Category: General

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General MSPress Announcements

“The Compassionate Physician Discoverer” Dr. Barry Coller, 2015 Commencement Address of the Northwestern University Feinberg School of Medicine

This week, Dr. Barry Coller’s 2015 commencement speech at Northwestern University Feinberg School of Medicine entitled, “The Compassionate Physician Discoverer” debuts via the Medical Commencement Archive.

Screen Shot 2015-08-13 at 3.07.39 PMDr. Coller is a respected educator and a leader in hematological research. He graduated from Columbia College in 1966, received his M.D. from New York University School of Medicine in 1970 and completed his residency in internal medicine at Bellevue Hospital and advanced training in hematology and clinical pathology at the National Institute of Health. He is currently the David Rockefeller Professor of Medicine, the Head of Laboratory of Blood and Vascular Biology, Physician-in-Chief of The Rockefeller University Hospital, and Vice President for Medical Affairs at The Rockefeller University. He also serves as the founding Director of the Rockefeller University Center for Clinical and Translational Science. Dr. Coller’s research interests have focused on hemostasis and thrombosis, in particular platelet physiology. He helped developed abciximab which, to date, has treated over five million patients – I’m sure we’ve all heard that drug in pharmacology many times!

Dr. Coller began his address by reflecting upon, what he believes, are the two pillars of medicine: science and humanism.

“The expert physician has a comprehensive and deep scientific understanding of the causes of illness and the rational basis of disease prevention and therapy; the compassionate physician applies that knowledge with sensitivity to the unique needs and circumstances of a single complex individual.”

He further explains that medical humanism has five core elements: the preciousness of human life, respecting and protecting a patient’s dignity, celebrating human diversity, sympathetic appreciation of the complexity of the human condition and lastly, a commitment to social justice, universal access to medical care, and global responsibility.

Of course, a leader in research will not fail to emphasize the importance of furthering science:

“…I appeal to each of you to be a medical discoverer by which I mean applying the scientific method to address a health need… you live in an age of ever faster technologic change, much of which meets the criterion of disruptive innovation, wherein new technology does not simply improve on previous technology, but forces radical transformation.”

At the end of his speech, Dr. Coller concludes with this piece of wisdom:

“Art, literature, poetry, theater, and cinema help you keep the patient’s perspective before your eyes, but nothing is as good as really listening to your own patients, sympathetically hearing their life story, and learning what they have teach you. And nothing is as rewarding.”

 

Categories
General Lifestyle

Torn Between a “To Do List” and a “Social Life”

I have always been an overachiever, no doubt about it; always wanting to be one step ahead of the rest, always ahead of the game. For example, if I finished a school assignment by 7 o’clock in the evening, instead of taking the night off, I’d start on another assignment I knew was coming up. This was the motto I lived by all my life, until I finished my 1st year of medical school, that is. As a pre-med and 1st year medical student, I constantly told myself I’d fill my summer up with resume-building extracurriculars. But people kept telling me, “It is your FINAL summer off for years to come, enjoy your time!” Me?! Taking time off? Not being productive? I couldn’t even bear the thought. By midway into my 1st year, I already had research for the summer set up, in addition to potential shadowing opportunities in fields of interest to me. I factored it all into the schedule for my seemingly lengthy, but in reality limited, 6 weeks of summer: research, volunteering, shadowing, studying for boards. My plan was to complete all my research and volunteering positions throughout the days, and study a few hours for Boards at night.

Today, 2 days into my official summer vacation, I realized I had failed to factor some crucial aspects into my schedule: my family, friends, & outright sanity! I have worked too hard all year not to enjoy a few weeks of bliss. I deserve to wake up to a day filled not just with endless studies and a “To Do” list the size of my Grey’s Anatomy textbook, but rather to a day of, yes, some work and productivity, but also some well-deserved fun! Since this realization, I have altered my schedule drastically, allowing myself to live the next 6 weeks with this new mindset. On top of everything, my sister is tying the knot the last weekend of my summer, an event I underestimated in terms of the time and effort it would take to plan for. These happy times with family and friends will be memories I will cherish forever. Ok, so you can’t exactly add “planned sister’s wedding and hung out with friends and family” to your resume, but one cannot compare the value of building those precious memories with a completed “To Do” list. I know I will regret it down the line if I don’t allocate some time during the summer for my loved ones.

