Ask the Medical Student!

Miscellaneous and Personal Stuff I Must Share
21

Although i did not stay on my diet, it is not lack of fortitude. I once followed a doctor’s diet so well i was starving. I ended up in the emergency room. Ketones in my urine and all.

I ended that ultra bland diet when my husband threw a fit and threw my plain unsalted rice and dry toast across the room and told me that I was not going to listen to that quack any more. My stomach pains did not get better while on the diet and did not get worse when i resumed my normal variety of food. I don’t know why i stopped getting the pains.

Med Student,

How many of your classmates already think they are god? I worked at the UofC Hospitals at the IS helpdesk. Several medstudents thought they were far too important to pick up their passwords in person.

22

lee:

Believe it or not, very few. I think that we have the Admissions Committee to thank for that, as they seem to prefer the more down-to-earth candidates. UK has long thought of itself as mainly a primary care school, and the “gods” aren’t interested in being family doctors.

We do have a few arrogant asses, though. You could almost understand it if they were at the top of the class, but they’re not. In fact, when I think of our top 4 or 5 students academically, they’re also among the nicest and most down-to-earth people in the class.

I can see the situation you described, though. The worst thing about the pre-clinical years (the first two) is that nagging and constant thought that if I’m not studying, I should be. Sometimes it seems like the least little imposition on top of the pile is just the last straw. That isn’t to say it’s right, it just happens.

Dr. J

23

Your (or any other doc-type here) thoughts on treatment of depression/anxiety disorders. My sister (in her mid-forties) has a history of depression and anxiety;for the past few months she’s been having a hard time with anxiety; she’s been seeing a psychiatrist. Treatment: medication. Yesterday he gave her yet another kind of pill. I asked her about COUNSELLING – doesn’t he talk to her about her problems, life, whatever, at an effort to get at the problem. Her response: it’s a chemical imbalance in the brain and he’s trying different types of medication. I think this is b.s. Yeah, I know studies have shown there are chemical imbalances related to mental disorders, but I thought psychiatry was about working with the psyche as well as the physical. I can see things in her life (or NOT in her life) that might be contributing to her problems, but the freakin’ doctor is just giving her pills!

24

I think I’m going to be sorry I posted but I have to correct you Edwino. Helicobacter pylori does not technically fit Koch’s postulates, since the disease can exist in the absence of the organism and vice-versa. That said, I still think Robin Warren is a gutsy genius.
That bland diet is idiotic. It’s not a great idea to give out free medical advice over the net but I’ll share my ulcer diet with you-if it hurts, don’t eat it!
Psychobunny (Yes-I’m a doctor-either that or I’m wearing somebody else’s labcoat)

25

Sycorax-studies have shown that for mild-moderate depression medical therapy is as effective as counseling. Only problem is they didn’t test the two combined. Maybe the Doc has been overwhelmed with patients who run screaming at the mention of therapy but will accept treatment for a “chemical imbalance”.

Psycho “I think I need both” bunny

26

I seem to remember reading a study that did test counseling + medication, and the results were no better than medication alone for mild to moderate depression. Counseling alone came in far behind. The most important benefit of counseling is to help the patient get through the 3-4 weeks it can take the meds to kick in.

Psychobunny–welcome! If I may ask a question on my own thread, what field are you in? (I’m starting the residency thought process.)

Dr. J

27

Glad to help-Dr.J. I’m a flea. (Internal Medicine to the rest of you). I do a lot of teaching so I am used to advising the students on specialty choices-ask away.

28

Thanks psychobunny. I knew someone would call me on this, but I was too lazy to repost (graduate school and medical school mentalities are pretty different…)

For the record (and serving as catharsis to keep this medical knowledge thing going through PhD time):
Koch’s postulates

  1. Isolation of the agent from EVERY case of the disease.
  2. Purification and culture of the agent, preferably without animal cells (artificial media).
  3. Infection causes the disease, and you should be able to repurify the agent.

I’m frankly surprised that you guys didn’t take me up on disgusting clinical stories. Give the average man a little initiative and you wouldn’t believe the heaps of trouble he can get himself into.

