Our Worst Enemies

My Facebook Newsfeed has been covered with the Dove Beauty Debate.

It's a fairly powerful video for those who have every felt ugly. Most of us recognize this is untrue, but it's a message that is deeply ingrained. It is unacceptable in many cultures to be confident in one's looks. Our superficial self is less important than how we act "beauty is only skin deep".

Women learn to go to the washroom in groups and complain about our appearances. I remember being so proud of myself for dancing with a boy for the first time in 7th grade but feeling an overwhelming need to put myself down while in the washroom with the grade 8s. It's not like I was tied up and told that I was unattractive. Since I was able to pay attention I was susceptible to all the messages about what beauty is. I was not beautiful.

Speaking of these messages, what about those Ax ads? You know, the ones where women go running after boys who spray themselves with Ax body spray? Yuck. Unfortunately, Ax is owned by Unilever, the same company that owns Dove. Does it matter? I don't think so. The message of the Dove ad is just as valid.

A counter ad has also been making the rounds. Personally, I don't think they get it. It's about how guys are self confident and women try to make them feel bad about themselves. Thanks for supporting the previous ad.

Why does this matter? So what if women secretly think they are pretty but are afraid to admit it in public? There are thousands of articles on pubmed looking at the correlation between low self esteem and health, they speak for themselves. Women in my office have a hard time telling me what it is that is actually bothering them because they don't consider themselves important enough to take up my time. I'm astounded by the number of women I've seen in my very short career who have ignored the signs of cancer until it is too late to do anything.

We are taught in med school to address the patient as a whole. Is there a link between feeling beautiful and caring for one's health? There may be. Honestly though, I didn't find as much evidence as I expected. There are many studies on eating disorders and body image, as well as self esteem and cancer and sexual dysfunction.

Helping parents to raise men and women who are strong, who love themselves, and who will treat their bodies well is important to me as a family doc. I'm happy to see my colleagues, family, and friends debating the topic.

Not even the end of second year

And already my colleagues from medical school who have chosen other specialties are dissing family medicine docs.

We are not just a dumbed down version of your specialty, or even all the specialties.

We are a specialty of our own. We deserve your respect. I guarantee, no matter what you think, you could NOT do my job for a day. I couldn't do yours. And that's ok. It's why we chose different specialties to match to.

I know we need to be cocky to do our jobs well, but it should never, ever, be at the expense of another specialty.


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Half day back

Many of the family medicine residency programs now have half days back to our home clinic. It's a way for us to integrate the learning we're doing in the specialties to regular practice. It also let's us follow our treatment plans and know if we've made good decisions with our patients.

Today was a half day back for me. I followed up on three treatment plans. All going well. All on course. All getting better.

It's one of those days when I feel like I'm doing what I should be.


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Family Food Lore

When I was hospitalized as a teenager, my dad would come to visit me at dinner time. The hospital food they gave me was awful, seriously terrible. Rubberized pork chops, cold mashed potatoes and cooked carrots. There is no food I hate more than cooked carrots. My dad would sit with me and eat my food for me so the nurses wouldn't give me trouble for not eating. He didn't really know how else to show he cared that I was in hospital in the first place.

We would do the same when we visited other sick friends in the hospital. Bring chocolate or cookies and fruit then share them. Our family would bring Christmas dinner to the long term care facility and enjoy food and fun with my grandmother with Alzheimer's.

Families see food as a way to heal and to show we love each other.

We all have stories in our family about food. The chicken soup that grandma makes that can make anyone feel better, the day Uncle Bob started eating again and we all knew he would survive, turkey dinners mean that family is coming over and the house will be filled with love.

It can make things very confusing and difficult when a loved one at the end of life stops eating. We know from our family lore that food means love and health. It can be devastating when families aren't able to provide one of the few comforts that they know how to give.

Families often want to use what many health care providers consider to be extra-ordinary measures to prevent their loved one from starving. This includes tubes from nose to stomach or a tube inserted into the stomach or intestine through the skin which requires surgery. I've spent quite a lot of time explaining to families that at the end of life we don't really care if we are eating. When the family pushes for tubes, I ask them about the food lore in their family. Through that conversation we are able to find other aspects aside from the food that made the interaction loving.

Having my dad with me despite his hatred of hospitals was a huge deal. Singing songs with my cousins was wonderful. The story of the magic soup doesn't need the soup to be told. Memories of Christmas dinners are as much about the conversation and weird dates as the turkey. Holding hands, hugging, kissing and laughing are as much a part of family food lore as the food itself.


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My niece is the coolest girl I know

She loves our family and wants to hang out with all of us when we come visit. She wears party dresses almost every day and loves how they swirl around her. But that doesn't stop her from painting, jumping in leaves, climbing trees or being swung by her hands and feet.

She knows that wearing two colours of nail polish is twice as pretty. That her aunts will never believe that she's not ticklish and that we will always love her.

