It's been some time, guys. I probably lost my audience now because intermission lasted for about 3 months. A lot has gone on in that time. I'll do a quick summary and get you guys up to date on what's new and what's good.
When I last wrote, we were in the midst of Block 2, which focused on genetics, development, reproduction, endocrinology and oncology. The block was kind of grueling and took a lot out of me, especially towards the end. Going through the block was kind of frustrating since it seemed like all the topics in the block were random and didn't really connect. My opinion of the block changed towards the end when everything just seemed to click. Going through clinical immersion in the week towards the end was kind of cool because I got to see some of the principles I learned put into practice in gynecologic oncology.
Block 2 officially ended on Halloween night. Exam week consisted of three tests: a 4 hour essay exam with 5 questions (each with 3-5 parts), a structure test considering of an anatomy practical with prosections and a 30 min histology test with virtual slides, and a mock Step 1 test. Five weeks later, (this past week), I received my report card. As far as I'm concerned, I still get to keep my allowance. I love going to a school that's pass-fail with no ranking. Apparently I "met expectations" and I did well on the structure exam (anatomy practical + histology). The NBME (practice step 1 test) went well too. I was a bit disappointed though because my lowest sub-scores were in epi/biostats and pharmacology, which is totally messed up since I'm an MPH student and I love pharm.
Speaking of MPH, one of my MPH classes which I thought would be cool (and was kind of cool), turned out to be a complete time-sink. When I saw that mental health epidemiology was being offered this past semester, I thought-cool! Well, it turned out it had less to do with epidemiology and more to do with community based research, research ethics and law. All in all, I ended up writing about a grand total of 30 single-spaced pages for this class, as well as reading two 250 page textbooks. Here's the cherry to top the cake: I was the only person in the class. Oh, and it wasn't any other class--it was a 3-hour discussion-based class.
My other MPH class, a 1.5 hour seminar classs ended up being another time-sink. I'm sorry, but any class that requires you to write 4, 2 page single-spaced papers, and one 5 page single-spaced paper, along with putting together a website, should not be a 1.5 credit hour class. I'm glad it's over. By the way, here's a link to my website if you're curious.
Currently we are in Block 3 which is titled "Food To Fuel." Unlike Block 2, Block 3 is very focused and more predictable than Block 2. Namely, half the block is spent on biochemistry and the other half on GI. We just finished the biochem part and are moving on the GI stuff. So far, so good. My IQ group is solid, and things have been ok for the most part. Biochem has mostly been review from my Rice days. GI is somewhat time consuming but is pretty doable.
For some reason, I feel like things in Block 3 are more clinically relevant than they were in block 2. I shadowed an internal medicine resident a couple weeks ago and I got to see some Block 3 work put into practice when we saw a patient with liver cirrhosis. It was kind of cool to study the liver in biochem and then see what you learned present in the clinic as a real-live patient.
I'm starting to get a taste for what internal medicine has to offer. I like to think through problems and use my basic science knowledge to figure out what's going on. I knew all along that I was definitely more into the medicine side of things than the surgical side of things, but I think Block 3 has only supported my initial feelings. It's obviously too early to tell exactly what works for me and what doesn't, seeing as I haven't really seen any patients on my own yet, but you can get an idea of what you like judging from the subjects that interest you. For instance, I despire pretty much anything relating to anatomy or histology and I liked endocrine and biochem. The dial is definitely leaning towards medicine as opposed to surgery, radiology, etc. (you know...all the fields that can make you rich).
Speaking of anatomy, this block we started dissections. Here at Case we have 4 students to a cadaver and we do dissections in two hour sessions about 6 times the entire block. Our cadaver is named Burt. He's a pretty cool guy, except for the fact that he's ridiculously skinny and finding structures such as vessels in him is a pain since they're so tiny and I lack the fine motor skills (and anatamoical knowlege) to identify and tease things apart.
Let's see...what else...the election season was also kind of intense. This was the first time I have ever been active in the political process and it was rewarding. It's crazy how politics can be so polarizing. The political season was draining. In the end, I think we elected the right guy, but only time will tell.
We had a nice week long Thanksgiving break. I turned another year older. The Cavs season started. Anyone who knows me knows that the only thing that gets me through the dreaded winter is watching the Cavs. What's great is that they are awesome this year. I'm finally getting to go to my first game of the season tomorrow. Lower bowl seats...I'm pumped!
Also, recently Case Med put on their Doc Opera show. Doc Opera is a variety show where students get to display their talents through live songs and filmed skits. If you want to get a taste for some of the work done in Doc Opera, go to youtube and type in "doc opera." For the show, I worked with my Block 1 IQ group (the best group ever) to produce a 4 minute skit based off of the TV show "Survivor." It took some time editing the film, but man was it worth it. I'm looking forward to next year already!
To wrap up, we have a week left before we get out for Winter Break. It'll be a good time to catch up on videogames (err...I mean work...) and relax. Seriously though, I'll be sticking around school for a bit to make some more progress on my MPH resarch capstone. I'll also need to work on a research proposal for the summer. It looks like my research mentor from Cincinnati will help to set me up with someone to work with over the summer, but I'll need to do some work to figure out exactly what I want to study over 8 weeks. I have a bunch of ideas in mind...I'll have to figure out what I can get done that will still leave me a decent amout of time to golf and sleep.
I'll update this blog periodically on random events and things that are going on. This entry was kind of bland, I know. I'll mix it up to keep things interesting. Adios.
Thursday, December 11, 2008
Friday, September 12, 2008
Hurricanes and Hormones
Hello, world. It's been sometime since I've updated this blog. It's funny because I've had about 12 different people ask me when I'm going to update this thing. Your wish has been granted.
I was going to put this off until tomorrow since it's past my bed time, but I can't sleep tonight. Well, first of all my big dog Yogi is barking at the neighbors who are hanging out by their deck, but more importantly there is this crazy hurricane spinning around in the Gulf about to ravage Southeast Texas. Normally hurricanes don't affect me since I'm about 1400 miles north of the gulf, but this one is about to hit Houston where I lived for about 3 years. I have some good friends in Houston and I'm kind of worried. For those of you hunkered down in H-town reading this: be safe and I hope to talk to you on the flip-side. For some comedic relief here's a clip of Geraldo Rivera getting rocked:
So you might be wondering how med school is going. I have the perfect analogy for you. Med school is like a hurricane. It moves you around a bit, gives you a breather when the eye passes over, then rocks you again before it leaves. The only difference between a real hurricane and med school: med school doesn't pass over and move inland; instead, it comes back and hits you hard again. Week in and week out. Imagine a hurricane on a pendulum.
Sorry, the political season has got me exaggerating a bit. It's not really like a hurricane, but it's close. Honestly, school is busy. There is a ton of work and reading to stay up on. Just when you think you have a break (Saturdays and Sundays), you quickly realize that there is material you should be covering instead of watching that Browns game, or golfing with your buddy who is still on summer break since he goes to a school on a quarter system (damn you OSU).
Block 2 has been somewhat frustrating due to the nature of the material being covered. Somehow we are supposed to be learning about genetics, but somehow endocrine and reproduction is thrown in there for good measure. At times it's kind of challenging trying to see the rationale in some of the material being thrown at us. How is thyroid function related to the "human blueprint"? I can probably make some hand-waving argument as to why we learn some crazy endocrine during this block, but it's a stretch. Apparently, block 2 is the only block where there is a ton of material kind mixed and jumbled without a clear purpose.
So far of the subjects being covered in this block, embryology has probably been the most frustrating since it requires to most rote memorization. Embryo has been presented to us via lectures and these study guide packets. I think there is enough material presented to us to learn what we need to learn, but it's time consuming to take it all in. Sometimes I feel like I'm trying to memorize the dictionary.
IQs have been pretty solid for the most part. My group is productive and we cover all our objectives. Also, the topics covered so far in IQ involve endocrine which I don't mind. It's becoming apparent that pharmacology is turning out to be one of my favorite parts of med school. Sometimes when I'm going over my case objectives and doing research, I tend to get lost in the mechanisms of action of the drugs and how they work chemically. Someone in my IQ group asked how thyroperoxidase works chemically and I was about to jump up to the board and draw an electron pushing mechanism, but I had to ask myself "is this clinically relevant?" and go on to restrain myself and suggest that the group move on to the other objectives.
Really, that's been the theme of how I've been managing my time so far during the preclinical years. I constantly ask myself two questions: (1) "is this clinically relevant?" and (2) "what's the take home message?". Frankly, I think these are two important questions that med students need to ask themselves when they're studying, especially in open-ended curricula like ours. I'm coming to terms with the fact that I am not going to be solely a scientist, but a clinician interested in advancing medical science. I don't need to know everything. I don't need to memorize everything. Working out in the mornings and reading a good book at night to maintain my sanity is more valuable for my long-term health than memorizing some minutiae from Robbins Pathology, board scores be damned (or so I say that now...)
You may be reading this and thinking "duh" but this is a big deal for me. I definitely suffer from a DSM-IV Axis II disorder: Obsessive Compulsive Personality Disorder. I tend to get somewhat worried and flustered when I feel I should be studying more. Learning to let go of the books and seek a balance in life has been one of my biggest goals for med school, especially as I get older and transition into the next phase of my life. I think so far I've been good at it, but it's tough. Especially when you're around a bunch of smart, motivated individuals and you realize how much more you could learn. The guilt felt when you don't attend a Thursday morning review session, or when you can't make that weekend study session...it's somewhat painful.
Even when you are not studying as much as you could, it's tough to maintain perspective and realize what the "big picture" is. I was reminded of this "big picture" this past weekend when I had my OB-GYN RAMP. RAMP, another acronym, is a glorified shadowing program where first years shadow different physicians. Two weeks ago I went to a hospice to learn more about end-of-life care. This past Wednesday, I had a chance to see the opposite end of the spectrum and spend time on the OB-GYN wards at University Hospitals.
I'm not sure how you all feel, but in-patient settings scare me. Yes, I am scared of hospitals (you might be wonder why I want to be a doctor). As I entered the ward I was given a key-card to get some scrubs to change into. First, I spent about 15 minutes trying to figure out how the damn scrub machine worked. The whole time about 3 different doctors and a couple nurses walked by and giggled. I felt like such a dumbass, and I still do.
So I put on the scrubs and I went to the desk at the center of the ward to find a "house-officer." I'm going to throw this out there: going to the desk in the middle of an in-patient ward is like walking up to a liquor store in the inner city (yes I've been to a liquor store before, but not for Cavasier...but directions). It's kind of scary. Nurses sit around the outside of the desk like gangsters. They kind of just hang out and look tough while you walk by. You ask them where the house officers are and they give you a funny look as if you were lost. Eventually they nod over to a couple docs sitting on the other side of the desk.
The docs for the most part are pretty nice. They're like the store owners. Pretty much accommodating and easy going. And no I am not implying that nurses are mean people. They are actually pretty awesome and serve an integral role in our healthcare system. I just think I have somewhat of an inferiority complex right now.
To make a long story short, I was invited to see a C-section delivery in the wards. I stood against the wall as I saw the delivery take place. Two things: (1) C-section deliveries require a very aggressive approach from the OB-GYN. Imagine cutting a hole in a pregnant woman and yanking a baby out. Literally. (2) Anesthesiology seems more appealing to me than it first did. I was surprised seeing the anesthesiologist comfort and talk to the mother while she is undergoing the delivery. The anesthesiologist doc also spoke with the father trying to reassure him as he was kind of freaking out as the baby was coming out. Furthermore, these guys know their pharm real well. The field definitely seems more appealing than it once did. Still, all that responsibility scares me.
Oh ya, I forgot, a baby was brought into this world. Good times, indeed. It was honestly pretty amazing. But it's funny how the OB-GYN acts when the baby delivered. She kind of yanked the baby out and put him on a back table, then went back to the mother to close up shop. It seemed very "business-like." Frankly, that's how the OR is, and I don't know if I like it. It just seems too technical and formal for my liking. I guess I'll learn more during my rotations.
In closing, I promised to make this blog more interactive. I'm going to pose a series of questions and I want to get your thoughts. With elections coming up, I know there's been a lot of crap being spewed by both sides, but unfortunately there has been very little discussion of what I feel to be the most important issue: healthcare. I understand that we all have different opinions and viewpoints. Furthermore, I don't really care if you're republican, democrat, independent or apolitical. I just want your opinion. First, check out this article, which is a good view of both healthcare plans. Second, respond to the following questions: (1) can private markets be utilized to lower healthcare costs and improve healthcare coverage, or is government intervention necessary? (2) What can politicians do to help contain healthcare costs? (3) What if anything should physicians do to help contain costs?
I was going to put this off until tomorrow since it's past my bed time, but I can't sleep tonight. Well, first of all my big dog Yogi is barking at the neighbors who are hanging out by their deck, but more importantly there is this crazy hurricane spinning around in the Gulf about to ravage Southeast Texas. Normally hurricanes don't affect me since I'm about 1400 miles north of the gulf, but this one is about to hit Houston where I lived for about 3 years. I have some good friends in Houston and I'm kind of worried. For those of you hunkered down in H-town reading this: be safe and I hope to talk to you on the flip-side. For some comedic relief here's a clip of Geraldo Rivera getting rocked:
So you might be wondering how med school is going. I have the perfect analogy for you. Med school is like a hurricane. It moves you around a bit, gives you a breather when the eye passes over, then rocks you again before it leaves. The only difference between a real hurricane and med school: med school doesn't pass over and move inland; instead, it comes back and hits you hard again. Week in and week out. Imagine a hurricane on a pendulum.
Sorry, the political season has got me exaggerating a bit. It's not really like a hurricane, but it's close. Honestly, school is busy. There is a ton of work and reading to stay up on. Just when you think you have a break (Saturdays and Sundays), you quickly realize that there is material you should be covering instead of watching that Browns game, or golfing with your buddy who is still on summer break since he goes to a school on a quarter system (damn you OSU).
Block 2 has been somewhat frustrating due to the nature of the material being covered. Somehow we are supposed to be learning about genetics, but somehow endocrine and reproduction is thrown in there for good measure. At times it's kind of challenging trying to see the rationale in some of the material being thrown at us. How is thyroid function related to the "human blueprint"? I can probably make some hand-waving argument as to why we learn some crazy endocrine during this block, but it's a stretch. Apparently, block 2 is the only block where there is a ton of material kind mixed and jumbled without a clear purpose.
So far of the subjects being covered in this block, embryology has probably been the most frustrating since it requires to most rote memorization. Embryo has been presented to us via lectures and these study guide packets. I think there is enough material presented to us to learn what we need to learn, but it's time consuming to take it all in. Sometimes I feel like I'm trying to memorize the dictionary.