Of course, I am filling my schedule with productive, career-building endeavors; however, I am not overwhelming my life with these plans. I plan to enjoy my time and to experience exciting pursuits with my loved ones. I am extremely satisfied with the decision I’ve made: the decision to have a summer I can remember for the rest of my life, yes, but one that also includes a realistic amount of academic accomplishments.. I mean, after all, how much of my Boards studying am I REALLY going to remember? Five percent, if I’m lucky. And at the end of it all, I know one person who will be the MOST thankful and excited about my decision: my loving sister. I can spend some quality time with her, helping make the happiest time of her life one to cherish forever. For those of you who wish to fill your summers with career-building activities (a.k.a. my fellow overachievers), below I have listed some things that were on my list to achieve this summer. I hope they spark some inspiring ideas and fuel motivation that may have dwindled if you are anywhere close to the state of mind I am in after a year of hard work! Good luck to you all!

  • Volunteer at a Hospital around your area, or school’s area, or where you plan to apply for residency. It is never too early to get your foot in the door and start forming connections with program directors in residency programs you will be applying to in a couple of years! You can even find individual doctors in departments of interest to email and ask if you can shadow.
  • Volunteer for a humanitarian project. I am personally volunteering for the 2015 Special Olympics World Summer Games in Los Angeles, California. Any small gesture to give back to our community, preferably using the knowledge we have learned thus far, would be more than enough. A little help from a lot of people combined turns out to be surprisingly impactful!
  • Do research at your school. By finding a project at your school, you will be able to continue the research throughout the following year if the project extends past the summer. This shows longitudinal dedication, without adding an unmanageable workload on top of your coursework.
  • Light Boards studying. Key word: LIGHT. We are probably not going to remember much for the Boards from this summer. Maybe look over some drugs and bugs. Maybe Pathoma or Kaplan videos, focusing on topics that particularly confused you during your 1st year or that you were never able to grasp.
  • Pursue your hobby, and do it in a way that is applicable to medicine. Residency programs do look for a well-rounded applicant, after all. For example, I thoroughly enjoy writing, and now blog for the MSPress. This allows me to relish in my hobby, while giving me a solid accomplishment to add to my resume. For those of who might like to paint, paint a medical scene!

There are many many more, these were just a few. Above all, remember to always update your resume (you will regret it if your achievements pile up and you forget the details), and remember to enjoy life!

Featured image:
100! ;D by Abdulrahman AlZe3bi.

 

Categories
General

Neurology and Us: What Are Our Minds?

Conceptual side profile of a human face, with see through illustration of the brain.

As medical students, we have to take many classes. Some of them are relatively easy, and some of them are hard. One class notorious for being very difficult is neurology. Despite this, though, I find neurology to be one of the most fascinating subjects we study. Think about it: everything we call “us” arises somehow out of vast networks of interconnected neurons. It is mind-blowing to even begin to contemplate the complexity of the neuronal machinery responsible for such tasks as creating our thoughts, emotions, personalities, etc. etc.

For millennia, philosophers have been attempting to accurately describe what it is to be human without the aid of neuroscience. Only recently has neuroscience been added into the mix of this speculation; the first notable contribution of neuroscience to theories of mind appeared in 1949 as Donald Hebb’s book The Organization of Behavior. For the first time in a major publication, a neuroscientist postulated that it was possible for the purely physical processes of neuronal circuitry to explain psychological phenomena like states of mind and learning. Before the advent of neuroscience, learning was considered a psychological phenomenon, and any attempt to explain it in detail had no recourse to neurophysiology. Now, learning is taught in medical school curricula as at least partially due to changes in both presynaptic and postsynaptic neuron adaptations (changes in neurotransmitter release rate in the presynaptic neuron and long term potentiation in the postsynaptic neuron). This represents a paradigm shift in the way we think about ourselves. Is learning the only psychological phenomenon explainable by changes in neurotransmitter release and altered receptor densities? Are all aspects of our minds the result of nothing but extremely complex neuronal circuitry?

