i had the incredible experience today of getting to watch super_blaze win his bracket of the st. anthony's triathlon! for a blow-by-blow account of the race, combined with the pictures i took of the event, check out the post by the blaze himself.
you go, blaze! :-)
i cannot speak for all medical schools (there were certainly things in the 101 list that do *not* apply to my program), but it seems that there's a general tone of animosity directed at the students, particularly by the science ph.d. professors. anatomists, in particular, seem to despise medical students. they think we're stupid (<--heard at many an anatomy lecture last year: "if you don't understand this, you're so dumb you should get up, leave, and go fill out a subway application")*. one of my study buddies had a conversation with a physician she shadowed before beginning medical school and he issued this caveat: "watch out for the ph.d.s. they're bitter because they didn't get in to med school." ouch. ordinarily i'd have thought this physician's hypothesis was off, but after what i've observed, i'm not so sure anymore.... at the very least, they hate teaching--that much is clear. since mwms is an odd place that runs on a pbl program, the school has made some very bassackwards curricular decisions. they're still trying to figure out the best way to "teach" and test our knowledge. while our anatomy class was a 10 week marathon of lectures, we're now deep into the pbl portion of our program. so far, the way we've been tested is in the form of "learning issues." basically, after our group finishes a case, we're supposed to pick learning issues, relevant to the case, on which we want to be tested. the powers that be try to act like these should be discrete packets of knowledge for the case at hand, but since that's impossible (the books, after all, aren't designed around our cases!), what ends up happening is that we pick chapters from our various books. so, for any given exam, there might be 40 or so learning issues, all derived from different chapters. all the groups choose their own issues and go at their own pace, with some direction given by the faculty facilitator. for the last pbl exam that the class of 2010 took, the majority of the pbl cases were based on neuroanatomy. by the time they were finished with the 8 cases for that block, most groups had picked nearly the entire neuroanatomy textbook. *gulp* it's simply not possible (in my opinion) to learn all of neuroanatomy on one's own by reading the textbook, particularly in 6 weeks when that's not the only class/book/bit of material one has to learn during that time. there are only 6 hours of pbl class per week, so discussing all the material in group is not really an option, either. basically, we're left to sink or swim on our own. many groups, as a result, have attempted to make the learning issues more manageable. in other words, while the group as a whole reads broadly during the case, learning issues are picked with what the group feels it needs to be tested on in particular. the thought is that if the group is specific about learning issues, there won't end up being 50+ learning issues on an exam. basically, pbl groups are trying to choose wisely so as to survive these horrid exams. as list 101 indicates, though, everyone in medical school is smart. there's nobody there who didn't have to do some amount of more-than-ordinary work to get accepted. everyone is self-motivated, if not exceptionally so. but are we treated as if that's a given? heck no. we're treated like incorrigible schoolchildren. lest you think i jest, consider the following email (only modified by changing names to protect privacy) sent by the professor in charge of compiling all the learning issues for the exams. i swear to you, it's all about the tone.
Dear class of 2010:
After compiling the exam topics sheet from the 1st 2 cases, I have noticed that most groups are choosing only a few topics from each case. These cases contain many more basic science topics than are being chosen at this time. For example, why are most groups avoiding gross anatomy? If you are deciding to avoid gross anatomy because you “already had that,” you are making a huge mistake. What you already had was a “survey” course, not a full anatomy course. As stated by I and Dr. Head Anatomist several times during anatomy, you MUST choose anatomy exam topics in PBL to learn this science well enough. You were also told by Dr. Head of PBL and I that in PBL you must review topics several times to fully understand them. Why are you not reviewing anatomy? Aren’t you discussing gross anatomy during the cases? If not, you should be!
Please be reminded that you are in medical college where you need to learn all the basic sciences in a PBL curriculum. In this curriculum, it is assumed that you take the responsibility of learning seriously and become adult learners where you are responsible for your own education. Most of you are achieving that goal, but others need to be reminded from time to time that this freedom in your education comes at a price. If you continue to minimalize exam topics as a strategy to score better on PBL exams, this strategy WILL backfire: you will not learn enough basic science information to score well on PBL exams, the COMLEX exam, or to be a knowledgeable physician.
