medical school

how political is medical school? asking because I was recently in touch with an old friend (with whom I have radically different political views, on some things anyway) whose medical career essentially tanked and went to hell for reasons that he viewed as political (although I'm pretty sure there was more to the story).

not very, ime! i mean ppl have their views, i guess, but save for the existence of some student groups that are inherently political (we've got universal healthcare groups, and both pro-life and pro-choice groups), politics isn't something most of my classmates keep up on.

that being said, the general climate could be regarded by a selective minority as stiflingly ~liberal~. social conservatism doesn't gain a lot of traction around here, nor should it (IMO---if what ppl do with their private lives is something you spend a lot of time getting aggravated about, you might want to avoid a job that places you squarely in other ppl's business).

or do you mean small-scale political, like "office politics" style?

In my experience, you are probably in more risk of getting screwed in terms of the internal politics of academia (which are always insane, although much less so than was my experience with grad school, which had fewer people, and a much different approach to professional education, at least for me).

My school is supposedly kind of rare, but there is a healthy population of conservative oh God Obama is going to ruin medicine now we will only make $150,000 per year WHAT WILL WE DO* here, along with a healthy population of idealistic young liberal sorts like myself. (Discussions of abortion are especially awkward, since Gtown itself is officially pro-life and no abortions are performed at University hospital.) If someone is going on and on publicly about "We must act in the image of Christ" or "Dick Cheney is probably actually Satan" or "Obama's socialized medicine will destroy the foundation of America" then it gets weird, but that's poor judgment as much as anything. My thinking is that to be a good doctor you have to know when to shut the fuck up sometimes, and that includes a lot of quiet nodding with patients and higher-ups who are saying shit you don't believe about shit that isn't important to the work you're trying to do that day. A lot of this is me being naturally non-confrontational, but I think it's valuable to not piss anybody off unless you have to. Some patients are horrible people, but they're still sick.

With that said there is at least a 15% chance I will intentionally pick a fight in our Ethics course next quarter, but that is a whole other story.

*I completely appreciate that $150,000 is a rad amount of money to make, but to be fair $250,000 of debt (plus whatever you carry in from undergrad loans) is a serious consideration. An extra mortgage's worth of debt makes fiscal conservatives get kind of tight, especially when you factor in malpractice insurance and the fact that doctors are by and large horrible at being businessmen.

My thinking is that to be a good doctor you have to know when to shut the fuck up sometimes, and that includes a lot of quiet nodding with patients and higher-ups who are saying shit you don't believe about shit that isn't important to the work you're trying to do that day. A lot of this is me being naturally non-confrontational, but I think it's valuable to not piss anybody off unless you have to. Some patients are horrible people, but they're still sick.

otm x1000000

i should probably stfu more often

It is super-hard sometimes, though! Especially about medical stuff where you feel the need to say something but Zero idea what is going on (at least for now), or when you are having more of a conversation part and have to remember that your normal self-deprecating "Yeah I don't know how they let ME into medical school, I am like two generations removed from hillfolk" shtick is probably not the best thing for someone who is consenting to the idea that you can identify what is going on with them, and how it can be resolved.

My thinking is that to be a good doctor you have to know when to shut the fuck up sometimes, and that includes a lot of quiet nodding with patients and higher-ups who are saying shit you don't believe about shit that isn't important to the work you're trying to do that day. A lot of this is me being naturally non-confrontational, but I think it's valuable to not piss anybody off unless you have to. Some patients are horrible people, but they're still sick.

this is beautiful and otm

ONE DOWN

basically got my best path score thus far with just a shameful amount of guessing

also, this might just be curricular hypochondria, but i think i have actually given myself carpal tunnel syndrome. shooting pain around my wrist when i type or write notes long hand. 2.5 MORE DAYS

good luck man, my finals are done and im on the ride home now. still hungover, but i deserved last night for this semester

also, got an A- on my bioorganic chem final, WHAT UP

also genuinely interested in fl3x md and their school of public health/int'l health opportunities

I can't remember if you ever met my gf when you were still in Chicago? Because she's in a grad program right now for international public service and has recently become super-interested in public health. I bet you two would have lots to talk about, or at least books/resources to recommend each other.

so the political situation i was talking about was abortion. my friend (who is now, I gather, personally against abortion although at the time I think he was not really leaning one way or the other) reported to very pro-choice politically-active chief resident during his residency; my friend wound up getting very bad evaluations and he chalks it up to being politically motivated, although, I think there were other issues at play (he let it slip that he fell asleep during rounds once, although I can't imagine that doesn't happen a lot; and apparently he'd written very bad cross evaluations of people above him that he'd believed would be anonymous but in the end maybe weren't, as he received very poor evaluations in response); the end result of it was that, after getting to residency, I think he was basically completely stalled in his medical career. I think there's a fair amount of bitterness and also egotism involved; also, since I disagree with him on almost everything politically I don't have enormous amounts of empathy about it, but I hadn't really thought about how someone could get sidetracked and potentially derailed at that point into their career path. And I wondered, on things like abortion: what do you, as a medical student, learn about it? How elective is such learning?

