Challenge Accepted

In a recent post that I saw on HuffPo regarding the PR problem with family medicine.  It was a very well written piece written by Dr. Ranit Mishori entitled Time for Total Medicine: Get Family Medicine Out of the Shadows.  I thought it was a well written opinion piece and dutifully tweeted it to my all of 50 odd followers and 300 some friends on Facebook, thinking that it would be nice to bring it to people’s attention.  While I was completely well intentioned in that act (as with twitter its hard to express much of an opinion other than “hey check out this story” in 144 characters), it was brought to my attention by Dr Mike Sevilla in his latest blog talk that merely re-tweeting is not necessarily enough.  In order to enact change and understanding anybody who has a vested interest needs to make there own voice heard.  So, Dr. Sevilla, challenge accepted.

First of all, I liked how she described a standard conversation trying to explain what a family physician does by essentially saying what they are not.  They are not surgeons, cardiologists, gynecologists, dermatologists etc. yet deal with problems and procedures in all of these categories and more.  Honestly, I feel that Family Docs really ought to be classified as all of the above, rather than none of the above.  I see the mentality that Family Docs aren’t any of these specialists as a contributing factor to the popular feeling that if you are a smart medical student you should be a specialist rather than a generalist.  This idea can’t be farther from the truth, yet it continues to be felt through out the medical community and the public.

For example, as a third year medical student (almost 4th year as the class above me has now begun their journey into their intern year), I have gotten the chance to rotate through various specialties.  This is a standard practice and gives all medical students a well rounded feel of all aspects of medicine.  It also gives an incite into how different docs in various specialties feel about docs in other specialties.  The incite that I have come home with is a very mixed picture.  Perhaps MCV (VCU to be politically correct) is a little more friendly to the idea of family medicine.  Generally when I mentioned to any attending that I was interested in going into family medicine, they replied quite positively and informed me how much what I was learning on that particular rotation would come in handy as a family doc.  There were still those that told me that there is no money in family medicine and I should consider something else or those that thought not doing procedures every day would be boring.  However, those latter statements to me seemed to be more personal preference rather than an actual attack on family medicine.

I feel that many schools could learn from MCV in how it is able to portray the specialty of family medicine.  I may be a bit biased as I was one of the co-presidents of our Student Family Medicine Association group, but I feel that as a group we helped to make the presence of family medicine known amongst the medical student body.  However, there is still work to be done as I realized at the end of my family medicine rotation.  We had a group discussion at the end where many students expressed how they never realized the breadth of knowledge and pathology that family docs see on a daily basis.  Most students went into the family medicine rotation assuming they would be bored diagnosing colds, allergies and managing hypertension and diabetes all day.  While those are a big part of family medicine it is far from everything.  I saw and helped to work up a patient who presented in the earliest stages of being HIV positive (a strange viral prodrome), something that my preceptor at the time had never personally seen in his many years of practice.  A classmate of mine worked up a patient who was diagnosed with Creutzfeldt-Jakob disease and other classmates saw numerous small procedures performed by their preceptors.

In talking with one of the family medicine program coordinators I was surprised to hear how many of my classmates (many whom I wouldn’t have expected) suddenly saw family medicine as a viable option for a career and no longer just a “back up” plan.  It is this change in mentality that needs to be spread.  In order for family medicine to come out of the shadows, medical schools need to be able to show students just how exciting family medicine can be.  I know family medicine is not for everybody, but there are many people who don’t give it a second look simply because they don’t understand it.  So I’m going to continue to do my part and spread the word of the Family Medicine Revolution and hope that more medical students hear me and give it a second look.  I know I don’t have a big voice as a third/fourth year medical student but I will do what I can.  Next year I am volunteering to help teach first year medical students basic clinical exam skills and hope to be able to mentor them on the benefits of family medicine.  I will also continue to blog and tweet on the benefits of primary care and the joy of family medicine.  Viva la Revolution!



