I have an announcement to make! After 48 hours of incredibly hard work and very little sleep:
A new thesis comes into the worldTo prevent the spread of germs (mine to you), visitors are very welcome after April 2nd.
Thursday, February 25, 2010
The Post Triumphant!!
To prevent the spread of germs (mine to you), visitors are very welcome after April 2nd.
Wednesday, February 24, 2010
We're Not Alone
And, as proof that others have felt this way since time began (or at least since the first world war):
Turning and turning in the widening gyre
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,
The blood-dimmed tide is loosed, and everywhere
The ceremony of innocence is drowned;
The best lack all conviction, while the worst
Are full of passionate intensity.
Turning and turning in the widening gyre
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,
The blood-dimmed tide is loosed, and everywhere
The ceremony of innocence is drowned;
The best lack all conviction, while the worst
Are full of passionate intensity.
Surely some revelation is at hand;
Surely the Second Coming is at hand.
The Second Coming! Hardly are those words out
When a vast image out of Spiritus Mundi
Troubles my sight: a waste of desert sand;
A shape with lion body and the head of a man,
A gaze blank and pitiless as the sun,
Is moving its slow thighs, while all about it
Wind shadows of the indignant desert birds.
The darkness drops again but now I know
That twenty centuries of stony sleep
Were vexed to nightmare by a rocking cradle,
And what rough beast, its hour come round at last,
Slouches towards Bethlehem to be born?
(Yeats, The Second Coming)
Things Fall Apart
The book by Chinua Achebe describes a man who watches in dismay as his way of life becomes obsolete. The analogy is a pretty good one for 3rd year at the JMP. The first two years, you mosey along, doing PBL like it's a hobby, thinking to yourself how fun medical school has turned out to be. You don't actually bother to remember much from the first year, and you remember a little more from the second. Third year, you begin to realize ways in which some of the common myths passed around the JMP are actually hurting some of its type A procrastinators (hmm, I wonder if I fall into this category).
First, I'm exhausted so please take this post, if you happen to be reading it at the moment, with a grain of salt.
To reiterate: please take this post with a grain of salt. None of these generalizations are subscribed to by everyone, professors and students, in the JMP -- in fact, I think only a few individuals actually believe them. But they have somehow become acceptable to say. I debunk them below.
Top Ten Myths Passed Around the JMP
1. "Don't worry now -- after all, the boards/thesis/exams/wards are a long way away. The best preparation is lots of fun and sleep." This is not true. I cannot even tell you how many times people (including professors) brushed me off instead of helping me find the tools to really learn and make myself a better student. Now, in my 3rd year, I find myself having to correct mid-course. Sleep is important, obviously. But so is taking your work seriously! You're not paying $30,000/year to scrape by.
2. "Oh, whatever -- I barely studied. Who cares, anyway? Screw it." This attitude is addictive. I know I've gotten sucked into it. But really, people? This is not middle school, it's medical school. I realize they both begin with M. But you're still too cool for school?
3. "You'll never know everything, so don't worry about it. Just enjoy it the first time around, it'll be back." Yes, but if you never take the time to understand it when it's fresh and exciting, it'll always be a mystery and eventually you'll develop a mental block, whether it's EKGs, ABG's, or other acronyms that scare you. Better advice would be, "There is a lot to learn, but don't feel anxious. Just take it one step at a time and focus on the task at hand."
4. "Medicine keeps changing. Don't bother to memorize anything." This is something I've heard again and again and again, and truly it does students a disservice. Memorization helps you remember things so that you can understand them the second time around. And glycolysis hasn't changed in my lifetime (or yours, either)! Anatomy? Still the same (evolution isn't that fast). Normal vital signs? Very crucial. So ditch the hippie attitude. It is important and we do need to know it by heart. When it changes, we'll have a basis to understand the change.
