Categories
Lifestyle Reflection

The Hypocritical Oath

Taking the Hippocratic Oath is a rite of passage. Before any physician enters Exam Room 1, he recites these words, written by Hippocrates centuries ago. These words are powerful; so powerful that they are treated as more than just words. These words represent a physician’s love and devotion to his patients.

No matter how stressful this field can be, I have always seen physicians set these words—the oath—as their standard. As physicians (or budding physicians, in our case), we tell others to fill their bodies with nourishment and to practice a variety of healthy habits. But, the question remains: do we treat our own bodies the same way?

As a public health major, I’m all about “prevention.” My special interest is the prevention of chronic disease. Whenever I go home, I am the first to scrutinize my parents’ pantry—making sure their ketchup is devoid of high fructose corn syrup and that their fridge is filled with raw food. When I talk to my friends or relatives, I push them to exercise because “it really only takes thirty minutes of your day, and you’ll feel amazing afterwards!”

Basically, I play the pushy health coach. But is this health coach all talk and no walk?

Sadly, I don’t always abide by the values I preach. Even though I know I should be drinking water equivalent to half my body weight in ounces, I generally don’t. Well, why not? Sometimes I don’t make it a priority, and other times I forget. Many patients probably experience a similar scenario. Likewise, I often see my fellow classmates put academics above their health at school. I can be guilty of this too.

When I started thinking about our habits, I was hard on myself and my peers. As healthcare practitioners, our own health should never be placed on the backburner. More importantly, I don’t like the idea of telling my patients to do A, B, and C if I can’t do A or B or C myself. It just doesn’t seem very reasonable. I’ve come to the conclusion that there are two ways I can approach this in the future:

  1. Practice what I preach
    OR
  2. Preach with empathy

I’ve realized it’s okay to push those I love to be better, even if I’m far from that point myself. But this conversation should be accompanied by a discussion on health barriers. It’s hard to get your limp legs out of a warm bed in the morning, but what will help you rip off the covers and jump on the treadmill? Sleeping with your sports bra on? Placing your alarm farther away from the nightstand? We all know what “healthy” looks like; what we don’t always know is how to achieve it. I want to share my own obstacles with patients while also discussing theirs.

Bottom line: I don’t have to be perfect to offer health advice…I just need to be compassionate.

Featured image:
The road to health by Sarah Joy

Categories
Reflection

A Touch of Musicianship in Osteopathy

While the “power of touch” is a key aspect of osteopathic medicine, its practicality transcends that of its function as a noun. Indeed, touch is a physical contact between one or more surfaces, but it is also transmitted by non-physical means. Touch is so crucial in osteopathy because it can be used in diagnosis and treatment, especially when applying principles of osteopathic manipulative treatment and while compounding as a method to communicate with the patient and better understand the underlying condition.

The art of touch whether physical or non-physical is a skill that will take many, many years of practice and will be continuously refined throughout the career of osteopathic physicians. However, I have recently come to realize that the concept of touch is best exemplified by the musicianship of piano playing and I have used this analogy in my study of osteopathic manipulative treatment as a first year medical student.

In terms of physical touch, there are different degrees and levels of contact. We can simply put our hands on the patient to touch them and do our examinations. We can simply lay fingers on the piano and produce a sound. But when we begin to analyze just how we put our fingers on the piano, this produces more than just a sound- it creates more specific sounds, tones, volumes, colors: music. When putting your fingers on the piano, there are more variables than one might imagine. Just in the first note, there is so much to consider. The pianist must consider the attack- how does one approach the keys? In a shy, quiet piece of music, the fingers must slowly and sneakily slip onto the keys; in a boisterous fanfare piece, the fingers must quickly and boldly strike the keys. In essence, in the simple act of putting hands on the piano keys for the opening note, we have already considered, speed, attitude, and force in just that one touch.

