Archive for category Medical School
Bias
Posted by medaholic in Medical School on August 26, 2010
Today, I saw a young female who was 35 weeks pregnant. She was also a crack cocaine user.
When I see a patient like that, it’s hard not to be biased. Her clothes were unkempt, she smelled, her eyes had dark bags hanging underneath and strange mannerisms. Yet deep down, I know she was a person that deserved my help and respect, just like everyone else.
So why when I first saw her did it take several seconds to get over my prejudices? Was it because here was a women who was harming her body and baby with drugs, while so many other people desperately want a child but can’t have one due to miscarriages and infertility?
I’m confident that I’ll encounter many unpleasant people in my rotations, some downright nasty. It’s so hard to be empathetic to people who purposely harm themselves or try to use you. I can see why lots of doctors get jaded and become mistrusting. It’s part of the hidden curriculum no one ever teaches you.
I don’t really have a specific train of thought or conclusion to this post. Just a pondering from today.
The Shortlist Year Two
Posted by medaholic in Medical School, Thoughts on August 13, 2010
About a year ago, I made a list of specialties that I was considering.
Now at the start of third year, I am writing down the top five specialties currently in the considering. I’ve had more time to shadow and do electives in a variety of fields. So here they are, my shortlist at the end of M-2, with explanations below.
Top 5
- Internal Medicine – Still tops the list, especially since my favorite subjects so far has been in internal (cardiology, pulmonary, GI, oncology). The diversity along with the chance to further subspecialize appeals to me a lot. I like problem solving, working on complex cases, team environments and interacting with patients.
- Family Medicine – Diverse, flexible, wide variety of practice. Can never rule out primary care.
- Gen Surg / Ortho - Unfortunately or fortunately? I haven’t ruled out surgery yet. Although I am pretty confident I am more for medicine, I like working with my hands, working on teams and seeing positive results. The satisfaction knowing that you made a difference, that your hands fixed something, makes surgery highly appealing. Though I don’t think I am focused enough to do a sub-specialty surgery that has a narrow scope like ENT, Ophtho, Urology, etc. Though I think plastics is super cool.
- Neurology / Physical Med & Rehab – A different pace of medicine, often more focused on management instead of cure. Similarities to internal perhaps?
- Emergency Medicine – Things I like: Quick, fast-paced, great learning experiences in past, wide scope of practice and skillset. Dislike: Shift work, no continuity of care (not having “your” patients, following up after admission)
Bottom 5 - (no particular order)
- Pathology – No interests at looking at slides, cells and cadavers. It doesn’t make pathologists any less of a doctor. It just wasn’t meant for me.
- Anesthesiology – Puts me to sleep, just like it does for patients undergoing surgery.
- Psychiatry – After learning about it in class, I found it fascinating. A super important field that often goes neglected but again just not for me. Psych is part of every field of medicine, hopefully I’ll see my share of psych patients in another field and do a good job caring for these under-served patients.
- Cardiac / Neurosurgery – I don’t have enough passion in these two fields to give up the rest of my life
- Medical Biochem / Genetics / Microbiology & Lab Med – Had enough research experiences to know I can’t spend the rest of my life doing lab work. Would much rather be at the bedside than the bench.
Changes
Decrease
- Ophthalmology – The eye is still pretty cool topic and restoring vision is still admirable work. But it’s narrow focus and few procedures makes it less appealing to me. I enjoyed studying Ophthalmology (spelled with two H’s!) a lot this year but I didn’t have any special interest to pursue a surgical career in eye care. Still an important topic to know no matter what you end up in.
- Radiology - I thought long and hard about this one and after multiple electives, I can happily say, it’s not for me I liked my experiences in interventional radiology and ultrasound. Learned a lot reading Xrays and CTS. Was bored to sleep in nuclear imaging. Reading radiology accurately is an essential skill that all clinicians should have. I feel like if I go into Internal, I’ll get my fair share of radiological interpretation to satisfy me. As for interventional, I can’t bear the thought of going through a five-year residency program reading films just to get the chance to do procedures.
Increase
- Dermatology – I was actually quite engaged and interested when we learned about dermatological problems in class. Not all just acne and botox. Though I feel like what they showed us in class (all the interesting rare stuff) is quite different from real life practice.
