Not on my watch

In my ethics class, we talk a lot about medical interventions and dying. It's pretty well-known that many medical intervention are overused. The patient's underlying condition won't improve, the treatment will decrease the quality of life in the time the patient has left, or the treatment won't relieve pain. Patient and families often feel that medical staff push interventionso on them that they don't actually want.

I generally believe that we should try to change this culture of excess intervention, respect the patient's wishes, known when to "let go". I think many students also agree to this principle.

But I can also understand doctors and medical staff who end up intervenening more than is necessary. I think it's because we all want to avoid death even though the hospital is full of death and dying. In a recent post in "A Cartoon Guide to Becoming a Doctor" talked about how doctors want to personally avoid patient death,  "Every time I cross covered the hospital as an intern, I would pray to get through the night without harming anyone." (Cross cover is when interns receives the patients from the day team and takes care of them through the night. It's problematic because the new doc doesn't know the patients well.)

I haven't experienced the death of a patient I had responsibility for but I know that it'll be a milestone experience. It'll be something I'll remember for a long time even if my medical decisions did not cause premature death. I'm not really looking forward to it either.

Docs don't want patients to die "on their watch" so they end up prolonging dying until the next shift takes responsibility for the patient, and the next after that...

Hymen Shmymen

 Just want to say that I and two other smart young ladies write a blog focused on gender and science. This entry is cross posted at herstoryofscience.blogspot.com. Please check it out!
 
Since medical school began, I've only managed to read one non-required book in the last two months. It's not a fact I'm proud of but I think I spend my scarce time wisely. I read Hanne Blank's Virgin: The Untouched History, an account of the history and nature of virginity. It's an accessible and entertaining read for my overtaxed brain.

This was one thing I learned:

Despite the lack of any actual studies in the literature regarding whether horseback riding, gymnastics, or riding bicycles might have to do with womens' hymens, virtually every contemporary writing about virginity aimed at teen girls is duly equipped with a disclaimer that says something along the lines of 'many girls tear or otherwise dilate their hymen while participating in sports like bicycling, horseback riding, or gymnastics.'"

Woah. There is no scientific evidence that these activities stretch or tear the hymen! Yet I've heard this countless times in teenage girl magazines or otherwise informative literature on puberty and sexuality. Be sure, this "fact" is not just something from conservative abstinence-only sex education curriculum but widely seem in popular and generally accurate sex ed. It's probably in those puberty books your pediatrician recommended you to read. Understandably this belief was popularized in order to dissociate hymen with virginity. In recent years (decades?), it's become more acceptable for girls to participate in sports and the hymen less a gauge of virginity.

I think it also shows that the empirical evidence or lack thereof don't affect people's beliefs that much, in sexual matters and otherwise. In medical school we grumble all the time about evidence-based medicine. It should dictate medical practice but often it doesn't. Doctors and patients often want and perform procedures that aren't medically better than the other options.

Have you heard this when you were growing up?

Lists: Things I'll Find in Norfolk

In one of my favorite books, Never Let Me Go, Norfolk, England is where lost things end up.
Kazuo Ishiguro writes: "When we lost something precious, and we’d looked and looked and still couldn’t find it, then we didn’t have to be completely heartbroken. We still had that last bit of comfort, thinking one day when we were grown up, and we were free to travel around the country, we could always go and find it again in Norfolk.”

Norfolk wasn't just a repository of lost objects. It also held missed opportunities, words left unspoken, and roads not taken, friends who grew apart, and other experiences forever receding from the present.

Heart shaped pendant
My mom gave it to me when I was in middle school but it sat in a box for years because I thought it looked too dowdy. Everyone else had those silver Tiffany chokers. Then in senior year or maybe junior year of undergrad I began to wear it continuously. Before then I didn't have one necklace that I wore  all the time. But I soon got used to it hanging around my neck when I woke up in the morning.

I lost it the day I left Detroit Metro Airport for Denmark. Later walking past the dancing water fountain in McNamara terminal I felt the chain sliding oddly around my neck. It had broken but was still draped around my neck. But the pendant was nowhere to be found. I must have lost it when I was taking off my layers at the security checkpoint.

