MD Class of 2012 Blog


Monday, October 5, 2009

ER, PIMPING and Medical Education

At Brown, we have a class called "Doctoring." It's how Brown has figured out how to teach us to be doctors (the more personal, less factual stuff we'll all need to know before we hit the real world--the world of Turk and JD on Scrubs aka intern year or residency--and beyond). The way they do it is they teach us through checklists. I had no idea before I started learning all this stuff that there's actually a secret system to the way doctors talk to their patients. Thinking back, I'm trying to figure out if I would be upset as a patient knowing that my doctor was trying to "warm me up" with small talk before getting to the meat of the interview. I guess even when you know that a doc's trying to do that, it still works and you still feel more at ease. So how does one become a doctor / get initiated into this secret society that is medicine?

Medicine, like all sports teams, has a certain rite of passage that one must go through before being accepted as a part of the "team." Learning the medical interview is the first step of initiation. The basic History and Physical (H&P) has been used by physicians for centuries. It's a systematic way of figuring out what's going on. It's a way to listen to the patient's side of the story (the subjective) and then test your hypothesis for what the patient might have with the physical. Every doctor learns the order of this interview along with all the abbreviations. CC, HPI, PMH, FH, SH, Nutrition / Sexual history (they don't have an abbreviation because oftentimes they're omitted because they're not as pertinent to the case), ROS, PE. In our first year, we learned how to take a history. We could do it in our sleep. Now, we're learning how to put it all together with the physical exam.

An integral part of the doctoring class is the 1st and 2nd year mentors. Us students go to a doctors office or hospital and shadow practicing physicians and see real patients. We put our memorized checklists to use and ask all the questions. The challenge this year, is to learn what questions to ask and when. More than that, it's to know what parts of the physical exam to perform based on the patient's presenting complaint. This year, we're supposed to put it all together--all the stuff we learned last year, the history and the physical exam. It's a daunting task, but we'll be on the wards in May, so I speak for myself when I say that I'm feelin' the pressure.

My mentor, an ER physician in Massachusetts, is helping me realize all the things I have yet to learn by constantly "pimping" me. Pimping, is something that will happen to us for the rest of our careers. It's how your superiors tell if you're smart, and how well you're understanding what's going on. I feel like it's also a way of them showing off how much they know and how little you know. The way it goes is they'll ask you questions, usually until you get one wrong. For me, it's making me realize how little I know even though we've taken so many courses, and how much I have yet to learn. It's a great way to learn, but again, it's putting the pressure on.

One thing I've had to get over is the very concept of a medical student or a resident. Medicine is something you learn over a long period of time. It takes time to store and be able to recall all that information. There's always going to be a first time for medical students and residents--whether that's performing a procedure or asking a question or giving bad news. Before, I thought about what I might do if someone in my family got sick. Would I let a medical student or a resident make decisions / do procedures for/on him/her? Now that I'm a part of the system, I've encountered so many kind and generous patients who have graciously let me poke around, listen to their hearts and lungs (at first in the wrong and then in the right places and positions), push on their bellies, shine lights into their eyes etc. As a patient myself, or a family member, I might get annoyed by a medical student doing all sorts of things to me / my loved on.

A nice elderly couple last week in the ER made me think about my own biases. The woman was in for stomach pain, and the husband was there by her side. I asked her if I could take her history, and then my mentor came in and watched me perform a belly exam (after he had taught me last week how to do it on another patient) and then present my findings to him. The woman was so kind. She let me proceed and the whole interview and PE took longer than it would have had my mentor done it all. Afterwards, the couple asked me where I was in school, how I was liking it, and if I knew what kind of doctor I wanted to be. They told me about their daughter who was in her 4th year at another medical school (I forgot what kind of doc she wants to be). We had a brief conversation and as I was leaving I thanked the woman for letting me take her history and examine her. She replied, "You've all got to learn on someone. My daughter learned from all sorts of patients, and I'm happy to contribute to your medical education as a way of giving back to the medical community."

The encounter made me think about my own biases and practices. I'm going to the doctor tomorrow for a regular check up, and like the woman from last week, I'd be happy to help contribute to someone's education. If there's a medical student / resident there, I'll be happy to let them interview me / do a physical. We all have to learn somehow.