Proponents of a theory termed eliminative materialism believe all of the commonly held beliefs about our minds will soon be replaced by neurophysiological explanations at the level of neuron circuitry. As the Stanford Encyclopedia of Philosophy puts it in the entry on the philosophy of neuroscience:

“Eliminative materialism (EM) is the conjunction of two claims. First, our common sense ‘belief-desire’ conception of mental events and processes, our ‘folk psychology,’ is a false and misleading account of the causes of human behavior. Second, like other false conceptual frameworks from both folk theory and the history of science, it will be replaced by, rather than smoothly reduced or incorporated into, a future neuroscience. . . according to EM, continuing development in neuroscience will reveal that there are no such things as beliefs and desires as characterized by common sense.”

Will eliminative materialism turn out to be the correct account of our behavior? Who knows? The debate rages on. Neuroscience continues to uncover more physical processes underlying the way we experience the world, but competing theories claim the irreducibility of our experiences to mere materialistic phenomena. Even if I could, for example, fully explain the state of your nervous system down to the smallest detail after you learned of the passing of your loved one, does that mean I really know what you’re feeling? Does a specific brain state actually equate to an emotion as we experience it as conscious beings? I don’t know, that’s above my pay grade, but it’s fun to think about, isn’t it?

Source: Stanford Encyclopedia of Philosophy

Featured image:
object. by Evan

Categories
Disability Issues General Lifestyle

Deafness as a culture

“Try not to associate bodily defect with mental, my good friend, except for a solid reason”
– Charles Dickens, David Copperfield

What is the first thought that pops into your head when you think of the word deaf? Do you think of a disability? An inability to function in society? Do you think of loss? Of a deficiency in one of the most vital senses? Or do you think of group of people with similar values and beliefs, brought together through their experiences?

The medical model sees deafness as a disability, an impairment that needs to be fixed. A disability is defined in the Oxford Dictionary as a physical or mental condition that limits a person’s movements, senses or activities. In this sense, one could agree that deafness is considered a disability. However, deafness comes in two forms: deafness, indicating disability, and Deafness, indicating a culture.

Culture is defined as the ideas, customs, and social behaviors of a particular people or society. Deafness can therefore be viewed as a disability or an altered human experience. Deaf culture can include beliefs, behaviours, traditions, history, and values of the community. Deaf culture is an ethnocentric culture, based more upon sign language and relationships rather than a common native land – it is a global culture. Deaf Culture sees itself as a language minority than a disability.

 

Values and Beliefs

A culture tends to have its own beliefs and customs that are shared by its members, and deaf culture is no different. Deaf social protocol is based upon maintaining good visibility with others in the environment (Deaf Culture 2014).

Some examples of social customs within this culture include:

  • Rules of etiquette for getting attention and politely negotiating a signed environment
  • Keeping one another informed of what is going on in one’s environment – for example, letting someone know that one is going to the bathroom (in the hearing environment this is often not needed)

 

Arts and Literature

As with other cultures, deaf culture is rich in history and art. Storytelling also makes up a big part of the culture. Clayton Valli was an American deaf linguist who created works in ASL performed through handshape, movement and facial expression. One of his pieces of work, called Dandelion can be found here.

There is also a National Theatre of the Deaf in the USA that involves productions using ASL and spoken word. Their mission statement is to educate the public and open their eyes and ears to deaf culture (National Theatre of the Deaf 2014).

Media is a vital component in getting ones message heard, and many artistic groups throughout the world have increased awareness of deaf culture, helping to stem ignorance and begin a conversation about the experience of being deaf. Movies and TV programs also need to start promoting deafness not as a pathological condition but as a way of life, helping to banish this perception of disease and impairment.

