"[Until I read blogs written by physicians], I had no idea what it was like to be a physician."
Who would probably NOT say something like this:
a) A blogger who is a pre-med student 2 years away from medical school
b) A blogger who has been a nurse for 28 years
c) A blogger who is a patient that has suffered from a chronic condition for 3 years
d) A blogger who is an average, healthy 32-year-old female.
Did you choose B? I sure would have.
So you can imagine my shock when I read that quote on the high-quality Emergiblog, authored by a nurse of 28 years. Of all the people in this world beside doctors themselves, wouldn't you assume that nurses would the ones who understand doctors the best??
Sure, everyone knows that there is a varying level of disconnect between the two professions, but for being someone who has worked alongside doctors for nearly three decades you'd think she would understand what doctors are like.
It's great to see, then, that maybe blogging could be a tool for breaking down the walls between health care professions.
Unlike perhaps many medical students and doctors, I've got a soft spot for respiratory therapists, nurses, hospital security guards, and naturopaths, all because I've gotten to know some personally both before and after they entered their professions. Once you realize they're people too, people that you respect, you're much more inclined to respect their profession and look more closely for what they have to offer. Reading what they have to say, on blogs for instance, can help you towards that realization.
If reading blogs written by people in different health care professions helps us understand them more, then why couldn't that be one more step towards truly working together as a team.
PS - I think it's impressive that she would write that reading doctor's blogs has helped her "appreciate" physicians more than ever, especially considering how much crap nurses generally take from some doctors. Nice to see someone who has been in the profession that long who can still write things that are not bitter & jaded, when it's almost certain that over the years she has had to deal with more than a few doctors who haven't appreciated her as much as they should.
Saturday, June 30, 2007
"[Until I read blogs written by physicians], I had no idea what it was like to be a physician."
Friday, June 29, 2007
- "This is what an cardiac electrophysiologist looks like."
Spoken by a lecturer, showing a photograph of a man in scrubs
- "Clean, neat appearance engenders trust."
Somewhat important for patient care.
- "Demonstrate an active interest in the patient."
Even if they're REALLY boring?!
- "The physical exam begins the moment you enter the room. Note the following things: gender, ..."
Spoken by a professor
- "Thank you for your attention and respect. Last year, a student threw a paper airplane at me during lecture."
Spoken by a professor at the end of a lecture. He was serious, and he was not impressed when it happened.
- "Would you all SHUT UP?!"
Spoken by a student, to the entire class, who apparently did not agree with the perspective of the above professor
- "The only way you could get kicked out of medical school is to bring a tommy gun to class"
Spoken the dean of another Canadian medical school, recounted at two separate times by two separate people
- "We're paid to be scared."
Lecturer talking about treatment of Congestive Heart Failure
- "Maybe the reason the basketball hit him in the scrotum is because he just had big nads?"
Pathologist, trying to explain why a patient attributed his testicular cancer to being hit in the... ahem... 'nads.'
- "When you refer your patient to the urologist, you better explain that they're going to get a gun shooting all sorts of needles up their butt."
The same pathologist, demonstrating yet again that pathologists don't need beside manner since they have no patients.
Wednesday, June 27, 2007
The thing about medicine is that once you're in it, it's pretty hard to get away from it.
I started this blog over a year ago (and clearly forgot to celebrate its anniversary with fanfare of any sort), and evidently even at that tender naïve age I was aware of that fact. Enamored, actually, you could probably say. I knew that it would happen, and I was actually excited about living every moment enriched by my training in the medical sciences, making a difference in people's lives everywhere I went, breathing and living a life of medicine. I even used that phrase to name my blog.
Boy, was I delusional.
Okay, it's not that big a deal...yet. But it is happening. Here's a story to show how medicine has pretty much taken over my thoughts and day-to-day existence.
On the plane on the way to a much-appreciated vacation last week, I got up to use the restr (those little rooms far too small to be called 'restrooms') and, wouldn't you know it, I ended up getting trapped by the beverage cart. The stewardesses had apparently taken the lighting of the final "Restroom Occupied" light as their signal to block the aisle with their large metal goodie-carts-on-wheels. They hid their glee well behind their powdered faces, perfectly poofed hair, and polyester neckerchiefs, but I could tell they were pleased with themselves and their strategic timing.
