Our medical school has a strategy to fight the sagging number of doctors choosing family medicine as a profession: expose students to the profession through a mandatory course in family medicine. Unfortunately, if you ask anybody in my class, it's quite apparent this strategy is probably doing more harm than good.
It involves exposing us to family medicine by arranging for us to shadow family physicians for a few hours per week in our first two years, assigning various time-consuming projects, and providing a number of family medicine-related lectures, attendance to which is encouraged (with limited success) more by sending threatening e-mails to the students than by providing interesting topics.
Then, we are given an exam for each of our first four semesters, asking medically relevant minute details from the lectures, such as, "How many people died in Somalia last year?" "Which of the following is an example of grey literature?" and "What does the E stand for in FIFE?" (the latter of which I know quite well after getting yelled at by a patient for using said technique).
I'm not sure who thought making medical students write exams on boring lectures that they've been guilted into attending would develop in us a passion for the field, especially when we're already overwhelmed with the study load for our other courses. It's a good thing we are instead able to develop this passion by spending time with family doctors, right?
Well, it's not that simple. Personally, I lucked out, and ended up with outstanding tutors. I'm among only a few people who had an excellent experience with all my various tutors, getting the chance to regularly see patients on my own and conduct histories and physical exams, and fill out prescriptions, referrals and lab requisition forms.
Unfortunately, for many people in my class, the taste of family medicine they got from this experience is a very bitter one.
First of all, urban family practice is very different from what family medicine used to be. While rural doctors still do a lot of procedures and deliveries, most of the doctors we shadow have cut down on the amount of these extra services, including following patients in the hospital.
Secondly, with the increases in class sizes, only a small number of students are one-on-one with the doctor, and even after grouping students, the faculty is still having a hard time finding
doctors willing to teach.
So, the preceptors they do sign up aren't all doing it out of a love for teaching, and the students suffer for it. Two students that I know spent most of their shifts with one physician sitting at the end of a hallway, called in only once to see patients. Two others I know spent a semester watching the doctor perform alternative medicine such as waving his hands over the patient (all of which he billed the government for), and they even spent a whole shift punching out pieces of aluminum foil, to build up the doctor's supply of tinfoil confetti to tape on to patients' hands as an (undoubtedly ineffective) alternative medicine method.
However, despite the lectures, exams, and poor shadowing experiences, the course is by no means a complete failure. Some students, like myself, have a fantastic experience with the doctors, getting to do and see a lot, including surgeries and infant deliveries. And even if it didn't convince anybody to become a family doctor, the amount of clinical and patient experience we got will give us a step up for when we start our medical student internships in the fall.
Additionally, the course also gave us the chance to practice a few office procedures, such as prescription writing, suturing, biopsies and excisions, which is the fun 'doctor stuff' that everyone looks forward to in med school. Unlike the medical students from some Canadian schools, though, we never got the chance to learn how to place IVs in our first couple years of med school.
As well, everybody in the class was exposed to the huge variety of sub-specialties of family practice that exist when we spent time with two specialized family physicians. Family doctors can tailor their practices with a focus in prenatal care, oncology, surgical assist, inner city medicine, emergency, hosptialist, sports medicine, and many other fields, something I didn't know before med school, and a realization that definitely piqued my interest as I search for a specialty that satisfies my desire for variety.
Finally, the rural exposure component of the course is one that is apparently a lot of fun. After two years of medical school, we get the chance to spend some time in a rural community, an experience I'm looking forward to right before I start my third year. This is evidently one of the redeeming factors for this course, and hopefully when I'm shipped out, I'll have a few interesting stores to share... and not spend the whole time punching out tinfoil confetti.
Monday, July 14, 2008
The failed mandate of our family practise course
Thursday, July 03, 2008
My new favourite blog: Science-Based Medicine.
Are You Clean Inside?
You may have seen them. The websites that promote natural healthy cures if you buy a certain product. Liver cleanses, colon flushes, to rid the body of 'toxins' and 'caked-on stool inside the colon.'
The websites themselves can be pretty convincing. They use big scientific words, often refer to accurate physiology to support their claims, and most of all, are full of testimonials from people who swear the product worked on them (a big red flag...real doctors make treatment decisions based on scientific studies, not testimonials).
Therefore I'm excited to introduce you to Science-Based Medicine, a blog I found while looking up some drugs that naturopaths were prescribing to a friend (admittedly out of fear for my friend's well-being).
Written by a surgeon, it discusses a number of naturopathic, natural, and alternative treatments from a person with much more medical experience than I have. Which I find refreshing because, as I said, with all the accurate facts mixed in with the bogus claims, these websites can be somewhat convincing and be somewhat successful at hiding the con within, even from a person like myself with six years of university training in biology.
Yes, I used the word con. That's the strongest word I've used towards any complimentary or alternative treatment on this blog to date. While I have in the past admitted to trying to be open-minded towards alternative treatments, some of them are just flat out there to con you.
As an aside, my friends who are studying to become naturopaths tell me they will spend most of their careers trying to distance themselves from these blatant conmen "that make us look bad," as they assure me there is still some science to what they practice (I will admit, though, that my goal of keeping an open mind to at least some of what they practice continues to grow an increasingly difficult task).
But more on the cons.
Consider the Liver Cleanse, which claims to flush out gallstones without surgery.
Or the Colon Cleanse, which claims to flush out toxins and caked-on stool from your colon.
While the websites can be convincing, Science-Based Medicine reveals them for what they are: absolute money-grabbing frauds. The author debunks the Liver Cleanse here, and the Colon Cleanse here.
If you don't want to read the full description there, in short, the very 'cleanse' itself becomes the things you think you're getting rid of: items you eat when taking the "Liver Cleanse" clump together to form objects which look like gallstones... and the very powder you take for the "Colon Cleanse" (clay and fiber) clumps together to form objects which look like caked-on toxins. All of which can be fished from your stool, photographed, and submitted to the website at will, along with your name and city, to be added to the list of testimonials.
And about all those "caked-on toxins and stool'? The surgeon states that in all his years of opening peoples' bowels, he has never seen anything like that in an actual person's intestines.
Please don't be the next victim to these scams. Ask your doctor about anything you're unsure of...and ask them to perform a search of the scientific literature if it's a treatment they're unaware of. Because some of these don't just take your money...they can actually cause you harm.
