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So many lawyers, so little time...

"The prospect of hanging focuses the mind wonderfully"--Samuel Johnson

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Location: Louisville, KY, United States

Gastroenterologist, cyclist, cellist, Christian, husband, father, grandfather.

Monday, May 16, 2005

Things they taught me in medical school

It's been fun to visit the blogs of medical students and residents. Its good to see that all the old battles are still being fought, such as the student's desire to learn vs. his need for sleep and family interaction, or the student's humanitarian instincts vs. the cynicism that medical training seems to breed. It also give me cause to reflect on my own academic heritage. Like it or not, our instructors exert a profound impact that remains with us during our careers.

I don't always remember complex interactions and metabolic pathways, but I usually remember pithy aphorisms. Here are a few that I remember:

Only half of what we teach you is true. It is up to you to figure out which half it is.
I don't think this was true, actually. Most of what they taught us concerning the science of medicine was true, although big chunks of it are now obsolete. I missed most of my pharmacology lectures because I was not about to sit in class for eight hours straight. The time was much better spent down at the glider park (I no longer had my motorcycle and needed some reason to needlessly risk my life). I'm glad I didn't expend a tremendous amount of energy learning about nitrogen mustard or reserpine. We never use that stuff anymore.

Of course, the love of knowledge and the discipline of study is what we needed, but it definitely wasn't being taught in our pharmacology classes. I hope the medical schools are doing a better job with it these days.

If the patient has pain anywhere below the 'belly button' and if s/he has an an appendix, then always at least think about appendicitis.
This has been a nifty little rule as of late. Gastroenterologists are basically internists with endoscopic skills, so we don't usually see much appendicitis; they usually go straight to the surgeons. If the patient has a weird presentation, such as pain on the wrong side of the abdomen, or a protracted course, they often get misdiagnosed and sent to me, the lowly GI guy. "They still have an appendix; why, I bet they have appendicitis!" I've been right about that several times this year already. Its a great 'grandstanding' diagnosis to make, and the outcome is always good. It makes me want to learn how to go in and whack those suckers out myself sometimes.

Medicine is a jealous mistress.
This of course isn't true in this day and age, with the growing numbers of women in medicine. Maybe medicine is a dysfunctional viragoe who treats its practitioners like sex slaves chained down in the basement. Maybe not. But it certainly isn't a jealous mistress anymore. The allure just isn't there.

The problem with being on call every other night is that you miss half the action.
The medical school I attended truly believed this, and changed it only when applications for residency began to fall because people were just not willing to be abused when they could go to a perfectly good program that had every third or even (gasp!) every fourth night call. It was also wrong. It reduced the practice of medicine to the learning of techniques and the acquisition of facts so that we, the doctors, can fix them, the patients. It ignored our own human limitations, our need for family interactions, our need to participate in communities of faith. In short, it called us to sacrifice a big chunk of our humanity upon the altar of medicine.

Don't wear the clothes in which you dissect your cadaver to the student union if you want to hit on the babes.
I bet this one is still true.

4 Comments:

Anonymous Chris said...

Just recently found your blog. It's excellent. A physician who can (and cares enough to) write well. I know it's hard to transition from medical note scribbling to full expression of feelings and insight. Keep up the good work!

7:23 PM  
Blogger JusPasenThru said...

Thanks!

8:40 PM  
Blogger Dreaming again said...

Your post made me grin.
Two weeks ago I got into an argument with my GI doctor over my untreated 'high blood pressure'.

I kept telling him that I don't HAVE high blood pressure. He kept insisting that at 150/95, it most certainly is. I informed him, that my normal blood pressure is 110/65 and it's only high because "you GI type doctor's like to put camera's where camera's don't belong!"
He did let it drop ... to find out from my PCP that ... I don't have high blood pressure, it is in fact, my fear of GI docs and their camera's!

Proof that my fear is valid was today's EGD done without sedation! (due to risk of breathing complications with myasthenia gravis)

Pk

9:34 PM  
Blogger JusPasenThru said...

Don't tell anyone I said this but...those guys make me nervous, too. Hope your test went well!

7:55 PM  

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