This left me stranded in their little lair at the back of the airship. I thought about popping the emergency door to get back at them (those slides look like a blast), or raiding the "Buy-on-board" cabinets when they weren't looking and stuffing my pockets with tiny liquor bottles and crusty sandwiches, or even worse, tampering with the smoke detector, but was prevented by the presence of another passenger back there, so instead I decided to talk to him instead.
"Stranded back here as well?" I asked him.
"No, actually, I've actually got arthritis and am just kindof moving around a bit so I don't get too stiff."
I replied, "How long have you had arthritis?"
"Are you currently on any medication for your arthritis?"
"Are there any factors that make your arthritis worse or better?"
"Are you frightened in any way by your arthritis?"
"Does the pain wake you up at night?"
"On a scale of 1 to 10, where 10 is the feeling of getting your eyeballs and fingernails ripped out by tiny monkeys and having scorpions invade and subsequently sting every orifice, how bad is the pain?"
And, remembering the latest research, I made sure not to tell him about my experiences with arthritis.
Actually, I didn't say any of those things. But in all seriousness, all of those questions did flood my mind, as if I was back in my OSCE again and had to think quick of something to ask him.
So, instead of carrying on a normal conversation, I was forced to wait for the storm of questions in my mind to quell, and in that time I only managed to blurt out something awkward like "Oh, that's good."
I then got to stand there uncomfortably with him while realizing that I apparently can't carry on a conversation without my med school training trying to take over.
Oh well, it's not like something like this won't happen again. In fact, it has happened to me before. And wait until I provide the list of foods I have trouble eating now, thanks to medical school.
Wednesday, June 20, 2007
Here's a little something I began writing in the midst of finals.
Even though I love med school, and I'm glad that I'm a part of it, and I'm excited to become a doctor, and it's a dream come true... there is such a thing as "too much of a good thing."
Just picture a dump truck full of your favourite ice cream pouring its load all over you (or "pancakes every morning").
That's what med school is like when things get intense...
you remember liking it way back when,
you know you worked hard to get there,
and yet you still feel like it's taking over you, drowning you, going to kill you.
It's nice to be in my summer break and back to enjoying the dump truck load of ice cream from the sidelines, and not drowning in it.
Jail: Several hours a day spent in a 9' x 9' cell with small windows, where you sleep as well.
Medschool: Several hours a day spent in a 9' x 9' PBL room, where you sleep as well during naps and finals.
Jail 1, Medschool 0.
Jail: You get to leave early if you display good behaviour. If you misbehave, you stay the full length of your term.
Medschool: You don't get out any earlier if you display good behaviour. If you misbehave by acting unprofessionally, you stay longer (repeat a year.)
Jail 2, Medschool 0.
Jail: You have to do something pretty horrible to get in (kill a person, rob a bank, etc.)
Medschool: You have to do a lot of pretty horrible things to get in (MCAT, applications, interview, etc.)
Jail 3, Medschool 0.
Jail: You meet cool people, like folks who know how to draw tattoos, make crossbows out of toothbrushes, and survive a jail brawl using a cafeteria tray as a riot shield.
Medschool: Over 99% of the people you meet can do none of the above things.
Jail 4, Medschool 0.
Jail: Nobody bats an eyelash if you're a little rude to somebody.
Medschool: You have to take a class on being nice to people, which only makes you want to be more rude to people, but you're not allowed. So, you secretly live vicariously through a certain Dr. House.
Jail 5, Medschool 0.
Jail: Regular conjugal visits (or so I learned from the movie Office Space)
Medschool: No regular conjugal visits.
Jail 6, Medschool 0.
Jail: No homework.
Jail 7, Medschool 0.
Jail: If you don't like something, there's nobody to talk to, so it won't get changed.
Medschool: If you don't like something, you have to search amongst the bureaucracy to find out who to talk to, and once you do, it still doesn't get changed.
Jail 8, Medschool 0.