- OBSGYN – Not a bottom 5 specialty but nowhere near the top either. I was lucky enough to scrub in on a few C-sections this year. The miracle of life is unlike anything else, it really is beautiful. Though the frequency of malpractice/lawsuits and preference for females in this specialty are enough to rule it out for me.
Not Quite a Medical Student
Posted by medaholic in Medical School on April 13, 2010
Even as I am finishing up my 2nd out of 4 years of medical school, I often don’t feel like a true medical student. Although we may have learned about all the systems, dissected the entire human body and built a good foundation of medical knowledge, we have truly yet to experience what it means to be a doctor.
Next year is the start of clerkship and it is both exciting and frightening. Exciting because we will finally see patients daily, care for them, write up orders and learn the practice of medicine. Frightening because all our shortcomings and incompetency will reveal themselves.
So even as I pass the halfway mark on my undergraduate medical education, I feel as if I have yet to begin. I guess I’ll find out what kind of a person and a doctor I will become next year. Exciting. Frightening.
See One, Do One, Teach One
Posted by medaholic in Medical School, Thoughts on March 29, 2010
To learn medicine, they say you need to see it done once, do it yourself once and finally teach someone else how to do it.
This has always been the way it was taught. But despite being such a classic didactic model, I wonder if this is the best and right way to learn?
I remember the first time I heard about the hidden curriculum of medical school. It was the story of medical students performing pelvic exams on unconscious patients who had not given their consent. The argument was where else would students get the chance to practice, no patient would want a inexperienced student doing an unnecessary and invasive exam, all in the name of learning. And I’ve talked to some senior doctors about this, and even though they are very ethical and caring doctors, they shared their experience about going along and not questioning it, even when they knew it was wrong. I’m afraid I will be in similar situations in the future, and I am scared that I will not know what to do.
Today, I stumbled across a report on “Providing a strategic vision for improving patient safety” and came across the following quote.
“The old approach to teaching procedures—See one, Do one, Teach one—
is antithetical to safe, patient-centered care. Simulation provides the
opportunity for one to see as many as one would like, do as many as
are necessary to demonstrate procedural competence, and leave the
teaching to experts.”
In one sense, I agree completely that simulation can be a perfect way to hone your skills so you can be competent when you finally see your patients. On the other hand, I also think that you can’t learn and understand the complete practice of medicine in the classroom or simulation room in this case. You learn medicine by interacting with human beings, real patients with real diseases. You remember faces and emotions associated with diseases. You get the real deal, not just a fictitious rigid simulation. I don’t know what my complete thoughts are about medical school training, but I just want to leave you all with this quote by one of the greatest physicians of the 20th century.
He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.
- William Osler
Risk Averse
Posted by medaholic in Medical School, Thoughts on February 26, 2010
http://www.flickr.com/photos/west-park/3414758732/
Inspired by a post on Risk Taking and Failure written by a friend.
One of the most important skills everyone should learn is how to take risks. I’m not talking about foolish or rash decision making but of calculated and beneficial risks. For the most part, I credit a lot of my success to my willingness to take action in the face of uncertainty. Winning scholarships, getting job positions, finding opportunities, getting into medical school are all things I have benefited from taking good risks.
In many careers, calculated risk taking has many benefits. Business opportunities if coupled with entrepreneurial spirit and hard work can result in large financial gain. New artistic direction can be what separates you from the crowd. Having the courage to start a conversation with someone you don’t know may blossom into an important relationship. However, medicine often discourages risk taking, often to the point that erring on the side of caution is preferred.
Any risk will always have a chance of failure. You should only take risks if the odds are in your favor or if the reward far outweighs the cost. And that is exactly the problem in taking risks when it comes to medicine – the cost of failure is high.
A wrong mistake can lead to crippling disability. An erroneous slip can lead to a malpractice lawsuit or a license suspension. One lab test missed or improper history can mean life or death. For example, even if the benefits of immediate treatment means a speedy recover, if a diagnosis is made and treatment started without confirming the diagnosis, the results may be disastrous.
