An Indian woman, a Japanese woman, and a Syrian woman, all training to be doctors at Women’s Medical College of Philadelphia, 1880s. (Image courtesy Legacy Center, Drexel University College of Medicine Archives, Philadelphia, PA. Image #p0103) (x)
*Women’s Medical College of Pennsylvania.
Somebody That I Used to Know (med school version)
Now and then I think of when I went to lecture
And sat through all those Powerpoints that made no sense…
The person who graduates from medical school is often not the person who graduates from residency and starts practice as an attending. Those years in between are grueling and can be soul-sucking. Physicians are humans too–all the things patients want we want too. I want to have time to sit and talk with you. Sometimes I just can’t. I want to be a good doctor, a good surgeon. I want you to get better.
When I go home and things don’t go well, I am upset, and lash out at my friends and family, and I cry too. And on a selfish level, yes I want to be respected. I have not spent a single holiday in 7 years with my family, I spent them working. I have missed weddings and funerals. I haven’t taken a vacation in years because I can’t afford it. I live in a tiny apartment, and drive a 12 year old car with tape on the bumper. So when I am immediately confronted by a family or patient that I don’t care, or read these articles that say I only did this to get rich I, over time, get more and more dismayed and disgruntled. Why the #$%^ did I do this to my life if all my patients think is I’m a money-hungry dirtbag? I took anthropology in undergrad, and it doesn’t help me deal with these frustrations any better.
But I do it because I like it. Because it’s challenging. And because I want to help people–when things go right, there is no better job in the world (and that has NOTHING to do with my salary). I like that I have job security, even though reimbursement has dropped 20%, which means at least a 20% pay cut when I finish training. If I wanted to be rich, I’d have gone to business school.
BMD, CNN commentor on this rather inane piece of writing by a non-medical professional entitled “Can we educate future physicians to be more human?” —
When you’re laying on the table, heart stopped, chest cracked open like a floorboard in an abandoned house, ask yourself; ‘Do I really care how much they pay this doctor?’ and ‘Do I want the BEST surgeon, or just some guy who could pass a test?’.
When disasters strike and a small wound, like a broken hand, can compound quickly into shock, do you want a doctor, or a carpenter?
It’s easy to condemn what someone makes when you currently place no value in their service, but when you need them, only the most committed are there. 5 A.M. going to work you could care less what a surgeon sacrificed, but when you’re on the table with a piece of your dashboard in your head, you hope he did his homework.
Doctors should be among the highest paid people in the world, not because they get the educational marathon award, but because they heal us. They keep your kids sniffles from becoming pneumonia, or diagnose that blockage in grandma’s heart. They keep the things we love alive. No banker, carpenter, fisherman, cop, lawyer, or athlete does, but who cares how much they make, right? They earned it, unlike those selfish doctors.
Some of you could use a perspective adjustment. Time will offer one. A doctor will very likely one day be offering you advice about your health that will affect your future, and how much future you have left. You may then hope he or she is the best, and not distracted or disgruntled about some silly construct (money) , created to keeps us as slaves.
shocked monkey, CNN commentor (on this article which is a good read but contains a serious amount of lunacy in the comments from the non-medically aware) —
As a current university student, I hear a lot of talk about getting into med schools these days. I’m no stranger to the usual “sorry, I have to study for the MCAT” or “I’ve been doing nothing but studying for the MCAT!” liners from friends and strangers alike. Problem is: med school acceptance rates are and have always been very low nationwide. That means a lot of people get rejected. A lot of people’s dreams of becoming that doctor: dashed!
Yes, it’s really hard to get into a good med school. You have to be [presumably] smart, have top of your class grades, a great MCAT score, and a handful of other merits to warrant consideration, much less an interview.
Personal belief: a lot of people who want to become doctors should probably be doctors if they are passionate enough. Problem: the system is naturally set up to be incredibly selective and elitist. Most people will probably concede the first point, but elitist, Irving? Come on, that’s a bold statement to make.
Allow me to explain.
Take the freemasons, for example. Way back in the day, they used to be one to the few groups that possessed the necessary knowledge to build solid and admirable buildings. In fact, having the ability to physically construct—not architect—buildings was one of the most respected professions back then. And so, the fraternity of the Freemasons protected that knowledge. They controlled it: providing and handing down the knowledge to construct buildings down to the next generation of the Freemasonry, withholding it from the public as a way to extoll themselves. But the knowledge of construction work isn’t protected nor is it as respected nowadays as it was a few hundred years ago, now is it?
But what made it selective and seemingly elitist back then? It wasn’t necessarily because the knowledge of making buildings was impossibly hard to understand; it’s because it was—excuse the pun—constructed to appear that way.
Tech startups have emerged in the past couple of years at a ridiculously rapid rate. If you wanted to start a company, all you needed is pretty much a laptop, some cash, and a lot of hard work. But to get into med school, there are bureaucratic vines to wade through. And most people just aren’t “qualified” enough on paper. The tech world is always ripe for disruption. The med/health care world? Not nearly as much.
I will venture to say that starting and building a successful company is as difficult as becoming a doctor. What makes the two different is that the knowledge that one would need to pursue the former is scattered around the Internet, made possible by the countless free contributions and resources people have willingly provided throughout the decades. The knowledge for the latter, however, is sheltered behind the elitist walls of med schools.
