In an effort to be counted among the Gay Guys, Commie Bastards, Libertarian Objectivist Christians, and , I thought I’d finally start my inevitable “Ask the Med Student” thread.
General health topics? Medical politics? What it’s like to cut up a dead body for study purposes? I await your queries.
Note that this is in Great Debates, because that’s where all the “Ask The…” threads seem to be, and because you people will argue about anything. If it gets too nice or chit-chatty, we’ll go to MPSIMS.
When dissecting a corpse, do you get to see the face, generally? Or only the portions you will be dissecting? I heard a while ago that the face remains covered. Just want a confirm-or-deny.
Derleth–no, we had no rule about keeping the cadaver’s face covered. We did often keep it covered, but that was mostly because we stored them covered with towels soaked in preserving fluid and we would usually just uncover the part we were dissecting. We saw his face on the first day in the lab, even though we didn’t do the head until the end.
I have actually done THIS. How this came to be on my road to clinical psychology is a long story. I know in our situation (in Gross Anatomy) not only did we not keep the face covered, but we dissected it, as well as the internal part of the skull. Harder to do that with a cloth in the way.
this is a good idea for a post...trying to think if I have any health concerns to bring up...actually I will stick with philosophical/psychiatric questions.
How does the health profession generally approach mental illness? I would assume most practitioners would adhere to the "medical model" of psychopathology. ARe there circumstance under which you would approach mental health problems as NOT medically related?
Anyone who “Asks the Medical Student” about medical problems, diagnoses, etc, and takes his/her advice is most unwise. Moreso the medical student who issues such advice.
KarlGauss has it right–as a second/third year medical student (depending on how the boards went), I am neither qualified nor willing to dispense actual medical advice. Therefore, avalongod, I will tell you the truth about carpal tunnel–I don’t know. Such is the lot of the medical student at this point–I know what it is, but I’m not sure what to do about it.
lee–stomach ulcers are caused by a lot of things, chief among them a bacterium called Helicobacter pylori.
For your other question, avalon–I will probably be able to tell you more about that in a few years. I hope I’ll be able to tell you a lot more about that, since I want to do a double residency in family practice and psychiatry. (I’m particularly interested in where the two intersect.) I’m not really familiar at this point with the other “models” for thinking about mental illness. I know that I would like to consider most psychopathology as a problem that can be treated–is this what you mean by the “medical model”?
I can tell you that the general attitude toward mental illness among my classmates is not good. I really think that a lot of them don’t look at psychiatric conditions as “real problems” at all, and that bothers me.
avalongod: Fortunately, there’s a wealth of information available about carpal tunnel syndrome at your library, at most workplaces, and through the links provided here: http://www.healthlinkusa.com/carpal_tunnel_syndrome.html
I am a third year med student but frozen in my training because I left medical school after 6 months in the clinics to pursue a combined PhD degree in Human and Molecular Genetics. I have just finished the first year of my PhD.
I’m posting more around here since the beginning of the week because I am in a really slow lab. We work on social amoeba, with an 8-12 hour doubling time, but I’m doing really cool stuff. Soon, maybe back to the break-neck world of fruit flies!
Anyhoo, if the kind Student-Doctor J (ethics violation to call yourself Doctor before graduation! tut-tut-tut ) needs any help, I can lend an ear. I won’t give direct medical advice because that would be legally and ethically foolish. But I can sure answer questions about the exciting world of sleep deprivation and massive memorization. You have no idea of how hard it was for me to start thinking again at the beginning of grad school. I swear, they actually expected us to have new ideas!
Lemme just add I’d be happy to share grossly obscene medical school/clinics stories if so desired. Rectal foreign bodies always a fave around the dinner table.
I’m going to move this to MPSIMS. As the doc-in-training said, this is where most of the “Ask the…” threads have been posted, but I’ve been moving a bunch out because they haven’t been debate threads. Since there’s no debate here, I’m moving it.
DoctorJ,
About the attitude that mental problems aren’t a ‘real illness’ you mentioned earlier.
