Thursday, January 21, 2010

Caliber

Caliber. It's a word I've been wondering about in the last few days.

First, I'm taking this course this semester called "evidence-based medicine," or EBM for short. It's basically a crash-course on epidemiology (so right up my creek). We mostly learn about the different study designs and their inherent strengths and flaws. The idea is to make us better "consumers" of medical literature, because God knows there's a ton of bad literature that's published, even in reputable medical journals (e.g. MMR vaccine causes autism).

Anyway, my friend Aiden says things that really bugs me. He's against abortion (okay, fine, whatever), he's against embryonic stem cell research (okay . . . still fine I guess), he's against the current health care reform (he's entitled to his opinions), and he's skeptical of evolution and global warming (alas, these I can't accept). But the two statements that really make me bristle are the following:
"I'm just aiming for the lowest tier of primary care: family medicine. I don't want to compete against people for top specialties. P = MD!!"
---and---
"You know, I don't like statistics and I don't get it. So after I'm done with [EBM], I'm just going to skip all the statistical and data stuff and jump right to the conclusions and discussion sections of papers, because that's all that matters."
With respect to both, all I can ask is: Is this the true extent of your caliber as a future physician? In response to the first quote, the fact you're calling family medicine the "lowest tier of primary care" only serves to reinforce the notion of family medicine as being somehow inferior to other branches of medicine (it's not). Using that as your excuse to not try your hardest, or using that as your excuse to "only" pass, I wonder . . .

The second quote I actually alluded to briefly in an earlier post. Of the two statements, this one makes me bristle the most. Several of us looked at him when he said this and were like, "We do NOT want to ever be future patients of yours." There are so many bad papers out there that still somehow get published! The only way to really understand which are actually good is to look at the study design, methods, data collection and analysis (statistics). I mean, I seriously do fear for his future patients if all he reads of a paper are the abstract, conclusion, and discussion sections. I mean, what kind of patient care will he give if he doesn't read the medical literature fully, and ends up going along with the conclusions of a really bad study (again, e.g. MMR vaccine causes autism)? I mean, really? Seriously?

On a related note on caliber, I was talking to a friend about the kind of education we're getting here at med school as we walked to the parking lot earlier today. We both went to the same university for undergrad, and we both appreciated the kind of education we received there. Like any school, there are good and bad professors. But back in undergrad (and definitely in grad school) there were plenty of great, even amazing, professors. Many of our undergrad professors challenged us to think, not to just memorize facts or apply facts to a more difficult situation.

Here in med school there are also good and bad professors, but most are just "okay." Many of the faculty are rather old and seem pretty "stuck in their ways" insofar as how they teach and what they teach. Few present new advances in the fields they're teaching, or even attempt to make lecture interesting (and it's sooo easy to make cardiology interesting, but instead they've somehow turned me off to it). And many, being PhD's (nothing against PhD's), don't try too hard on making the material relevant to clinical care. Oftentimes they fail to answer our singular question as med students: Why should we care and how do we utilize this to help patients?

Fortunately, my EBM small-group facilitator is a doctor who makes us think about precisely that question. While reading the rather dry medical literature, she challenges us to think: "Why're we reading this? Will this help our patient? If so, how? And then what? What're the next steps for treatment?" She treats us almost as if we're on a team discussing the papers and then how to best care for a hypothetical patient. And we all really appreciate that. She does what lectures too often don't: challenge us to think critically about the material and then apply it to a patient scenario. We need more people like her teaching our courses, but alas that's probably a personality bonus more than anything else. (I still believe that all professors have to take a mandatory annual teaching workshop, because so many - wherever you are - ARE bad.)

Lastly, my roommate was shadowing his mentor the other day, a family physician. A patient came in complaining about shoulder pain. The doctor did a physical, examined heart and lung sounds, asked about family history, etc. What he forgot to do was address the shoulder pain. Just as he finished up after about 20 minutes, he asked if the patient had any questions, at which point she mentioned the shoulder pain again. Only then did he remember to examine her shoulder. Seriously?

