Dr. Marc Siegel has a great piece in the Washington Post today about the up-and-down, back and forth, try-this, try-that world of being a doctor today. And again, I wonder, “What am I getting myself into?” (via MedRants )
I guess I’m just curious–if the solution isn’t single-payer , or some sort of national system, then what is it?
If I ever wanted to start a cult, I think I’d follow the acculturation techniques I’ve been subjected to in med school. It’s only been two weeks and I’ve already used “superior mediastinum” and “jugular notch” twice in two conversations with friends. That was a pretty quick conversion.
I’m still at a stage where I can appreciate being a non-medical person, but can just barely see my future as a physician as well. I’m both doctor and patient. In a class on good communication, we were warned about using medical lingo with patients–to avoid it, and be conscious of it, because it will happen, and it can be intimidating, frightening, and confusing to patients. The best analogy that I can make is a discussion of cars or sports–two areas in which I have almost no knowledge. If a mechanic were to tell me my car had some sort of serious problem, dealing with anything from the carburetor to the spark plugs, I’d be utterly lost, leaving it up to trusting my mechanic to do the right thing (and not rip me off for it). The same with sports. Whenever my friends start talking about if I “saw that last game” or talk about a player, or, like last night, I land on the green spot in Trivial Pursuit, I’m completely lost. I generally nod my head, or admit defeat (and plead complete ignorance). I think it’s probably similar for a patient to be told about some condition they have that’s as hard to spell as it is to pronounce.
But then the medical side of me starts to kick in. Like in the conversation I had with my friends, it really *is* easier to talk about certain parts of the body if you know their names. Or it’s even easier to use the anatomical terms–when I tried to explain what the “superior mediastinum” actually is , I caught myself wanting to describe it as “the part of your body that’s deep to your sternum.”
I guess it’s something to be conscious of, and try to avoid; the sooner I start learning how to translate from Doc Talk to English, the better. (Then again, I guess I should probably learn how the medical lingo first.) Communication’s clearly vital between physician and patient, for a number of reasons: patient adherence to the plan that the patient and physician create, litigation, autonomy… the list goes on and on.
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Just finished my first histology quiz, met with a rousing failure.
Upon trying to identify “basal layer epithelium,” I was told by the TA that “you should probably look at the correct slide and try again.”
At least I’m not in this sinking ship alone–my classmates felt pretty unprepared, too. Two weeks left; it’s time to hit the books.l
Or if it’s not hate, it’s frustration. *Severe* frustration. For me, it usually starts out externally: “I hate histology! I hate the spleen!” Then it becomes irrational: “I hate med school! I can’t stand all this work!” And finally, personal: “I hate not knowing! I hate being clueless!”
For today, my dear friends, I began to hate med school.
Now, I know it’s fleeting, and temporary–my demeanor wouldn’t allow anything else–but my frustration grew by leaps and bounds, out of seemingly nowhere. Yesterday was fine. I remember telling a friend “med school’s not as bad as undergrad.” (I know realize I only said this because the topics we had covered had been mostly review and refresher.) I should’ve predicted this as I read today’s histology the night before. I was already struggling to understand the lymphatic system, and class wasn’t much better. We were looking for cellular components of slides that were infinitely indecipherable. You look at a microscope for so long, and the dark pinks merge with the light purples and everything just becomes a blur.
Then came anatomy; the dissections seemed reasonable enough in lecture: examine the posterior and superior mediastinum–find the major blood vessels and nerves. Reality’s always a little different story. When your body is tumored from the lungs out, and fat and scar tissue covers the part you’re trying to dissect, it becomes a mess of tubes, connective tissue, and confusion. I felt completely helpless; I was so lost that I couldn’t even hazard a _guess_ as to what I was viewing. Is this the vagus nerve? Or maybe it’s the phrenic? Is this fascia or hemiazygos vein? And then tumor after tumor after tumor. (It always makes it much worse when the TA or professor comes over and probes exactly to the right spot. You tell yourself “they’ve done this before,” but it still doesn’t help your ego.)
