ndab Ah Yes, Medical School: Seeing Is Believing

Thursday, January 12, 2006

Seeing Is Believing

One great thing about being a third year medical student (stop laughing) is that everything you see, hear, smell, etc. on the wards is so new to you that you really have no idea if what you are observing is important, relevant, or even present in the patients you are studying. This is another way of saying that you have absolutely no responsibility for being right about anything, as long as you have a pulse, show up on time, and can at least pretend like you are paying attention (for personal lessons on my patented "I look like I'm paying attention but I'm actually daydreaming about Natalie Portman" face, the same squint-eyed, furrow-browed face that has fooled everyone from high school teachers to attending physicians into thinking I was furiously focused on the stream of poo emanating from their mouths, inquire below). The downside of all this is that at some point, like say when you're the chief resident in your field six or more years later, you're going to have to actually know something. And if you don't, you not only make yourself look bad, you make the specialty you are representing look even worse.

I bring this up because I observed a rather interesting event on my second day of inpatient internal medicine this afternoon, one that really makes me wonder whether I've actually been right all along in my as-yet-incomplete and poorly thought out theory that...well...medicine is bullshit, and succeeding in a medical field is all about who can bullshit the best and convince everyone else that their bullshit is cleaner than yours. Don't get me wrong, medicine (and I'm speaking broadly here, so not just internal medicine) has obviously done billions of wonders for prolonging people's lives blah blah blah, but while I can't really describe what I mean in words just yet (as this is something still formulating in my mind), I know what I mean. I hope that is vague enough for you.

Anyways, our chief resident gathered me and the other four medical students rotating through internal medicine at a specific hospital and conducted the first of our physical diagnosis rounds, where we are introduced to patients with interesting physical findings on exam and then have to figure out what's going on, with chief resident guidance and teaching along the way. In other words, this is the part where we ignore that whole "a patient is a human being to be respected with privacy" crap and instead adopt the "a patient is part of a circus freakshow and must be displayed, poked, and prodded by as many people as possible in as open of an arena as can be found" philosophy of patient care, where not even my dreamy blue eyes and soothingly sexual voice can put a patient at ease. I actually enjoy these rounds, because sometimes I...brace yourselves...learn something. Really, I swear.

After seeing a few patients, she asked any of us if we had patients with interesting findings that the group could check out, and one of my colleagues (who I must admit is one of the rare medical students I genuinely respect, mainly because he's almost as big a jackass as I am) recommended one of his patients, ultimately proving that if one learns nothing else in medical school (and believe me, most don't), it's that one should never, ever volunteer for anything. Ever. He described a malar rash we were supposed to see, and we went in to see the patient. The chief did an exam and started pointing out a rash she was outlining with her finger on this lady's face. Now, I didn't see a damn thing other than a big bandage over her right eye that was placed there after her eye surgery that morning, but if you refer to the first sentence of this post, you'll find that this sort of thing happens to me all the time and I just did what I normally do and kept my mouth shut. Also, being at the absolute bottom of the totem pole means you speak your mind when it does not come at the cost of embarrassing your superiors, so I've gotten pretty used to this scenario. We talked some more about the rash, look at it for a little while longer, and then walked out.

It's at that point that my friend (obviously feeling as stupid as I felt at not seeing what should have been a textbook rash) looked at his notes, smiled like the jackass that he is, and said, "Oh, umm, so ya the patient we were supposed to see was actually in the other bed." Which means we saw the wrong patient. Which means the patient we saw did not have the disease we thought she had. Which means there was no rash. Which means the chief, drawing on four years of clinical experience, essentially willed into an existence shared only by her imagination a rash that was in fact not there, never was there, and likely would never be there. Which means the chief tried to teach us and show us a rash that never existed, and we (sort of) believed it and were ready to learn from it.

In other words, medicine is bullshit.

Now, it's obviously ridiculous to draw that conclusion based solely on one example, but I just thought I'd describe this scenario because a) it actually happened, b) it probably happens all the time, and c) I really think I might be on to something here, as I'm wondering how much of medicine is really just a product of one's imagination versus how much is rooted in actual science, fact, and reason. In other words, how much of medicine is geared towards the patient, and how much is really only for our own peace of mind? After all, if someone can will a figment of one's imagination to appear on the face of another person, how much more can one imagine? A diagnosis that is wrong? A cure when there is in actuality no hope? I'm clearly not even sure where I am going with this, but hopefully you get a sense of what I mean, and if not, I'll try better next time.

