Yesterday during one of my clinical exam courses, we were faced with the task of delivering bad news to patients. This wouldn't have been a particularly difficult exercise except that they brought in an actor to play the part of a patient newly diagnosed with MS. As our group leader scaned the room to choose a volunteer to "break the news" to the actor patient, I slunk into my chair, terrified at the prospect of being chosen.
This is a new feeling for me in recent years, and one that I feel surprisingly frequently during med school. It's this inexplicable urge to pull the covers over my head and disappear rather than complete some of the tasks before me. I think the last time I had such a visceral reaction to anything came in my childhood whenever my parents urged me to step outside of my comfort zone and be social. Believing that I'd overcome these adolescent challanges, I haven't had the chance to reflect on the root of the feelings until now, some 10 odd years later.
To a large extent I knew that medical school would bring new challenges and force me to grow as a person, but I never guessed that I had such a deep seated fear of being "on the spot." I can only think that my insecurity grows from the knowledge that some day I'll have to deliver bad news, have the right answers, and make the right decisions that directly impact people's daily lives; talk about jumping out of the frying pan and into the fire.
It can only make me a little jealous of my peers that seem to have a natural knack for stepping into the spotlight. I wonder what goes through their heads as they raise their hand or jump up to be a volunteer, because I'm pretty sure it deviates far from my internal dialogue of "oh shit, oh shit, what do they want me to do?"
I guess, though, at this rate, the fire is only going to get hotter and that's probably a good thing; because let's face it, I can't stay under the covers forever.
Wednesday, January 21, 2009
Tuesday, January 13, 2009
It's not a necklace, it's a stethoscope 1:29 PM
Even from my limited exposure to clinical medicine, I've a few things that frankly make no sense to me.
1) Most physicians have a limited understanding of how to conduct a complete physical exam.
2) Rather than admitting that there's a deficiency, they refer to their skills as "focused."
3) Medical records are jumbled copy/paste nightmares.
4) Rather than reporting complete history and physical findings, most information is copied from a template. So even though your medical record says the doc didn't hear any "bruits, rubs, murmurs or gallups" on your cardiac exam, most docs don't even know what those four things sound like.
5) This doesn't seem to bug anyone in the hospital.
Certainly this isn't true for all physicians. There are many that are very good at their jobs and always take meticulous notes on their patients, but these physicians are rare treasures. I just can't understand how so many people have become so complicit in poor record keeping, considering the field is more or less built on tracking patient's conditions over time.
With a new president taking office, and a big emphasis being placed on the failing healthcare system in this country, I think that docs need to realize that when they point fingers at who drives up medical costs, they should note the three fingers pointing back at them. How many cases of hypertension haven't been recorded because the doctor and nurse take the blood pressure wrong, or not in both arms? How many doctors can't actually see the fundus on and eye exam, but say they do because it's simpler to lie? I get it that most docs are overwhelmed with work and don't have time to be as thorough as they should be with every patient, but is that really an excuse?
I feel as though this attitude that basic skills can be glossed over starts as early as medical school; rather than becoming experts on history and physical in the first two years before we're responsible for patient care, we're expected to perfect our skills "on the job" even if this means sub-par care for hospital inpatients. I feel like this lack of understanding on how to teach reflects a large shortcoming on the part of medical school curriculum; these skills are too important to be "self taught" regardless of how good medical students are at self directed learning. Hell, in elementary school when we learned how to write cursive, we would sit at our desks for hours at a time writing over and over again under teacher supervision until we were able to perfect each letter. It was grueling, but by the end of the third grade we could all write in cursive.
Apparently, though, having one 2 hour session on how to listen to the heart should be enough for a medical student. At this point I would ask everyone to raise their hand if they feel comfortable with their doc only having one session on how to listen to the heart, though the effect is lost on the internet.
Am I just crazy? Do I seem totally irrational to the people reading this? I would like to think that as a lowly second year student I just don't completely understand, but I don't think I'm that naive.