That is why we are taught to be thorough in our history taking and physical examinations. That is why checking up on patients is so important, so that no alarm signs slip go unmissed. That is why a differential diagnosis should be long and comprehensive, even if some items are highly unlikely. That is why extensive lab tests, imaging and consults are required. Don’t jump to conclusions. Be thorough even if it is going to cost you time and money. As a generalized rule, doctors err on the side of caution.
I think that is something I quite miss from my life before medical school. The chance to take risks and face the outcomes and consequences. I could aimed for all sorts of goals because I knew had the ability to rebound from my failures. I could push myself to my limits, be committed in several activities and try new endeavors. But now, I have a duty and a privilege to my future patients. To do well in my studies and become a good doctor. Instead of pursuing other interests, I have a job that I should do to the best of my abilities.
Perhaps I am over-exaggerating my situation to prove a point. It’s a bit like growing up. In yours twenties, you don’t have much to lose. If someone offered you one chance to win a million dollars on a 10:1 coin flip, would you take it? If you win, you get $1,000,000 but if you lose, you have to shell up $100,000. Mathematically, agreeing to the bet would be a no brainer. Now add twenty years to the same scenario, a house, a mortgage to pay, a car, a spouse, kids and bills that you are just scraping by with, your decision to take that bet drastically changes. If you win, a million dollars that could result in retirement but if you lose that money, how are you going to pay next month’s rent? Provide for your family? Would you still take that risk?
[I realize that the possibility of going into $100,000 of debt in your twenties is a great setback. You could even argue that when you're 40 and you have a stable job, you are more in a position to lose $100,000 than when you are just starting your career, but these numbers are just an arbitrary scenario and I hope you got the main point I was trying to make]
Possibility is traded away in return for stability. Predictable outcomes are favored when what you risk losing is greater than the gain. When you become responsible for other people, especially in a job like medicine where a doctor-patient relationship is so important, I would feel really bad if I made a risky decision that negatively affected someone else.
So although risk-taking is a valuable trait to have, I often think being risk averse is also an equally important trait to have especially in medicine. Being paranoid and nit-picky, which is excessive at times, may one day save a life. Someone’s obsessive need for perfection or his insecure fear of failure can make a positive difference.
What are your thoughts on risk taking and risk aversion?
Choosing a Specialty
Posted by medaholic in Medical School on February 13, 2010
The major concern of most premedical students is whether or not they will be admitted to medical school. They fret over getting the best grades on their term papers, labs and exams. They often spend a summer studying for the MCAT while working in a research lab. They also volunteer on the side and remain committed to extracurricular activities they have picked up.
However, once students enter medical school their previous academic worries are replaced with the one question, “What kind of a doctor will I be?”
Failing out of medical school is an uncommon event. Most people who have made it this far will have developed the work ethics and study habits to pass. There are also staff and administration that will do their best to help you graduate, whether that be from financial difficulties or stress. Most schools have maternity leave policies and accommodate students taking a year off. Getting through medical school for the most part is straightforward. I believe the hard part is finding yourself amidst the medical culture that becomes all pervasive.
During your undergraduate studies, so much time is spent working towards being admitted into medical school that not much thought is given to what kind of a doctor you want to be. For one, it’s hard to truly understand the differences between all the specialties, especially if you have never had any exposure to them. Many students may think that surgery sounds cool and prestigious, but few know the grueling realities and lifestyles associated with it and likewise for the many other specialties of medicine.
In the first two preclinical years, medical students are exposed to the many areas of medicine in the classroom. They get snippets into the diseases and types of patients found in each but never a complete picture.
Now that I am coming to the end of my preclinical studies, I still feel as confused as ever as to which specialty I will end up choosing. It is always a concern that is lingering in my thoughts. What if I want to do a competitive specialty such as radiology, ophthalmology or plastics? Will I be too late to consider them because I have not done any research or networking in these fields? Or even the fields I think will be unlikely, such as psychiatry or OBGYN, how will I know if I actually don’t like them or not? Will lifestyle and pay be a factor in my final decision?
Hopefully, by next year I will have an answer or a rough idea. But take heed premedical students, your questions of What are my chances of getting into medical school will soon be replaced with What medical specialty should I choose? Your worries and concerns don’t fade away after entering medical school, it just becomes different. Every phase of life has its own challenges and rewards.
