Archive for September, 2009

Déjà vu

September 17, 2009

Six weeks to go until exams:

One more week of Respiratory block.

One week of break

Three weeks of Renal block

One week of Exam study…

EXAMS.

Is there some vortex where time goes? I’d like to find it + slip inside for a while so I can catch my breath a little.

Advertisements

Borderline personality disorder

September 9, 2009

That is, I think my school has one. Monday morning, opening my email:

Hi Loser Medically Blonde,

As promised  your paper was reviewed*. You have now been awarded a borderline pass.

Regards,

Your Medschool

Confused but happy. What message does this send to all the little kiddies out there? Don’t worry, if you fail, just try, try again, just wait until someone decides that you should be awarded extra marks…

*I have no memory of them promising this, & I know I didn’t ask for it. But that could because after I heard the words “don’t have to sit a supp” I maaaaaaay have blanked out a little…

The role of jargon

September 7, 2009

Picture 12

I wonder why we need little sub-languages within English? To make those who understand it feel better?  To decieve those who do not understand? Because it’s easier, shorter, quicker?

There is exclusive jargon in all fields of study. Words that baffle us and halt our understanding. Simple concepts become impenetrable to the newcomer because they do not ‘speak the language’ and need a translator in order to understand. In the Netherlands, students can’t even apply for medical school unless they have previously studied Latin!

Recently a friend of mine studying primary education was being taught the concept of the atom in the most ridiculously highbrow way. We sat around my kitchen table one afternoon drinking peppermint tea, eating strawberries, making silly analogies, drawing atoms and colour-coding her periodic table, that she commented “oh my god, this is so simple – why do they have to make it sound so hard?” She is going to be a fantastic teacher because she can simplify concepts into analogies fit for a five year old. So why can’t her lecturers do the same for her?

A research proposal assignment that we are doing at the moment is like gobledegook to me but Dutchboy is promising to explain it because he says “It’s really easy – just made to sound hard”. What is the motivation for this? Do people who know the jargon just want to use it to sound sophisticated? Educated? What is wrong with breaking it down? Why do we have to write our exams & report back in class in technical, medical jargon when we will be explaining things to patients in THIER languages anyway?

The article below has a different take. It describes how the role of jargon, in medicine, can be a self-preserving mechanism. Insulating doctors from having to deal with the emotional reality, in order to give them space to think, clinically.

From page 25 of the 7th edition of the Oxford Handbook of Clinical Medicine:

By some ancient right we assume authority to retell the patient’s story at the bedside – not in our own words but in a highly stylised medical code: “Mr Hunt is a 19 year old *caucasian male*, a *known case* of Down’s Syndrome with little intelligible speech and an IQ of 60, *who complains of* paraesthesiae and weakness in his right *upper limb*…he *admits to drinking 21 units per week* and *other problems are…”

Do not comfort yourself by supposing this ritualistic reinterpretation arises out of the need for brevity. If this were the reason, and we are speaking in front of the patient, all that is in bold above could be omitted, or drastically curtailed. The next easy conclusion to confront is that we purposely use this jargon to confuse or deceive the patient. This is only sometimes the case, and we must look for deeper reasons for why we are wedded to these medicalisms.

We get nearer to the truth when we realise that these medicalisms are used to sanitise and tame the raw data of our face-to-face encounters with patients – to make them bearable to us – so that we can *think* about the patient rather than having to *feel* for him or her. This is quite right and proper – but only sometimes. Usually what our patients need is sympathy.

These medicalisms enroll us into a half-proud, half-guilty brotherhood, cememted by what some call patrongage and others call fear. This fear can manifest itself as intense loyalty so that, err as we may, we cling to our medical loyalties unto death (that is of the patient, not our own). Language is the tool unwittingly used to defend this autocracy of fear. The modulation of our voice & the stylised vocabulary, in the above example of Mr Hunt, ensures that we take on board so little of our paitent that we remain upright and afloat, above the whirlpools of our patients’ lives. In this case, not a case at all, but a child, a family, a mother worried sick about what will happen to her son when she dies, a son who has never *complained of* anything, has never *admitted* to anything, expresses no *problems* – it is our problem that his hand is weak, and his mother’s that he can longer attend riding for the disabled, because she can no longer be away from home and do her part-time job.

So, when you hear yourself declaim in one breath that “Mr Smith is a 50 year old caucasian male with crushing central chest pain radiating down his left arm”, take heed. What you may be communicating is that you have stopped thinking about this person. Pause for a moment.

Look into your patient’s eyes: confront the whirlpool.

Is fat a dirty word?

September 4, 2009

Picture 5

LATE AFTERNOON, GP’s OFFICE, OBESE PATIENT & WIFE STRUGGLE TO FIT INTO CHAIRS.

GP: clicking through results on computer So, I’ve found it difficult to get to the bottom of your shortness of breath. Your lung function tests have come back okay, + you don’t appear to have a virus or bacterial infection. Heart looks alright. Your blood pressure is being managed well. But you’re still getting symptoms?

Pt: just when I push myself too hard. You know, walking up stairs.

GP: Okay.

Pt: Yeah.

GP: Mmm.

*pause*

GP: Well, we can keep looking…

My brain: HE’S OBESE.

The consultation continued & at no point was the patient’s weight, diet or lifestyle addressed. It was at this point, that I realised that the GP I was on placement with was also overweight. I hadn’t noticed it before but suddenly the (large) elephant in the room was pointing at the fact that maybe weight loss wasn’t being mentioned because of the GP’s own weight?

I’m wondering what percentage of GP’s do push weight loss on patient’s as a first line treatment. This probably sounds extremely naive + green of me, but in a country that has recently overtaken the USA in terms of an overweight population, then shouldn’t we have more focus on…er…losing said weight?

This patient may go home thinking that their weight in not an immediate danger because the doctor didn’t mention it. But my heart just bleeds for the years of substandard quality of life/health that he has lived because of his weight. I feel strongly that excess weight IS a disease-state & should be treated as such. As doctors, I feel there is a responsibility to help patients achieve their ideal healthy weight. I’m not talking, turning everyone into paranoid anorexics but if you read any WeightWatchers or Slimming magazines (my mum used to be a WeightWatchers Leader) the majority of people being profiled say that their wake up call was from their doctor.

On the other hand, for all I know, the GP had tried unsuccessful for the last ten years to get this pt to lose weight. That must be disheartening. But, with my naive optimism, I’d like to think people would still try.

If obesity or weight loss ever becomes a health care specialty, it’s an area I’d really like to work in. I find the determination & psychology behind extreme weight loss inspiring. But then again, I could easily become the doctor who gives up & just stops mentioning it…

Memorieeeeees

September 1, 2009

My memory is a trash talking leg-warmer wearing hairdresser who chews gum + talks about celebrities using their first names. It has no problem reciting celebrity trivia, the hyphenated names of their children, recipes, the hair colour of certain friends at certain points in time, where clothes were bought + at what price, what was eaten on nearly any given date in the last five years + the minute running details of all friends relationship sagas.

It does, however, have serious problems with basic mathematical tasks. Like my own age. Anyone enquiring as to my vintage gets “1985”. The alternative is to be met with a blank look as I try to remember what we ate at the last party…

Other people’s memories are Jason Bourne. Lean, well trained, better looking than the average memory, able to digest + recall an entire Medmap after reading it once.

I group study with the owner of such a memory + take great joy in being able to ask her any question at any time + know it will always be answered by a perfect textbook answer. Why? Because she is remembering EXACTLY what she read in the textbook.

How effing cool is that?

I have memory envy.