Category Archives: Laughter & Medicine

Students of Medicine

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The following is a transcript of a post by ‘Egyptian Doctor’ in the thread “Being a good medical student doesn’t mean you’ll be a good doctor” in the forum.facmedicine.com discussion board started October 2013. All copyright including graphics depicted remain with their respective owners.

There is a saying that you enter medical school wanting to help people but exit it wanting to help yourself. It may be a cynical view, but a realistic one. The criteria to being a good medical student are far different from being a good doctor. Medical education may be breeding a legion of self-serving, grade-grubbing, SOAP-note spewing machines rather than the empathetic, compassionate and caring physicians of admission essays yore.

 I was no different. My first two years of medical school, I was largely a disinterested student. I didn’t care for basic sciences, research or pathology. Like many others, my knowledge waxed and waned with the test schedule, and after Step 1, I entered my clinical years an acceptably successful medical student.

 Excellent medical student, terrible clinician

 Third year begins a reign of terror lead by the constant gauntlet of heavily-weighted rotation grades, standardized exams and the looming threat of residency applications and the Match, when, after 20 years of schooling, some pie-in-the-sky computer would tell me if I was good enough or not to be a doctor, and subsequently determine my life for the next three to seven years.

Grades were a priori to make myself the most competitive residency candidate possible. I studied and worked hard. Each patient became an opportunity for me to impress on notes, rapid-fire oral presentations and predict nuanced “pimp’ questions. I learned to charm patients just enough that they’d acknowledge my care to the attending during rounds. I interrogated my patients just enough to write the excellent notes I knew I’d be evaluated on. I learned about my patients by memorizing their daily lab values to proudly recite on rounds.

Patients weren’t people with problems but stepping stones to rack up points with the attending. Once rounds were over, patients became time-sucks from studying time, an exam worth 30% of every rotation grade. Real humans do not follow textbook presentations, but exams do; the warm body in front of me only detracted from my evaluation by cold scantron. By my attendings’ clinical comments, I was an excellent medical student, but I knew I was a terrible clinician, rehearsed only in the games of academia, not medicine.

How I learned to stop worrying about the Match and love patient care

My shift in paradigm came with a shift in career path. My worst fear as a fledgling surgeon was not matching for a residency spot. My worst fear as a fledgling emergency physician was killing a patient. Suddenly playing doctor became very real, and in the middle of my OB/GYN rotation, I started to care not about textbook presentations but real-world ones. I didn’t care for OB/GYN and volunteered to cover the peripartum critical care unit, a similar environment to emergency medicine.

My first day on the unit, I saw a patient roll in as I was in the middle of practice questions on the computer. I glanced up but returned to my test preparation, justifying my delay in evaluating the patient because the resident was still in surgery. Half an hour later, the resident came to evaluate the patient and I followed — the patient was obtunded, hypotensive and sitting in a growing pool of her own blood. It would not have taken a MD to realize that this patient required immediate medical attention, and I kicked myself for not evaluating her sooner. I may have been a pretend doctor, but it finally struck me that I was a pretend doctor on very real patients.

For the rest of my time in the unit, I made it a point to personally round every hour, on the hour, on every patient. I didn’t always write notes for these hourly rounds — getting credit was no longer important to me — patient care was. While they initially questioned my obsessive rounding, the residents quickly came to trust my dedication and leave me to my own in the unit, knowing I’d alert them if necessary.

At my institution, hell hath no fury like an OB/GYN resident unnecessarily interrupted, so I spent my time reading on appropriate treatment courses for the different conditions I saw in the unit. After I rounded, I’d give the resident a list of orders to put in, and the nurses began to treat me as the main provider in the unit. I got to be the first person to make critical medical decisions, responding to truly acute situations and drastically changing the course of a patient’s treatment. I pulled long hours and hardly studied in the traditional sense with prep books and practice questions, but I was constantly reading on my patients. That shelf exam and clinical evaluations were my best of the year. I had learned to stop worrying about the Match and love patient care.

Not “just” a student

After that revelation, I fought to earn more responsibility and trust on each rotation; I learned more, gained competence and became more satisfied in my chosen career in medicine. During emergency medicine , the specialty that started it all for me, I learned more medicine in one month than I did in my entire third year. It was a pass/fail course with no motivation by grading, but I was terrified I would be the first person to evaluate a patient and not recognize a critical condition. That hemorrhaging patient from day one on the peripartum critical care unit still haunted me. People can decompensate quickly and unpredictably — at any moment, you may go from being “just” a student, to being the only medical provider in the room.

At the end of that rotation, Step 2 breezed by with none of the misery I experienced with Step 1. Behind each question I’d see faces of patients with that exact presentation; behind each answer choice, I’d see the clinical consequence of making the wrong decision. Finally, I understood what it mean to be both an excellent medical student, and (at my level of training) an excellent clinician.