Please let me remind you that the PBL exam will be comprised of 185 questions. If you choose too few exam topics, your exam will have 8 or more questions from each topic. As you might not be aware, deriving 6, 7, 8, or more questions from a topic requires that I examine you on very minute details: the kind of details in which you may need to memorize charts or graphs to answer. If you choose enough topics, say 4, 5, or 6 from each case, then I can attempt to make your exam from big picture topics that are most important clinically. Although not always reached, this is my goal.
In closing, let me make it perfectly clear that choosing very few exam topics from cases in not a good strategy: neither for the PBL exam, nor for your medical education.
Another Frustrated Anatomist, Ph.D.
the med school hell blog just posted the "101 things you wish you knew before you began med school" list. i wish i could say the list was wrong or inaccurate, but much of it is true. dead-on true.
apparently, i'm a highlighter b!tch. hey, at least that indicates that i belong! ;-)
first, a bit of background: i was born and raised in a suburb of a large american city. during my school years, the public education system in my area was in turmoil. since my parents place a high value on education, they decided to make a huge financial sacrifice by sending me to a small private school for 6th-12th grades. although, like any other, my education had its ups and downs, the community of the school was, at the time, like a family. even though it's been over ten years since i graduated from high school (gasp), i still keep in touch with many of my friends from school. we rarely have a chance to see each other anymore, seeing as we're all scattered across the globe by this point, but these are all good friends--the kind that i can pick up the phone and call and talk to as if no time has passed. it's rare in life, i think, to find people with whom one can connect so well and i feel very blessed by their friendships.
yesterday i received an email from one of these friends, whom i'll call dr. cs (<--he's a doctoral student in computer science and is probably one of the few, like me, who will be an eternal student--i think he's more than earned the title of dr by now, even if the school wants to milk a few more research papers out of him before dubbing him officially). three years ago i attended dr. cs's wedding--a beautiful event that brought a bunch of us back together, reunion-style, as a rare treat. dr. cs married mrs. cs, who, although i don't know very well, i really, really like, and i suspect could become a good friend, were it not for the gap of many miles between us. in short, dr. & mrs. cs are a great fit. so i was thrilled, a few months back, to hear that they were expecting their first child. they're the type of people that you just know will make great parents.
so dr. cs sent this email yesterday, titled something to the effect of "greetings from x_state." this perplexed me a little, since x_state isn't where he lives, but it is where another of our friends live, so i thought maybe they were on vacation. unfortunately, the title of dr. cs's email belied the content. it turns out that they were in x_state for a friend's wedding. the night of said wedding, mrs. cs went into early labor and ended up giving birth to their son, i.w.g., at a mere 26 weeks' gestation. it was an unexpected early delivery with dire consequences.
for three weeks they went on the roller-coaster ride of having their baby in the nicu and all that that entails. on tuesday, after many ups and downs, little i.w.g. succumbed to his illnesses (primarily premature lung disease with what sounds like a secondary nosocomial pneumonia on top) and died. dr. & mrs. cs kept a blog about the experience--a heartbreaking, tender, thoughtfully written account of each day in this baby's life--and it absolutely crushed me to read it. i cannot even begin to fathom the pain and suffering they've endured. i thought about posting the link to the blog here, but in the interest of protecting their privacy, i've decided against it.
given that i'm still having a hard time wrapping my brain around the notion that my friends from middle school are even having babies, i can hardly grok the fact that something like this--something so tragic that involves such an adult, mature response to endure--has happened to my friends. i'm in utter shock. when did we all grow up? when did we become adults who have to decide on dnr orders for our babies? it makes me miss the days of worrying about getting my homework assignments in on time (for those of you who were there, think fruit flies!) and worrying about where we'd go to college. that time seems so much more tame and simple in comparison to this....
i couldn't help but wonder, as i read their blog, what it would have been like to be in their shoes these past few weeks. i've seen the sickest of the sick babies in the nicu (the university medical center in which i worked for a number of years has a level 5 nicu--the highest level of care available for infants), but i've always looked at these infants from a provider's perspective. i recall the first time i entered the nicu, while shadowing one of our attendings and a fellow, and my shock and awe at the fact that the first baby on whom we consulted had a foot (i kid you not) no bigger than the pad of my thumb. i imagined, at the time, how hard it would be to care for these tiny babies...but i didn't imagine how horrible it must feel to be the parent of one of these children. the sense of helplessness, in particular, must be overwhelming. i particularly never imagined that my friends could be in this position--especially when i'm not so sure that any of us feels so far from childhood ourselves....