Never Bored
Posted by medaholic in Medical School, Thoughts on February 4, 2010
http://www.flickr.com/photos/ericouano/163139402/
Although I was busy during my undergraduate studies, I can still remember days or weeks where I would be bored with school. If I was particularly on top of my school work, I would often take the weekend off and do absolutely nothing productive and instead something fun. I would slack for weeks at a time and know that I could catch up. I remember studying for chemistry intensely until I knew the periodic table and each element’s properties down cold. There were tests where I could recite dozens of physic formulas without the need for a cheat sheet. I remember having to find extra work to do to challenge myself, get involved in clubs, and push myself to go beyond class expectations.
On the contrary, nowadays it seems like work always has a way finding me. It’s rare to have a spare moment just to read leisurely or contemplate about life’s big mysteries. There’s always more diseases to study, new terms to look up, clinical opportunities to be involved with. And I know as soon as clerkship starts and residency, it’s only going to get busier.
Medicine is challenging. Compounded with my initial dislike for rote memorization – though it has improved a lot – I often find learning everything overwhelming. When I peruse the titles on the library shelves, there seems to be a textbook for every imaginable disease possible, irregardless of how obscure they may be. There’s such a variety of subjects to learn, ranging from anatomy to epidemiology to each specific specialty. For a curious person like myself who likes to know everything about anything, I find it hard to have the same confidence of knowledge as I did in undergrad. Even for common conditions such as hypertension or diabetes, there is a wealth of knowledge out there that keeps changing.
I knew what I was signing up for when I decided to go to medical school. Long hours, grunt work and a whole lot to learn. It can get draining, mentally, emotionally and physically. There will be days where going to the washroom and taking a nice hot shower will become a luxury. Sleepless nights, angry patients, grieving families. Life long learning until the day you stop practicing.
Medicine can be pretty tough, but boring? There’s rarely a dull moment. There’s always something to do, something to learn, something to challenge you. It’s a trade-off I can live with.
The Difficult Patient
Posted by medaholic in Medical School on February 3, 2010
I was doing an ER shift today when I came across my first difficult patient. Mr. K was a 50 year old divorced man who came in irritably on a stretcher having passed out from COPD exacerbation. He was shaking all over and showed a distrust for the medical system: the paramedics that brought him in, the nurses, the entire system.
Nothing destroys a relationship with a patient faster than distrust and I realized it was going to be a tough situation as soon as I took his history. “Jesus ****ing Christ, Why are you asking me again! I’ve already told you guys ten times what my medical history is like! Just do what you need to do and get me out of here.”
It was uncomfortable, after discussing with my preceptor, to go ask more follow-up questions and do a physical exam. I felt defeated and flustered. What knowledge and competence I had about his condition evaporated once his bitter criticism hit me. For the most part, the limited patient encounters I had before were generally positive with them being encouraging and understanding that I was still a medical student. There’s always two sides to a coin.
After the shift while walking home, this difficult patient encounter lingered in my mind. I guess sooner or later, every medical student becomes a bit more cynical and pessimistic. Their young idealism and optimism is replaced with harsh reality, death and disease. And although I remain positive about medicine, there are hard lessons and growing pains to be experienced. Even though it is difficult, I will continue to respect and treat my patients with dignity, irregardless of religion, race, age, disease or attitude.
Medicine is interesting in this respect. It not only builds knowledge, but also character. You slowly begin to realize what kind of a person and eventually what kind of a doctor you will become with each patient encounter. I hope I can become a doctor my patients trust.
A Typical Day in Medical School
Posted by medaholic in Medical School on January 23, 2010
Disclaimer: I have not yet begun my clinical rotations so this is just one student’s brief summary on a typical medical school day in the preclinical years.
http://www.flickr.com/photos/dhdesign/1096464615/
7:00 AM – My alarm clock rings. I quickly turn it off. 5 minutes later my second alarm which I always have as back up goes off. Going to class is too important to be left to chances; having two alarms is much safer. I brush my teeth, eat breakfast and pack all my notes, textbooks and laptops, which have been sprawled over my desk from yesterday’s late-night studying, into my trusty backpack.
