The Official Anti-Clinical Medicine Thread

[b&ierstiefel]

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Did they tell you why they gave you below expected? Below expected, to me, is consistently showing up late, not completing tasks, etc. If they really gave it to you for simply not liking IM they have serious problems.

Seriously. If this were to be the case, that attending needs to be smacked.

 

[sacrament]

Two rotations down and I already have a low-grade level of disdain for clinical medicine. Can't wait for my path rotation. Hope to God I love it. If neither path nor rads catch my interest, I might be S.O.L.

 

[b&ierstiefel]

Welcome to our club sacrament. Hopefully path and/or rads will strike your fancy 🙂

 

[yaah]

Allow me to paraphrase Juan Rosai: The study of radiology deals with shadows. The study of pathology deals with substance.

Many like dealing with shadows. Perhaps more mysterious. I, however, would prefer to know what something actually looks like than try to determine what it "may represent."

Which clinical rotations have you thus survived? They never seem to end and are basically a variation on the same themes. These themes include patterns of elimination, character of the eliminations, patient's (or their proxy's) perspective on the eliminations, charting the eliminations, examining the eliminations, ordering tests on the eliminations, and then calling others to inform them of the eliminations. Once the eliminations have normalized, the patient can go to rehab where they will be charted again until they become abnormal and they return to l'hopital.

Personally, I couldn't stomach going to school for so long in order to become an expert on human eliminations.

 

[sacrament]

Allow me to paraphrase Juan Rosai: The study of radiology deals with shadows. The study of pathology deals with substance.

Many like dealing with shadows. Perhaps more mysterious. I, however, would prefer to know what something actually looks like than try to determine what it "may represent."

Which clinical rotations have you thus survived? They never seem to end and are basically a variation on the same themes. These themes include patterns of elimination, character of the eliminations, patient's (or their proxy's) perspective on the eliminations, charting the eliminations, examining the eliminations, ordering tests on the eliminations, and then calling others to inform them of the eliminations. Once the eliminations have normalized, the patient can go to rehab where they will be charted again until they become abnormal and they return to l'hopital.

Personally, I couldn't stomach going to school for so long in order to become an expert on human eliminations.

I started out with peds. I had no idea that motivated, adult, highly-intelligent people could spend so much of their lives obsessed with the feces and urine of others. I longed to leave peds, being under the mistaken impression that I would also leave behind feces and urine. My next stop was surgery, where I learned that now I could be fascinated not only with feces and urine, but also flatus, and now the feces, urine and flatus of elderly, cranky men. Waking up a 70-year-old man at 5 AM every morning to ask him if he farted or had a poopy overnight might sound glamorous, but quickly wears thin.

 

[yaah]

Ah yes, pedes. That was 6 weeks of my life that I want back. They don't want your help, in most cases they don't need your help. But yet we must proceed to attempt to find this out in spite of them. I don't really enjoy a career where I enter the room and the object of my investigations glares at me as though I am the antichrist and would sooner stab me with my penlight than let me touch their belly. I get enough of that in my social life.

In terms of surgery, it's all just unpleasant. Whoever yells the loudest or says things the most forcefully will generally get their way. I also did not enjoy tying knots. Or maintaining the sterile field, which is an oxymoron. They get mad if you walk into the OR in anything other than scrubs. Yet they wear these scrubs all day. They wear them when they spill their coffee, go to the bathroom, change the dressing on the VRE patient, go to the cafeteria for lunch, and sneak off to the back room for nookie with the nurse. Yet they are still proper OR attire whereas the shirt that I picked up from the cleaners the day before is improper.

 

[sacrament]

Ah yes, pedes. That was 6 weeks of my life that I want back. They don't want your help, in most cases they don't need your help. But yet we must proceed to attempt to find this out in spite of them. I don't really enjoy a career where I enter the room and the object of my investigations glares at me as though I am the antichrist and would sooner stab me with my penlight than let me touch their belly. I get enough of that in my social life.

In terms of surgery, it's all just unpleasant. Whoever yells the loudest or says things the most forcefully will generally get their way. I also did not enjoy tying knots. Or maintaining the sterile field, which is an oxymoron. They get mad if you walk into the OR in anything other than scrubs. Yet they wear these scrubs all day. They wear them when they spill their coffee, go to the bathroom, change the dressing on the VRE patient, go to the cafeteria for lunch, and sneak off to the back room for nookie with the nurse. Yet they are still proper OR attire whereas the shirt that I picked up from the cleaners the day before is improper.

Oh lord, the "sterile" field. It's just ridiculous. I worked at Intel before going to medical school, in the fabrication plants. The ones where you wear the full-body suits and have to pass through air-locks before entering the facility. Where everything has to be thoroughly wiped down with alcohol before you can bring it inside. That's sterile. The OR is not sterile. I was shocked sh1tless the first time I realized you could just walk right into an OR from the hallway so long as you had a hairnet and a mask on. Are you kidding? This is modern sterile technique? And I get screamed at by a bitchy scrub nurse because I came within 10 feet of her Mayo tray? DO YOU REALLY THINK IT F-ING MATTERS YOU CRAZY BITCH?! On the one hand the sterile precautions are absurdly lax in the first place; on the other hand they practice these techniques with draconian fury. I'm so completely unconvinced by all of this that whatever research exists to support it would have to be performed anew by myself personally before I believe it.

