"Ethical Erosion"

I read an interesting article in the New York Times today. It discusses how the third year of medical school with block clinical rotations lead to the "ethical erosion" of medical students -- how medical students stop being patient focused and start being disease focused.

It's hard not to fall into that trap. Just earlier today, I found myself talking about my "schizoaffective patient" and my "depressed patient" instead of "my patient WITH schizoaffective disorder" or "my patient WITH depression." I think as long as I try and stay aware of how I am talking ABOUT patients, how I am talking TO patients, and how I feel about patients, it will go a long way to preventing this "ethical erosion."



P.S. On a less serious note, this blog is a hilarious insight into the last two years of med school

"They're trying to kill me"

I've started my psychiatry rotation this week at Wesley Woods Hospital.


1)
I've talked to my first schizophrenic patient. This Modest Mouse song, "World at Large" reminded me of him.


Went to the porch to have a thought. 
Got to the door and again, I couldn't stop. 
You don't know where and you don't know when. 
But you still got your words and you got your friends.


I know that starting over is not what life's about. 
But my thoughts were so loud I couldn't hear my mouth. 

2)

coun·ter·trans·fer·ence/ˌkountərˌtransˈfərəns/

Noun:

The emotional reaction of the analyst to the subject's contribution. (google dictionary)

3 days in and I'm definitely feeling it. I have felt unusually anxious the last few days, and it's not "the crazy rubbing off on me." Rather, I think it's the effect of talking about these incredibly personal details of people's lives and having to remain stoic and objective about it. It's sad. It's draining.

This sounds like a pretty negative post, but I am actually excited about the rotation. I think I'll learn a lot, but I also think it's going to be difficult.

3) 

I learned my "tell." 

Today we had to practice the psychiatric exam with a partner in the class. The clerkship director said he would be coming around to give us feedback and specifically let us know what our "tell" is -- what gives us away when we're nervous. He said by knowing our "tell," we could work to not let it show during patient interviewing.

My "tell" is that I flush -- my face and neck turns bright red. Awesome -- because I can really change on working that, ha.

When you start dreaming about hemorrhagic ovarian cysts

you know have been on ob/gyn too long ;)

This last week marked the end of my ob/gyn rotation...ending on a high note with gynecologic surgery (gyn surg).

The last two weeks have been my favorite of rotations thus far. Yes, you have to be at the hospital early. Yes, you have to present patients to intimidating attendings. Yes, you will mess up and get yelled at by scrub/circulating nurses. Yes, people can be grumpy for no reason. Yes, you will be on your feet for so long during surgery that you put ice packs on them when you get home. BUT IT'S SO MUCH FUN. I can honestly say that I've enjoyed every day that I've gotten to be in the OR.

I love the hands-on aspect. Here is a list of just a few of the things I've gotten to do the last two weeks.
--sewed up a patient with a subcuticular suture
-- cut a fibroid uterus in half (after it was removed to be sent to pathology)
--biopsied a lesion on a cervix
-- played with hysteroscopic tools
--closed fascia by tying knots

Surgeries I've seen:
-- total abdominal hysterectomies
-- supracervical hysterectomies
-- ovarian cysts removal
-- ovarian mass removal/omentectomy/bowel resection
--laser ablation of vulvar lesions
-- cystoscopies
-- dilation and curettage

I also just started feeling more comfortable as an M3 by the end of the rotation. Some residents are nice, some residents are mean -- same with attendings. I don't know if I have just gotten used to being the bottom of the totem pole, or if I've just become a more competent M3, but these last two weeks I have felt good about where I am.