5. "In PBL, students call the shots and can learn whatever they want, however they want to learn it." Again, not true. There are standards, they are simply not published. So please, please ditch this myth and the passive-aggressiveness it generates. If you want us to learn something specific, don't use the unit exam to tell us this -- just tell us! Believe me, we won't be offended or crippled by a little spoon-feeding now and then. Getting angry at us when we don't want to 'challenge ourselves' is a failure to recognize a cry for academic, or personal, help. All together, now: 1, 2, 3...HELP!
6. "This is great preparation for the real world." No, this is the real world. I've said this before, and I'll say it again. You don't tell a 5-year-old that learning to write is super easy, so why are they stressing? You don't tell them that a playground fight is no big deal. No, you help them with their writing, even if it takes you three hours, and you clean the wounds from the fight while trying to figure out what's going on with your kids. Here's a secret: medical students are just 5-year-olds who are older. So please accept the fact that for us, life is actually difficult, the demands on our time are perhaps more than we have the skills to deal with, and that yes -- when we're 50 it might be easier for us, but we're still LEARNING. That's why it's called school. So please be patient instead of dismissive when we're stressed or overwhelmed. Of course, that is never an excuse for us to act mean or rude. But realize we're learning more than how to use an iphone app. Some of us are still learning how to keep ourselves clean and clothed.
7. "We have an integrated curriculum." No, we have three arms of the curriculum -- clinical skills, master's thesis, and PBL. They are all vying for our attention (which is very flattering, by the way). They're all useful and exciting. However, they are not integrated. Each arm rarely can describe what's going on with the other two. All of them tend to demand a lot of time and effort. Please don't pretend that you've integrated the curriculum -- you've presented the curriculum to your students, who are integrating it in their studies. But we may as well be taking three entirely different classes in three different departments on three different campuses, because that's how much logistical coordination and effort is required to pull it off. And THAT'S OK. But let's be honest.
8. "We know what you're going through." I appreciate this as what it's meant to be -- a genuine expression of empathy. However, rarely does someone use this when they actually know what I'm going through. Unless you have individually met with a student and figured out how they learn, their academic history, what their home life is like, their level of fatigue, their morals and values, and their other commitments -- then no, you have very little idea of what they're going through. This just sounds dismissive. See #6, above.
9. "Everyone needs a therapist." No. Everyone needs more sleep. Everyone needs food and water and shelter from precipitation in freezing weather. But everyone does not need a therapist. If YOU need a therapist, that's absolutely fine. I like therapists. Hell, I even let them use my bathroom! (That was a joke. Joke. Joke.) But my point is, please, please, please stop telling me I need a therapist. If I've offended you, I'm sorry. Otherwise -- huh? Stress is okay. Sadness is normal. If I feel like I'm sliding, I'll go to a therapist. But it's just rude to assume you know what someone else needs unless you're deliberately trying to stage an intervention. I realize the point of this is to emphasize that MANY medical students go through depression or have other mental health needs, and I think that needs recognition. I just don't need to find a therapist myself to recognize that others might want one! I SUPPORT YOUR DECISION TO GO TO THERAPY. I SUPPORT YOUR DECISION TO GO TO THERAPY. I SUPPORT YOUR DECISION TO GO TO THERAPY. Ahhhh.
10. "If a student doesn't do well on this exam/thesis/final/oral/preceptorship, it must be that there's something wrong in the student's personal life." This is actually not a bad assumption for a professor to make, but it would be a lot easier if they also understood something else: I care about your subject very much. I do not deliberately want to blow it off. But I'm juggling, and sometimes, I cannot prioritize your subject/ball. Sometimes your subject/ball will drop on the ground. I will pick it up, dust it off, and continue to juggle. But until I'm a master juggler, balls are gonna drop. If it belonged to you, I'm truly sorry and will try to do better. But it's really not personal -- it's not about you, and it's not about my personal life. It's purely about my juggling ability.
Wow, that was cathartic. Okay, back to my real life. Which right now involves an emergency nap (we had an exam this morning).
P.S. I just want to say that you rock. That's right, YOU -- mom, dad, brother, friend, partner, unsung professor who really gets it, loved-one-in-some capacity -- you are people I care about, look up to, and try to do well for. Thank you for being there.
