Top 3 Thoughtful Reads Today plus an Overdue Rant

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1. Panda Bear, M.D.’s Defending the Pie. An emergency physician’s opinion on medical quackery, “dis-ease”, and what one should be conscious of as a potential patient.

Sure, anybody can see somebody with a cold or some other minor complaint and the odds are good that nothing they do, provided they don’t get too jiggy with it, will do much harm. But let’s suppose that you have never rotated on a medical service or done your share of critical care. Suppose you have never worked in an emergency department or spent a few sloppy months on the labor and delivery floor. Imagine, if you can, seeing a provider for your family’s medical care who is treating your kids but has never had a lick of formal pediatric training or so little that she has never seen the really bad pediatric diseases that look like a little bit of nothing when they first present. Does your chiropractor, for example, know the odds that a fever in a neonate is some flavor of bacteremia that needs aggressive treatment?. Let us further suppose that while your chiropractor has spent hundreds of hours learning how a little normal misallignment in the spine can cause “dis-ease,” he has never had to recognize appendicitis, pancreatitis, or the first subtle hints of colon cancer. In short, while a lot of primary care is routine stuff, little potatoes that the school nurse would have to work at to screw up, not all of it is and if all you’re barely qualified for is to pass sick patients to somebody else as some kind of completely redundant middleman, maybe you should stick to the entertainment business and leave medicine to those with training.

Update (3-28-2008): This post has very intelligently proven its point. And I very much agree with most of its reasons. However, I personally believe that the complementary benefits of the ancient forms of healing should be explored and given its place. Nothing should be unknown to us. We should not block knowledge or even theories from disciplines outside of our hard-wired structures—modern structures at that. While I am totally for research and evidence based principles of care, I think western medicine has no monopoly of truth. Neither does eastern medicine. While there should be some form of check and balance as to proven fact and false claims, integration of these methods of care, especially when of great advantage to the patients, should be given a chance. Integrate the positive practices of these so called alternative principles (I speak mostly about activities like yoga, meditation, art therapy, etc.) as a complementary and gentle arm to patients’ ways to recovery with the current chemotherapy for example, but not cancel chemotherapy all together. As sometimes, some patients (and so do all of us) need positive reminders at the very least. I liken some complementary processes to the process of writing. Many times, it is not what we actually write but the process itself makes us learn and thus evoke self evolution.

2. New York Times’ Mixed Messenger by Peggy Orenstein. A realistic word on reality that has been existing for so long and many preferred to deny, ignore, or pretend otherwise. It is a sincere and sensible essay that I resonate with personally.

A few weeks ago, while stuck at the Chicago airport with my 4-year-old daughter, I struck up a conversation with a woman sitting in the gate area. After a time, she looked at my girl — who resembles my Japanese-American husband — commented on her height and asked, “Do you know if her birth parents were tall?

Most Americans watching Barack Obama’s campaign, even those who don’t support him, appreciate the historic significance of an African-American president. But for parents like me, Obama, as the first biracial candidate, symbolizes something else too: the future of race in this country, the paradigm and paradox of its simultaneous intransigence and disappearance.

I am myself biracial—East Indian and Filipino. In my own high school (a private Chinese school, with a small minority being Filipino — go figure!) in my home country, I experienced being teased for my “different” race. It came in the form of childish or thoughtless (though rarely cruel) comments about my ethnically distinct features and darker complexion—which now is simply seen as an exotic tan. ;-) But the reality is, these judgments or stereotyping coming at you in whatever form still speak of the reality that these biases and disrespect are passed on and learned, especially as a child.

This particular life experience along with my other social exposures has led me to further explore through the rest of my curiosity about other races and cultures. It led me to develop an awareness of the existence of the international community. It led me to celebrate my own diverse background. It led me to develop respect towards other people different from myself. This consciousness, sensitivity, and respect should be shared and brought to surface.

3. Dr. Val and the Voice of Reason’s Young Doctors are Easy Targets for Marketing Messages. This post points out the strong need for a more balanced solution to residents’ salary issue in urban areas.

Some attending physicians are understandably annoyed when residents don’t pay close attention to their carefully prepared lectures. Dr. Wes describes his frustration when his young protégés seem more interested in filling their bellies (with pharmaceutical sponsored luncheon fare) than their minds with his years of wisdom. Although I am absolutely sympathetic to Dr. Wes – and always tried hard to be attentive and respectful to my mentors – I wanted to point out that there is an underlying educational crisis at work in urban centers where some residents train. Here’s one NYC resident’s experience:

After taxes, my annual resident salary was about $39K/year. I worked at a hospital in New York City where rent for a small one-bedroom apartment was about $29K/year (which is now closer to $48K). Living on $10K/year in New York City is next to impossible (as you can imagine) and so my survival required undignified behaviors such as crashing “drug rep dinners,” working second jobs on post-call days, and living in crime infested places with lower rents. I got a job as a bartender at a fancy restaurant so that I could get a free meal and some survival cash now and then, and also worked an IT job from home.