 

Cochlear Implant Controversy

Cochlear implants are electronic devices that can be surgically implanted in patients who are deaf due to sensory hair cell damage. They can provide hearing in order to increase understanding of speech, and it is estimated that 324,000 people worldwide have received them as of 2012 (NIDCD 2013).
Although this may seem like an incredible treatment for those who have difficulty hearing, it also gives the suggestion that deafness is a condition that needs to be fixed. Some deaf people are not so much against the cochlear implant, than what it represents: a lack of respect for their culture. Indeed, some people have gone so far as to describe these devices as a means of cultural genocide.

It can be argued that deafness, as a cultural identity, should be encouraged to thrive and be supported in today’s diverse society. Others believe that every child should be given an equal chance in life. Through cochlear implants one will have opened the door to greater opportunities, such as better chances of finding employment, integrating with the community at large, and achieving a greater level of success. But why should a deviation from the norm result in fewer opportunities in the first place? Shouldn’t we be dealing with this inequality rather than trying to cover it?

Doctors may see a deaf child as missing something vital, being impaired and therefore not able to function in society. The word impairment implies fault; imagine the implications this can have on a child who is told they need to be fixed. Children should feel proud of who they are, not ashamed of what they were born with. What kind of impact would such thoughts have on their self-esteem? We all know how isolating it can feel to be different during childhood; why should we push these children further away from society?

Cochlear implants are seen as being oppressive: an illustration of our overreliance on the biomedical model. Instead of seeing a child as impaired, it would be more helpful to see the child as having a different natural language. We live in an age where we preach about acceptance and diversity. Shouldn’t we be embracing the deaf culture instead of annihilating it?

What does this mean about the future? If we find the cure for deafness tomorrow, does that eradicate an entire culture? Will there be people out there who will refuse to accept the cure for their child? And what implications will that have on the medical profession – can we accept this refusal? After all, every child deserves the best start in life. Where do we stand between respecting ones beliefs and doing the best for our patient?

 

Diversity

It has been suggested that deafness can be an isolating experience; you are part of a minority, cut off from the rest of the world. One could also argue that there are plenty of cultural minorities out there; despite English becoming more and more vital in our multicultural environment, there are many minor cultures out there who do not have English as their native tongue and are therefore cut off from a large part of civilization. Does that stop them from being a culture?

Diversity is a good thing: it is what makes society grow. It is needed for creativity, for quenching ignorance and progressing as a race. What is considered normal in this day and age? Having an illness gives you a new identity, a new way of looking at the world and translating your surroundings. What is considered illness to one person is considered normal to another. By embracing the different views on deafness, we embrace the diversity of mankind and what it has to offer.

 

References
Deaf Culture. 2014. Comparative chart: deaf and ethnic cultures [Accessed: 17thDecember 2014]
Deaf Cultural Centre. Arts & Culture [Accessed: 17th December 2014]
Jones, M.A. 2002. Deafness as Culture: A Psychosocial Perspective. Disability Studies Quarterly. 22:51-60
National Theatre of the Deaf. 2014. About the National Theatre of the Deaf [Accessed: 17th December 2014]

Featured image:
DEAF project #5 by Dario-Jacopo Lagana’

Categories
General

Call For Medical Student Writers

The Medical Student Press invites all current medical students to apply to join the MSPress Blog team. The MSPress Blog is a weekly publication featuring humorous, instructive, creative, and opinionated pieces.

Regular writers are required to submit one piece a month. To join the collaborative and expressive MSPress Blog team, visit our application site. CV and writing sample are required. For further information, feel free to contact the current MSPress Blog Associate Editor, Marija Kusulja (blog@themspress.org).

Categories
General Lifestyle Opinion

Staying Alive

https://www.youtube.com/watch?v=n5hP4DIBCEE

https://www.youtube.com/watch?v=ILxjxfB4zNk

Have you seen these videos that promote hands-only cardiopulmonary resuscitation (CPR)? Unfortunately, they don’t appear to be as popular and catchy as the song they feature.

