The International Aspect

International education: what gives?

Though I'm hopelessly poor in international experiences, I do hold the belief that they can be vital to a person's resume, no matter what career they go into. I went to a college that stressed international education. In fact, its study-abroad program was basically its selling point, as it is one of the nation's better-known schools for having a large proportion of its student body study abroad (about 50%). That said, I was in the 50% that did not study abroad, and do I regret it? Not really.

My Mother came to the United States in the 70s from Indonesia along with her immediate family. Some other 1st-generation immigrants from her family are here in the States as well. I grew up around both my father's "American" culture and my mother's "South-East Asian" culture, being exposed to the practices, customs, and languages of both. However, I've been largely assimilated into U.S. culture, as I hardly know more than 3 words of my Mom's native language, and can only barely point the country itself out on a map (yeah, it's the one that shares an Island with Papua/New Guinea).

Anyway, other than being a hybrid of Chinese and White by blood, I'm a very American guy. I've had many friends/acquaintances go abroad for 3 months during college to...Dominican Republic, Ethiopia, China, Germany, even Peru. Their experiences have changed them and have been very valuable. I envy the clinical experiences they've had and the languages they've learned. But strangely, I feel right at home with the path I've taken. I've spent my summers doing research and my semesters loading up on the science courses I've needed.

Ultimately, I used my extensive research experience as my pitch to the admissions committee. Not every single person needs to boast working an AIDS clinic in Sub-Saharan Africa, right? It's a plus, but (at least not yet) it isn't an un-written rule like hospital volunteering is.

But just how important is the international experience? While shadowing the ophthalmologist last Thursday (who graduated from my college as well, albeit awhile ago), he asked me the dreaded question, mid-operation mind you: "So where did you go for your Study Service Term?"

"...Actually, I didn't do it. I took the alternatives instead."

"[Just about jabbed the sedated patient's eye with his scalpel] Are you kidding me? Yuki, Yuki, Yuki!"

The usual question, usual response, usual shocked answer. He wasn't actually upset, I mean it's my life, but he made his speech about how his time in Central America was so pivotal to his identity as a doctor.

"Down there...you practice real medicine. No bureaucratic systems or endless paperwork to get in your way; you do medicine on needy people and get to the heart of what it is all about. Only there are you a real doctor."

Yes, yes, I know. Things are different out there, outside the high-gates of this magical country stained with power-politics and malpractice suits. He kept telling the other docs that I was going to become a "missionary doctor", as if to poke fun at the fact that I've done nothing outside of the U.S. I didn't take offense then, and don't now, but he was just another person laying into me for not going abroad during college.

Is it that important? I don't doubt for a second that the experience is valuable...to understand another place, another culture, another people. Places where 911 doesn't get you to the nearest ER within 10 minutes, places where insurance is a foreign concept and places where germ-theory hasn't yet permeated common knowledge. I'm aware of this, and while brute knowledge/awareness is no substitute for experience, I'd say I'm more culturally sensitive than a lot of other pre-MDs I know. Unless driving the 2007 BMW your Dad bought you to school, and complaining about how "hard" life is at your $850/month 1 bedroom apartment on the Canal constitutes cultural sensitivity. Not every medical student is like this, but they do tend to come from higher tiers of society and these attitudes have been seen again and again.

But again, being an American citizen going to an American medical school to practice medicine in America for your entire life, will having visited or not visited a foreign country prior to medical training affect your skill at practicing medicine? America does have a great amount of immigrants living in it from every conceivable location; no matter what kind of doc you are, you are going to work directly with patients and patients come from everywhere. Just as with many other careers, inter-cultural awareness/sensitivity is important ("Diversity Training" on that show, The Office). Yes. I know this. Perhaps it is even more important in medicine because of the relationship you establish with your patients and the diversity of beliefs as they pertain to medicine found around the world.

I'm not sure what the general consensus is out there, but in the bubble that I've grown up in, people seem to think that your ability to practice medicine is directly proportional to how much international service you have done. I'm sure there are many great docs out there who have never left their state! I'm sure there are radiologists and pathologists out there who do impeccable work, never having spent a second serving in a foreign country. I'm also sure there are docs from this same pool who have spent time abroad and feel that it has helped them become who they are.

