Saturday, September 27, 2008

The curse of the medical student on obstetrics

Number of babies delivered on Monday and Tuesday morning while I was scheduled to be in the obstetrician's office: 9

Number of babies delivered on Monday and Tuesday afternoons while I was on the ward waiting for deliveries: 0

Number of babies delivered on Wednesday when I had been scheduled for a day of looking at rashes with a dermatologist: 6

Number of babies delivered on Thursday when I had been scheduled for academic sessions: 5

Number of babies delivered on Thursday night and all of Friday when I chose to give up sleep and instead sit on the ward in order to assist with some deliveries: 0

Plan to increase the number of deliveries for my second week of Obstetrics: Release prostaglandin into the city water supply, show up at the hospital, and wait. (For those who don't know, prostaglandin is used to induce labour)

I did get to see two c-sections, including an emergency one at 3:00 am for a prolapsed umbilical cord - very intense - but so far, no natural deliveries here.

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Friday, September 19, 2008

When patients try to fool doctors - four interesting types of fakers

Most people have heard of Munchausen's syndrome, a fascinating condition in which patients try to fake a condition in order to draw attention or sympathy.

There are a few syndromes that doctors need to keep in mind, some of which are quite fascinating, in which the patient tries to fool the doctor for various reasons. Here are some of those conditions, how the patients fool the docs, and how the docs avoid being fooled.

1. Drug-seekers

What are they

In a sentence, the bane of any ER physician's existence. They're either addicted to pain meds, or obtain and fill prescriptions then sell them on the street to addicted people for a huge profit.

How they fool doctors -

Drug seekers can be very slick. I have seen a patient had another doctor vouch for them, one who wore their full police uniform, an adorable 80-year-old church organist, and even nurses and doctors ... all of whom were found to be getting prescriptions for pain medications and selling them illegally.

How doctors recognize them -

Besides being highly suspicious of any patient who asks for narcotics, some regions have databases that doctors can use to determine if a patient has filled a suspicious number of pain prescriptions. However, some drug seekers raise a lot of suspicion on their own. They'll claim to be allergic to every non-addictive type of pain medication, which is statistically unlikely. Others are just bad actors. They’ll shriek and cry at the lightest touch when a doctor pokes their back to find out which part hurts… then later, the doctor will give them a friendly pat on the back, and find that the supposedly painful spot no longer seems to hurt.

2. Malingerers and Insurance Hopefuls

What are they -

A "malingerer" is defined as a person who fakes an illness with the intention of avoiding duty or work. I'll lump these in with patients who fraudulently fake or exaggerate illnesses to try and get insurance payouts.

How they fool doctors -

Malingerers will seem to have a lot of pain, and some actually are suffering from very real pain. They use this, however, to prey on a doctor’s empathetic side. They can also be quite convincing actors when they demonstrate just how incapacitated they are.

How doctors recognize them –

By knowing the physical exams and anatomy very well, doctors can get suspicious if the results of a few different tests of the same joint or muscle aren’t consistent. Some malingerers, though, can be fooled quite easily. Even I have had my suspicions raised with a patient who struggled to raise her arm a few inches when I asked her to demonstrate her range of motion. When I then asked her to show me how high she could raise it before her accident, she effortlessly shot her arm up high above her head!

3. Psychogenic nonepileptic seizures

What are they –

This is a term for people who appear to be having seizures, but it turns out that they are actually not suffering from epilepsy – for various reasons, they’re faking the seizures.

How they fool doctors –

Anybody in a doctor’s office or emergency room who is having what appears to be having a violent seizure, will obviously get the benefit of the doubt. In fact, in some cases, it is many years of investigating and giving high doses of seizure medications before a doctor realizes that the patient has been having nonepileptic seizures the whole time.

How doctors recognize them –

Research has shown that nonepileptic seizures occur more commonly in a doctor’s office or waiting room, or when there is a witness around. Some medical textbooks suggest giving such patients a sugar pill or an injection of water while telling them that this medicine has been known to cause seizures, and seeing if the patient starts shaking. While this can seem deceitful, the lie isn’t usually necessary: some patients still have these fake seizures even if they are told that they are being given something that can induce both real and fake seizures. Other things doctors look for are things such as where the patients bite their tongues, which is often in a different location for real and fake seizures, and the length and frequency of the seizures.

4. False comas

What are they –

Hopefully I don’t need to explain what a fake coma is. I will mention though, that people fake comas for a variety of reasons. Some people with psychological conditions feel safe in a hospital, and fake a coma so they are surrounded by doctors and nurses. Others have been found to fake being knocked unconscious on a ski hill, because they can’t afford a bus ticket home and would instead prefer taxpayers pay for a helicopter to fly them to the nearest city.

How they fool doctors –

By laying very, very still.