-Ed Cheung

Tuesday, September 22, 2009

Oh man

It's been a while since I've last put something up here. The thing that happens with each test, is that the week / week and a half before, my life "falls apart." It's not that it actually falls apart, but that I neglect almost everything but studying for the test.

In medical school, I've found that with each new disease process / illness we learn about, I think I have it, or I think I know someone that has it. After just finishing the cardiology block, I thought I had a big left ventricle in my heart. One morning, I woke up, thought my heart felt funny (I was probably just hungry), so I put on my stethoscope and had a listen. Stepping back, it was a weird thing. I was in the bathroom brushing my teeth after just getting out of bed, looking in the mirror to make sure my stethoscope was in the right place, listening to my heart. As I listened more, I thought I heard an extra beat. Thinking back to what I had studied and learned a few days earlier, I knew that sometimes you can hear an extra beat. Normally, everyone knows of the "lub dub" sound. But sometimes there can be a "lub dub-dub" sound. It the "dub-dub" part gets longer when you breathe in due to pressure changes in the chest increasing blood flow, thus changing the amount of blood that's in your heart, changing the timing of closure for two of the valves. Anyways, that's normal. What's "not normal" in people over 40 is when you hear "lub-lub dub," which is what I thought I heard. That sound, the "lub-lub dub" is indicative of a bigger left ventricle (the workhorse of the heart). Now, I swear, cardiologists say they can hear the difference, and so can I when I listen to the heart beats on a CD or online with the diagrams or EKG playing along with the sounds. Listening to the real thing is different though. It's quite a bit harder. So after freaking out a bit, listening to my heart, convincing myself I had a big left ventricle due to biking across the country (I felt like an awesome athlete), I then thought I heard a murmur (telling me I had a leaky valve). AHHH!!

There's only one thing to do when confronted with a situation like this: go to the doctor... a real one. Well, thank God I'm surrounded by tons of real doctors. I had my cardio small group leader, a cardio fellow @ RIH take a listen. The results: no murmur, and normal "splitting of S2 (when you breathe in, the "dub" turns into "dub-dub")." Relieved I was able to concentrate again.

Cardiology was great. I liked it a lot. The test? Not sure. I normally don't finish quickly, and this time I finished super fast, checked my answers a few times and then still with lots of time left and the normal speedsters still in the room, I couldn't take it anymore and left. So does that mean I don't know my stuff, that I studied a lot and did well, or that I totally missed the boat on a bunch of questions? We'll find out in a week or so.

Off to a dentist appointment and then the ER to shadow.

Till next time.
-Ed

Sunday, August 30, 2009

From One Routine to Another

This summer was exactly what I needed. For a lot of my classmates, summer consisted of staying in Providence and doing research, or travelling abroad as part of their scholarly concentration, or some activity related to medicine. Instead of focusing on medicine all summer, I decided to ride my bicycle home (from Providence, RI to my home town of Los Gatos, CA). I needed something for myself. Something I would cherish forever. Something to break the monotony of continuously studying or working since before high school (summers included). This being the infamous “last summer” (third year starts in May), I figured it was ok to be selfish. It ended up being one of the best decisions I’ve made so far.

In high school and college, I had come across Joseph Campbell’s writings on the importance of a young man’s rite of passage a few times. One of my favorite movies, Motorcycle Diaries, depicts Che Guevara riding his motorcycle from Argentina up to Venezuela during medical school. Combining Joseph Campbell’s ideas of a young man’s rite of passage, my past traveling experiences in Latin America and my adventurer spirit, hitch-hiking through Central or South America seemed perfect. Convincing my folks to let me do it, or recruiting friends to come with me was difficult (to say the least). Instead, I opted to explore my own country in a unique way while challenging myself physically (versus mentally, which is what I had been doing all year).

First year med school trained me to follow routines. Wake up, breakfast, school, eat, school, exercise, eat, study, sleep… rinse and repeat. Everyone has his/her own routine until the week before an exam when everything goes out the door and nothing else matters but cramming as much information into your head as possible.