7:45 AM – I make the quick walk to school. Living on campus is a luxury, the time you save from commuting is worth the higher prices you pay on rent. If you don’t live at home and have the option of choosing a place, live by the university. You won’t regret it.
8:00 AM – The first lecture of the day is beginning and the classroom is only 70% full. Stragglers and latecomers slowly file into the lecture theater, while the rest of us are just waking up. The smell of coffee and breakfast snacks fill the room. Thank God for caffeine.
8:30 AM – It’s halfway through the lecture and at this crucial point, depending on how good or bad the lectures has been going, I will either increase my concentration and focus for the remaining slides left or… begin checking my email.
8:45 AM - The daily newsfeeds and listserv messages begin flooding my inbox: faculty emails, student group event announcements and people looking for rent or pawning their old textbooks. If I’m lucky, there might be some personal emails from friends and family.
9:00 AM - Break time. Get up, stretch, go to the washroom. Only a few more minutes before the next lecture begins.
10:00 AM – Students in scrubs fill the hallway to the anatomy lab. The smell of formaldehyde is one that you don’t forget easily. Time always passes by quickly in the lab as we dissect our cadavers. Our group rotates responsibilities of cutting, reading the dissector and referencing our anatomy atlas. Tip: learn to use all your tools, not just the scalpel. The blunt scissors, probe and your fingers are often times better than the blade when it comes to dissecting.
12:00 PM - The combination of anatomy lab chemically induced hunger and classes all morning really work up your appetite. If there’s a lunch-time talk with free food I try to attend. If not, the lunch hour is a great time to hang out with friends, make necessary phone calls (banks, utilities, etc) and catch up on some studying.
1:00 PM - On alternating days, we either have small group learning or clinical skills teaching. If it is a small group session, ten or so medical students along with a preceptor begin discussing the case prepared for that week. After each session, we set out our learning objectives created for next time’s discussion.
3:00 PM – If it is a clinical teaching day, my group follows a preceptor to see patients. We practice our history taking and physical examination skills, while learning about different medical conditions. Clinical teaching is definitely an enjoyable time for me. It’s just a small taste of what is to come.
5:00 PM - My day at school officially ends, but the real work is about to begin.
5:30 PM - I usually head to the gym for a quick workout or relax a bit. Balance is key to a healthy lifestyle in medical school.
6:00 PM – Study. Study. Study
7:00 PM – Cook dinner. Whatever is most convenient is usually eaten first. Groceries are usually only done on weekends when there is time. Often, eating dinner is either in the company of friends or school notes. I also like to cook my meals in bigger portions and back the leftovers for lunch.
8:00PM – 10:00PM – Study. Study some more. There’s an awful lot of stuff to learn in medicine.
10:00 PM – Dedicated instant messaging / facebook / answering email time. Showers are nice too.
11:00 PM – An hour is lost from being unproductive and/or procrastinating.
12:00 PM - I usually get solid studying done at these wee hours. My circadian rhythm just happens to coincide with the midnight hour to be a productive one. I like to study and work until I feel tired and head to bed. But lately, I’ve been trying to keep a more regular routine. I often feel like sleep is a nice bonus for people in medicine, it’s nice to have but isn’t always required or permitted.
Summary
The day I have described to you is probably one of the busier days of the week. There are probably 2-3 of those days and another 2 more relaxed days with less class and responsibilities. Apart from class time and basic necessities, a lot of time is spent studying or doing other school related work. For the most part, medicine is not a 9-5 job, especially as a student when there is so much to learn. I feel like I could study 12 hours a day for several months (I wish I could) and still have lots to learn. I guess that is why the time it takes to train a doctor is so long (6-10 years).
If you have any questions about what a typical day for a medical student is like or want to contribute your experiences too, please leave a comment. Thanks!
Anatomy Lab Munchies
Posted by medaholic in Medical School on January 12, 2010
There’s something strange about the embalming chemicals in the anatomy lab. I’m always starving when I come out of the anatomy lab. And it seems that this is a common experience amongst medical students. It’s kind of disturbing that you would feel hungry after cutting human tissue for the last hour or so.
I guess just another peculiarity of med school.