Wednesday, July 29, 2009

Equal education?

Throughout third and fourth year of med school, students work with a team of residents and attending physicians either alone or with another med student. At least in internal medicine, each student has his/her own patients and reads up on and follows those patients. Different teams may specialize in different types of patients and even within a single group, the types of patients followed by one student (by chance) could end up being very different from those followed by the other. This leads to a lot of variability in what each student learns from their experience on the rotation. For example, most of the patients that I've followed in my internal medicine rotation so far have had liver disease or a bile duct/gall bladder problem. I've read up on these conditions a lot and think that I'd do a pretty good job at examining, diagnosing and treating a patient with these disorders. But other students on the rotation with me have completely different patients, some have more cardiology patients, others have more kidney patients, and each (I assume) are more familiar with those conditions than I am. I hope that it evens out soon... these practice questions that I've been doing for the final exam really shows the bias in my experience with patients. I switch teams (and hospitals... and cities) next week, so I hope to get some exposure to the type of patients that I haven't gotten a chance to see yet.

btw... (can't believe it's already been a month, only 22 more to go).

Monday, July 27, 2009

Social Health

3 weeks into medicine now and things are pretty busy, but I'm having a lot of fun and learning a lot. I'm still missing a lot of the knowledge, but I definitely feel more comfortable around the hospital and with patients. One thing I've noticed though is how important social situation is to health. Yeah, it seems obvious, but working in the hospital really opened my eyes about it. Of the dozens of patients I've seen, only two of them have a stable living situation. The major reason behind this is lack of access to healthcare. People who are living stable lives likely have the resources to take care of their health and even if they have a problem that can't be prevented (like a genetic clotting disorder), they can keep a close eye on it and live a relatively healthy life that doesn't require them to be hospitalized much. People who have unstable social situations have bigger things to worry about than why their stomach hurts when they eat or why they're slowly starting to turn yellow. They don't catch their clotting disorder until they get a large clot in a major vessel (i.e. the portal vein) and get life-threatening (and much more costly) health problems like losing their liver. A little early education and a $4 a month drug could have prevented a hospital stay of several hundred thousand dollars and a death in the 20's.

Saturday, July 11, 2009

72 hrs later

So, as I mentioned before, we were told that we'd feel a bit more comfortable about starting the wards 72 hrs into it. Well, I just got back from my 3rd day in the wards and I do feel a bit more comfortable. I've figured out the basics of the computer system and I've gotten a little bit better with rounding, presenting patients and writing notes on my patients. So, after 72 hrs here's my impression on internal medicine (and maybe being a 3rd year med student as a whole):

The goods (in no particular order):

1. Getting to be where the action is.
Yeah, I don't get to actually do much, but each day I do get to closely follow a team of doctors debate and make many potentially life-altering decisions on several people.

2. Applying all that medical knowledge to real people
I finally see how many of those lists and seemingly endless facts finally make some sense. I'm far from being comfortable with them, but at least I get to see them applied to real life. And, applying it to real life goes a long way to putting those facts in memory. For example, knowing that low platelets can be an effect of liver failure is much easier when you've seen that Mr. X, your patient with liver failure needs to get a platelet transfusion before every procedure.

3. Talking to patients
This is actually the most satisfying part of going into the hospital. I get to spend some extra time with my patients and actually get to know them. They're pretty bored and enjoy talking to me. I feel that by spending more time with them, I get to better understand their expectations, fears and frustrations. It never ceases to amaze me how honored I feel when a stranger opens up to me and tells me everything about them.

The bads (in no particular order):

1. I'm useless.
I get to be part of a team of physicians that help make a very sick person well again, but I am completely useless. As a medical student, almost nothing I do has any consequence on the patient's stay, and the few things I get to help with, the team really doesn't need my help. Sometimes I feel like I'm in the way. The only part that makes me feel like I'm actually having an effect is when I get to relay the patient's concerns to the doctors because I get to spend more time with them (see the goods).