She also thinks that I know how to draw EVERYTHING. I think it helps that she only asks me to draw animals and pancakes.


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Graduation Festivities

I'm going to skip over the MCCQE and what I've been up to since writing it, with a promise to come back to it later.

Tonight our convocation festivities start.

One of the guys in my class said that he thought his family was making a much bigger deal of this than he thought it was worth. He recognizes that getting to this point in our lives is huge, but from his perspective, just another step.

I definitely get that. I think that these celebrations are a way for us to share what we've been doing for the past 4 years with our family and friends.

From our perspective, not much changes from when we first got our white coat four years ago to when we get our parchment tomorrow. It's true we've grown and learned, but we have been doing this at incremental steps so that it doesn't seem like much has changed. It's true that there has been work, but there's been fun and we've been doing it as a class with whom we've become close. It's hard to think about our day to day work as difficult when you're doing it with friends. Plus, we still need to start our residency in July which means packing, moving and trying to not look like an idiot on our first day. Our focus is far ahead to what is yet to come.

Our families on the other hand, have been dreaming of this day for longer than we have, even if they don't want to admit it. They are so proud of what we have done, seen and learned. They recognize the changes in our personalities, appearance and confidence. They are excited to see the class again since not seeing us all together since year 1. There have been few opportunities for them to share our accomplishments with us. They are excited to take photos of the new doctor in the family, to shake our hands and give us hugs. And to brag to everyone who will stand still for more than a few seconds to hear that cousin impostor is graduating from med school on Friday.

Our family and friends are proud of us.

I can't blame them really. I couldn't be more proud of my class.

OHIP Decision

This article in the Globe and Mail indicates an interesting change in how OHIP may be delivered and how it's payment may be considered.

"More broadly, the case suggests Canadians should be savvier before going under the knife, asking doctors how many of a given operation they have performed, and their death and complication rates. It also raises a delicate debate: How many operations does a surgeon have to perform to be considered proficient?"

When you consider several factors, including Malcolm Gladwell's Ten Thousand Hour Theory it's hard to imagine how medical students and physicians ever see enough of a specific pathology to master it. (In case you are unfamiliar with this theory, it essentially states that to truly be the master of *something*, you need to have practiced it for 10, 000 hours. Essentially four hours a day for ten years.)

Medications and imaging reduce the severity of many pathologies we may normally see. Speaking with residents and consultants, it seems that 10 years ago putting in chest tubes and draining abdominal ascites were procedures often done.

Now though I can honestly say I've seen 2 abdominal ascites drained and 2 chest tubes placed (both on the same patient). I would not be able to perform one myself if the need arises, but now that I've finished the rotations in clerkship where I might see one, I have to hope that when residency rolls around I'll have another chance.

Something as uncommonly seen as this cavernous brain stem tumour would be difficult to master based on number of cases alone, though interesting that the American surgeon managed to amass 200 cases. Would virtual cases or those practiced on animal models count to one's mastery?

What is most concerning about the principle behind this ruling in favour of Brad's family is that if everyone decides to only be treated by the very best, those of us training to do our best are unable to learn. When the specialists retire, the patients will have set up a situation with no one to care for them.

Clearly this is taking it to the extreme, but I think the point is still valid. Medical trainees need to learn on real patients. Patients deserve the best care. These two factors do not need to be mutually exclusive and we see that in academic hospitals.

When trainees are in the OR with their consultants, the trainee does the majority of the surgery while the consultant assists. The consultant is there if the trainee needs help and to offer advice about unusual findings during the procedures. The patient gets the care of several surgeons, often two anesthesiologists and 2-3 nurses during their surgery. The trainees have read about the case and the pathology and are up on the latest findings (unless they are terrible trainees, but that's another story).

I'd feel safe in a training hospital.

But I'm still stuck on what it will take for me to be a great family doc. Our residency is only 2 years. I feel like I haven't been studying enough to be on top of everything I'm supposed to know for clerkship let alone residency. Getting my 10, 000 hours in is going to be a challenge.

Currently, I'm in the hospital on the weekend, taking an extra call shift in the hopes of seeing a new pathology I haven't seen before. I know that I learn by seeing and doing and that I can't do this from home.

All talk no action?

One of the first 'touchy feely' things we talked about in med school was how to doctor the doctor. That is, how to treat a colleague in need of medical attention.

I've been thinking a bit about that discussion and how applicable it really could be.

There's something terribly abstract about a lot of the discussions we have in our weekly groups. We talk big, things we would do in certain situations, but will we actually act this way?

I spent a large part of the last three weeks in the hospital with my parent who was having heart surgery. This was unexpected and very scary. My family was kept in the dark quite often about what was going on. Doctors would talk to the stoned patient who would then pass on incredibly strange interpretations of what was going to happen next/what had already happened. At one point, the staff had Dad wrapped up and ready to ship to another hospital while my mother and I were worried in the waiting room, oblivious to why the procedure had taken so long and wondering if anyone was going to come and talk to us. Apparently, they weren't.