What do you think influences these students to eventually come to this mindset?Is it that since there isn’t a bug to kill, they feel powerless and so refuse to aknowledge the validity of a mental ‘illness’?What’s your take on this?
If this question makes no sense, please forgive me.I haven’t been to sleep since Thursday.
Ah Ha! My doctor, just out of med school herself, told me that was an urban legend! Instead of ordering any tests or prescribing anything she put me on the following diet:
nothing acidic, no fruit, no soda, no tomatoes
no fat (the pain could be gall stones, so lets be safe and not eat any fat she said)
no salt (you eat too much anyway and salt is bad for you)
no spices (they inflame the ulcer)
no hot beverages and allow my food to cool off before eating.(they inflame the ulcer)
no dairy ( i am mildly allergic to cow’s milk, it makes me sneeze)
Avoid all of my favorite foods, it i am enjoying my food too much i create more stomach acid and that is bad.
She sad to try this diet for 3 weeks, and check back. She said the diest would probably be made permanent. This was 3 years ago. I stopped seeing her then. The stomach pains eventually ( it took over 2 months) went away.
H. pylori has been shown to be the causative agent of many stomach ulcers by Koch’s postulates. These were partially shown in 1983 by Robin Warren, an Australian pathologist who noticed the bacteria in at least half of his ulcer biopsies. Later, he cultured it, swallowed it, and guess what he developed? Yup – ulcers.
While your diet may or may not have been good for any number of reasons (I am not your doctor…), chances are you could have been helped either equally well or better (less impingement on lifestyle) by triple therapy for H. pylori (three antibiotics, or two antibiotics and pepto-bismol last time I checked). It is far, far easier to take antibiotics for 2 weeks than maintain a specialized diet for a lifetime or even 2 months, and I commend you on your fortitude of staying on the diet. There are also plenty of good drugs to cut down acid production if you feel that that is the problem and you want to go back to your old eating ways.
3BM–I think a lot of it comes from lack of personal experience. If there is one attribute common to most medical students, it is stability and tenacity–“sticktoitiveness”, if you will. (This is far more important than academic prowess, IMO.) Most of them feel that if they’ve had any problems, they were able to suck it up and get over it, and that everyone else should just be able to do the same.
Most of them can relate to being physically sick, and can scale that experience up in their minds. They might relate depression, however, to those few weeks when they felt really down and then just pulled themselves up out of it. They don’t really grasp that there’s a qualitative difference between that and clinical depression.
Of course, that’s my impression, and certainly not all med students are that way, but I get that feeling from a lot of them.
DoctorJ, yesterday a doctor had to give me some very bad news and I was impressed with how gracefully and compassionately he delivered it. I was wondering how, or if, they train you for this in medical school. To me, that would be the hardest part of the job, even worse than having to look at blood and guts.
Also, do they give you instructions on how to handle a situation that could go either way? Say if there was a fifty percent chance that someone had cancer, and you wanted to make them aware that this was a very real possiblity yet not make them lose all hope. Seems like an impossible task to me.
Tatertot–first of all, I wanted to say how sorry I was to hear about your bad news.
We do in fact train for scenes like that–we had a whole course on the medical interview. Last year we learned all about the basics, and this year we covered more sticky situations–breaking bad news, difficult/combative patients, the sexual history, etc. We had patient-actors come in and act out the interviewee, so we could practice before we have to do it for real.
In fact, there was a question on the USMLE Step 1 (I didn’t get it, but others did) about a man who is in the hospital and has terminal lung cancer, and who wants his wife in the room with him when you tell him the news. How would you best arrange the bed and the chairs? (I’d say patient in bed propped up, doc in a chair at the bedside, and wife sitting on the bed with the patient or in a chair on the same side as the doc.)
When you’re dealing with the situations that could go either way, I think it is important to shoot straight. There is such a thing as being too blunt, but dancing around the point doesn’t do anyone any good. I imagine it takes years of practice. The important thing is to understand the patient’s impression (and that of the family) before you let him go, and to talk again after he’s had a day or two to think about it.
If it gets too nice or chit-chatty, we’ll go to MPSIMS.