minute drive to our clinic location. My clinic afternoon is always filled with brilliant and hilarious conversation to and from our clinic, as well as a number of knowing looks behind the back of our preceptor when he is acting inept / absent-minded / odd / just plain insane. This post is a story about our preceptor acting in such a way.

Actually, I'm killing two birds here. Not only is this post about our i/a-m/o/j.p.i. preceptor (I'm getting the hang of turning everything into an abbreviation, as doctors apparently like to d0), but it will also co-feature my clinic partner Kristine. On occasion she has been known to read this blog, and has been begging for some time to be featured in a vignette herein. I am happy to finally give her the honour.

Before you think my preceptor is unfit to practice, let me just explain some things. His sense of humour is very...different, and he has known a lot of his patients for years and they have a lot of respect for him, which was surprisingly evident in every interaction they have with him. So, though you may be shocked by some of the things that you will see below (as I was), remember that in a lot of respects this is like old friends joking around and I am under the impression that the doctor knows when such antics are appropriate. That being said, if you still think it is inappropriate, well, that is your right as a human being, and I will definitely not be surprised.

Explanations and disclaimers having been issued, here, in abbreviated form, I present some gems from our time together, our meaning Kristine, me and the preceptor.

  • Doctor, to patient: "[Student] will now give you your immunization"
    (Student = either Vitum or Kristine. Identity protected for student's privacy.)
    "But I have never given a needle before!"
    Patient: [looking terrified, about to object, but interrupted by doctor...]
    Doctor: "Aaaaaand... GO."

  • Students, to doctor: "Shouldn't you wear gloves while you remove these staples from a scabby infected surgical wound?"
    Doctor: "Oh, that's right. Do as I say, not as I do."
    We've turned our doctor into a hand-washer. We never used to see him washing his hands

  • Vitum, interviewing patient: "And did you experience any other pain after that?"
    Patient: "No, none."
    Doctor, to patient: "Tell Vitum the truth."
    Patient: "What?! I am telling the truth."
    Doctor: "No, you're NOT. (almost shouting) Tell him."
    Vitum: (shocked)
    Patient: "Oh, that's right, there was this one other time..."

  • Vitum, trying to show off his stunning powers of observation: "Why does our preceptor have a painting titled Porcupines Mating on his wall!?"
    Kristine: "It says Porcupine MOTHER"
    Vitum: (to himself) "I need to wear my glasses more..."

  • Preceptor (to patient): "Dr. Vitum will see you now"
    Vitum (to Kristine): "Did he just call me

  • Preceptor (to patient): "Vitemme will see you now"
    Kristine (to Vitum): "Did he just call me a female version of your name?"

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    Tuesday, April 17, 2007

    Overwhelmed much?

    Finals are about six weeks away, and I'm already feeling the heat.

    Let's just say that despite the slow start to the semester, last semester's finals was the most intense academic gauntlet I've ever been through, and it was on material I was familiar with, a lot of which I had seen in my undergrad. It involved being closed up in a study room, immersed in my studies, from wake to sleep, for about three straight weeks. I hate study rooms, and got through undergrad without having to use them much, so for me to do that is a feat in itself.

    This semester is going to be a different story.

    This semester, we have an extra five weeks of school covered in finals, all material that I have never really covered before. The weeks we have had have been much more intense and involved a lot more information than last semester. We have also had significantly more clinical skills instruction, as well as a course in pathology that we didn't have last semester.

    We will have finals in:

    • clinical skills
    • family practice
    • infectious diseases
    • cardiology
    • fluids electrolytes renal genitourinary
    • pulmonary

    as well as three extra finals:

    • histology
    • pathology
    • anatomy

    as they relate to the above finals.

    Oh, and one ten-page essay. Okay, that could be worse, but have pity: it has to be about relating a medical condition with the social aspects. What, since when do patients have a social side to them?!?! This will be hard for my science-based mind to wrap itself around!!

    Yep, feelin' the heat. Good thing I find most of it fascinating.

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    Sunday, April 15, 2007

    The day we'll all never forget

    Susan and Marcus are very different people.

    They’re different ages, they have different hobbies, and live in different cities.

    They have likely never met each other before, and they probably never will.

    But today, suddenly, they both had a few things in common.

    They both woke up thinking it was going to be like any other normal day. They both soon realized how wrong that was – instead, they both had a day they’ll never forget.

    As well, they both sat inside an air ambulance beside a first-year medical student as they were airlifted to a downtown hospital.

    That’s right, I finally had another chance to shadow air paramedics again, and this time, it was unbelievable. We took calls from the moment we began our shift until the very end. It more than made up for the last time I shadowed, which involved sitting in the station for twelve hours straight and was just about as exciting as watching the Montreal Canadiens stumbling attempts to set up a defensive hockey play.