It's my understanding that no school has an OB-GYN clerkship where learning how to do any abortive procedure (other than maybe a D&C for non-fetus-related reasons) is taught, which makes sense because any school that could be portrayed as forcing students to learn how to abort fetuses is basically asking for non-stop protests. It is also my understanding (I am not 100% sure this is so, but I am pretty sure it is) that in an elective clerkship opportunity in the fourth year (the curriculum in the first three years is pretty rigid), it is possible to train with a doctor who does perform abortions. Also, I know a girl who is involved in Med Students for Choice, and they just had a convention (in Salt Lake City, which is the weirdest possible place to have that convention) where they seemed to learn some of the basic practice of it. So you can if you want, but you don't have to.

My school is run by Jesuits, so abortion is kind of the elephant in the room. Any fourth year opportunities would have to be off-site (which is not to say at another school; we're affiliated with Washington Hospital Center, Virginia Hospital Center, and some other public hospitals that have nothing to do with Catholicism), and technically doctors can't even prescribe birth control at the University Hospital or Student Health Center on campus. In practice, all but the most fervent believers will happily write you a prescription for contraceptives related to Premenstrual Dysphoria or acne or some other thing that birth control medications also do. You can't do that with abortion, but I am pretty sure there are doctors In our Ethics course, we spent a day talking specifically about the whole Jesuit part of our Jesuit application, and what that meant; I ended up getting laughed at for trying to devise a tortuous but within-the-rules way to work around the ban on in-vitro fertilization. I am kind of curious to see what the explanation is for treatment of ectopic pregnancies that remain viable to the point of causing damage.

I have like Zero desire to do anything related to either gender's reproductive system, so I am sure there are some subtle and infuriating nuances I will never get to encounter. Outside of Ob-Gyn or Family Medicine I do not know why you would be in a position to have an argument about abortion with your attending, so it might just be that the abortion argument is just a stand-in for the guy being either sanctimonious or just stupid enough to get into a moral debate with the chief resident who believes the exact opposite thing as you. There is also the evaluation thing, which kind of seems like the mark of a dude who assigns fault to everyone else's shortcomings but his own. Those people are not good people to have around in general.

Downside of giant replies: I write them in pieces and forget to finish all the sentences:

2nd paragraph: You can't do that with abortion, but I am pretty sure there are doctors who are affiliated with the University Hospital who will do abortions at an off-site location.

i was wondering about that too because i had been reading that not many medical students were learning how to do it but i can see how "be[ing] portrayed as forcing ...." would be bad.

but then again, it seems like something you should know the basic mechanics of since it's so common. forcing people to learn how it's done isn't forcing them to do it. i don't know how doctors learn though.

learn everything i mean, not just that

We haven't learned a ton of procedural stuff of any sort, I guess. Like 95% of our education in the first two years is centered on stuff that is on the first step of the boards, and then we have like physical diagnosis stuff out on the margins (and sometimes that can be of depressingly little value). It's a little better in third year, but you've only got a limited amount of time everywhere. Like I am not sure I will ever learn how to place a coronary stent, beyond the basics of "find the occluded artery, put it there."

thanks, that was very interesting!

I'm still waking up, but, as an aside: a friend of mine did a reproductive health externship this summer that definitely involved abortions, but yeah at no point will we be getting them in the curriculum.

not sure how this is related, but: we actually just began our workshops on the genital/pelvic exams, and the male session involves students working with mock patients, and the female session involves observation and practice with a plastic model. due, apparently, to budget shortfalls, but not the best way to do things imo

w/r/t politics: getting into it with your attendings while you are a student is just bad business, in general. while i'm usually a very even keeled and personable dude, there are some things/ppl that will get my hackles up; was just watching a missed ortho lecture last night that was a reminder that some of the people that are my superiors/instructors/whatever are deeply, deeply douchey. also, there's a possibility that i'll have a resident that's four years younger than me (26 v. 30), which isn't guaranteed weird, but i can see possible tension there

in the end, i will have to remind myself that the person writing my evaluation (of a mere 4 weeks of work) is probably not someone i should get into any kind of protracted ideological disagreement with. because, yeah,

BAM

curious to know what the post-earthquake response as been on y'alls campuses

also my dad just mentioned that he's thinking of trying to get down there sometime in the future (he's a reconstructive surgeon, so he'd be doing "clean up work" as they say), so that's neat.

aaaaaaaaand renal/endo/pharm midterms tomorrow whoops time to get off the internet

hello cushing's disease, how are you

We were in the middle of another charity driving thing so our response was a little slow, tbh. They started a contest btwn the first and second years to see who could raise more, so hopefully we will make more stuff happen.

haha so i just cruised through the note coop wiki (which is where i do a lot of studying, actually) and noticed that we have a new Med Wiki Blog. Called.....The Wog.

lol midwesterners

:-/

also: we had one of those fundraisers, too, between classes! raised a decent sum for PIH, it was good stuff.

