Your body as a cheat sheet

I often get ideas for comics a la Dr. Fizzy’s but I can’t draw at all. Alright, you don’t need to be good at drawing to make nice comics, but creating a comic does require that you put the idea in comic format. And that’s where I fail. So, without further ado, the text version of my comic ‘idea’, which I really needed to share.

A lot of medical students in the Netherlands are required to take a progress test four times a year. The idea of this test is to gauge your level of knowledge and see how you progress – in year one, you only need to get a few questions right, but after 6 years you need be able to answer all of them. (not really true, I think it was about 75% or so but they say that these questions are things every doctor should know. As if every doctor knows the exact prevalance of pyloric stenosis in the population…) Anyway, four times a year, medical students from all over the Netherlands are put into a sports hall for four hours and made to do this test. It’s a great moment to meet up with people from past tutor groups etc.

Shivering (it is ALWAYS cold in these halls!) you open your test booklet. Some questions depend on pure knowledge (I still can’t remember dermatomes) but others can be answered using the most efficient cheat sheet ever – your own body.

1. Lesion of which nerve causes the so-called ‘dropping hand’?

Being  Pencak Silat player, this is rather easy to find out. Just hit yourself in various places and examine the result. This may impact your ability to hold a pencil, however, as I found out.

2. The m. supraspinatus assists in which movements?

This muscle is located at the top of the schoulder blade, so you can actually feel it. Try various movements to determine when it contracts.

3. Which muscle is responsible for lateral flexion in the ankle?

This question can be answered similarly to question 2 – try to do the movement and feel which muscle contracts. Of course, this only works if it’s a multiple choice question.

4. The diaphragmal muscles have a function during vomiting, true or false

This question actually made me feel sick – I tried to simulate vomiting movements (silently of course :P) and tried to feel whether I felt my diaphragm doing anything. I think I slightly overdid it.

5. What happens when the Thomson test is done on a person with a ruptured achilles tendon

The Thomson test involves squeezing your leg calf – the foot is supposed to go in plantar flexion when everything is alright. Yes, I looked that up because I couldn’t remember – I tried pinching my leg during the test but you can’t really bend sideways so you can see what’s happening under the table…

Cancer isn’t a fair opponent.

Usually, when speaking about people who have cancer, it’s said they are ‘fighting’ it. And when they finally succumb, it is said that they ‘lost the fight’.

Apparently, no one realized that it isn’t a fair fight. You can’t really fight someone who stabs you in the back… A cancer cell used to be part of the body, used to be a normal cell but then it suddenly went rogue and multiplied itself, shaking off all the regulatory systems the body uses to prevent such things from happening. Cancer is the ultimate betrayal, as your own cells will turn against you, trying to take over everything.

How are you supposed to fight things you can’t even see? After all, if you’ve got to miss work or school due to the flu, no one will accuse you of not being positive enough, not fighting the virus… But cancer patients are expected to carry their burdens with happiness – if you don’t, you might not get better and then it’s your own fault if you die.

One of the most memorable patients I’ve met, was a man who survived cancer.  This man had indeed survived the fight against cancer… but he was also a veteran, a veteran of the invisible war waged within his body. And just like in other wars, these fights leave invisible scars.

Contrary to our expectations, he wasn’t really happy that he had survived. Yes, he was glad to be alive and to be able to see his grandchildren,  but on the other hand, he felt like he couldn’t trust his body anymore. The chemotherapy treatments really took everything he still had left – he didn’t have energy anymore for simple things like enjoying a walk, doing household work. And what would prevent another bunch of cells going rogue? There was no way to say whether all cancer cells had truly gone. He felt like a time bomb.

Cancer is really like that. You can’t really fight it. You can only try to hold on and hope you’ll pull through, that the medication kills the cancer before it kills you.

People who are killed by cancer aren’t losers.

Helpful advice

The process of getting all my ECTS in the system was quite lengthy and involved lots of e-mails, angry calls and personal visits to the student administration. Nearly everyone had some helpful suggestions as to how I should solve the problem.

1. Call the newspaper! Everyone ought to know how they’re treating students!
2. Call the national ombudsman! (after I dismissed the newspaper suggestion due to a potential bad effect on my reputation)
3. Can’t you call her manager? (NO, dad, he is the manager.)
4. Are you sure you attended the practical? There’s got to be a reason for those missing points… (YES I AM 100% SURE I WAS THERE!!!!!!!!!)
5. Computers are bad. Software is bad. This is yet another example of the evilness of technology. You shouldn’t trust them.
6. You should contact the student administration office (planning office).
7. You should contact the planning office (student administration office).
8. Have you already contacted both the student administration and the planning office? (student consultant)
9. Calm down, relax, you’ve got 8 more weeks… (student administration office… The advice that started everything.)
10. Never mind, just fill out this form and we’ll fix it. (student administration office – the advice that made everything worse)

How I got my points? An angry call to the planning office where a kind lady finally got the student administration office to process my form.

I’VE ALMOST GOT MY BACHELORS!!!!!!!!!

Just when you think it’s all over…

September 2008 (CT is a first year)

Student information center: We’ve made this NEW AWESOME web-portal which will replace Blackboard!

CT: *logs in at NewAwesomePortal*

NewAwesomePortal: Unfortunately, there is a delay in the development of this portal. Please continue using Blackboard.