29

Thank you DoctorJ, I appreciate both your sympathy and your answer. I’m glad to know that they do give you some training in that area, it seems cruel just to throw you out there and expect you to muddle through on your own. I’m curious, do they encourage med students & doctors to get counseling when the burdens of the job get to be too much, or are you just expected to tough it out?

Another question, how do you feel about nurse practioners? When given the choice, I always chose one as the primary care provider for both myself and my son because I like how they are more apt to speak in layman’s terms and seem more sensitive. To be fair, I’ve noticed that a lot of doctors seem to be more “human” these days, as well. Is there a movement in med school to train doctors to be more down to earth? I’m not saying that I ever thought they were mean, or anything, just kind of distant and scientific.

Just one more, do you think that sticking people with needles (ie to draw blood or start an IV) is more of a gift or a skill that can be taught. It seems that some people are just so much better at it than others. The other day, I had to have two IVs, and the first one took two holes and today my entire hand and wrist are black and blue. The other one took one prick and I’ve just got a teeny little scab. Does luck come into play with this at all? Have you done one yet? Were you scared?

Okay, I lied, another question. Does it hurt your feelings at all when people refuse to let you try things out on them? I’ve always let med students try on me, because I figure they need to learn sometime, and I am just a saint of a woman ;). I can understand how someone might say no, though, and I’m wondering if you feel kind of bad about it.

Keep up the good work in med school! When I’m a wealthy hypochondriac and you are my personal physician, I expect you to have all the blood diseases of the Amazon down cold. You can never be too careful with those, ya know.

BTW, is it just me or are anetheisologists as a group kind of kooky? Don’t get me wrong, all the ones I’ve met have been competent and great people, just a little out there. Are they the weirdos of the med world?

30

They do encourage us to do so. In fact, the med school has a program called MS3 (Medical Student Support Services), through which we can see a psychiatrist, counselor, etc. totally free and totally confidentially. I have made use of this service, and I suspect many others in the class have done the same. The only thing I don’t like about it is that they use UK’s psychiatry department–don’t get me wrong, they’re great, but they are also my teachers. It was weird when my shrink lectured to us.

At this point, my feelings are mixed. On the one hand, all the ones I’ve known have been wonderful, including the one that I see at Student Health. On the other hand, I don’t like the idea of a clinic as a whole bunch of PA’s and nurse practitioners with a single doctor as “supervisor”. I realize it’s probably the most efficient way of going about it, but I’m not that interested in efficiency.

I think that med schools are taking more down-to-earth people, and there are fewer people in it these days purely for the money. Also, residencies outside surgery are not quite the dehumanizing experience that they used to be. (They’re still tough, but to my knowledge you don’t see many 36-hour shifts anymore. Psychobunny–is that right, or am I deluding myself?)

Haven’t learned to do it yet–that comes in our Scut Monkey course at the end of July. It always struck me as a gift. I hope I’ve got it. I really hope that my classmates who practice on me have got it. :slight_smile:

Not in the least. Up to this point, all my “patient care” has been purely academic, so I realize they’re doing me a favor by letting me thump around on them for 30 minutes. Then again, I have encountered very few people who refused.

I’ve always thought the same thing about psychiatrists–which is probably why I’m headed in that direction. :slight_smile:

Psychobunny–I’ve never heard the term “flea”. Medicine is my first rotation in August–any words of advice?

Dr. J

31

Anesthesiologists may be odd, but anesthetists are the ones who do the work. You have nothing to worry about. DoctorJ, nurses have to do the same things for less. Saying someone’s a doctor tells a person little about how skilled he is, or how much he actually knows. CRNAs (Certified Registered Nurse Anesthetitsts, to pick an example) do their job without any oversight, and they do it exceedingly well. They can do anything from intubation to IV starting in addition to keeping the gas mixture good and everything running up to snuff. CRNAs can manage pain of all types, from chronic to acute, from trauma to neuralgia. You have to respect anyone who can administer narcotics so well nobody gets hooked. Getting off of my hobby horse, nurses and doctors are both needed. Just don’t think the ‘Dr.’ is that special.

32

I am also in a sad position just now, and coming into close contact with the whole health care system (CAN), and it can be very frightening.

