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.