IQs have been pretty solid for the most part. My group is productive and we cover all our objectives. Also, the topics covered so far in IQ involve endocrine which I don't mind. It's becoming apparent that pharmacology is turning out to be one of my favorite parts of med school. Sometimes when I'm going over my case objectives and doing research, I tend to get lost in the mechanisms of action of the drugs and how they work chemically. Someone in my IQ group asked how thyroperoxidase works chemically and I was about to jump up to the board and draw an electron pushing mechanism, but I had to ask myself "is this clinically relevant?" and go on to restrain myself and suggest that the group move on to the other objectives.
Really, that's been the theme of how I've been managing my time so far during the preclinical years. I constantly ask myself two questions: (1) "is this clinically relevant?" and (2) "what's the take home message?". Frankly, I think these are two important questions that med students need to ask themselves when they're studying, especially in open-ended curricula like ours. I'm coming to terms with the fact that I am not going to be solely a scientist, but a clinician interested in advancing medical science. I don't need to know everything. I don't need to memorize everything. Working out in the mornings and reading a good book at night to maintain my sanity is more valuable for my long-term health than memorizing some minutiae from Robbins Pathology, board scores be damned (or so I say that now...)
You may be reading this and thinking "duh" but this is a big deal for me. I definitely suffer from a DSM-IV Axis II disorder: Obsessive Compulsive Personality Disorder. I tend to get somewhat worried and flustered when I feel I should be studying more. Learning to let go of the books and seek a balance in life has been one of my biggest goals for med school, especially as I get older and transition into the next phase of my life. I think so far I've been good at it, but it's tough. Especially when you're around a bunch of smart, motivated individuals and you realize how much more you could learn. The guilt felt when you don't attend a Thursday morning review session, or when you can't make that weekend study session...it's somewhat painful.
Even when you are not studying as much as you could, it's tough to maintain perspective and realize what the "big picture" is. I was reminded of this "big picture" this past weekend when I had my OB-GYN RAMP. RAMP, another acronym, is a glorified shadowing program where first years shadow different physicians. Two weeks ago I went to a hospice to learn more about end-of-life care. This past Wednesday, I had a chance to see the opposite end of the spectrum and spend time on the OB-GYN wards at University Hospitals.
I'm not sure how you all feel, but in-patient settings scare me. Yes, I am scared of hospitals (you might be wonder why I want to be a doctor). As I entered the ward I was given a key-card to get some scrubs to change into. First, I spent about 15 minutes trying to figure out how the damn scrub machine worked. The whole time about 3 different doctors and a couple nurses walked by and giggled. I felt like such a dumbass, and I still do.
So I put on the scrubs and I went to the desk at the center of the ward to find a "house-officer." I'm going to throw this out there: going to the desk in the middle of an in-patient ward is like walking up to a liquor store in the inner city (yes I've been to a liquor store before, but not for Cavasier...but directions). It's kind of scary. Nurses sit around the outside of the desk like gangsters. They kind of just hang out and look tough while you walk by. You ask them where the house officers are and they give you a funny look as if you were lost. Eventually they nod over to a couple docs sitting on the other side of the desk.
The docs for the most part are pretty nice. They're like the store owners. Pretty much accommodating and easy going. And no I am not implying that nurses are mean people. They are actually pretty awesome and serve an integral role in our healthcare system. I just think I have somewhat of an inferiority complex right now.
To make a long story short, I was invited to see a C-section delivery in the wards. I stood against the wall as I saw the delivery take place. Two things: (1) C-section deliveries require a very aggressive approach from the OB-GYN. Imagine cutting a hole in a pregnant woman and yanking a baby out. Literally. (2) Anesthesiology seems more appealing to me than it first did. I was surprised seeing the anesthesiologist comfort and talk to the mother while she is undergoing the delivery. The anesthesiologist doc also spoke with the father trying to reassure him as he was kind of freaking out as the baby was coming out. Furthermore, these guys know their pharm real well. The field definitely seems more appealing than it once did. Still, all that responsibility scares me.
Oh ya, I forgot, a baby was brought into this world. Good times, indeed. It was honestly pretty amazing. But it's funny how the OB-GYN acts when the baby delivered. She kind of yanked the baby out and put him on a back table, then went back to the mother to close up shop. It seemed very "business-like." Frankly, that's how the OR is, and I don't know if I like it. It just seems too technical and formal for my liking. I guess I'll learn more during my rotations.
In closing, I promised to make this blog more interactive. I'm going to pose a series of questions and I want to get your thoughts. With elections coming up, I know there's been a lot of crap being spewed by both sides, but unfortunately there has been very little discussion of what I feel to be the most important issue: healthcare. I understand that we all have different opinions and viewpoints. Furthermore, I don't really care if you're republican, democrat, independent or apolitical. I just want your opinion. First, check out this article, which is a good view of both healthcare plans. Second, respond to the following questions: (1) can private markets be utilized to lower healthcare costs and improve healthcare coverage, or is government intervention necessary? (2) What can politicians do to help contain healthcare costs? (3) What if anything should physicians do to help contain costs?
Friday, August 29, 2008
Week 2 Update
I think this past week, which was the 2nd week of our 2nd block, pretty much gave me a glimpse of what med school from here up until February of 2010 will be like: pretty crazy. Yes, it is kind of like you're drinking from a fire hose, but it's not as terrible as some people make it out to be. Basically, every Monday, Wednesday and Friday, we have our small group IQs from 8 to 10 followed by two hour long lectures (or interactive medium sized groups) until noon. On Tuesday we usually do some combination of gross lab and histopathology until noon. On Thursdays we have optional review sessions which are videostreamed online.
The theme of this week is "Sweet life." I like how the administration tries being cute about things by coming up with random themes for the weeks. Basically "sweet life" entails endocrinology with an IQ case emphasis on diabetes.
On Monday I got to meet my new IQ group. Group 20 is pretty solid. We tend to work very efficiently. Our facilitator is in his final year of MSTP studies (year number 7 or 8 or something absolutely insane like that). He's a pretty cool guy. Our two cases this week involved type 1 and type 2 diabetes respectively. We learned a bunch about the pathophysiology, diagnosis and treatment of these diseases. After IQ, instead of having lectures, we had a 2-hour long medium sized interactive group discussion regarding a problem set involving intracellular signalling pathways. These small groups consist of about 12 students and a facilitator. I definitely learn a lot from the groups and I seem to stay awake seeing as participation is mandatory.
Tuesdays suck. The reason I dislike Tuesdays is because my two least favorite subjects are covered during these days: anatomy and the dreaded histopathology, which I'm sure you already know about. I didn't mind anatomy in block 1...perhaps because I didn't realize how ridiculous it would become. During the first couple blocks of our program, we are introduced to anatomy solely through prosections. Don't worry, I didn't know what the hell that meant until I got here. Basically, instead of spending all day in lab cutting up bodies and screwing up body parts (dissection), they are already cut up for us. So we rotate through several stations while the professors point all the relevant parts to us. I kind of feel like this is a waste of time...perhaps because I'm not so good at keeping up with the reading ahead of time. Part of the reason why I don't keep up so well with my anatomy reading is because it's so damn boring. Anatomy, while not all memorization, is mostly memorization. I HATE rote memorization. Seriously, we have names for all these random ass things in the body. Who the hell cares? I sure don't, though I should and believe me I will be this Labor day weekend! Honestly, the only cool thing about memorizing some crazy anatomical names is that it makes you sound smart. I have mad respect for all my colleagues doing the masters in applied anatomy. You guys are crazy.
Now Wednesday was interesting. I was 20 minutes late to IQ group. I left home at 7:15 and I got to school at 8:20. Apparently there was some ridiculous accident on the highway and I had to literally ride a 25 mph road all the way into town. My IQ group wasn't really hard on me for being late, but I felt ridiculously bad. I brought bagels for them today, so hopefully I made amends.
What was really cool about Wednesday was that I got to go visit a hospice for a program we have called RAMP. Yes, another god-forsaken, unnecessary acronym which stands for Rotating Apprenticeship in Medical Practice? (I think?). These are basically glorified shadowing sessions where small groups of students are sent out to hospital and community practices to shadow different types of physicians. I was placed in a group to go check out palliative/end-of-life care. Honestly, I wasn't too thrilled about the placement. Seeing people die sure doesn't sound appealing, does it? It turned to actually be pretty cool. We got to talk to a couple of patients in the hospice about their experiences. The one was this sweet old lady dying of what seemed to be lung disease. The other was this middle aged guy dying of Lou Gehrig's. It was kind of cool to see how at peace they were. The actual hospice was really nice inside. It had a nice home-like feel to it, which was a stark contrast to the drab appearance of the outside. The hospice is right next to the lake, so some of the residents have an amazing view. One cool thing I learned was that Medicare pays for the cost of hospice care provided that your prognosis is that you will die in 6 months or less.
Thursday was pretty much a review day...nothing too exciting school wise. A couple cool things though. First, I got to eat dinner with an old friend from high school whom I haven't seen since. He actually sought me out and got in touch with me, which was awesome. It's great to see people you haven't seen in so long, especially old friends!
Another cool thing was Barrack Obama's nomination acceptance speech. I don't want to make this too political because arguing politics is kind of futile and time is at a premium for me now days, but I'd like to add the disclaimer that I am a local campaign volunteer and I have decided to support Obama. I don't agree with everything he says , but I love his vision and passion. I'm an independent voter, relatively moderate with a slight left bias, and I actually admire John McCain. To cut to the chase, Obama's speech Thursday night, which was well past my bed time thanks to the whole stupid mountain time zone thing, literally blew me away. If you don't feel a little inspired after this speech, then I don't know what to say. If you have some free time this weekend, and you haven't seen the speech I encourage you to put aside your political biases for a bit, take some time out and see it. You can check the speech out here.
If you haven't thought about the election yet, check out the candidates' websites and read up on their policies. I also encourage you to play nice and be respectful of others' opinions. As much as the media may focus on pointless issues like Obama's religion or McCain's 7 houses, I think that on a whole Americans have two good nominees.
Have a safe and happy Labor Day Weekend!
The theme of this week is "Sweet life." I like how the administration tries being cute about things by coming up with random themes for the weeks. Basically "sweet life" entails endocrinology with an IQ case emphasis on diabetes.
On Monday I got to meet my new IQ group. Group 20 is pretty solid. We tend to work very efficiently. Our facilitator is in his final year of MSTP studies (year number 7 or 8 or something absolutely insane like that). He's a pretty cool guy. Our two cases this week involved type 1 and type 2 diabetes respectively. We learned a bunch about the pathophysiology, diagnosis and treatment of these diseases. After IQ, instead of having lectures, we had a 2-hour long medium sized interactive group discussion regarding a problem set involving intracellular signalling pathways. These small groups consist of about 12 students and a facilitator. I definitely learn a lot from the groups and I seem to stay awake seeing as participation is mandatory.
Tuesdays suck. The reason I dislike Tuesdays is because my two least favorite subjects are covered during these days: anatomy and the dreaded histopathology, which I'm sure you already know about. I didn't mind anatomy in block 1...perhaps because I didn't realize how ridiculous it would become. During the first couple blocks of our program, we are introduced to anatomy solely through prosections. Don't worry, I didn't know what the hell that meant until I got here. Basically, instead of spending all day in lab cutting up bodies and screwing up body parts (dissection), they are already cut up for us. So we rotate through several stations while the professors point all the relevant parts to us. I kind of feel like this is a waste of time...perhaps because I'm not so good at keeping up with the reading ahead of time. Part of the reason why I don't keep up so well with my anatomy reading is because it's so damn boring. Anatomy, while not all memorization, is mostly memorization. I HATE rote memorization. Seriously, we have names for all these random ass things in the body. Who the hell cares? I sure don't, though I should and believe me I will be this Labor day weekend! Honestly, the only cool thing about memorizing some crazy anatomical names is that it makes you sound smart. I have mad respect for all my colleagues doing the masters in applied anatomy. You guys are crazy.
Now Wednesday was interesting. I was 20 minutes late to IQ group. I left home at 7:15 and I got to school at 8:20. Apparently there was some ridiculous accident on the highway and I had to literally ride a 25 mph road all the way into town. My IQ group wasn't really hard on me for being late, but I felt ridiculously bad. I brought bagels for them today, so hopefully I made amends.
What was really cool about Wednesday was that I got to go visit a hospice for a program we have called RAMP. Yes, another god-forsaken, unnecessary acronym which stands for Rotating Apprenticeship in Medical Practice? (I think?). These are basically glorified shadowing sessions where small groups of students are sent out to hospital and community practices to shadow different types of physicians. I was placed in a group to go check out palliative/end-of-life care. Honestly, I wasn't too thrilled about the placement. Seeing people die sure doesn't sound appealing, does it? It turned to actually be pretty cool. We got to talk to a couple of patients in the hospice about their experiences. The one was this sweet old lady dying of what seemed to be lung disease. The other was this middle aged guy dying of Lou Gehrig's. It was kind of cool to see how at peace they were. The actual hospice was really nice inside. It had a nice home-like feel to it, which was a stark contrast to the drab appearance of the outside. The hospice is right next to the lake, so some of the residents have an amazing view. One cool thing I learned was that Medicare pays for the cost of hospice care provided that your prognosis is that you will die in 6 months or less.
Thursday was pretty much a review day...nothing too exciting school wise. A couple cool things though. First, I got to eat dinner with an old friend from high school whom I haven't seen since. He actually sought me out and got in touch with me, which was awesome. It's great to see people you haven't seen in so long, especially old friends!
Another cool thing was Barrack Obama's nomination acceptance speech. I don't want to make this too political because arguing politics is kind of futile and time is at a premium for me now days, but I'd like to add the disclaimer that I am a local campaign volunteer and I have decided to support Obama. I don't agree with everything he says , but I love his vision and passion. I'm an independent voter, relatively moderate with a slight left bias, and I actually admire John McCain. To cut to the chase, Obama's speech Thursday night, which was well past my bed time thanks to the whole stupid mountain time zone thing, literally blew me away. If you don't feel a little inspired after this speech, then I don't know what to say. If you have some free time this weekend, and you haven't seen the speech I encourage you to put aside your political biases for a bit, take some time out and see it. You can check the speech out here.
If you haven't thought about the election yet, check out the candidates' websites and read up on their policies. I also encourage you to play nice and be respectful of others' opinions. As much as the media may focus on pointless issues like Obama's religion or McCain's 7 houses, I think that on a whole Americans have two good nominees.
