The failed mandate of our family practise course

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.

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Blinded by the silver lining

As I've mentioned before, some people seem to be much more willing to open up to you about their medical details when they hear you're a medical student. Often this involves unpleasant details, such as elaborate depictions of fungating lesions and uncontrollable bodily functions. Once in a while, though, I get a response I don't expect.

I was at a coffee shop a couple weeks back - to relax, not refuel, unlike during the school year - and was served by a cashier whose competence at baristing I immediately called into question. After she dropped a few things, had difficulty counting out my change, and made something other than what I ordered, I admittedly made some silent judgments about her intelligence too, which I assumed were related to the lack of natural pigment in her hair.

It was a slow day, and so when I went to return my dish before I left, she started making conversation. "You're a student around here you said? What are you studying?" "I'm taking medicine," I replied, and braced myself for the "Oh, let me show you this rash" or something of the sort.

"Oh, neat, do you know much about Alzheimer's disease?" she asked. "My dad has had that for the last seven years or so. It's pretty interesting, isn't it, with the tau protein deposits and the beta amyloid plaques, and all that."

I think my jaw noticeably dropped. She wasn't so blonde after all!

She went on to impress me with the other things she had learned about the disease, and talked about how she had moved in with her dad to take care of him when he got considerably worse, so that he wouldn't have to go to an old age home. She had left her job as an accountant and found the coffee shop gig which didn't require her 9-5; that way, she could spend more time with him.

Alzheimer's is a terrible disease. Many people get upset as it ravages the cognizance of their loved ones, feeling as though they can only stand by helpless as the person they love is taken away from them, a bit at a time, leaving an empty shell of the personality they once knew. Some even choose to not deal with the stress of the disease by moving their parents to an old age home and not bother visiting.

With this in mind, I asked, "that must have been difficult, I imagine, watching him change so much over the years?"

Her response to that question surprised me even more.

"No, no! It's the best thing that could have happened. You see, as he loses more of his memory, he's been becoming more and more like a child. Now we hang out and make jokes and play in the backyard like kids, and have so much fun. If it were a heart attack or a stroke that took him, then it would be instantaneous - I wouldn't have the chance to say goodbye. This way, though, it's been slow... and so I have had many years to accept that he'll no longer be with me soon, and I've been able to say goodbye."

Not only did I learn once again to not judget a book by its cover, but I also got the chance to see someone who embodied the "acceptance" phase of grief more than I had ever seen before. Perhaps it was because I was expecting her experience to be the same as the others I'd heard of, that she was full of anger at the situation because she had to watch this disease degrade her father to the point that he now is fully dependent on support from others. Instead, she embraced it. The amount of positivity she had for a disease so ruthless was truly inspiring.

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Doctors are better than nurses.

Okay, okay, there is no way I actually believe that doctors are better than nurses. Too many nurses are friends of mine and know where I live and would make me pay dearly if I ever actually held beliefs like that. I just put that in the title to get your attention (and it worked, right?)... and in the past I've made a point of proclaiming my respect for good nurses on many occasions.

But on to the story. Something interesting is happening in the medical blogosphere I thought I'd draw your attention to.

Three days ago, Guitar Girl, RN apologetically admitted to correcting a new intern in front of a patient.

A doctor who replied to that post in the comments section is getting roasted for presenting his opinion on how doctors and nurses have different roles in the care of a patient, for saying things like, "If you believe a nurse would ever have as much medical knowledge as a physician, even after 50 years of clinical experience, I'm sorry to break the bad news of reality to you. It simply will never happen."


Despite the fact that this quote is surrounded by other comments proclaiming his respect for nurses, he's being called "arrogant." Nurses and medics are politely (and not so politely) disagreeing with him, with many of the possible exceptions to his statement being brought up. It's actually turning into really quite the interesting conversation because some other nurses are actually defending him. I recommend you grab a coffee and check out the discussion.

My take? Well, I've already been told to turn up the respect a little (by someone I respect) once on this blog in the past couple weeks, which is enough for me, so I left my comment there instead.

I'm also going to conclude that to me, this appears to be one of those issues that is SO sensitive, that anyone who tries to present their viewpoint runs the risk of getting misinterpreted... even if they're attacked for the tone of what they're saying and not actually the words they're using.

That being said, I enjoy watching people dialogue opposing viewpoints, and hopefully everyone will come away understanding the opposing points a bit better. Respect all around. (Fat chance, though, right?)

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Oh, you're a medical student?

Now that I'm well into medical school... well, who am I kidding, this happened back in pre-med too... family or friends or even strangers are willing to tell me the most gruesome details of their personal medical lives.

It's partly a testament to the amount of respect doctors have. They know that I should be able to understand that part of their lives a bit differently than some of their other friends. They know that I won't go broadcasting their story to the rest of the family.

It's also partly a testament to apathy. Why book an appointment when Vitum is here and I can just ask him? I'm not mocking them... just saying, there are plenty of things I've not bothered to see a doctor about that maybe I should have (like how it always burns when I use the toilet).

They way I respond to these varies on the situation. Sometimes it's about old aunt Helga who is having trouble getting up off the couch these days, and I smile and nod. Sometimes it's about Jimmy's dad who now has a tumour, and I ask if they have biopsied it yet and how the treatment is coming along. Sometimes its about the fungating, smelly growth on their foot, which they insist on showing me, wafting its visible fumes vigorously towards me ("Does that smell like anything bad?") - for those people, I try to encourage them to see a doctor and explain I haven't had a lecture on that yet so please take it away from my face...politely.

I don't usually provide an opinion as we've been warned to not provide advice to people outside the office setting (or at all, really, right now, since we're still students) - we've been told enough horror stories of lawsuits from such situations - so I usually simply tell them that's something they should discuss with a doctor. I don't want to be telling somebody that a mole is nothing of concern and have it turn out to grow into a massive tumour.

However, a couple times I've grown quite concerned after I asked a few questions and end up being a bit more insistent that they go see their doctor. In fact, for a couple of my friends, I asked them to go the hospital right away. One of those people ended up needing surgery.

I appreciate being the person that people feel they can approach with questions, and being able to apply my interest in science to the answers. That's undoubtedly one of the many things that attracted me to medicine as a career. We'll see if I can put up with it happening more than once or twice every few weeks.

A story on this topic: Blinded by the Silver Lining

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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.

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