First, I'm exhausted so please take this post, if you happen to be reading it at the moment, with a grain of salt.
To reiterate: please take this post with a grain of salt. None of these generalizations are subscribed to by everyone, professors and students, in the JMP -- in fact, I think only a few individuals actually believe them. But they have somehow become acceptable to say. I debunk them below.
Top Ten Myths Passed Around the JMP
1. "Don't worry now -- after all, the boards/thesis/exams/wards are a long way away. The best preparation is lots of fun and sleep." This is not true. I cannot even tell you how many times people (including professors) brushed me off instead of helping me find the tools to really learn and make myself a better student. Now, in my 3rd year, I find myself having to correct mid-course. Sleep is important, obviously. But so is taking your work seriously! You're not paying $30,000/year to scrape by.
2. "Oh, whatever -- I barely studied. Who cares, anyway? Screw it." This attitude is addictive. I know I've gotten sucked into it. But really, people? This is not middle school, it's medical school. I realize they both begin with M. But you're still too cool for school?
3. "You'll never know everything, so don't worry about it. Just enjoy it the first time around, it'll be back." Yes, but if you never take the time to understand it when it's fresh and exciting, it'll always be a mystery and eventually you'll develop a mental block, whether it's EKGs, ABG's, or other acronyms that scare you. Better advice would be, "There is a lot to learn, but don't feel anxious. Just take it one step at a time and focus on the task at hand."
4. "Medicine keeps changing. Don't bother to memorize anything." This is something I've heard again and again and again, and truly it does students a disservice. Memorization helps you remember things so that you can understand them the second time around. And glycolysis hasn't changed in my lifetime (or yours, either)! Anatomy? Still the same (evolution isn't that fast). Normal vital signs? Very crucial. So ditch the hippie attitude. It is important and we do need to know it by heart. When it changes, we'll have a basis to understand the change.
5. "In PBL, students call the shots and can learn whatever they want, however they want to learn it." Again, not true. There are standards, they are simply not published. So please, please ditch this myth and the passive-aggressiveness it generates. If you want us to learn something specific, don't use the unit exam to tell us this -- just tell us! Believe me, we won't be offended or crippled by a little spoon-feeding now and then. Getting angry at us when we don't want to 'challenge ourselves' is a failure to recognize a cry for academic, or personal, help. All together, now: 1, 2, 3...HELP!
6. "This is great preparation for the real world." No, this is the real world. I've said this before, and I'll say it again. You don't tell a 5-year-old that learning to write is super easy, so why are they stressing? You don't tell them that a playground fight is no big deal. No, you help them with their writing, even if it takes you three hours, and you clean the wounds from the fight while trying to figure out what's going on with your kids. Here's a secret: medical students are just 5-year-olds who are older. So please accept the fact that for us, life is actually difficult, the demands on our time are perhaps more than we have the skills to deal with, and that yes -- when we're 50 it might be easier for us, but we're still LEARNING. That's why it's called school. So please be patient instead of dismissive when we're stressed or overwhelmed. Of course, that is never an excuse for us to act mean or rude. But realize we're learning more than how to use an iphone app. Some of us are still learning how to keep ourselves clean and clothed.
7. "We have an integrated curriculum." No, we have three arms of the curriculum -- clinical skills, master's thesis, and PBL. They are all vying for our attention (which is very flattering, by the way). They're all useful and exciting. However, they are not integrated. Each arm rarely can describe what's going on with the other two. All of them tend to demand a lot of time and effort. Please don't pretend that you've integrated the curriculum -- you've presented the curriculum to your students, who are integrating it in their studies. But we may as well be taking three entirely different classes in three different departments on three different campuses, because that's how much logistical coordination and effort is required to pull it off. And THAT'S OK. But let's be honest.
8. "We know what you're going through." I appreciate this as what it's meant to be -- a genuine expression of empathy. However, rarely does someone use this when they actually know what I'm going through. Unless you have individually met with a student and figured out how they learn, their academic history, what their home life is like, their level of fatigue, their morals and values, and their other commitments -- then no, you have very little idea of what they're going through. This just sounds dismissive. See #6, above.