Before I left Denmark I bought a daisy pendant, a very popular design by Danish jeweler Georg Jensen, as some sort of compensation, but it's just not the same.

A pair of angled forceps
My grandfather had a tremendous influence on my life. He was also an otolaryngologist. He taught me never to run around, laugh too hard, or talk too much while eating nuts. One of the last times I saw him before he died, he gave me a pair of forceps not because he wanted me to be a doctor but because they're just so useful for picking at things!

Sometimes when I get something valuable, I squirrel it away in a safe place. But I decided that I would honor his memory by actually going to use this tool, or at least looking at it everyday, so I kept it at home on my desk in a pen cup. But somehow throughout the years of undergrad, I lost it.

You can by forceps shaped exactly like the one I had at any surgical supply store. But of all the things I've lost, I would most like to find this one.  I would give a lot to get it back again.

 
My hospital birth certificate FOUND! 
My mom dug through a lot of boxes of my school projects, notes and childhood mementos to find this little slip of onionskin paper. It says my birth date, time, weight and was signed by the attending physician, who apparently was a family friend of my grandparents. There's no way my mom will let me hold on to anything important anymore.

The movie adaption of Never Let Met Go has been reviewed by various media outlets. But if you haven't read the book, you MUST NOT read any reviews of the film or book that give away the reason for the children's isolation. You will do yourself a great disservice.

Things I think about: The next 10 years

It's in part the publicity about the Sex and the City movie, in part the transition to medical school -- a narrowing career path, and in part joking with some friends here in Århus, that in the past couple weeks I've imagined a life like this 10 years from now. 

They include: 

an apartment in NYC

a vineyard in upstate New York

a cat

a stay-at-home husband to cook, clean, and oversee the wine-making in our vineyard

and a job to support all this

As you can see, some of these goals are more realistic than others. Or actually only one is likely to come to fruition and it doesn't involve real estate or subservient spouses. 

With all seriousness, none of these things will happen, probably. And really, I don't want a stay-at-home husband to cook and clean. By calling out the inadequacy and injustice of patriarchy -- assuming the male experience to be the correct and universal one -- I don't want simply assume the dominance. That's not feminism. 

But all this represents some things that I do hope to have: a sense of home and permanence. It's not anything I want now! But I think that after 10 years, I'll be weary of school, of moving around every few years to complete my education and start a career. I want to be able to live life the way I want, maybe have some choice in the city or region I live. And I would really like to have a cat. It would be a nice life. 

Flash Forward

In a recent conversation, I revealed that I can't imagine myself more than five or seven years into the future. This means that I cannot picture myself to older than 28. Or maybe 10 years in the future at the very most.

Last weekend Monika and I drove around the East Lansing area to look at apartments and houses for rent to live in when we're in medical school this time next year. We were trying to find a house for rent in Okemos. Having seen the ad online, it was in a neighborhood neither of us had been to so we didn't know what kind of houses were there.

We quickly learned that this was probably not a neighborhood that typically rents to poor students. It's a very nice upper middle-class neighborhood -- big houses, mature trees that hide each house from the next. I saw a middle-aged man riding his bike with (presumably) his son behind him on a little bicycle.

There, along the winding tree-lined road, I had a flash of a vision of myself far into the future: me in middle-age, living in a neighborhood with kids, maybe having kids of my own. It was scary. I don't think I'm ready to imagine a time when I'll have finished school, have a career, have an income, a 401K. It's overwhelming to even think about the trappings of middle-age and middle-class life.

I realized that at this point in my life, I actually want a sense of incompleteness. I want this life of a student, the lure of degrees yet to be completed, and the future left open.

Because we all need to learn about STIs in women

I love medicine and I love the human body (a feeling pursue sapiance captures nicely here) and it pains me a little to hear medicine described as an all-out racist, sexist, and heteronormative medical-pharmaceutical complex because I feel as if all medical professionals are being tarred with the same brush. I know of students and medical professionals who not only know their science, but are also socially conscious. (I like to think of myself among their ranks). I'd much rather highlight the efforts of people trying to do something about the outdated ideas that exists in medicine.