Jail: The feeling of freedom when you leave is like none other.
Medschool: The feeling of freedom when you leave is pretty great, but it's overshadowed by the feeling of having to start residency.
Jail 9, Medschool 0.
Jail: You're surrounded by people who never wanted to be there.
Medschool: You're surrounded by people who competed to be there and are starting to question why they are there.
Jail 10, Medschool 0.
Jail: Physically violated by other occupants in unimaginable ways.
Medschool: Mentally violated by faculty by means of meter-high stacks of textbooks and notes to memorize...in unimaginable ways.
Jail 11, Medschool 0.
Jail: When you complete a jail term, people don't want you in your neighbourhood.
Medschool: When you complete a medical degree, people would love to have you in their neighbourhood.
Jail 11, Medschool 1.
Jail: When you find a job once you're out, people avoid you.
Medschool: When you find a job once you're out, you get called by people at all hours of the night.
Jail 12, Medschool 1.
Posted at 22:51
Saturday, June 16, 2007
...Continued from Preliminary Thoughts on Interdisciplinary Health So would I go see a chiropractor or a naturopath or a DO? Right now, probably not. Would I recommend patients see one? At this point, I don't think so. Based on my impression of them (admittedly based on anecdotal comments and impressions from friends) I haven't been convinced they do more good than harm. But would I recommend against a patient seeing one, or try to stop a friend from going to see one? Nope. I might pass on the paraplegic story, but I'm not against people finding what works for them, and I haven't been entirely convinced that these other practitioners do more harm than good. And if my smart friend is convinced enough about naturopathy to pursue a career in it, there's gotta be some merit to it. Like I said, while the conceptions I hold now may be misinformed or even grossly incorrect, I do believe there's value to be gained from interdisciplinarity, and I consider myself open-minded and willing to change should I be proven wrong.
For interdisciplinarity being the newfangled wave in health care, throughout my time in hospitals and med school, I sure haven't gotten the sentiment that it's put into action very much.
After reading my previous post, my naturopath-student buddy asked if I'm for or against interdisciplinarity. I want to be clear: I'm not against it at all; I think that there's a lot to gain from it, if implemented properly ... i.e. not in the forced way described by the "Anonymous Therapist" commenter on my previous post.
My point is simply, I haven't seen much interdisciplinarity in action or even in theory at this point in my medical training, despite its lauded usefulness.
In fact, even though I'm only less than a quarter of the way in, to date I've felt the sentiment actually leans toward the opposite, almost against interdisciplinarity. I haven't felt much like we're being told to consider all those other professions as peers, equally-valuable limbs and body parts of the conglomerate, undoubtedly creepy-lookin' monster that is the health care industry. Can't function without the others, you can't live without one body part, so the interdisciplinarists might say (I'm abusing that word, aren't I?).
So how might the average medical student who has gone through the same training I have respond to this equal-value-body-part-organism metaphor? They'd probably say, "hey, you can actually live without some body parts. Naturopaths - they'd be the tail! Better off without 'em. You don't need a tail. You can function just fine without one. Humans, the smartest beings on earth: no tail. And we're better off for it...even the dumbest of us can't run in circles chasing it, which makes them look smart, because some people I know probably would chase their tails, if they had one."
Note that I said the average medical student - again let me point out this is not my opinion. In all honesty, I do feel myself and my profession could stand to learn some things from her and her profession. What I am talking about is the sentiment that I've felt to this point in medical school. Given the lack of interdisciplinary discussion at this point in our training, I wouldn't be surprised if a good number of my classmates thought like this.
Where do I get this impression? Experiences like, say, the time when one of my professors actually mentioned naturopaths directly in one lecture: "Sprinkle some herbs over a bunch of white beads and give that to a patient to eat? How will that help the patient?!" Yep, interdisciplinarity in action. That's what we've learned about naturopaths to date in medical school. And you wonder why some doctors look down on naturopaths.
