A lesson in shirking

September 22, 2007 at 12:11 am (Clinical rotations)

I’m finished with neurology and have fully recovered from surgery. Some of the beauties of neurology are the good hours, easier cases, and residents that don’t care how much effort students put in. During my month of neuro, I managed to skip every clinic day using a variety of lame excuses. I was allowed to show up late to rounds, slip out of rounds by standing in the back of the room, and leave some days as early as 10:30AM. The neurology rotation certainly was a lesson in shirking.

I remember when I was a pre-med I thought that medical school was supposed to be extremely difficult, that everyone I would encounter is a perfect professional, and that I would accumulate a vast amount of knowledge that when applied in the right setting, nothing short of magic would occur every time. In reality, med school does involve a lot of memorization, but the first semester seems to be the hardest part. Once you’re over that hurdle, the rest of the first two years is smooth sailing. Whether the classes became easier or I became better at studying is a moot point. I realized that the $60,000 spent on the basic sciences was a scam provided by crooks to line their pockets. If any of my readers are interested in learning about medicine, use this list of websites to pick up information about any topic in medicine. Using these sites—especially eMedicine, UpToDate, and the FDA’s drug guide—will tell you more than any textbook on the subject.

To make matters worse, the pinnacle of your knowledge comes from the basic sciences. Once you hit STEP I, it’s all downhill from there. Sure, you may get more comfortable asking the right questions during a patient interview, but your ability to diagnose and treat is largely based upon the training you receive at the beginning of medical school. Therefore, you must study hard and do your best during the first two years. You’ll hear stories that the students who are at the top of the class during the first two years will do poorly during third year because they lack people skills. Meanwhile, the bottom 15% will shine on the wards because of their wonderful ability at interacting with others. Unfortunately, what you’ve heard is just a fairly tale. The students who work hardest at the beginning do so throughout medical school. You’ll have tests in third year just as you do as first and second years. And while you have evaluations, those grades are based upon your interactions with the residents and attendings. Your evaluators rarely get the chance to see you talk to a patient for more than 2 minutes during rounds. In effect, your people skills only need to extend to the point of being polite to the attending and answering the questions correctly during the pimping session.

The second myth is that medical students and physicians are extremely professional. I, along with many other bloggers, have mentioned that physicians at all levels of training can be royal a-holes. Medical schools do not make ethical behavioral, professionalism, teaching skills, or leadership ability a serious part of application package. Because of the choices made by admissions committees, we are left with physicians who are just as immature as the pre-meds you encounter that spout off their GPA’s within the first five minutes of meeting them. People who are brats at the age of 21 do not ever grow up.

Finally, I learned that there is no magic to medicine, only a convenient guessing game that eerily resembles weather forecasting. Tell me about the patient with the sore throat and cough. What does he have? What are you going to treat it with? If you can come up with the correct diagnosis, I’ll gladly grant you the title of World’s Best Doctor and refer all of my patients to you. The problem is that medicine still has a long way to go before becoming a true science. Figuring out the cause of an infection is incredibly tedious. For example, I had a surgical patient develop an abscess after an operation. Collecting a sample of fluid was hard enough. We had to ensure that the bacteria in our collection was really from the patient’s body and not a contamination from another source. Then, we had to wait several days while the infectious disease doctors cultured the bacteria and tested various medications to check the susceptibility of the microorganisms. Finally, we had to begin treatment. Again, there is no rule for how long to give a patient antibiotic therapy. The most common prescriptions are for 7, 10, or 14 days—football scores. In reality, there are no studies to support the utility of one length of treatment versus another.

In summary, any growing cynicism that you may notice developing within yourself is totally natural. I got into this field because I like medicine and I like working with different people everyday. However, I never knew about all the BS I would have to encounter along the way—physicianship training, problem-based learning, scut work… While I certainly don’t regret my decision to become a doctor, I am constantly annoyed by all of the things we have to go through that is neither related to medicine or patient care.

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The future: what if the restaurant business followed the medical mindset?

September 6, 2007 at 2:07 pm (Uncategorized)

For my 10th wedding anniversary, I visited my favorite upscale restaurant in the city. It features a filet mignon dinner that was literally prepared in Heaven and delivered to our table by angels. The head chef, Pierre Brennen, had years of training from the finest culinary schools in France, along with experience in Italy and Thailand. On the rare occasion that I feel like spending $100 on a meal, I come here to Bruno’s.

Today, however, the head chef was gone. The kitchen doors swung open and I witnessed several of the chef assistants packing boxes and leaving the restaurant as if they had been fired. The doors swung closed and my server came to the table. Instead of the typical tuxedo-wearing waiter that I’m used to, this new guy was dressed in street clothes that were probably pulled off of the asphalt of Bourbon Street. I stared at this teenager closely and then realized that I had originally seen him behind the counter at Burger House.

He asked to take my order, claiming that he would prepare something extra special for me. I was startled.

“You’re going to cook the food?”

“Of course,” he replied. “Bruno’s realized that it could save money on cuisine by firing the chefs and replacing them with fast food cooks.”

“But what about the dishes? How could you have any training and experience in the restaurant business?”

“I’ve got plenty of training and experience. I took a two-week course in heat lamps and an additional week in deep frying. I’ve spent at least six months preparing burgers and fries, if not more. I’m certainly qualified to handle steak and lobster.”

“How can you be prepared to put together a filet mignon without going the route of Mr. Brennen?”

“Bruno’s realized that all of that extra training in culinary school is unnecessary and expensive. By hiring us, we’ll be able to provide the same product at a reduced amount. In the end, we’ll pass on the savings to you.”

“You can’t be serious! Surely 3 weeks at the Burger House does not equal the same amount of training that chefs possess.”

“Well, I’m currently a level 1 cook. Some of the very eager employees take a one-month course at the community college to further their knowledge of high cuisine.”

“But how would you know the detail of the different meals? Master chef Brennen had tons of training and experience to guide him.”

“If anything, Brennen’s training made him too narrow. He had all academic training. Me, on the other hand, I’m more well-rounded and haven’t limited the scope of my practice. I also have more real-world experience.”

“How can any this be possible?”

“Some senators were once in here during the old days and noticed that high cuisine is far too expensive. The government realized that by recognizing fast food cooks as master chefs, we could be paid on a similar scale as the Mr. Brennens of the past. The result is that we can pass the savings on to you.”

“But your menu prices have gone up and the wait time is longer.”

“You’re only looking at the final cost. The man power costs have decreased. What you’re paying extra for are the new compliance officers and package inspectors. We have to make sure that we catalogue all of our ingredients and then follow the same procedure for every meal. Gone are the days of adding a pinch of salt for flavor. Now, every item used in a recipe must be fully tested, measured, and retested before going into a dish. Sure, it takes lots of paperwork, but you’re getting a safer product now.”

“Does anyone go to culinary school anymore? How do you progress cooking science and create new dishes?”

“With recipe programs and well-authored cook books, I can prepare any meal. Besides, what are these new dishes that you speak of? Every meal that could ever be created has already been produced. There is nothing new that we could learn about food.”

“You’ve got me there. In that case, I’ll take a number 14, ’round steak wrapped in bacon.'”

“Excellent choice. Would you like fries with that?”

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