Oh lord a House of God question

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well, its a matter of degree. I think the mistake most pre-meds make is that they are there to "cure" people. You cure relatively few people. People who are "cured" usually don't need a hell of a lot of medical care. It is the chronically ill people who the magic of medicine is able to keep alive that demand all your time. To give a really general estimate, you are curing 10% of the time, and 90% of the time you are patching up chronically ill folks so they can go home to live in a wheelchair or whatever. The sicker they are, the more of your time they are going to take, and the less you can do for them. So, if you are "obligated" to take care of a really sick person who you know is not going to get better, what are you going to do? Turf. So, you have to look at the bright side...and accept the fact that many people won't get better, and be very happy when you are able to quickly turn someone around so they can get back to a productive life. You can have big dreams, but you have to accept small improvements sometimes if you want to be happy.
 
House of God is a C- book that should long ago have dropped of the unofficial required reading list for pre-meds/med students.

It reflects a bygone era of medicine and should be read as history rather than current events.

Shem is correct about the horribly ill, demented elderly who we elect to torture with polypharmacy and medical intervention. Panda has also issued some eloquent polemic against this particular sin. You will see it in your career - the 95 year old demented, bed-bound, blind amputee who comes in for a stroke and whose family wants you to "do everything."

He is also correct about the culture of "turfing." No body really likes admitting to their service. As you will see admitting a patient to an inpatient team is a ton of work. The best nights on call are the ones where you get the fewest "hits."
 
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Sometimes the best that you can do is to relieve pain and suffering for the chronically ill and diseased. You do this with the hope that all of your primary care is balanced by those who are doing research to prevent illness and disease.

You don't have to work the carnage at Big City General Hospital. If it suits you better, how about working in a medium sized community clinic or specialty care center?

And as you go along, counter your jadedness with kindness... don't allow yourself to fall into the emotional abyss that is always nearby.
 
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am i the only one that hates the writing style in house of god?
 
AmoryBlaine said:
It reflects a bygone era of medicine and should be read as history rather than current events.
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How so? I'm trying to remember The House of God I read 6 years ago, but the only bit that seems antiquated is the emphasis on autopsies. But the rate of autopsy has gone down a lot in the years since then. Interestingly, that bit was repeated in the first episode of Scrubs as well. I wonder where they got it from considering how much more modern that show is.

Otherwise what's really different? Yeah the sex parts were probably overdone. There's plenty of that in Mount Misery too... radslooking's point is well taken. It seems (having not done internship, just rotations) that 90% of your time is taken up by GOMERs and such. It's not 100%. The other 10% is paperwork (kidding!).

But ok, barring those two points, what else is different about internship now?
 
the fat mans rules apply to every aspect of residency and perhaps beyond! the overall story was raunchy but there are valid points that are brought up that apply to the practice of medicine here in the US.

i always recommend my interns to read HOG and become familiar with the fat mans' rules before the start of inpt wards because it applies. even after all these years.

...and a word of advice to someone intending on a career in medicine. please lower your standards. this 'self-righteous' attitude about wanting to 'help people and sing kum-ba-ya and wear sandals' is great for the personal statement and the interview. it makes the interviewer see themselves in you back in the day when they had hope and were not so pessimistic and jaded. it will be a matter of time before you'll share these sentiments!

good luck👍
 
Neuronix said:
How so? ... but the only bit that seems antiquated is the emphasis on autopsies. But the rate of autopsy has gone down a lot in the years since then. Interestingly, that bit was repeated in the first episode of Scrubs as well. I wonder where they got it from considering how much more modern that show is.
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In years past teaching hospitals were required by the federal government to have a significant autopsy percentage of patient deaths for student instruction. Since the elimination of that pathology requirement, teaching hospitals simply stopped doing them as a part of residency curriculum. All modern hospitals have the facilities to do autopsies but only do them when requested, or when there's doubt as to the cause of death.

My take was that Kelso wanted J.D. to get the autopsy because he, Kelso, wanted to prove a point to a new intern, and, that he wanted to be known as "old school" concerning his medicine.
 
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Going to give another vote for "its really more like Grey's Anatomy".


(and stop reading doctoring books. they are all biased.)
 