9. "Everyone needs a therapist." No. Everyone needs more sleep. Everyone needs food and water and shelter from precipitation in freezing weather. But everyone does not need a therapist. If YOU need a therapist, that's absolutely fine. I like therapists. Hell, I even let them use my bathroom! (That was a joke. Joke. Joke.) But my point is, please, please, please stop telling me I need a therapist. If I've offended you, I'm sorry. Otherwise -- huh? Stress is okay. Sadness is normal. If I feel like I'm sliding, I'll go to a therapist. But it's just rude to assume you know what someone else needs unless you're deliberately trying to stage an intervention. I realize the point of this is to emphasize that MANY medical students go through depression or have other mental health needs, and I think that needs recognition. I just don't need to find a therapist myself to recognize that others might want one! I SUPPORT YOUR DECISION TO GO TO THERAPY. I SUPPORT YOUR DECISION TO GO TO THERAPY. I SUPPORT YOUR DECISION TO GO TO THERAPY. Ahhhh.
10. "If a student doesn't do well on this exam/thesis/final/oral/preceptorship, it must be that there's something wrong in the student's personal life." This is actually not a bad assumption for a professor to make, but it would be a lot easier if they also understood something else: I care about your subject very much. I do not deliberately want to blow it off. But I'm juggling, and sometimes, I cannot prioritize your subject/ball. Sometimes your subject/ball will drop on the ground. I will pick it up, dust it off, and continue to juggle. But until I'm a master juggler, balls are gonna drop. If it belonged to you, I'm truly sorry and will try to do better. But it's really not personal -- it's not about you, and it's not about my personal life. It's purely about my juggling ability.
Wow, that was cathartic. Okay, back to my real life. Which right now involves an emergency nap (we had an exam this morning).
P.S. I just want to say that you rock. That's right, YOU -- mom, dad, brother, friend, partner, unsung professor who really gets it, loved-one-in-some capacity -- you are people I care about, look up to, and try to do well for. Thank you for being there.
Thursday, February 18, 2010
You know you're a lucky lady when...
...your brother initiates a dinner-rescue-plan whereby he spends twenty minutes convincing you he means it when he offers to drive an hour out and an hour back JUST to have dinner because he knows you're stressed out from studying and you refused to drive out anywhere.
...your mom hears of the plan and comes along, bringing soup for your freezer.
...and a jacket from your dad, who bought you one as a surprise (thanks! it's awesome!)
...you go out to dinner with them, and your mom and brother are charming, listen to your inane and nerdy stories, gently tell you about what's happening in the real world, and then your brother picks up the tab.
...the cat is so happy to see them that she bounces around like a kitten, even though she's 12.
...you have them to go home to once the boards are over.
Sigh. Warm. Fuzz.
...your friends buy you frozen yogurt and invite you to a party
...your fiance thinks you have every right to vent, even if you really don't
...your classmates share study resources with one another and truly wish each other well
...your cousin doesn't need stitches after all! :)
...your friends find romance and it makes them happy, thereby making you happy
...people come home from abroad and leave you a voice mail
I could go on for ages. This counting blessings thing gets addictive.
...your mom hears of the plan and comes along, bringing soup for your freezer.
...and a jacket from your dad, who bought you one as a surprise (thanks! it's awesome!)
...you go out to dinner with them, and your mom and brother are charming, listen to your inane and nerdy stories, gently tell you about what's happening in the real world, and then your brother picks up the tab.
...the cat is so happy to see them that she bounces around like a kitten, even though she's 12.
...you have them to go home to once the boards are over.
Sigh. Warm. Fuzz.
...your friends buy you frozen yogurt and invite you to a party
...your fiance thinks you have every right to vent, even if you really don't
...your classmates share study resources with one another and truly wish each other well
...your cousin doesn't need stitches after all! :)
...your friends find romance and it makes them happy, thereby making you happy
...people come home from abroad and leave you a voice mail
I could go on for ages. This counting blessings thing gets addictive.
