Tuesday, 8 May 2007

Things I've learned from Med School (Part II) : Patience, my love.

In our blessed faculty’s hospital , known as el Demerdash (a governmental/university/teaching/really cheap and miserable for the most part hospital), you’ll find a huge display of human misery. It’s really one of the bleakest places I’ve ever been, particularly the children’s hospital which is always overcrowded.

When you’re in your 5th yr of med school and you’re actually dealing with patients hands on, you realize with a great degree of shame that you’re intimidated by them. You actually perspire, tremble a little and wonder if you were really cut out for this when you have to perform an examination or even take their history.

Is it because we still haven’t gotten used to the idea that we’ll be dealing with human beings and not just answer sheets? Sure.

Is it because not an insignificant number of our professors will make fun of us at the smallest mistake in front of the entire round?

Well, sometimes. Depends on how resistant you are to ridicule really

Mainly though…It’s because Demerdash patients are professionals and I’m talking about the chronic patients especially. They know more than you do. Much more than you do. The thing is, someone say, with hepatitis or with a valve disease has been coming to this hospital for 10+ yrs. He’s listened to the professors talk and talk and talk in both rounds and in private lessons. So basically these patients have graduated from med school twice over. When you go up to one of them all full of the intention to act as ..errr…doctorly as possible, he/she gives you the complete scientific explanation of their condition and how to examine them(where to put your hand , how hard to press , which order to use..etc.). Naturally, you’re crushed and the idea of crawling into the foetal position in a corner somewhere doesn’t seem so bad considering what a silly little thing you actually turned out to be.

Ah yes... I remember my first sheet when the patient pointed out that I had forgotten to ask him his job and marital status and started to tell me point by point what to write about his disease and what not to write . I particularly remember how he said in the exact scientific (English) terms : “I had rheumatic fever when I was eight now I have a double mitral lesion and my father died of coronary heart disease “. I didn’t even know what a double mitral lesion was at that time. There are actually ones who taunt you when mess up something. Like a couple of weeks ago a cardiac patient asked me “ How do you expect to auscultate the femoral without palpating it first?" with a smirk and a sinister look from behind his glasses. “ Well um…I …um…know where it is already!” was all I managed.

Yes, great comeback , I know.

There are even famous patients who get phoned (via their cellphones or special patient “caterers”) in especially for exams and for lessons. These are usually the ones with textbook cases and clear enough cardiac murmurs or signs for our inexperienced ears and eyes or just really rare ones we usually expect to only hear about but never see.

This is all for a price, of course. Rounds are cheaper than lessons as expected ; an hour or 2 is a pound or 2 from each student making up about 40-60 pounds depending on the round each day. Lessons though are about 70 L.E / student for about 6-8 patients and there are roughly about 80 students per lesson. Exams though, well, now we’re talkin’! If you look gullible, a patient can actually squeeze over 150 pounds from you during an exam. There are stories about having to give up earrings and watches. I have even heard a girl actually got asked to give up her wedding jewelry during the exam. Why pay up? Well, there’s always the fear that the patient may give you the wrong information during history taking, therefore steering you away from the correct mode of examination or diagnosis. When your examiner spots something shady in your sheet and asks the patient to confirm, they of course say something completely different. There goes quite a chunk of your grade and your future plans.

Why,thank you very much Mr. Chronic patient sir.

I don’t know if this makes me sound cold-hearted or if the entire situation is too bizarre to make me sound otherwise. It’s like the people you go into medicine to try and help end up being the bane of your existence for the last 2 (and most crucial) years of your undergraduate studies. I don’t resent paying the money but I do resent being taken advantage of, I resent this entire system of teaching medicine and come to think of it, I resent having to feel resentment towards somebody with a chronic illness actually.

Good God, that was long…Ah , well …till next time !


Juka said...

Waga3ty 2alby. Then again, can you blame them for trying to take advantage of you guys? I'm sure they've got quite the "ends-justify-the-means" outlook to all you new med students. To them the whole thing is mundane, been here done that! They figure they might as well profit while they are at it.