Chiropractors? There's a whole other topic. Based on how some of my colleagues view chiropractors, in this organism of equally-valuable parts they'd rank chiropractors as, say, the appendix (ie. another organ of no known usefulness). One med student asked me, "How come chiropractors get to call themselves doctors?" Clearly subtle hints of superiority are more than evident in that statement. Another med student told me about her experience volunteering in a rehabilitation ward, and told me, "I was shocked at how many of the patients there were rendered paraplegics because of a chiropractic adjustment." Not a shining commendation by any means.
Moving away from hearsay: my limited experience with chiropractors, when I accompanied a friend on an chiropractic visit, was that the adjustments were very much aggressive, near-violent; and the doctor was very much like a salesman, near-slimy. My honest opinion of them, however, is I have yet to see first-hand any harm they have done, and I have read testimonials saying that they have made a huge positive difference in some patient's lives (but so have miracle healers...hmm).
And what about the ol' D.O., or Doctor of Osteopathy? Thanks to ads at test-prep courses and in pre-med literature aimed at pre-professional students and mostly worded along the lines of "Have you considered D.O.?" (which actually come across as "Hey eager pre-med student, have you considered D.O. as a backup plan should you be too dumb to get into med school and yet still crave the feeling of being called 'doctor?'") an impression of this profession among medical students as being a profession for pre-meds not smart enough to get into med school might be understandable. Fortunately, in a random encounter starting a conversation with a stranger on a park bench in London last year, I have met a D.O. student and know that to not be true.
D.O.s claim that they are another type of doctor, "equal to M.D.s in the eyes of the law." So why aren't D.O.s mentioned in medical school then? Maybe it's just because I'm in a Canadian medical school, but I think there's more to it than that...
Would my preferences change if I were taught the merits and capabilities of these professionals and believed that evidence showed they are medically indicated and make a significant positive difference in certain conditions? Definitely.
The thing is, at this point, I haven't had the chance to go look up this evidence on my own. Not because I'm lazy, but because I've been too busy learning the things my medical has deemed important... and this isn't one of those things. But supposing I take the initiative to look this up on my own; what about the other students in my class? How will they know what to think about chiropractors and naturopaths and DOs other than what they've heard from their friends or seen on YouTube? Hopefully you can see why I think that training future doctors should involve discussions about these other healthcare professionals, because I do think that medical professionals have a lot to gain from an interdisciplinary mindset and from each other.
I honestly hope that my school starts touching on these other important parts of the health-care profession as I proceed through the curriculum. But if med school keeps on going the way they've been going so far, and don't explain to future doctors what each of these other healthcare professionals do, "interdisciplinary health care" will just be another Utopian ideal with no manifestation in this world... another untapped gold mine.
So would I go see a chiropractor or a naturopath or a DO? Right now, probably not.
Would I recommend patients see one? At this point, I don't think so.
Based on my impression of them (admittedly based on anecdotal comments and impressions from friends) I haven't been convinced they do more good than harm. But would I recommend against a patient seeing one, or try to stop a friend from going to see one? Nope. I might pass on the paraplegic story, but I'm not against people finding what works for them, and I haven't been entirely convinced that these other practitioners do more harm than good. And if my smart friend is convinced enough about naturopathy to pursue a career in it, there's gotta be some merit to it.
Like I said, while the conceptions I hold now may be misinformed or even grossly incorrect, I do believe there's value to be gained from interdisciplinarity, and I consider myself open-minded and willing to change should I be proven wrong.
Friday, June 15, 2007
Guest-written by my classmate Jay...used with permission, of course. I don't just steal things off my friends' Facebook profiles without asking!
1) I now get annoyed when conversations, even daily conversations I have with family and friends, aren’t quick and to the point, and last longer than 8-10 minutes.
2) The only treatment for a muscle injury is nothing.
3) A patient will not fully disclose the information you inquire about until after you’ve asked, re-phrased, asked again, re-phrased again, and then asked while cocking your head slightly to the side in a conscious gesture of interest... I call it the power-cock.
4) Prednisolone is Snoop Dogg’s prednisone.
5) On a scale of 1 to 10, 5 is not firm enough to penetrate.
6) Even for $14,000 per student, a well-thought-out curriculum and well-taught lectures aren’t guaranteed.