Have a safe and happy Labor Day Weekend!
Tuesday, August 19, 2008
Real Science
Block 1, "Becoming a Doctor," ended last Friday after our 5 hour-long Summative Synthesis Essay Questions (SSEQs). Basically this is a flashy way of saying we had a long ass test consisting of four essays. Overall I thought the test well. I wrote too much for many of the essays and I think my answers were kind of verbose and perhaps somewhat peripheral to the questions. We had one question asking us to describe how the poverty-gap, which is worse in the US than other developed nations, affects the health of the poor. Granted the question was politically charged to begin with, I ended up writting about supply-side economics and how public health funding is affected by fiscal policy. I am in medical school, right? I think it's safe to say we all passed, but we won't know for sure until tomorrow when we receive our feedback.
This week is when med school, in the traditional sense, really begins. Block 2 is called "The Human Blueprint." During this 11 week block we learn primarily about genetics and development. I think genetics is interesting, but I can honestly tell you that the material is out of my comfort zone. I am comfortable with molecular genetics, to an extent, especially with regards to pharmacology and biochemistry. There is still a bunch of other stuff that I am not comfortable with including patterns of inhertience, karyotypes and all the "big picture" genetic issues. Show me a nucleotide structure and I will feel at home. Talk about chromosomal abnormalities and I will freak out.
I might just be overreacting a bit because frankly, I am kind of overwhelmed right now. Every day we seem to have a ton of reading and things we need to go over. It's easy to get lost in detail and lose focus of clinically relevant concepts. I probably know more about genetics than what I give myself credit for, or so I hope.
Speaking of being overwhelemed, this week really is brutal: Instead of having our normal IQ groups, we have a ton of lecture, since this is the first week of the block and we're supposed to be getting acclimated to the new material. For once, I kind of don't mind the lectures since it's nice to have all random details focused into core concepts, but I can see it getting old real fast. I am looking forward to IQ and getting underway with new cases next week. Also during this block, we begin to learn about performing a routine physical exam. We get to practice on each other and standardized patients. It should be good times.
I know it's only been two days, but this basic science is kind of killing me. For one, I am in the small minority that misses public health. Luckily for me I'm taking an MPH class (and seminar, and working on my capstone-albeit at a snails pace) starting this Monday. The class is on mental health epidemiology and it should be interesting. Second, ever since I got to intubate that mannequin, I am really itching to get back to some EMS fun. I was contemplating signing up for one elective to spend 2 hours each week at Metro ER to shadow a doc and learn some procedures. I'm probably going to hold off on this for a bit and see how my schedule falls into place first. It's too easy to commit to activities around here.
In other news, the weather up here in Cleveland has been awesome lately. I came back home from school at around 8:30 pm today and it was actually kind of crisp outside-it feels like fall. I like the fall because it means 1.) football and 2.) greens fees at golf courses will go down soon. It's too bad the best weather of the year has to be when school starts up and I start to get swamped. Oh well.
This week is when med school, in the traditional sense, really begins. Block 2 is called "The Human Blueprint." During this 11 week block we learn primarily about genetics and development. I think genetics is interesting, but I can honestly tell you that the material is out of my comfort zone. I am comfortable with molecular genetics, to an extent, especially with regards to pharmacology and biochemistry. There is still a bunch of other stuff that I am not comfortable with including patterns of inhertience, karyotypes and all the "big picture" genetic issues. Show me a nucleotide structure and I will feel at home. Talk about chromosomal abnormalities and I will freak out.
I might just be overreacting a bit because frankly, I am kind of overwhelmed right now. Every day we seem to have a ton of reading and things we need to go over. It's easy to get lost in detail and lose focus of clinically relevant concepts. I probably know more about genetics than what I give myself credit for, or so I hope.
Speaking of being overwhelemed, this week really is brutal: Instead of having our normal IQ groups, we have a ton of lecture, since this is the first week of the block and we're supposed to be getting acclimated to the new material. For once, I kind of don't mind the lectures since it's nice to have all random details focused into core concepts, but I can see it getting old real fast. I am looking forward to IQ and getting underway with new cases next week. Also during this block, we begin to learn about performing a routine physical exam. We get to practice on each other and standardized patients. It should be good times.
I know it's only been two days, but this basic science is kind of killing me. For one, I am in the small minority that misses public health. Luckily for me I'm taking an MPH class (and seminar, and working on my capstone-albeit at a snails pace) starting this Monday. The class is on mental health epidemiology and it should be interesting. Second, ever since I got to intubate that mannequin, I am really itching to get back to some EMS fun. I was contemplating signing up for one elective to spend 2 hours each week at Metro ER to shadow a doc and learn some procedures. I'm probably going to hold off on this for a bit and see how my schedule falls into place first. It's too easy to commit to activities around here.
In other news, the weather up here in Cleveland has been awesome lately. I came back home from school at around 8:30 pm today and it was actually kind of crisp outside-it feels like fall. I like the fall because it means 1.) football and 2.) greens fees at golf courses will go down soon. It's too bad the best weather of the year has to be when school starts up and I start to get swamped. Oh well.
Tuesday, August 12, 2008
Exam Week
This week is weird. It kind of feels almost like what finals week would feel like back at Rice, the only difference is I'm not pulling all-nighters culminating with breakfast at Taco Cabana at 5 AM. To all my Rice people: you don't know how much I miss TC. It's probably a good thing I came back home for school though, since I end up eating home cooked meals which are quite healthy, not to mention delicious.
The first thing I noticed this week was how short our IQ case was. This week we're discussing medical errors. Tomorrow our group reconvenes and discusses the learning objectives we formulated on Monday. Somehow I doubt we'll spend the entire two hours talking about medical errors.
Today was especially strange since it felt like public health classes all over again, just a bit angrier. Yes, I said angrier: I'll explain. Just to summarize for my friends out there scattered throughout the world, basically, the entire medical school class is split into 20 different IQ groups. While we discuss cases in our IQ groups, during this first block we also worked on a population health descriptive statistics project where we were assigned to learn more about health indicators in a specific Cleveland neighborhood. Today, each IQ group presented their findings in medium group settings of 4 IQ groups/room.
When I walked in my group's assigned room this morning, my day become about 50x better since I saw my MPH program advisor and capstone chair sitting in the front. For those of you who don't know him, Mendel (professionally referred to as Dr. Singer, but he'd rather be called Mendel) is awesome. He's this goofy and nerdy orthodox Jewish guy with this crazy beard. He has 8 kids! He pretty much taught me everything I ever need to know about biostats and most recently cost-effectiveness analysis. I also learned a lot about medicine from him..ok maybe not. But if you go into his office sometime, he has a little game called "med school in a box." Check it out-you'll find it hilarious. Also, don't be offended if he makes fun of you for being a med-student. As a Ph.D statistics/policy-type person, he considers himself a "real-doc." Whatever.
Our presentation went well, and I thiought the other presentations were good too. Afterwards, was when all the fun started.
I think what makes Mendel such a great teacher is his willingness to ask for student feedback and use that to continuously improve his teaching. After our presentations were over he asked for feedback regarding the project. To be blunt, shit hit the fan.
I think it was pretty unanimous that most people were unhappy with the project. Basically it was an exercise in descriptive statistics which many people found ambigous, without sufficient context, and of little clinical relevance. Part of Mendel's job I guess, is to take all this feedback and give it to our block leader, who came up with the project idea (who is a great guy, albeit opinionated, controversial and somewhat disorganized which is unfortunately leading to his continued unpopularity among students).
Personally, I wasn' too thrilled with the project. First of all, I was frustrated that I had to mess with NEOCANDO data when I have my own database of research info that I need to manipulate for my MPH capstone (in fact I shouldn't be writing this blog right now, I need to be working on MPH stuff...). Second, the ultimate goals and expectations of the project were not made clear, and I think that is what also contributed to a lot of frustration. Finally, even after we get all these population health trends, we have to ask our-selves: as future physicians what can we do to change things? As we talk about macroscopic determinants of health I continue to question the physician's role in society. There is so much more I want to read/write/discuss about with regards to health policy, politics and ethics. I won't bore you with these posts now, but I will later. In fact, one of my friends (Gabriel Valle) and I are thinking of setting up another blog to consdier some of these issues to help spur a bit more dialouge.
The session after our presentations regarded our behavioral health projects, where each member of the class was challenged to meet the goal of walking 10,000 steps/day. There was also a lot of interesting feedback regarding this challenge which I will touch on in later posts. I easily get 10,000 steps a day. Actually, that's a lie. I really only take about 2000 steps a day, but if you consider my early morning workouts and converted the exercise into steps, then I'd easily cross 10,000. The only problem is when I'm so committed to my workouts already, the last thing I remember is to convert the numbers into steps and enter them online. Oops. Needless to say, I didn't win any prizes today.
In the afternoon we had buddy lunch. Basically each first year student is matched with a second year student as a mentor. My buddy is awesome. He gave me a lot of good heads-up info for the block to come. He's even letting me use one of his textbooks from last year. Hopefully I'm not sufficiently jaded and overworked to be a friendly buddy for some (un)lucky MS1 next year.
After an hour or so studying some epidemiology a couple friends and I went over to an activities fair where a bunch of extra-curricular clubs set up tables to talk a bit more about their respective groups. In the end I signed up for four interest groups. Psychiatry interest group: duh, it's kind of sad though only about 4 people signed up. Neurology interest group: neuroscience is cool. Emergency Medicine interest group: I kind of miss EMS, so why not? Anesthesiology interest group: wtf? Ya, to be honest I'm really not that interested in anesthesiology (to be fair, right now I'm not interested in it). Something about prepping people for surgery and pretty much being their lifeline while some guy cuts them open just scares me. Nevertheless, I still felt compelled to join. You see, they had this mannequin out on the table. As I walked by I saw a 4th year trying to explain to one of my first year classmates how to intubate. I immediately thought back to Rice EMS and the fun we had doing speed intubations on mannequins. I jumped in and played around for about 5 minutes, intubating the damn thing about a dozen different times. I think the 4th year kind of looked at me the whole time and thought I was crazy. It was therapeutic. Don't ask.
I spent the rest of the afternoon/early evening studying for the exam. I came home, mowed the lawn, played with the dogs, and here I am rambling away. Good times. I'll need to focus a bit harder tomorrow and make sure I have my material down cold. I'll write again after the exam.
The first thing I noticed this week was how short our IQ case was. This week we're discussing medical errors. Tomorrow our group reconvenes and discusses the learning objectives we formulated on Monday. Somehow I doubt we'll spend the entire two hours talking about medical errors.
Today was especially strange since it felt like public health classes all over again, just a bit angrier. Yes, I said angrier: I'll explain. Just to summarize for my friends out there scattered throughout the world, basically, the entire medical school class is split into 20 different IQ groups. While we discuss cases in our IQ groups, during this first block we also worked on a population health descriptive statistics project where we were assigned to learn more about health indicators in a specific Cleveland neighborhood. Today, each IQ group presented their findings in medium group settings of 4 IQ groups/room.
When I walked in my group's assigned room this morning, my day become about 50x better since I saw my MPH program advisor and capstone chair sitting in the front. For those of you who don't know him, Mendel (professionally referred to as Dr. Singer, but he'd rather be called Mendel) is awesome. He's this goofy and nerdy orthodox Jewish guy with this crazy beard. He has 8 kids! He pretty much taught me everything I ever need to know about biostats and most recently cost-effectiveness analysis. I also learned a lot about medicine from him..ok maybe not. But if you go into his office sometime, he has a little game called "med school in a box." Check it out-you'll find it hilarious. Also, don't be offended if he makes fun of you for being a med-student. As a Ph.D statistics/policy-type person, he considers himself a "real-doc." Whatever.
Our presentation went well, and I thiought the other presentations were good too. Afterwards, was when all the fun started.
I think what makes Mendel such a great teacher is his willingness to ask for student feedback and use that to continuously improve his teaching. After our presentations were over he asked for feedback regarding the project. To be blunt, shit hit the fan.
I think it was pretty unanimous that most people were unhappy with the project. Basically it was an exercise in descriptive statistics which many people found ambigous, without sufficient context, and of little clinical relevance. Part of Mendel's job I guess, is to take all this feedback and give it to our block leader, who came up with the project idea (who is a great guy, albeit opinionated, controversial and somewhat disorganized which is unfortunately leading to his continued unpopularity among students).
Personally, I wasn' too thrilled with the project. First of all, I was frustrated that I had to mess with NEOCANDO data when I have my own database of research info that I need to manipulate for my MPH capstone (in fact I shouldn't be writing this blog right now, I need to be working on MPH stuff...). Second, the ultimate goals and expectations of the project were not made clear, and I think that is what also contributed to a lot of frustration. Finally, even after we get all these population health trends, we have to ask our-selves: as future physicians what can we do to change things? As we talk about macroscopic determinants of health I continue to question the physician's role in society. There is so much more I want to read/write/discuss about with regards to health policy, politics and ethics. I won't bore you with these posts now, but I will later. In fact, one of my friends (Gabriel Valle) and I are thinking of setting up another blog to consdier some of these issues to help spur a bit more dialouge.
The session after our presentations regarded our behavioral health projects, where each member of the class was challenged to meet the goal of walking 10,000 steps/day. There was also a lot of interesting feedback regarding this challenge which I will touch on in later posts. I easily get 10,000 steps a day. Actually, that's a lie. I really only take about 2000 steps a day, but if you consider my early morning workouts and converted the exercise into steps, then I'd easily cross 10,000. The only problem is when I'm so committed to my workouts already, the last thing I remember is to convert the numbers into steps and enter them online. Oops. Needless to say, I didn't win any prizes today.
In the afternoon we had buddy lunch. Basically each first year student is matched with a second year student as a mentor. My buddy is awesome. He gave me a lot of good heads-up info for the block to come. He's even letting me use one of his textbooks from last year. Hopefully I'm not sufficiently jaded and overworked to be a friendly buddy for some (un)lucky MS1 next year.
After an hour or so studying some epidemiology a couple friends and I went over to an activities fair where a bunch of extra-curricular clubs set up tables to talk a bit more about their respective groups. In the end I signed up for four interest groups. Psychiatry interest group: duh, it's kind of sad though only about 4 people signed up. Neurology interest group: neuroscience is cool. Emergency Medicine interest group: I kind of miss EMS, so why not? Anesthesiology interest group: wtf? Ya, to be honest I'm really not that interested in anesthesiology (to be fair, right now I'm not interested in it). Something about prepping people for surgery and pretty much being their lifeline while some guy cuts them open just scares me. Nevertheless, I still felt compelled to join. You see, they had this mannequin out on the table. As I walked by I saw a 4th year trying to explain to one of my first year classmates how to intubate. I immediately thought back to Rice EMS and the fun we had doing speed intubations on mannequins. I jumped in and played around for about 5 minutes, intubating the damn thing about a dozen different times. I think the 4th year kind of looked at me the whole time and thought I was crazy. It was therapeutic. Don't ask.