I got to the point where I just about gave up. I started picking at a blood clot in the vena cava, wondering how I got myself into this mess. Spending my early twenties cleaning out a hearty blood clot, hundreds of miles away from the guy I love, picking through connective tissue, staring at cells through a microscope that mean nothing to me. With formaldehyde fingers, an awakening on the wrong side of the bed, and my expectation that I generally know my stuff, I wonder if I’m going down the right path.
I know I’ll wake up tomorrow feeling completely different, but right now I’m a little overwhelmed (and I know it’ll only get worse). I can’t help but fast-forward to Bard-Parker’s recent frustrations and wonder if I’ll feel the same way. I’m just trying to keep everything in perspective –and remember that I’ve still got friends and family, a roof over my head, food in my stomach, my sanity, my health, and many other things that most of the world–or even the country–don’t.
Update 2004 : I noticed a bunch of people are finding this entry through Google. Just to let you know, I don’t hate med school at all. It was just a difficult time–I think something most med students probably go through. Just like everything else, the feeling passed. I’m enjoying med school.
As part of our new curriculum, medical students are required to have a “scholarly concentration”–something similar to an undergraduate minor, where students will take a couple classes, have the opportunity to do research in that field, and write a paper over what they’ve learned. The idea is to give students an area of knowledge depth , instead of just normal med school breadth .
Anyway, I’m considering doing mine in Bioinformatics; not so much information processing as practical technology to help physicians work and/or learn. I’m just in the brainstorming stages of where I’d like to go with this right now, but if you’ve got any pressing problems that really bug you, I’d love to hear about them. (Or, if you’ve got any ideas sitting on the back burner, I’d love to hear them, too!)
As a single-payer advocate, there’s nothing that bunches my panties more than confusion between health care systems. I’ve seen it on StudentDoctor , on MedPundit , and now over at MedRants . If for nothing else, please read this and pass it on to others so we can have an honest, fair, and informed debate; all I’m doing is trying to clear up some confusion and over-generalizations that are far too common in the health care debate.
Taking DB’s post as an example of some of the confusion:
Most physicians believe that the United States has the best health system in the world. I am aware of those who argue against that idea, but I dismiss them as a very vocal minority.
They would argue that outcomes are the same or better in Canada and Great Britain. This article should make them pause.
Op death rates ‘far higher’ in UK …
… However, this article reinforces my belief that our system is far greater than a single payor system…
… This article should make those who favor one payor systems reconsider their positions. The coming articles should shed even more light on this issue. Kudos to the physicians for performing this important research.
The article linked to, as far as I can tell, exposes some problems with the national health system in the United Kingdom. If DB were using it as evidence against a national health system , or Britain’s health program in general, that’d be one thing. However, he also claims it’s evidence against Canada’s system, as well as “one payor systems.” The problem with this analysis, is that single-payer is a completely different concept. It’s apples and oranges. Let me provide some definitions:
There are three basic types of “national health programs” — that is, programs where a country’s government has some major role in providing health care to all of its citizens.
* A national health system , known as “socialized medicine” by some, is the British system, as well as the system in Cuba. The health care system is controlled and run by the government. Doctors are employed by the state, usually as salaried positions; hospitals are, for the most part, publicly owned and operated.
* A national health insurance system , known as “socialized insurance” or “single-payer” by some, is the system used in Canada, Denmark, Japan, and several other countries. The health care system is still private (save for government hospitals and doctors who choose to be employed by them), meaning physicians still work in their private practices. However, the government (or a quasi-governmental entity) administrates and pays for the health care.
* A multi-payer health insurance system , known as “all-payer” by some, is used in France, Germany, and Israel. The system is similar to the single-payer system, but, as the name implies, instead of one payer, there are multiple quasi-governmental entities that act as payers (usually referred to as “sickness funds”).