House of God is nearly 40 years old. A snapshot in time, fictionalized and representative of little that is current or widespread in medicine. Its about residency which is a whole different world than the actual practice of medicine. Read it for enjoyment much as you would People magazine; no more.

It is human nature to not want to take on extra work; the guys at my carwash time and time again fail to vacuum the trunk (despite my requests) and the grocery bagger won't take the time to double bag a heavy load. Its the same with medicine; more patients means more work, less time with family, etc. So there is a certain amount of turfing...at least at the resident level. Attendings are less likely to do this because a) they make more money with more patients (in the community, not salaried physicians) and b) they aren't doing all of the work in a teaching hospital. Turfing is natural, but it certainly doesn't happen with every patient, as sometimes we actually realize the patient is better off on our service.

Buffing the chart? While it might make sense if you're trying to turf someone but most people I know don't engage in much buffing...if the patient needs to be turfed, they need it, regardless of what the chart says. I was never taught to buff a chart during medical school or residency. If you call getting a patient off oxygen, removing their drains, getting them to ambulate all so the SNF will take them in transfer buffing, then so be it...but this is typical and usual medical care. Now this is not so true of the small community hospital trying to transfer a patient to the tertiary care center. They either grossly overestimate the patient's illness (usually because its Friday pm and they don't want to round on the patient over the weekend) or they underestimate it, (usually in the case of GOMERs) so that you will take the patient.

At any rate, its not all or none. Some physicians work harder to save patients just as some car detailers work harder. Its not a function of the medical field.

I'd suggest you stop reading these books or watching any tv shows for information about what medicine is like and realize its a field populated by a wide variety of people, most of whom really care about doing a good job and taking care of their patients.
 
Moxess said:
Really? I come off as self-righteous? 😵
I'm just wondering whether the entire system of modern medicine is based on buffing and turfing. I don't think anyone's really answered my question yet.
I understand turfing is there, but do we go to medical school just to learn how to buff a good chart?
House of God makes it sound like trying to keep ANYONE alive is a bad thing. I've been on SDN for a while and not gotten that impression...it seems like people still at least try to keep people from suffering.
The House of God makes it seem as if there is no middle ground: you either do nothing, or you are a Jo, a person who goes all out on patients and ends up making them worse.
I'm just a little confused because he seems to portray those who keep anyone alive at all as crazed madmen...except Fats

It seems like no matter what I say I'm going to get shat on, though I'm not in any way trying to suggest that I expect to be going in there and saving everyone....or even many people at all. I'm just confused about how prominent turfing/tormenting gomers is. I don't want to be the ******* like Jo who prolongs their suffering...
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I think why people have trouble answering your question is because medicine is a very varied field. You have pathologists and radiologists who barely see patients, so are only peripherally involved with this discussion. You have psychiatrists who aren't "buffing" any charts, or surgeons who aren't "buffing" too many charts, but mainly trying to surgerize people back to health. Granted, sometimes it appears to be worthless to treat chronically ill people, such as doing a sacral decubitus surgery on a chronically ill, demented patient, but that doesn't mean the entire system is corrupt or worthless. It just means sometimes its frustrating, and yes, some of the things we do are worthless or near worthless, but we have to do them anyway.

Also, HOG is written about residency, which is it's own world in itself. Residents are salaried workers, and there is NO incentive to do extra work (unless it helps you learn....but people err on the side of doing less work). So you have to understand that residents are more likely to "buff" and "turf" more than anybody else in medicine. And you'll find doctors run a whole gamut...generally most want to help the patients, but there are some who are generally just interested in getting by and earning some money. Most are good hearted souls.

My point? HOG is too simplistic. It has a few good points, but just doesn't apply in many cases.
 
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About the Scrub's comment earlier, the show's creators actually studied the book while researching medical society. You can see a lot of HOG in Scrub's; i.e. JD and Turk bring to mind Roy and Chuck.
 
Moxess said:
but one thing I can't get over is:
The author keeps saying that you can never cure anyone's disease, that all you do is turf them somewhere else.
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In my ultra short residency stint, I was surprised at how much in-patient medicine was a big nothing. Rota virus, sickle cell crisis - mostly just hydrate them. A few days in the hospital and several bags of normal saline (a bag of water with about a pinch of salt added) and they go home and somebody is expected to pay thousands of dollars - for a bed and some very slightly salty water. If the sickle cell person had simply drank a little more water the week previous, they would have probably never have had the crisis. Its like 5,000 dollars for $15 of actual value.