How doctors recognize them –

While there are some non-invasive tests that can be done to determine if a coma is indeed real, sometimes doctors aren’t even trying to “catch” a fake coma when they do their neurological exam and find that some results don’t add up. Also, patients who appear to be in a coma but resist the doctor opening their eyes, or flinching when the doctor’s stethoscope swings close to their face, obviously raise suspicion. Obviously to determine legitimacy it’s important the doctor knows what is normal, because strangely enough, patients with legitimate comas have been seen to do odd things such as cross and uncross their legs.


It goes without saying that doctors need to be careful when they suspect such occurrences. If a doctor confronts a suspected drug-seeker, malingerer, false coma patient, or psychogenic seizure patient, this can result in a very upset and sometimes even abusive patient. Two sentences that I know of that have resulted in a doctor getting punched in the face by a patient: “For the last time, I am not going to give you strong pain medication,” and “This isn’t a real seizure!” Even worse, if a doctor is wrong, they will be withholding care from people who are suffering very real medical conditions.

That’s not to say, however, that these “fakers” don’t need help. While the financial gains for drug-sellers or insurance scammers are usually based on greed alone, people who are addicted to drugs, or feign comas and seizures, can have very real and complex psychogenic conditions (to give you an idea of how complex these conditions can be, some patients may not even be aware they are faking). While they can make a doctor’s work more challenging, at the end of the day all of these people do need real treatment – not with narcotics or anti-seizure medications, but with psychological counselling to determine the underlying reasons that are compelling them to fake these conditions.

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Saturday, September 13, 2008

Join me on my first on-call shift, and find out why I slept so little

For the future (and pre-clinical) medical students out there who are wondering what being "on call" is, I have just completed my first call shift. Therefore I am now a reliable source for information about what being on-call means. Here's how my night went:

5:00 pm ::: Start of on-call shift. On the phone with a friend in residency asking for some on-call tips. #1 tip: While on call, eat, sleep, and pee when you can. You don't know when your next chance will come.

5:21 pm ::: Fell asleep on the toilet while eating a granola bar.

5:36 pm ::: Woken up by a patient who claimed I was sleeping in his bathroom.

5:37 pm ::: Patient's claim corroborated by nurse, who is kind enough to explain to me what an "on call room" is, and where I could find it in the hospital.

5:41 pm ::: Changed out of my scrubs into pyjamas. Realized scrubs are more comfortable and changed back. Fell asleep.

6:12 pm ::: Woke up. The pager they gave me is making weird, loud beeping noises and has stopped showing the date and time. Now the display was just showing "911" and a few extra random numbers. Must be broken.

6:22 pm ::: Finally figured out how to make the pager stop malfunctioning and making such loud noises: take out the battery. Able to sleep again.

9:38 pm ::: Woke up abruptly. Some dude is banging on my door and shouting something about being "my resident" and how they have called me "100 times" in the last two hours. Must've had my phone on silent. Turned up the TV so I couldn't hear him, going back to sleep.

10:26 pm ::: That same dude got hospital security to unlock my door and wake me up. He is telling me to go to the sixth floor to "see a patient" with "delirium." Not sure what that means. Not sure what delirium is, either.

10:34 pm ::: Saw the patient - turns out the he is actually just a really nice guy who is a government agent, and he explained to me that he is being held against his will and that the nurses were trying to poison him. Helped him find his way out of the hospital so he could get back to being a secret agent.

11:17 pm ::: Back in the on-call room. Spent an hour propping all the furniture against the door so that my resident and the security guard couldn't come wake me up again.

12:19 am ::: Jumping on the bed.

2:54 am ::: Removed the pile of furniture from my door when I started getting hungry. Roaming the hospital looking for unconsumed foodstuffs on patient trays.

3:19 am ::: Found half a brownie and some cold soup on a patient's tray, and drank some apple juice that a patient thought they could hide from me by putting it in a pan under their bed. The apple juice wasn't very good, but it was free.

3:40 am ::: Running from the paediatric nurse who caught me drinking all the infant formula.

4:51 am ::: Back in the on-call room - can't sleep. Damn ambulances keep going by my window.

7:36 am ::: Woken up by security, who came in through the window this time, clever fellows. They told me to get out. Figure that means my call shift is over - going home to bed.

Turns out this call thing isn't so bad. It's basically watching TV, eating and sleeping. I think I could get used to doing this every fourth night.

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Monday, September 08, 2008

Top 10 List: Ten things I learned in the first week of third year medical school

1. If you give a bunch of medical students pagers, many of those pagers will go off during the very next lecture.

2. If you train and test medical students in anatomy, physiology and pathology for two years, when you give them a schedule saying "Monday - On Call" they will likely have no idea what this means or what they are supposed to do. Or if they should bring their pagers.

3. Lectures by fourth-year students explaining what "being on call" means and what to do when on call are very helpful. Lectures by senior faculty describing the abstract, theoretical concepts of effective learning aren't so much.

