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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Well at least next year, it will be easier...right?

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."

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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.

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Year 1...Done. Vitum Medicinus: 1/4 M.D.

"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:

• going to the movie theatre for the first time in months (Knocked Up attempts to be a chick flick AND a comedy, and while it has a few good laughs, in the end it comes up short at both)
  
  
• attending the end-of-year party where everyone (except me, of course) partied hard and relaxed (I say not me because I was heeding the advice delivered to me in a text message from my mom: "Congrats on being done! Party easy." Love ya, mom.)
  
  
• saying goodbye to med friends who will be redistrubiting all around the world to do incredible things
  
  
• enjoying this beautiful city - driving around parks, laying on the beaches, wandering through forests
  
  
• and starting to re-establishing communication with my dear friends outside of medicine whom I have simply not seen for months, perhaps one of the worst aspects of this exam period. I saw my sister today for the first time in two months...and we live just a few blocks apart. Each time I try to explain what I've gone through (I'll detail it here in a bit). I hope they understand and don't simply think that I am avoiding them.

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.

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Eaglestar's Dilemma: Study for finals, or see his child?

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.

"Who knows!"

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.

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You thought the pharmaceutical industry was slimy... version 2

In this season where time is valuable and finals are so close, I'm resorting to a sneaky measure basically the same as re-gifting... putting some nice new wrapping paper on a previous gift and handing it off as something new. Yes, I'm re-dating a blog post as if I just wrote it today.

Okay, not really. I'm just kindof supplementing it. There's a reason to this, beyond the fact that I'm too busy to actually write a whole new post: it's that though my daily study time devoted to procrastination, I found another incredible article about drug reps. It's hefty, but well-written and choc-full of fascinating and jaw-dropping anecdotes.

Take, for instance, the drug rep who arranged for a doctor to receive an "unrestricted educational grant" of $35,000 from a drug company...the doctor requested the cash so he could install a swimming pool in his back yard.

This whole crazy world of drug reps is one that I'm just starting to learn about. As a medical student, it's a little scary. I'd like to say that I'll be immune to it, but if I'm faced with accepting the kleenex box with a drug company's name on it, what's wrong with that? And if that's ok, then what's wrong with taking the pen? then the anatomical poster - it's for my patient's benefit! then lunch for my office staff, and then the dinner at a steakhouse, then a trip to Paris, and then asking for an unrestricted educational grant of $35,000??

Here's the link to the article.

And here's the link to my previous blog post, in case you missed it.

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