"Medicine is considered a profession because of, in part, the strength of bonds among physicians. Certified to educate and police one another, Physicians accrue responsibility for one another's competence and conscience."
Rita Charon JAMA 286(15):1900
I am now writing this after our White Coat Ceremony weekend - which was absolutely lovely. Before medical school, I was both in awe of and appalled by the idea of the white coat. I think my feelings about it have become even more complex lately.
Our keynote speaker was incredible and he ended his speech by saying, never forget that your white coat makes people feel comfortable telling you things they've probably not told anyone; that it allows you the honor and privilege of hearing someone say, "thank you, you saved my life" and mean it; but it also means you'll have to say "time of death..." someday. It's pretty heavy for a piece of cheap white cotton/polyester.
February 18, 2010
February 16, 2010
Funny (?) medical diseases
Some medical diseases with funny names (not necessarily outcomes) are:
Chinese Restaurant Syndrome
(allergy to MSG, monosodium glutamate)
and
Licorice Intoxication
(for those of you who appreciate this kind of stuff: licorice disables an enzyme that converts cortisol --> cortisone, so you have lots of cortisol around. This excess cortisol binds to the aldosterone receptor. The effects of this are similar to aldosterone (except more) and increase sodium and water retention, increase blood pressure).
and
ACHOO syndrome
(Autosomal Dominant Compelling Helioophthalmic Outburst Syndrome)
which affects somewhere around 10-20% of all people and means that you sneeze when you look at bright lights (like the sun). Sneezing in response to photons (light particles).
pretty cool name, though, right?
Chinese Restaurant Syndrome
(allergy to MSG, monosodium glutamate)
and
Licorice Intoxication
(for those of you who appreciate this kind of stuff: licorice disables an enzyme that converts cortisol --> cortisone, so you have lots of cortisol around. This excess cortisol binds to the aldosterone receptor. The effects of this are similar to aldosterone (except more) and increase sodium and water retention, increase blood pressure).
and
ACHOO syndrome
(Autosomal Dominant Compelling Helioophthalmic Outburst Syndrome)
which affects somewhere around 10-20% of all people and means that you sneeze when you look at bright lights (like the sun). Sneezing in response to photons (light particles).
pretty cool name, though, right?
sucking the marrow out of the weekend
2 of my most favorite people
They say in medical school you're perpetually behind, so the best thing to do is to accept it and keep on keeping on with everything. I think that quality of never being able to feel like we're actually on top of what we have to do may be one of the reasons that lately, everyone is feeling so down on themselves without really knowing why. This is why weekends like this past one - a long weekend combined with a final exam on Friday morning, so that the whole weekend was spent in complete and utter glee - are so important. They let us pursue the other parts of our lives, the other parts of ourselves that we may not have created a space for at medical school - partly because there's just not enough space for full personalities, and partly because there are not enough different situations to bring out very many qualities. Mostly medical students are super bright, uber motivated, incredibly curious, really kind, and very hardworking - but that's because those are the qualities perpetuated by the institution of medical school. But what about the parts of us that are creative? or fun? or daring? or interested in chinese american history, athletic events, knitting? Is there no place for any of these things in our lives during medical school?
Early on, a professor told us to decide on one non-medical aspect of our lives to work really hard to maintain during medical school, because the rest would fall apart. I remember thinking, one non-medical aspect of my life - hah! There are so many non-medical aspects of my life that are vital to my well-being, how could it be possible I would only have time enough for one?
Fortunately, I have been able to maintain more than one - but only slightly and only with incredibly hard work, diligent time management, and impossible energy. And my more than one non-medical aspects are staying in touch with my family and very close friends, as well as working out consistently. That's all I consistently commit time and energy to that has nothing to do with learning medicine. How is it possible that my life went from so full of so many questions and directions to being even fuller with just one big thing.
Side note, I went to the Museum of Chinese Americans this past weekend - and it was one of the greatest museums I have ever visited. It made want to learn more about Chinese and Chinese American history. I'm looking for book suggestions.
