Pretty Laid Back

I'm a pretty laid back guy...

I've always prided myself on being able to distill things down to their essence and then accomplishing them with speed and efficiency. This applies to school, as I got through pre-med college work accomplishing the same as others while putting in 50%-75% of the energy.

I realized that a lot of energy is wasted on things as simple as gossip, freaking-out, and over-studying. The group of super-gunners at my school will study in the medical center for 12 hours straight with no breaks and burn out. I stick to a solid schedule of daily study, leaving time for relaxation, keeping my head fresh for the next day. All the while, I feel relatively comfortable with the material, though this will change as time goes on and things become more unfamiliar and nasty.

We had some "soft" classes today; I think I'll enjoy them because they provide the training for the other half of being a physician: clinical work. Actually, being a good clinician is probably 90% of being a doctor, while the hard-science background is still just as important.

Concepts of Health and Disease: This one is pretty cool. Think of the scenes in House M.D. when the team stands around a white-board and writes down what the diagnoses could be. Only in real life (on previously written-out cases). Seven of us sit in a little conference room with a faculty facilitator. In our case, it's a tough, mid-40s guy from Brooklyn with a thick New York accent. Seriously, the guy sounds like a mobster and you think he's picking a fight with you when he talks, but it's just how he talks! He's a Ph.D. in immunology and microbiology so he's going to be schooling your ass, too. And he does!

His job is to steer us in the right direction and keep us from going too deep into blind alleys. So we started with a case that seemed simple enough; a 45 year-old guy comes into the Emergency Dept. complaining of crushing chest-pain, shortness of breath, all that. Turns out, things get real tough real fast. We're all first-years, so we're all newbies when it comes to real medicine like this. We'd get stumped all the time and the facilitator would have to be like,

"...maybe....do a physical exam?"
"...try asking for a blood test? But be specific!"
"Hold on! Is a cholesterol level of 250 mg/dl really unremarkable?"
"You're missing an important detail!"

It got tough. We'd get to a part where we collectively said, "we need data from a physical exam" or "we need to do a urine test", at which point the facilitator would hand out the results of those tests. With the new data, we'd develop our hypotheses and think of more things to try to narrow things down. Along the way, we run into countless terms, procedures, tests that we know nothing about and have to go home and look them up. He had chest pain, but how can you rule out pulmonary edema? His WBC count was a little high, but that tells you nothing about a possible myocardial infarction. His serum albumin level was this but you thought it should be that...or his creatinine phosphokinase level said this.

It was all over and by the end of the session we only had a vague idea of what might be wrong with lots of data pointing nowhere (because we're all very new). Humbling, exciting!

Evidence Based Medicine: Decent. Not too exciting but kind of fun. Run by the emergency medicine department, so you get to see lots of Emerg. docs and read a lot of emerg. cases. I like that aspect of it. This course is about accessing data and articles and scientific/clinical studies within the scope of practice. It's about using patient data to help your own practice and how to know when a study has valid/invalid, relevant/irrelevant results. Cool.

Well...tonight I'm going to hit some more thoracic-region anatomy. Biochem and molecular cell started off really fast, but mostly college review. *deep breath* Let's do this...