Tuesday, February 16, 2010
Running (out of excuses not to run)...
Wow, I'm prolific right now. I don't even know why. Today I went for my first run in a long time -- I think since I went running with B when I was visiting him. And it felt GOOD! I got a mild runner's high going in maybe the first five minutes, and then I kept it up for pretty much the whole half hour. And it was beautiful, the sun was slanting in over the bay, and people were out and about, and I just had fun. So many adorable dogs, it was an animal lover's paradise this afternoon. And perhaps the best part was that when I got home feeling all glowy and athletic, I saw the sun setting out of the window and that was spectacular, too.
Thanks for finding this place, Mom and Mashi!! You both rock big-time.
Um, so why don't I do this more often?
Thanks for finding this place, Mom and Mashi!! You both rock big-time.
Um, so why don't I do this more often?
Musings on V-Day
This Sunday was Valentine's day, and I didn't get to see B, but we had already celebrated the weekend before. I got him the first season of Chuck, which is apparently no longer online, and he took me out for a champagne brunch! Yum. It was right after symposium AND the medical school formal, so that was a wonderful chance to relax together before the boards/law school resumed control of our lives. I don't think it's cool that people kept bugging him about coming to see me specifically for V-day -- poor guy! We already celebrated together. Yeesh, leave him alone. My mom, however, flew out to see my dad in Tokyo for Valentine's Day! Aww, cute parents.
I don't think Valentine's Day should be a Hallmark (tm or whatever) holiday, with lots of commercial stuff, but I think it is a nice idea. I think it's nice that the we care enough about love to set aside one day out of the year, one day when you are allowed, even expected, to spend time with your partner. And if you're single, I think the point of Valentine's day is to enjoy yourself, just remembering who you are and the talents you bring to the world, maybe appreciating the gifts you've been given. Showing yourself some serious love!
My favorite single Valentine's Day has always been (surprise surprise) a cup of tea, a cat, and a good book. There was one time people made anti-Valentine's Day cards at my high school because they were single (and again in college), but somehow it seemed too -- unhappy to be making cards against love, or against yourself for being single, or against the world for not providing someone... I don't know. My mom is an optimist and it's a trait I greatly admire. Life is too short to be cynical and too long to stay angry, you know?
Eve Ensler did the V-day monologues to reclaim Valentine's Day, in part. I think they're very powerful for women who aren't aware of their sexuality, or don't feel they can own up to it properly. But on the other hand, I think our society is a little too obsessed with sexuality. Somehow, the content of your character gets lost by the wayside.
Anyway, so back to the cup of tea, cat, and good book (I wasn't single this year, but I was far from my valentine, and from my non-furry family members): One of my favorite series of all time is Anne of Green Gables by L.M. Montgomery. By the standards of the day, Anne was very liberated -- but she just did her own thing and lived by example. Kind of like my grandparents and my parents, come to think of it.
This is a V-day-appropriate verse from Locksley Hall by Lord Alfred Tennyson that LM Montgomery quotes from a lot:
Love took up the glass of Time, and turn'd it in his glowing hands;
Every moment, lightly shaken, ran itself in golden sands.
Love took up the harp of Life, and smote on all the chords with might:
Smote the chord of Self, that, trembling, pass'd in music out of sight.
Many a morning on the moorland did we hear the copses ring
And her whisper throng'd my pulses with the fulness of the Spring.
Many an evening by the waters did we watch the stately ships,
And our spirits rush'd together at the touching of the lips.
I don't think Valentine's Day should be a Hallmark (tm or whatever) holiday, with lots of commercial stuff, but I think it is a nice idea. I think it's nice that the we care enough about love to set aside one day out of the year, one day when you are allowed, even expected, to spend time with your partner. And if you're single, I think the point of Valentine's day is to enjoy yourself, just remembering who you are and the talents you bring to the world, maybe appreciating the gifts you've been given. Showing yourself some serious love!
