1. You feel very stupid when a doctor asks you a question in front of a patient and you don't know the answer. It doesn't matter that I've only been in medical school for five weeks, you still feel like you've seriously missed the boat.
2. I don't think I want to be an ER doctor. I've always thought ER sounded like an interesting specialty and it still is...but after a day at the ER in Strathmore, AB I think that I like the people interactions too much to be an ER doc. Interacting with the patients in that setting tends to be very brief, check them out, make sure they aren't dying, and send them on their way or admit them to the hospital - you don't have the time or need to form any real kind of relationship with them, you just address their immediat concern, and I think that I want a specialization where develop longer term relationships with your patients. That being said, watch this blog as I'm sure my ideas of what a 'good' speciality will change once or twice in the next year and a half.
3. I've decided that getting viral hepatitis is a bad idea whether A, B, C, D, or E I don't want it. Luckily I've been vaccinated against A and B but I have no plans in the immediate or distant future to share needles with IV drug users, or engage in other similar risky behaviours...I like my liver just fine the way it is and it can be damaged enough by fat let alone adding the risk of a viral infection on top of it all.
4. I'm realizing that in medicine when you have a bad day it has the potential to be a really bad day. Imagine establishing a relationship with a patient who is terminally ill that could be cured by an organ transplant of some sort but because they have too many risk factors against them and their illness isn't acute enough they won't be put on the list (or they'll be put too far down the list) to receive the organ that they need before they pass away...I think that passing that kind of news along would generally make you have a bad day, even though it is no fault of your own. The idea of being a 'healer' is something that I believe draws many of us medical students to pursue this career. However, I suspect that we are going to find that there are some days we feel like we are fighting a losing battle. We are going to face a combination of patients that don't care about their own health (or didn't care in the past and now face the consequences) and a system that is flawed - insufficient resources for growing needs. Organ transplants are a prime example. The number of people requiring transplants is going up, success rates for transplantation procedures have improved in the last 20 years (I believe) but the supply of available organs is decreasing or remaining constant. The same thing applies with screening and diagnostic techniques like colonoscopies. If I understand the science correctly many colorectal cancers could be caught by regular colonoscopies, in the same way that mammograms catch breast cancers. However, the resources are simply not available to meet the demand and so it forces medical professionals to rank patients according to immediate need, placing the priorities of one patient above those of another.
5. If I understood the doctor yet and I had to get a blood cancer I would rather get a faster growing one than a slow growing one. At first this seemed counter-intuitive however the explanation made sense. Fast growing cancers are dividing much more often than the normal healthy cells of your body. Chemotherapy can target dividing cells and you have a much better chance of eliminating the cancer that is dividing quickly because you can target it. Slow growing cancers that grow at similar rates to your normal cells are much more difficult to target and kill completely.
6. Mnemonics are very useful. Mnemonic is just the fancy name for a memorization technique and can be as simple as remembering something to the tune of a song, a phrase, or an acronym. The acronym I learned this week is VEAL to help me remember the complications of Portal Hypertension. V stands for varices (essentially varicose veins in your esophagus, they are bad). E stands for encephalopathy (this is essentially brain problems, also VERY bad). A stands for ascites (this is the accumulation of fluid in your peritoneum basically your abdominal cavity and increases your risk of dying quite significantly, thus it too is very bad). Finally L stands for liver cancer or hepatocellular carcinoma, as I'm sure you've guessed by this point liver cancer too is bad. In one simple sentance - Portal Hypertension is bad.
7. People are amazingly generous to medical students. On Saturday I did a day of shadowing at the Strathmore Emergency Room (which I found out is one of the busier ERs in the province). While there the doctor had me taking histories from the patients before he saw them. I introduced myself the men, women, and children who were clearly uncomfortable and had been waiting, possibly for hours and they allowed me to fumblingly work through a somewhat directed history to try and find out what the doctor needed to know to make a diagnosis. Some of them even allowed me to ask them questions that were clearly of no relevance to their complaint but allowed me to work on my history taking skills. We have been told in our Ethics class that doctors enjoy a unique place in society because people will tell us pretty much anything, even though we are complete strangers. Listening to the patients on Saturday made me realize that it is true, and with these stories comes a responsibility to respect the patients who are coming in their discomfort, pain, and need for assistance, to respect their privacy and to do everything you can to ease their pain. I don't know if my class will take the Hippocratic Oath upon graduation or not but there is a modernized version (at least modernized in 1964) that definitely has new found relevance after my day of dealing with 'real patients'.
I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help. Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University. |
8. I still don't really like to study. I'm not sure if I have ever actually enjoyed studying. I've always had this sense that studying is work and there is something, anything that I could be doing would be preferable. While I've certainly found activities that are less preferable than studying it is not my favorite activities. However, this coming Friday I have my first Formative Exam. At the UofC exams come in two flavours - formative and summative. Formative exams are worth 0 points. The come half way through each course and act as a check point to make sure you are on the right track, and you are learning what you ought to be learning. So, I've decided to try and treat this as a real test that does count for something in order to get the most out of it...so my 'day off' tomorrow is going to be largely studying but hopefully it will be a fine day and I'll get to enjoy some of it. One thing that is very nice about UofC and many other medical schools is that we are graded on a pass/fail system. While we will still find out what our actual score was (e.g. 37% or 93%) our transcripts will only record pass/fail. The pass/fail line is not set at 50% but is rather based on competency. Instructors sit down and create an examination. They then determine what percentage of questions a medical student at the examinee's level should get correctly to demonstrate competence. We are not being asked to know every single thing we have learned because that is impossible (although it would be nice). We are required to demonstrate competency as first year medical students, and this same philosphy will extend through the rest of our training...so hopefully on Friday I will demonstrate that I am competent. If not I guess I'm going to have to sort out how to become more competent at my study strategies. A friend of mine once described his overweight grandmother's attempt to lose weight by various diets - Cabbage, Atkins, Grapefruit, etc. His conclusion however was that she should try the 'less food diet'. I suspect that if my competency is found to be inadequate the best study techniqe for me to try would be the 'more studying technique'. However, Friday should give me a good indication where I'm sitting and if I need to change.
9. This 'point form' list has become rather long, however I will conclude with one final observation from the week - while it is possible for me to function on five hours of sleep I don't function an an optimal level and caffeine intake is insufficient to compensate for the lack of sleep cycles. Thus, my goal needs to be a minimum of six hours of sleep/night...so we'll see what this week holds.