    Susan woke up with the back pain that she had felt since New Year’s, but for some reason today it just wouldn’t go away. She took some more of her prescription pain meds. Nothing. More pills. Nothing. “Honey,” she said to her husband, “can you drive me to the hospital?” The nurses there realized quickly that no matter what they threw at Susan, her pain wasn’t going away. They checked on her throughout the morning, and faithfully charted her pain levels: six out of ten…9/10…8/10…20/10, defying the constellation of pain medications that were being pumped pretty much non-stop into the veins in her arm. When the doctor came to see Susan, he thought she could be suffering from a crushed vertebrae, a tumour pressing on a nerve in her mediastinum, or perhaps even the rare possibility of an aortic aneurism or dissection. It was past time for Susan to get some medical imaging done. In the big smoke, no big deal. Out here, though, well…impossible. In a rural centre like this, a CT scan wasn’t an option. Susan had to be sent somewhere where it was. The doctor picked up the phone and called for a helicopter, and we came and took her to the imaging machine that so many people, unlike Susan, have such ready access to. I felt bad as the paramedics resisted Susan’s husband as he begged to join her on the helicopter. I knew I was taking his seat.

    Marcus woke up sad that the first camping trip of the summer, an early one, was coming to an end. The weekend had been perfect – great fishing, canoeing, beer drinking and quality time with his four best friends in the whole world - they’d grown up together, and did everything together. As they were driving home together, though, the driver lost control, destroyed a van carrying a young family, flipped over and over and ended up in a ravine. Three of his friends joined two little girls in the minivan who went straight up to heaven the instant the vehicles hit. When the ambulance got there, they paged the helicopter right away, as well as the community’s only trauma doc, a board-certified general practitioner and an experience-certified specialist in everything. The doctor struggled to get Marcus intubated as the ambulance raced to the soccer field at the edge of town, where a police officer had put out some orange pylons to set up a crude landing site, and radioed the coordinates to the incoming helicopter. We touched down, blowing over the little pylons, and quickly got the patient transferred into the chopper.

    As the helicopter blades sliced through the air and we quickly gained altitude, I looked out the window and watched the two fire trucks and two ambulances, representing most of this small town’s emergency resources, form a convoy back into the town. The smell of the patient’s vomit quickly filled the back of the helicopter. The paramedics worked to start an IV and keep his vitals stable, and when we finally landed, we went from the helipad down the elevator to the emergency room where I watched the waiting trauma team spring into action. The flight paramedic called out the details of the crash, then the resident went through a full-body assessment of the naked victim, surrounded by a respiratory therapist setting up the ventilator, the X-ray techs setting up films, a lab tech taking blood, a medical student ogling, an attending doctor overseeing, a nurse hooking up monitors, and another nurse writing down the details the doctors shouted out.
    I stood, my back against the wall, for the first time realizing what “fingers and tubes in every orifice” actually meant as a foley went in, a doctor checked for bleeding from the ears and prostate, and vomit and air fought for the right to use the mouth or nose as an entry and exit point. The last I saw of the patient was when they took him to get his head CTd, apparently something doctors like to do when the side of the head looks like a giant bruise and feels like mush.

    These were just two of the cases that I saw first hand today. Overall, we flew four separate patients – two transfers, two traumas – went to five hospitals, worked two hours extra beyond what should have been a 12-hour shift, and spent more than four hours in flight. For me, it was a dream come true. All the money in the world couldn’t have bought a non-stop action-packed day like that. The experience was outstanding, the paramedics were so hospitable and so glad to have me join them. It was a day I would never forget, and I’m going to spend a some time this summer once school settles down not only accepting the paramedic’s invitation to come back, but also looking for places in North America that train and hire helicopter physicians.

    As fantastic as an experience as I had, it was bittersweet. Sitting right beside these patients whose lives have been immeasurably affected was sobering. It’s likely that two – possibly all four – of the patients I met today will be dead within a week. Even if they make it, though, today will be a day they’ll never forget, either.

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    Friday, April 06, 2007

    People in class that I admire

    We recently completed a survey of our class, which turned up some interesting statistics. I knew already there were a few people that I really looked up to, and have written about some of their accomplishments in the past (including some who are Olympians, politicians, media pundits and more), but after reading the survey results, I now know there are a lot more. Here's a few:

    • The people in my class who took the MCAT more than twice (my worst nightmare).
      9 people.

    • The people in my class who applied to medical school more than 3 times.
      38 people, including 4 who applied 5 or more times. Wow... that's persistence.

    • The people in my class who are responsible for balancing med school studying and classes like the rest of us, but on top of that, have children and are responsible for cooking for their family, helping their kids with homework, and playing chauffeur mom or dad to soccer and dance lessons.
      10 people.