7) Foosball is a cunning game of skill, agility, dexterity, and mental steeliness.
8) Short white coats do two things: they instantly identify you as a clueless rookie… and, they make kids cry.
9) The one time you fake it and say you can hear a bruit or murmur, the clinical instructor will say that there isn’t one.
10) Med school is nothing more than just really hard school.
Update: Jay wrote another list at the end of second year.
Thursday, June 14, 2007
"Research is a real problem. Doctors just make up the data. They don’t report negative side effects, no question about it."
Someone at New York magazine had a brilliant idea a few weeks ago.
"If I ask a bunch of doctors a bunch of questions," they pondered, "but promise them anonymity, just think all the great dirt I'll be able to print! They'll be so straightforward and honest, I'll be one of the few people on earth to know what doctors really think."
Someone at New York magazine seems to have forgotten about the medical blogosphere.
Every day, countless doctors rant anonymously about the dirt that goes on in hospitals. They just happen to do so in the form of blogging.
But someone at New York Magazine ended up doing the interview, writing the article, and hey, it got published. How Comrade found this article in the New York magazine online four full days ahead of print, I'll never know, but thank him, since you'll probably find it quite interesting.
Selected highights, my smartass comments in italics:
- Why you have to wait so long in a doctor's waiting room.
It's because you are not the doctor's only patient.
- Doctors make up research data.
Did you know that 86% of statistics you hear are made up on the spot?
- The way we train doctors now is worse than it used to be, because the residents who do surgery on patients are now allowed to do surgeries after they have had time to sleep.
Yeah, you'll have trouble convincing me of that one. Say it with me: "Old-Boy's-Club."
- Patients have to wait for 45 minutes after they press the call button, not because nurses are standing around chatting, but because there's a nursing shortage.
Hmm, so it's not just in Canada, eh?
- Doctors think that "By virtue of our training and knowledge, we can get away with... treating patients like shit."
Strange, it took me only one year's worth of med school finals to get that feeling. At this point, I call it self-respect. Three more years of this and you'll probably call it me being an asshole.
- A doctor admitted to dropping a baby once.
You think that's a big deal? Read the next one.
- Doctors feel powerful when they've killed somebody.
I told you you need to read this article. Here's the link again.
After reading that article, I'm surprised that even at my early stage in the game, a lot of it I could have told you. A good chunk of it is, in fact, common sense. Think about it. Doctors like seeing patients that don't yell at them. Surprise. You have to wait in the waiting room for a long time because, well, doctors are seeing other patients. Surprise again.
But there's one thing that I'm surprised they didn't mention. It's...wait a minute, what? you want my opinion?
Sorry, but apparently in training for making a living by, well, mostly giving my professional opinion, it's been made abundantly clear that I am not to provide medical opinions of any sort. Not even to a friend who asks about their cold. Or growth. Or whatever.
Of course, I'll give you my opinion anyways. That's what this blog is all about. But here, I'm protected by my fancy disclaimer at the bottom of this page. Yeah, it probably provides little more protection than did those fancy flying-squirrel-like jumpsuits that early would-be aviators donned before jumping to their deaths, but at least it's something.
So here's what I think. I'm surprised the article didn't ask any of the doctors their take on the "interdisciplinary health team" that everybody is talking about.
I was talking about this interdisciplinary health thing with a nurse friend of mine the other day. I was going with that old joke that I find so funny (that no nurses see any humour in at all), telling her, "I can't wait until I've graduated med school so I can boss around nurses." (That is NOT how I will approach nurses on the wards...trust me, I know better.) But after we got back on speaking terms, we got into this talk about interdisciplinary health care - a concept that is very interesting, considering how little of it I've heard in my med school curriculum.
Medicine these days is supposed to involve all "health professionals" on an "equal playing field" - doctors, nurse practicioners, nurses, licenced professional nurses slash registered practical nurses (depending on your geographical location), respiratory therapists, physiotherapists, occupational therapists, chiropractors, naturopaths, quack cure-all syrup salesmen... (uh, in no, particular order...I swear...), all working together in perfect harmony like oompa-loompas churning out everlasting gobstoppers. If that's the case, though, and if it's the new wave, how come I haven't been taught that yet in medical school?