 

[deschutes]

Hello sacrament and welcome. I hope you hang around. I like you already!

I find your choice of words to describe clinicians - "adult" (vs. "mature") - most illuminating 👍

~
Some of you may be familiar with the Milgram experiment.

If Stanley Milgram's obedience studies were the truth in a grain of sand, then surely floor medicine is the living breathing universe.

 

[b&ierstiefel]

Oh lord, the "sterile" field. It's just ridiculous. I worked at Intel before going to medical school, in the fabrication plants. The ones where you wear the full-body suits and have to pass through air-locks before entering the facility. Where everything has to be thoroughly wiped down with alcohol before you can bring it inside. That's sterile. The OR is not sterile. I was shocked sh1tless the first time I realized you could just walk right into an OR from the hallway so long as you had a hairnet and a mask on. Are you kidding? This is modern sterile technique? And I get screamed at by a bitchy scrub nurse because I came within 10 feet of her Mayo tray? DO YOU REALLY THINK IT F-ING MATTERS YOU CRAZY BITCH?! On the one hand the sterile precautions are absurdly lax in the first place; on the other hand they practice these techniques with draconian fury. I'm so completely unconvinced by all of this that whatever research exists to support it would have to be performed anew by myself personally before I believe it.

Hahaha...you echo the thoughts that went through my head when I got yelled at for, what seems to be, just being present. Sure a hairnet and a mask and the silly gown can help preserve some sense of sterility but there's gotta be more sources of infection that are yet out of our control. Wait...why am I saying "our"...I ain't no surgeon 🙂

During my surgery rotations, I got more grief by nurses than the actual surgeons. But I can understand where they're coming from...they get ordered around everyday and they must feel like crap. But the med student vs. nurse - clearly the nurse has the upper hand cuz the med student can't talk back or say "no" (until he/she is a 4th year 🙂 ). Some of them were cute too but a significant proportion of them had personalities of a wet fart when it came down to dealing with the med students.

The surgeons I worked with, fortunately, were very nice to students...well there was one or two assbags thrown into the mix but I just didn't scrub into their cases.

Oh well, it's all good. Hope y'all are having a great weekend.

 

[Whisker Barrel Cortex]

Allow me to paraphrase Juan Rosai: The study of radiology deals with shadows. The study of pathology deals with substance.

Many like dealing with shadows. Perhaps more mysterious. I, however, would prefer to know what something actually looks like than try to determine what it "may represent."

The difference my fine pathologist friend is that those shadows can tell what is wrong with a patient without a) taking it out or b) sticking a needle or biopsy gun into it. You look at sample only after we've stuck a needle into that shadow or a surgeon has filleted the patient open and taken out that shadow. 😀 Much love for pathologists, though. You guys do good work, all while avoiding rectal exams!

 

[yaah]

I knew one of my radiologist friends would be compelled to comment there! Hey! I didn't say it! Rosai did! My sister doesn't like it when I criticize radiology either. I don't do it unprovoked! We just got a comment about deciding between the two. I like radiologists they are smart people, and usually very nice people.

But yeah medicine is all teamwork anyway. Any field is pretty weak and undesirable in isolation. It's whatever part of the whole package deal that appeals to you that you should go for. Some people like the process, some like the result, some like the social issues, some like everything, some just like bulking up their resumes.

Who knows what evil lurks inside the hearts of men? The shadow knows...

 

[b&ierstiefel]

The difference my fine pathologist friend is that those shadows can tell what is wrong with a patient without a) taking it out or b) sticking a needle or biopsy gun into it. You look at sample only after we've stuck a needle into that shadow or a surgeon has filleted the patient open and taken out that shadow. 😀 Much love for pathologists, though. You guys do good work, all while avoiding rectal exams!

Well without radiologists, we would sometimes be at a loss as to where exactly to stick the needle. The relationship between the radiologist and the pathologist is a good one...it doesn't come near how bad the relationship between internists and surgeons can be.

We pathologists avoid rectal disimpactions in addition to rectal exams 🙂

 

[deschutes]

We have a cardiology elective student from out east in our house right now.

Naturally the after-dinner talk segued into clerkship experiences and specialty choices. And I - fresh from Teams - had to bring in my peeves about floor medicine into the discussion.

Admissions... rounds... dictations... phonecalls... discharge summaries...
(Oh, and seeing patients for only 1 hour out of the workday 9...)

It seems I said enough to make him remark, "Actually I don't know why I'm doing Internal."

I said, well if you like it why not?
And he said that Internal was what he went into med school thinking he would do...
(We posters have been here before so I will not flog a dead horse.)