I especially admire a professor for her gender-balanced lecture on sexually transmitted infections. I think it shows that not only can you be a doctor and still have a heart, but small but meaningful change from within is possible.

I had this professor for a human pathophysiology course, the study of human diseases. When we arrived in class for the lecture was on sexually transmitted infections, my professor began by saying that she made changes to the lecture notes left by the last professor who taught this class. The last professor did not discuss STIs in females! No talk of signs and symptoms, manifestations, treatments, modes of transmission of STIs for females. My professor was appalled by this omission and made sure to include these discussions in her lecture.

She explained that perhaps because many STIs have few signs and symptoms in women, the previous professor thought it was acceptable to exclude any discussion of them. The causes of STIs -- the kind of virus or bacteria -- would already be covered in discussions of STIs in males. Of course this excuse didn't make much sense to my professor and me. Even if there are few symptoms in women, it is important for students and sexually active people to know that there are few symptoms in women so that we can be all the more vigilant.

I especially admire a professor for her gender-balanced lecture on sexually transmitted infections. I think it shows that not only can you be a doctor and still have a heart, but small but meaningful change from within is possible. Even though she did not re-educate years of students for whom this important demographic was missing from their human pathophysiology education in STIs, I still think it was good of her to point out this omission. She could have just changed the lecture and given it without any of the students knowing about the previous version. In explaining it to us, she taught us that medicine is still riddled with pockets of misconceptions and outdated information, but that she as the new instructor and we as students, are capable of teaching and learning better medicine.

This brings me to a point about medical education. My professor prefaced her explanation of the STI omission (and indeed apologized for delaying the start of her lecture) by acknowledging that she was an anthropology major as an undergrad. With that perspective, she was able to easily spot the embedded in medicine. It also restored my belief that my non-science education as a Comparative Cultures and Politics major in the college of public affairs will still pop up to shape the way I see medicine. Because sometimes all the talk of non-science majors, well-rounded students sounds like meaningless admissions committee blather.

Let's not forget that women make up an increasing proportion of medical school students, which can only be a good thing. In 2008, 47.9% of medical school students were female. It's not quite equal yet, but in 1988, it was 35.2% and a mere 8.8% in 1968. (Source: AAMC )I think many women, not necessarily anthropology majors, will be watchful for accurate medical information about themselves.

All this, good things for medicine. Keep women and anthro majors coming in medical school.

Prioritizing Aid - More Questions Than Answers

There are many worthwhile causes to champion, injustices to fight, both financially and through other actions. Should I donate to an organization that, say, helps fund the education of girls, clean water, or HIV/AIDS prevention and treatment? Should I fund a domestic or international cause? Should I lobby for environmental issues? Universal healthcare in the U.S.?

I feel that I am prioritizing one condition over the other by devoting my efforts to a cause. Of course we should contribute toward solving all the world's problems, but I recognize that our resources -- money, time, political will -- are limited, so we can only give publicity to some diseases and not others.

Now expand this on the scale of national governments, multilateral aid organizations. We all have to make choices about how much to fund for what. Each foreign aid budget, domestic health budget, and NGO has to prioritize what it will spend the most money on.

I often read about how easy and cheap it is to cure a certain disease but there's no effort to do so. No global funds, no rock star benefit concerts, no massive whatever-color-ribbon campaigns. There is no publicity, funding, and political for very urgent needs with simple solution. I've heard that with just a little more push we can eradicate the last few pockets of polio, or with some cheap drug we can save lots of people from something terrible.

The latest example of this is Nick Kristof's column about pneumonia published on Mother's Day (The Killer No One Suspects). According to Kristof, a course of antibiotics to treat pneumonia costs only 27 cents, but pneumonia registers on few people's consciousness as a widespread, emergent disease.

This leads me to ask why some diseases or conditions get more attention than others. Is there some general fascination with the new and incurable disease that plagues all of us? Is it only greed and fame of politicians, drug companies, and scientists that set funding priorities?

