What doctors REALLY think... and preliminary thoughts on interdisciplinary health

"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.

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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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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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