He said he found pathology really cool, but felt he wasn't smart enough. 😱

U of Ottawa is doing something right! Apparently in the first two years, they teach systems-based histology and pathology very well. The students come away with the impression that the pathologists know everything cold!

 

[b&ierstiefel]

Isn't it funny that a lot of our conversations while we are doing our clinical clerkships comprise of complaining about how much our life sucks? At least it did for me 🙂

Now that I've been done with clinical medicine for a few weeks now, I find myself talking about more non-medicine topics even when conversing with some of my other med school buddies. Occasionally, I diss clinical medicine when hangin with some of my friends who are going into path cuz that's always fun of course.

Deschutes, you're technically in your senior year now. It boggles my mind to see that you still have to put up with this clinical stuff 😕 . How many more months do you have left of this?

 

[deschutes]

Deschutes, you're technically in your senior year now. It boggles my mind to see that you still have to put up with this clinical stuff 😕 How many more months do you have left of this?

Well, I just started clerkships in March of this year you see. Toldja it's a 3-year program - they take away all the summer holidays and squish it into 3.

So I'm only an ignorant third-year student who is 6 months into clinicals. My 4 remaining rotations plus 1 month of electives will take me right up until mid-April 2005, and I graduate one month later - God willing.

It's insane.

 

[b&ierstiefel]

And I thought I'd be able to avoid the floors altogether after my last day on subinternships...but alas, that was not the case. A good friend of mine got admitted to the hospital yesterday; and I got to visit him on the floor. Wasn't wearing no white coat...no stethoscope...no tie. One of the first times I've walked into a patient's room calm and relaxed (but worried sick of course).

Shortly after I arrive, all the disgust I had for clinical medicine that had left my body was reborn within me. A big team of neurologists enter the room to do their big ol' neuro exam. Yep the attending, his underlings (residents), and several of the underlings' underlings (the M3s). And one of them had a damn videocamera to tape the whole encounter...apparently it was a good case. As much as I value medical education, I was able to gain an appreciation from the patient's perspective. The way in which consent was gained and the whole neuro team - patient encounter occurred was quite callous from my perspective as a 3rd person.

These neurologists saw my friend as a specimen...let's ask him a bunch of hard questions, ask him to repeat a whole bunch of tongue-twisters, and have him perform a bunch of complex actions and see him screw it up! Clearly he was very frustrated as he was slipping up and making mistakes...and everytime he messed up somewhere, this little bastard resident (I knew of him when I did my neuro rotation a year ago and I don't like the guy to begin with) kept smiling and nodding.

Then when things were all done and over with, the whole team walks out. I proceed to lurk in the shadows checking email at one of the computer pods. The way the attending then proceeded to have fun pimping the medical students made me sick. Then he asked the med students to each do a neuro exam and do a big write up since this was an interesting case. And the whole time I'm thinking, "let the guy get some damn rest!"

Anyways, that's my rant for the day as this whole thing has been on my mind since yesterday afternoon. He's improved quite remarkably over the last day; however, the neurologists say that he likely won't be back to 100%.

 

[deschutes]

Hey Andy - sorry to hear about about your friend. Both the fact that he is in hospital, and the fact that the little jingle with the neurology team left a bad taste in your mouths! I hope he will get better soon.

But... 100%? 🙂 I don't think that I function at 100%!

Hospitals and doctors are a ghastly business aren't they.
Or perhaps, being ill is a nasty business, period.

Ever since I started Internal I have been telling my non-medical friends (or what few remain of them!) to please for the love of God make sure they drink lots of water and poop every day and not smoke for it'll kill you and not drink for it'll kill you.

With dreadful lack of empathy, even I get impatient with waiting for my poor overworked family doctor.

 

[b&ierstiefel]

Thanks for the kind words. The rant kinda got the bitterness back outta my system...my worries for the consequences this event has on my friend still lingers (he was searching for jobs when all this happened, I can't imagine what's going through his mind in terms of how this will all affect his life). Honestly, I can't even think really of the whole applications matter now either...screw it for now. I've kinda gotten my mind off applications by reviewing some of the neurology I learned years ago to make sense of all of this. I've got some ideas but really, I have no clear clue as to the true etiology of this. He's a rather young guy for what happened to him (he's older than me but not by too much). This should not have happened to him...but it did...and there's gotta be a reasonable cause to this.

He's supposed to get an echo and MRI/MRA today...I just hope it doesn't happen at 3 am like I've seen in some of my previous patients. He needs his sleep and frequent wake-up's during the middle of the night is definitely not what he needs.

 

[yaah]

Come now, Andy, we all know that it is vital to wake up the patients at 5am every day so that we can listen to their lungs. Wake up from that sound peaceful sleep! Get up from that supine position! We need to hear if there is fluid in your lungs preventing you from breathing properly!!