Had a child with a large perineal abcess. Surgery did an I&D, and we started them on IV antibiotics. A couple of days later the child was sooooooooo much better. Then I get the C&S back, and the particular bacteria was not even sensitive to the particular antibiotic we were using. After surgery it was the bodies innate (to use a chiropractic term) healing ability that did all the work - but again someone is expected to pay thousands of dollars for a an incision and drainage that probably took all of 5 minutes of actual work, and several days of antibiotics. Some current studies show that one thing people with great longevity have in common is lack of antibiotic use - so the abx treatment was not just worthless but potentially harmful.

I saw surgery do some great things emergently, but medicine was pretty hit and miss. A code, or something benefits from medicine (as opposed to surgery). Outpatient clinic was more frustrating - most people came in for things I would never think of seeing a doctor about. I really felt most were just whiners
 
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honey, you're in high school. you can't understand until you have been where we are, no matter how hard you try. shadowing is not the same. being a medical student gives you a taste, but it is not the same. why don't you relax and go read a non-medical book. enjoy being seventeen. if you go into medicine, it will eat up your twenties.

i can't explain the "whole goal of medicine" to you. like i said before, you cannot understand fully until you have walked in our shoes. but some general principles are promotion of health and treatment of disease. some diseases are chronic and require long-term treatment. the older you get, the more medical conditions you collect. we try to maximize quality and quantity of life, and educate patients about their disease. in internal medicine, we don't usually "fix" things. sometimes we do- cipro fixes a uti pretty well. but for most conditions we give medicines to control risk factors and try to prevent problems down the line.

you cannot understand residency until you have done it. try as you might, you just cannot understand.


Moxess said:
Yeah but is turfing the whole goal of medicine? I understand that medicine is only a stall, and you're only keeping people alive longer, but there must be more than just thinking of ways to buff and turf patients.
Also, do most people turn into horrible bastards like Roy? I can understand the cynicism and sarcasm but damn it's like he is trying to get everyone he loves to hate him
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Moxess said:
Yeah but is turfing the whole goal of medicine? I understand that medicine is only a stall, and you're only keeping people alive longer, but there must be more than just thinking of ways to buff and turf patients.
Also, do most people turn into horrible bastards like Roy? I can understand the cynicism and sarcasm but damn it's like he is trying to get everyone he loves to hate him
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People in and out of medicine engage in all sorts of self-destructive behavior. Part of the book (and the sequel, mount misery) focuses on Roy's somewhat dysfunctional upbringing and relationship with his father; this may be to blame as much as his medical training.

The issue of curing patients is interesting. 1990's comedian Chris rock had a funny and insightful bit on this. "Doctors can't even cure atheletes foot! They're never gonna cure AIDS; they ain't no MONEY in curing it. The money's in the MEDICINE! What they will do is find a way for you to live with it."

Probably as cynical as HOG, but it seems true that, outside of infections and certain surgeries to remove/replace dysfunctional organs/parts, we don't "cure" much. So many things can be TREATED to make people's lives easier and make them function better and be happier, but very few things present themselves, get treated, and just go away, never to present again.

I'm not sure how far along in training you are (someone said Highschool), which might be relevant. During your training you'll see all sorts of disgusting things that may mature you, make you bitter, or at the very least, temper some of your enthusiasm about just how much much to let "medicine" affect you. On the other hand, maybe you'll wait awhile, see how other parts of the world work befor going to med school. In that way, maybe you'll have the perspective to see that medicine, in many ways, is just a really cool job that, despite its severe time committment, doesn't have to completely overrun your life, personality, and ego. And then you could see these parodies for what they are.
 
Doowai said:
In my ultra short residency stint, I was surprised at how much in-patient medicine was a big nothing. ... I saw surgery do some great things emergently, but medicine was pretty hit and miss. A code, or something benefits from medicine (as opposed to surgery). Outpatient clinic was more frustrating - most people came in for things I would never think of seeing a doctor about. I really felt most were just whiners
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Let's not forget HOG rule #13 (the last and final rule): The delivery of good medical care is to do as much nothing as possible.

