This new generation of med students

We're a generation who knows what it means to be without a physician. After almost 20 years of looking for doctor I ended up going to med school - it would be faster. We're disillusioned with the health care system, concerned that it will fail us and our families in our times of need. During some group discussions we have covered the concept of allowing our family to jump the queue of diagnostic testing to ensure that they are seen and treated while the disease is still manageable.

It boggles my mind that physicians of previous generations don't recognize that we don't put as much faith in the system as they do. Neither do our future patients.

The internet and poor availability of health care have made doctors less important. On more than one occasion over the past two weeks I've seen patients bring in pages they've printed off the net and question the doctor's decision regarding tests to the point of getting a second opinion on the same day. The patients are assuming that they know more than the physician who has been studying the material for years. Granted, this is how we are taught to approach the physician - patient encounter, always ask the patient what they think the problem is since they'll have a good grasp of what's going on since it's happening to them. Some patients take this as the doctor not knowing what is happening. In reality it's often the doc fishing for a fact that the patient has hidden as though this is an episode of CSI.

When I was growing up, my family doc knew all. The man was a brilliant diagnostician and a terrific doctor. Our community loved him and held him in the highest esteem. Who could blame him for wanting to be a doctor 24-7?

When your patients aren't providing you with that love and support, I think it's easy to see why many of my generation of doctors feel a strong need to make sure their life outside of work satisfies their well being. Docs that are now entering the work force are choosing to work fewer hours and spend more time with their families, hobbies and life outside of work. Macleans magazine misinterpreted this as female docs choosing to leave their profession to raise their families, but it's the men as well. The "pink ghetto" is a concept that many older, male docs choose to believe is true. I've had several docs over the past few weeks say things to me like "female doctors should be sterilized before entering med school", "women doctors are the reason we have a shortage right now" and my favourite who said both, "white males are discriminated against in the admissions process" and "there are more women than men in med schools now which is just going to make the doctor shortage greater as we move forward". Wow.

I don't deal with incorrect, inflammatory statements in an acceptable way - i.e. nodding and smiling. It's bull shit.

I'm not done ranting, more on this soon.

Pessaries and Circumcision

This week was a bit more dull than last - probably because I wasn't in the OR at all. I spent most of the week with family docs plus some time in the ER and with an internist at the hospital. My list for this week:

• performed a 6 month well baby check up with the cutest baby ever
• met a born again Christian/recovering alcoholic
• danced with a delirious geriatric patient to try to keep her in her room in the ED
• heard the distinctive tinkling of someone with a bowel obstruction
• met someone who had been hit by a train and survived
• learned what shifting dullness was and how to properly check for pitting edema
• saw a stress test in action
• heard COPD, emphysema and chronic bronchitis
• saw a woman with shifting pain that the doc didn't know what to do with - not sure why she wasn't referred to rheumatology, even though it wasn't in the joints, it may have been fibromyalgia
  
• speaking of rheumatology, why are none of these docs on top of management??? Tylenol for RA?? wtf?
• was lectured endlessly on the woes of the Canadian family doctor and how we'll never make any money
• saw a woman with scleroderma and pronounced sclerodactyly
• she was happy to let me feel her fingers and skin to get an idea of what to expect
• there are support groups for those with scleroderma
• I think the doc was dissapointed - I'm pretty sure he was hoping to stump me with that one ;)
• watched moles and skin tags be burned off
• closely followed with the first time I've almost fainted (no lunch + burning flesh = syncope)
• saw a circumcision - uck - how can you do that to your baby??
• met a man who takes 72 pain pills a day for his chronic pain
• my first question - do you still have room to eat food? Apparently his appetite is still strong
• heard a pan systolic murmur
• found a melanoma spot in an elderly woman's mouth
• wrote the admission notes for a patient who was unconscious - or at least attempted to, I wasn't that great at it - this is how we learn though
• saw a uterine prolapse and a pessary insertion
• examined a few pregnant bellies
• saw several cervixes (cervi?)
• met "that guy", the one who thinks that because he's on lipid lowering meds that he can eat whatever he wants and as a result his blood sample was 1/2 fat so the lab couldn't do cardiac enzymes - those guys actually exist!
  

Still freaking out a bit about finals but I this week has been busy enough that I haven't really noticed. I'm doing a 5 week "elective" at a large centre away from med schools. It means I get to see a lot and I'm the first in line to watch it all happen/learn how to do it myself.

It's been great to see a team of doctors, nurses and nurse practitioners that work together so well. It makes me want to work at least part of the time in a hospital. So far this week I have seen:

• carpal tunnel release surgery
• the suturing was so neat and close to invisible I'd be surprised if there was any scarring
  
• laparoscopic cholecystectomy
• I will never consider eating beluga caviar again

• C section, double ovary removal, tubal ligation
• aortic aneurysm
• cranial fracture
• very sick people
• drug seeking people
• intubated 2 people
• put a peripheral IV line in one
  
• took close to 20 histories
• did abdominal, respiratory, cardio and MSK exams
• missed a fracture
• got to hang out in the OR, ER, family doc's office

All together, it was a great experience for a first week!!

Still waiting for the hook

When I got back to town yesterday there was a notice from Purolator on the window. My heart sunk into my toes. Not anatomically possible, I know, but it sure felt like it. I've been in a total panic since exams were over that I wouldn't get the 30%s I needed in my exams to pass the courses. It doesn't help that many of my classmates also feel the same way and came to me to make themselves feel better.

As much as I like being able to help people, I need to have my own space. One day I was having a hard enough time getting my own studying done but ended up talking classmates off the ledge. It's weird that I seem to give off an aura of someone who is on top of their studies to some people in the class, but others treat me like I'm an imbecile.

Toward the end of the year I was growing very weary of my classmates and was looking forward to summer. I'm hoping I can stay relaxed enough until the final marks are posted that I'm actually able to enjoy my summer!!