Such thoughtful touching is similarly applied in osteopathy. It is possible for the physician to lay his or her hands on the patient with a coordination of speed, attitude, and force. The result is that this becomes more than a touch and can be sensed by the patient. Not only does sincerity convey a more comfortable environment for the patient, but it also establishes a sense of trust towards the physician. This closer connection improves doctor patient communication and relationships. Putting thought into physical contact also prepares the physician; the act of thinking about the contact stimulates a patient centered approach. Even before touching the patient, the physician would have already considered the general state of the patient while determining the components of the first approach to touching the patient. The physician will have evaluated whether to approach the patient more lightly or with more boldness. I believe that this consideration and thoughtfulness in the initial approach to the patient best sets the stage for patient care. Perhaps if physicians do not consider as much, they will simply lay their fingers on the piano and produce a sound that is not music.

Featured image:
Piano Solo 2 by j_arlecchino

Categories
Clinical Reflection

Working Miracles With Gravity

Before medical school, I worked as an assistant at the clinic of a physical therapist. Half of the physical therapist’s business was bread-and-butter physical therapy, but the other half was vestibular rehabilitation. The therapist specialized in diagnosing and treating balance and dizziness disorders of the inner ear. And guess what? Most of his patients were there as a last resort, because the doctors and their drugs weren’t working. They had fallen through the cracks, and the tragedy is that the most common cause for their dizziness is easily treatable, in 5 minutes, with only a table and some body positioning.

Benign paroxysmal positional vertigo, or BPPV, is caused by rogue calcium carbonate otoliths. These otoliths escape from the utricle of the inner ear and make their way into the semicircular canals (usually the posterior semicircular canal). These otoliths cause aberrant movement of the fluid in the semicircular canals with changes in head position, confusing the brain, which is getting mixed signals about the body’s orientation in space from the right and left semicircular canals. Predictably, the brain’s confusion manifests as vertigo, which  defines as “an illusion of self or environmental motion.”

Patients with BPPV suffer from sudden dizzy spells triggered by changes in head position, usually lasting 15-20 seconds. Movements like looking up, rolling over in bed, or getting up out of bed in the morning set the world spinning, often with an accompanying nausea. As you can imagine, these patients do everything they can to minimize their head motion. They move in a characteristically rigid fashion, keeping their heads as still as possible in order to avoid repeat attacks. Clearly, this is an extremely unpleasant condition; one that is experienced at least once by 2.4% of the population. The good news, however, is that it is easily treatable, as long as it is recognized.

A certain amount of diagnostic finesse is required to rule out central nervous system problems, but once the proper neurological exams have been performed, BPPV should be high on the differential for patients with the symptoms described above. The test for BPPV is called the Dix-Hallpike Maneuver, in which the practitioner provokes a dizzy spell by changing the patient’s head position and observing the eyes for nystagmus.

Once a diagnosis has been made, treatment consists of The Epley Maneuver, which is nothing more than a simple series of head and body positions designed to use gravity to reposition the rogue otoliths into the utricle where they can no longer confuse the brain by moving semicircular canal fluid inappropriately. When the patients I saw were cured of their vertigo so quickly, with such a simple technique, they wasted no time in hailing the physical therapist I worked for as a miracle worker. They had been miserable for months, and that’s all it took to fix it?? In these situations, the patients were always ecstatic. I couldn’t help but smile.

As we go into rotations, residency, and practice, I hope we will be able to catch these patients before they fall through the cracks. My purpose in writing this article is to get the word out , because it is so easily treatable without the use of expensive, ineffectual, toxic medications. All we have to do is recognize it when we see it. As an added benefit, maybe someone will call you a miracle worker one day.

References
http://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo
Harrison’s Principles of Internal Medicine, 19th Edition, Chapter 28
http://www.neurology.org/content/70/22/2067.long

Featured Image:
Vertigo by Diana Mehrez

 

 

Categories
Lifestyle Public Health Reflection

Giving Blood

When my cousin mentioned that she wanted to give blood, I was happy because she voiced a wish of my own. I had wanted to donate blood for years, but I never met the eligibility criteria: either I didn’t weigh enough or I was anaemic. I had been fully eligible for over a year, but I kept postponing my donation for no reason other than the fear of facing the unknown alone. Having found another person to share the experience with, I was finally brave enough to follow through and donate.