What's really ironic is whether the author meant this as a joke, or actually as a very telling statement. Internal Medicine, Peds, FM, much of OB/GYN, and the other primary care fields all share one thing in common. 90% of what we do is tell people that there is nothing wrong with them, that their problem will go away, or that it won't go away but isn't anything serious, etc. For those 90%, "doing nothing" is the best thing you can do, as doing something usually ends up being more expensive and causing complications. This is true both in the inpatient and outpatient settings. To be happy in the primary care fields, you have to enjoy interacting with patients who are not sick. Interestingly, what's really wrong with our current health care system is that we do things for people who are not sick. Everyone with a headache gets a CT. If you have a complaint, you get a pill for it. The fat man was right. The best internists don't do tests for everyone.

The "fun" in IM comes from making that cool diagnosis, but it only happens rarely. When I'm on the inpatient service, I let the residents know that there will be one cool case, and it's their job to find it in the sea of pneumonias, heart failures, and COPD exacerbations on the service. The fun also comes from meeting those patients with the usual diagnoses, and getting their stories. If that doesn't do it for you, you will not be happy in these fields.

For example, my day today (short add-on clinic, usually much longer than this):

1. A physician patient calls me from the ED, because he's constipated and can't get his bowels to move.
2. A 58 yo female with hot flashes and lots of anxiety debating going on HRT given the WHI study, vs other choices.
3. An 85 yo male with a hip T score of -4.0 who has seen multiple NYT articles about the dangers of bisphosphonates who now refuses to take his alendronate.
4. A 61 yo female with a history of back pain since an MVA, not getting better with PT.

I'll be able to fix #1. So will nature and time, for that matter.
I spent 30 minutes convincing #2 that HRT was unlikely to cause cancer in her tomorrow, and that it's the best plan given how disabling her symptoms are.
I spent 40 minutes failing to convince #3 that the articles in the NYT were talking about 20-30 reported cases of long bone fractures, case reports, compared with 300,000 hip fractures annually, making the benefits of bisphosphonates seem clear. That being said, I have a rule in my clinic: I don't force any 80 year old to do anything. If they made it that far, they've obviously done something right. Who am I to argue?
I spent 30 minutes with #4, and I'm not proud of the outcome. She's going to the pain clinic for an injection. Her back pain is not that bad, and a steroid injection is not likely to help her. Maybe it will work.

I had a great day in clinic. Not because anything was terribly challenging. Heck, I bet my mother could have handled #1,2, and 4. It was great because the patients are fun -- each is different, and it's great to see how they work things through themselves.
 
aProgDirector said:
I spent 30 minutes with #4, and I'm not proud of the outcome. She's going to the pain clinic for an injection. Her back pain is not that bad, and a steroid injection is not likely to help her. Maybe it will work.
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:laugh:I hear you. You just can't argue with everyone and I get too busy, tired and disgruntled to argue with anyone sometimes.
 
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Moxess said:
Well if I can never understand it without doing it, I assume it's sorta okay to go in without FULLY grasping what you're doing. From the sound of it, that's what happens to most people. >_>
BTW, if anyone cares, whether or not HOG is that relevant, I liked it enough to pick up the sequel.
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I don't think any of us knew exactly what were getting ouselves into :scared:
 
moxess, it's admirable that you are trying to get a sense of medicine before committing to it. i think most of us did hospital or clinic volunteering before applying to med school. i also shadowed several different docs. i am also a third generation physician and saw my father go through med school and residency.

despite my somewhat better than usual pre-med "clinical" exposure, i still had a pretty poor understanding of what i was getting myself into.

you start to get a sense of what the practice of medicine is like as a ms3, more so as an ms4 sub-i, where you learn to work like an intern (except your workload is smaller, and you are closely supervised by an upper level resident who signs your orders). by the time you start to understand what clinical medicine is like, you are too far in to turn back.

no matter how rigorous your med school clinical years are, or what your previous training was, you can't fully understand what it's like to be a resident until you are a resident. sure, i can tell you i have spent 17 of the last 25 months on call. but do you know how that feels? do you know what it means? and there is much more to residency than just the hours.

you can't "understand medicine" by reading house of god. btw i love that book. i have read it three times. the first time i started to read it, i was disgusted and didn't get very far. i read it as an ms4 and thought it was moderately amusing. i read it as an intern and laughed my ass off. read it again as a resident and laughed even more. placement comes first- so true. i always think, "where am i going to send this patient upon discharge?" are they good to go home? will they need rehab or a snf?