But that's another story for another day - I have a rant on that waiting in the wings...to be continued.
Click here to read the continuation of this post.
Sunday, June 10, 2007
Oh wait... it won't.
During finals, a friend in my class told me that this was about the highest level of stress she has ever been through.
She wasn't the only one. I saw a few people crying in the halls before finals, and had to handle the odd late-night telephone call with a sobbing classmate on the other end of the line.
"I can't believe this," she told me, apparently asking for help finding the end of the tunnel. "The second-year students are done already, so second year can't be much harder, can it?"
"Actually," I replied, "I hear second year is a lot harder. At least we had one final out of ten where we had the feeling we had studied everything. Apparently, that feeling goes out the window for even the anatomy lab final next year."
"Well, once we get through that, it will be great to get to third year. We'll actually be doing medical stuff and won't be in classes any more."
"Uh, well, from what I've heard, third year does have lectures in it, in addition to being on the wards more than full-time. And, you have to write finals for each rotation that are standardized across North Amercia."
"Well, at least after several weeks working through, say, surgery, you'll know the information inside and out."
"Actually, I think that you can't be guaranteed to see everything in your rotation that will be on the test. So, for most of the stuff you need to know for finals, you need to study from books on your own, between seeing patients, between lectures, and between being at the hospital full-time."
"Huh... wow... well, at least.... at least you're only doing one final at a time.... just surgery, or just ob/gyn, none of this infectious diseases and cardio and renal and pulmonary all in just a few days."
"Yeah, I suppose, but what if you're in your emergency rotation and in comes a 76-year-old smoker with COPD (a chronic respiratory disease) who has a blood creatinine of 1800 (likely kidney failure), who is short of breath due to an acute exacerbation of congestive heart failure (uh, clearly a cardio problem)... and has S. aureus sepsis (you guessed it, infectious diseases)?"
"You're not helping."
Added 15 June: I was talking to a doctor the other day who described third year like this: "You get thrown into it and are just like 'WOAH - I've learned more in my first four weeks of third year, than in my entire last six years of university.'" Scary.
Saturday, June 09, 2007
"I don't know what to do with myself," my friend said over the phone the day after finals. "I don't have anything to go study."
He was serious. I felt the same way.
"Maybe I'll go read some second-year Anatomy," he offered.
Not an option, I told him. We met up, and proceeded to go to the beach and fall asleep on the sand. Then, when my parking ran out, we moved to another beach, and, well, fell asleep there, too.
That's right - I spent over an hour doing something other than studying, and was able to enjoy it. No thoughts of panic. No feeings of guilt.
My last couple of days have involved:
I start work on Monday, researching and writing Internet-based educational materials for a couple of emergency medicine docs. It will be nice to have evenings off, and to catch up on the countless posts and ideas that I've had for the blog. And July 17, well, let's just say I've got a bit of a surprise coming up. Stay tuned.
This summer should be fun. And relaxing.
Ahh, relaxing. Haven't done that in a while. Excuse me while I get back to it.
It's good to be done.
Friday, June 01, 2007
With this whole studying for finals thing going on, especially now that classes are over and I am leaving my study books at school because all I do at home is sleep (and I wonder why I go all the way home just to do that - why not sleep on the clinical skills practise beds!), I feel like I've been fairly disconnected from my family, my friends outside of med school, and heck, even a large number of my med school classmates that choose to hole up in a study room other than my own.
Turns out I'm not the only one that feels this way.
In a rare study break opportunity, when my attention-deficit was getting the better of me, I turned to a friend in my class that I was studying with... we'll call him Eaglestar (hey, again, as is my policy with classmate aliases - he chose his own), and asked him about his son, who was just born a couple months ago.
"Hey, Eaglestar, how's your son doing?"
He lifted his shoulders in the air.
We all had a good laugh about it, but we probably should have been crying. In fact, I've decided that anybody in my class that I see smiling is simply neurotic...there is no joy right now!
Yep, guess I'm not the only one who feels disconnected from anything not med school.