all that said, my heart goes out to all the parents and caregivers who work so tirelessly to ensure the well-being of these tiny little babies. and to dr. and mrs. cs--i am in awe of your courage and fortitude throughout this nightmare of an experience. i know, in the deepest part of myself, that you touched little i.w.g. with your love and care. his time here may have been short--but because of you, i am certain it was also full of warmth.
the supreme court released its decision re: partial birth abortion today. i wish i could provide a direct link to the court document, but it's a rather large pdf file, and i have nowhere on the web to store it myself. so if you're interested in the nitty gritty of what i'm about to say, you may want to go read that document first. now has a link to it in their news section, as do several other news pages and organizations.
if you've been reading my blog, you know by now that i consider myself a feminist. i tend to agree with liberal politics, primarily because i'm an academic at heart and i'm always questioning everything. (my favorite question growing up: why?) i believe that conventions are made to be questioned and analyzed, not reflexively followed. i also am an exceptionally sensitive person, one who holds life dearly enough that she's been known to run into traffic to save a turtle about to meet its demise by attempting to cross the street. i cried when someone killed the wasps outside my house recently, even though i was afraid of them (i don't like pain and therefore avoid critters that sting/bite/want to eat me). basically, i'm a big mush--my heart is always on my sleeve and, no matter how hard i try, i cannot conceal this fact.
that having been said, i struggle with the issue of abortion. i feel that life is sacred. i've always been fascinated by childbirth and i know i'll likely end up focusing my career on women's health. *and* i have a strong respect for women's bodies and their choices about what happens to their bodies. so although i don't think i could ever have an abortion myself (<--i'm a little biased because i have fertility problems and it would be pretty darn hard for me to get pregnant without medical intervention), i think every woman has a right to choose. i also acknowledge the fact that, given my interest in women's health care, i may be trained and/or asked to perform this procedure. this fact scares me, but i acknowledge the reality, nonetheless. i cannot imagine the suffering that an unwanted child must endure throughout his or her life. i also don't think any woman should be forced into poverty or put her life in jeopardy for a fetus. it's my opinion, plain and simple.
when i first heard about partial birth abortion, i was incredibly disgusted. the description of the procedure seemed absolutely horrific to me and i couldn't understand why anyone would ever want to have that kind of an abortion. then i read the supreme court ruling.
if i'm understanding it correctly, a partial birth abortion involves delivering the fetus to a certain point and then killing it. in contrast, other types of late-term abortion involve dis-membering the fetus in utero and then delivering it. knowing what i know about science (remember, i just studied embryology and neuroanatomy, among other things), if i had to choose between someone whacking me on the head to kill me versus tearing me to shreds, i'd choose to be whacked. it's not even in the realm of being contestable--one act causes immediate death, the other is pure torture. but what did the courts just do? they just prevented physicians from performing the "humane" form of abortion while permitting them to torture fetuses via the alternate method. they say they're trying to preserve the sanctity of life--how on earth does this decision uphold that sanctity? seriously! can anyone follow the logic here? or did they simply make the decision so ambiguous as to prevent providers from performing any late-term abortions? hmm....
i really don't understand how the same government that has allowed us to invade other countries where we are killing innocent children and that allows our children to access guns so that they can kill each other can take a stand against killing a fetus that cannot survive outside of its mother. i also don't understand how our government can refuse to allow sex education to be taught in schools. if they don't want women to have abortions, then why aren't they teaching pregnancy prevention? if they're professing abstinence as a "cure" to prevent pregnancy, then why is the government (in some states) requiring young girls to be vaccinated against sti's? if they truly believed in their abstinence programs, there would be no need for the vaccinations. oh, wait--that's right--boys can have all the sex they want and spread around the sti's while girls have to remain abstinent until marriage wherein they get exposed to sti's because the guys were sleeping around--that's why we're mandating the vaccines, right?
i swear, if it weren't for the right to free speech, i think i'd be on the next plane out of this country. until the government takes away my right to rant, though, they'll just have to deal with me screaming from my blogspot.
i want somebody to give me one good reason as to why we should still be allowed to own guns in america.
seriously. why the heck should a college student be able to go out and buy two guns that give him the means to kill 33 people?!?!? i know, i know, some will argue that being able to own a gun is a fundamental american right--but just because however many hundreds of years ago (before we wiped out nearly the whole environment) we supposedly needed guns to "protect ourselves" from animals, does that mean that it's still a good idea for harboring weapons to remain a fundamental right? we're certainly not at risk from being eaten by bears anymore. it has also been proven that ownership of guns results in more intentional and accidental deaths than in protection from robbers or "bad guys," etc. so don't even try to tell me that people need guns for protection--i personally think that's absolute bullsh!t.