that being said, you can't read house of god and think that you have an understanding of what medicine is like. like others have said, it is stylized and fictional (although based on the author's experiences at bid).

you may want to try some more warm and fuzzy books, such as on doctoring or this side of doctoring: reflections from women in medicine. also i would recommend shadowing docs in clinic in the hospital, and sitting down with them to ask them what they like and don't like about their jobs. you can see what current resident concerns are here on sdn. you can learn about the different medical and surgical specialties in the ultimate guide to choosing a medical specialty.

despite that, you still can't completely understand until you are here.

Moxess said:
Well if I can never understand it without doing it, I assume it's sorta okay to go in without FULLY grasping what you're doing. From the sound of it, that's what happens to most people. >_>
BTW, if anyone cares, whether or not HOG is that relevant, I liked it enough to pick up the sequel.
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Doowai said:
In my ultra short residency stint, I was surprised at how much in-patient medicine was a big nothing. Rota virus, sickle cell crisis - mostly just hydrate them. A few days in the hospital and several bags of normal saline (a bag of water with about a pinch of salt added) and they go home and somebody is expected to pay thousands of dollars - for a bed and some very slightly salty water. If the sickle cell person had simply drank a little more water the week previous, they would have probably never have had the crisis. Its like 5,000 dollars for $15 of actual value.

Had a child with a large perineal abcess. Surgery did an I&D, and we started them on IV antibiotics. A couple of days later the child was sooooooooo much better. Then I get the C&S back, and the particular bacteria was not even sensitive to the particular antibiotic we were using. After surgery it was the bodies innate (to use a chiropractic term) healing ability that did all the work - but again someone is expected to pay thousands of dollars for a an incision and drainage that probably took all of 5 minutes of actual work, and several days of antibiotics. Some current studies show that one thing people with great longevity have in common is lack of antibiotic use - so the abx treatment was not just worthless but potentially harmful.

I saw surgery do some great things emergently, but medicine was pretty hit and miss. A code, or something benefits from medicine (as opposed to surgery). Outpatient clinic was more frustrating - most people came in for things I would never think of seeing a doctor about. I really felt most were just whiners
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i tend to oversimplify things, but I will say that fluids seems to cure about 50% of the problems i see. steroids, fluids, antibiotics, surgical intervention if necessary, physical therapy, and social work. Give me those things and i can take care of most stuff.
 
aProgDirector said:
Let's not forget HOG rule #13 (the last and final rule): The delivery of good medical care is to do as much nothing as possible.

What's really ironic is whether the author meant this as a joke, or actually as a very telling statement. Internal Medicine, Peds, FM, much of OB/GYN, and the other primary care fields all share one thing in common. 90% of what we do is tell people that there is nothing wrong with them, that their problem will go away, or that it won't go away but isn't anything serious, etc. For those 90%, "doing nothing" is the best thing you can do, as doing something usually ends up being more expensive and causing complications. This is true both in the inpatient and outpatient settings. To be happy in the primary care fields, you have to enjoy interacting with patients who are not sick. Interestingly, what's really wrong with our current health care system is that we do things for people who are not sick. Everyone with a headache gets a CT. If you have a complaint, you get a pill for it. The fat man was right. The best internists don't do tests for everyone.

The "fun" in IM comes from making that cool diagnosis, but it only happens rarely. When I'm on the inpatient service, I let the residents know that there will be one cool case, and it's their job to find it in the sea of pneumonias, heart failures, and COPD exacerbations on the service. The fun also comes from meeting those patients with the usual diagnoses, and getting their stories. If that doesn't do it for you, you will not be happy in these fields.

For example, my day today (short add-on clinic, usually much longer than this):

1. A physician patient calls me from the ED, because he's constipated and can't get his bowels to move.
2. A 58 yo female with hot flashes and lots of anxiety debating going on HRT given the WHI study, vs other choices.
3. An 85 yo male with a hip T score of -4.0 who has seen multiple NYT articles about the dangers of bisphosphonates who now refuses to take his alendronate.
4. A 61 yo female with a history of back pain since an MVA, not getting better with PT.