The academics of medicine often makes us forget the “59 yo AA M, PMH CHF dx 2010 (EF 20% by TTE 8/2013) p/w SOB x 2d” is a real person, with real vulnerabilities and real fears. We are not “just” students, but trainees and members of the medical profession. Grades and exams do not define us, but are simply checks on clinical competence. Trite as it may be, remember what you wrote about in your admissions essay — why you embarked on this journey in the first place. We came to medical school not to become excellent medical students, but to become excellent doctors.

Always keep that in mind. Everything else, the grades, the Match, the exams, will fall in place.

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Hearts, Doctors, Love

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lub dup.. lub dup..

Out of breath? Palpitations? Skip beats? It could be signs of heart problems.. That or you could just be in love. Either way, have a date with your doctor today and find out. Happy Healthy Hearts’ Day everyone!


Smile Therapy

As doctors sometimes the work that we do becomes routine and mundane, but then something unexpected happens that makes us realize why we do the things that we do. The following is a status update on a colleague’s FB page. Couldn’t help but smile myself. 🙂

“at the clinic earlier, a patient who was biopsied back in 2011 and has seen a couple of nephrologists (and fellows) since comes in. She tells me that I gave her the best explanation regarding her condition ever. She had stopped seeing her doctors since late 2011 because they didn’t explain what they were doing and what they had been looking for in her labs. So yeah, I left the clinic and my smile was *thiiiiiiiiiiiisssssssss* big. hahaha”

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About the author:

Tennille Tan, M.D. is a graduate of the UERMMMC College of Medicine Class 2005 and is a board certified nephrologist.


A fruit a day..

Daily Prompt: Ha Ha Ha

Tell us a joke! Knock-knock joke, long story with a unexpected punchline, great zinger — all jokes are welcome!

Photographers, artists, poets: show us FUNNY.

nutricious

Several years back I was eating fruits with my brother and sister when I chanced upon a worm in the fruit I was just about to bite into. For a brief moment I remembered a lecture in our parasitology and invertebrate zoology class (it gets worse in medicine class, but I digress) about worms being extra sources of proteins. Whatever. I then nonchalantly flicked it towards the direction of my sister who as expected reacted with a deafening scream of pure terror.

Oh, did I forget to mention the fact that for unknown reasons she’s terrified of them creatures?

Anyway, she told me how much she hated me for (it was a lie i’m sure of it, she always tell me that when I do crazy things to her) and kept yelling at the top of her lung capacity.

“Kadiri ka talaga kuya!” (“you’re really yucky big brother!”) she screamed at me.

“Well actually, there’s something worse than finding a worm in your fruit as you bite into it” I countered

“Talaga? Ano?” (Really? What?) she asked in full sarcasm.

“It’s biting into a piece of fruit and finding half a worm”

End of current discussion.


Chart Wars

After spending four years in med school, one year of internship, three years of residency and some time as a hospitalist, you tend to get the hang of how things work and sometimes writing patient histories and writing orders on the patient chart becomes semi automatic somehow. But sometimes, some things get lost in translation from the native tongue to the standard English language the as the following allegedly actual chart entries in one of the biggest government hospitals might attest to.

Patient has chest pain if she lies over her left side for over a year.

On the second day, the knee was better and on the third day, it disappeared.

She has no rigors or shaking chills, but her husband states that she was very hot in bed last night.

The patient is tearful and crying constantly. She also appears to be depressed.

The patient has been depressed since she began seeing me in 1993.

Discharge Status: Alive but without permission.

The patient refused autopsy.

The patient has no previous history of suicides.

She is numb from her toes down.

While in ER, she was examined, X-rated and sent home.

The skin was moist and dry.

Occasional, constant, infrequent headaches.

Patient was alert and unresponsive.

Rectal examination showed a normal sized thyroid.

She stated that she had been constipated for most of her life, until she got separated.

The lab test showed abnormal lover function.

The patient was to have a bowel resection. However, he took a job as a stockbroker instead.

Skin: somewhat pale but present.

Patient has two teenage children, but no other abnormalities.

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photo taken from http://www.bs757.com


Chasing Dreams.. Again

[NB: This article was previously published in my other blog as chasing dreams sometime in 2008. This has been slightly modified and updated from the original article for this blog post]

nurturing the dream

While on board a bus in heavy traffic, this thought came into my mind: when we were still kids and the issues of global warming and the environmental concerns were already present, although not yet a tangible reality, we were told to plant seeds in the hope that it will one day become a majestic tree.

Needless to say, that was a long time ago.

Now all grown up, I realized that it was not entirely a lie but it was more of a half-truth if you please. I do not know if it was an oversight of my teachers then, but in hindsight and retrospect, they should have also taught us that it was not enough that you plant a seed and hope that it will grow. It should be nourished, taken cared of and even protected from the harsh elements. Or perhaps they were actually wise in letting us learn that fact of life for ourselves as we grew older. I will never know. What I do know is that seeds are pretty much like our dreams. It’s not enough that we have a dream, it should be protected, nourished, and nurtured until it becomes a reality.