when i was in middle school, my friend's mom was shot in my front yard. in life before cell phones, she happened to have a c.b. radio underneath the passenger seat in her car. when the robber appeared at her car window, she reached for the radio, and the person trying to rob her thought she was reaching for a gun and shot her. my family and i ended up underneath the couch in the living room until the cops arrived. my friend's mom survived--luckily, she'd placed her arm up in a defensive position and the bullet lodged in her arm--but i don't think any of us felt safe again for a long time following. would owning or possessing a gun have helped us in this situation? not a chance.
about fifteen years after this incident, i worked in the burn unit at a large trauma center. the physician for whom i worked, an amazing burn and trauma surgeon, allowed me to shadow him one day when most people were on vacation (sometime between christmas and new year's day). i'd never gotten to observe surgery first-hand before that day, and what i saw, i'll never forget. sometime around 3pm on a bright, sunny afternoon, the trauma team was paged to the trauma bay for an incoming gsw (gun shot wound) victim. because of hipaa laws, i cannot go into the details here about why the guy had been shot in the middle of the day or by whom, in particular, he was shot. but what i observed that day in the o.r. only underscored my already strong anti-gun position. this guy had been shot by a member of a law enforcement agency in an effort to (supposedly) protect the public. what i learned during the surgery, however, was that he'd not been shot by just any kind of bullet. the bullet with which he was shot was of the sort that is created to cause the most damage to whatever it hits. and, believe me, it did more damage than you can imagine.
i guess i can understand why law enforcement members carry guns, even though in most other countries, they do not carry weapons. but in my opinion, there is something absolutely sick about the fact that we allow people (law enforcement or otherwise) to run around with guns that are made to be not only lethal, but totally destructive. i don't know enough about guns to know whether the student at vt was using unusually destructive guns or bullets, but the descriptions of the violence certainly make it sound as if the weapons he used were not "ordinary." why do we allow such weapons to be sold? if we really think that we still need to have the right to bear arms, why not make them single-bullet guns that have ordinary bullets? why do we allow the sale of such destructive weapons? do we really think the average citizen needs a multi-bullet containing super-gun to protect him- or herself?
here we are, invading other countries on the premise that they harbor weapons of mass destruction. has anyone bothered to look in our backyard?!?!? i wish somebody would invade us and save us from our own self-destruction....
i know it's spring, but nope, i'm not talking about dirt.
sod, aka sphincter of oddi dysfunction, is the most recent diagnosis i've been given for my abdominal ailments. those who know me well will attest to the fact that i have the unlucky misfortune of developing random medical problems...but this has to be one of the oddest. [no pun intended, of course. ;-) ] This wouldn’t necessarily be a bad thing, in and of itself, but the new GI I saw here (the last one went AWOL...so bizarre) doesn’t have the equipment (nor do any of the other docs/facilities around here) to do the serial manometry testing on my common bile duct (cbd) that is needed to prove the dysfunction and determine treatment.
Thursday, after learning all of this from the new GI, I called my GI in the large city in which I grew up. The city is not too terribly far from where I live now, and my parents still live there, so it seemed like returning to the GI who (a) knows my history, (b) i admire, and (c) has access to better/more/newer equipment than physicians in this area would be a logical next step. being the dedicated physician that she is (and yet another one of these amazing female docs that i'm afraid will burn out too early as a result), she called me that night at 9:30 pm from her office.
In speaking with her, however, I realized that being diagnosed with sod (and confirming the diagnosis) is more complex than I imagined or had been lead to believe by the GI doc here. She explained to me that, even in large metropolitan cities with major teaching hospitals such as the one with which she's affiliated, most docs/facilities don’t have the equipment for this procedure because it is not done often anymore. This has something to do with the fact that anesthesia and analgesics interfere with the function of the sphincter, such that the test has to be done under unusual conditions (<-- note that I didn't ask her to elaborate on this; my immediate ally mcbeal mental image of having a tube shoved down my throat while fully lucid frightened me into silence). So, basically, if this procedure is offered, it’s only performed at major medical school centers where it’s being used for clinical trials/exceptional cases/studies.