I was startled to discover that if you are taken to a hospital by ambulance and admitted, and your doctor doesn’t have priviledges there, the first he’s likely to hear about it is when your records are forwarded to him after you’ve been released. Dead or alive.

Is this right?

33

I hope I didn’t leave the impression that I thought the least bit poorly of nurses. Quite the contrary, let me assure you. The reason my feelings are mixed on PAs/LPNs has nothing to do with their qualification–I just don’t want a clinic where I do nothing but “supervise” while they do all the thankless work.

My favorite clinic that I’ve been in is one here in town. Two people work in the office–the Dr., and his nurse/office manager, Shirley. She does very little medical work, mostly giving shots and the like. The short visit with this doctor is 15 minutes–that’s 15 minutes with the doctor, not 15 minutes where the doctor is running through four different exam rooms. If you need a full physical, it’s 30 minutes. He takes the temp and BP, he does the whole interview, he sits and talks with his patients. Sure, it’s not efficient, and he doesn’t make as much money as he could. He enjoys his job. There isn’t much between him and the patients, and I like that.

I do take issue with this statement, though:

I like to think that it tells you quite a bit about how skilled he is and how much he knows. Someone who has graduated from medical school and a residency should be quite skilled, and know quite a bit. Otherwise, I’m wasting my time. Sure, there may be parts of the job that someone else can do just as well, but to say that an M.D. and board certification don’t imply at least some level of knowledge and skill is, frankly, insulting.

Dr. J

34

what is the most difficult part of medical school for you?

35

How much insulin should an insulin-dependant diabetic inject per day if that person was 6ft tall,200-230 lbs and physically active?

36

DR. J,

What Doctor on ER do you most identify with?

I await your answer eagerly.

37

Elbows–I really don’t know. I’m sorry you had a bad experience.

Chief–without a doubt, Gross Anatomy. It isn’t that I’m the least bit squeamish about cutting up a cadaver. I’m not particularly good at rote memorization or spatial relationships, both of which are absolute necessities in Gross. (I’m better with functions and processes–a Physiology person rather than an Anatomy person, as we put it.) Plus, I just found the subject really boring, and spending several hours in the lab dissecting excruciatingly so.

I didn’t get a passing grade in Gross, and had to make it up with a test last summer. It has helped considerably to have a context to put it all in, though–I kicked the test’s ass, and I think the anatomy part of the Boards was one of my best sections. So I think I’m over it.

Spooje–I’d have to look it up.

Shirley–Good question. I really identified with Kellie Martin before they offed her. A lot of people criticized her for being an “annoying hangdog”, but that’s just another way to pronounce “medical student”. Among the docs, I’d say that I identify with parts of each of them, but none of them completely. If there’s one that I don’t identify with at all, though, it’s Benton–I’m glad there are people like that out there, but I’m not one of them.

If you remember that episode with the wild med school Halloween party, which involved a flaming couch thrown out the window and doing shots from the IV practice arm, a lot of people asked me, “Are med students really like that?” Er, um…yes.

Dr. J

38

This is really gross, but you have to get used to gross stuff, I guess, being a doctor and all.

Why is my earwax black?

Note: It’s been black for a couple months now.

39

Dr. J: first, how on earth do you find the time to post?

Second, what does it mean to be “throwing PVCs”? (I think that’s the term; I may have it off a little.) The only PVCs I know are those chemical thingamabobs in paint remover, which you’re not supposed to breathe. The ER PVCs seem to happen whenever someone goes into cardiac arrest, or at least at a time when whatever is wrong with the patient is causing all the doctors to yell out a lot of orders all at once.

40

Saxface–I wouldn’t even want to speculate. I know there is a huge variation in normal ear wax color, but beyond that I have no idea.

missbunny–I find all kinds of time to post now because I’m on break until the first of August. I normally don’t post all that much, but since I study at my desk where my computer is, it makes for a convenient study break every so often. I expect my posting time to go down the tubes when I start my rotations.

A PVC is a premature ventricular contraction. The heart usually contracts in a nice smooth wave starting at the top with the atria and continuing through the ventricles. That way the atria pump blood into the ventricles, and the ventricles pump it out. A PVC, then, is when the ventricle contracts before it has had time to fill.

Dr. J