I spent the rest of the afternoon/early evening studying for the exam. I came home, mowed the lawn, played with the dogs, and here I am rambling away. Good times. I'll need to focus a bit harder tomorrow and make sure I have my material down cold. I'll write again after the exam.
Thursday, August 7, 2008
Jail, Blue Toes and Stethoscopes
I want to start off by thanking everyone who took the time to respond to my post either online or in-person last week. I'm simply amazed that people actually read what I have to say. It's gratifying. It seems like this blogging thing is becoming a weekly affair. I want to write more, but it's getting kind of tough, especially with this MPH work I'm trying to get out of the way before the "real science" hits. In the future I'll try having new posts every Monday and Thursday.
The theme of this week, per block 1 faculty leaders, has been health inequities. In our IQ groups (small groups) our case has centered around STDs. As part of our learning experience we had the opportunity to head out into the community to learn more about HIV/AIDS. I was paired with one of my friends to head out to the county jail in downtown Cleveland (seriously, there is a jail directly across from the Browns Stadium!).
Care Alliance, a federally funded medical care center for the indigent population conducts public health research regarding medical care seeking behavior among HIV positive inmates upon their release from jail. Basically, I had the opportunity to shadow one of the researchers during her interview with an inmate. I had the opportunity to chime in and talk with the inmate during this time.
I got to know Steve pretty well. He is 29 and has been a crack addict for the last 20 years. Do the math. He's also done pretty much every other drug on this planet. Steve has a high school education and has been homeless the last decade. His family has pretty much shunned him from their lives and he was basically free to roam the streets and make money as a sex worker. Five years ago he was hospitalized to undergo surgery for pericarditis. The surgery was successful, but the experience was life changing. As he was resting upon completion of the operation, he was told of his HIV status. Awesome.
Five years later after some petty theft he's in jail on a cloudy day sharing his sensitive life story with some random "kiddie-doc" Indian student from the suburbs. What I haven't told you yet was how smart Steve is. Apparently he picked up Spanish and sign language while on the streets. He elaborately explained to me the concept of a secondary immune response. He also relayed to me his knowledge of 2nd generation atypical antipsychotic and their neurochemical effects. Wow. How did this guy ever end up on the streets and get to where he is?
It was pretty obvious in my time interviewing him that Steve had some serious emotional health concerns. His ADHD was blatantly obvious. He was frustrated at himself and at the system. He acknowledge that he needs help, but he's also angry at his family for not supporting him. Moreover, he's angry at himself for letting the people who were in his life, down. Apparently psychiatric care in jails consists of pill-pushing with minimal to no psycotherapy. I think all Steve wanted was to talk to someone. I could tell after sometime he felt a bit relieved to get his thoughts off his chest as he was really looking forward to scheduling a follow-up meeting with the researcher. His psychological concerns were compounded by the fact that his viral load has worsened over the course of his stay. He thinks he might have to start some treatment for his HIV soon. He probably should.
I became really interested in correctional and forensic psychiatry after my time at the jail. It just amazes me how addiction and emotional concerns are brushed aside. Aren't these supposed to be "correctional" facilities? How can you "correct" someone if you just have them take some antidepressants and their best medical care is some doctor on a television screen evaluating them from 200 miles away in Columbus? Perhaps if he saw a child psychiatrist at age 9, his life might have turned out different? Perhaps, not? My questions and insight are kind of premature based on this one experience, but I'm interested in learning more. It's kind of funny that I think of his HIV as an afterthought to his psychiatric problems, seeing as the purpose of the trip was to learn more about living with HIV. Really though, I don't think the emotional and physical components of the disease can be separated. They really are intertwined.
School this week has been pretty solid for the most part. Lectures have been boring, but the IQ group discussions have been good. Our final communications seminar, which was a synthesis of all the skills we've learned so far, went well. My IQ group took a field trip to our neighborhood in Cleveland which we are doing our population health project on. The neighborhood, South Broadway, is basically south of downtown and consists of the old Slavic village. It's kind of run down, but pretty much an average Cleveland neighborhood. They have a pretty cool ice cream place. I recommend the black walnut.
There were only two things this week which kind of sucked. First, my big left toe is bruised. I think this came as a result of my overly active kind of stupid and crazy weekend. First, I played several intense games of pick-up basketball last Friday. This is probably where most of the damage happened. I then played 9 holes of golf immediately after the basketball. After that I went swimming for an hour. The next afternoon I walked 18 holes of golf. On Sunday morning I rode the exercise bike for 20 minutes, played a quick 15 minute pick up game with the old-timers at the racquetball club and played another 18 holes of golf in the evening, but I rode a cart that time instead. The good news was I shot an 81, and I very well could have broke 80 had I not been stupid on two of the holes.
As a result of my being young and stupid, I limped around school the last several days. I wrapped my toe up with some tape yesterday and it feels much better now. I'm going to try to take it a bit easy this weekend (though I must get my Friday basketball in-it's a must). Not to mention, next week we have our block 1 exam, so I'll need some down time to study anyway.
The other thing this week, which was not fun, was purchasing a stethoscope. I never realized that picking a scope would be so time-consuming and nerve wrecking. I was torn between two particular types, but I ended up picking the one made of "trumpet brass and chrome." Yes, my stethoscope has chrome. I feel so special.
The theme of this week, per block 1 faculty leaders, has been health inequities. In our IQ groups (small groups) our case has centered around STDs. As part of our learning experience we had the opportunity to head out into the community to learn more about HIV/AIDS. I was paired with one of my friends to head out to the county jail in downtown Cleveland (seriously, there is a jail directly across from the Browns Stadium!).
Care Alliance, a federally funded medical care center for the indigent population conducts public health research regarding medical care seeking behavior among HIV positive inmates upon their release from jail. Basically, I had the opportunity to shadow one of the researchers during her interview with an inmate. I had the opportunity to chime in and talk with the inmate during this time.
I got to know Steve pretty well. He is 29 and has been a crack addict for the last 20 years. Do the math. He's also done pretty much every other drug on this planet. Steve has a high school education and has been homeless the last decade. His family has pretty much shunned him from their lives and he was basically free to roam the streets and make money as a sex worker. Five years ago he was hospitalized to undergo surgery for pericarditis. The surgery was successful, but the experience was life changing. As he was resting upon completion of the operation, he was told of his HIV status. Awesome.
Five years later after some petty theft he's in jail on a cloudy day sharing his sensitive life story with some random "kiddie-doc" Indian student from the suburbs. What I haven't told you yet was how smart Steve is. Apparently he picked up Spanish and sign language while on the streets. He elaborately explained to me the concept of a secondary immune response. He also relayed to me his knowledge of 2nd generation atypical antipsychotic and their neurochemical effects. Wow. How did this guy ever end up on the streets and get to where he is?
It was pretty obvious in my time interviewing him that Steve had some serious emotional health concerns. His ADHD was blatantly obvious. He was frustrated at himself and at the system. He acknowledge that he needs help, but he's also angry at his family for not supporting him. Moreover, he's angry at himself for letting the people who were in his life, down. Apparently psychiatric care in jails consists of pill-pushing with minimal to no psycotherapy. I think all Steve wanted was to talk to someone. I could tell after sometime he felt a bit relieved to get his thoughts off his chest as he was really looking forward to scheduling a follow-up meeting with the researcher. His psychological concerns were compounded by the fact that his viral load has worsened over the course of his stay. He thinks he might have to start some treatment for his HIV soon. He probably should.
I became really interested in correctional and forensic psychiatry after my time at the jail. It just amazes me how addiction and emotional concerns are brushed aside. Aren't these supposed to be "correctional" facilities? How can you "correct" someone if you just have them take some antidepressants and their best medical care is some doctor on a television screen evaluating them from 200 miles away in Columbus? Perhaps if he saw a child psychiatrist at age 9, his life might have turned out different? Perhaps, not? My questions and insight are kind of premature based on this one experience, but I'm interested in learning more. It's kind of funny that I think of his HIV as an afterthought to his psychiatric problems, seeing as the purpose of the trip was to learn more about living with HIV. Really though, I don't think the emotional and physical components of the disease can be separated. They really are intertwined.
School this week has been pretty solid for the most part. Lectures have been boring, but the IQ group discussions have been good. Our final communications seminar, which was a synthesis of all the skills we've learned so far, went well. My IQ group took a field trip to our neighborhood in Cleveland which we are doing our population health project on. The neighborhood, South Broadway, is basically south of downtown and consists of the old Slavic village. It's kind of run down, but pretty much an average Cleveland neighborhood. They have a pretty cool ice cream place. I recommend the black walnut.
There were only two things this week which kind of sucked. First, my big left toe is bruised. I think this came as a result of my overly active kind of stupid and crazy weekend. First, I played several intense games of pick-up basketball last Friday. This is probably where most of the damage happened. I then played 9 holes of golf immediately after the basketball. After that I went swimming for an hour. The next afternoon I walked 18 holes of golf. On Sunday morning I rode the exercise bike for 20 minutes, played a quick 15 minute pick up game with the old-timers at the racquetball club and played another 18 holes of golf in the evening, but I rode a cart that time instead. The good news was I shot an 81, and I very well could have broke 80 had I not been stupid on two of the holes.
As a result of my being young and stupid, I limped around school the last several days. I wrapped my toe up with some tape yesterday and it feels much better now. I'm going to try to take it a bit easy this weekend (though I must get my Friday basketball in-it's a must). Not to mention, next week we have our block 1 exam, so I'll need some down time to study anyway.
The other thing this week, which was not fun, was purchasing a stethoscope. I never realized that picking a scope would be so time-consuming and nerve wrecking. I was torn between two particular types, but I ended up picking the one made of "trumpet brass and chrome." Yes, my stethoscope has chrome. I feel so special.
Wednesday, July 30, 2008
Ethics, Dead Bodies and Touchy-Feely-ness
I've been bad about updating this blog. To my vast audience out there (of probably one or two people), I sincerely apologize. It's not that I don't want to write, it's just that when I get home I eat dinner then flip open my weekly copy The Economist, get pissed off at the world for a bit and pass out shortly after at around 10 -ish. Today, I broke the vicious cycle and I am writing to update you on my life adventures.
Last week we had our first real case study in our IQ group (small-group session). The case centered around the behavioral and psychosocial factors involved with diabetes care in a Mexican-American women with presumably no health insurance, among other obstacles. Overall I learned a lot about diabetes and I was able to refresh my memory on some public health and epidemiology principles I learned about last year.
Something came up during our last session on Friday that I have wanted to bring up in this blog, and that is the notion of ethics regarding pharmaceutical companies and physicians. In this particular case we were reviewing, the doctor treating the Mexican-American diabetic at the clinic gave her free samples of Avandia (rosiglitazone) to help her manage her diabetes. One of our group objectives, which we came up with, was to study and learn more about the ethics regarding free samples as well as other gifts given to physicians by pharmaceutical drug-reps (including free dinners/lunches to pens sporting the nifty trade names of all the drugs on the market).
Our group concluded that accepting free samples could affect a physician's prescribing practices. For instance, say you're a physician and you get a bunch of free samples of drug A. Say that there is another drug B, which is the exact same as drug B, but a generic version which is much cheaper for the patient. By giving free samples of A, you might be more tempted in the future to keep giving A even though it would be easier for the patient if you would just prescribe B. Get the idea?
It's hard to believe these types of arguments. You would think the physician should exercise discretion. Apparently the general argument regarding gift-giving is that any gift, no matter how big or small, can affect you subconsciously. Yes Dr., that Viagra pen you are holding can influence your prescribing practices. Maybe it does, maybe it doesn't. Honestly, I don't know. I guess a bunch of psychologists and economists did some studies and showed that it does.
Well my group pretty much agreed that these gifts are probably not good. That's fair for them to think that way and I have no problem with that. The crazy thing is, I have a feeling most of my class thinks negatively about pharmaceutical gift giving, even with regards to small things like pens or staplers.
This is kind of a problem for me. See, all of a sudden I feel like I turned from a nice friendly, resourceful guy into a dirty little whore. As my group members were reaching a consensus, I was slowly hiding that Olanzapine pen into my cargo pant pocket...
My family has a history with pharmaceutical companies. As I mentioned before, my dad is a self-employed child and adolescent psychiatrist and he knows all about drug reps. They visit him in his 3 offices all the time. They call the house all the time. They've even hooked me up with other docs they know so I could shadow them. Hell, one of them even helped get me a summer job.
But it's more than that. You see, back in the day (as in about 7 or 8 years ago) there were very little restrictions drug reps could do with regards to gift giving. I've sat in club seats before for the Indians, Browns and Cavs. I've been to fancy 5-course dinners where I get confused about the silverware sequence. I've experienced a couple free rounds of golf at country clubs (which is kind of funny since my dad doesn't golf). I even got a free trip to Hilton Head with my dad to "attend a conference." In reality, he drove the cart and gave me counseling to help me on my way to breaking bogey golf in paradise. This was just part of life growing up, that is once my dad got hist medical license in 1994 after training for a bazillion years. Hard, I know.
You might have read that last paragraph and lost what little respect you already had for me. Am I adding insult to injury by telling you that about the only pens I carry around are pens my dad gets for free?
Gone are the days of free trips and tickets to pro sports games (yes, I actually paid $200 to see Lebron beat the Pistons last year). This is a good thing, and my dad thinks so too. However, the free meals and pens are still around. I don't know if this is necessarily a bad thing, though.
First, I'm not sure if the standard arguments regarding pharma gift giving applies to my dad's line of work. In C&A psychiatry, there are no generic medications. All the drugs on the market are patented and will remain that way for some time. Furthermore, all treatments are made off-label. Drug companies are prohibited from marketing their medications for off-label purposes, and from my experience in pharmaceutical research and from my dad's anecdotes, I believe that this is actually reflected in daily practice with drug reps.
Furthermore, I think people need to realize that drug companies and physicians act like business/businessmen. Yes, not every physician is working a salaried academic position in a hospital. Most physicians operate practices or work in small-practice/business settings. This is even true for surgery where there has been a great shift towards outpatient care. Whether or not you agree with this is another matter. We may hate pharm companies, but in the end of the day, if they're not making those drugs and coming up with discoveries, we're screwed.