That happened to me during my neuro rotations - the resident or attending would tell me to go and see a certain patient who had "interesting physical exam findings" (an oxymoron in my textbook of clinical medicine). I usually did but ended up talking with them instead and we vented together about the insanities of clinical medicine.

 

[b&ierstiefel]

Actually, here's my theory regarding early prerounds and early rounds.

It's all about writing: "S - no complaints."

If it's 5 am, of course the patient ain't gonna have no complaints...either he/she is tired or was doped up with pain meds when complaining of pain a few hours before.

When patients say, "Damn, do you ****ers HAVE to come see me this early? I was trying to sleep!" they still get a "S - no c/o" in their notes after I respond saying, "Sorry sir/mam, I know it must be very frustrating to be woken up frequently during the night and then have the doctors come and see you bright and early in the morning. Please sir/mam, tell me how that makes you feel."

 

[Brian Pavlovitz]

Hello, friends! It's been awhile.

I just started my glorious third year a few weeks ago, and all I can say is: THANK GOD FOR PATHOLOGY!!!

I started in the Respiratory Care Unit (a 2 week rotation for Internal Med), and it was actually a pretty decent introduction into the world of clinical medicine: only 10 patients max. in the unit, no call or weekends, and I didn't have one patient to call "my own". But, the crap that these poor interns have to put up with is really amazing. "Rounding" is not what it's cracked up to be (very attending-dependent). Everyone has diabetes and is overweight. Can't I just start Path residency NOW??!!

Oh well, I suppose it's good to have a light at the end of the tunnel. Once my roommates spring for DSL, I should be able to write more frequently (I popped home for a weekend of respite from the big city). Glad to see things are moving along for everyone--good luck to all of you interviewees! I'm truly jealous!!

*sigh* Coronary Care Unit starts tomorrow. Ever onward!

 

[b&ierstiefel]

Hello, friends! It's been awhile.
I just started my glorious third year a few weeks ago, and all I can say is: THANK GOD FOR PATHOLOGY!!!

Good to see ya again. I wish I had realized my interest in and been committed to pathology at the START of M3 year instead being all wishy-washy for the first 6 months of that year. Ah...who cares...that year would've still sucked anyway 🙂

I started in the Respiratory Care Unit (a 2 week rotation for Internal Med), and it was actually a pretty decent introduction into the world of clinical medicine: only 10 patients max. in the unit, no call or weekends, and I didn't have one patient to call "my own". But, the crap that these poor interns have to put up with is really amazing. "Rounding" is not what it's cracked up to be (very attending-dependent). Everyone has diabetes and is overweight. Can't I just start Path residency NOW??!!

Unit work is not as bad as a general medicine or teams month. And don't you feel lucky you won't have to do an intern year. WOOHOO! No intern year! Interns are really amazing for all the stuff they have to put up with. 3rd year med students feel they are at the bottom of the totem pole...and to an extent that is true. But considering all of responsibilities and all the crap people have to deal with, I think the interns get the worst of it.
Diabetes, overweight...do they also have HTN, CAD, COPD, CHF? If so, what you've got is the VA syndrome. Do you work at a VA hospital by any chance?

Oh well, I suppose it's good to have a light at the end of the tunnel. Once my roommates spring for DSL, I should be able to write more frequently (I popped home for a weekend of respite from the big city).
*sigh* Coronary Care Unit starts tomorrow. Ever onward!

You bet your ass it is! Also realize, that once you go to DSL or cable, there ain't no goin' back to no dial-up! I love my broadband. I pay a lot for my broadband. This will continue as I hate payin for it but I'll never give it up.

 

[deschutes]

why on earth would anyone do Internal Med???

Ahh, the eternal question... too often accompanied by a visceral reaction.

I recently met an M4 - an otherwise very sane and cool guy - who wants to do Internal. I asked him why, and he said he felt that Internal was satisfying, that it was what medicine was all about - knowing what to do for the patient, and knowing why (even if it wasn't a precise tissue-diagnosed "why"). He said he could deal with Teams, and playing the Teams game really wasn't so bad.

This was a guy who didn't mind going in at 6:30am on a cardiology elective to pre-round.

~
Earlier in the week an Internal Med recruitment moment arose. My staff person said to me, "Have you considered Nephrology? You're very personable. I was going to be a pathologist once. Keep your mind open as you rotate through your clinicals."

It was good to hear, especially after the misery that was the Teams experience. There are aspects of Internal, Peds, Psych - and I am sure Family, Ob/Gyn and Surg - that I enjoy, but I still found absolutely no reason to waver.

I've thought long and hard and I've decided there are levels of insanity to which I will not descend, and I must draw the line while my faculties are still intact - because heaven knows that we medical people are all able to suck it up much too well, and I would doubtless do the same if my path led to a residency in Internal.

I have a particularly strong aversion to the prospect of ever having to be anything like an ectopic senior on-call.
An ectopic senior is one, just ONE senior resident who comes in from another hospital for the night to cover both teams - about 30-40 patients whom they have never seen before and will never see again - and all Emerg consults/admissions. Frankly I think that is a particularly nasty bit of madness. Why would I want to go anywhere near a specialty that bullies its trainees into such submission?

