Within a test tube throw away — or at least within the city limits — is most often found the mother institution. Behind the historical trail of white coats there exists a story of discovery, medical evangelism and no small degree of strife. The evolution of the American medical school still isn’t over. We are stuck in the thick educational batter consisting of an unequal measure of teaching, patient care and research. And as it is stirred and nurtured we discover the overpowering odor of research.
Foremost in the minds of today’s medical educators is the crusade for ever more funding. Expertise in writing grants for pet research projects far outweighs the energy spent on teaching tomorrow’s doctors. No one would argue with the contributions made by twentieth century research, only a foolish person would suggest we rediscover the nineteenth century French penchant for clinical medicine to the exclusion of new science. No one would venture to suggest the complete unveiling of the human genome is worthless, not even to suggest its only tangentially valuable to clinical medicine. Apple pie and all of that.
But as you view the ramparts of the modern hospital and enter into its sacred halls, brushing past hurried young men and women in white, you must realize the extent of the system’s deficiencies. Just as apprenticeship-trained practitioners in the late nineteenth century gave way to more scientifically oriented physicians trained in academically sophisticated medical schools, now those very clinicians are stepping back from the teaching podium, replaced by PhDs, laboratory-trained specialists in any science with a remote bearing on medical practice. Now teaching the first two years of medical schools are these research-obsessed professors who view teaching as an annoyance and who, anyway, do not understand what a clinician needs to know in order to care for patients. To a large degree we have lost our way in the maize of evolving scientific data. The task of selecting what is clinically relevant has fallen on the medical school deans who have manipulated the curriculum with varying amounts of self-interest and reason.
From a century of medical practice characterized by virtually no science, where ancient treatments carried forth from previous centuries and myth and astrology served as the profession’s high water mark, we arrive today at a teaching menu stuffed with bits and pieces of high tech research. Succulent morsels by themselves, curious if not intriguing, these hors d’oeuvres have little to do with curing patients and nothing at all with caring. The medical school curriculum is in danger of becoming modeled after an advertisement with out-of-context sound bites flashing forth as real information. Curriculum committees struggle like intellectual chefs, constantly rearranging their plateful of goodies, unsure which to feed to the dog and which to save for their ‘culinary’ curricular presentation.
Sometimes I really ponder over treatment problems. I really hate those cases where both options stink. For example, you have an elderly patient in afib.. something I see all the time!
- Choice A: Put them on Coumadin. They don’t embolise but they bleed like stink. Nosebleeds. Head bleeds. GI bleeds. Lacerations that bleed. Dental work that bleeds. I hate it — certainly not an option for those who are a great fall risk.
- Choice B: Don’t put them on Coumadin. Presto! No bleeding! But them they come in one day with a dead leg or a huge hemispheric stroke and end up an amputee or a vegetable.
I guess you just have to decide which bad thing is more likely to occur. I’m not sure what I’d choose if I were the patient — what would you do?
Remember when you were a premedical student in college? It seems like a century ago for many of us who have just completed the first year of medical school. It feels that way because our lives have changed dramatically. Normal life seems to have vanished, and suddenly, 24 hours in a day are not enough to get through the enormous volumes of information that we are expected to learn for every exam. It seems virtually impossible. We barely have time to eat or sleep.
Medical school is not the end of the world. Take it from us, students who have been there, when we say that medical school is what you make of it. Do not let medicine define you; instead, you should tailor medicine to your lifestyle. Otherwise, you might become overwhelmed by the demands of your new life and lose the sense of why you chose medicine in the first place.
How do you survive medical school?
Physicians, and medical students for that matter tend to fall into 10 different categories — which type are you?
One afternoon in clinic, a patient’s wife stopped me in the hallway. I had just finished describing an operation to her and her husband, obtaining his consent and answering their questions, but I wasn’t surprised that the woman was still worried. Despite her easy smile and infectious throaty laugh, she had appeared anxious throughout the visit, the corners of her mouth twitching and her hands flitting from her hair to her face to her pocketbook and back to her hair again.
In the hall, she opened her mouth to speak but stopped abruptly when one of the residents, a doctor-in-training, passed by. Once the resident was out of earshot, she cleared her throat. “Please don’t bring any students into the operating room,” she said, looking toward where the resident was standing. “It’s not that I don’t like these young doctors. I just don’t want one practicing on my husband.”
(Source: The New York Times)
A day in the life of a paranoid schizophrenic — keep in mind most hallucinations are auditory, visual hallucinations are relatively rare.
Med students are taught about everything from pathology to microbiology, but are they asked to learn enough about public health policy?
There are drugs that help you remember what you learn, and ones that erase your memory. But until now, there have no substances with the power to enhance and strengthen old memories hovering on the brink of being forgotten. Now a group of neuroscientsts say they’ve isolated a single enzyme in the brain that can help long-term memories remain crisp in your mind.
With knowledge comes responsibility, and while physicians have insight into the inner workings of the human body and how it responds to disease (more than just a neat party trick), they’re also charged with using that information to make sure they don’t miss the cardinal signs of problems that can lead to the rapid deterioration of a patient.
In our classes we learn about a number of problems that are slow to progress - important to catch but not immediately threatening to life or limb. But as we go through our training, once in awhile we’ll learn about the classic presentation for a problem which, if missed, will result in the patient dying or being seriously disabled within a relatively short period of time, and the physician being in serious trouble if they had the opportunity to catch the problem early but didn’t.
Whenever these come up I try and make a mental note of them, mostly because I don’t want my patients to suffer because of a preventable error on my part.
I’ve racked my brain for what appear to be some of the common ones, most of which I had never heard of before starting medical school. Coming in, most of us already knew that chest pain that radiates down the left arm and up to the chin could be a myocardial infarction (medical speak for heart attack), which usually comes up in first aid classes. On the other hand, I never realized that green vomit could be the sign of something quite ominous, or that what might seem like a minor bump on the head needs swift medical attention.
I’ve seen this patient so many times! Another reason to love the ED.