Quick question from a pre-med..

[Neurocentric]

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Hey guys. I hope it is okay if I ask this question in here. I know that most of you are starting or are already on some rotations and so you probably will be able to answer this for me. Also, I did a search and could not find the answer to my question, so if there was a post and I missed it, I apologize.

First off, I've wanted to be a physician forever, and while I won't say I've picked a specialty, I have tended to learn towards surgery. Anyway, I am not scared nor turned away by blood or gore, so that's not the issue. Since I haven't shadowed yet, I only have what I see on medical shows to go by.

When people in pain are screaming, whether it is caused by a procedure, or their wounds, it bothers me. I cannot stand to see people in that much pain. I've always figured that this would be something I would get used to, or adrenaline would take over and it wouldn't matter much. This issue won't sway me from becoming a physician, but I was just curious if dealing with this kind of thing is frequent, and what kind of things I can do to deal with it.

I'm sorry if this sounds like a stupid fear or question. I'd love any constructive views or advice you can give me. Thanks in advance.

 

[McGillGrad]

This issue won't sway me from becoming a physician, but I was just curious if dealing with this kind of thing is frequent, and what kind of things I can do to deal with it.

I'm sorry if this sounds like a stupid fear or question. I'd love any constructive views or advice you can give me. Thanks in advance.

Most of the screaming and pain comes in the basic science years, mainly from your classmates and you.

You will become desensitized to most things by the time you start rotations.

 

[Neurocentric]

Most of the screaming and pain comes in the basic science years, mainly from your classmates and you.

You will become desensitized to most things by the time you start rotations.

haha

That's good to know. I can deal with that kind of screaming. It's easy to tune out.

 

[cpants]

As an MD you will definitely have to put a lot people into pain. You do what you can to minimize that (appropriate analgesia, adjusting your exam, working quickly, etc.). When treating a patient in pain ask yourself if what you're doing is really necessary for the pt's treatment? If it's not don't do it. If it is then don't feel bad about it.

 

[Neurocentric]

As an MD you will definitely have to put a lot people into pain. You do what you can to minimize that (appropriate analgesia, adjusting your exam, working quickly, etc.). When treating a patient in pain ask yourself if what you're doing is really necessary for the pt's treatment? If it's not don't do it. If it is then don't feel bad about it.

That is good advice, thank you 🙂

I will definitely try to make sure my patients are in as little pain as possible if I can.

 

[BobBarker]

Most of the real screamers are faking.

 

[smq123]

That is good advice, thank you 🙂

I will definitely try to make sure my patients are in as little pain as possible if I can.

The worst is on peds - little babies screaming because of what YOU are doing to them (drawing blood, putting in an IV, looking in their ears, swabbing their throats, doing an LP) is the hardest to adjust to. You do get used to it, though, and it's usually for a very very good reason.

 

[SouthernSurgeon]

The worst is on peds - little babies screaming because of what YOU are doing to them (drawing blood, putting in an IV, looking in their ears, swabbing their throats, doing an LP) is the hardest to adjust to. You do get used to it, though, and it's usually for a very very good reason.

Agreed. Sewing up a little baby's face while two nurses were holding her down and mom was staring over my shoulder was one of the more intense things I did in med school.

 

[Neurocentric]

The worst is on peds - little babies screaming because of what YOU are doing to them (drawing blood, putting in an IV, looking in their ears, swabbing their throats, doing an LP) is the hardest to adjust to. You do get used to it, though, and it's usually for a very very good reason.

Agreed. Sewing up a little baby's face while two nurses were holding her down and mom was staring over my shoulder was one of the more intense things I did in med school.

I have a feeling - those reasons above and more - that my peds rotation will be the hardest one. But I will do my best to curb the emotions.

 

[MattD]

As an MD you will definitely have to put a lot people into pain. You do what you can to minimize that (appropriate analgesia, adjusting your exam, working quickly, etc.). When treating a patient in pain ask yourself if what you're doing is really necessary for the pt's treatment? If it's not don't do it. If it is then don't feel bad about it.

I kinda disagree. It's human to feel bad about it. Allow yourself that. You still have to do it, but it's ok to feel bad about it. Work to preserve your humanity. Not feeling bad about hurting someone makes it easier to not care that you're hurting someone.

 

[ACSurgeon]

Hey guys. I hope it is okay if I ask this question in here. I know that most of you are starting or are already on some rotations and so you probably will be able to answer this for me. Also, I did a search and could not find the answer to my question, so if there was a post and I missed it, I apologize.

First off, I've wanted to be a physician forever, and while I won't say I've picked a specialty, I have tended to learn towards surgery. Anyway, I am not scared nor turned away by blood or gore, so that's not the issue. Since I haven't shadowed yet, I only have what I see on medical shows to go by.