CPR is a basic life supporting activity that literally saves lives. Even though the majority of the public is familiar with the concept or CPR, most don’t feel confident in executing it when the need arises. This could be because there are not enough first aid courses. However, I think there is another important factor for consideration.

Media and the entertainment industry, especially films and TV shows, portray physicians performing CPR as a miracle. The setting usually includes a gasping patient whose ECG suddenly flat-lines; then the doctors run in, yelling ‘blue code’, and immediately applies defibrillator pads on the patient’s chest. There may be sparks, and the patient is usually shown to give a jolt, often waking up and becoming completely alert and fully recovered.

Following this highly romanticized portrayal of CPR, it’s not a surprise if non-health professionals decide to merely wait for heroic EMTs, paramedics or physicians. In fact, some may view CPR as a seemingly complicated procedure that requires special equipment with the ability to bring a dead person back to life.

I don’t expect medical TV shows to be completely accurate or to portray entirely realistic situations; nevertheless, the repetitiveness of this false portrayal of resuscitation sticks in the minds of viewers. The entertainment industry is not responsible for educating the general public, but even if they don’t portray CPR entirely accurately, they shouldn’t lead their viewers astray. Repetitively being exposed to on-screen resuscitation, people can come to believe that defibrillators are an essential piece of equipment, without which resuscitation isn’t possible and the best approach is to leave it up to health professionals. Furthermore, showing conversion of flat-line ECG into sinus rhythm implies that electricity can restart a human heart. With the amazing automated external defibrillators becoming more widely used, a non-health professional can use them without knowing which rhythms are convertible, but I still believe they need to be aware that flat-line ECG means there is no electric activity in the heart, and that electricity cannot reinstate it; all a defibrillator can do is give a jolt to an irregularly paced heart which will hopefully terminate the irregular rhythm, allowing the natural pacemaker to take over and reinstate sinus rhythm.

The media has a strong influence on all of us. While attempting to amuse the audience and gain financial reward, the media should still impart important and accurate life lessons.  Thanks to TV series and films, I don’t expect anyone would struggle to remember the emergency telephone number. Yet, because of the same media influences, many people would wait for an ambulance and their magical defibrillator instead of starting CPR themselves. Instead of giving false impressions about resuscitation, the media could play a large role in popularizing CPR as a simple, but vital action that can be performed by anyone, anywhere. Even though it is not the point nor purpose of the entertainment industry, this is an important message that can be relayed without requiring producers and actors going out of their way.

Featured image:
cpr mother & child by zen Sutherland

Categories
General Lifestyle Opinion

I Will Not Try To Fix You

Disability—The Oxford dictionary defines disability as “a physical or mental condition that limits a person’s movements, senses, or activities.”

Although some disabled people have medical ailments, the two conditions are not synonymous. While a disabled person might require medical attention, disability is defined by social barriers, not pathophysiology.

It is an umbrella term and includes impairments and activity limitations. Impairment is a problem in the body’s structure or function; activity limitation is a difficulty encountered by an individual in executing a task or action.

Disability is a complex phenomenon, reflecting the interaction between features of a person’s body and features of the society in which he or she lives. Overcoming the difficulties faced by people with disabilities requires interventions to remove environmental and social barriers.

Those with disabilities have capacities for motor, sensory, and cognitive tasks that differ from the “norm.” Each individual has different qualities and capabilities, but defining this “norm” is practically impossible. Society can create barriers that do not allow an individual to develop to his or her full potential. Likewise, society can remove disabling barriers. A wheelchair user cannot get into a building with steps at the entrance, but a ramp or a lift completely removes that particular barrier. Seated before a ramp, is an individual in a wheelchair disabled?