I checked categories to which this entry belongs, I'm selecting many of them. This is because that at some level, these health, gender, environmental, and social issues are interrelated, cycles of poverty, environmental degradation leading to health effects, tuberculosis exacerbating AIDS, etc. But most organizations have one or several focuses, some of which leave other behind. Inevitably, aid organizations or lobbies will be fighting for the same funding, the same piece of the pie so to speak. Expansion of one program may see cuts in another. Am I second guessing myself too much? Is this the activists' curse of caring too much?


x-posted at Choice Words

I would gladly use a free domestic violence prevention pen.

This article in the NYTimes today was very encouraging.

Taking a Page, and a Pen, From Makers of Medicine

Free pens — bearing the names of drugs like Viagra and Januvia rather than the letters NYC — litter doctors’ offices all across New York, part of an often-criticized strategy by drug company sales representatives known as detailers, who traditionally go from waiting room to waiting room giving gifts to entice doctors to prescribe their products.

Now in New York, there is a new kind of detailer: people like Ms. Franklin, who are part of a campaign by the city to use pharmaceutical industry marketing savvy to spread the word about healthy practices to doctors in neighborhoods where patients often have the least access to the latest news in health care.

I think it's a very creative and simple way to engage health care providers in their patients' well being. In particular, I liked that this article highlighted a domestic violence prevention campaign, which does not usually fall in the duty of health care providers. Yet doctors are in a special position to speak to their patients honestly and confidentially about not just their bodily functions but their family situations too. I hope this idea takes off. I would gladly use a free domestic violence prevention pen.

I have no illusions that physicians are limited in their ability to mediate domestic violence. I mean, we're not asking them to all quit their jobs and work at domestic violence shelters. I think that we should recognize that health care providers have within them opportunities to care for their patients in many ways, and we should make use of them. All they can do is ask their patients and coax them into seeking help. But even "just" talking about domestic violence can have a powerful effect to recognize that abuse happens and to offer help.

In that spirit, I want to plug MSU Safe Place. I'm proud that MSU has its own domestic violence shelter. It is the only university in the country with a shelter program. Its shelter, counseling, and support services are free, confidential, and for MSU students, faculty, staff, their families and children. Like the article emphasized, dating and domestic violence happens to young people, old people, married couples, and unmarried couples, so college students can just as much be abusive relationships.

Doctors as allies and enemies

I have been feeling uneasy about the relationship between doctors and feminists because I am both a (future) doctor and feminist. A while ago I went to a Planned Parenthood conference for college activists in Michigan with fellow members of MSU Students for Choice, and the issue of doctors vs. women or doctors' alliance with women came up. In addition, Women's Council is getting ready to show the documentary "The Business of Being Born". I fully support the screening and have actually planned the logistics of the event. But I felt that now is the time I talk about my views of medicine and women.

I want to be on the side of both doctors and feminists. But I know that some feel the two fields are incompatible, that feminists hate doctors and doctors aren't supportive of women.

First, I want to identify a phenomenon that I have observed: doctors are sometimes praised and at other times villified by feminists.

My experiences with pro-choice activists has been that they are sympathetic and grateful for doctors who perform abortions. For pro-choice activists concerned about abortions as a public health issue, obstetricians who perform abortions are good doctors. When abortions were illegal, they risked their medical practice to perform them. When abortions will legal but faced violent opposition, they risked their lives to perform them. The few were murdered by anti-abortion extremists in their own clinics became martyrs to the cause. The abortion doctor in a several hundred mile radius is applauded and praised. I'm probably not going to be an obstetrician/gynecologist, but if I were, I would feel that my work has a purpose.

But many pro-choice women are also feminists who feel disempowered by a medical profession that is patriarchal, impersonal, selfish and downright inaccurate. The same ob/gyns that women are appreciative are included in their critique of all doctors. I have also noticed a weird confluence that both anti-abortion and ardent feminists call doctors who perform abortions "abortionists". This language intentionally removes the accolade associated with being a "doctor". A doctor is an abortionists for killing babies or for humiliatingly poking around a woman's reproductive organs or cruelly performing an abortion.

Secondly, I have more to say on my thoughts about medicine, but it started to go off topic from feminism and choice, so I'll save that for another day.

(Pre)Medicine. Part I.