I'll be able to fix #1. So will nature and time, for that matter.
I spent 30 minutes convincing #2 that HRT was unlikely to cause cancer in her tomorrow, and that it's the best plan given how disabling her symptoms are.
I spent 40 minutes failing to convince #3 that the articles in the NYT were talking about 20-30 reported cases of long bone fractures, case reports, compared with 300,000 hip fractures annually, making the benefits of bisphosphonates seem clear. That being said, I have a rule in my clinic: I don't force any 80 year old to do anything. If they made it that far, they've obviously done something right. Who am I to argue?
I spent 30 minutes with #4, and I'm not proud of the outcome. She's going to the pain clinic for an injection. Her back pain is not that bad, and a steroid injection is not likely to help her. Maybe it will work.

I had a great day in clinic. Not because anything was terribly challenging. Heck, I bet my mother could have handled #1,2, and 4. It was great because the patients are fun -- each is different, and it's great to see how they work things through themselves.
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perhaps even more sad is that even if the steroid injection works, it may not have been the steroid that actually made her better.
 
Moxess said:
Now I know the stuff about being demeaned and long hours and gomers and all that horrible stuff in the House of God is true, but one thing I can't get over is:
The author keeps saying that you can never cure anyone's disease, that all you do is turf them somewhere else. He makes it sound like diseases don't even really exist, it's just the "revolving door" or medicine as he says. You just buff and turf them places and do as much nothing for them as you possibly can, even for the dying young...apparently this will help them die more peacefully.
Can someone please tell me that THAT part at least is BS? At the risk of sounding VERY naive, I'm going to say that there MUST be more than just turfing/doing nothing. I can only guess he was trying to really portray that the illusion of the American medical dream is an illusion and the whole "you can't treat anyone" thing is just some sort of exaggeration...
Then again maybe I'm just caught in the illusion, but I really hope not. Just a little confused because everyone says "oh wow this book was exactly like my internship" and this made me raise an eyebrow at the "revolving door" concept being the only thing behind modern medicine.
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You just have to understand that most of what we do in modern American medicine is either useless or only marginally effective. I would say, without exaggeration, that I could probably randomly cancel half of my orders and the outcome for my patients wouldn't change one iota. This is because as a nation we are terrifically over-doctored and over-medicated. I happen to be at the cutting edge of the money-laundering racket as I work in Emergency Medicine, a specialty where we throw thousands of dollars at problems that in most other countries don't even rise to the threshold of a doctor's visit. Either that or we flush wads of banknotes down the crapper pointlessly extending the lives of the living dead as they rot away in their fly-blown nursing homes.
 
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Our system is also completely devoid of common sense. I just spent a month in the ICU and half of my patients were people struggling, almost yearning to die but we kept them going because their families could not let go. I'm talking about 90-year-olds with terminal cancer who will never come off of the ventilator much less leave the hospital who for days and weeks at a time are kept in some meta-stable, near-death condition while their families watch the bed-side monitor for hours on end, taking every transient improvement in vital signs as an indication that granny's going to pull through.

We have created a new species, "Homo Tubalis," or "Tube Supported Man," who breathes, eats, urinates, defecates, and performs every function of life through a tube.
 
House of God taught me that age+BUN=Lasix dose...
 
By the way, if SDN ever archives my blog you could read a lot about modern medical education of a lot more recent vintage than "House of God."
 
Call me cynical, or just really jaded after watching a chuck norris movie while having a nurse call me 3 times to give me results on a phos which was ordered yet never done, but I have the resutls somehow 🙂confused🙂, but there are many themes in that book which are still true. Other than infectious diseases, there are few conditions which we treat with the intention of cure, we ameliorate and modify risk factors and patch up just enough to get them the hell out of the hospital. I can't save people from themselves, and that includes their actions and their bodies natural tendancy to die, it happens, people die and I'll probably have a few knock off tonight while I'm on call.