February 9, 2010
Prescribing Medication/There is no balance
We had a lecture today on religion and spirituality and their roles in medicine by one of my favorite professors. He began the lecture saying "If there was a risk-free intervention that was associated with >10 years of additional life expectancy, would you be interested in learning about it?" He then proceeded to show us research that supported praying for people who are sick increasing health outcomes, correlations between attending religious services and better health, and that ordained people are healthier then the average non-religious person. The data were very convincing but there were so many questions left unanswered including:
-Is bringing religion into medicine actually "risk free"?
-How do you standardize prayer?
-What efforts were made to control for confounding factors such as the effect of having a community or a strong family structure on health - both associated with religious people and good health; showing a relationship, but not causality (one did not cause the other, necessarily)
-If we do buy into this enough to at least say it couldn't hurt and may help some patients, how do we talk about religion and spirituality with patients?
Our professor left us with the idea to open up the conversation to those questions - to take a "spiritual history" and ask how the patient thinks this will affect her/his medical care and/or health. I'm still not quite sure I could talk about this smoothly, without clouding the conversation with my own judgment about specific religions (and organized religions, more generally). Plus, what if someone has religious beliefs that really don't jive with me? Many religions are patriarchal and even misogynistic - an association with those sorts of beliefs would be a hard thing to support in one of my patients. But maybe prescribing something more general, like meditation - or clearing moments for reflection - or attending a support group or community gathering regularly (regardless of whether it's neighborhood softball or a book club or church).
On another note, tonight I attended a panel of Family Medicine Ob-Gyns who talked about their career paths and the choices they've made. They agreed that there is no balance, only tilting to one extreme and then the other - but that they love it and couldn't imagine being happy doing anything else. One of the physicians brought her ten year old daughter who talked quite candidly about what it's like to have a mom who is a physician, especially one who leaves in the middle of the night to deliver babies. The daughter said that it was hard because she missed her mom, but that there were some times that her mom kept as sacred (her birthday, for example) and that overall, she was really proud to have a mom who is a doctor and thinks it is inspiring her to want to be a doctor too. Hard to argue with that.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
“As Galen says, 'confidence and hope do more than physick – he cures most in whom most are confident’ … Faith in Gods or in the Saints cures one, faith in little pills another, suggestion a third, faith in a plain common doctor a fourth.”
– Sir William Osler
-Is bringing religion into medicine actually "risk free"?
-How do you standardize prayer?
-What efforts were made to control for confounding factors such as the effect of having a community or a strong family structure on health - both associated with religious people and good health; showing a relationship, but not causality (one did not cause the other, necessarily)
-If we do buy into this enough to at least say it couldn't hurt and may help some patients, how do we talk about religion and spirituality with patients?
Our professor left us with the idea to open up the conversation to those questions - to take a "spiritual history" and ask how the patient thinks this will affect her/his medical care and/or health. I'm still not quite sure I could talk about this smoothly, without clouding the conversation with my own judgment about specific religions (and organized religions, more generally). Plus, what if someone has religious beliefs that really don't jive with me? Many religions are patriarchal and even misogynistic - an association with those sorts of beliefs would be a hard thing to support in one of my patients. But maybe prescribing something more general, like meditation - or clearing moments for reflection - or attending a support group or community gathering regularly (regardless of whether it's neighborhood softball or a book club or church).
On another note, tonight I attended a panel of Family Medicine Ob-Gyns who talked about their career paths and the choices they've made. They agreed that there is no balance, only tilting to one extreme and then the other - but that they love it and couldn't imagine being happy doing anything else. One of the physicians brought her ten year old daughter who talked quite candidly about what it's like to have a mom who is a physician, especially one who leaves in the middle of the night to deliver babies. The daughter said that it was hard because she missed her mom, but that there were some times that her mom kept as sacred (her birthday, for example) and that overall, she was really proud to have a mom who is a doctor and thinks it is inspiring her to want to be a doctor too. Hard to argue with that.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
“As Galen says, 'confidence and hope do more than physick – he cures most in whom most are confident’ … Faith in Gods or in the Saints cures one, faith in little pills another, suggestion a third, faith in a plain common doctor a fourth.”
– Sir William Osler
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