This is a touchy subject and I'm still trying to feel my way through. Are pharm companies evil? Maybe. It all comes back to business, money and politics. We live in America. Home of individualism and capitalism. Is it fair for patients? Probably not. Is it good for their health? Probably not.
In the end, I really don't care that my new pen screams "Olanzapine" on the side in fancy handwriting. In fact, Olanzapine is a shitty drug. Just ask all those poor schizophrenic or bipolar patients who develped hyperlipidemia, metabolic syndrome and type 2 diabetes. Screw olanzapine. I do have to admit though, the Olanzapine pen is amazing. I just hope I can make it four years without having to give up all those cool pens in my desk at home. Believe me, they really are cool. They write well and sure beat the hell out of the crap you get in the store.
Seriously, what do you all think? Do you think physicians should accept minor gifts? And no, this is not a rhetorical question...tell me what you think.
Moving on...in other news we had our first gross anatomy lab yesterday. We got to hold prosected hearts and lungs. I held a human heart and stuck my fingers in it to get a feel for the flow of blood through the chambers and valves...sweet. The lungs were soft and kind of mushy. Lab made me hungry. For edible food, not body parts.
We're a little more than half-way through our first block. I think a common complaint many students have is that they are getting tired of the non-medical concerns for patients. These concerns include public health and psychosocial considerations of disease and illness. When are we going to learn REAL science? That's a common question.
Now I know I've always been interested in psychiatry. It's kind of in my blood and it's been validated by the research and clinical experiences I've had before (though I admit this might change after third year, who knows), but I think it's been further validated by the fact that I really don't mind the "touchy-feely" stuff we do during this block. In fact, I kind of like it. Not to mention, when I'm collecting medical history from standard patients, I kind of tend to venture off and ask questions regarding how they feel about certain things. This isn't to say I don't like hard science. In fact, anyone who knows me knows that I am quite into chemistry, especially organic. It's just that I think psychosocial considerations are an important fascet of medicine which are often ignored by physicians. It doesn't mean we have to be all goo-goo with our patients and go Dr. Phil on them, but we need to acknowledge external considerations such as personal, interpersonal and societal circumstances. Our fancy pants procedures and magic pills will not cure our patients alone.
I do understand the frustration my classmates might be having. The social sciences are difficult to appreciate without actual real-world experience. Science is important in medicine, but you can't reduce your patient to a certain pathophysiological state. It's not like biochem where I can draw a pathway or show a mechanism. I always thought of myself as a researcher and I think (even to this day) I'll probably end up in academics, but I have to admit, I'm really dying to get away from the basic science books and to get more clinical exposure. You should check out my blog two years from now when I get out on the wards and ask me how I feel then.
Last week we had our first real case study in our IQ group (small-group session). The case centered around the behavioral and psychosocial factors involved with diabetes care in a Mexican-American women with presumably no health insurance, among other obstacles. Overall I learned a lot about diabetes and I was able to refresh my memory on some public health and epidemiology principles I learned about last year.
Something came up during our last session on Friday that I have wanted to bring up in this blog, and that is the notion of ethics regarding pharmaceutical companies and physicians. In this particular case we were reviewing, the doctor treating the Mexican-American diabetic at the clinic gave her free samples of Avandia (rosiglitazone) to help her manage her diabetes. One of our group objectives, which we came up with, was to study and learn more about the ethics regarding free samples as well as other gifts given to physicians by pharmaceutical drug-reps (including free dinners/lunches to pens sporting the nifty trade names of all the drugs on the market).
Our group concluded that accepting free samples could affect a physician's prescribing practices. For instance, say you're a physician and you get a bunch of free samples of drug A. Say that there is another drug B, which is the exact same as drug B, but a generic version which is much cheaper for the patient. By giving free samples of A, you might be more tempted in the future to keep giving A even though it would be easier for the patient if you would just prescribe B. Get the idea?
It's hard to believe these types of arguments. You would think the physician should exercise discretion. Apparently the general argument regarding gift-giving is that any gift, no matter how big or small, can affect you subconsciously. Yes Dr., that Viagra pen you are holding can influence your prescribing practices. Maybe it does, maybe it doesn't. Honestly, I don't know. I guess a bunch of psychologists and economists did some studies and showed that it does.
Well my group pretty much agreed that these gifts are probably not good. That's fair for them to think that way and I have no problem with that. The crazy thing is, I have a feeling most of my class thinks negatively about pharmaceutical gift giving, even with regards to small things like pens or staplers.
This is kind of a problem for me. See, all of a sudden I feel like I turned from a nice friendly, resourceful guy into a dirty little whore. As my group members were reaching a consensus, I was slowly hiding that Olanzapine pen into my cargo pant pocket...
My family has a history with pharmaceutical companies. As I mentioned before, my dad is a self-employed child and adolescent psychiatrist and he knows all about drug reps. They visit him in his 3 offices all the time. They call the house all the time. They've even hooked me up with other docs they know so I could shadow them. Hell, one of them even helped get me a summer job.
But it's more than that. You see, back in the day (as in about 7 or 8 years ago) there were very little restrictions drug reps could do with regards to gift giving. I've sat in club seats before for the Indians, Browns and Cavs. I've been to fancy 5-course dinners where I get confused about the silverware sequence. I've experienced a couple free rounds of golf at country clubs (which is kind of funny since my dad doesn't golf). I even got a free trip to Hilton Head with my dad to "attend a conference." In reality, he drove the cart and gave me counseling to help me on my way to breaking bogey golf in paradise. This was just part of life growing up, that is once my dad got hist medical license in 1994 after training for a bazillion years. Hard, I know.
You might have read that last paragraph and lost what little respect you already had for me. Am I adding insult to injury by telling you that about the only pens I carry around are pens my dad gets for free?
Gone are the days of free trips and tickets to pro sports games (yes, I actually paid $200 to see Lebron beat the Pistons last year). This is a good thing, and my dad thinks so too. However, the free meals and pens are still around. I don't know if this is necessarily a bad thing, though.
First, I'm not sure if the standard arguments regarding pharma gift giving applies to my dad's line of work. In C&A psychiatry, there are no generic medications. All the drugs on the market are patented and will remain that way for some time. Furthermore, all treatments are made off-label. Drug companies are prohibited from marketing their medications for off-label purposes, and from my experience in pharmaceutical research and from my dad's anecdotes, I believe that this is actually reflected in daily practice with drug reps.
Furthermore, I think people need to realize that drug companies and physicians act like business/businessmen. Yes, not every physician is working a salaried academic position in a hospital. Most physicians operate practices or work in small-practice/business settings. This is even true for surgery where there has been a great shift towards outpatient care. Whether or not you agree with this is another matter. We may hate pharm companies, but in the end of the day, if they're not making those drugs and coming up with discoveries, we're screwed.
This is a touchy subject and I'm still trying to feel my way through. Are pharm companies evil? Maybe. It all comes back to business, money and politics. We live in America. Home of individualism and capitalism. Is it fair for patients? Probably not. Is it good for their health? Probably not.
In the end, I really don't care that my new pen screams "Olanzapine" on the side in fancy handwriting. In fact, Olanzapine is a shitty drug. Just ask all those poor schizophrenic or bipolar patients who develped hyperlipidemia, metabolic syndrome and type 2 diabetes. Screw olanzapine. I do have to admit though, the Olanzapine pen is amazing. I just hope I can make it four years without having to give up all those cool pens in my desk at home. Believe me, they really are cool. They write well and sure beat the hell out of the crap you get in the store.
Seriously, what do you all think? Do you think physicians should accept minor gifts? And no, this is not a rhetorical question...tell me what you think.
Moving on...in other news we had our first gross anatomy lab yesterday. We got to hold prosected hearts and lungs. I held a human heart and stuck my fingers in it to get a feel for the flow of blood through the chambers and valves...sweet. The lungs were soft and kind of mushy. Lab made me hungry. For edible food, not body parts.
We're a little more than half-way through our first block. I think a common complaint many students have is that they are getting tired of the non-medical concerns for patients. These concerns include public health and psychosocial considerations of disease and illness. When are we going to learn REAL science? That's a common question.
Now I know I've always been interested in psychiatry. It's kind of in my blood and it's been validated by the research and clinical experiences I've had before (though I admit this might change after third year, who knows), but I think it's been further validated by the fact that I really don't mind the "touchy-feely" stuff we do during this block. In fact, I kind of like it. Not to mention, when I'm collecting medical history from standard patients, I kind of tend to venture off and ask questions regarding how they feel about certain things. This isn't to say I don't like hard science. In fact, anyone who knows me knows that I am quite into chemistry, especially organic. It's just that I think psychosocial considerations are an important fascet of medicine which are often ignored by physicians. It doesn't mean we have to be all goo-goo with our patients and go Dr. Phil on them, but we need to acknowledge external considerations such as personal, interpersonal and societal circumstances. Our fancy pants procedures and magic pills will not cure our patients alone.
I do understand the frustration my classmates might be having. The social sciences are difficult to appreciate without actual real-world experience. Science is important in medicine, but you can't reduce your patient to a certain pathophysiological state. It's not like biochem where I can draw a pathway or show a mechanism. I always thought of myself as a researcher and I think (even to this day) I'll probably end up in academics, but I have to admit, I'm really dying to get away from the basic science books and to get more clinical exposure. You should check out my blog two years from now when I get out on the wards and ask me how I feel then.
Wednesday, July 23, 2008
Reflecting on a Crazy Day: One of Many To Come
Today was a long and hectic day. Yes, it was a bit crazy, but more importantly, it was good.
It all began with an IQ group session from 8 to 10. Each week we are introduced to two cases. On Mondays we receive the case and formulate objectives, which are points of interest relevant to the case we wish to learn more about. Each person in the group researches each objective and reports back to the group again on Wednesday (or Friday, depending on which case we are discussing). We meet three times a week.
The groups are facilitated by faculty members, or sometimes 4th year medical students. Our faculty adviser happens to be a pediatrician. Along with having a facilitator, during each session we elect a group leader and two scribes. Generally, one scribe jots down notes on the dry-erase board while the other takes notes to be posted online on our group wiki site.
The theme of this week happens to be diabetes, with special regards to the social/cultural/economic implications. Basically, we are concerned with an ecological perspective of diabetes. To supplement our holistic diabetes education this week, we have already had some introduction the disease basics through a brief lecture yesterday. Furthermore, we witnessed a shared medical appointment (more to come later in this post) as well as a field experience regarding diabetes.
I love small group. First of all, everyone in my group is great. Overall, they are each pretty cool, ridiculously smart and quite resourceful. Second, I hate lectures. For me, I get very little utility out of sitting in a seat with a bunch of other people, bored out of their minds, "soaking-in" random fact, after fact. I learn best, either 1-1 with a professor or friend, or in a small group setting, or better yet, sitting alone with a textbook. While I'm fortunate in that Case doesn't have as many lectures as most med schools, we still have them. Although they are quite informative, they can also be boring. I keep thinking of histopathology. Oh, have I ever told you that I abhor histopathology?
During Monday's small group, we were all quite ambitious. In the end we came up with almost 20 different objectives to research. So yesterday evening, I spent over five hours sitting at my desk at school sifting through random-ass information pertaining to diabetes care. Everything from biochemical mechanisms to social and behavioral concerns with regards to access to care and treatment adherence. In theory, this was a great exercise. I now know so much information about diabetes. I know about the drugs. I know a decent chunk about the basic science behind it. I know the lab values used in clinical settings. I know behavioral health models to conceptualize care. I know all about various health disparities stratified by income/race/ethnicity. You get the point.
Well, here I am...8 AM...ready to roll. I had my morning workout, a good breakfast, hell even my commute was awesome...I'm pumped. I'm armed with this arsenal of knowledge to share with my friends and hopefully learn from them as well. We were assigned our roles, and today I was the scribe. Our group leader was very astute and made a PowerPoint slide template for me to jot main points on, which made my job easier. There was one problem,though: we had so many damn objectives to cover we could only brush the surface of each issue during the two hour period! We had a lot of informational overlap but I learned a few cool things from my buddies. Did you know that hemoglobin A1C levels can be used as a cross check for patient adherence to treatment regimen? Better yet, did you know that if you press shift-tab you can get back to the previous hierarchy of bullet points on PowerPoint slides? OK, so I'm a bit PowerPoint illiterate, but it was a cool bit of information!
Small group came and went pretty quickly. While we did have a lot to cover, and we each weren't pleased with our pace and how in-depth we went with each topic, we know we will get better at timing and objective formulation. Besides, the five hours of diabetes research was worth the effort, even though I didn't get to talk about a bunch of it. Besides, I tend to rant about things anyways. I don't think the group would want me to ramble about age adjusted epidemiological studies, or cost-effectiveness analysis.
After small group we had an hour long lecture regarding the various study designs in epidemiological investigations including case-control, cohort, and randomized clinical trials. This was all review for me, so I basically sat around and worked on some other assignment we had to do for tomorrow. We did get little clickers to answer some questions regarding trial design. I feel bad for people in my class who haven't had epidemiology before. The professor started off with a tricky question portraying a retrospective cohort study, without ever going over the difference between prospective and retrospective perspectives in cohort analyses.
Then again, everyone is really smart and I'm sure they'll figure it out soon. That's something I've realized: if there is something I don't know, or am not comfortable with, there is guaranteed to be someone else in the class who is good with that topic. For instance, I suck at histo, but I'm sure there are dozens of students who could help me out. Likewise, I'm knowledgeable about epidemiology and I'd be more than happy to help clarify issues for others. Being pass-fail really throws away competetion and makes life that much better.
After the lecture we witnessed a shared medical appointment with about four diabetic veterans receiving care at the local VA. The presentaiton was pretty cool and it really showed me the importance of a team based approach, and peer support in effective diabetes management. I thought the presentation was hilarious. This one patient gets up to the mic to answer a students' question and basically talks about how he has learned to say no to a bunch of food groups such as pop (soda for you costal weirdos, or 'coke' for you Texans). At the same time this other diabetic on the other side of the table starts to inconspicuously drink his coke!
The shared medical appointment lasted for an hour. After a quick lunch, we went in small groups of about 8 students each to different sites around Cleveland for a "field-experience." I had the opportunity to visit the Lennon Diabetes Center, an outpatient diabetes education center which is part of Huron Hospital, a Cleveland Clinic affiliate, in East Cleveland. For those of you outside of CLE, East Cleveland is a very impoverished area. Ok, for real, it's the ghetto. I still think it's a bit funny to find a corporate giant like the Cleveland Clinic operate a hospital in an area where most patients probably lack health insurance. Gotta love Medicaid/care, I guess.
