“Humanism” and “professionalism” in medicine

I just finished my first set of exams for the year, so naturally, I’m slacking off to wax philosophical about my existence in general and my life as a medical student in particular.

“Humanism in medicine” or “humanistic medicine” has become a bit of a buzz phrase in medical education. Likewise, “professionalism” is a word that gets thrown around a lot, at least at my school, in reference to everything from lecture attendance to dress codes. As medical students, we’re expected to speak the appropriate language, to behave in the appropriate way and, above all else, to think the appropriate thoughts: the obese patient isn’t just fat and lazy, but the victim of poor education or cultural priorities. Likewise, the rude patient is more than just a simple jerk. They try very hard to make us empathetic, respectful, patient, considerate, and all manner of other wonderful things that you could hope for your doctor to be. That’s one hell of a lofty goal, and I can’t say that I’m not just the tiniest bit intimidated.

As much as I’d like to think of myself as a somewhat mature person, the truth is that I’m the kind of person that enjoys internet drama, that has trouble getting out of bed before the clock strikes noon, and that gets excited at the prospect of shoving sweets in my mouth. I’ve spent my entire life to date in the ivory tower that is academia and so, have no idea how real people actually live their lives. To think that in one more year, I’ll actually be on the wards in my white coat– it’s a bit of a terrifying thought.

The first day…

So… today was the first day of my second year of medical school, and though I would have been happy to let it pass without comment, I ultimately decided that it would be nice to post about the goings-on in my life every once a while. For being the beginning of my last year of classroom-style education, it was surprisingly same-old-same-old, though I do have a few changes from last year to note:

  • I’ve moved. Luke and I moved to a new apartment about a month ago. Now, rather than taking the bus as I had done before, I’m a 15-minute walk from campus. The upside is that I’m no longer bound to the sometimes-reliable but always-inconvenient bus schedule; the downside is that I’m actually responsible for when I get to school… which means I no longer arrive 10 minutes early. This means I no longer have my pick of seating, a condition which is made worse by the fact that…

  • The auditorium is smaller. This new auditorium is nicer than our old one, but I liked having 2-3 seats to myself, dammit!

  • I have a new backpack. A sexy Swissgear backpack with a cell phone holder on the strap. …did I mention the cell phone holder?

Teaching hospitals

A few days ago, I overheard a conversation at work. One of the other medical students was speaking to my research mentor’s secretary, and the gist of the conversation, to which both the medical student and the secretary seemed to agree, was this: “I try to avoid going to teaching hospitals for my medical care because I don’t want medical students and residents to ‘practice’ on me.”

I’m not going to pretend that medical students, residents, and other trainees know what they’re doing, and I acknowledge that people have the right to choose who takes care of them. I concede that health is an important thing, and that it shouldn’t be entrusted to just anyone; healthcare isn’t something to be toyed with or taken lightly. Even still, this sentiment doesn’t quite sit right with me, especially coming from someone who is, herself, a medical student.

First of all, teaching hospitals (especially those at major academic medical centers) tend to be at the bleeding edge of medical technology and to offer the most advanced techniques and therapies available. These are places that worry a great deal about their reputations and have the resources to attract the most prestigious, most top-of-their-game staff members. This is why the rich and famous tend to seek out these academic teaching hospitals for the various surgeries and other procedures that they may need.

Secondly, while there will be trainees running around who will have some responsibility in your care, nothing is done without the oversight of a full-fledged attending physician. It’s true that medical students or residents may be given the opportunity to “practice” on the patients, but the attendings will do their best not to put you in any real danger. In fact, many patients volunteer for trainees to practice simple procedures on them (for example, drawing blood or taking a blood pressure), because they want to give back to society for the wonderful care they’ve received. Furthermore, with so many trainees around, there will be more people looking at and talking about your case. Attendings are human, too, and sometimes they miss things just like everyone else. At a teaching hospital, medical students and residents are around and can potentially catch their attendings’ mistakes.

Lastly, and perhaps most importantly, you’re a medical student! You’re going to be poking and prodding and practicing on hundreds of patients before you feel like you know what you’re doing! How can you expect other people to allow you to practice on them, when you’re not even willing to have it done to you?

Vulgar medical mnemonics

Me: So if you’ll lie back, I’m going to listen to your heart.
Patient: Like this?
Me: Yes, that’s fine. It’ll just take a few seconds.
Me: (Remember: a pervert touched me… a pervert touched me…) Sir, I think there might be something wrong with your perv– err… pulmonary valve.
Patient: …what did you say?

Okay, so the above scenario has never actually happened to me. But with all the off-color mnemonics that the various professors, textbooks, and TAs have been feeding us in order to help us remember the material, I live in fear that it will happen sooner or later. The advantage of mnemonics like these is that they make a big impression and are easy to remember, the disadvantage… well… I think I’ve covered that already.

Below are some of the more amusing and more vulgar of the mnemonics I’ve come across so far in my first year of medical school:

A pervert touched me.
This is the one that I mentioned in my little introduction scenario. It’s a way to remember where to listen for the heart sounds associated with each heart valve. From right to left, top to bottom (the order in which you would read a page written in English if you’re facing the patient), it stands for: Aortic valve, Pulmonary valve, Tricuspid valve, Mitral vave.

Clean my butt Zach Thomas.
This is a lovely little mnemonic, used to remember the major branches of the facial nerve within the parotid gland. These, starting from the bottom up (or from inferior to superior, as the anatomists prefer), are: Cervical, Marginal Mandibular, Buccal, Zygomatic, Temporal.

OOO to touch and feel a virgin girl’s vagina and hymen.
This one’s for remembering the 12 cranial nerves in order: CN I is the Olfactory nerve, CN II is the Optic nerve, CN III is the Oculomotor nerve, CN IV is the Trochlear nerve, CN V is the Trigeminal, CN VI is the Abducens, CN VII is the Facial, CN VIII is the Vestibulocochlear, CN IX is the Glossopharyngeal, CN X is the Vagus, CN XI is the Spinal Accessory, CN XI is the Hypoglossal.

Some lovers try positions that they can’t handle.
This one is handy for remembering the bones of the wrist: Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate.

Those are all of the interesting ones that I can think of at the moment– I’m sure that there will be more once school starts up again.