My favorite single Valentine's Day has always been (surprise surprise) a cup of tea, a cat, and a good book. There was one time people made anti-Valentine's Day cards at my high school because they were single (and again in college), but somehow it seemed too -- unhappy to be making cards against love, or against yourself for being single, or against the world for not providing someone... I don't know. My mom is an optimist and it's a trait I greatly admire. Life is too short to be cynical and too long to stay angry, you know?
Eve Ensler did the V-day monologues to reclaim Valentine's Day, in part. I think they're very powerful for women who aren't aware of their sexuality, or don't feel they can own up to it properly. But on the other hand, I think our society is a little too obsessed with sexuality. Somehow, the content of your character gets lost by the wayside.
Anyway, so back to the cup of tea, cat, and good book (I wasn't single this year, but I was far from my valentine, and from my non-furry family members): One of my favorite series of all time is Anne of Green Gables by L.M. Montgomery. By the standards of the day, Anne was very liberated -- but she just did her own thing and lived by example. Kind of like my grandparents and my parents, come to think of it.
This is a V-day-appropriate verse from Locksley Hall by Lord Alfred Tennyson that LM Montgomery quotes from a lot:
Love took up the glass of Time, and turn'd it in his glowing hands;
Every moment, lightly shaken, ran itself in golden sands.
Love took up the harp of Life, and smote on all the chords with might:
Smote the chord of Self, that, trembling, pass'd in music out of sight.
Many a morning on the moorland did we hear the copses ring
And her whisper throng'd my pulses with the fulness of the Spring.
Many an evening by the waters did we watch the stately ships,
And our spirits rush'd together at the touching of the lips.
I think the fourth line is especially powerful. Is losing yourself in the music a good thing? I hope so! I think if it's your ego, it must be :)
How can I help you?
I'm going to try to express what bugs me so much about our clinical preceptorships. It's not just visiting a new hospital every semester and getting taught by another new doctor whom you'll only meet three times. I like the patient visits a lot, and I like hearing people's stories and practicing physical exam and seeing how the whole hospital/clinic/ER works, but...still. I hesitate. Here's what happened this morning:
She was pretty stoic about her condition. After years of working as a health worker herself, she was hospitalized by sudden and severe back issues that left her in a wheelchair for life. In addition, she is obese and diabetic. She has fungal infections in the folds of her skin, which had opened the pathway for bacterial infection. She has had several severe cellulitis infections (skin infections that turn red, make you swell up, and spread rapidly). Luckily, her partner seems to be supportive but there are, as she pointed out, limits.
She agreed to speak with me, told me her health history, and then gave me her story. She knew all of her medications, trade name and generic, with dosages and also what they do -- which I think is an unmatched feat (among the patients I've seen). But as she spoke to me, I got this overwhelming sense of -- what are you going to do? Like she was testing me, and wanted me to 'practice' on her, but also that she was fed up.
So what did I do? Given that we didn't have to do the whole exam for our last two patient visits, and that my preceptor was waiting, I opted to do a focused H&P (meaning the problem at hand, any relevant history -- which is often extensive, and then pick one system to examine). With her, obviously, it was skin. I wanted to do the neuro exam, too, which is much more extensive and involves cranial nerves, motor, sensory, and mental status -- but I had a feeling she had had it. I asked if her feet hurt, and she said yes, but I could touch them. And I was thinking -- why am I here? To practice? I can't help you -- I don't have the knowledge. I can do a neuro exam, but you don't need one. You need to go home. I got this overwhelming sense of shame, making someone go through the paces -- and there was no interest from her about what they were teaching us, etc, which you often get if you examine healthcare workers. So I think she was humoring me, and I did the basics and ran -- well, not quite, but spent almost as much time on her labs (40 minutes) as with her (70 minutes).
Wimpy? Dumb? Good idea? Bad idea? I mean, obviously, I can't and won't when I'm on the wards -- but on the wards, I'll have a function that goes beyond putting people out for the sake of my own learning.
