Tuesday, September 30, 2014

Perspective

Got to see a couple of my favourite kids in my practice. They're loud and busy and not at all shy. 

Thing 2 was sitting at the end of my exam table on my wheely stool. He pulled out the stirrups and told us these were obviously for his elbows. Obviously. He then proceeded to go through the drawers and pull out speculums, pads, swabs, pap brooms, etc. and "mix a potion".  

So silly. So awesome. 

After getting his vaccine, he stomped off down the hall to find my candy stash and grab an extra handful. 

I wasn't invited

Sweet old man with known prostate cancer, as I try to explain that he now has mets to his spine. "So the cancer moved out of my prostate and into my spine?"

"No. Your prostate cancer had babies and sent them to your spine. "

"Oh. They didn't even invite me to the baby shower!"

"Well, cancer is a jerk."

Wednesday, September 24, 2014

Terrifying noise

Just getting to sleep, window open, when I hear an ambulance at full tilt and a helicopter. I'm off call entirely, but because I'm in town it's reasonable to ask me to show up if they need more hands. 

The questions going through my head:
- am I going to get called in?
- is it one of my patients?
- is it one of my neighbours?
- did I miss something the last time I was in the Emerg?
- would I have been able to handle whatever is going on in the Emerg tonight?

So much for sleeping tonight. 

Saturday, September 6, 2014

Zestfully pronounced

TV show: image of police officer checking pulse of clearly frozen guy on the side of road, calls in a death for a coroner 
Me: well, you know what they say about being cold and dead....
My partner: that it's better to be cold than dead?
Me: no....
My partner: that's what they should say
Me: they say that someone isn't dead until they're warm and dead
My partner: that sounds like "you're not fully clean unless you're zestfully clean"
Me: exactly, only based on real science

Wednesday, September 3, 2014

Professionalism

Especially at this time of year, when med students are being introduced to their profession, I hear the word professionalism getting thrown around. It drives me a little crazy because what the administration, vice deans, etc. actually mean is "please don't embarrass us".

The subtle threats of discipline are based on a very narrow definition of professionalism. The powers that be (PTBs), want med students to behave like sweet children at all times. Med students should drink responsibly. They should use Facebook for only chaste reasons. They should not introduce themselves as doctor until they have actually finished med school and have an MD.

The PTBs are a little right. These acts are indeed part of what makes a medical student professional. But to become  physician whose colleagues will consider professional, there are many more "soft" skills these students need to become proficient with.

1. Social Media. SoMe is not the devil. It should be embraced by physicians and those in training. This article does a good job of briefly outlining the risks and benefits of practicing medicine in a world with social media. I use Twitter to keep on top of new research in family medicine and emergency medicine. Following FOAM articles on Twitter and blogs puts the basics learned in classrooms into a clinical perspective so that students' medical education is integrated, and, more importantly, self directed.

2. Self directed learning. To continue growing as a physician, we need to keep ourselves motivated to follow clinical questions that pop up during the day, and learn the skills required to do this. The idea of a flipped classroom starts to put the onus on students to prepare and do work outside of the classroom. I dream of a med school where all the teachers are passionate about their subjects and happy to put effort into preparing both the pre-work and the actual activities. Can you imagine these teachers working together to bring med students from being given predigested information to being able to answer questions similar to what will come up in real life practice? Encouraging students to feel comfortable asking for clarification? Moulding these students into future colleagues they want to work with?

Ideally by the end of the classroom portion of med school, the students would be ready for self evaluations of their work. Students should feel comfortable with what they do and do not know, and being comfortable with the vulnerability needed to ask for their teachers' opinions of their progress.

3. Communication. Not just using your doctor words, but learning how to have conversations with colleagues that are uncomfortable. Being able to disagree, admit you were wrong or that you made a mistake, asking for help, asking someone who knows more about a topic to teach you. These are all skills a professional doctor possesses. Our small groups, flipped classrooms, and clinical teaching environments are perfect places to cultivate these skills. We should be encouraging all teachers to work on communication with their med students while also teaching how to take a pulse. Praise the student who says they have no idea what they are supposed to be feeling for in a pelvic exam or are not sure how to read the chest x-ray. Don't demean these students or treat them like they're a waste of your time. These are the future colleagues that won't be too cocky to ask for the second opinion that could save a patient's life.

4. Self Care. A burned out physician is useless to their patients and to their colleagues. Learning how to take care of their mental and physical well being needs to get more than just lip service in medical schools. I have a lot more to rant about this, and will. Later.

5. Advocacy. Pick something that you love. Learn more about it. Make the world a better place. Most PTBs are pretty good about encouraging this, especially because when med students do good things, it makes up for all those times they embarrass their schools.

6. Compassion for each other. The competition that got us into med school can turn into icky feelings when we are thrown together for more than 4 years of intense, sleep deprived, time together. It's time to learn how to get along, how to make each other into the best docs possible. This includes all that I mention above. Do you have a secret that makes studying for anatomy a lot easier? Share it with your anatomy table, or hell, why not the whole class. Is someone missing from class for days at a time? Quietly check in to see if they need notes, a beer, or a shoulder to cry on. Something my small groups and I do is a weekly "check in" to encourage this behaviour. We start our sessions by discussing what important (or interesting) thing happened this week. I learned about my students' struggles with head and neck anatomy and watched as they helped each other through it. When a student disclosed a horrific event from his past, I was proud to see his classmates reaching out figuratively and literally to console him and thank him for sharing.

Medical students want to make the world a better place. Practicing professionalism through their education will help them to make that happen.