When people in pain are screaming, whether it is caused by a procedure, or their wounds, it bothers me. I cannot stand to see people in that much pain. I've always figured that this would be something I would get used to, or adrenaline would take over and it wouldn't matter much. This issue won't sway me from becoming a physician, but I was just curious if dealing with this kind of thing is frequent, and what kind of things I can do to deal with it.

I'm sorry if this sounds like a stupid fear or question. I'd love any constructive views or advice you can give me. Thanks in advance.

Most surgeries today are done with the patient under general anesthesia. Thus, little screaming takes place 😀.

On a more serious note, I don't think surgery has more screaming/suffering patients than other services. Maybe that's the case when you go to see a consult in the ED. However, on the floor, most patients are well medicated pre/post-operatively.

 

[Neurocentric]

Most surgeries today are done with the patient under general anesthesia. Thus, little screaming takes place 😀.

On a more serious note, I don't think surgery has more screaming/suffering patients than other services. Maybe that's the case when you go to see a consult in the ED. However, on the floor, most patients are well medicated pre/post-operatively.

The bolded part made me laugh. However, there is always the issue of a patient waking up during surgery if they had an issue with the anesthesia.. however, I know that's very rare.

I'm more worried about rotations during medical school, where I will be exposed to plenty of specialties.

 

[Neurocentric]

I kinda disagree. It's human to feel bad about it. Allow yourself that. You still have to do it, but it's ok to feel bad about it. Work to preserve your humanity. Not feeling bad about hurting someone makes it easier to not care that you're hurting someone.

Yeah, my issue is letting it get the best of me since while it is necessary - ex. doing an LP to determine meningitis or something - hearing people in so much pain makes me upset.

An example was a documentary I saw of a child getting a bone marrow biopsy for his leukemia.. he was screaming so much. I have no idea how the doctor performing the procedure got through it, except knowing it had to be done and trying to get it done as quickly as possible.

 

[Tiger26]

Agreed. Sewing up a little baby's face while two nurses were holding her down and mom was staring over my shoulder was one of the more intense things I did in med school.

and borderline inhumane--all patients regardless of age should get adequate analgesia.

this is really what conscious sedation is for

 

[Neurocentric]

and borderline inhumane--all patients regardless of age should get adequate analgesia.

this is really what conscious sedation is for

This is a good point. I'm assuming the child got some sort of anesthesia.. maybe was just scared that he/she had to be held down.

 

[cpants]

I kinda disagree. It's human to feel bad about it. Allow yourself that. You still have to do it, but it's ok to feel bad about it. Work to preserve your humanity. Not feeling bad about hurting someone makes it easier to not care that you're hurting someone.

Don't get me wrong, I don't like putting people in pain, but there's a difference between having empathy and feeling bad about what your doing. I understand that something is painful but necessary, and I do what I can to minimize that pain. If I've done those things, what reason do I have to feel guilty for what I've done. I empathize with the person, but I feel good knowing I've helped to minimize their pain and hopefully improve their health.

 

[SouthernSurgeon]

and borderline inhumane--all patients regardless of age should get adequate analgesia.

this is really what conscious sedation is for

Thanks for judging based on my one sentence blurb. We obviously gave the kid sedatives as well as TAC. I didn't use an injectable local because it would have taken me more sticks to anesthetize the area than it did to just sew it up quickly. We still needed holders since the kid wasn't OUT and mom was still a stress-ball (understandable).

 

[Jolie South]

Most surgeries today are done with the patient under general anesthesia. Thus, little screaming takes place 😀.

On a more serious note, I don't think surgery has more screaming/suffering patients than other services. Maybe that's the case when you go to see a consult in the ED. However, on the floor, most patients are well medicated pre/post-operatively.

Agree. Surgery has virtually no screaming. Everything is very controlled and the patients are well medicated.

Working on the ED, on the other hand, will get you exposed to pain and yelling. The ED is not for me.

 

[Neurocentric]

Agree. Surgery has virtually no screaming. Everything is very controlled and the patients are well medicated.

Working on the ED, on the other hand, will get you exposed to pain and yelling. The ED is not for me.

haha Emergency Medicine honestly has never been for me. I was actually talking to a friend about this. Not only does the screaming and pain turn me off to it, but I just don't think I feel like dealing with 20 people who are just there for a cough. I feel like medical school would be a waste.

If surgery is what I ultimately pick, I'd love to do neurosurgery. The brain is just.. so damn cool. Don't get me started, hehe.

Thanks for all the replies, everyone. 🙂

 

[Tiger26]

Thanks for judging based on my one sentence blurb. We obviously gave the kid sedatives as well as TAC. I didn't use an injectable local because it would have taken me more sticks to anesthetize the area than it did to just sew it up quickly. We still needed holders since the kid wasn't OUT and mom was still a stress-ball (understandable).