She said to me, "This is not how I envisioned living at 5X years old. It's not much fun having to show your boobies to everyone (common site of fungal infections). I don't want to visit the hospital again for another 7 years." My preceptor seemed to think that much of it stemmed from carrying extra weight -- probably around 100 lbs. But the fundamental question I wanted to ask this brave, somewhat fed-up, and talented historian was, "I'm not even on the wards yet. So how can I help you?"
And the painful answer is, I can't. I can just learn from you in order to help someone else. And none of my professors have given me a truly good justification for why one patient (who has 'volunteered,' but often is simply doing it as a favor to their doctor) should go through an hour or two of crap for me.
I mean, some patients really enjoy teaching. They enjoy interacting with a medical student, they like telling their stories, they don't mind someone spending an extra hour with them. But inevitably, as a student, you are called upon to examine and interview people who don't really get much out of it. And unlike when you're on the wards or when you're a physician, you can't say, "I know this is annoying/embarrassing/painful, but I'm really trying to help you." Because you're not trying to help them! You're just trying to get to the point where you could.
She was pretty stoic about her condition. After years of working as a health worker herself, she was hospitalized by sudden and severe back issues that left her in a wheelchair for life. In addition, she is obese and diabetic. She has fungal infections in the folds of her skin, which had opened the pathway for bacterial infection. She has had several severe cellulitis infections (skin infections that turn red, make you swell up, and spread rapidly). Luckily, her partner seems to be supportive but there are, as she pointed out, limits.
She agreed to speak with me, told me her health history, and then gave me her story. She knew all of her medications, trade name and generic, with dosages and also what they do -- which I think is an unmatched feat (among the patients I've seen). But as she spoke to me, I got this overwhelming sense of -- what are you going to do? Like she was testing me, and wanted me to 'practice' on her, but also that she was fed up.
So what did I do? Given that we didn't have to do the whole exam for our last two patient visits, and that my preceptor was waiting, I opted to do a focused H&P (meaning the problem at hand, any relevant history -- which is often extensive, and then pick one system to examine). With her, obviously, it was skin. I wanted to do the neuro exam, too, which is much more extensive and involves cranial nerves, motor, sensory, and mental status -- but I had a feeling she had had it. I asked if her feet hurt, and she said yes, but I could touch them. And I was thinking -- why am I here? To practice? I can't help you -- I don't have the knowledge. I can do a neuro exam, but you don't need one. You need to go home. I got this overwhelming sense of shame, making someone go through the paces -- and there was no interest from her about what they were teaching us, etc, which you often get if you examine healthcare workers. So I think she was humoring me, and I did the basics and ran -- well, not quite, but spent almost as much time on her labs (40 minutes) as with her (70 minutes).
Wimpy? Dumb? Good idea? Bad idea? I mean, obviously, I can't and won't when I'm on the wards -- but on the wards, I'll have a function that goes beyond putting people out for the sake of my own learning.
She said to me, "This is not how I envisioned living at 5X years old. It's not much fun having to show your boobies to everyone (common site of fungal infections). I don't want to visit the hospital again for another 7 years." My preceptor seemed to think that much of it stemmed from carrying extra weight -- probably around 100 lbs. But the fundamental question I wanted to ask this brave, somewhat fed-up, and talented historian was, "I'm not even on the wards yet. So how can I help you?"
And the painful answer is, I can't. I can just learn from you in order to help someone else. And none of my professors have given me a truly good justification for why one patient (who has 'volunteered,' but often is simply doing it as a favor to their doctor) should go through an hour or two of crap for me.
I mean, some patients really enjoy teaching. They enjoy interacting with a medical student, they like telling their stories, they don't mind someone spending an extra hour with them. But inevitably, as a student, you are called upon to examine and interview people who don't really get much out of it. And unlike when you're on the wards or when you're a physician, you can't say, "I know this is annoying/embarrassing/painful, but I'm really trying to help you." Because you're not trying to help them! You're just trying to get to the point where you could.
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