This picture is not so different in the Philippines either. It so much is a reminder of accounts of low resident salaries there.

It does not help that he/she is made to work a whole lot of hours a week. Medical schooling and training has explained to us in some way or another why these traditional work hours are kept. I personally do not mind the required hours as long as the educational return would be worth the while. But that is another story. Medical schooling have at some point trained us not to complain about unfair returns in work situations. Or we simply do not have the energy left after all the toil required.

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Here is the part where I rant at last.

When I was a senior clerk rotating in a tertiary hospital in the Philippines, I shared the most unnecessary experience with my classmates at its obstetrics and gynecology department. Sadly, a big part of that rotation was spent trying to survive the attitude problems and work ethic of the residents. There was absolutely some line crossing—I’ve felt we had been disrespected as medical students in being used as personal errand runners. I mean, I have no qualms about helping out. Someone has to do the scut work and all that relates to hospital work. But this is absolutely not about that. This is about the absence of teaching, especially in comparison to the other departments we rotated through. We sat through their Grand Rounds but no further resident-mentor roles were assumed except when attendings were present. They just went about their work and treated us like nuisances or like we owed them our lives.

Some examples I can remember of the day to day… It was lunch time and the important ward work was done for the moment. The residents paged one clerk to the office, and I reported right away, as the page was a stat. Once there, I found these residents having lunch and taking their time (which I would fairly recognize as their right but excludes the right to usurp my time). A resident told me in a condescending tone to go a few blocks off the hospital to the copy service, as she needed it for her personal presentation to an attending. Another time, they placed the same stat page during lunch time and told one of us to deliver invitation letters to various clinics around town for an upcoming department affair. When a group mate of mine was made to do this task, there was no regard for transportation expenses (in a place where very few students had their own cars, we had to take cab rides or less convenient jeepney rides to get around). He had to spend for his trip around town to deliver invitation letters because the resident running the department was too cheap to buy stamps! Another student recounted being called in from the clerk’s quarters to go to the department office at lunch —just to purchase a bottle of soda! And the page was stat!

Truthfully, these unpleasant experiences would have been easily forgotten had there been some effort to mentor. But there was none. Or at the very least, maintaining ethical behavior. (I am glad to have realized at the time that it was unwise to go head-on with the immaturity in front of me. So, my group mates and I took the rather hard but honorable route of just woefully taking it—though honestly, this was a case of just avoiding fuss to survive the rotation and moving on.) In fairness, there was one resident who broke free from the gang mentality and taught us some at least as she should, while maintaining appropriate boundaries between her professional requests and her personal wishes.

I was so terribly disappointed at my rotation that I decided to do my required post-graduate year at another hospital in a different city—one of the best decisions I have made in my medical life! (Perhaps I will write about this much better experience here someday.) I expressed my thoughts (albeit distilled to “I did not have a very good experience as a clerk here. I am applying elsewhere for internship.”) to the attending who sat as chair of the program in a casual encounter when I was about to graduate and submit an application for the post-grad match.

Fortunately, we later had another rotation in a maternity and puericulture center, where we received a fair and most educational obstetrics experience. I am very thankful for that chance sans the nightmare bunch who were supposedly our mentors.

It is a sad recollection for me. It is the first time I have written about it. It mainly remained as an interns’ quarters chat. I hope the situation subsequently evolved, and that later batches have had a more rewarding experience.

Having recounted my stories, I still keep in mind and heart my appreciation and enormous respect for the better role models (including those in obstetrics) whom I have met before and afterwards.

That said, let me end my noise now.

~ by Karina Descartin on 25 March 2008.

3 Responses to “Top 3 Thoughtful Reads Today plus an Overdue Rant”

  1. I’m sorry (but NOT surprised) to hear of the horrible experience you had. When I was a third year medical student on a vascular surgery rotation, one of the residents paged me “stat” to tell me that I was the worst medical student they’d ever seen. Nice touch. My offense? I had transported a patient to the recovery room at the request of some nurses who needed space for incoming patients (and there were no transporters available). Apparently the resident had a hard time finding the patient and it was inconvenient for them to walk from the recovery room to the step down unit.

  2. Thanks, Dr. Val! As they say, “What does not kill you strengthens you.” Or something like that. :-)

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