Now, with that information, let’s rumble.
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The SUMMIT Labs are doing some really incredible stuff just down the road. We got to test-drive some of the latest-and-greatest in the medical learning technologies world today.
* I started off at the virtual laproscopic surgery unit, which uses two laproscopic surgical handles to simulate a surgery; on the screen in front of you, you can run a Java applet with full 3D graphics and real-life object dynamics to practice grasping objects, cauterizing, stenting, clamping, clipping–you name it. It’s partially used to help beginners get a feel for the instruments, but it’ll also be useful now that surgical residents are ahem , limited to 80 hours a week. The program has 20+ different scenarios, with varying degrees of difficulty. (Video gamers like myself only have an edge for the first two times on the simulator; after that everyone else’s hand-eye coordination skills catch up, according to the research they’ve done.)
* Next was a well-designed, attractive, and seemingly *useful* Shockwave/Flash clinical physiology website. I’m as tech-friendly as anyone can be, but most of the learning tools I’ve seen haven’t taught me much. In this one, however, you can test different clinical scenarios with patient physicals. You can do a virtual eye exam, and see what a patient with an optical motor neuron problem will look like upon examination, and then test your abilities with virtual patients who present with an unknown condition.
* The Media Server Project and E-Pelvis are two other interesting projects–the former has cataloged images from many medical disciplines and has a searchable index; the latter is a pelvic exam simulator that allow students to practice pelvic exams and give pressure and sensitivity readings back to the student, so he or she can improve technique before he or she does an actual exam on a patient.
* Finally, the Advanced Immunization Management Project allows developing nations’ public health departments to calculate the funding they require for their country’s vaccines. It’s primarily funded by Bill and Melinda , and teaches basic economic principles to health managers. It’s currently only available in English and French, so it’s got a ways to go, but it’s certainly a useful tool (even if it’s pretty dry and chock-full of items like “capital costs” and “operational costs”). The goal is to pass it on to provide it on CD to countries, so that the countries can then determine the funding they require and apply for that funding to GAVI , the Global Alliance for Vaccines and Immunization.
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We talked about veracity and confidentiality today in my ethics class, and one of the main reasons for it today was out of respect for the patient. From what I’ve seen from shadowing several doctors (as well as comments from several medical students at another school), I don’t think “respect for the patient” falls very high on the physician’s list of priorities. Our lecturer made the point that HIPAA only came into play after the system did such a poor job of protecting patient data, and if we don’t get better, Congress might step in again and make the restrictions even tighter. We’ve got to do a better job protecting patient privacy, despite the tendencies to discuss patients in public.
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At some point during the hoop-jumping of my premed undergraduate life, I came to the quite striking realization that I can, indeed, take myself too seriously. And all was good. I stopped obsessing so much, worried less, gained a little life-insight, and my stress and anxiety levels decreased. I’m starting to think I’m less Type A than I thought. Maybe I just became Type A because it was easier than dealing with some of my issues. So it goes.
But now that I’m in medical school, and will most likely be responsible for others’ health, well-being, and lives , am I taking my classes too lightly, or is this very analysis proof that I’m still over-analyzing and taking myself too seriously (yet again)? I just wonder to what degree my memorization of epithelial cell histology is going to affect my outcomes as a doctor. (Okay, just writing that last sentence made me realize I’m being a little anal here, but I’m not stoppin’ now.) These what-ifs just keep entering my head, but at least my logical side is starting to counter back (okay, you might not remember what a hemidesmosome is in 10 years, but my grandparents’ generation were probably never taught that they existed, and they’re doing fine; there will also always be books you can read if you really do need to recall what a hemidesmosome does).
Update: And then, after reading about Hermes’s shift , I’m reminded that medicine is creating enough of its own problems. A professor mentioned on Friday that around 20% of visits to Stanford’s ER are due to drug side effects, interactions, or complications. There’s still a lot of improvement to be done, whether I learn that the basal lamina is made out of collage type IV or not.