Quite simply, I am stopping my future self from being unhappy... 😉

Internal Med in practice, gets in the way of my being human.

I wish it wasn't so, but it is. Likely it is my own defect or inefficiency, but to constantly be told to "Know thy patient!" when these individuals are in fact being reduced to less than the sum of their parts... immobile aggregations of potassium or bilirubin non-compliant with their meds all wrapped in a uniform shade of blue, at which we incessantly poke and prod with all manner of plastic or steel or ray-gun...

Ideally I would be able to rise above being bogged down by these details, to be able to see the person and not merely the disease. But it will take a long time to get there, and I am afraid of losing sight of that goal in the grind.

~
My staff person was stellar - she suggested I pick up a palliative patient, socially. She felt it was important for medical students to have some exposure to the dying process.

4 years of med school, and this is the first time anyone has tried to teach me about death and its inevitability - and how we must face it.

 

[b&ierstiefel]

This was a guy who didn't mind going in at 6:30am on a cardiology elective to pre-round.

Didn't mind going in at 6:30 am? 6:30 am? Hah! On cardiology here at Michigan rounds start at 6:30 am. The interns would come preround at like 5-5:30 am! 😱 ZOINKS! Perhaps Michigan is one of THOSE places....

Earlier in the week an Internal Med recruitment moment arose. My staff person said to me, "Have you considered Nephrology? You're very personable. I was going to be a pathologist once. Keep your mind open as you rotate through your clinicals."

You should try this line deschutes. If the medicine attending asks you, "Why don't you go into IM?" your response should be, "Why don't you take this spoon and eat my ass." (anyone know which movie that quote came from?)

Internal Med in practice, gets in the way of my being human.
I wish it wasn't so, but it is. Likely it is my own defect or inefficiency, but to constantly be told to "Know thy patient!" when these individuals are in fact being reduced to less than the sum of their parts... immobile aggregations of potassium or bilirubin non-compliant with their meds all wrapped in a uniform shade of blue, at which we incessantly poke and prod with all manner of plastic or steel or ray-gun...

Well put.

My staff person was stellar - she suggested I pick up a palliative patient, socially. She felt it was important for medical students to have some exposure to the dying process.

Um...medical students die everyday...it's called 3rd year.
"They can take our lives, but they can never take our freedom."
"Every man dies, but not every man truly lives."

 

[yaah]

Didn't mind going in at 6:30 am? 6:30 am? Hah! On cardiology here at Michigan rounds start at 6:30 am. The interns would come preround at like 5-5:30 am! 😱 ZOINKS! Perhaps Michigan is one of THOSE places....

I come in at 6:30. I'm going to be a hellish attending and force my residents to come in early as well because the morning is the most productive part of the day. I can't wait.

 

[deschutes]

If the medicine attending asks you, "Why don't you go into IM?" your response should be, "Why don't you take this spoon and eat my ass." (anyone know which movie that quote came from?)

(Not a clue! 😉 )
The attending was too nice. "Sit when you can, that's the rule."
In response to 0745h city-wide rounds, she said "I don't attend anything outside of regular business hours. Then again, I consider 8am to be outside of regular business hours."

And we took 10 out of a crazy weekend call day to crunch lunch - her treat - and talk about the sort of music people play in research labs.

I come in at 6:30. I'm going to be a hellish attending and force my residents to come in early as well because the morning is the most productive part of the day.

The world is run by larks, unfortunately, and the sizable population of owls are not wide-awake enough at 6:30am to protest.

When I am an attending, I will have my residents leave at 5pm and come in at midnight. At least that way they will get some sunshine 😛

If you liked Monty Python, you might like "Owls and larks, knotters and simplifiers"

"...Larks launched into an account of how, that very morning, they had completed their daily eight kilometre run, milked the cows, baked the bread, and put the finishing touches to their latest string quartet, all before breakfast. They do their best work in the morning, go to the cinema in the afternoon and by nine at night they are normally tucked up in bed..."

"...Owls complained bitterly about the early morning habits of their spouses, their children, the milkman, and the people in the flat above. One owl described how he was wakened and brought a cup of tea at about 9.00 a.m. by a person or persons unknown, though in twenty years he had never gained sufficient consciousness at that early time to work out who it was (his wife confirmed this, and said it was she). Thirty minutes later the same person (still unknown) handed him a large piece of paper on which his name was clearly printed, to remind him who he was. On a good day he was ready to start work about six hours later, and after an early dinner at about 9.00 or 10.00 p.m. he sat down at his word processor, normally finishing at about 4.00 or 5.00 a.m. Although this respondent had won two Nobel prizes, the larks at the table obviously disapproved of such decadence."

