Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

White Coat Ceremony

During orientation week at my medical school, the last night of the week is reserved for the White Coat Ceremony. This ceremony is where the incoming medical student has a physician place their white coat, shake their hand and where they are officially welcome into the practice of medicine. This ceremony marks their first taking of the Hippocratic Oath (with a re-take for the practicing physicians).

There is usually a nationally recognized speaker – for my year is was Benjamin Carson, M.D., chief of pediatric neurosurgery at Johns Hopkins- who sets the tone of the entire program. I have heard White Coat Ceremony speeches by Former Surgeon General Jocelyn Elders and other nationally known physicians. Every time I attend one of these White Coat Ceremonies, I am reminded of why I went into medicine in the first place and the “humanism” of my practice.

Even today, in 2007, the infant mortality in Mississippi is higher than in many third-world countries. In New Orleans, many patients with chronic diseases such as hypertension and diabetes face an uphill battle to find adequate primary medical care for simple maintenance of their conditions after Hurricane Katrina wiped out many clinics in the poorer neighborhoods. In Appalachia, the complications from untreated hypertension have left many without renal function who have to rely on hemodialysis three times each week.

We still have a health care system in this country that shuts out large populations who either do not have jobs that provide health insurance or jobs with health insurance benefits that are woefully inadequate. Many of these people avoid seeing a physician when early intervention could likely make the difference between remaining healthy or progressing to a chronic state of illness that will be life-changing.

Obesity is rampant in all segments of our population yet the morbidly obese face discrimination and ridicule by hospital staff, physicians and large segments of society who see them as lazy and responsible for their condition. In most cases, morbid obesity comes from lack of access to foods that are lower in fat and higher in nutrition because of cost or lack of knowledge. After gaining a large amount of weight, even walking around the block becomes more than many of these people are able to achieve.

When I think about attending the White Coat Ceremony at my medical school this year, my focus will be on how we can raise the quality of delivery of health care across all segments of our society. It is my belief that preventive medicine needs to be practiced more than interventional medicine. The poor, the morbidly obese, and those who lack knowledge are among the most difficult patients that any physician will ever treat.

The morbidly obese are a rapidly growing segment of our collective patient populations with problems such as non-healing venous stasis ulcers, lymphatic dysfunction, obstructive sleep apnea, early congestive heart failure, depression, Type II diabetes of the young and predisposition to thromboembolism. Even a relatively minor surgical procedure such as an appendectomy becomes a major undertaking in a person who weighs more than 300 pounds let alone 400 – 500 pounds. I have watched my colleagues deliberately avoid treating morbidly obese patients who have sought their care because they didn’t want to deal with the possible complications.

Morbid obesity is showing up in middle school, junior high and high school with some individuals weighing so much, they become unable to attend school. In the cases where these morbidly obese individuals are able to attend schools, many physical education classes are unable to accommodate these children who desperately need to learn how to exercise and eat properly in order to undo 200-300 pounds of weight. In most cases, these children do not need to be subjected to gastric bypass surgery but need simple education and good food choices along with making aerobic exercise a regular activity.

With every patient, we as physicians, need to look toward preventive medicine and patient education. To do otherwise, keeps us on a path where health care costs will continue to sky rocket and soon, too costly for most people to be able to afford. It is up to us, as physicians, to lead this country back to basic good health for every segment of our population.

26 June, 2007 Posted by | medical school | Leave a comment

My First Week of Medical School

Many people have asked me, “What was medical school actually like?” “What was you day-to-day schedule?”. I will attempt to describe my first day in medical school from the time I woke up to the time I fell asleep in this essay.

I woke up at my usual time of 4:30AM. I was raised on a farm and getting up early is as much a part of my life as brushing my teeth every morning and evening. I am fortunate that I actually have always had less of a sleep schedule than most of my buddies and thus, I generally awaken around 4:30AM without the need of an alarm clock. I also roll out of bed and hit the shower while my single cup of “Joe” is brewing.

Over coffee, I usually catch up with the newspaper (online) and then I headed out the door for my walk to the subway station. This walk generally took about 20-minutes and was a built-in source of exercise for me for the first couple of weeks of medical school. My coursework on the first day consisted of Introduction to the Practice of Medicine Class at 8:AM- 10AM, Psychiatry at 10AM to noon. Lunch was from 12 noon to 1PM. Afternoon was Gross Anatomy Lecture from 1PM-3PM and Gross Anatomy Lab from 3PM to 5pm.

All of our lectures were in 50-minute blocks with 10 minutes of break in between each lecture. This allowed us to get a drink, walk around and prepare for the incoming lecturer. It also allowed the media person to set up in between the lectures as our lectures were available for download and all PowerPoints were down-loadable from out seats. Most of us took notes on the Powerpoint slide sheets or just listened in class.

Our syllabi had been handed out during orientation so that we knew the objectives and content with each lecturer. We also knew which textbook readings were to be covered. My Introduction to the Practice of Medicine course had a syllabus that contained an outline of the lecture. There was no text reading for this opening lecture that included the duties of a physician, how to fill out a death certificate and how to gather and interpret vital statistics for a locale such as birth rates, death rates and rates of disease.

With all of my syllabi and text books, I would remove the covers, take the books to Kinko’s and have the bindings removed. I would then have three-holes punched and I would place these sheets in large 3-ring binders. I had a binder for each course. In the evening before each course, I would remove the syllabus sheets for that course, remove any textbook pages that I thought I might need and place them in a small 3-ring notebook along with sheets of lined notebook paper (for taking notes). This was the notebook that I brought with me to school. I would have the subject matter divided by separators so that I had all of my information with me for the day.