I've started to read Pauline Chen's columns in the NYTimes. There are two columns that I want to bring up together, Stories in the Service of Making a Better Doctor and The Misery of the Med Student. Both of them ask basically the same questions. What makes a good doctor? How do we train medical students to be good doctors? The consensus is that well-rounded individuals make good doctors. We want doctors who can related to their patients, who can talk to them well, who care about them as a person and not as a disease, etc.

But I'm not sure how to judge medical schools' efforts at making well-rounded doctors. Are they really successful? Or are they just making some insincere effort at making it seem like medical schools care about more than the science of human body function?

Chen writes positively about the addition of narrative medicine in medical school and residency curricula. These are classes in which students read fiction and non-fiction works to gain better insight into a patient's Her column has anecdotal evidence for it and she says that studies have shown that it is successful. But it is also true that most doctors don't love literature, the arts, or the social sciences as much as people with advanced degrees in those fields. Otherwise they wouldn't be doctors. I think narrative medicine classes valuable if they can be taught so that even med students who don't like literature can discuss it in a meaningful way that helps them as doctors. Otherwise, as one comment said, it's just a glorified book club.

Med schools now require a certain number of humanities credits so they can accept more well-rounded applicants. But how do you know who took humanities classes as a undergrad because they really liked them or because they needed it to apply to med school?

Or do you even think this distinction matters? It is really hard to study anything other than medicine when you're in medical school because there's so much medicine to learn. Everything else has to get put on the backburner. One comment talks about the difficulty in fitting in other interests in med school:
I am a medical student with a literature background from undergrad. I wholeheartedly agree with the purpose of these programs, but the reality is this: the things one must learn in the med school — anatomy, physiology, pathology, immunology, microbiology, etc. — are simply too time-consuming to allow more than a cursory study of literature in some kind of throwaway class. Those students who are interested in it will explore further, but the vast majority won’t find it useless and will just resent it.

Dr. Chen had a similar experience in medical school. There was just so much to learn that these other efforts didn't diminish the amount of sheer information they had to learn. She writes:
Some of my professors tried to 'humanize' the process. They invited us to dinner in their homes, supported our extracurricular efforts to set up health screening clinics in low-income neighborhoods, and tried to make our basic science courses more relevant to working with patients. But sitting where I am now, as someone who teaches medical students and who loves helping others as a doctor, I can understand the challenge they faced. Given the fire hose of information medical students must learn in just four years, how does one ever gently take a sip?

Is waiting to go to medical school after earning some "life experience" the remedy to the lack of empathy, humanities, and high burnout? Several of the comments were from people who had a career before entered medical school and they seemed happy with their decision. I think this is generally a good idea, but it doesn't address whether or not medical education as it is should be changed. It simply gives med students time to steel themselves before plunging in.

I don't know the answer to these questions. In an ideal world, we would all be Renaissance men and women. Our journals will contain anatomic diagrams alongside sketches of landscapes, the Madonna, and fantastic flying machines. We'll spend our days in the chemistry lab and write music by night. We'll all be well-read, empathetic, intuitive, doctors.

But in reality, our time is finite. We have to make choices, prioritize, and prepare for standardized exams. And I have physiology lectures to watch. Oh, and I could be totally wrong about everything because I haven't actually gone to med school.

That's all for tonight. The next post about this matter is going to get a lot more personal. I reflect on how I have taken to trying to be a well-rounded (future) physician.

Where I will be this summer

I started this blog in part to keep track of my adventures this summer, so I am now making the official announcement about my plans:

I will be a Policy and Government Affairs intern at AIDS Alliance for Children, Youth & Families, an non-profit in Washington DC. (I'm going to Washington!) AIDS Alliance is an advocacy group particularly for women, children, youth, and families with and affected by HIV.

As a Policy and Government Affairs intern, I will research policy, legislation, write letters to policymakers, and maybe even go to Capitol Hill. I think I'm going to learn a lot about domestic policies about funding, prevention, and education for HIV/AIDS.

I'm leaving Memorial Day weekend and won't be back until the weekend before the fall semester starts, so pretty much the entire summer.

I will be posting my weekly essays here and uploading photos of lovely Washington DC. I hope someone reads this so my efforts are not soley for my own archives.