And that’s part of the reason I am writing all of this again now. A good friend of mine once told me that his dreams of becoming a doctor are becoming blurry and his work in the hospital only make matters worse.

It pains me to know about his situation and not be able to do anything about it. He has the intelligence, the skills and most especially the heart and passion needed to be a doctor. Wait, no, a great doctor. All that bars him from being so is a piece of plastic that serve as proof that he has the license to practice.

How 1,200 questions divided among twelve subjects taken in a span of 4 days determines who is “qualified” or not to treat people of their medical ailments is not for me to judge. Why must his his dream of being able to help others through healing of the body and of the spirit so elusive in the first place?

During our freshman medical orientation talk, one of our professors told the story of a young and promising medicine student who wanted to quit his studies because as much as he wanted to become a doctor, he wanted to be a pilot as well. When he told his professor his dilemma, all he was told was “I don’t see anything wrong with that.” Whoever said you could not pursue both dreams? To make the long story short, the young doctor to be did not drop out of school, finished his degree and went on to pursue his other dream. The last time he saw him, our professor said that he maintains his private practice as a doctor while flying for a commercial airline twice weekly.

Likewise, I had the chance once to meet a fellow doctor that not only treats people with pills and prescriptions, but he also heals with the arguably best medicine there is: laughter. And no, he’s not Dr. Patch Adams, although I did have the pleasure of meeting him once when he visited the country. He is Dr. Carlo Jose San Juan creator of the medical comic strip callous comics.

But going back to my friend, he once wrote on his online post, that he was at a crossroad and had asked for a sign. In irony, I had hoped that he failed in getting the promotion so that he can be once again free to chase that dream of his. And I’m still hopeful that his dream will be realized one day.

Our dreams may be grand or otherwise, but what is important is that they are our dreams, not dictated upon us or simply borrowed from others. We may have others who share and support our dreams, but ultimately it is ours to fulfill.


Mythbusters (repost)

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start them young ..

[NB: These are old posts which I will repost from my old blog which I started early back 2007 which got torn down by friendster. I am reposting them for public consumption. Salamat po ]

Here’s my take on Medical School Myths, Mythbuster style

Myth 1“I am better than my classmates” NOT.

Everybody in my class is better than me. They know more, they sleep less, and they are all better looking than me. Sabi nga ni Nel sa PBB “Lahat sila pang main dish, ako.. pang appetizer lang”. Buti na lang Mr. Personality ako Myth Busted

Myth 2 “Biology is the best pre-med”

I saw this one on a phamplet published by UST describing biology as the “preferred pre-med” for medicine. God, kung alam ko lang sana nagnursing na lang ako or nag medtech para sana mayfallback man lang ako. I guess kanya nila sinabi yun para wala ka talagang choice kung hindi magtapos ng med diba, ano ba pwede trabaho ng biologist? Myth Busted

Myth 3“All of the answers are in the books”

This is true up to a certain extent, until of course your professor blurbs out the proverbial phrase, “Class, base on my experience” In which case when examinations come, always choose the answer your proffesor told you even if all the books you read glaringly point out otherwise. Myth busted

Myth 4“If you retain about 15% of what you read in med school then you are already a good doctor”

I heard this when I was cramming up for an examination. It was supposedly quoted by Dr. Gisbert of Makati Med. What if 7% lang alam ko, does that make me an average doc? Myth Plausible

Myth 5“Teacher’s are gods and there powers trickle down to their Secretaries”

This 2 beings in med school are all omnipotent, in a whim they may make your life a living hell. They are the law, and what they say is final. There are always 2 sides to a coin, 1 good and 1 bad, usually the latter of the 2 beings would be mephisto incarnate. Myth plausible

Myth 6“Anak ng Diyos”

Meron din kami nito. This is the student who has the right blood lines, he/she is considered royalty in med school, in the corporate world he/she is the boss’s son/daughter. Even the feared secretaries kowtow to such a being. They get all the breaks. Word of advice, befriend such a being. Myth True

Myth 7 “Sandali lang ang medicine anak”

It takes too long, 4 years of premed, 4 years of med proper plus a compulsory 1 year of internship, another 3 months to wait for the august board exams, another 6 if you’re taking February. Two to three days to wait for the results, then 1-6 months being a pre-resident (depends I heard meron daw nagtiis ng 2 years), then another 3-5 years for residency training. Add 2-3 years for a subspecialty, and a life of reading volumes and volumes of books. Bottom line is by the time your earning your 1st paycheck your classmate in high school has already earned his 1st million. 26 na ako nay at nagaaral pa rin ako. Myth busted

originally posted @ jimbopogi.blogs.friendster.com on March 09, 2007

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