The visit was pretty enlightening. I basically got to chat with a type 2 diabetic for about 90 minutes. My buddy, Eugene, told me all about life with a chronic illness. If there is one thing I got from this experience, is a true appreciation for the struggles and hardships the chronically ill face. I know that a ton of people (23.6 million to be exact) in the US suffer from diabetes. But the truth is, unless you live with one, or are very close to one of those people, it's easy to gloss over the difficulties they truly face. Eugene has to check his BGLs three times a day. He has to be hawkish in his dietary approach. He has to make sure he also exerices appropriately without going hypoglycemic. He has other complications such as minor neuropathy. He even suffered from retinopathy in the past. Seriously, living with diabetes is tough. So I encourage all of you to just take a moment and appreciate what many individuals have to go through each day. These guys are warriors, the majority of them are optimistic and have great outlooks on life. Overall they make the rest of us look like pansies.
What really struck me about today's visit (other than the fact that we saw a hyperbaric chamber used to help treat vascular complications...I immediately thought of TO) was the fact that Ohio is one of three states which has not passed a diabetes cost reduction act. Basically, a bunch of people with state regulated insurance still have to pay out of pocket for diabetes education. While medication and physician vistits are important, diabetes management must include patient empowerment and proper education in order for adequate self-managment. Apparently Gov. Strickland has pledged to sign the bill, but apparently, there are "more pressing matters" to tend to first, before the bill gets signed. Sad.
After an hour break where I got to hang out with some friends and try to relax a bit (we actually had a civil discussion regarding politics which was quite awesome), we began our final leg of the day which was our first real clinical training: learing to interview a patient. We split into small groups of about 5. Each group was led by a 4th year med student. Our student leader was incredibly helpful. She gave us a rough outline regarding interviewing patients. She then actually interviewed a standardized patient to help us get started with an example. We each had an opportunity to interview the patient. This was fun. First, the standardized patient was really good at her job. Second, I got to brush up on old EMS acronyms like OPQRST. I was thrilled to see that they actually use these acronyms in real medical practice. The more I think about it, EMS was like mini medical school. I'm so glad I had that experience. Interviewing the patient was a bit tricky, but it wasn't bad at all. I really enjoyed it and it brought back memories of rolling around in the back of the ambulance on bumpy Houston highways doing rapid head-toe physicals and starting IVs on near-dead trauma patients. Good times. For me at least, not the patients.
At this pint it was about 7:30 PM. I did work for about 30 minutes and made it in time to eat out with the family. It's my parents 26th wedding anniversary today. Wow, they are old farts.
I should get to bed. It's almost 11, and I have to wake up at 5 AM to repeat the process. I kind of like this med school thing. It's not easy, but it's fun. One day at a time, I guess.
It all began with an IQ group session from 8 to 10. Each week we are introduced to two cases. On Mondays we receive the case and formulate objectives, which are points of interest relevant to the case we wish to learn more about. Each person in the group researches each objective and reports back to the group again on Wednesday (or Friday, depending on which case we are discussing). We meet three times a week.
The groups are facilitated by faculty members, or sometimes 4th year medical students. Our faculty adviser happens to be a pediatrician. Along with having a facilitator, during each session we elect a group leader and two scribes. Generally, one scribe jots down notes on the dry-erase board while the other takes notes to be posted online on our group wiki site.
The theme of this week happens to be diabetes, with special regards to the social/cultural/economic implications. Basically, we are concerned with an ecological perspective of diabetes. To supplement our holistic diabetes education this week, we have already had some introduction the disease basics through a brief lecture yesterday. Furthermore, we witnessed a shared medical appointment (more to come later in this post) as well as a field experience regarding diabetes.
I love small group. First of all, everyone in my group is great. Overall, they are each pretty cool, ridiculously smart and quite resourceful. Second, I hate lectures. For me, I get very little utility out of sitting in a seat with a bunch of other people, bored out of their minds, "soaking-in" random fact, after fact. I learn best, either 1-1 with a professor or friend, or in a small group setting, or better yet, sitting alone with a textbook. While I'm fortunate in that Case doesn't have as many lectures as most med schools, we still have them. Although they are quite informative, they can also be boring. I keep thinking of histopathology. Oh, have I ever told you that I abhor histopathology?
During Monday's small group, we were all quite ambitious. In the end we came up with almost 20 different objectives to research. So yesterday evening, I spent over five hours sitting at my desk at school sifting through random-ass information pertaining to diabetes care. Everything from biochemical mechanisms to social and behavioral concerns with regards to access to care and treatment adherence. In theory, this was a great exercise. I now know so much information about diabetes. I know about the drugs. I know a decent chunk about the basic science behind it. I know the lab values used in clinical settings. I know behavioral health models to conceptualize care. I know all about various health disparities stratified by income/race/ethnicity. You get the point.
Well, here I am...8 AM...ready to roll. I had my morning workout, a good breakfast, hell even my commute was awesome...I'm pumped. I'm armed with this arsenal of knowledge to share with my friends and hopefully learn from them as well. We were assigned our roles, and today I was the scribe. Our group leader was very astute and made a PowerPoint slide template for me to jot main points on, which made my job easier. There was one problem,though: we had so many damn objectives to cover we could only brush the surface of each issue during the two hour period! We had a lot of informational overlap but I learned a few cool things from my buddies. Did you know that hemoglobin A1C levels can be used as a cross check for patient adherence to treatment regimen? Better yet, did you know that if you press shift-tab you can get back to the previous hierarchy of bullet points on PowerPoint slides? OK, so I'm a bit PowerPoint illiterate, but it was a cool bit of information!
Small group came and went pretty quickly. While we did have a lot to cover, and we each weren't pleased with our pace and how in-depth we went with each topic, we know we will get better at timing and objective formulation. Besides, the five hours of diabetes research was worth the effort, even though I didn't get to talk about a bunch of it. Besides, I tend to rant about things anyways. I don't think the group would want me to ramble about age adjusted epidemiological studies, or cost-effectiveness analysis.
After small group we had an hour long lecture regarding the various study designs in epidemiological investigations including case-control, cohort, and randomized clinical trials. This was all review for me, so I basically sat around and worked on some other assignment we had to do for tomorrow. We did get little clickers to answer some questions regarding trial design. I feel bad for people in my class who haven't had epidemiology before. The professor started off with a tricky question portraying a retrospective cohort study, without ever going over the difference between prospective and retrospective perspectives in cohort analyses.
Then again, everyone is really smart and I'm sure they'll figure it out soon. That's something I've realized: if there is something I don't know, or am not comfortable with, there is guaranteed to be someone else in the class who is good with that topic. For instance, I suck at histo, but I'm sure there are dozens of students who could help me out. Likewise, I'm knowledgeable about epidemiology and I'd be more than happy to help clarify issues for others. Being pass-fail really throws away competetion and makes life that much better.
After the lecture we witnessed a shared medical appointment with about four diabetic veterans receiving care at the local VA. The presentaiton was pretty cool and it really showed me the importance of a team based approach, and peer support in effective diabetes management. I thought the presentation was hilarious. This one patient gets up to the mic to answer a students' question and basically talks about how he has learned to say no to a bunch of food groups such as pop (soda for you costal weirdos, or 'coke' for you Texans). At the same time this other diabetic on the other side of the table starts to inconspicuously drink his coke!
The shared medical appointment lasted for an hour. After a quick lunch, we went in small groups of about 8 students each to different sites around Cleveland for a "field-experience." I had the opportunity to visit the Lennon Diabetes Center, an outpatient diabetes education center which is part of Huron Hospital, a Cleveland Clinic affiliate, in East Cleveland. For those of you outside of CLE, East Cleveland is a very impoverished area. Ok, for real, it's the ghetto. I still think it's a bit funny to find a corporate giant like the Cleveland Clinic operate a hospital in an area where most patients probably lack health insurance. Gotta love Medicaid/care, I guess.
The visit was pretty enlightening. I basically got to chat with a type 2 diabetic for about 90 minutes. My buddy, Eugene, told me all about life with a chronic illness. If there is one thing I got from this experience, is a true appreciation for the struggles and hardships the chronically ill face. I know that a ton of people (23.6 million to be exact) in the US suffer from diabetes. But the truth is, unless you live with one, or are very close to one of those people, it's easy to gloss over the difficulties they truly face. Eugene has to check his BGLs three times a day. He has to be hawkish in his dietary approach. He has to make sure he also exerices appropriately without going hypoglycemic. He has other complications such as minor neuropathy. He even suffered from retinopathy in the past. Seriously, living with diabetes is tough. So I encourage all of you to just take a moment and appreciate what many individuals have to go through each day. These guys are warriors, the majority of them are optimistic and have great outlooks on life. Overall they make the rest of us look like pansies.
What really struck me about today's visit (other than the fact that we saw a hyperbaric chamber used to help treat vascular complications...I immediately thought of TO) was the fact that Ohio is one of three states which has not passed a diabetes cost reduction act. Basically, a bunch of people with state regulated insurance still have to pay out of pocket for diabetes education. While medication and physician vistits are important, diabetes management must include patient empowerment and proper education in order for adequate self-managment. Apparently Gov. Strickland has pledged to sign the bill, but apparently, there are "more pressing matters" to tend to first, before the bill gets signed. Sad.
After an hour break where I got to hang out with some friends and try to relax a bit (we actually had a civil discussion regarding politics which was quite awesome), we began our final leg of the day which was our first real clinical training: learing to interview a patient. We split into small groups of about 5. Each group was led by a 4th year med student. Our student leader was incredibly helpful. She gave us a rough outline regarding interviewing patients. She then actually interviewed a standardized patient to help us get started with an example. We each had an opportunity to interview the patient. This was fun. First, the standardized patient was really good at her job. Second, I got to brush up on old EMS acronyms like OPQRST. I was thrilled to see that they actually use these acronyms in real medical practice. The more I think about it, EMS was like mini medical school. I'm so glad I had that experience. Interviewing the patient was a bit tricky, but it wasn't bad at all. I really enjoyed it and it brought back memories of rolling around in the back of the ambulance on bumpy Houston highways doing rapid head-toe physicals and starting IVs on near-dead trauma patients. Good times. For me at least, not the patients.
At this pint it was about 7:30 PM. I did work for about 30 minutes and made it in time to eat out with the family. It's my parents 26th wedding anniversary today. Wow, they are old farts.
I should get to bed. It's almost 11, and I have to wake up at 5 AM to repeat the process. I kind of like this med school thing. It's not easy, but it's fun. One day at a time, I guess.
Friday, July 18, 2008
Medicine, Public Health and Politics
It's official. I'm done with my first week of medical school. Overall, I can say it was definitely less stressful than the first week of college, much less stressful than the first week of high school and not quite as frightening as the first week of junior high, that is until I saw my first histology slides.
The first five weeks of medical school, otherwise known as Block 1, is titled "Becoming a Doctor." We focus on public health and related topics such as biostatistics and epidemiology during this period. We still learn a little basic science during this time, and we also start learning the basic aspects regarding physical diagnosis. The material is fairly straightforward (it's really a review for me so far), but it's very interesting and can make for great discussion.
One of the first interesting topics presented to us this week was the tension between medicine and public health. Generally when you think of the two, they should be related, right? In reality, they're not. Fundamentally speaking, medicine is very individual oriented whereas public health considers a greater population. Medicine takes a biomedical perspective. Public health considers broader determinants of health such as socioeconomic status. You can get rich doing medicine. You'll be broke doing public health.
For me, the fun this week began when our block leader (who happens to be one of my mph advisors), gave us a presentation where he presented data from studies looking at the interface between socioeconomic disparities within a society and associated health outcomes. There is data which shows a greater income disparity within a population, regardless of total net income (wealth) in that society, is correlated with worse health outcomes than would be observed in populations with a more level income distribution. As you can predict and probably know, America tends to have worse health outcomes than pretty much any other industrialized nation since the poverty gap here is quite large. Of course, these data may be potentially misleading when considering the measurements/standards used, but nevertheless, I think we can all agree that there are quite a few health disparities across the spectrum of socioeconomic status.
All was fine and dandy during this presentation, until our block leader brought up an analogy to bring up the point he was trying to make. The poverty gap in this nation is analogous to the difference between first class and economy on an airplane. Those in first class have it made, right? They have a ton of space. Lots of food. Comfort. The works. Those in the back don't have it quite as good. Tall people like me suffer. We may or may not get food (probably no food at all these days given our atrocious economy). We may not get as good of service as we would if we were in first class. We might even resent those sitting in first class because they have it made and we don't. The best way to make the flight fair for everyone would be to eliminate the class system and have one seating section.
But is this really fair? What if you have enough money to pay for the first class seat, don't you deserve it? Really the analogy when extended to healthcare, becomes a political question. I'm sure you've figured what I'm getting at: the concept of a national health care system. See, I don't know if this is really fair for everyone. I believe people should have options. Inequalities are not inequities.
So consider the poverty gap in the US like a room with a very high ceiling. If we want to improve the health of those worse off, why don't we just raise the floor closer to the ceiling? Really, who cares how high the ceiling is. This is how I think about this issue. We need a standard minimum care for individuals in this nation. In theory this is awesome, but how to we pay for it? Now we're talking politics.
It seems like people in America 1.) don't know what universal healthcare is and 2.) are afraid of it. First, universal healthcare does not have to mean socialized medicine. These are two different concepts people. It doesn't mean you'll be waiting in these god-awful lines to get your immunizations. Universal healthcare can merely mean making sure the worst off in our society have access to decent, affordable healthcare for basic needs. Of course, we are all to some extent somewhat afraid of this because we don't know how we're going to pay for it. Dare I say the "T" word....taxes...yeah, scary.
Before I let my political thoughts get in the way of making a coherent post, I can basically tell you that the presentation was quite controversial. I understand what our block leader was saying. You would have to be pretty naive to not admit that our country has serious health issues. Some people in this country are simply getting the shaft. Some people are going bankrupt because they can't keep up with escalating health care costs to manage their chronic conditions.
So what do we do about it? Frankly, I don't know. I wish I did. I understand both sides of the argument. We live in a country that embraces free market capitalism and innovation, and I am proud of that. Access to healthcare, which I have discussed, is an issue. However, what our block leader was getting at was that more upstream issues such as socioeconomic status can be potentially viewed as the root of the problem. Should we do a better job of redistributing income by raising taxes for the well off? Should we extend current tax cuts and continue with supply side economic principles? These are some heavy issues and various people have different opinions.