    • The girl in my class who continued to come to class even though she was 9 months pregnant - her water broke in class, in fact - and she proceeded to return to class two days after her baby was born. The faculty gave her the chance to take a year off and resume classes at this point next year, to which she responded, "Maternity leave, shmaternity leave." Talk about a trooper.

    • The people in my class who have husbands or wives in different provinces and are doing a long-distance marriage for a few months until their significant other can move to where our school is.
      Not sure how many people. A number of the long-distance relationships ended because of the distance... the marriages, from what I know, are still holding on strong.

    • The people in my class who have >$50,000 in debt already.
      8 people.

    • The people at the opposite end of the spectrum who had full-fledged successful careers going, and left those careers knowing that they could make a bigger difference by taking a pay cut and becoming a physician.

    • The girl in my class who earned the 99th percentile for her MCAT scores.

    • The people in my class who have the nerve to e-mail our class president or faculty about problems rather than approach individual students themselves (this is my sarcastic portion of the entry, which deserves a post in itself...maybe another time).

    • The girl in our class who just earned her Canadian citizenship.

    • The girl in our class who could have gotten into medical school in a European country "by sending in an application, transcript, and a bribe," but instead came to North America where bribes don't get you into medical school (at least we like to tell ourselves that).

    • The guy in our class who is a fully-qualified medical doctor in Russia, but found out that it would be easier to get licenced in Canada by re-taking medical school. That's commitment.

    • The government (ok, another sarcastic entry here, I know the government isn't in my class but anyways...) who decides to allow a fully-qualified Russian doctor to jump the queue for immigration to Canada, but doesn't let him qualify in Canada even though he is entirely competent (more about this here).

    These are just a few of the incredible people that I am surrounded by. What a privilege.

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    Sunday, April 01, 2007

    End of an Era... Goodbye, Medicine

    My time in medical school has had a lot of ups and downs, both academically and with a number of personal issues, and over the past month or two I've had to put a lot of long, hard thought into whether or not a vitum medicinus (a life of medicine) is really right for me.

    After hours of self-contemplation, a number of discussions with faculty members, the Dean of Student Life, and even the dean of my medical school, I've finally jumped through enough hoops to officially withdraw from my medical school program.

    So many hoops - it's not easy getting in, and it's even harder to get out, especially when the government contributes to so much of our tuition!

    I haven't talked to anybody else in my family or friends about this. Please don't be offended if I haven't consulted you about it - it's a decision that I have had to make for myself. Obviously, so many people are going to want to know why so I thought it would be easier - and more fitting, perhaps - to put my thoughts here.

    I've decided to abandon the dreams for a few reasons. I've had a rollercoaster of a personal life over the last several weeks, including the rough end to a couple of romantic web-based relationships and the accidental death of my beloved pet turtle Spencer, who helped me realize that my dreams of going into medicine were just an outside shell and didn't show who I truly was inside (In lieu of flowers, please make donations to the Canadian Cancer Society). I clearly don't know much about medicine yet, and learning by trial and error is probably not the best way... apparently three Advil is way too much for my turtle with a headache.

    The medical program has become difficult for me to handle as well. Aside from a couple of
    bad experiences, we learn so many secrets from the lives of patients that it just becomes difficult to keep them all. Going to class with dental students is just too confusing for me - I can never tell if the extra points they throw in about tooth health are things we med students need to know, or if it will just be relevant to the dentists. And, already, all of my friends are asking me about their nasty conditions, and I don't know the answers yet. Besides, who's to say that in four years, that I'll be able to help them? What if I make a bad medical decision when I'm treating a friend and they end up like Spencer? I couldn't handle that guilt.

    And I haven't even really been fitting in with my friends at medical school. The few people I have gotten to know don't really seem to like me that much, and on the whole, I haven't really been accepted by everyone else. Everyone seems to be way more
    driven and intelligent than I am. Group studying is more like 'make Vitum look stupid' time, and even at lunch their little reindeer games of 'name the capital' or 'name the cofactor' really exclude me. Heck, their IQs are all at least 65.

    As well, a few other factors completely irrelevant to medical school have come into play; struggling to afford the escalating price of gasoline; frustration with the leaders of the United States, Iraq, and Luxembourg; and the ever-mounting tension of whether or not the Toronto Maple Leafs will make the playoffs.

    So what's next for Vitum? Not sure, really. I'm making arrangements to travel home and spend some time with my family, and also take a trip to a few places in the world that I've really wanted to visit - Australia, Brazil, Ireland, and Oz. Hopefully during that time I'll come up with something that better for me to do as a career. I'm considering something along the lines of writing for my local library's monthly children's newsletter, becoming a skyscraper window washer, or maybe just running off to the jungles and living free with the friendly animals. But for now, it's time for me to hang up my barely-used stethoscope and ceremonially burn my white lab coat.

    Thanks so much to everyone who has read this blog. Check back in a few days and hopefully I'll have one or two final medical stories that I've been waiting to write about.

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