Patient centred my large white bum.

Losing control of something as simple as how information is passed on to us was incredibly upsetting, especially for me. I had no idea I was such a control freak, but apparently no one else was surprised.

My father is now home and doing well and doesn't remember much of his hospital stay. All the more reason that his medical decisions and information should have been considered with a family member present. I'm glad he's doing well, but confused about how others dealt with the situation.

Apparently my entire family but one is afraid of hospitals and illness. They choose to ignore it and hope for the best. The one exception is overseas - I can't imagine how stressful that can be.

What bothers me about everyone being afraid of hospitals is the assumption that I will just take care of everything. I get that I'm in med school and can handle a bunch more and understand what's going on. I worry that when my parents are old and in need of help that I will be expected to be the one to take care of them. That worries me. A lot.

I was also thrown by classmates' reaction to me while this was going on. I am currently the epitome of depression. It's from being emotionally and physically exhausted and just so far behind in everything that I need to do. I know it will go away, but I really need support now while I deal with it.

One classmate who I consider a friend but wouldn't think of asking for help emailed me her notes to keep me in the loop on days I missed. I was surprised and very very happy that she cared that much and recognized that I needed a hand. A few others in the class have been very supportive. Ones I would and would not have expected. They noticed I was missing and wanted to know if I needed help. So fantastic.

Others that I consider to be friends are completely ignoring me. I guess they're waiting for the non-depressed me to show her face before trying to engage in conversation again.

This makes me worry about 'the person in our class who will develop mental illness during our 4 years here'. Apparently there's one in every class. I hope the person who notices the out of character behaviour is able to help and can act in the idealized way we discuss in our groups.

Do what you love and the rest will follow

'Do what you love and the rest will follow' is advice that I have passed on to anyone wishing to apply to Medical School. It really doesn't get more simple than that. I love swinging in the park, hanging out with my brother's kids, eating chocolate and drinking coffee, hitting the gym and cooking. I loved my jobs, the volunteering I did before I got here and the degree I was studying. That shone through on my essays and in my interview. If I had done everything by the book and volunteered in an emergency room or done a degree in biomedical sciences, I'm not sure I would have been admitted. That's the selfish side of doing what you love.

The practical side is that it makes everything you do easier. When we're little and have to go somewhere we don't want to, we dawdle. I'm sure it drove our parents nuts. It takes forever to get a kid that doesn't want to go somewhere out the door. Putting on shoes, finding coats and remembering to go pee can take an hour. I wonder if it's fair to assume that when I'm taking forever to get to my early morning meetings with faculty and administration if it's just that I don't want to go there. The days that we have early morning clinical methods however, I'm out the door like a shot.

I'll try to pay attention next year during clerkship to find out what gets my feet moving in the morning and what will make it easier to leave the house. That might finally let me know which specialty is calling my name!

Here is a set of links to advice from the women at 'Mothers in Medicine'. They are what these women would have wanted to know upon their acceptance to med school. Things like don't lose yourself, don't do it for the money, you will miss and love the classmates you currently want to throttle, the happiest med students are in their mid twenties, all the crap will be worth it, take a calcium supplement, don't let yourself get too fat, write in the school paper, it will all work out, you're never alone.

Expectations

It's time for another rant. I'm in a terrible head space right now because my mother laid a wicked guilt trip on me last night. The family came to town for Easter Vigil Mass and I chose to go with them rather than skip it or go to a much closer (and as it turns out, 2 hour shorter) service. But I went. And I went to communion. Then in front of the church, she told me that I shouldn't have gone to communion, that living with my partner means that I'm not allowed to go to communion. She loves me, but needs me to know that it's not OK that I think that I'm eligible to go to communion. She wants me to annul my previous marriage and get married and make everything legal and perfect. Since weddings are so cheap, and med school is practically paying me to attend, of course I'll do that. I'll do it tomorrow. And then everything will be absolutely perfect and she'll love me.

But wait. I don't want to have children. Oh, well, you can't be a good Catholic and not procreate like little bunnies. Ok, so what if I'm biologically incapable? Well that's fine then.

But wait. You're willing to counsel women in making their own choices? You will help a person through their last moments on earth with pain relief that may hasten their death as a side effect of alleviating their pain?

I don't know why I'm trying so hard to be a good child. She's already picked the perfect one. It's the one that drinks almost every night, always assumes she can have the car, lies to both my parents, isn't planning on a future education and will likely be married and pregnant and married by the time she's 25. That's the perfect daughter.

The one who never drank through high school, worked her ass off at home and outside of home to provide for herself and family, who got into effing medical school but lives with her boyfriend...well that one's just plain evil.

I'm so incredibly jealous of friends and class mates who have a safe home and haven with their families. It's hard to imagine a place where you know that everyone will love you, even if you decide you want to be a doctor.