Sorry dude--had kind of a hair trigger on that post. I've just seen a lot of situations where sedation could have been used a lot more liberally with peds lacs

 

[Jolie South]

haha Emergency Medicine honestly has never been for me. I was actually talking to a friend about this. Not only does the screaming and pain turn me off to it, but I just don't think I feel like dealing with 20 people who are just there for a cough. I feel like medical school would be a waste.

If surgery is what I ultimately pick, I'd love to do neurosurgery. The brain is just.. so damn cool. Don't get me started, hehe.

Thanks for all the replies, everyone. 🙂

Well, the brain itself can't "feel" pain. It has no nociceptors.

The thing I saw in the ED that looked like one of the most painful things ever was I&D of an intra-nasal MRSA abscess. Man, a pimple on your nose is painful enough. They shot this guy up with lidocaine, then vigorously scraped around in there with a hemostat, then milked the abscess with another finger. The lidocaine did nothing. We had to stop to give the guy a break for a couple of minutes in between each round of hemostatting/milking.

 

[Jolie South]

Sorry dude--had kind of a hair trigger on that post. I've just seen a lot of situations where sedation could have been used a lot more liberally with peds lacs

Really? I've found people to be overly cautious with kids, to the point that they use EMLA cream to start IVs, etc.

 

[MattD]

Really? I've found people to be overly cautious with kids, to the point that they use EMLA cream to start IVs, etc.

That's been my experience, typically the need to hold down a tot has less to do with inadequate pain control and more to do with inadequate handling of their anxiety. It's not that the suturing is painful, it's just panic that some big stranger who's dressed weird is jabbing a needle at the kid's face in a situation where he's already been in pain and feeling like things are completely out of his control.

 

[MattD]

Don't get me wrong, I don't like putting people in pain, but there's a difference between having empathy and feeling bad about what your doing. I understand that something is painful but necessary, and I do what I can to minimize that pain. If I've done those things, what reason do I have to feel guilty for what I've done. I empathize with the person, but I feel good knowing I've helped to minimize their pain and hopefully improve their health.

Yeah, I understood what you meant, no worries. I agree that there's no reason to feel guilty about it afterwards, it's all about empathy. Frankly, there are plenty of times where you have to turn the empathy off too if you want to get the job done, I know I've thrown up that lead wall between what I was doing and what the patient was experiencing more than once. Even so, it's important to let it touch you when possible.

 

[Neurocentric]

Well, the brain itself can't "feel" pain. It has no nociceptors.

The thing I saw in the ED that looked like one of the most painful things ever was I&D of an intra-nasal MRSA abscess. Man, a pimple on your nose is painful enough. They shot this guy up with lidocaine, then vigorously scraped around in there with a hemostat, then milked the abscess with another finger. The lidocaine did nothing. We had to stop to give the guy a break for a couple of minutes in between each round of hemostatting/milking.

hehe I agree on the brain comment. I know of some surgery (cannot remember the name) where they essentially knock the person out for the drilling and opening of the skull flap, and wake them up for when they need to figure out what's going on with the brain. I always thought that, yeah, they wouldn't feel the surgeon touching the brain, but wouldn't they feel the fact that half their skull flap is off if the anesthesia isn't on? That might be a stupid question, lol.

That guy in the ED must have been in so much pain. That's something that probably would have disturbed me for the rest of the night. That's also what I mean - how do you turn that off so you can sleep?

 

[smq123]

That guy in the ED must have been in so much pain. That's something that probably would have disturbed me for the rest of the night. That's also what I mean - how do you turn that off so you can sleep?

While I won't lie that there are patients who keep you up at night, you're often so busy that you don't usually dwell on it. Plus, like I said, that sort of stuff bothers me less because while he was in pain, he NEEDED to have that abscess drained. Otherwise, especially because it was in the nose (i.e. close to the brain), he could have been really really really sick if people were "nice" and left it alone. Knowing that you probably saved his life, or saved him from more serious health problems, is enough to help you sleep at night.

 

[Neurocentric]

While I won't lie that there are patients who keep you up at night, you're often so busy that you don't usually dwell on it. Plus, like I said, that sort of stuff bothers me less because while he was in pain, he NEEDED to have that abscess drained. Otherwise, especially because it was in the nose (i.e. close to the brain), he could have been really really really sick if people were "nice" and left it alone. Knowing that you probably saved his life, or saved him from more serious health problems, is enough to help you sleep at night.

That's a good way to look at it, thanks. 🙂

I guess I'm just getting ahead of myself, but the truth is, you will never know what it's like until you're actually IN it, and at that point, you've invested a ton of money. Sure, there's volunteering and shadowing, but I'm not sure a lot of physicians would let you see situations like at at a pre-med level (or maybe there are docs that will). The fear I have is my only fear, and I'm lucky for that. To know that there are ways to get over it make me feel better, especially if I'm busy all the time, which always helps and is a major distraction.