I am a medical student, an aspiring Emergency Medicine specialist, an advocate of blood and organ donation, and I am fully eligible to give blood. Who better to donate than me? How can I expect other people, who are less aware of the need for blood products or the process of blood giving, to volunteer for this seemingly unpleasant act, without serving as an example?

Let me tell you, it was not a big deal. The whole experience was actually quite different from what I expected. I expected to be in pain, to feel dizzy and to have to spend a whole day preparing and recovering from giving blood. Here is what actually happened:

After a usual day of classes and a light lunch, we walked to the Croatian Institute for Transfusion Medicine, nervous but excited. We were met by very friendly staff, who responded to my nervous humour with witty jokes. I have to give them credit, because they made a big difference in my first experience. While they joked and kept the mood light, they were professional and reassuring.

The nurse who welcomed me didn’t believe I weighed enough, but a quick consult with the scale proved him wrong. After a quick check of my haemoglobin level and a small routine examination, I was given a questionnaire to fill out about my medical history, medication use, lifestyle and traveling.

It was encouraging to see that quite a few donation beds were taken. A few people seemed to be regular donators, as they chatted between themselves and with the staff, looking completely at ease. While waiting for a donation bed to clear, the staff chatted with me about medical university workload and our health system. After a very short wait, I was shown to a donation bed and got comfortable in a head-and-feet-up position. My cousin couldn’t give blood herself as she was anaemic, so she kept me company. I have to admit my eyes did widen at the sight of the 16 gauge needle, but a nurse inserted it in my cubital vein quickly, and I can’t say that it hurt.

I squeezed my stress ball to keep the blood flowing, had sips of water, and chatted with my cousin and the staff. As I watched the red fluid flowing from my vein to the bag, I didn’t feel faint, as I expected. I did have a weird sensation I can’t describe, which was probably psychological, but there wasn’t pain, sweating, dizziness or any other symptom I expected I would have due to my low blood pressure. It didn’t last more than five minutes, which is a lot quicker than I thought it would be. Even though I felt completely fine, I was advised to stay on the bed for a few more minutes just to rest.

After a friendly goodbye from the staff, and a present of a pen that looks like a syringe, I was shown to the cafeteria where I got a drink, a warm meal and a doughnut. I left the site feeling happy knowing my blood will help someone else, and elated with the enjoyableness of the experience.

For the rest of the day, I made sure to keep hydrated and have healthy meals, but otherwise I went about my usual business: I walked my dog, studied and went to the gym (exercise isn’t recommended straight after giving blood, but I was careful not to strain myself).

I realise that giving blood isn’t the first thing to pop into your mind when you imagine a perfect day, but it’s a quick and easy thing to do. It doesn’t take a lot of time and effort on your part, but it can make a big difference in someone’s life.
Find out more about donating blood, eligibility criteria, and how to get ready for a donation, with special notes for first time donors.

A few facts from the American Red Cross:

  • Every two seconds someone in the U.S. needs blood.
  • More than 41,000 blood donations are needed every day.
  • Although an estimated 38% of the U.S. population is eligible to donate, less than 10% actually do each year.

Give blood, save lives.

Featured Image:
Blood Donation Appointment in Calendar/Journal by Oliver Symens

Categories
Clinical Reflection

Chronic Fatigue Syndrome

The year was 2011 and I was an undergraduate student at Weber State University in Ogden, Utah. I was on the premed track and looking for doctors to shadow and research to participate in. I was also working part time at a physical therapy clinic and one day I started a conversation with one of the patients. After hearing a little about my interests and career goals, she became enthusiastic about introducing me to her doctor who was conducting research on chronic fatigue syndrome.   I had never heard of the syndrome, but I was eager to take on any new medical experience and jumped at the opportunity. One week later I found myself at the clinic of Dr. Lucinda Bateman in Salt Lake City.

After meeting with Dr. Bateman and discussing chronic fatigue syndrome, I followed her throughout her day and sat in on several appointments. Because chronic fatigue syndrome is a relatively unknown condition, Dr. Bateman and her patients were strong advocates of educating as many people as possible about the condition, including me.