Oh, I should also add d) it reminded me, yet again, to never volunteer for anything.

(And in case you are counting, I made five direct references to excrement in this post. Hi Mom!)


Blogger Anhoni Patel said...

Ack! At least the rash wasn't on her ass or cooch or something.

Oh, and it sounds like med school is the same as law school. a whole lot of bullshit.

6:30 PM  
Blogger An Enlightened Fellow said...

Well, somewhere in all the nonsense that is medicine, some sense is bound to emerge eventually.

6:54 PM  
Blogger Motherkitty said...

How pathetic not to be able to say "I just don't see it" without any repercussions from the chief resident (even though the chief resident also didn't see it). How can you and the other med students learn without being honest and not just be a bunch of dorks standing there with your thumbs up your behinds, or, sucking on your thumbs while scratching your behinds?

7:13 PM  
Blogger mallymoodle said...

I've spent time teaching histopath to medical students and at all levels of medicine (currently a neurosci PhD student), you gotta learn how to bullshit and bullshit convincingly.

You can't see a particular cell type? You've got to look for the speckles in the nuclei! You cant see the speckles? Theyre right there!!!

7:37 PM  
Anonymous Anonymous said...

i'm reminded of the emperor's new clothes. :) great story. hopefully if your theory is accurate it can bring about cures when there are none. lucidkim

7:48 PM  
Anonymous Anonymous said...

Thats why I like engineering and not medicine/laws...

7:52 PM  
Blogger Miss D said...

Wow, and ditto for architecture...

9:54 PM  
Blogger Sarah said...

This comment has been removed by a blog administrator.

12:23 AM  
Blogger HHD said...

Like the time a physician ordered 4 mg solumedrol q 4 hours instead of decadron 4 mg q 4hours and the patient went into a coma! His response? "Oh, shit!". Ha, ha.

5:01 AM  
Blogger Not this time said...

My friend has had 'stomach problems' her whole life. A lot of pain... a lot of exploratory surgeries and pats on the head later, and she's still in pain. She's also *very* crazy. She decided to go to her clinic and refuse to leave until she had a diagnosis. So they gave her one: Pelvic Prolapse. Now her symptoms have changed to exactly match those of the condition, and she's much happier, and also in more pain.
I would have given her a bullshit diagnosis to get her out of my clinic, as well, though.

6:15 AM  
Blogger MedStudentGod (MSG) said...

I'm currently seeing this myself. My wife was very ill these last few weeks and 3 different doctors came up with three similar, but still ineffective ways of treating her. One walked in and had her diagnosed within 3 seconds! I swear...I've never been so unimpressed with the whole "do a thorough and efficient physical because you will be far more likely to properly dx and treat patients" in my life.

BTW...love this blog. It gets me through the scut of being a book-monkey constantly.

6:28 AM  
Anonymous Anonymous said...

EEk! what if it had been something a little more serious than a rash??? now this poor patient is laying in bed thinking "great, not only has my eye been operated on, but now I've got a rash" OR WORSE.. she knows the error... and so does her roomie... and they are now both laying there realizing how incompitent the people are who are caring for them!!! Don't be afraid to speak up! PLEASE

8:08 AM  
Blogger Carina said...

Recommended reading to all!!! My hubby's said that same thing more than once.

You are at the least the Prince of Medicine (not the King, as that's Dr. Doug at Placebo Journal).

10:16 AM  
Blogger missbhavens said...

Happens all the time...disturbing, yes. But next time, just go ahead and be a wise-ass and speak up! What's the worst that can happen?

12:07 PM  
Blogger Em said...

Sounds a lot like nursing, too.

You know, if you ever do publish, this blog would make a great TV show.

2:09 PM  
Blogger llyase said...