 

[yaah]

I like that. Actually, I can be an owl, but I am more efficient in terms of work and learning, test taking, etc, all that academic stuff, when I get up early. If I had a month off I would probably not get up at 5:30 every day. I am also not one of the early morning runners. I hate running. I go by lots of those people every morning driving towards campus. Insane, they are.

I base my early morning thing on what I prefer more. Do I prefer to get up later, rush into work and potentially be late for conferences, then stay later and catch up on everything? Or do I prefer to wake up a bit earlier, come in, catch up on things, and then start the day? The latter. It's more my compulsiveness shining through.

Speaking of being a lark, it is now 9:45 and I am off to bed.

 

[b&ierstiefel]

I base my early morning thing on what I prefer more. Do I prefer to get up later, rush into work and potentially be late for conferences, then stay later and catch up on everything? Or do I prefer to wake up a bit earlier, come in, catch up on things, and then start the day? The latter. It's more my compulsiveness shining through.

If I were a morning person, I'd totally prefer starting in the morning. My problem now, especially as a 4th year med student with senioritis is that I don't like sleeping too early. And I HAVE to get 6-7 hours of sleep per night or I'm screwed the next day (which probably explains why I didn't perform at tip-top shape on post-call days during infernal hell medicine). Oh well, I think when residency (aka boot camp) starts, I'm gonna have to shape up in terms of sleep schedule.

And yaah, it's probably not compulsiveness. It's heart! It's desire! It's all about the desire! (ok ok, i been watchin MNF since getting home).

Addendum: Deschutes, that line about having someone eat your ass with a spoon comes from American Pie 2. Another classic Stifler line.

 

[deschutes]

I think the owl vs. lark tendency is determined the same way as is extraversion vs. introversion - to viz., which do you prefer to be?

I can be a lark too - there are certain times in the year when I wake up at 5am, spring out of bed and study like a charm. But these moments are few and far between.

My Achilles' heel is study time. I prefer to get through what I need to get through the night before and rest easy, rather than waking up early and running the risk of not having enough time to finish reading.

If there was no study, it would be a great deal easier to go to bed at 10pm.
Heck, if there was no SDNPath, it would be a great deal easier to go to bed at 10pm! 😀

 

[b&ierstiefel]

Heck, if there was no SDNPath, it would be a great deal easier to go to bed at 10pm! 😀

I second that! Checking ADTS this late at night is pointless. Checking email at this time is also pointless (all you get is a bunch of spam that can be deleted the next morning/afternoon). Hence, SDN Path it is!

Damn it's almost 2 am already. I promised myself I'd sleep at midnight tonight. Damnit!

 

[b&ierstiefel]

Bump.

Keep up the hate.

 

[deschutes]

I think I blew off most of my steam on jeff2005's rant thread. I'm on my last lap now.

4 days of Internal... just 4 days... ending next Friday with another brick-stack of MCQ's, each question designed to boggle the mind being a whole page in length.

Friday October 8th at 12:30pm, I will be done with this interminable infernal rotation! A Thanksgiving weekend free of call! Sushi first, and then a night at the Philharmonic! Parting is such sweet-ness!

 

[b&ierstiefel]

Friday October 8th at 12:30pm, I will be done with this interminable infernal rotation! A Thanksgiving weekend free of call! Sushi first, and then a night at the Philharmonic! Parting is such sweet-ness!

Big props and congrats in advance on finishing this week. Is Canadian Thanksgiving in October?

Sushi...brilliant!
Philharmonic...brilliant! What performance will you be attending there?

 

[deschutes]

Between studying for the IM final 😡 and waiting on more invitations 😡 and trying to figure out how many trips I should make to the Midwest 😡 I think I'm going to go mad. 😡 😡 😡

Someone write me a script for metoprolol already!

Rest assured, I'm not usually like this.

Oh who am I kidding.

Today was even a good day. One consult! I love the nephro physical exam - or lack thereof. It's all about the volume status. And if it's on an ICU/CCU patient with a line in, you needn't fuss around pretending to see the bloody JVP. Sure, go ahead and pound on his back if you want. Only the pee matters anyway.

 

[b&ierstiefel]

Between studying for the IM final 😡 and waiting on more invitations 😡 and trying to figure out how many trips I should make to the Midwest 😡 I think I'm going to go mad. 😡 😡 😡

Someone write me a script for metoprolol already!

1.25 kg Xanax PO TID, first dose STAT.

Just kidding. Studying for any IM final is truly maddening. I just refused to study. I took that whole week off. I was even out of town for a few of those days. However, I scored average on the shelf so I don't recommend my approach. Keep on keepin' on.

Regarding interviews, you mentioned a while back that your transcript doesn't have any of your clinical grades yet. I would suspect that the number of interview invites will pick up come Nov. 1st.

 

[deschutes]

Is Canadian Thanksgiving in October?
What performance will you be attending there?

The CPO is playing Wonders of the World - with George Gao on the er-hu (Chinese violin). Can't wait!

Yes, Canadian Thanksgiving is Oct 11. Don't look at me - in my 2+ years here I have not figured out the reason why. But half a Friday, a Saturday, Sunday, and a whole Monday without call!!! It will be a thing of beauty.

