The First Reprieve

This weekend has functioned as the first real "break" of my medical school career. The School of Medicine teaches its Basic Science years with a module plan. For 4/6/8 weeks, we students learn about a specific subject or system (such as Genetics or Inflammation and Immunity) and everything involved with it (such as Biochemistry, Cell Biology, etc) instead of having individual lectures over each traditional science subject. It seems as though the module system produces the same scores (if not higher) on board exams and presents the material in a manner that is more intuitive to the students being able to assimilate it with how it will be used in practice.

These modules culminate in a final exam (or a midterm and final for longer modules) that accounts for the overwhelming majority of a student's final grade. This results in a very cyclical life for students, as they go from feeling good at the beginning of a module to being increasingly more stressed until, as one lecturer stated, their eyes explode with stress right before the exam. Post-exam, assuming one's scores are passing (that's what we shoot for in med school. Not high grades, just passing), the system resets and we're not longer stressed.

This past week we had our first exam and the past few days have been wonderful. No longer do I view time as studying/should-be-studying, but I can view it as busy/FREE, if only for a few days.

So, in honor of the first exam being out of the way, I leave you with a few (humorous?) mnemonics that helped along the way:

Can I Keep Selling Sex For Money, Officer?
(Citric Acid Cycle Intermediates)

High Profile People Act Too Glamorous, Picture Posing Every Place.
(Enzymes of Glycolysis)

Val Raced Harry Through Walmart For MILK.
(Essential Amino Acid Abbreviations)

Until next time.

People Eating Tasty Animals?

Today was our second session of the clinical skills lab. These sessions could best be described as trying to teach us how to actually be a doctor. It is here that we learn and practice patient history, vital signs, heart/chest sounds, and all physical exam techniques. The students attend each lab in professional dress (with white coat and stethoscope) and see "patients," actors who have been trained in the proper techniques.

We are currently learning how to measure vitals. There are typically four main vital signs that physicians (or nurses or whoever is seeing you) check.

-Pulse (Heart Rate)
-Blood Pressure
-Temperature
-Respiratory Rate

These signs assess basic bodily function and serve as the first physical step in the clinical process of diagnosis. I say the first physical step of diagnosis as the patient history (as stated in my previous post) typically holds the crown for most important aspect of diagnosis.

Fun fact: while most everyone is familiar with how a doctor will assess your pulse (feeling the radial artery), take your temperature (a thermometer, be it tympanic or oral) and check your blood pressure (a sphygmomanometer and stethoscope), measuring respiration is typically done a little more covertly.

Think about it. Has your doctor every told you she/her is checking your respiration and watched you breathe? The likely answer?

Nope.

When someone knows their respiration is being counted, they inevitably think about breathing and thereby change their normal rate. Doctors typically hold the pulse longer than needed and count breathes or gently place a hand on your shoulder while doing so, allowing them to easily count the number of breaths while also measuring your heart rate.

Of course, a physician can always just watch a patient breathe while taking the history and count the number. Yet, (as one lecturer noted to the awkward laughter of the students) this can be a bit challenging when done on a female patient. Polite society dictates that eyes be up top and not down at chest level, especially during conversation.

Until next time.

A Good Word of Advice

Heard today, during our first session at practicing to be a doctor:

"The patient is the expert on the illness and disease. The doctor is the expert on how to fix it. Listen to the patient."

A Thought

As we sat in our first lecture of the day, and our first real lecture of actual "doctor" things (how to take a patient history), I could not help but be caught up by a point that was made. More specifically, a comment about a point. We were discussing why one should always strive to do a "patient-centered" history. It is exactly what the name implies. As much as an awkward student-doctor can, we are to encourage the patient to tell their story and naturally explain everything about their problem or situation. Among other things (such as being more effective and generally making everyone feel better), this has been proven to be a faster method of interviewing. The lecturer, who I've enjoyed and still do, followed up this point by stating that it was a "good thing." As a physician, it's better for me from a business standpoint to see six patients in an hour instead of four, and if a patient-centered interview can do that then why not?

But no one asked the question (although I don't think in the middle of an already-running-late lecture was the best place to do so anyway), "Is this really the best way to do things?" Should we, as the ones who allegedly "run" the field of health care, choose to base our habits and practices from a fiscal standpoint? Even if we include the fact of it being faster and therefore a better business practice among the variety of other reasons- some altruistic and for the better of the patient- for choosing to practice in this manner, won't the aspect of money and payment always be creeping in the back of our heads?

I know this- like so many other things- stems from a very naive and elementary point of view, but can I really say it would be better for me to shed my idealistic view completely and work with the way things are, never questioning?

The Swing of Things

We're halfway through the first real week and a routine already seems to be developing. The morning typically passes with three fifty-minute lectures that masquerade as simple and comforting. "Three hours a day? That's cake," one would seem to say. And it is...kind of...if you're willing to work. Each lecture consists of (depending on the lecturer) anywhere from 60-85 (sometimes 100+) slides that are jam-packed. If one focuses- and truly pays attention- the material is manageable- if there's also a commitment to reviewing/studying later that day. Thus far, I've been able to keep up and stay on top of things. I know and acknowledge that I am still blissfully ignorant of what things will be like when this continues for weeks/months/years, but for right now I call it manageable. It seems like this shouldn't be that unexpected, however, seeing as though the lore exists of school being hell, 175 random students manage to pass each year. The afternoons are filled with a variety of labs/small group/clinical skills sessions that (sometimes) remind all of us that there is that whole being-a-doctor note that this will end on.

An example week:
Fun fact for the day:
Some axons (namely the ones that run from the base of your spinal cord down your leg) can be up to a meter long. Good thing we've got those neurofilaments to hold 'em together.

Cloaked!

Today was the (symbolically) significant White Coat Ceremony. As we advanced nervously across the stage and accepted- through the donning of the white coat- the responsibilities and duties of a physician (as represented by the weight of the coat on our shoulders), an array of thoughts couldn't help but run through the minds of all of the now student-doctors.

Will I handle, with competence, the journey before me?
What will make me stumble?
How will I be challenged as a person and a healer?

And most importantly: How good do we all look in these coats, eh?!?!



Good lookin'!