Believe me, things are even worse in vet medicine. We have to deal with:
a)A range of species
b)Crap histories from vague owners
c)Crap physical exams (try telling a feral cat to sit still!)
d)The owners ego ('don't blame yourself Mrs G for missing the anal furunculosis that has caused your dog excruciating pain over the past 3 weeks)
e)Finances (a huge % of clients can't afford effective treatment, so we often have to opt for the old default tx's i.e jab of antibiotics,painkillers and if you're a dinosaur: prednisolone)
f)Limited controlled studies. 99% of what we choose to do is based on anecdotal evidence, opinion and voodoo. Or extrapolated from human medicine...
g)Lack of mentoring post graduation. Imagine being made to do an ovariohysterectomy on your first day, without assistance and only a textbook for guidance!
Or,(as was my experience),be expected to juggle 40 patients solo in 1 day (5-10 minute appts)while simultaneously dispensing drugs,writing histories on an unfamiliar computer system, administering treatments,chasing lab results and... operating on patients without senior vet backup:)
How do you cope? You bullshit coz there is ALWAYS 'more than one way to skin a cat'. And you get by. You learn how to throw together fragments of info from university to make what ever you come up with sound vaguely plausible. Eventually you may even start to believe your own nonsense.
The only thing that is certain in human (and veterinary medicine) is that there are no RIGHT answers, just a range of options, some more sensible and effective than others.

3:08 PM  
Anonymous Anonymous said...

Yeah...prior to my first year seminar for my phd in medical research, I was told that if there were any questions I could not answer, just make something up and make it sound convincing and no one would have the guts (or ususally the knowledge) to disagree just in case they were wrong!
Bullshit is running rampant in many a field I think!


6:36 PM  
Blogger lee said...

Saw a thing on telly a couple of days ago about the incredible number of people who are operated on for problems they don't have,or they wait years for a knee operation and the wrong knee is done!(frig!)Let's not even think about the number of people that die each year from doctor error.(The fake doctor will know the particular word that applies in that case...i can't remember it.You know...oh...bugger,can't remember).Fake doctor/flabby MP look-alike ,please don't become a doctor that treats symptoms with a pill-treat the CAUSE of the symptoms.Because there is a difference and not all doctors seem to realise it :) .

12:49 AM  
Blogger Kyla said...

Of course there's going to be BS in the medical field. It's sadly a hard phenomenon to avoid. Can you name a profession that is 100 percent bullshit-free?

Then again, the potentially dire effect on people's lives caused by medical BS may be much, much worse than other types of BS.

4:06 AM  
Blogger trusty getto said...

Well, you've articulately explained why suing docs is like shooting fish in a barrel - b.s. doesn't hold up on cross-examination! :)

Anhoni, too, is correct, lawschool is b.s.

I, for one, can't wait for you to begin your residency.

5:54 AM  
Blogger Mic said...

That's why they say doctors are "practicing medicine".

10:10 AM  
Blogger Nikki said...

What a gong show. That's hilarious.

I'm just starting my clerkship (do you guys call that internship? -- full time hospital year anyways) and have quickly learned that residents aren't necessarily any smarter than me. Of course there's the odd one who's like a freaking encyclopedia, but holy crap, some of them seem to have slept through medical school. Scary.

3:34 PM  
Blogger mallymoodle said...

*snort* I wouldn't be surprised if some of the docs you meet on rotation did sleep through med school.

In one of the classes I taught, I had a student who didn't attend 1/3 of the time, slept through another 1/3 and then had the nerve at the end of semester to say she didn't learn anything! (Though she did pass her exam so here's to being a study champ)

7:08 PM  
Blogger "Jet" said...

I hope I never become sick enough to be someone elses medical project. But in reality, that is how you, the student learns.

9:30 PM  
Blogger EnnuiHerself said...

"medicine is bullshit, and succeeding in a medical field is all about who can bullshit the best and convince everyone else that their bullshit is cleaner than yours."

Wow, that just about sums up how I feel about scientific research. Whoever can keep the biggest lie going for the longest time wins the Nobel Prize.


6:51 AM  
Blogger Random "Frequent Flyer" Dent said...

BS this BS that, don't correct your tutor/teacher/etc and risk lookin a fool to your classmates.

And that people can do NOTHING and still pass...frightening that MD's can do it.