Eventuality said...

You're not cold-hearted, it's a cold-hearted reality we live in, where people with diseases actually benefit from being ill, and even use blackmail.

All I can say is, Rabbena ma3aky ya benty :)

pink panther said...

hi ravine

been reading your blog, really like your writing.

they should dictatphone or video record your examinations on your patients. that would exclude any patients changing their answers and hopefully eliminate bribery although i m sure the bulk of bribery cases are because students want to cheat. Can that be suggested?

Bribing patients is so abhorrent and is the reason why there are so many cases of negligence in egypt. If they didn't cheat, they might actually learn something so that next time they don't get a text book heart murmur, they can diagnose it as oppose to leave the patient to go into v.fib. in some alleyway on his way back home.

Ravine85 said...

Juka :Salamet albek! Yeah, I guess most of them think that if they're gonna let few hundred pimply faced med students poke at them, they might as well make it worth their while.

eventuality: Thank you :)

Pink Panther : Thanks, I'm flattered to bits :D
While it's a good idea, however ,we're talking about a hospital where X-rays get stolen so they can be melted to extract their silver content, so I'm not really sure how long equipment like that would survive.
While many cases could be considered bribery , many others are extortion. While you can basically buy the sheet but still get no where when the doctor starts asking you (the ones who do that though are usually the ones who just want to pass, they however still get called "doctor" at the end of it all), you could also have worked your ass off but you might still have to be a decent sum so the patients (who really know their stuff)won't give you the wrong information to work with or waste your precious, short exam time.
Someone who would bribe a patient would definitely not be able of realizing the responsibility required of his/her job and I can't really fathom how one could cheat while builing their entire career.

We need the text book mumurs though dammit! Like I said, we still have baby ears and we're in a faculty where you learn much more after graduation than before.

pink panther said...

I meant the university should have those not the hospital. Surely the university can afford a couple of dictaphones off of ebay or something. Innovate!

Ravine85 said...

We get examined in the uni's hospital.
I'm guessing they've got some cash stashed away somewhere, I think they use it to set up retirement parties for our professors though lol .
The idea of explaining e-bay to our dean is setting my fantasy into overdrive. O the possibilities!
But u're right , we have to innovate to get ourselves out of this drama somehow.

Phobos said...

Hi , FAkkarteene bil ayyam el ....... yallah , ahi 3addit , :) I am a graduated doctor, from 3ein shams univ, and of course demerdash hospital. I graduated 2 years ago and now I'm in the USA trying t o get things fixed :) . Studying to get a license to study in the US , and Dr. Osama is a lovely guy :P < I suppose guys like him because he is sincere in a way that is lacking in most people today, .. and ofcourse he is hilarious.

pink said...

lololol at the explaining it to your dean.

yeah, i meant that the money for the dictaphones would be coming out of the university budget. The hospital may be poor but that's to do with another budget pot: health.

You could try suggesting it and do a petition or something. Although I do recognise that a lot of people probably depend on this system to pass their exam.

Change comes with one person doing something different. You

Ravine85 said...

^I get your point , I just mean they'd probably be stolen from the hospital within a week of purchasing them.
Good idea about the petition, I think I'll try talking about it with one of the guys in the student's union and see if we could go somewhere with it.

Ravine85 said...

Phobos : Wassup doc?
Good luck with your license first of all!
As for Dr.Osama, well there's a line between being sincere/frank and being sexist, rude and obnoxious. He frequently crosses that line and despite what you male doctors think, at a certain point female doctors get sick of your jokes and just want to shoot your collective brains out for being jerks to us. LOL nothing personal begad I'm just joking but he is extremely annoying sometimes. We ba3dein he's hilarious we kolo bas threshold el sakh-sakha 3and talabet teb very low. Ay 7aga yed7ako zay el hebl 3ala tool.

pink said...

cool, hope you can get somewhere with it. keep us updated