Politics permeates medicine, and it all starts in med school when we're naive kiddos memorizing histology slides. At Case we have a couple medical organizations on different ends of the political spectrum. There is American Medical Student Association, which supports universal healthcare, and is generally averse to the presence of pharmaceutical companies in teaching hospitals and medical schools. The American Medical Association's medical student chapter is much more conservative. The AMA is a huge physician lobbying group which basically owns congress. They vouch for physician interests and advocate for market based healthcare reform. This past week, AMSA gave us a nice presentation. I'm sure we'll hear from the AMA later during the block.
Frankly it's all overwhelming. I keep questioning myself what my role as a physician is to society as a whole. I know what my duty is to an individual patient, but what about the greater population? I guess it all depends on what you believe in and you perhaps lean politically. I'm still trying to figure things out. I'll let you know when I have some answers.
The first five weeks of medical school, otherwise known as Block 1, is titled "Becoming a Doctor." We focus on public health and related topics such as biostatistics and epidemiology during this period. We still learn a little basic science during this time, and we also start learning the basic aspects regarding physical diagnosis. The material is fairly straightforward (it's really a review for me so far), but it's very interesting and can make for great discussion.
One of the first interesting topics presented to us this week was the tension between medicine and public health. Generally when you think of the two, they should be related, right? In reality, they're not. Fundamentally speaking, medicine is very individual oriented whereas public health considers a greater population. Medicine takes a biomedical perspective. Public health considers broader determinants of health such as socioeconomic status. You can get rich doing medicine. You'll be broke doing public health.
For me, the fun this week began when our block leader (who happens to be one of my mph advisors), gave us a presentation where he presented data from studies looking at the interface between socioeconomic disparities within a society and associated health outcomes. There is data which shows a greater income disparity within a population, regardless of total net income (wealth) in that society, is correlated with worse health outcomes than would be observed in populations with a more level income distribution. As you can predict and probably know, America tends to have worse health outcomes than pretty much any other industrialized nation since the poverty gap here is quite large. Of course, these data may be potentially misleading when considering the measurements/standards used, but nevertheless, I think we can all agree that there are quite a few health disparities across the spectrum of socioeconomic status.
All was fine and dandy during this presentation, until our block leader brought up an analogy to bring up the point he was trying to make. The poverty gap in this nation is analogous to the difference between first class and economy on an airplane. Those in first class have it made, right? They have a ton of space. Lots of food. Comfort. The works. Those in the back don't have it quite as good. Tall people like me suffer. We may or may not get food (probably no food at all these days given our atrocious economy). We may not get as good of service as we would if we were in first class. We might even resent those sitting in first class because they have it made and we don't. The best way to make the flight fair for everyone would be to eliminate the class system and have one seating section.
But is this really fair? What if you have enough money to pay for the first class seat, don't you deserve it? Really the analogy when extended to healthcare, becomes a political question. I'm sure you've figured what I'm getting at: the concept of a national health care system. See, I don't know if this is really fair for everyone. I believe people should have options. Inequalities are not inequities.
So consider the poverty gap in the US like a room with a very high ceiling. If we want to improve the health of those worse off, why don't we just raise the floor closer to the ceiling? Really, who cares how high the ceiling is. This is how I think about this issue. We need a standard minimum care for individuals in this nation. In theory this is awesome, but how to we pay for it? Now we're talking politics.
It seems like people in America 1.) don't know what universal healthcare is and 2.) are afraid of it. First, universal healthcare does not have to mean socialized medicine. These are two different concepts people. It doesn't mean you'll be waiting in these god-awful lines to get your immunizations. Universal healthcare can merely mean making sure the worst off in our society have access to decent, affordable healthcare for basic needs. Of course, we are all to some extent somewhat afraid of this because we don't know how we're going to pay for it. Dare I say the "T" word....taxes...yeah, scary.
Before I let my political thoughts get in the way of making a coherent post, I can basically tell you that the presentation was quite controversial. I understand what our block leader was saying. You would have to be pretty naive to not admit that our country has serious health issues. Some people in this country are simply getting the shaft. Some people are going bankrupt because they can't keep up with escalating health care costs to manage their chronic conditions.
So what do we do about it? Frankly, I don't know. I wish I did. I understand both sides of the argument. We live in a country that embraces free market capitalism and innovation, and I am proud of that. Access to healthcare, which I have discussed, is an issue. However, what our block leader was getting at was that more upstream issues such as socioeconomic status can be potentially viewed as the root of the problem. Should we do a better job of redistributing income by raising taxes for the well off? Should we extend current tax cuts and continue with supply side economic principles? These are some heavy issues and various people have different opinions.
Politics permeates medicine, and it all starts in med school when we're naive kiddos memorizing histology slides. At Case we have a couple medical organizations on different ends of the political spectrum. There is American Medical Student Association, which supports universal healthcare, and is generally averse to the presence of pharmaceutical companies in teaching hospitals and medical schools. The American Medical Association's medical student chapter is much more conservative. The AMA is a huge physician lobbying group which basically owns congress. They vouch for physician interests and advocate for market based healthcare reform. This past week, AMSA gave us a nice presentation. I'm sure we'll hear from the AMA later during the block.
Frankly it's all overwhelming. I keep questioning myself what my role as a physician is to society as a whole. I know what my duty is to an individual patient, but what about the greater population? I guess it all depends on what you believe in and you perhaps lean politically. I'm still trying to figure things out. I'll let you know when I have some answers.
Monday, July 14, 2008
Getting Underway
Today, as a member of the martriculating class of 2008, I will uphold these values and principles throughout my medical career.
As I care for my patients, I will:
Yesterday I was sworn into the medical profession in Severance Hall. I got my white coat, albeit a short one. It was pretty awesome. For those of you not familiar with Severance Hall, it is the home of the Cleveland Orchestra. Basically, the hall is ballin'. That's all you really need to know.
So today began the first official day of classes. The curriculum starts out with an introduction to public health including epidemiology and biostatistics. The day basically consisted of an overview of the block. The block leader happens to be the director of public health and my MPH program advisor. A lot of what was said today was stuff I pretty much heard last year in his public health class, so it got kind of old pretty fast.
While the discussion of public health basics, including an overview of definitions and a contrast of the terms medicine, public health and population health were discussions I've heard and read about in the past, I think it was a great idea for the curriculum leaders to get us started focusing on public health. Public health and medicine are too often sepearated and I think a greater unity between the two needs to be achieved for healthcare in this country to improve. Bold, ambitious and potentially unlikely due to the presence of lobyists and general scumbags, I know. Nevertheless, it was interesting to rexamine the tension between the two disciplines.
The day ended with a small group discussion of a book we were assigned to read over our incredibly short, or otherwise non-existent summer. The book we read was How Doctor's Think by Jerome Groopman. Overall, it was a pretty interesting read (a tad repetetive) regarding cognitive errors made in medicine. It brought to light the aspect of medicine as an art. It was enlightening but also a bit discouraging in its view of patient care in the US. I recommend it. Check it out.
Something nice about the curriculum here at Case is the incorporation of longitudinal blocks including structure, which consists of anatomy and histopathology. Tomorrow begins the structure component. We'll be going over some anatomy as well as histopath among other things.
So if there was one thing I learned on my first real day of classes: I most likely do not want to be a pathologist. I spent a couple hours this afternoon reading our pre-class reading for tomorrow, and it was not a pleasant experience. I'm sorry, but histopath is a snooze fest. It just does not seem interesting to me at all. Besides, it doesn't make much sense. Seriously, I couldn't tell if that virtual H&E slide was a cell or some shit on a slide. I'd rather just push some electrons around and do something cool like that. This is going to be a rough go for me since I've never had any histology, ever. Hopefully it will make a bit more sense after it gets explained to us tomorrow.
As I care for my patients, I will:
- Build a relationship of trust and respect
- Treat patients with dignity and compassion
- Listen with sincerity and objectivity, and
- Value my patients' emotional, spiritual, and cultural needs
- Emphasize preventive care,
- Promote patient education
- Improve access to public health resources, and
- Commit to the continuous improvement of healthcare through social activism
- Collaborate with my peers to engage in effective teamwork,
- Hold myself accountable to teh highest standards of patient care and personal conduct
- Remember that it is a privilege to serve patients and represent the medical community, and
- Strive to extend my influence beyond medicine to society at large
- Possess the humility to acknowledge my mistakes and learn from them,
- Know my own limitations and seek the counsel of others,
- Avoid complacency by remaining abreast of developments in my field, and
- Commit to the education of the physicians who will carry the medical standard beyond my time
Yesterday I was sworn into the medical profession in Severance Hall. I got my white coat, albeit a short one. It was pretty awesome. For those of you not familiar with Severance Hall, it is the home of the Cleveland Orchestra. Basically, the hall is ballin'. That's all you really need to know.
So today began the first official day of classes. The curriculum starts out with an introduction to public health including epidemiology and biostatistics. The day basically consisted of an overview of the block. The block leader happens to be the director of public health and my MPH program advisor. A lot of what was said today was stuff I pretty much heard last year in his public health class, so it got kind of old pretty fast.
While the discussion of public health basics, including an overview of definitions and a contrast of the terms medicine, public health and population health were discussions I've heard and read about in the past, I think it was a great idea for the curriculum leaders to get us started focusing on public health. Public health and medicine are too often sepearated and I think a greater unity between the two needs to be achieved for healthcare in this country to improve. Bold, ambitious and potentially unlikely due to the presence of lobyists and general scumbags, I know. Nevertheless, it was interesting to rexamine the tension between the two disciplines.
The day ended with a small group discussion of a book we were assigned to read over our incredibly short, or otherwise non-existent summer. The book we read was How Doctor's Think by Jerome Groopman. Overall, it was a pretty interesting read (a tad repetetive) regarding cognitive errors made in medicine. It brought to light the aspect of medicine as an art. It was enlightening but also a bit discouraging in its view of patient care in the US. I recommend it. Check it out.
Something nice about the curriculum here at Case is the incorporation of longitudinal blocks including structure, which consists of anatomy and histopathology. Tomorrow begins the structure component. We'll be going over some anatomy as well as histopath among other things.
So if there was one thing I learned on my first real day of classes: I most likely do not want to be a pathologist. I spent a couple hours this afternoon reading our pre-class reading for tomorrow, and it was not a pleasant experience. I'm sorry, but histopath is a snooze fest. It just does not seem interesting to me at all. Besides, it doesn't make much sense. Seriously, I couldn't tell if that virtual H&E slide was a cell or some shit on a slide. I'd rather just push some electrons around and do something cool like that. This is going to be a rough go for me since I've never had any histology, ever. Hopefully it will make a bit more sense after it gets explained to us tomorrow.
Friday, July 11, 2008
Professionalism
The point of today, our second and final day of pure orientation activities, was to discuss the concept of “Professionalism.” Apparently this is a hot topic in medical education these days. For those of you not in the medical field, you might be wondering why professionalism is such an important point being emphasized in medical schools. After all, aren’t doctors supposed to be these amazingly smart and altruistic human beings putting their patients before just about anything? Furthermore, shouldn’t medical admission committees be picking students already exhibiting professionalism? Here’s an even better one you may be thinking…what the hell is professionalism?
These are all questions I had and still have. I hate discussing really abstract topics open to various lines of interpretation. To me, it’s akin to asking “what’s the meaning of life?” or something crazy and philosophical like that.
What’s kind of funny is I kind of get the feeling most current doctors feel the same way I do about professionalism. My dad’s a child and adolescent psychiatrist. I asked him today, what do you think professionalism in medicine means? After about a two second pause, “Umm, yeah, just be nice to your patients and don’t do anything stupid, you’ll be fine.”
Even my faculty interviewer, during my interview day at Case, brought up the point of professionalism. I think it was a standard question he was supposed to ask me. See, we were really talking about the Cavs for about 30 minutes, then he kind of forgot about the questions he was supposed to be asking me. So, here I am talking about LBJ’s lack of a jump shot and he just blurts out, “what does professionalism mean to you?” So I gave these awesome spiel about this book I read, Emotional Intelligence, and how success in life is predicated on interpersonal relationships and listening skills. I somehow tied that into my idea of professionalism, which is basically being a good person. I then flipped the question back at him. He was kind of stunned. He then looked me square in the eyes and said, “you need to show up on time.” Awesome. Don’t be late and you too will be exhibiting professionalism.
The point I’m trying to make is that professionalism is abstract and it means many different things to different people Communicate well (“be nice to your patients”). Be responsible (“show up on time”). Be competent (“don’t do anything stupid”). Etc.
And that was the goal today: to define what it means to be a professional. See, at Case we aren’t conventional. For one our curriculum is not typical. We have this weird Harry Potter social structure going on. Furthermore during our White Coat Ceremony we are not sworn in to our profession reciting the Hippocratic Oath. We make our own oath. And that, was what we were to do today.
It sounds pretty cool, and frankly it is a bit exciting. I understand why the school makes us go through this activity, See, professionalism, whatever that may mean, is a serious issue. We no longer live in a society where a physician is free to be the virtuous and wonderful healer that he or she is trained to be. Their lives are controlled by insurance companies, pharma and even the government. Health care costs are rising. People are getting fat and dying. Physicians are becoming ever more cynical of a modern medical system run by businessmen and bureaucrats. As such, they become cynical when the treat patients. They are angry at the system. They are angry at their patients for not taking proper preventive measures. They are angry at themselves for getting into medicine in the first place.
See at one point they were happy, little, idealistic medical students ready to go out there and change the world! Viva la revolucion, baby! Idealism is awesome, but it often is accompanied by unawareness.
I saw a bit of that idealism today. In order to create our class oath, we split up into small groups of about 11 students. The groups include our original IQ groups from yesterday with the addition of one or two students from the Cleveland Clinic Lerner College of Medicine (CCLCM). CCLCM trains students for careers as physician investigators. The program is research intensive and 5-years in length, but they still get their degrees from Case.
As a group we came up with a bunch of attributes a physician should exhibit. Some examples included, competence, compassion, empathy, humility among others. After spending an hour or so in our small group, we met in a larger group of about 40 students to create a condensed list.
It was when we were combining our lists I saw some of the idealism of some of my colleagues. What really struck me as the bulleted point on one of the lists stating “understanding the basic right to healthcare.” This statement kind of struck me because it didn’t seem necessarily appropriate to include it in a discussion of professionalism. An ideal physician has a responsibility to treat an individual patient regardless of his/her ability to pay. Nevertheless, this is not equivalent to saying that everyone has a right to healthcare. Maybe in Canada or the European Union sans Switzerland, but not here in America.