Many of the patients shared their stories with me. One woman I remember vividly: she was quite thin with short cropped hair and wore a smart business suit and trendy glasses. The immediate impression I had when I saw her was that she was someone who got things done. Her story was heartbreaking. I listened as she described her life before chronic fatigue syndrome and how she was a “go, go, go” person. She worked full time, ran long distance races, and was active in every sense of the word. Then, one day, she could not get out of bed. Her muscles ached intensely despite the fact that she had not exercised the day before. She was debilitated by an intense fatigue she could not overcome. These symptoms lasted for days before she scheduled an appointment with her primary care doctor. All the tests came back negative and she was prescribed bed rest, which did not resolve any of the fatigue or pain.

I could tell as she was recounting her story that she was trying not to become emotional. She was still experiencing the fatigue and recalling the activities she used to enjoy was difficult for her. I felt I could begin to understand some of what she was going through, because I could remember how cripplingly fatigued I had been when I had contracted infectious mononucleosis as a teenager.   I could not imagine having to deal with that kind of fatigue for months or years on end.

After shadowing Dr. Bateman, I went on to finish my undergraduate degree and was accepted into medical school. I heard nothing of chronic fatigue syndrome for years. In February, 2015 I was surprised to see that NPR had published an article on the syndrome. The article was written to cover a new report published by the Institute of Medicine. The report legitimizes chronic fatigue syndrome (known as myalgic encephalomyelitis in Europe), establishes  new diagnostic criteria  , encourages more research into pathophysiology and treatment, and recommends that the name of the disease be changed to Systemic Exertion Intolerance Disease (SEID).

According to the report, “between 836,000 and 2.5 million Americans suffer from myalgic encephalitis/chronic fatigue syndrome,” and the hallmark of the disease is “a substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities, that persists for more than 6 months and is accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest.”

As we go through medical school and enter practice, I think it is a good idea to be on the lookout for these patients. I highly recommend reading the report for educational purposes, especially since, according to the report, less than one-third of medical schools educate their students about chronic fatigue syndrome and fewer than half of medical texts mention it. The disease is poorly understood, but increased awareness and future research may help fill in our knowledge gaps and assist in finding effective treatments for those who suffer from chronic fatigue syndrome.

Read the NPR article: “Panel Says Chronic Fatigue Syndrome Is A Disease, And Renames It”

Read the Institute of Medicine report “Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness”

Featured Image:
cfs by Jem Yoshioka

Categories
Opinion Reflection

Dear Doctor

Dear Doctor,

I hear you when you speak of that girl in the hospital ward. The ‘overdose in bed three.’ I hear the harsh judgements sneering through your lips, the sighs and the mutterings of ‘what a waste of life.’ As a student, I am all too privy to such remarks made in the corners of these hospitals. I have fallen upon them again and again.

Please do not be so quick to stereotype. Do you know how it feels to have your mind infiltrated by such intense emotions of self-hatred and loathing? Do you know how lonely it can be to lie curled within the four walls of your bedroom, just you and your mind waged in an eternal battle?

Yes, I realise how cliché that sounds. I know you have just come back from speaking to a young gentleman who has been paralysed. I know you have spent your years dealing with the terminally ill, holding the hands of the dying as you speak to a family overwhelmed with grief.

How can a teenage girl compare? Yes, she may appear to have everything. But aren’t humans’ more than just molecules and proteins? Don’t we all have dreams and desires of our own? What is it that makes us human? Our relationships, our goals, our ability to connect with one another. How would you feel to have these vital components torn away from you? No, it is not the equivalent of the man next door whose wife has just died. But that does not mean that she does not deserve your attention and your respect. You may have lived through the battles of the emergency department, the grievances of the families, the diagnosis’s of tumours to children barely in their teens. But she has not.

Look at her, sitting on the bed, her head bent over her lightly covered shoulders. Look at her, fingers fidgeting with the bed sheets, unsure what to touch or who to speak to. She is scared. She is in a new place. There are bright lights glaring down upon her, strangers rushing past her, eerie machines beeping at her. And inside her mind, the battle is continuing to rage. Look at the scars glistening upon her skin as she cowers in a blanket, trying to hide her wounds from the world. Aren’t those battle scars as well?