2. I don't know anything
This may be specific to me since I took 4 years off between finishing 2nd year of med school and starting 3rd year. I've forgotten a lot of facts. Everyone around me is nice and I haven't pimped at all, but the really easy questions that I get, I still have trouble answering. It hasn't all come back to me yet, but then again it's only been 3 days.

3. Studying
Along the lines as #2 and also specific to the fact that I took 4 years off. I've had no reason to memorize lists of facts in the last 4 years and I haven't bothered finding a good way to do it. I remember at one point in the second year of med school, I would learn the pathophysiology of an entire organ system in a week or so before the final exam. Now, I don't even know where to begin. I'm hoping this comes back to me also.

4. Of course, the hours
No matter what, I can't get used to getting up at 5 am (or before) every day. I've gotta learn to sleep earlier.

In all likelihood, these opinions will change in another 72 hours. Overall, I like internal medicine so far. I'm learning a lot and it's not completely exhausting (yet). We'll see how I feel about it as I get more into it. Stay tuned.

Tuesday, July 7, 2009


All right! 3rd year of med school officially started and with it, after another long orientation, I got my first patient. Unfortunately, because I showed up in the middle of the day, I had to pick up a patient who has already been in the hospital for weeks. This means going through a lot of charts (dozens per day, by various MDs, nurses, pharmacists, therapists, etc.) There are two problems with this: 1) I have no idea how to use the hospitals computer system and have to click around for several minutes before I can get to where I need to go. 2) So many abbreviations! I know that doctors like shorthand, but just with this one patient, there are a dozen abbreviations that I've never seen before. Some even have multiple meanings. I've figured a lot out from context: SBP = systolic blood pressure, but SBP treated with cefotaxime is spontaneous bacterial peritonitis... seems easy to figure out, but when your eyes are glazing over the 24th progress note, its easy to confuse the two. Others, I still have no idea... the google helps, but I'll just have to break down and ask someone about some of them tomorrow.

We were told that within 72 hours most of this will make sense, but I have a hard time believing that. We'll see. Meanwhile, I gotta figure out how I'm going to preround tomorrow morning (see the patient before the residents and attending physician does) and prepare myself to present my patient to the attending (focused, yet thorough - seems like an oxymoron to me).

mfp = my first patient

Monday, July 6, 2009

I am oriented (sort of)

It's finally here, the first day of third year. Today was orientation day... all day getting lectures about what to expect next year and how to survive through it. For the most part there was nothing eye-opening from the various lectures. A couple of things stood out. One was a discussion on how to get along with others in our "team" (attending physicians, residents, nurses, etc. that we are working with) and how to carry ourselves in the hospital. One administrator stated that we should remember the saying "When in Rome, do as the Romans do." To an extent, I agree with that, but not everyone in medicine provides a good example and we should judge for ourselves what is appropriate in a hospital setting and we shouldn't blindly imitate the attitudes and actions of those above us. (Luckily, another administrator quickly mentioned that we should also be a force of change to make the hospital a better place).

Along these lines, I was pleasantly surprised that the med school and hospital are largely aware that the environment of medical education isn't perfect and seem to be working to improve it. I wasn't surprised by the report (of med schools in general... not just mine) that abuse of students is fairly common. To deal with it, a recent addition to our school is the implementation of an on-line method to report inappropriate behavior or abuse by others in the hospital. The report goes to an ombudsperson who is not a physician and has no relationship with any medical department. Although it is sad that such a system is necessary, it's nice that a lowly student can bring inappropriate behavior to light without fear of reprisal by those above them (something several students I know who have gone through med school before me have complained of).

Anyway, enough with the bad stuff... Tomorrow is orientation for my first clinical rotation: internal medicine. I'm fairly excited to start (though not excited about the hours) and will hopefully be able to relate some of my experiences here (really, more for myself than my three faithful readers, but you guys might find it interesting also).