In fact, I’d be interested in knowing how many entering medical students think that a physician should believe that everyone deserves the right to basic healthcare. Personally, this is something I believe in, but I don’t think it is something that should constitute professionalism.
It seems as if the notion of a physician’s responsibility to an individual patient was being mixed with a physician’s responsibility to society. Notions of policy and public health arose during our discussion. Should a physician be an advocate for basic universal health care? Should a physician even have an obligation to society in the first place? Wow, these are some serious questions.
Seeing the idealism in the room was kind of exciting. While I‘ve had plenty of experiences with the health care system through my training as an EMT and my background in public health to have become completely jaded already, I felt a glimmer of hope again. Kind of like I did when I first decided to become a doctor. While talking about professionalism wasn’t necessarily my cup of tea, it was necessary. In our world today, it’s too easy to become cynical, no matter how kind-hearted you may be.
Here’s to hoping that glimmer of idealism doesn’t fade.
These are all questions I had and still have. I hate discussing really abstract topics open to various lines of interpretation. To me, it’s akin to asking “what’s the meaning of life?” or something crazy and philosophical like that.
What’s kind of funny is I kind of get the feeling most current doctors feel the same way I do about professionalism. My dad’s a child and adolescent psychiatrist. I asked him today, what do you think professionalism in medicine means? After about a two second pause, “Umm, yeah, just be nice to your patients and don’t do anything stupid, you’ll be fine.”
Even my faculty interviewer, during my interview day at Case, brought up the point of professionalism. I think it was a standard question he was supposed to ask me. See, we were really talking about the Cavs for about 30 minutes, then he kind of forgot about the questions he was supposed to be asking me. So, here I am talking about LBJ’s lack of a jump shot and he just blurts out, “what does professionalism mean to you?” So I gave these awesome spiel about this book I read, Emotional Intelligence, and how success in life is predicated on interpersonal relationships and listening skills. I somehow tied that into my idea of professionalism, which is basically being a good person. I then flipped the question back at him. He was kind of stunned. He then looked me square in the eyes and said, “you need to show up on time.” Awesome. Don’t be late and you too will be exhibiting professionalism.
The point I’m trying to make is that professionalism is abstract and it means many different things to different people Communicate well (“be nice to your patients”). Be responsible (“show up on time”). Be competent (“don’t do anything stupid”). Etc.
And that was the goal today: to define what it means to be a professional. See, at Case we aren’t conventional. For one our curriculum is not typical. We have this weird Harry Potter social structure going on. Furthermore during our White Coat Ceremony we are not sworn in to our profession reciting the Hippocratic Oath. We make our own oath. And that, was what we were to do today.
It sounds pretty cool, and frankly it is a bit exciting. I understand why the school makes us go through this activity, See, professionalism, whatever that may mean, is a serious issue. We no longer live in a society where a physician is free to be the virtuous and wonderful healer that he or she is trained to be. Their lives are controlled by insurance companies, pharma and even the government. Health care costs are rising. People are getting fat and dying. Physicians are becoming ever more cynical of a modern medical system run by businessmen and bureaucrats. As such, they become cynical when the treat patients. They are angry at the system. They are angry at their patients for not taking proper preventive measures. They are angry at themselves for getting into medicine in the first place.
See at one point they were happy, little, idealistic medical students ready to go out there and change the world! Viva la revolucion, baby! Idealism is awesome, but it often is accompanied by unawareness.
I saw a bit of that idealism today. In order to create our class oath, we split up into small groups of about 11 students. The groups include our original IQ groups from yesterday with the addition of one or two students from the Cleveland Clinic Lerner College of Medicine (CCLCM). CCLCM trains students for careers as physician investigators. The program is research intensive and 5-years in length, but they still get their degrees from Case.
As a group we came up with a bunch of attributes a physician should exhibit. Some examples included, competence, compassion, empathy, humility among others. After spending an hour or so in our small group, we met in a larger group of about 40 students to create a condensed list.
It was when we were combining our lists I saw some of the idealism of some of my colleagues. What really struck me as the bulleted point on one of the lists stating “understanding the basic right to healthcare.” This statement kind of struck me because it didn’t seem necessarily appropriate to include it in a discussion of professionalism. An ideal physician has a responsibility to treat an individual patient regardless of his/her ability to pay. Nevertheless, this is not equivalent to saying that everyone has a right to healthcare. Maybe in Canada or the European Union sans Switzerland, but not here in America.
In fact, I’d be interested in knowing how many entering medical students think that a physician should believe that everyone deserves the right to basic healthcare. Personally, this is something I believe in, but I don’t think it is something that should constitute professionalism.
It seems as if the notion of a physician’s responsibility to an individual patient was being mixed with a physician’s responsibility to society. Notions of policy and public health arose during our discussion. Should a physician be an advocate for basic universal health care? Should a physician even have an obligation to society in the first place? Wow, these are some serious questions.
Seeing the idealism in the room was kind of exciting. While I‘ve had plenty of experiences with the health care system through my training as an EMT and my background in public health to have become completely jaded already, I felt a glimmer of hope again. Kind of like I did when I first decided to become a doctor. While talking about professionalism wasn’t necessarily my cup of tea, it was necessary. In our world today, it’s too easy to become cynical, no matter how kind-hearted you may be.
Here’s to hoping that glimmer of idealism doesn’t fade.
Thursday, July 10, 2008
The First Day
Having had about 18 years of formal schooling thus far, the first day of med school really should not be that big of a deal, espeically since I spent the past year at the med school working towards my MPH. So I took it in stride. I went to the gym early in the morning like I normally do, and I then took the drive down to school like I did for my MPH classes this past year. It seems like a lot of people hate commuting, but I normally enjoy my commute to and from school. It's a great way to kick-back (but pay attention to the road of course), let my Solara cruise at 65 down I-90, listen to some tunes, emit copious amounts of CO2 and continue our nation's dependence on foreign sources of oil. Good stuff.
Today was a bit different. Well for one, I left the gym at around 7:30 AM. Bad idea. I kind of forgot about rush hour. You see, when I had MPH classes, they were normally in the afternoons. What normally averages to a 28minute 45 second ride (that's right, I'm such a geek I actually have an average commute time calculated) took about 40 minutes. I was cut off by about 4 different people and I almost crashed into a construction cone on Euclid Ave.
Luckily for me, there was no hurry since orientation really did not begin until 8:30. I was looking forward to a nice hearty little breakfast with maybe a bagel, banana and some orange juice. Well, instead I had some cream filled pastry, but the good news was the orange juice was there. Perhaps the administration should consider the public health ramifications of feeding the next generation of expert clinicians, policy-makers and medical thought-leaders foods high in carbohydrates and hydrogenated fats. Sorry, the public health part of me is getting out-I'll try to contain it.
I spent the next 15 minutes chatting and introducing myself to one of my colleagues. Wait, did I say colleague? You mean, I'm going to be a doctor? He's going to be a doctor? We're both going to be doctors? Wow, life really is about to be different.
Soon enough 8:30 rolled around and the introductory speeches began. Enter Hogwarts School of Medicine. Case is different from other medical schools in that the student body is randomly organized into four smaller groups we call "societies." Each society has a leader, who is a physician/administrator to assist in any way with the personal and professional lives of students. The society deans, as we call them, each gave excellent speeches. Part of the reason I chose Case over other medical schools was the support system offered by the societies. I had great experiences in high school and college with similar systems, and from what I've seen at Case today, I think I'll have a positive experience here as well.
After the society speeches, a group of enthusiastic and helpful M2s gave us newbies a run down of the curriculum and how learning at the SOM works. One of the hallmarks of the WR2 curriculum, which supposeldy is like the greatest thing since sliced-bread, are inquiry (IQ) groups. In these groups of 8-9 students, we learn through reading and researching medical cases. There are 2 cases each week. In order to prep us for a tutorial IQ session in the afternoon, one of the M2s interviewed a real patient regarding endocrine dysfunction he has been experiencing throughout his lifetime.
It wasn't until lunchtime when I realized how lucky I was. We ate lunch in our society groups and I was able to meet the 40 or so students in my society including the 7 other individuals in my IQ group. What I realized was how diverse, talented and genuine each person was. I met students fresh out of college, older students who are married or have decided on a drastic career change, students like myself who have taken only a year or two off between college and med school. I met musicians. I met atheletes. I met people from California as well as people from Cleveland and even from around the world. What was awesome was that each person I met, from early in the morning through lunch and in the afternoon, was not only unique and gifted, but was friendly. It looks like the school picked a good bunch of people.
After lunch we split into IQ groups to run our mock case. Our IQ facilitator, a 2nd year, was great. We played a game called samurai slapper, arguably the most frustrating game ever, as an icebreaker. Basically, the group forms a circle with one person in the midle. Everyone on the perimeter sticks their hand out with their palm facing up. The person in the middle starts the game by picking somebody. This person who is picked must say the name of another person in the group before the guy in the center slaps his/her hand. The person whose name was said aloud must say another person's name before the guy in the middle slaps his/her hand. If anyone on the perimeter fumbles by failing to say a name before his/her hand is slapped they assume the position in the center.
When I was in the middle, I died. This game was tough. The thing is, it worked. I now know all the names of my IQ peers. Overall, the IQ session was great and I think my group really clicked. It's a good thing our group looks like it will work out, since we will be seeing a lot of each other over the next 4 years.
I was kind of wiped out after the IQ session, but I decided to head over to the campus bookstore to attend the medicine open house. Honestly, I wasn't really interested in purchasing any books, nor eating the pizza or cookies they offered (books are cheaper online and I had too much junk food in one day!). I just wanted to get a chance to meet some of my other classmates. It seems like a lot of them have already met each other since there have been some social events earlier in the week. One of the drawbacks with living far away from school is it's difficult/not economically feasible for me to drive down to school or bars/clubs in the area to hang out with other students. So this was my first time getting to meet some people and I'm glad I did.
Honestly, I wasn't too excited about starting med school, but my tune has changed somewhat over the past 12 hours. I think the people you surround yourself with on a daily basis have a huge impact on your outlook. It seems as if I've got a great group of people to help me get through medical school and into residency. Hopefully, I can do my part to help them as well. We'll see how tomorrow goes.
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Today was a bit different. Well for one, I left the gym at around 7:30 AM. Bad idea. I kind of forgot about rush hour. You see, when I had MPH classes, they were normally in the afternoons. What normally averages to a 28minute 45 second ride (that's right, I'm such a geek I actually have an average commute time calculated) took about 40 minutes. I was cut off by about 4 different people and I almost crashed into a construction cone on Euclid Ave.
Luckily for me, there was no hurry since orientation really did not begin until 8:30. I was looking forward to a nice hearty little breakfast with maybe a bagel, banana and some orange juice. Well, instead I had some cream filled pastry, but the good news was the orange juice was there. Perhaps the administration should consider the public health ramifications of feeding the next generation of expert clinicians, policy-makers and medical thought-leaders foods high in carbohydrates and hydrogenated fats. Sorry, the public health part of me is getting out-I'll try to contain it.
I spent the next 15 minutes chatting and introducing myself to one of my colleagues. Wait, did I say colleague? You mean, I'm going to be a doctor? He's going to be a doctor? We're both going to be doctors? Wow, life really is about to be different.
Soon enough 8:30 rolled around and the introductory speeches began. Enter Hogwarts School of Medicine. Case is different from other medical schools in that the student body is randomly organized into four smaller groups we call "societies." Each society has a leader, who is a physician/administrator to assist in any way with the personal and professional lives of students. The society deans, as we call them, each gave excellent speeches. Part of the reason I chose Case over other medical schools was the support system offered by the societies. I had great experiences in high school and college with similar systems, and from what I've seen at Case today, I think I'll have a positive experience here as well.
After the society speeches, a group of enthusiastic and helpful M2s gave us newbies a run down of the curriculum and how learning at the SOM works. One of the hallmarks of the WR2 curriculum, which supposeldy is like the greatest thing since sliced-bread, are inquiry (IQ) groups. In these groups of 8-9 students, we learn through reading and researching medical cases. There are 2 cases each week. In order to prep us for a tutorial IQ session in the afternoon, one of the M2s interviewed a real patient regarding endocrine dysfunction he has been experiencing throughout his lifetime.
It wasn't until lunchtime when I realized how lucky I was. We ate lunch in our society groups and I was able to meet the 40 or so students in my society including the 7 other individuals in my IQ group. What I realized was how diverse, talented and genuine each person was. I met students fresh out of college, older students who are married or have decided on a drastic career change, students like myself who have taken only a year or two off between college and med school. I met musicians. I met atheletes. I met people from California as well as people from Cleveland and even from around the world. What was awesome was that each person I met, from early in the morning through lunch and in the afternoon, was not only unique and gifted, but was friendly. It looks like the school picked a good bunch of people.
After lunch we split into IQ groups to run our mock case. Our IQ facilitator, a 2nd year, was great. We played a game called samurai slapper, arguably the most frustrating game ever, as an icebreaker. Basically, the group forms a circle with one person in the midle. Everyone on the perimeter sticks their hand out with their palm facing up. The person in the middle starts the game by picking somebody. This person who is picked must say the name of another person in the group before the guy in the center slaps his/her hand. The person whose name was said aloud must say another person's name before the guy in the middle slaps his/her hand. If anyone on the perimeter fumbles by failing to say a name before his/her hand is slapped they assume the position in the center.
When I was in the middle, I died. This game was tough. The thing is, it worked. I now know all the names of my IQ peers. Overall, the IQ session was great and I think my group really clicked. It's a good thing our group looks like it will work out, since we will be seeing a lot of each other over the next 4 years.
I was kind of wiped out after the IQ session, but I decided to head over to the campus bookstore to attend the medicine open house. Honestly, I wasn't really interested in purchasing any books, nor eating the pizza or cookies they offered (books are cheaper online and I had too much junk food in one day!). I just wanted to get a chance to meet some of my other classmates. It seems like a lot of them have already met each other since there have been some social events earlier in the week. One of the drawbacks with living far away from school is it's difficult/not economically feasible for me to drive down to school or bars/clubs in the area to hang out with other students. So this was my first time getting to meet some people and I'm glad I did.
Honestly, I wasn't too excited about starting med school, but my tune has changed somewhat over the past 12 hours. I think the people you surround yourself with on a daily basis have a huge impact on your outlook. It seems as if I've got a great group of people to help me get through medical school and into residency. Hopefully, I can do my part to help them as well. We'll see how tomorrow goes.
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