Imagine how it feels to have a mass of doctors suddenly gathering around your bed, all looking upon you with pity. Do you realise how exposed it can feel to be probed with such personal questions? The intricacies of your mind held open for a stranger to dissect.

‘Do you have any plans to end your life?
What methods have you thought about?’

She needs a friend. She needs someone to take her hand and ask her how she is feeling. Forget the Fluoxetine, the charts filled with drug doses. It is not a prescription pad that she needs. She needs a human touch.

I know she cannot hear you as you make your curt remarks. I know you will walk towards her filled with smiles and concerning eyes. I have seen that gentle handshake that you have mastered over the years, the slight pitch in your voice as you gently prod your questions. There is no doubt that you have a bedside manner. And within one minute you are gone, the prescription chart left upon her bed for the nurse to dispatch the drugs. The girl still sits there, her posture unchanged, unsure if the conversation had taken place.

I know you are busy. I know you have a team of doctors to command, a list of patients to see, a hospital to run. Yes, I know you have sat through hours of exams, studied well into countless nights to get to where you are standing now. I have respect for the devotion you have put into your career.

But please do not forget that young girl. Please remember to hold your tongue the next time you see a teenage overdose. Yes, to you it is another statistic to keep record of, another prescription to fill out. But to that teen lying in the corner, throwing up the contents of her stomach? She wanted to die just two hours ago. Do you know how that feels? To feel hopelessness so deep, that the future is but one long tunnel, filled with uncertainties and fear. Do you know how it feels to hold a bottle of pills in your hand, staring longingly at the container, at the hope it contains inside?

Yes, she will be fine. She will be discharged within a few hours, another free bed to fill. But please, the next time you come across such despair in someone’s eyes, do just one thing; sit down on the bed beside them, and ask them how they are. Look into their eyes as they speak, and let your whole being be encapsulated by their story. Let them open up to you, with patience and empathy. If someone had done this to them before, do you think they would be in this position now?

Please, the next time you blurt out another cutting remark, a sneer at the cries for attention. Look across the room at your patient sitting there. Look at their posture, their body language, their eyes. Does this look like the sort of person who needs your judgement? Or does this look like someone who needs a listening ear?

 

Featured image:
Writing with Ink by urbanworkbench

Categories
Clinical General Opinion Reflection

One Size Does Not Fit All

I recall being fresh out of my first year of medical school and ecstatic to be spending my break not in a class room, but at an actual pediatric oncology unit. The night prior to my first day in clinic, I spent time reviewing immunology and looking ahead at the oncology lectures from the Clinical Medicine class I would take the next year in school. I wanted to be prepared in front of my new mentor.

The next morning, I hardly had time to impress my preceptor let alone introduce myself before we were running around. We stopped at the pathology lab. I gazed through the microscope, trying to remember what I had read the night before about identifying abnormal cells.

“I have a new patient that arrived today. She is very sick. We have to tell the family the definitive diagnosis. Come with me.”

We urgently walked up to the inpatient floor into one of the rooms. A beautiful young girl was sleeping in the bed. Her parents and grandma were diligently by her side. They froze and looked at the doctor. This was the final confirmation they had been waiting for. They held onto the hope that they had been sent to the oncology floor by mistake.

“We have confirmed that your child has a rare cancer.”

4729016997_bc4ec39867_bI watched as any sliver of hope vanished from their eyes. They would not wake up from this nightmare. The moment my mentor delivered the diagnosis, I could feel the world take a 180 eighty degree turn for this family. It was as if their world froze at that moment. How could this be? The child looked so peaceful, fast asleep while hospital monitors blinked around her. Just a week ago, they were running around to sports practices and dentist appointments and going through the everyday motions that we consider to make up a normal life. I’m not even sure that this family was breathing at this moment. The room became deafening silent as all the color drained from their faces. The doctor proceeded to talk about what would happen in the days to come. What did this mean for their child?

