Friday, April 26, 2013

And Then We Came To The End

Those following along at home may have noticed a slight delay in my posts (read: 18 months). While I cannot say such a hiatus is excusable I like to think justifiable explanations exist, predominately the clinical years of my medical training, the application and acceptance process of residency, attempting to not be an awful husband, and the minor time sink of fatherhood. Pun intended. So what might I say about the past 18 months?

I think I now understand the concept of Stockholm Syndrome.

I say this because for the past two hours I have been free of the yoke of education for the first time in twenty years. Today I finished my last required day of medical school. True, the small details of some paperwork and actual graduation must occur, but for all intents and purposes I am no longer a proper student.

And I have no idea what to do with that.
There have been moments, days, weeks, and months that were pretty awful over the course of the past four years, but I'm having a surprisingly difficult time identifying them. All I can think is that this is traumatic bonding. Everyone else who has sat through countless powerpoint lectures (sometimes at the speed of 160 slides/hour), spent hours hacking their way through anatomy lab, study on white boards in study rooms (sometimes while dancing to headphoned music and having friends unjustly laugh at you), and dragging themselves through clinical rotations probably knows what I am talking about.

I've never really been anything other than a student, so what does one do in the wild working real world? Work, I suppose? All I know is that I am excited to find out. I also have a sneaking suspicion residency will still involve a plethora of learning, lectures, and superfluous activities just with a paycheck and real risk. Which is also pretty cool, because let's be real: while I have actually *gasp* enjoyed medical school, I am pumped as hell to be done.

I have to note, however, that I could not have finished the past four years without the help of my ridiculously supportive and loving wife. I guarantee she has bore the brunt of more useless medical facts than she thought existed; sometimes so far past her line of acceptable discussion that I couldn't identify it if I tried. To her, I give a million thanks.

In addition to the better half, I have to thank my parents for always being around to talk or offer a break, my sister and her family, my in-laws, my extended family, and my friends/class mates. I am convinced that all of you, and no doubt your parallels to those other students reading this, are what make medical school enjoyable and worth it for all of us. Thank you immensely.

So I suppose this is it. The end. Or more accurately: the end of the beginning. Which might take some getting used to.

Until next time.
(Because let's be real, when have I ever not had more to say?) 

Wednesday, November 16, 2011

Manual Over Autofocus.

I am astounded that in a month I will be one half of the way through my third year of medical school. As I've gone through a handful of rotations and have spent more time than I cared to at the hospitals, I've noticed something that has been irritating me. As a student, for as much as we are active and participating in patient care, we spend a lot of time observing. We watch residents, attendings, and nurses, seeing how they interact with patients and approach the art of medicine. The mantra that is often taught, or supposed to be taught, or ideally taught but secretly thought by some of those teaching as foolish, is that in medicine you should not treat the disease; you should treat the patient.

The sentiment of that statement rings true with how I feel. The execution? Not so much. Many physicians stop short of treating the disease, let alone the patient. Instead, they treat the symptom or a specific manifestation of the disease. An ID doctor treats the infection; the surgeon opens and drains the abscess; the endocrinologist manages the diabetes. This makes sense from a practical point of view. If I have learned anything over the past two and a half years it is that I cannot learn everything. An expert should handle the complexities and nuanced management of certain conditions. But what happened to treating the patient? (This is not to say specialists cannot treat the patient instead of a symptom or aspect of disease; it simply means I haven't seen it yet. I am wanting to, believe me.)

Recently on rounds, the attending reminded us that "In medicine, we treat the patient, not the numbers." This statement was made regarding abnormal lab values. It was meant to remind the students and residents that we cannot simply try to correct abnormalities on paper; we must look at the patient clinically to confirm, adapt, and change plans. Sadly, it was meant on nothing more than a level of clinical correlation. As opposed to a grander statement about the lofty responsibility of treating the patient, it was about confirming laboratory findings clinically. What this statement actually did for me was point out the failures of the medical team to go beyond a talking point and treat more than the patient; I instead wondered: what about the person?

Too often it seems medicine becomes bogged down in labs or physical findings. Sodium is corrected; cholesterol is monitored. While these things are astoundingly important, I do not want to be a physician who works through tunneled vision. I do not want to be a physician who treats the patient instead of the disease.

I want to be the doctor who cares for the person.

Most of the people I have worked with thus far- who no doubt care about patients immensely and typically practice good medicine- do not focus on the patient as a person. Maybe this is naive and foolish. Maybe I cannot actually appreciate the weight of what it means to be a physician and all its struggles because I haven't reached that point yet. Honestly, I do not know and don't get me wrong: there have been a handful of docs who continually impress me both with their control of medical knowledge and their approach to patient care. Such physicians do exist. I just suppose my hope is to join their ranks in one and half years (technically) and four and half years (board-certified-ly).

Until next time.