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Found: The Joy of Medicine

It has been way too long since I last posted anything on this blog.  I have to say that the last few months have absolutely flown by.  Since my last post I finished up (and passed) my surgical clerkship as well as finished a month long rotation through family medicine and am currently in the middle of a month long neurology clerkship.  I honestly can’t believe how quickly time has been moving over the past several months.  It often seems like the year is moving by ever quicker.  Perhaps it is due to the fact that I am now having to focus on my schedule for fourth year and decide which electives I want to do as well as apply for any possible away rotations that might be useful.  Perhaps it is secondary to having completed the vast majority of the clerkships and that I can now see a light at the end of the third year tunnel (that no longer appears to be a freight train).  Or perhaps it is because I feel like I have reacquainted myself with the joy that I originally found in medicine in the first place and have discovered a group of practitioners who are many times more passionate about the medicine they practice than any that I have worked with all year.

The group of individuals that I am referring to are the Family Medicine doctors that I worked with over the past month.  I primarily worked with two physicians Dr. Ryan and Dr. Epperson.  Both of them help to remind me of the humanity of medicine and the joy of providing care to patients of all shapes and sizes.  Working with Dr. Ryan I got a chance to work with pediatric patients a couple days a week in an underserved area of town.  As usual, every time I work in one of these clinic settings I am reminded of just how fundamental primary care is in helping people and how necessary it is to have a patient advocate to help guide them through the complex medical system.  Dr. Epperson gave me a very different perspective as he had previously worked in a rural clinic and provided care from first responder to hospital to outpatient follow up.  He helped me to appreciate the usefulness of a detailed history and a good exam, helping me to pick up subtle key findings to guide in the diagnostic process.

Dr. Ryan also introduced me to a whole new community of health care practitioners who actively communicate online via blogs and twitter.   I have since been trying to keep up with some of the recent topics being discussed via the #hcsm (health care social media) and #MedEd (medical education) hashtags and passively absorbing quite a lot from this community.  I feel that getting involved in this group is a good step forward in shaping who I will be as a physician and how technology could influence my practice.  It seems to be a great way to bring together two of my passions (medicine and technology).  I am really curious how technology is going to shape the future of medicine and I would like to remain on the forefront of that development.  However, I am still trying to understand how it can help in practice, beyond discussions amongst practitioners.

On one last note, I know I tweeted (twitted, twat…?) about a story I had found on the NYTimes but I wanted to post it again as it is really worth a read.  Life Interrupted is a blog by a young woman, Suleika Jaouad, diagnosed with cancer and her reflections on that experience.  She also posts a video blog and has a twitter feed that you can follow as well.  It’s really quite inspiring.

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Hands of Blue

Today’s post is going to be a little different from the standard of this site.  No, I’m not writing about Firefly, but I’ll get to that connection in a bit.  I would like to take the opportunity to give a brief glance into an aspect of medicine that few get the opportunity to experience.  An opportunity that few physicians get to take part in and even fewer medical students.

I am talking about surgery, specifically, Cardiothoracic surgery, or surgery that takes place by opening up the chest of a patient and putting them on cardiopulmonary bypass in order to operate on the heart (doing coronary bypass, valve replacement, or placement of assist devices).  The reason I feel the need to post about this is because I know I have been given the opportunity that few people (physicians and medical students included) get the chance to experience first hand.  For the last 6 weeks I have been on my surgical rotation, and was lucky enough to be able to spend two of those weeks working with the Cardiothoracic surgeons observing and assisting with open heart surgeries.

To begin with, being on surgery is an experience in and of itself and some things need to be understood before trying to go into detail of a specific type of surgery.  In any given surgery every person in the OR has a specific role.  First you have the surgeon themselves. Then you have the anesthesiologist, who makes sure the patient is asleep and all vital signs (blood pressure, heart rate, breathing etc.) remain within normal limits. Next, the scrub nurse maintains the sterile field—and yells at any medical students who are even thinking of moving into or out of said sterile field.

An easy rule to remember, once you are scrubbed in and sterile, is to keep your hands on blue.  All things that are sterile in surgery are draped in blue cloth.  See, the Firefly point comes back around.

Finally,  you have the circulating nurse, who retrieves supplies as needed and keeps track of the instrument count to make sure everything that was used during the surgery is accounted for at the end.  Then you have the medical student who does his absolute best to stay out of the way of the scrub nurse and assist the surgeon if at all possible (as well as try and answer any random pimp questions the surgeon asks of him).

Cardiothoracic surgery was by far the most amazing thing I have gotten to experience thus far in medical school.  The surgical team is like a well oiled machine compared to many teams and with good reason.  As the one attending put it, “death is following us all the time.”