It’s the unanswerables that keep me going, I think. My thirst for knowledge and answers, I guess. Lucky for me, we’re faced with these questions almost daily. (Or maybe I just think too much.)
Our classes thus far have been covering the body from a micro to macro scale. In our “Molecular Foundations” course, we’re talking about DNA, RNA, proteins, enzymes like telomerase . If we zoom out a bit, we seem to pick up where molecular biology leaves off, in histology. Histology’s electron microscope lets us see cell components and even large molecules, and staining with light microscopy picks up organelles and multiple cell layers, starting to make up tissues and organs. And then you zoom out a little further, and you dissect the lung, dive through parietal pleuras and reflect back serratus anteriors to understand the muscles, integument, nerves, blood vessels, organs, and everything from the superior to the inferior.
And then you wonder, well, that’s the whole body (unless you went a little smaller to individual atoms , or a little bigger to organ systems ); where does the stuff that makes the person come in? There are a couple answers that come to mind, but that’s not to say that any of them are actually right. There’s the soul , of course, but then where does that go? Or sit? Or exist? Is it on some metaphysical multi-dimensional co-existing plane of existence that, for one reason or another, is linked to our bodies but controls them (ie: “the ghost in the machine”)? Or are our personalities and behaviors just due to our incredibly-complex brain ? We’re still not exactly sure as to how it all works as a whole (we understand some of the mechanisms, but don’t yet understand all the connections). Or maybe none of us have any free will at all, maybe we’re all just a fascinating, real-world version of The Sims for some higher-power’s pubescent thirteen-year-old. I personally tend to think we’re mysteries of our own electrons, and discovering ourselves is some sort of necessary human ouroboros quest. We’re as much the order in the chaos as mathematics is.
It’s the unanswerables that keep me going, I think. My thirst for knowledge and answers, I guess. Lucky for me, we’re faced with these questions almost daily. (Or maybe I just think too much.)
Our classes thus far have been covering the body from a micro to macro scale. In our “Molecular Foundations” course, we’re talking about DNA, RNA, proteins, enzymes like telomerase . If we zoom out a bit, we seem to pick up where molecular biology leaves off, in histology. Histology’s electron microscope lets us see cell components and even large molecules, and staining with light microscopy picks up organelles and multiple cell layers, starting to make up tissues and organs. And then you zoom out a little further, and you dissect the lung, dive through parietal pleuras and reflect back serratus anteriors to understand the muscles, integument, nerves, blood vessels, organs, and everything from the superior to the inferior.
And then you wonder, well, that’s the whole body (unless you went a little smaller to individual atoms , or a little bigger to organ systems ); where does the stuff that makes the person come in? There are a couple answers that come to mind, but that’s not to say that any of them are actually right. There’s the soul , of course, but then where does that go? Or sit? Or exist? Is it on some metaphysical multi-dimensional co-existing plane of existence that, for one reason or another, is linked to our bodies but controls them (ie: “the ghost in the machine”)? Or are our personalities and behaviors just due to our incredibly-complex brain ? We’re still not exactly sure as to how it all works as a whole (we understand some of the mechanisms, but don’t yet understand all the connections). Or maybe none of us have any free will at all, maybe we’re all just a fascinating, real-world version of The Sims for some higher-power’s pubescent thirteen-year-old. I personally tend to think we’re mysteries of our own electrons, and discovering ourselves is some sort of necessary human ouroboros quest. We’re as much the order in the chaos as mathematics is.
It’s the one question I wonder if we’ll ever be able to answer; maybe we’re never meant to have one. If a drug can make a person become “not himself,” or an event can cause a loss of sanity, then maybe the self is much deeper than most of us take it to be. There’s a great passage in the Bhagavad Gita (that I of course can’t find) that makes me think “the Self” (or your particular word for it) is much deeper, permanent, and more constant than we take it to be.
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