Just when the family (and I) didn’t think it could get worse, they were told about the side effects of the medications – the only option to treat their child’s condition. The doctor began with the common side effects like nausea, vomiting, hair loss. Next, cardiomyopathies. Neuropathy. Loss of reproductive function. This is when this family broke. Loss of reproductive function. I always thought the diagnosis would be the hardest thing to hear. For them, the breaking point was learning of the adverse effects of the very medications intended to save the child’s life. These medications are meant to represent hope, protection, and reassurance for a life beyond disease. The doctor paused again, giving this family time to just cry. Tissues went around.

“This is hard. Take your time. I am here for you throughout this entire journey.”

I watched the mother of this little girl look at her own mother. It was a look of despair, yearning for answers that wouldn’t come. Even if her child survives, bits of the future have already been stolen. We left the room after two hours to let the family have time to process.

Outside of the room, I tried to process what I had experienced. The information I read in my textbooks and PowerPoints did not prepare me for that interaction. I looked at my preceptor for guidance.

“This is real. This is hard. We will fight with them, though. We do everything in our power not only to treat the cancer, but to make sure that cancer does not define their life. This is what we do.”

Throughout the rest of my summer, I went on a roller coaster from new diagnoses to the “completion of chemo party”, from being declared cured after a 5-year visit with no evidence of disease to the tragic death of a child. I watched children balancing school with chemo. I watched teenagers struggle with fear and bravery while grasping at any chance to maintain their independence. I watched parents struggle to care for a sick child while still being present for the other children they left at home. The things I learned that summer could not have been taught in a classroom. With every family I met from all over the world, I witnessed raw and vibrant emotions: fear, determination, sadness, and never ending hope, even in the wake of death. It is this hope that I take with me. It is contagious. These are the emotions that makes us human.

At one point during the summer, I asked my mentor what the secret was to enduring such difficult clinical conditions. I had watched him interact with all of his patients each day. Every single one loved him. The mother of that little girl later told me how he was able to comfort them, cry with them, joke with them, and laugh with them with such ease. He was able to guide them through this journey, with the help of hospital resources, to give them a life within this new normal. In response, he said:

“There is no such thing as being the best doctor in the world. You have to be the best doctor in the world for the patient sitting in front of you. That is my first priority, more than my research or my teaching. Get to know you patients and their families. Learn from their stories. Keep fighting to improve. That is how you become the best.”

3377110664_c71de81ebc_zSo much of early medical education involves pouring over books and PowerPoints, trying to memorize as many details as possible. It is important to have that foundation of knowledge, but what I have come to realize is that there are rarely pure “textbook cases” because so much more goes into caring for a patient. One size does not fit all in medicine. This experience brought back the humanity of medicine. I witnessed how knowing and understanding patients enables a physician to be an advocate for their patients, a role I consider to be the most important of the many roles a physician takes. I can never come close to knowing exactly what these families are going through. I also can’t thank them enough for allowing me to be present during their most vulnerable moments, for taking time to talk with me for a brief period to get a glimpse of their journey. Ultimately, this experience was a reminder that the art of medicine can’t be discovered in textbooks. It is learned from our patients and the uniqueness that their individual journeys bring to each patient encounter.

 

Featured Image

Lou Bueno
Lorena
Alice Popkorn

Categories
General Narrative Opinion Reflection

Visit Your Ill Loved One Less, Please.

Mr. Gerald knew the exact day, three years ago that his wife moved into assisted living due to her early-onset dementia and primary progressive aphasia. After being admitted, she suffered a femur fracture, underwent surgery, and soon was no longer able to walk. Her dementia progressed rapidly. As I sat collecting interview data from Mr. Gerald in the hallway, his wife was being moved from her bed to her wheelchair; she was now unable to speak, only able to change her facial expressions and occasionally move her hands. I feared talking to Mrs. Gerald’s love, as I knew that he must be hurting tremendously. Making Mr. Gerald relay the struggles of the last few years simply for the sake of practicing my interview skills felt wrong. My sorrow began to mirror Mr. Gerald’s as the story of his wife’s incurable condition unraveled. He told me the intimate details of the Gerald family dynamic with great accuracy, stating that he was happy to be teaching medical students about their experiences.