I would download my PowerPoint slides and place copies of these in my subject notebook when I got back home for the day. My lecture notes (or copies of note service) would also go into each subject note book. My textbook pages would go back into that textbook three-ring binder.

On my first day, I took notes and placed them in my Introduction to the Practice of Medicine binder when I arrived home at the end of the day. For psychiatry, again, the lecturer had no slides but discussed Erickson’s stages of development and Piaget. I took notes but knew that detailed explanations of these subjects were in my textbook.

For Gross Anatomy, I had the text pages with me and made notes in the margins of the material presented by the lecturer. I also made a few notes on photocopies of my Netter plates for use in our lab. During Gross Anatomy lab, I had my list of structures that I had made from scanning the dissector. I had also reviewed the relevant plates in my Netter atlas and had made photocopies of these plates. My photocopies were stapled to my list of structures.

In our first Gross anatomy lab, we studied the bones of the vertebral system and skeletal structures. We were also given instruction in how to work with the diener to keep our cadavers in good condition for the entire semester. We were also introduced to our cadavers and our tank groups (each was six people).

After lab was over, I took the subway back home (45-minutes) and walked from the subway station to my house. I then took an hour, made dinner, ate and begin to study and review the material from the first day’s lecturers. As I studied, I made notes an questions in the margins of my books, syllabi and note sheets. Since most of my notes were typed, I printed these out and placed them in my subject binders. I also studied and memorized the relevant bone structures using my bone box that was issued to me during the first day of Gross Anatomy laboratory.

My next task was to preview the notes for the next day’s subjects and do any readings/problems that had been assigned. After my previewing, my textbook pages, relevant notes and syllabi pages were placed in my daily notebook which went into my backpack. My next days courses were Biochemistry, Microbiology and Microbiology lab.

My day ended about 11 PM and I hit the bed because I knew that my next day would be starting at 4:30 AM. Since Tuesdays and Thursdays were shorter days (class started at 8AM but ended at 4PM) I actually had an extra hour on these days. We also had a Microbiology Discussion session on Tuesdays and a Biochemistry Case Discussion session on Thursdays where we would discuss clinical cases from the standpoint of these subjects. Our instructors would bring a case, present it and then we would discuss these cases in detail from the standpoint of the basic science involved.

When we started to actually dissect the cadavers, my Mondays, Wednesdays and Fridays included 2-3 hours of dissection in the evening after class was done. I would get some dinner at school and then get into the dissection laboratory to study and complete dissections. The extra dissection/study moved my bedtime back to after midnight on these nights.

I also studied in the dissection laboratory and with my study group on Saturdays. We would have an early breakfast (at one of the nearby churches to help them raise funds) and then study and quiz each other until noon. We would then study and quiz each other in the Gross Anatomy lab after lunch and generally until 3 or 4pm. After that, we would do another group session in Biochemistry and Micro and then head home around 8pm.

Sunday’s were generally my day of rest. I would spend a couple hours in the evening putting together my materials for my Monday classes but most of my studies would be completed in the time that I had put in Monday through Saturday.

If this amount of study time seems extreme, it was extreme in some ways. I would not stop until I felt I had mastered the material. I also made the crucial mistake of neglecting my physical conditioning in favor of my studies when I should have incorporated my studies into my physical conditioning routine. I ended up gaining a considerable amount of weight but my grades were excellent. At this point in my life, I know that I have to strike a balance and now I am in excellent physical condition with no neglect to my academics/reading.

Medical school was all about balancing my studies with my life. I learned to multi-task and I learned how to focus on getting things mastered and completed. I also learned the value of discipline. My schedule didn’t allow much “downtime” but the “downtime” that I had was utilized to an ultimate degree.

It becomes easy to procrastinate in medical school because the days are long and the material seems voluminous. I fought procrastination by asking myself, “Why are you avoiding getting on with this task?”. Since I never had a good answer for this question, I just broke the task into smaller tasks and checked them off until they were done.

As I have said in other posts on this blog, the telly went by the wayside. I would spend a bit of time on Sunday scanning the log for shows that might be of interest. I would program my recorder for the shows of interest and watch them the next Sunday if I felt like a bit of relaxation. In most cases, my relaxation became hanging out with my classmates and the telly wasn’t much entertainment. I still tape shows that I love or documentaries that might be of interest to my students as I am teaching more these days.

Other things that tended to waste my time in medical school were phone conversations. I seldom use my telephone more than 5 minutes per week and tend to use e-mail communication more. I also pick and choose the meetings that I attend. Many times, academic committee meetings can be a total waste of time and energy and thus, I pick and choose whenever possible. If something is mandatory, the organizers generally will time the meetings around the schedules of those folks who are attending.

One of my medicine professors encouraged us to read the case reports in the New England Journal of Medicine every week from the first day of medical school. He said that we might not understand all of the aspects of each case but that this habit would prove invaluable as we moved through the curriculum. He was totally “on the money” with this one. I can’t tell you how studying and reading these cases helped me on all steps of USMLE and in residency too.

Medicine requires that you read and keep up with the journals of your discipline. I strive to read selected articles in New England Journal of Medicine, Journal of American Medical Association weekly. I also read American Surgeon and Archives of Surgery regularly along with Nature Medicine (excellent articles to be found in this journal). I keep a computer log of the articles that I have read and their sources. This keeps me current with the literature as much as possible.

16 June, 2007 Posted by | first-year, medical school, medical school coursework, organization, study skills | 9 Comments