Even if a person is inclined enough to learn the material and science to ultimately qualify as a doctor, no one would trust him if he started his own practice or worked at a hospital because he lacks the proper accreditation from a med school—the necessary papers proving that he has a M.D. This is not always true in other fields, especially in technology and engineering.
I understand that doctors and other professionals in the med field are entrusted with people’s lives and their potential patients should reserve the right to be cautious. However, the red tape shouldn’t be so rigid when it comes to gaining entryway into med school.
It’s unfortunate that the open and easy-to-enter nature of many fields—such as computer science—is unable to grace the medical discipline. I can only hope that the recent advent of free online courses and tools will make the knowledge of the medical field more accessible in the future and less dependent on the “treasured” knowledge walled off inside med schools.
Take a look at the bolded: there is the answer to your quandary. There is the reason why the system is so cutthroat and selective. What an egregiously awful analogy. Would you want your ill family member treated in the same fashion and with the same care as you would a laptop with a shot motherboard? No? Then don’t draw such comparisons.
I would love a world where everyone was more knowledegable about science and biology, yes. But there is a huge difference between knowledge for your own use and the knowledge, skills and training required to PRACTICE ON OTHER PEOPLE. People cannot do med school on their own by reading things willy-nilly off the internet because the training involved requires so much more than that. Science is evidence and experiment-based. Where can one obtain standardized patients and clerkships on the internet? You cannot run out and grab a patient like you can get another OS to tinker with. You cannot read a book on how to be empathetic. You must experience it.
I do think the app process is a crapshoot and the system needs fixing. But in general, the idea is solid. Being a physician/medical professional is a privilege. The knowledge IS treasured, and the role is, at the end of the day, public service. Nevertheless, it’s public service that deals with life and death, and thus the rigid standards it upholds are warranted and necessary. Go ahead and learn as much as you want for your own sake. But if you want the license to even touch another patient, you need to work for it. Period. Healthcare may have become a business, but the sanctity of being a physician has not. It’s people-based, and you just cannot earn that role through the internet.
I am having so much trouble focusing. I started reading a phenomenal book about the art of diagnosis. I have also found several other books I want to read and a couple of published pieces about health care cost. But alas, I am stuck studying the details of DNA binding motifs. It is frustrating because after all these years I am ready to focus on things that are relevant to practicing medicine. And I know smart asses out there will try and argue that this is relevant to medicine, but tell me, when in my clinical career will I ever diagnose a person as having abberancies in their DNA binding motifs?
I hate to be the bearer of bad news, but you are going to continue to learn about/be expected to know/be tested on unpleasant details that you find useless, even in medical school. Undergrad is nothing. Curricula (especially those at the doctorate level) stay in place more often than not because they at least somewhat work, and even though some subjects appear to just be a colossal waste of time, we learn about them about because such knowledge allows us to separate the normal from the abnormal and thus, better prepare ourselves for the wards.
Some stuff is truly heinous (spermatogenesis in non-human species, anyone?), I agree, but DNA-binding motifs are by far and large nowhere near such a definition. Transcription factors and steroid hormones are incredibly important in…well, life. Both rely on their DNA-binding motifs to exert their effects. Fuck with an androgen receptor and see if that doesn’t have effects on the physiological and gender/psychosocial outcome of a patient. And that’s just one example.
I mean, think about p53. I’m sure you know about its role in cancer. The core protein has a loop-sheet-helix motif (among others) that allows it to fit into the major and minor grooves and inspect the DNA for damages. A missense or something that destroys the basic amino acid makeup of those motifs greatly reduces binding ability, likely upping the chance of less-restrained tumor formation.
The nice thing about actual med school vs. undergrad is that lectures—even in the basic science pre-clinical years—almost always include clinical correlates, with many being centered on a case, esp. if you’re in PBL. If you use good books throughout undergrad (Lehninger for biochem, Junqueira for histo/cell bio, etc) there are a ton of pathological applications included as well.
This was our slide for lupus. Why did I go to class?
Haha this is pretty funny. And I thought we had some bad slides….maybe this is supposed to be the start of an animation that just got frozen? I loved the Abbas text for immuno so that’ll help too.
Systemic lupus erythematosus is a Type III hypersensitivity, so defective clearance of antigen-antibody complexes (antibodies are to nuclear components like double-stranded DNA…yikes) lead to their build-up in tissues like the kidney as depicted here. Prolonged build-up causes massive inflammation and tissue death. When ag-ab build-ups occur in the renal basement membrane, glomerulonephritis occurs, which can be confusing since that’s also how Goodpasture’s Syndrome (a Type II hypersensitivity) presents. But if you do an immunofluorescent assay, Goodpasture’s shows up as a smooth layer of Abs against the renal bm instead of a disorganized clump of ag-ab complexes, as seen in SLE. Other systems affected are skin (hence the red rash), blood components, CNS, etc, though the renal failure is the leading cause of death from SLE.
New York Medical College Class of 2015 - Study Rock (song @ 1:45)
We’ll be cramming in the lab tonight
Cannot wait for post-exam bar night
Wish I was not so far behind
We just wanna see ya…PASS THAT!
~Every day I’m studyin’~