Who knows, I may yet find that wool winter coat that I so desperately need. Ahh... retail therapy.

Meanwhile I need to go and fill in these huge gaping holes in my reading. I still don't know anything about the liver or the biliary tree. I hate this. I never end up learn the liver or the biliary tree well because they're always taught at the end of a GI course, by which I am so back-logged that I never get more than a cursory glance at it.

 

[deschutes]

Studying for any IM final is truly maddening.

Especially around these chirpy internist-wannabes who keep piping up with A-a gradient calculations and 20 differentials for elevated Alk phos/GGT. When I can't tell the difference between psychogenic dyspnoea and Guillain-Barre, I know I'm in trouble.

Regarding interviews, you mentioned a while back that your transcript doesn't have any of your clinical grades yet. I would suspect that the number of interview invites will pick up come Nov. 1st.

Not if the bloody Dean's Letter shows "Performance Deficiency" on my IM rotation! 😡 😡 😡

I think I'm going to go swim. Like right now.

 

[b&ierstiefel]

The CPO is playing Wonders of the World - with George Gao on the er-hu (Chinese violin). Can't wait!

I've seen that instrument...one of my med school friends who collected exotic instruments had an er-hu. I've never seen it played well though.

Now what we need is for George Gao to perform with Metallica (since Metallica has ample experience playing with symphony orchestras) and play "Creeping Death". Other suitable tunes would include: "The Ballad" by Testament or "Cemetary Gates" by Pantera. That would rule! 👍

Meanwhile I need to go and fill in these huge gaping holes in my reading. I still don't know anything about the liver or the biliary tree. I hate this. I never end up learn the liver or the biliary tree well because they're always taught at the end of a GI course, by which I am so back-logged that I never get more than a cursory glance at it.

Just know PBC and PSC and how those two diseases would be imaged. Oh yeah and that whole thing about anti-smooth muscle Ab or crap like that...know that.

 

[deschutes]

Everyone in my class started a new rotation today.

From surgical clerk reports, I know now that I have been extremely stupid in scheduling my last block surgery at the tertiary care centre of excellence close to home vs. the 400+ bed hospital a 30-min busride to the south.

Clerks at the latter hospital finish at 2pm. 2 PM!!! For SURGERY!! *wails*

 

[b&ierstiefel]

Yeah we got the same issues here too.

Either you can do your rotations here at U of Michigan Hospital, get treated like stool, and work really hard, and get a Pass.

Or...

You can do you rotations out at Jokewood Hospital at Dearborn, get treated very nicely (unless you're doing OB/Gyn out there), leave early everyday, skip stuff, and get a Pass.

Choices choices choices...

 

[deschutes]

"Gentlemen, choose your hell."

Oh, and the centre of excellence does not have scrubs in a size S. My friend who is a size S surgical clerk told me so. Which means that I will have to find some (I wonder how, since they do not encourage stealing!) and proceed to do the hospital's laundry myself - laundry which has got bits of other people on it.

Grrrrreat.

 

[b&ierstiefel]

"Gentlemen, choose your hell."

Oh, and the centre of excellence does not have scrubs in a size S. My friend who is a size S surgical clerk told me so. Which means that I will have to find some (I wonder how, since they do not encourage stealing!) and proceed to do the hospital's laundry myself - laundry which has got bits of other people on it.

Grrrrreat.

If it makes you feel any better, I still have about 6 pairs of U of M scrubs in my possession. God knows when I'll actually walk all the way over to the hospital (it's a long 2 minute walk from where I am right now) and drop them off in the soiled bin.

 

[deschutes]

If it makes you feel any better, I still have about 6 pairs of U of M scrubs in my possession. God knows when I'll actually walk all the way over to the hospital (it's a long 2 minute walk from where I am right now) and drop them off in the soiled bin.

Oh I have absolutely no opposition to stealing these size S scrubs - they are available at every hospital in the city except the one I will be doing surgery at.

So in order for me to have a supply on hand, I have to launder them myself, or they will get redistributed everywhere else but here by the centralized laundry service. After all my efforts at thievery!

 

[deschutes]

This needed reviving.

As part of our last day of Family Med, we were supposed to prepare a 10-minute presentation - with instructions to spend half an hour on it (I spent more like half a week).

I thought it would follow that these presentations would be presented.

Apparently I was wrong.

So I felt like someone had stolen my thunder, especially since I fully intended to provoke responses to my chosen topic, i.e. "Generalists in Undergraduate Medical Education: Where are they?"

(Which was, as you can tell, a thinly-veiled excuse to induce a food fight.)

We were going around the table in the de-briefing hour, describing our most memorable experience. The others talked about how hands-on Rural Family had been - how many deliveries and casts and intubations they had done...