An individual with Down Syndrome can hold meaningful employment if provided with appropriate support. Down Syndrome itself is not a disability; it is a medical condition. An individual will experience specific barriers that emerge because of the relationship between impairments and societal barriers. The presence or absence of medical conditions can cause one individual to vary from another in terms of motor, sensory, and cognitive function, but an individual is only disabled when appropriate accommodations are not made.

As a societal construct, disability fluctuates in different settings. In a completely adapted home, or with adequate assistance, an individual might have no disability at all; while, in an environment without assistance, this person might become disabled.

Physicians treat medical conditions and, as such, they tend to focus on the “limitations” and “abnormalities” associated with disabled people’s conditions; heart disease, for example, in those with Down syndrome. Disabilities, however, are not medical conditions in and of themselves. The role of a physician is to assess the health of a disabled person, provide treatment for associated symptoms, and anticipate as well as prevent future complications. This can greatly improve a disabled person’s quality of life, and, in some cases, even prolong life. Fixing the disability is not in the doctor’s job description.

How do you, as a medical student, perceive disabled people? Do you feel as if medicine failed them by not being able to “cure” them?

Disability is not tragic; it is tragic that society doesn’t appreciate the abilities of disabled individuals.

Disabled people often report being patronized by medical staff, being described as having “a fate worse than death”, or carrying an “unhealthy gene”, as well as “suffering” from a condition. Consider the power of language. Great advances have been made in both medicine and technology, and even more in the public’s perception and understanding of disability.

Disabled people have more freedom, independence, and equality than they did previously, but there is further work to be done. Rather than making a distinction between disabled or not, physicians should be leaders in embracing diversity and independent living for all of their patients, including disabled people.

Dr. Chris Smith – a disabled associate professor of communication arts and sciences at Calvin College, USA – recently spoke about perceptions towards disabled people, stating that “the ultimate test of living in community is found in our willingness to change our minds about one another.”

People with disabilities have the same health needs as non-disabled people – for immunizations, cancer screening etc. They may experience a narrower margin of health, due to both poverty and social exclusion, and also because they may be vulnerable to secondary conditions. Evidence suggests that disabled people face barriers in accessing the health and rehabilitation services they need in many settings.

As future physicians, it is important to view disabled patients equally to all others, whilst acknowledging the barriers they face. When approaching your disabled patients, do not define them by their impairment, do not pity them, do not try to “fix” them; rather, appreciate their abilities, recognize them for their values and behaviors, support them to achieve their aspirations, and, most importantly, listen to them.

Featured image:
disability by Abhijit Bhaduri

Categories
General Literature

Moby Dick and Medicine

Last weekend, my classmates and I went on a ski trip to a most excellent resort in Vermont. This trip was partly a literature retreat for me, as I chose to reread a large portion of Herman Melville’s Moby Dick on the drive there and back. Upon arriving at the resort, I was inspired to write this post for two reasons. Firstly, the main room had a scenery that I felt to be most conducive to writing (see photo). Secondly, I had been thinking during the drive up to Vermont about how rereading Moby Dick, or any other piece of imaginative literature, is related to rereading texts in medicine, including our current lung unit’s clinical cases (as some of my classmates had been doing in the van), or even re-“reading” a real-life scenario during a pulmonary ward rotation. I realized that there are many similarities, some of which I will share in this post. Again, my central question is: what is the usefulness of reading imaginative literature for the progress of science and medicine?

Photo courtesy of Tony Sun
Photo courtesy of Tony Sun

First, I’d like to introduce, or for some readers, re-introduce Melville’s Moby Dick, a supreme example of American Romanticism. The Romantics were involved in a movement that affected Western art, music, and literature, primarily in the 19th century. In America, the chief Romantic writers were R.W. Emerson, N. Hawthorne, H. Melville, W. Whitman, and H.D. Thoreau. These writers wrote about the art of rereading texts, created characters that had to re-experience situations, and presented the meaning of redoing what has already been done or experienced. The last is of crucial importance and is what unifies the first two themes: rereading and re-experiencing. For any belated reader or writer, there is naturally an anxiety of comparison with precursor writers and readers. Belated individuals may ask themselves: how can I read in an original way, or, how can I write original ideas? For Melville, his question might have been: how can I create and write an original character that embodies vengeance, when Shakespeare had already done so with Iago, or John Milton with his Satan. But Melville overcame this anxiety. He created Ahab, a fusion and reworking of the characteristics found in Iago and Milton’s Satan.