On Buffing: 60% of medicine is paperwork, and half of that is buffing the chart. Buffing it to say the right things to get paid, buffing it to covery your ass when the lawyers come a sniffing, buffing the chart so the hospital aministration won't bust your ass on length of stay for things which don't pay. Buffing the chart to get things done.
 
orientedtoself said:
honey, you're in high school. you can't understand until you have been where we are, no matter how hard you try. shadowing is not the same. being a medical student gives you a taste, but it is not the same. why don't you relax and go read a non-medical book. enjoy being seventeen. if you go into medicine, it will eat up your twenties.

i can't explain the "whole goal of medicine" to you. like i said before, you cannot understand fully until you have walked in our shoes. but some general principles are promotion of health and treatment of disease. some diseases are chronic and require long-term treatment. the older you get, the more medical conditions you collect. we try to maximize quality and quantity of life, and educate patients about their disease. in internal medicine, we don't usually "fix" things. sometimes we do- cipro fixes a uti pretty well. but for most conditions we give medicines to control risk factors and try to prevent problems down the line.

you cannot understand residency until you have done it. try as you might, you just cannot understand.
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So how am I supposed to decide whether or not to go into medicine? Help me, I've been trying to decide for 1-2 years.
 
ramseszerg said:
So how am I supposed to decide whether or not to go into medicine? Help me, I've been trying to decide for 1-2 years.
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Conversely, how are we supposed to know whether or not you should go into medicine? Nobody can tell you. You have to come to your own conclusion.
 
I don't know if the OP is still here, but here is my take as a fellow noob.

Doctors are not saints. They are not above humanity, and people shouldn't think of them as such. We put doctors on a pedestal of greatness, as if they are Jesus-like in their infallibility and selflessness. The truth is they are some of the smartest, most selfless people you'll meet, but they're still people. They still have the same emotions and feelings all of us do.

As far as the constant turfing, I don't know first hand. But working in a pharmacy, I will say that its the same people that come in day after day. Its the old ladies and gents taking medicines every day that bring in the dough, not the person needing Cipro for a sinus infection. So most of your job is prolonging the inevitable.

If this bothers you, you can find specialties that are less apt to be like this. EM seems like a very good field for someone who wants to "cure" and "fix" people. Same as surgery. These fields are fields where you don't see the same people every week or month. Likewise, don't pick family medicine or IM if you want to see different people all the time.

The main thing you need to ask yourself is when you cure someone or fix them, what are you actually doing? You can't cure someone of death. You can only prolong the inevitable, in which case all patients are on equal footing. You're doing the same for all of them, whether it be a permanent treatment of medicine or a one-time fix.

I hope this helps, if you still visit the boards.
 
Hopefully this doesn't hijack this thread, but am I the only guy out here who thinks that HOG wasn't that great of a book?
 
Didn't particularly like HoG either.

Also, bear in mind that the guy eventually become a psychiatrist. So it's a chicken-or-egg question: did the hospital push him towards psychiatry, or was he just someone not suited to being an internist. It wouldn't surprise me if, for example, a surgeon wrote a book about his third year medicine rotation that just trashed the whole system, and to me this is similar. And a lot of internists would write negative books about psych. Everyone prefers different practice styles.
 
Moxess said:
Yeah but is turfing the whole goal of medicine? I understand that medicine is only a stall, and you're only keeping people alive longer, but there must be more than just thinking of ways to buff and turf patients.
Click to expand...

No, turfing is only a great strategy for residents, because you are only on a rotation for a specified period of time. I loved turfing to a patient to surgery because it meant that was one patient I never had to take care of.

Turfing doesn't work in the real world of medicine, because once a patient has seen you once, you're kind of stuck with them for forever (unless they fire you).

HofG wasn't a great book, but it's still an enjoyable read. The sex scenes are kind of out of date, but the gomers aren't. In fact, the gomerization of medicine has just gotten worse
 
rfv123 said:
House of God taught me that age+BUN=Lasix dose...
Click to expand...

wtf does that mean. I can say that has no bearing on the dose of lasix. guess ill have to read the whole book.

I've read part of it...not all. But i hear about it a lot. And from what I can tell, its an overly dramatic view of medicine written by someone who sounds like a histrionic girl.
 
I got through premed, med school and residency without reading House of God. As a fellow, I have better things to do that read fictional books about medicine. I'd rather watch one of those lawyer TV shows...Boston Legal is my favorite, followed by Law and Order. :laugh:
I agree age + BUN sounds like a stupid formula to determine Lasix dose. The dose you need is either equal to (if the dose worked) or double the last dose you gave (that didn't make the patient urinate...).
 
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