And when it got to me, I said my most memorable experience was when a patient had come in to "talk about her cancer" and the op that she was going in for, and that was exactly what the doctor did. He went over everything with her, answered all her questions. Told her that she wouldn't miss that one foot each of small and large bowel, she'd have tons left over. Talked about his personal knowledge of the surgeons who would be doing the op. Told her when she'd have her NG tube out, how soon till she was walking again, and how soon she'd be able to fix herself small meals. Told her to get her things in order before she left for the hospital so that she wouldn't have to deal with anything major in the 2-3 months after she got home...

Just good old-fashioned medicine, the sort of thing you can't learn from textbooks.

 

[deschutes]

Oh and get this... there's a journal out there called Academic Medicine, and one of the articles I turned up in the course of my reading was titled 'Teaching Social and Cultural Responsiveness to Medical Students: "It's all very nice to talk about in theory, but ultimately it makes no difference." 😀

 

[yaah]

'Teaching Social and Cultural Responsiveness to Medical Students: "It's all very nice to talk about in theory, but ultimately it makes no difference." 😀

It's true. It's like politicians talking about working together and their plans for a better nation.

It is important to be aware of cultural differences, but it is very hard to get into med school these days if you don't have a general awareness of the world around you. That being said, however, depending on where you grow up things just may never come up. So I guess it is important to talk about it. But really, you don't need 35 curriculum hours worth of multiculturalism training. 1-2 is plenty. Honestly. How many times can you hear that people of certain cultures may interpret medical information differently?

 

[b&ierstiefel]

Oh and get this... there's a journal out there called Academic Medicine, and one of the articles I turned up in the course of my reading was titled 'Teaching Social and Cultural Responsiveness to Medical Students: "It's all very nice to talk about in theory, but ultimately it makes no difference." 😀

Totally! I'm glad someone came out and said it. Our school really really overemphasizes this stuff. It's like they're trying to TEACH us how to be nice. C'mon, most of us aren't socially ******ed. And those who are, it's the med school's fault for accepting them anyway!

 

[deschutes]

While there is general awareness, the article verbalized some interesting points I hadn't thought much about...

Some which we are aware of:

'Students said repeatedly that ... they found the things they learned in PPS irrelevant when faced with the pragmatic considerations of ?the real world.?'​

It talked about the concept of 'Othering' - i.e. the case studies on which the course was based, served to perpetrate the very stereotyping that the course was trying to get rid of. You know, like this is the lady with the Arabic name and the head-scarf... this is the IV drug user in the community...

'Students tended to learn that the proper stance of a physician is one of social neutrality?classless, raceless, genderless, cultureless, as well as class-blind, color-blind and so on.'​

-- leading students to see ?those people? as having problems rather than learning to see themselves as equally affected by their own class, culture, and social background.

I thought like yaah and Andy did - that anyone who wasn't culturally-sensitive, well, what were they doing in medicine anyway??

And yet -

the students argued that because the third-year class was racially diverse and gender-balanced, racism and sexism must not be problems. They insisted it would a comfortable place for gay and lesbian students to be ?out of the closet,? though most believed there were no gay or lesbian students in their class.​

A student noted the less tangible effects of class status... "You don't know how to interact with people, you're like, ?Gosh you're a doctor,? instead of like all your friends' parents have been doctors ?"

One female student said - 'The more subtle things I am not even sure they recognize they are doing it ?. They would just be more likely to take the guy aside in surgery and show him something ? tell him that he is great?. You sound like you have a chip on your shoulder when you notice it.'

Bottomline - and where the real challenge lies:

When students do not see clinicians modelling practices that attend to the cultural and social diversity of patients and practitioners, they begin to see socially responsive medicine as, ?all very nice to talk about in theory, but ultimately it makes no difference.?​

(Citation: Beagan BL. Academic Medicine. 78(6):605-614, June 2003.)
(Interestingly enough, I note that Dr. Fantone is in one of the references listed! 🙂)

 

[yaah]

The thing I disliked (I have probably started lots of posts this way!) about PPS was that you would have this big session focusing on a Hmong family and their personal health practices and viewpoints, etc, but the correct way to go about things, as taught in the class, was simply to listen to the patient, respect their viewpoints, and consider their cultural beliefs when discussing treatments. Well, I call shenanigans on all of this because this is what should happen with every patient. Just because someone is of a different ethnicity suddenly means we should start listening to them and considering their personal views? Aren't we supposed to do this with every patient? It's a crock.

I understand that Arabic individuals, for example, often have difficulties when they go to the doctor because of cultural differences. But you know what? My grandmother who is as white and as american as they come ALSO has difficulties with the doctor not understanding what she means or how much she comprehends about her treatment. We need to stop focusing on cultural differences in patients and start treating every patient as an individual who deserves and demands our respect and best efforts. Clearly, this will include factoring in their personal background and beliefs.

😡 😡 😡 😡 😡 😡

 

[b&ierstiefel]

Bah Humbug!

Anyway, I'm gonna try reading that article when I get back. It has the potential to be a very interesting read and further add fuel to my fire!