You may ask: how does Ahab and Melville relate to science and medicine, and how is Romanticism related to the art of medicine? I see two main links, one being that reading the Romantics enables one to be more knowledgeable about the issue of originality, and two being that observing how the Romantics handle the art of redoing enables one to redo something and still retain originality. These two links are not mutually exclusive, and the second naturally follows the first—learning what originality is enables one to redo things in original ways. Take this for example: a pulmonary intern (keeping the lung theme) sees a case of fibrotic lung disease that had been presented recently at grand rounds. Now, repeat this situation maybe ten times, that is to say, the intern sees ten more patients with fibrotic lung disease and goes to ten more grand rounds on fibrotic lung disease. Could such repetitiveness lead to boredom for the intern? I can’t answer this from experience, as I’m only a first year student, but I’ve heard the answer to be: “Yes.” A bit of originality could help the intern out here, so here I invoke the experience of reading and rereading Melville: when I reread Moby Dick, or reread any other book, I remind myself to be more aware of where I reread, how long I reread, and how I feel when I’m rereading. And then I compare these to my previous experiences of reading Moby Dick, that is to say, where I first read it, or, where I previously read it. I would argue that the intern can try something similar with clinical cases and grand rounds: where did I last see this case of fibrotic lung disease? And how did I feel when I last saw this case? These questions can make each case of fibrotic lung disease original and interesting.

To finish this post, I’d like reflect on my previous post. In my first post titled “Imaginative Literature and Medicine,” I laid out my objectives and motivations for writing in this blog, and I identified three focal points that I can discern in the medical humanities: 1. a literary focus, in which writers identify characters in literature that are scientists and doctors and write about these characters; 2. a medical focus, in which doctors and scientists reflect on personal anecdotes and write about them creatively in the form of poems or short stories; and 3. a practical focus, in which writers identify links between literature and medicine and argue for the usefulness of reading imaginative literature in practicing medicine and science. My interest is in the third category, and admittedly, I think this is the most underdeveloped of the three categories. This second post on Melville, Moby Dick, and medicine (a convenient alliteration, I might add) is meant to not only continue where I left off in the first post, but also to start a trend for future posts, in which I will be drawing more links between medicine, science, and the American Romantic writers: R.W. Emerson, N. Hawthorne, H. Melville, W. Whitman, and H.D. Thoreau.

Featured image:
Ahab reloaded by José María Pérez Nuñez

Categories
General Opinion

Be Kind to Your Med Techs (And Everybody Else)

Before I was accepted to medical school, I was a medical technologist. This basically means I worked in the laboratory at a large hospital. I was playing one of the “behind the scenes” roles that many of us probably played while we were getting the medical experience required to get into med school.

Med techs are the people who run the CBC’s, comprehensive metabolic panels, amylases, lipases, pregnancy tests, urinalyses, cross-matches, etc. etc. ordered by the doctors. Usually, I was in direct contact with the nurses and doctors, who either called my line directly or came down to the lab if something needed to be clarified or a specimen needed to be delivered.

I’ll tell you right now the difference between a good day and a bad day at work. Two factors contributed: how swamped we were with patient samples, and how good of a mood the doctors/nurses were in (I say “doctors/nurses” because the moods of these two groups of people usually parallel each other quite well on any given day, and often the doctors communicate to other staff through nurses).

Of course, no matter what part of healthcare you work in, there are going to be days when the patients just don’t stop coming and you can’t catch a break. That’s unavoidable; the only thing you can do then is pray to the all-powerful but oft malicious gods of healthcare for some sort of respite.