This summer, I still had a routine, which was comforting, but it was completely different than what I experienced throughout the year. Wake up, break down camp, pack my bags, get on my bike and ride, eat lunch, get on my bike and ride, eat dinner, get on my bike and ride, set up camp, go to sleep… rinse and repeat. It was the comfort of routine without the stress of medical school. It was perfect.

Now that I’m back in Providence, my medical school routine has started again, but it seems different for some reason. After seeing so much this summer and meeting so many people from all different backgrounds with different life stories, I find myself appreciating medical school more. Yes, it’s still tough. Yes, there were 15 lectures (some great, and some not so much) in the first week. Yes, somehow I already seem to be behind. Yes, the boards are always looming in the back of everyone’s minds, but the task just doesn’t seem as daunting as it did last year.

Coming back refreshed, with biking as a new hobby (I think I’m addicted to endorphins and adrenaline) with a new adventure under my belt and new experiences to build upon, I feel ready to take on this upcoming year.

It’ll be interesting to see how things actually work out.

Till next time.

Friday, May 29, 2009

A Blur

During orientation, we heard it multiple times: “There’s such a vast amount of information you have to know in medical school, it’s like trying to drink out of a fire hose.” I’d say it’s pretty true. There’s an incredible amount to learn, and it sometimes feels like as soon as it’s learned, the test is taken, the information’s gone and it’s time to move on to the next block. I would extend the metaphor even further. If you’ve ever been tubing behind a speedboat, you know the feeling of desperately trying to hold on. It’s exhilarating, terrifying, exciting and sometimes you fall off and it hurts, but inevitably, you get back on and want more. That’s what my experience this year has been like, but not just with medical school. More with balancing medical school with the rest of my life. It seems like medical students and health care professionals are crazy. Everyone works their butt off, sleeps little, is stressed out, makes sacrifices, sometimes questions what they’re doing and why—but then something happens. We learn a little more about why something happens the way it does. A patient makes an impression on us. We make a difference in someone’s life. We get that much closer to the next step (3rd and 4th year when we get to be in the wards), which is that much closer to being a real doctor, and we experience that high that has kept so many people in the fraternity of medicine throughout the ages. It’s that high of finally attaining what we’ve strived for our whole lives that keeps us going.

It has been an adjustment. Undergrad seemed like child’s play. It mattered, but not that much. Now, we’re learning about things like bacteria, what a z-pack is, why Swine flu is called H1N1, anatomy and those raging hormones that our parents hated during our teenage years. Now, we’re supposed to know what those things are, how they work, and how they’re related. MRSA and VRE are no longer just random letters we see pasted to doors in the ER. Now, we know what those are (and we’re supposed to know what drugs to give to treat them, and how to avoid them in the first place). It’s a lot of pressure, but it’s what we’ve been striving for all these years. In a backwards and confusing way, we enjoy it; and even though we might get knocked off every once in a while, we scramble back on with anticipation for what’s next.

For many first-years, the summer between first and second year, the infamous “last summer” is for research, vacation or to spend time with loved ones. Many feel the pressure to keep pushing forward and dive into a research project so they can get published, so it can go on their resume, so they can do better in the Match. For me, I wanted to do something different. Something unusual. Something for me, but for others at the same time. So, I decided to ride my bike with a couple great friends from Brown from the Atlantic Ocean to the Pacific Ocean for a project a good friend and I started in the DR our senior year. We’ve given ourselves 53 days (3 days of rest) (www.onedreamtwooceans.com for more details on our ride and our project). It will be a trip to remember, the adventure I crave, and hopefully a money-maker for our project (again, medical students are crazy).

Looking back, it’s been a blur. Nine months ago, I didn’t know anything about medicine. Now, it feels like I’ve only scratched the surface of a massive amount of knowledge even though we’re one week away from the halfway mark of our classroom learning. The majority of the water from that fire hose seems to have missed my mouth, even though I was trying desperately to have a drink. We have one more test, and it’s summer. For me, my brain is essentially on vacation. Brown’s graduation was last week, and we had 2 more weeks after that when we were in the classroom. I’m ready for my infamous “last summer.” I’m ready for some time to reflect, to breathe, to give back to those I care about, and to prepare for what’s to come. I’m ready to slow down, to loosen my grip, catch up with friends and family, and get ready for second year, another crazy ride.