So yeah, caliber. A word I've been musing over for the last few days - what it means, how it applies to us, and to what caliber we must hold ourselves to as future physicians and educators, as well as the caliber we hold others at. Because down the line, someone is definitely going to be depending on us or what we say, and if we're wrong . . . well, let's hope we at least did no harm.
-----
On a completely different note, I chatted with Jay (Online Guy) briefly yesterday. He seems so busy as he's kind of hard to get a hold of to chat online. He started classes today, so he's likely to only get busier. And we still haven't talked about the possibility of meeting this weekend for a drink/coffee. :-/

So I sent him a message on OkCupid asking about his first day of classes, and whether they're everything he hoped for. Then I asked him if he was still interested in meeting up this weekend. Lastly I gave him my cell number. Omg was that too forward?! I don't know what "protocol" is for this!! This is too new to me . . . *freaks out*

On a related note (as I've so many of these in this post, lol), a guy messaged me on OkCupid recently. He's 34, in the health care field, and hoping to finish up his R.N. degree (nursing) soon. I messaged back a couple times, out of politeness. Then today he messages me asking me if I'm free to meet up this weekend for coffee or lunch, and he gave me his number. o_O! Is he being forward? I don't know how I feel about this, but I haven't responded yet. He is 34 (a good decade older than me) . . . oh, and he doesn't have a picture on OkCupid . . . *freaks out*

Okay. *breathes*

8 comments:

El Genio said...

In the first case, I think you were fine to give him your #. You guys have been chatting for awhile, and at some point you need to meet to see if things are going to go anywhere.

Guy #2 is more problematic. The no picture thing is an absolute no no. No excuse for it, period. Also, if you're messaging just to be polite, you shouldn't feel any obligation to continue, or to meet up.

Ron said...

ouch, your friend Aiden better change his attitudes or he should just not be a doctor at all in the future lol

Ron

David Jeffreys said...

Aek, you are top caliber in my book and will be one of our leading physicians in the future.

Luckily my family physician, an internist who formerly was a hospitalist, is also top caliber, so I feel very fortunate.

Having been in healthcare all my life (neurodiagnostics and sleep medicine, now retired), I typically question any suggestion or decision regarding my own health which consists of diabetes, pulmonary emboli, and limb-girdle muscular dystrophy. Fortunately for me, there is a wealth of information out there and I know how to access it. It constantly amazes me how much more I know about diabetes and muscular dystrophy than a lot of physicians know. Before acquiring these diseases, I already had a heads up about diabetic neuropathies and neuromuscular implications of the dystrophies and myopathies. Fortunately, as an insider I have been able to measure the caliber of those who treat me. Unfortunately, there are too many "Aidens" out there for the unsuspecting patients.

"Anything worth pursuing is worth pursing well." Keep up the high caliber standards and continue to be a role model and mentor for those around you.

James said...
This comment has been removed by the author.
James said...

It doesn't sound too forward for the 34 yo guy. It's contact info, it's not a big deal for some people to give that out.

But insist on a pic first.

And, what is a medical doctor doing with a Ph.D.? In what?

Mike said...

You weren't too forward in giving Jay your cell phone. Some guys just aren't the online type and hard to get a hold of on the computer.

As far as guy #2, just make sure he has a pic that you can see.

Aek said...

El Genio, Mike: Thanks, I was thinking something along those lines. Now, to figure out how to deal with it all.

Ron: Yeah. :-/ In his defense, it's not like he's unintelligent or woefully lazy . . . I guess he just doesn't want to put in more effort than he has to?

David Jeffreys: Thanks for the kind words. Though I may try to uphold myself to high caliber standards, I don't often meet them. But I guess that's just motivation/room for improvement.

James: Many of our courses are taught by PhD doctors, not MD doctors. For example, neuroscience is mostly taught by PhD neuroscience professors and not neurologists/psychiatrists. This is how it works at many (if not most/all) med schools, much to the chagrin of med students.

Dave83201 said...

very exciting post! i don't know if I have any good advice, but i can't wait to hear more...

I'll add more when we chat...