The first time that I witnessed a living person’s chest being sawed and pried open to reveal a beating heart, I was filled with an absolute sense of awe.  I have always listened to patients hearts, and even seen dead hearts during gross anatomy.  But to see and feel a living and beating heart is quite the experience (not just physically but emotionally and quite possibly spiritually).  You are gazing upon the one thing that never stops working, beat after beat, except for what I was about to witness.  The surgeon began to prepare the patient to be put on bypass, inserting various tubes into the right atria and aorta. I stood on the other side, holding the still-beating heart out of the way I couldn’t help but be amazed at the calm at which they did this, as if this were a perfectly normal and ordinary thing to do.  Then, once all the lines were in place, a clamp was placed on the aorta, completely isolating the heart from the circulation of blood in the rest of the body.  At this point, the heart is cooled down with ice and infused with a solution that arrests it in the phase of contraction called diastole and the heart stopped.  This is when the timer starts:  From this point on the surgeon can operate for up several hours without any damage occurring to the heart.

There were several types of operations that began in this same way.  First, there was the coronary artery bypass.  In this procedure, a vein or artery was transplanted from another site of the body (arm or leg generally) and ever so carefully sewn between the aorta and beyond the area of blockage on vessel on the heart itself.  These were probably the most fascinating as they involved very intricate suturing.  I have a hard enough time using a regular sized needle and sewing up a fairly large wound.  The steadiness of hand required to sew one small vessel onto another is beyond amazing in my eyes. The second type of surgery was valve replacement.  Here, the surgeon would cut open the heart and remove a defective valve, replacing it with a new one (either mechanical or tissue).  The third type of surgery I observed was the placement of ventricular assist devices.  These are internal pumps that aid a currently failing heart to pump blood to the body.  This last surgery is actually performed on a beating heart—the surgical team put the patient on bypass, but they do not stop the heart.  Again, here I thought suturing something that wasn’t moving was hard.  This procedure requires placing stitches into a moving object.  I have to say that I am completely in awe of the cardiothoracic surgeons for the time and skill it takes to do these surgeries.

Then, in a reverse process of the beginning, the heart was warmed up with the rest of the patient, the lines were removed, and the clamp was removed.  This is the point that it really the most amazing.  It’s at this point that the heart goes from still to starting to quiver.  Sometimes, it quivers and begins beating properly without any help, but most of the time it needs a little shock to get things moving in the correct sequence again.  The whole process is truly amazing to behold and I am glad to have gotten the chance to experience it while I could, because I know I will never get that opportunity again.

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Joining the Ranks

Just saw this and figured it was worth posting to help spread the word.  Let’s use the global community that we have all created to accomplish something great together.

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Birth Control “Scandal”

Haven’t posted in a while since I have been on my surgical rotation. However, recently there has been an interesting story in the news when law student Sandra Fluke testified before congress appealing for them to have birth control covered as part of women’s health. I honestly can’t believe what Rush Limbaugh had to say about it. I have to applaud President Obama for calling Sandra up and congratulating her on standing up for what she believed in. And of course, Jon Stewart had a great bit on the whole incident.  I have to say that I love the bit about the catholics complaining about tax dollars going to pay for people to have sex when the catholic church doesn’t pay taxes.  It is also convoluted to believe that tax payer money will be paying for people to have sex when it is their insurance company for which they are paying a premium for.  The only thing that the government is doing is mandating that insurance companies cover it.  Birth control is also not solely for the purpose of having sex, there are many problems, as stated by the physician at the end of the clip, that are treated with contraceptive pills (from bad acne, to painful periods, to preventing excessive bleeding and anemia).  Leave it to the republicans to turn it into a “our tax dollars are paying for you to have sex.”  It’s not about sex, it’s about women’s health.

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Sorry for not posting much recently. Between Christmas break and coming to the end of my Internal Medicine rotation I’ve been rather busy and haven’t gotten a chance to post anything. But here’s a link that I think many will like.

It’s At The 20! The 10! Can The Flu Go All The Way?

It’s a great little piece that I heard on the way home from the hospital today that made me chuckle, esp the bit about the flu having a break out season or being a complete bust as well as keeping H1N1 on the bench just in case.

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If Airlines were like Healthcare

Stolen from Controversies in Hospital Infection Prevention and too good not to pass on. Good follow up to my piece on Paper vs. Computer records.  Enjoy!

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