I think it is just a personal choice and that everyone has a different path. Sure, if I had spent time in Peru volunteering at a Peruvian hospital, I'm sure that my perspective on the human condition and patient care would be more broad today. But, won't I get the same training as the guy next to me who spends every other week in Haiti? I'll do schooling and residency and develop the skills needed to become an excellent physician. It all comes from within. Anyone reasonable enough to get into medical school has to have enough reason to acquire cultural sensitivity throughout their training and practice.

Bottom line? I agree that international experience can really help a physician have a wider perspective. But not having that experience can't hurt you if you work hard and do your part to become a great doctor. There's enough work to do in American health-care. This is where I ultimately want to practice. Can't I just focus here and not be hassled?

Light Shed

Well, since my post on Anesthesiology, I have had some light shed on the subject!

First, through an unexpected (but greatly appreciated) comment from an actual anesthesiologist, I got feedback on my post and then read her extremely informative post. The post is the result of her frustrations with the general misconception (even by other physicians) about her profession/specialty. Really informative and insightful stuff; just what I was looking for! Read it here.

The other aspect of this is when I shadowed an oculo-plastics ophthalmologist the other day. He is a friend of my friend, so I guess I'm connected to him by two points. Anyway, there was an anesthesiologist present during some of his cases, so I had the chance to talk to the gas man himself! It wasn't a very long interaction, but it was useful in any case. I also got to talk with a pathologist, who seemed quite happy tucked away in his nice office, far from the buzzing, meat-moving flow of the rest of the hospital. A few histology slides later, and I was on my way back to the O.R. to watch more eye-lids get slashed open.

Anyway, it goes to show. You must mature a lot during medical school; the exposure you receive, the blood and sweat you suffer, the time you spend, and the experiences you have probably all act to guide you into your own little niche. And as I've discovered elsewhere in life, things always change, and if you're up to it, they'll change for the better. I think the best I can do now is focus on the two years ahead...or perhaps just the month or two ahead.

Overwhelmed, but excited.

Countdown until day 1 of school: ~51 days

Skeptic

I'd have to side with Uncle Panda on the Chiropractic issue: Its junk science at best, and most likely just a quack/hoax to get gullible "patients" to cough up money for perceived symptom relief.

The very (shaky) foundation upon which this (undeserved and isolated) "branch" of medicine rests is itself laughable. Daniel D Palmer, back in 1895, created some theory that states that there is an innate life force which flows through all of your organs/tissues/cells via the spinal column. He said that 95% of ailments are the result of mis-aligned vertebrae, because the vertebrae "pinch" nerves. By performing physical manipulations on these vertebrae (vertebral subluxations), one can (supposedly) correct the nerve-pinching culprit and restore "flow" to the affected organ(s), relieving symptoms.

With over 60,000 licensed chiropractors "practicing" in the U.S., I'm sorry to see so much money being thrown at quacks. But aren't palm-reading, fortune-telling, and herbal-medicine shops still in business? Yeah, and that's the category that I toss Chiropractic in as well. The very nebulous nature of their catch-phrases (no two Chiropractors could agree on or tell you the exact pathology of subluxations and their supposed corrections) and reliance on high-frequency-return visits proves their illegitimacy as health-care providers. Food for thought:

There is plenty of room for the passage of spinal nerves and blood vessels through the fat-padded foraminal openings between the vertebrae. It cannot be imagined that slight displacement of a normal vertebra will place pressure on a spinal nerve. This was proven conclusively 25 years ago by experiments performed by Edmund S. Crelin, PhD, a prominent anatomist at Yale University. Using dissected spines with ligaments attached and the spinal nerves exposed, he used a drill press to bend and twist the spine. Using an ohm meter to record any contact between wired spinal nerves and the foraminal openings, he found that vertebrae could not be displaced enough to stretch or impinge a spinal nerve unless the force was great enough to break the spine [1].

Not only that, but time after time, investigators go to multiple Chiropractors and receive different results/treatments each and every time. One time I'm told my left leg is longer, another time vice-versa, and another time I'm told my bladder is going to be distended because my x, y, z nerve is pinched. You get the idea.

Baloney, baloney, baloney. You might get immediate relief, but that whole theory makes me annoyed.

And so, I'm quite a skeptic. Not to say that I refuse to believe in things that are not directly observable, but things like Chiropractic, acupuncture, ghosts, chi-manipulation...how can the masses fall under the opium so easily?