“I am with my wife every morning and afternoon for six days of the week; our daughter comes on the seventh day. I am her companion and I keep her active constantly.” Honored to be speaking to such a dedicated husband, I asked, “…and what is that time like? Do you feel that your presence helps your wife with her condition?” Silence fell upon the room. Mr. Gerald tried to speak but was caught by tears. “Please,” I said, “you don’t have to talk about anything that you don’t want to – you are doing such incredible things for your wife. Thank you so much for sharing with us.” The other medical students added their humble thanks and Mr. Gerald continued,

“the aids here, the nurses, they tell me that my wife lights up when I am around – that it is simply not the same when I am not here.”

I asked Mr. Gerald about the strain that this illness has had on life and he relayed that tending to his wife was indeed difficult but it was his duty to do so for his loved one. Being by her side was crucial to him. He described his other daily activities, revealing the healthy social and family life that he maintains outside the assisted living facility.

The physical examination was next, so we moved into Mrs. Gerald’s room. Calling her by her nickname, Mr. Gerald walked in with great enthusiasm and began attending to his wife. Her eyes opened and she smiled, fixating all her attention on her love and ignoring the three white coats that brooded over her.

Once my time with Mr. and Mrs. Gerald was over, I consulted Mrs. Gerald’s medical file. As I read, I came across notes from the assisted living facility’s social worker:

“Mr. Gerald visits his wife frequently. With time, he should do so less.”

That is all that was written. Posing that family or friends aught to visit their ill loved ones less often is not such a cut and dry topic and surely does not merit such stringent of a statement. All families react to illness differently and this should not only be understood by healthcare providers but respected. This was a case of absolute dedication. The physician-patient relationship is secondary to the loving human relationships that enrich patients’ lives. Recognizing this essential fact is crucial to approaching patients and their loved ones humbly – without it, true healing is not attainable.

 

Featured image:

MTSO Fan

Categories
Lifestyle Mentorship Reflection

The Importance of Mentorship

One of the most influential and uplifting things that can happen during medical school is finding someone older, wiser, and more mature than you and being blessed with the opportunity to be mentored by that person.

“I don’t think I can do this anymore.” As the words left my lips, I felt a slight twinge, a burning feeling. Shame. I was one month into medical school and I was already giving up. We were in a 7-week crash-course version of anatomy with lectures, Team Based Learning (TBL) sessions, and dissection in an overwhelming whirl that spun us ever more rapidly as the course progressed.  I wasn’t made to memorize the flexors and extensors of the leg and the nerves and vessels of the pelvis.  My brain wasn’t wired to take in this much information and properly spit it all back out. If this was medicine, I didn’t think it was for me.

There was a moment of silence on the other line. I sniffed and blew my nose. Dr. R finally spoke.

“Stephanie, tell me more about what you’ve been thinking about.”

Over the next half-hour, I shared with Dr. R my frustrations with the rote memorization of anatomy and the feelings of burn-out I was already experiencing, having come straight from college to medical school. She was patient and understanding, encouraging me with her own experiences. She acknowledged my perspective and in her gentle way, validated it. Suddenly, I did not feel so alone. To my surprise, I found myself filling with hope that I could find success in medical school. I wiped away my tears and ventured a small smile as she made me promise to update her in the next few weeks. When I hung up the phone, I glanced at the time— it was nearly 10:00pm. I had texted Dr. R that I hoped to talk to her sometime soon about something urgent, and she had texted me back immediately. I was so grateful that she didn’t hesitate to approach me during my moment of panic and self-doubt.


 If medical school is a marathon, then having a good mentor in medical school is like having a personal coach. He/she is on the sidewalks, cheering you on, letting you know about the hill up ahead, and reminding you of your goals during the long, empty stretches of road. You look over your shoulder and at times notice that your mentor is covered in sweat and dirt and Gatorade too. In fact, your mentor has another race, but he/she is taking time off to watch you run. From sharing about previous mistakes to being an example for how to run a race successfully, your personal coach and mentor becomes a role model throughout your marathon and beyond. 