But the second factor is something you and I can do something about as future doctors. I don’t know what your feelings are on “Reaganomics” (a.k.a. “trickle-down economics”), but I can tell you for sure that “trickle-down attitude” is most definitely a thing. If a doctor has an ungrateful, self-important, entitled, or simply negative attitude, then all of the people that doctor works with will absorb that negative energy.

As a med tech, I absorbed plenty of this negativity while working long night shifts. I’ve been yelled at for not having the test results of an order that was never put in. I’ve been hassled unnecessarily for CSF WBC counts before the tubes had even gotten to the lab. I’ve been berated by frazzled nurses because I needed them to get me a redraw due to hemolysis. Every time this happened, it shifted my stress and discontentedness level up a notch. It only takes a few notches to ruin an entire shift,and a few bad shifts in a row can cause burnout to quickly sink in. Work becomes death. Getting out of bed before a shift becomes nigh impossible. It gets more and more difficult to be fully engaged at work, which increases the likelihood of errors.

It’s not just med techs, either. The same thing happens to all allied health professionals. Phlebotomists, X-ray techs, radiology techs, nurses, CNA’s, orderlies, and even janitorial staff are affected by how the doctors in the facility are acting. Whether we like it or not, being a doctor means being a leader. So please, I beg you: be kind to your med techs (and everyone else).

 

Featured image:
Work Hard And Be Kind Wallpaper by Clay Larsen

Categories
General

The Chasm Between Pre-Clinical and Clinical Medical Education

Depending upon which school you attend, the first one to two years of medical school are predominantly classroom-based learning. As medical students, we spend countless hours memorizing facts about disorders and diseases. We pore over diagnostic criteria, look for the minutiae in radiographs, and stress about the side effects of antibiotics and other medications.  While all of this information is useful and important, the reality of medical education soon changes when students start spending time in the hospital and in various clinics.

In transitioning from pre-clinical to clinical education, it soon becomes clear to medical students that what you learn in class and what you actually see in patients is quite different. Furthermore, even when presentations are clear it is still not trivial to determine what an actual patient’s diagnosis may be.

One poignant example, which I remember well, occurred while I was shadowing a local pain management Physician as part of the early clinical exposure course at our school. The patient whom we saw had a textbook case of C-7 radiculopathy with associated shoulder pain and loss of sensation. We had learned about radiculopathy in medical school, and I had a working knowledge of the diagnosis.  After I had spent some time interviewing the patient, my preceptor asks me what I thought the diagnosis was. I had some idea that the patient had a radiculopathy, but in my nervousness and uncertainty all I could muster up were a few whispers and murmurs.  My preceptor turns to me and basically says that this was a very clear case of C-7 radiculopathy.  After hearing the diagnosis, I distinctly remember thinking that I had known the disorder and had seen the symptoms in the patient, but had been unable to connect the dots.

The ability to connect the dots and turn pre-clinical knowledge into data that is useful in a clinical setting is a difficult skill to acquire.  You have to deal with patients that have varying presentations and many associated comorbidities, both situations that are not emphasized in much of the book and lecture-based learning of the pre-clinical years.  The only real method to attain proficiency in a clinical setting is hands-on experience.

Noting this need for hands-on experience, medical school curricula has changed substantially over the last decade. More medical schools now offer early clinical skills and patient experiences in their curricula, hoping to bridge the chasm between pre-clinical and clinical education. At the school that I attend, we start to see real patients in the second week of our first year. In the second semester of our first year, we embark on a year-long experience in local clinics where we work with practitioners to learn the ins-and-outs of clinical medicine and practice. Most other schools have implemented similar programs. Furthermore, the trend towards shortening pre-clinical education to one to two years is a direct response to student need for early clinical experience.

While early clinical exposure is important in medical education, it must occur with a solid foundation of preclinical knowledge.  Balancing knowledge acquisition with practicing clinical skills is a juggling match every medical student must deal with. Luckily, we don’t have to learn all of it during medical school, as medicine is a lifelong learning experience.

Featured image:
stethoscope by Dr.Farouk