As a result, usually GIs go in "blind" (i.e. without the proof of elevated pressure in the cbd that clinches the diagnosis) and do a sphincterotomy. However, the risk of pancreatitis after the procedure and/or the need to have the procedure to repeated every few years is fairly high. Given these factors, the procedure is also not generally done in younger adults, since the risks increase over time. This makes me a bad candidate for an ercp with sphincterotomy, particularly without a proven diagnosis.
that evening, before this gi doc called me, I read some recent articles on PubMed to see if there were any new or alternative treatments available for sod. Some major medical centers have been experimenting with injection of botox into the sphincter, which prevents the sphincter from contracting and therefore reduces the pain-causing-pressure in the CBD. Of course, if this works, it has to be repeated every few months...but in my opinion, the possibility that it could work way outweighs the pain of the spasms. (I think there is only so much longer I can live on applesauce, rice, bananas, and toast before I go mad.... And the medications to treat the disorder, namely antispasmodics like levsin, are only so effective....)
She didn't know off hand whether anyone in the city is doing this procedure, so now I’m waiting to hear back from her as to whether anyone there is willing to shoot my sphincter up with botox. And my poor little sphincter doesn’t even have wrinkles yet! :-(
At one point, this GI doc, who is usually fairly upbeat (or at least on the optimistic side), asked me something to the effect of, "couldn't you get something that's treatable?!?" I know she meant it in kindness--she obviously does not like to see me suffer this way, particularly at such a (relatively) young age--but I was sobered. I'd never heard her sound quite so...well, almost hopeless, I guess.
It has taken me a while to digest all of this. Even after all I've been through medically, it didn't occur to me that this might be untreatable. I can't really wrap my brain around that notion yet--I'm simply not ready. A life of unpredictable, excruciating abdominal pain with intermittent bouts of diarrhea? No thank you.
Anyone know where I can get a refund for my body? I think mine may well be a lemon.
In the midst of my sleepless nights, I've been reading medical blogs. There are some incredible students, residents, and physicians out there capturing life on the front lines. Hearing their stories reminds me that I am not alone in my struggles, that my opinions on medicine and medical education are not as outlandish as I'd thought, and gives me hope that there just may be a community of healthcare providers out there who are eager to initiate change.
Tonight I read such a great post on "learning the hard way" that I decided was too important not to pass along. In it, Dr. J. makes eloquent observations about the current state of medical education.
I may soon have to start one of these "blogrolls," and link to these sites, because I have a feeling there are some bloggers out there who are well worth highlighting. Dr. J.'s site, though, is my spot of the day. I hope you appreciate his comments as much as I do.
when i finally got up later today (after finally fixing the smoke detector and getting some sleep), i realized that it was an absolutely beautiful day outside. since i haven't seen the sun in days, i decided i needed to get out. i'd never had the time before to check out some of the "trails" in my pud, so i grabbed my camera and ipod and set out on a walk. my expectations were minimal--the area i live in is truly beautiful, but the pud, like most, can be a little mc-village-y. i anticipated i'd find a long length of sidewalks through a few trees, with lots of views of the ubiquitous mc-lakes found in each and every neighborhood.
fortunately, i was wrong. the trails here are far from standard and the expanse of them is vast. i ended up wandering for two hours on dirt and mulch trails through pine thickets to wooden bridges to the bases of large moss-covered oaks. i got some amazing shots along the way, but none so impressive as the pictures i snagged of a gigantic great horned owl that i discovered perched in a pine tree. this bird was incredible--massive, majestic, and *present.* she didn't linger long (a family with some small, loud children came through on bikes and scared her off), but she remained still just long enough for me to capture her beauty.
on the whole, i feel amazed and astounded by my day's journey. seems like the pud really did earn its green title by preserving actual green space and not simply installing yet another over-fertilized golf course. and, i must say, it feels good to know that my condo association fees serve to provide owls with a habitat as much as they do to provide meticulous manicures to the bushes around my building. ;-)
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| Summerfiel |
when i bought my condo, i felt really lucky. it had been the first time in a long time that i'd had a space to call my own, and i knew i was moving into a development that, while not wholly original, at least had won some awards for maintaining green space/being somewhat eco-friendly. i found a unit in one of the "older" sections of this PUD (planned urban development; older = 2003 ;-) ), so i'm in a part of the community that isn't still under construction. as an added bonus, the woman from whom i bought the condo was absolutely meticulous--so all those things that used to trouble me about living in other people's homes (e.g. lack of labels on the circuit breaker, no fire alarms/extinguishers, etc.) were not an issue here. the place was just broken-in enough to have all the wrinkles ironed out, so to speak. on top of that, the things i detest--like mowing a lawn--aren't a concern here because the condo association takes care of all the external features of the property, even down to changing the light bulbs for the outside lights. not a bad deal, eh?