Good to know High School never ends.

2:56 PM  
Blogger DoctorEarly said...

Well articulated as always! Yes, belief can be everything and it can also be nothing. This antic helps serve to illustrate the reason why doctor's are always said to be practicing!

3:54 PM  
Anonymous Anonymous said...

Ha! I knew it was true!

9:41 PM  
Blogger dropdeadred said...

So I guess there is some truth to why doctors put a big X on the limb they will do surgery on...(another scenario for you?)

You students scare me.
But your blog is awesome.
I am a biology major considering medicine.

10:18 PM  
Blogger Emilian said...

This comment has been removed by a blog administrator.

11:19 PM  
Blogger karenology said...

This was a rather, uh, comforting post...

I've always had trouble in anatomy and biology type classes identifying stuff in slides and so forth. I'd chalked it up to some wonky visual recognition problem, but maybe all my professors have been bullshitting me.

7:25 AM  
Blogger greeneggsandtam said...

So wait. Are you saying I'm being woefully mislead into putting my trust into my family doctor? Damnit! Like there isn't enough to worry about in the world, what with that crazy bird flu and celebrity divorce. At least I feel I'm not so alone in the world. Sometimes I like to believe there is money in my account.

8:39 AM  
Anonymous Anonymous said...

Now look here, my imaginary evil twin believes everything the doctor tells us!! I also have her convinced that the word verification below is a secret message from Mother Theresa.

1:05 PM  
Blogger ArleneWKW said...

That rash mirage experience was laugh outloud funny! I needed that. Thanks.

1:09 PM  
Blogger MattHeatherEmma said...

Quick! Someone call the Proctologist...the chief resident's head is stuck up his a$$ again!
Thanks for the laugh! It made my hubby's day as he had a crap call night on the Peds floor.

9:22 PM  
Blogger Twanna A. Hines | FUNKYBROWNCHICK.com said...

Scary!! Time to buy that earth-crunchy-don't-trust-the-medicine-man alternative health book currently on sale at Borders. :)

Actually, I'd say the same bullshit goes for those who work in politics / the political areana as well. I'm not saying that *I* work in that arena. I'm just saying that I've heard that a lot of people say ... you know.

You don't know?

Oh, okay ... I'll just be quiet now and wait for your next post. :)

6:13 AM  
Blogger dr-exmedic said...

~Beauty's Baby~ said...
"Good to know High School never ends."

Med school is 4 years of school with the same 100-250 people, many of whom have never been out of school, going five days a week to the same or similar places, taking the same tests, at about the same times, with an identical diploma (MD/DO) at the other end. So this is hardly a surprise. :)

1:57 PM  
Anonymous Anonymous said...

Hehe.So I'm not the only one to have gone through that eh.Can't say
it feels good to be able to say that.
Third year Asian medstudent here.Yes,we go through much the same.
Hope the premeds are reading this.
Get out while you still can.

11:47 PM  
Anonymous Anonymous said...

I have an advice-type question: how does one tactfully get a second opinion?

I mean, do you just go in to the new doctor and say "Hey, I'm want a second opinion. No, I'm not handing over my medical file until you've made you call, cause, hey, I doubt your professionalism and I don't want you having any preconceived notions of what I might have. Now, here are my symptoms..."

8:26 AM  
Anonymous Anonymous said...

After getting up close and personal with a tenaculum on Thurs. during a uterine biopsy (done to me, not by me), I strongly believed I would never associate laughter with medicine ever again. Great blog. Are you available for family events? (Another unlikely association with laughter) "I think I'm going to pee my pants! If I had some on!" Quote that could be heard ringing through the Women's Health Group after my cervix danced a jig with the tenaculum.

12:42 PM  
Blogger Dana Lee said...

This comment has been removed by a blog administrator.

6:29 PM  
Blogger Me said...

This doesn't mean medicine is bullshit. It means your resident is an idiot and always will be. That was the actual take home message from that patient encounter.

11:45 AM  
Blogger pepay said...

wow you're a doc!

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We had the same thing in Paramedic School.

1st lesson

Always appear as a duckling on a still pond. Calm and cool on the surface while paddling feverishly underneath.

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