"my" student group (PHR-affiliate) is gonna try and do something soon, but it will probably be focused on haitian immigration more than direct relief.

cf my friend j3ff's editorial here: http://www.huffingtonpost.com/jeffrey-kahn/cut-the-red-tape-why-hait_b_434209.html

nother pharm class gbx? thought you took that last semester?

my stepdad (vascular surgeon, experience in trauma) is trying to find a group to go down with.

anyway there was a meeting i couldnt go to last thursday, i'm hoping either the pharm school or the school in general is planning trips down there over spring break, if that's even possible. still waiting to hear

pharm is a year long course for us right now

tomorrow is midterms for

pharm (steroids, diuretics, obesity, HTN, diabetes)
renal (Na balance, K balance, water balance, edema, renal failure)
endocrine (pituitary, adrenal, lipid/obesity, diabetes, bone regulation)

kinda freakin out a bit, but at least it's not finals

damn dude, how long has school been in session for? i'm about to start my second week, i dont think i have any true midterms until week 3ish?

also damn 3 in one day? how many classes are you taking?

six

we've been going since 4 jan

oh wow your break must have been short then (you're going to minn right?). i'm taking nine classes but it's only 21 credits. buying books is going to suck tho

yeah, 22 dec to 4 jan, super short

We got 2 weeks for winter break 1st year and then there's 3 weeks in second and third year, and then 4th year there's the weird extended period where you're supposed to be interviewing for residencies but otherwise are not in school. I forget how long that is for us (like six weeks? eight?).

We just did a three week section of renal and neuro. Renal was kinda weird because last year for renal physiology we had one professor give like a three week series of lectures that very carefully and entertaingly (in as much as renal physiology can be entertaining) explained everything really well, so everybody really liked renal. Then this year it was a bunch of people, and a lot of classes where they just dumped pathology on us, so there are not many of us who kept any interest in nephrology. Neuro is weird because a ton of people hate it but I think it is rad, so I can never accurately gauge the room's interest. It is definitely my favorite thing right now if I were to do a medicine residency instead of a surgical one (when I'd probably still go ortho), but I doubt I'm gonna get a handle on medicine vs. surgery until 3rd year. Sweet sweet 3rd year, so very close.

i'm taking a 5 credit neuro module this semester, not looking forward to this playing out

Neuro pharm seems less horrible than cardio pharm, although I haven't taken the neuro exams yet so maybe I am just full of unwarranted confidence. At the beginning of cardio they even told us, the hardest part of path was heme/onc, which we had just finished, and the hardest part of pharm was going to be cardio. And then they proved themselves right!

Although we did have anesthesia last week as part of neuro, and whoever said anesthesiology is like flying a plane seems totally otm, except I didn't realize that analogy also extended to the fact that accidentally nudging one dial a little too high would result in the plane crashing suddenly into the side of a mountain. That many drugs all at once just seems terrifying to me.

last year for renal physiology we had one professor give like a three week series of lectures that very carefully and entertaingly (in as much as renal physiology can be entertaining) explained everything really well, so everybody really liked renal.

whoah weird this is our situation, too, except that he's back this year. and i'm making him dinner in a few weeks.

i mean i secretly really like renal, even though i'm certain i'm going to do horribly on the test tomorrow. ditto most of this endocrine stuff: i like feedback loops and the like. seems like there's less weensy little facts to remember and more big pictures

just, like, really complex pictures. and ditto: i actually enjoyed taking my neuro final, even though i'd been up for like 24 hours. localization is neat!

localization is neat!

Did you use Blumenfeld? Great book, pretty much anyone I've met who likes neuro after med school learned how to localize from Blumenfeld.

Friday morning, I opened my Neurosciences Grand Rounds presentation (on Neurologically Unexplained Symptoms, aka Functional Neurology) with the maxim/joke I used upthread about the difference between psychiatry, neurology, and neurosurgery. No one in a room half-full of neurologists and neurosurgeons had heard it before. Now I can't find it anywhere online. Did I make it up somehow? I'm not usually that clever...

i hadn't heard it in that form, but i've heard similar jokes? usually a little more mean spirited, though, like psyches don't really know anything, neurologists can't really do anything, and neurosurgeons don't really know what they're doing

http://www.hollywoodreporter.com/hr/content_display/television/news/e3i6e742a66c22a2552a1b148e2c35adb6f

"HMS" is about the exploits of the sexy freshmen class at Harvard Medical School through the eyes of a young female student.

I am glad someone has decided to talk about how much exciting sexy action happens in medical school, because you know, that is absolutely a thing.

f u hms

i am getting laid *right now*

http://www.nytimes.com/2010/02/15/education/15medschools.html?hpw

more abt the exploits of sexy med school freshman

where is dyao

ayo