except for the little details about home ownership that didn't come into my consciousness before move-in day. the first thing that caught my attention was the light in the foyer/over the stair landing. i have absolutely no idea as to how to reach the darn thing to change the light bulb, since it's located on the ceiling in an area where there's a story and a half between said ceiling and the stairs beneath it. and, no, after having worked a year in a trauma center, i have no desire to even attempt to balance my ladder on the stairs and risk major injury over such a relatively minor thing. i also wondered how on earth i was supposed to clean the window in this area, as it, too, is out of reach; nor did i quite understand the placement of a "plant shelf" next to this window. so far as i could tell, the shelf and window were merely playground pieces for the cats, who seem to revel in making death-defying leaps across chasms of space. or at least, that's what i thought...until one day i realized that one of the cats had barfed on said shelf. lovely. every time i contemplated cleaning it up, all i could think of was the potential conversation among my colleagues: "what happened to blaze?" "well, you see, there was this incident involving cat barf...." amusing, but not exactly where i want my life to go, you know?
ah, but it gets better. after spending the last seven days at home, literally wallowing in my post-medical-school-demise and recent attacks of my gut from hell, i finally had the energy to go out tonight. and it was wonderful--my mom and i had dinner and then went to a local "open gallery night" at an artists' area in town. we'd looked for this part of town before, but hadn't been able to find it; so we were quite excited to find an amazing few blocks of refurbished homes all decked out with great (and i mean great) artistic treasures. it helped that it was a beautiful evening--perfect weather--and although i was tired by the time i got home, i also felt more hopeful than i had in a while. i love studying medicine, but, at this point in my career, i have little room to express the creative side of myself; outings like this remind me that there's a world beyond medical parameters and that i do still have passions beyond the latest bug that needs to be learned. when i got home, i ended up staying up later than planned--the hazards of indulging in yet another one of my passions, reading--so i didn't go to sleep until about 4 am.
At 5:45 am one of the fire alarm units in my home decided it needed new batteries. Could it tell me this subtly? Could it tell me this at a normal hour? Could it at least realize that i couldn't instantaneously replace its batteries? Oh, no. that would be expecting way too much in this technological age. instead of some sensible indication, i awoke with a jolt as my cat bolted off the bed where she'd been curled at my feet, and then proceeded to hope that the loud, obnoxious, intermittent beeping sound would cease and desist before i had to shoot the darn thing. no such luck. not only did it not stop beeping, but it turned out that the particular smoke detector having a fit was the unit in--you guessed it--the foyer. there's nothing quite like balancing a ladder on stairs at 6 am on a saturday morning trying to replace a battery in a smoke detector that says "welcome to home ownership!" unless, of course, you count the darn tax bill, but at least the tax bill doesn't have a beep-until-you-pay-me device attached to it.... never a dull moment!
last night, while suffering the pains of yet another bout of gi upset, i thought about the recent medication therapies offered to me for my latest body wars. several years ago, after my first set of surgeries, i went through a rather rough period of time during which i suffered nearly constant abdominal pain. during that time, though, i did discover a few meds that helped. one of them, zelnorm, was released toward the end of my struggle, so i only took it for a few months, but i did find some benefit from it. it was one of the meds mr_dr_do and i considered when i saw him last week. i decided to take a different route, but with my latest symptoms, the medication came to mind again last night as a possible solution. that was, until i opened up my web browser today....
it turns out that the fda has decided to recall zelnorm due to some "serious side effects" that it has observed in a certain percentage of patients recently. this represents drug #3 that i've taken in the past ten years that has been pulled from the market in this manner. which makes me wonder: if zelnorm has now been on the market since 2002 and they're just now pulling it off, does that mean that the fda was over-hasty in its initial approval of the drug? how come the pre-marketing studies did not reveal these problems? i was under the impression (perhaps false?) that the u.s. has one of the more stringent approval codes/processes for pharmaceuticals--but this makes me wonder, particularly as i'm reading about this on the heels of removal of a new parkinson's drug we just studied for a pbl case....