 

How did I meet Dr. R?  In fact, I was assigned to Dr. R’s mentoring group on the very first day of medical school.  As part of the Colleges program at Johns Hopkins, the mentoring group (known fondly as a “molecule”) is composed of one faculty member and five medical students in the same year.  The faculty member checks in with his/her molecule throughout their four years of medical school and provides guidance, assists with planning, and teaches clinical skills. Dr. R has walked with me through both personal and professional issues—from work-life balance to dealing with poor study habits to encouraging me to embrace my passions.  Moreover, I was absolutely touched that she managed to make it out to my wedding last summer.  In inviting me to shadow her in the hospital to having my molecule over at her house to meet her husband and children, Dr. R has generously opened her life up as an example of how one might pursue a career in medicine.  In doing so, she has become a true life mentor to me.

It is well-known that medical school isn’t easy. Thus, having a guide and avid supporter is invaluable. Mentoring programs are becoming more common nationally, as research has found that having mentorship is an important component of success in academic medicine (Cho et al, 2011). However, the importance of seeking mentorship from the start of medical school isn’t always properly emphasized. Do you currently have an influential mentor? In what ways have he/she supported you? How would you define a “good mentor”?

If you don’t yet have a mentor or your current mentoring relationship isn’t going as you hoped, not to worry! In my next blogpost, I will share some suggestions about how to get started with finding a mentor as well as how to make the most of a mentoring relationship.

 

Coming up…

“How to Approach a Potential Mentor and Get the Most out of a Mentoring Relationship”

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Friends by Hartwig HKD

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“Preserving the Nobility of Medicine” Dr. Robert Alpern, 2014 Commencement Address of the Northwestern University Feinberg School of Medicine

Page 1 copyIn continuation of the Medical Commencement Archive, this Friday we are releasing a new commencement speech. Today’s commencement speech is titled Preserving the Nobility of Medicine. This commencement speech was given by Dr. Robert J. Alpern, a Northwestern University alumnus, to the students of the Northwestern University Feinberg School of Medicine. The esteemed Dr. Alpern is Ensign Professor of Medicine and Dean at Yale University School of Medicine. He also is President of the American Society of Nephrology, as well as a sitting Advisory Council Member of the National Institute of Diabetes and Digestive and Kidney Diseases.

Dr. Alpern took a moment for students to take a closer look at the value and weight of the two-lettered title: MD. He reflected upon the unique status given to physicians, and the reverence given to doctors from the community and from patients. Yet, at the same time the medical paradigm continues to evolve. Dr. Alpern astutely foresees a future where physicians must adapt to the growing roles in the medical team, changes in bureaucracy, and the changing expectations of patient’s for their treatment. Dr. Alpern also notes that these changes will influence the training and education of physicians. On top of our own desire to stifle the monsoon current of medical information during our education, there are legitimate concerns that the future medical student will receive but an abbreviated biochemistry course, or won’t need to take an MCAT, maybe even spend less time in medical school. Yet, Dr. Alpern urges one thing: to value the pursuit of scholarship. He reminds us that only with a strong foundation may a strong physician be built.

“We observe the patient and draw on our scientific understanding of how the body works and sometimes does not work, to develop a truth that we can implement as an action plan. We must know clinical guidelines and the most up-to-date treatment algorithms, but we must also be ready to identify clinical circumstances in which they do not apply.”

Dr. Alpern eloquently explains that, above all else, the pursuit of knowledge and scholarship is indeed the nobility of medicine. He reminds us to respect this pursuit in lieu of the changes we will see in our futures as physicians, such that “we do not return to the era of trade schools of medicine”. Dr. Alpern further mentions that, in addition to being a scholar, the physician must be compassionate, and that neither trait is mutually exclusive:

“I also want to make the point that an emphasis on science is not the antithesis of compassion, but it is rather the complement of compassion”.

At the end of his speech, Dr. Alpern concludes with this piece of wisdom:

“Do not be intimidated by the evolving healthcare system. Rather, as the next generation of physicians, you will define healthcare, and you must define it well.”