4. Rounds are not to be confused with rounding. Rounds come in two types, teaching and grand. While teaching is done on grand rounds, it is not the same as teaching rounds. Likewise, teaching rounds are not necessarily grand, though I suppose they could be, in the same way that nice people can be jolly. Of course, the internet phenomenon Grand Rounds is entirely different and could be considered a third type.

5. Properly scrubbing for surgery as a medical student simply involves making sure you scrub your hands for longer than any of the other surgeons or residents.

6. Every time we need to write in a patient chart, we need to write the following:

  • Name
  • MSI (which stands for Medical Student Intern...or we can write Clerk instead)
  • our provincial College of Physicians number
  • our pager number
  • the Dr. we discussed the note with
  • the date and time
  • our favourite ice cream
  • a pencil-sketch drawing of ourselves acting out a favourite childhood memory
  • and which character we most resemble on the TV show Scrubs.

Oh, and we have to write something about the patient, too.

7. A hospital tour by a doctor who helped design the hospital will be much more engaging than a tour by an administrator who is reading the signs on the walls.

8. Suturing can be difficult, because if the real thing is anything like our training sessions, our patients' skin will be thick, easily bruised, very fragile, yellow, and smell and look like banana. (There was an "issue" with the bureaucracy with bringing in pigs' feet, as we've used in the past.

9. The summer is plenty of time to forget all the things medical you learned in the first two years of medical school.

10. Even if you remembered everything from the first two years of medical school, you would still know pretty much nothing compared to what a doctor knows.

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Friday, September 05, 2008

The real first day of medical school... a moment six years in the making.

I told a group of first-year pre-med students today, "The moment I'm at right now is where you want to be."

True, they all want to become doctors, so technically the moment they really want is med school graduation.

But what I'm talking about is that the learning I'll be doing this year - on the wards, seeing patients, learning medicine - that's the learning they wish they were doing this year.

Unfortunately for them, they are a long, long way away from this moment, and the learning they have to go through now is very different.

For them, they have to take courses in intro biology, biochemistry, organic chem, physics, a whole degree's worth of courses... the MCAT... the application process including interviews and admissions...and then two years of medical school which are fun and exciting and horrible and challenging and gruesome and interesting all at the same time.

All in all, at least a six-year that many of them might not make it through... and yet all they really want to be doing is learning how to take care of sick people in the hospital.

I know that it will only be a couple of months before I'm burned out from the day shifts, the night call, and the studying in every spare moment around those shifts, but right now, I'm so excited to start.

I had to keep myself from showing up to shadow at the emergency department tonight, after the doc orienting us this morning told us we could drop in anytime. Maybe I should wait until orientation week is over, I told myself.

Finally, we get to do what I signed up for.

Finally, there is a light at the end of the tunnel... only two years until I graduate.

Finally, it's starting to feel for real.

And talking to people who are six years of hard work away from this moment reminded me of what it took to get here, and made me appreciate it so much more.

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Tuesday, September 02, 2008

Job Title: Medical Student / "Health Remedy Engineer"

Job duration: Full time (approx. 168 hours/week, some additional overtime required)
Job location: Local university and all hospitals in a 3-hour radius, including some national travel in Year 4 (not compensated)
Advancement potential: significant
Experience: Will train
Required equipment (Textbooks, etc.): Supplied by employee (not compensated).
Term length: 4 years

Duties & Responsibilities:

  • Learn all common diseases and conditions and how to diagnose and treat them
  • Work well with people pushed to their extremes (and become one yourself)
  • Successfully pass frequent extensive examinations
  • Deal with life-threatening emergencies with a calm, cool head


  • Must have university degree (or nearly completed one), preferably a Ph.D. or M.Sc.
  • Excellent GPA
  • Vast array of extracurricular activities
  • Olympic medals and superhuman powers helpful but not necessary
  • Sense of humour is the common denominator noted among survivors of this position

Skills and Abilities:

  • Ability to stay awake for days on end
  • Ability to be on call (sample schedule of a night on call)
  • Ability to memorize large volumes of data
  • Ability to take verbal abuse and harassment in stride
  • Ability to deal with human remains in a respectful fashion
  • Be familiar with the following computer applications:,, CMA website, provincial medical association website, patient care database, X-ray viewer software, university website, course websites, patient logging websites, PDA software such as Epocrates, Archimedes, Merck Manual, Microsoft Word, Microsoft Excel, university tuition payment website, Solitaire

Hourly Wage: Starting at -$10,000, increasing to -$55,000, dependent on campus of emploment (no raises, and yes, that's correct, you pay us).
Benefits: 10% "student discount" at local pizzeria upon surrender of employee ID card. No dental, health or other benefits.
Scholarships: Some, available only to the people who are smarter than you

Application procedure:

Applications due date: September
Notification: May
CV: Include all details of employment and extracurriculars, being sure to account for every moment of your waking life. As well, include a contact person for all items on your CV that we can phone to ensure you are not making these things up.

Please note this is a very competitive position and that only successful applicants will be contacted. We thank you for your interest and hope you are insane enough to apply.

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