i know the media will be rife with lawsuits now (a quick google search to find the fda page for zelnorm told me that much), but one must wonder--what happens to the patients who were benefiting from this drug? i can't imagine anything quite so depressing as having a disease like ibs, finally finding a drug that works, and then having it pulled from the market. i guess one could say that the parkinson's situation is worse--but i'm not the sort of person who believes that suffering can be compared--so, either way, i feel for these patients.
i also am experiencing one of those moments in which it's becoming readily apparent that my medical education may be obselete before it even begins. we were recently asked by our school to upgrade to the latest pharmacology text, fresh off the press from lange. guess what its recommended treatment is for ibs? yes, you guessed it, zelnorm. lovely. it makes me wonder--what's the point of even having a pharmacology textbook if it's out-of-date as soon as it's published (if not before it even hits the press)? couldn't we have a more effective learning tool with an online text that is continually updated? i keep wondering when the medical education system will match up to the electronic era, but it seems we're not there yet.
yet another case of one step forward, two steps back....
it's time for me to get away from whining for a moment and, instead, give thanks.
why? because in the midst of all the hardship this year, my "sisters" in the class of 2010 have helped me tremendously. they've shared study tips and notes. they've made me laugh. they've taught me: about medicine, life, and the world at large. they've hugged me when i cried. they've made me feel useful and important. they've fed me. they've listened. they've spoken. and, bottom line, they've been incredible friends throughout what has been a very difficult and trying year for all of us.
why mention them here? you might ask. because these women, these fine, intelligent, sensitive, and strong women are not only my sisters, but your future doctors. and what outstanding physicians they will be! not because of training, book-smarts, or any of that--but, more importantly, because of their generous hearts.
my thoughts are with you, my friends. may you be able to access even the least learned fact and nail those damned exams! :-)
a few days ago, my friend j.p. blogged about her frustrations with the healthcare system and being a patient in it. today i discovered a recent blog entry from dr_couz (a FP resident in Canada who writes a wonderful blog about her experiences in residency there) discussing the lines physicians must draw between their personal and professional lives. now here i sit, pondering the paradoxical perspectives.
on one hand, dr_couz's commentary on boundaries hits me hard. i have a hard time keeping and maintaing boundaries (but, no, i don't have a "caretaker" personality or anything! ;-) ) and i've watched many a physician get burned by an inability to balance work and life or friends and patients--or both. most recently, a wonderful geriatrician spoke to our class after her last day in private practice. she's hardly retirement age; yet, she's retiring. when describing why she's chosen to take "time out" from being a physician, she told us a story about how she recently sent her husband to a patient's house to fix the patient's leaky shower head. yes, we live in an area where there are many elderly people in need of assistance in one form or another--but it took her getting that involved in her patients' lives to realize why she had burnt out. she simply became over-involved. this physician stood in front of my class and told us, point blank, to maintain our boundaries. she's a sobering example of what can happen when one crosses too many lines.
so, i get that i'll need to be cautious when i go into practice (if i ever get there!), because i know i have tendencies to be like this geriatrician, to want to fix everything. [i'm pretty good with a wrench and plumber's tape, actually. ;-) ] but i also must wonder, what about the fire?
my friend j.p. eloquently captured her rage at the healthcare system and at doctors in particular. she's encountered at least a hundred (if not more?) physicians who have been distant, absent, and even downright cold. many have not been well-versed in their own specialty, let alone anything remote to it. one could argue, perhaps, that this is just one person's perspective. and, oh, how i wish that were true. but it isn't. i know because her words resonate with my experiences as a patient. her question--wanna be my doc?--has also been asked of me many times, by many friends (and even some strangers!) in similar situations. this is being asked. of me. the first-year medical student....
one of the reasons i am a first-year medical student, though, is because i feel the fire, the rage, the dissatisfaction shared by so many patients. it's an emotion that can't--indeed mustn't--be ignored. thus i'm left to wonder: given that i cannot be physician to the masses, given that i am human and will make mistakes during my career, given that i have to be able to take care of myself as well as those around me, given all the barriers present in healthcare, how can one person make a difference? how do i remain open to people, to learning, to the tenets of my profession when it seems that so many physicians give up, burn out, or sell out? and how do i become a decent physician if i can't manage my own healthcare problems? if i cannot take care of the people i love? if i pin the essence of primum non nocere to my heart, will i always remember?
once again, all i'm left with are questions.
speaking of which, hey j.p., wanna come to med school? ;-)