CT + rest of medical students: *forget about NewAwesomePortal*

Three years later: January 2011

Student information center: NewAwesomePortal is now finished! New grades won’t appear on Blackboard anymore. Don’t worry, we’ll migrate all of the grades as soon as possible.

CT + rest of medical students: *too busy studying / working / slacking off to care*

May 2011

NewAwesomePortal: Look at me, I’m so beautiful. All departments can now use NewAwesomePortal! (except for the medical department, which will follow as soon as possible)

CT + rest of medical students: Shouldn’t we check whether our grades are correct? Well, they’ve got two months to fix it, let’s just wait.

July 2011

NewAwesomePortal: Grades are now finally accessible to medical students. Please fill out the following form if there are any mistakes.

CT + rest of medical students: OMG MY GRADES ARE INCORRECT AND I NEED TO APPLY FOR THE MASTERS PROGRAM IN JUST TWO WEEKS NOOOOOOOOOOOOOOOOOOOOOOOO!!!!!!!!

I’m really wondering whether they’ll be in time…

Do you have more complaints?

Yes, the above sentence is intended as weird as it probably sounds. Many of my classmates use this question when taking a history, so when the patient states their lack of energy, headaches and fevers, they ask ‘do you have more complaints besides the ones you mentioned?’

I’ve always considered this as very weird. The Dutch word for ‘complaints’ (like head ache, GI symptoms, blurry vision whatever) is ‘klachten’ and has exactly the same meaning as in English, meaning it can also refer to ‘the things people say when complaining about bad service’ or something like that.

So why would you use such jargon when speaking with patients? I always use ‘Are you suffering from something else?’ (‘heeft u nog ergens anders last van’, hard to translate in English).

Still, no one has ever mentioned this as feedback so I haven’t said anything about it as well. After all, I sort of trust the judgement of the people teaching communication and history taking skills… It’s still weird.

A Whine about not getting to learn enough.

It’s the USMLE time of the year so a lot of the bloggers I regulary read, post updates about their studying. I always thought it was a little bit amusing – studying 8 hours in a day, who can survive that? I never study more than 3-4 hours and that’s only for the final practical exams. Usually, I study less than 60 minutes a day.

Nope, I’m not lying and I’m not an hyper-intelligent gunner – most people in my year study even less than that. Why? Because it’s not necessary. If you only care about passing the test, locking yourself up the weekend before the test will suffice. Everyone I know is able to maintain their personal lives and part time jobs etc.

And that’s it. That’s the level of medical education in the Netherlands. Other educational tracks, like biology or biomedical sciences have much more difficult tests and require much more studying. Medicine still has the reputation of being ‘really’ difficult but so far, I’ve found that that’s not true. Personally, I try to get a good grasp of the material but the problem is, I’m not required to (tests are easy) so it’s hard to stay disciplined.

In one way, it’s nice – regulary studying 8 hours a day sounds bit insane. However, I lack a lot of knowledge that US and apparently also Irish doctors will eventually have. Of course, a lot of the medical stuff they learn won’t be applicable but it feels a bit stupid that an US first year knows twice as much as I (third year) do.

Still, the level of medical care over here isn’t much different from that in the aforementioned countries. I assume I’ll learn a lot when specializing – but still I feel a bit left out. There’s so much to know and the pre clinical years are the only years you’ll have enough time to get to the bottom, and we’ve barely scratched the surface…

(good luck to all of you taking the USMLE or a difficult test!)

(and I didn’t have any good ideas for the title so I’ll leave it like this. It’s a whine, I’m blessed I don’t have to sacrifice too much etc – but I think you US/other people will be much better doctors! 😦

Seven things that make me grumble about Methodology & Statistics II

1. ‘Hi, I’m your primary lecturer for this course. I’m not really THAT into statistics, as I’m just a Master’s Student but I’m sure it will suffice’.  100 yaws dropped. Why don’t we get a prof, like in our first year?
2. ‘What I’m going to uh explain, uh, is uh, how, uh, we uh (ad finitem)’. I’ve seen first years give better presentations
3. Three hours of worthless lecture that covers barely 5% of my high school philosophy course.
4. I hate my general methods of science teacher (a high school course, mandatory for everyone in all of the Netherlands, whether they do a science-oriented track or not) for spending soooo much time on Popper. Now I can mentally talk along with the lecturer, as he stumbles to explain what falsification is.
5. It’s a sign of weakness if you need to bash Christians in order to make your point. FYI, ‘because there are no journal articles in it’ isn’t the strongest argument against creationism. Also, it was rather ironic how you contradicted yourself regarding paradigms and the need to be willing to explore alternative paradigms – but I’ll leave that for now.
6. ‘We’re going to help you think in a scientific way’. You’re rather late to teach us this, if you’re serious.
7. ‘We’re going to teach you how you can open the full text version of an article on pubmed.com’. No comment.

The worst of all of it is: I actually like methodology and statistics. They totally ruin it by this excuse for a lecturer. I’ve had lectures by teaching assistants from my own year that were LOADS better. And perhaps it would help if they didn’t feel the need to repeat everything we’ve covered during first and second year: I doubt we’re going to learn anything more difficult than the Chi square method. REALLY. Am I weird for actually liking statistics?

Not vocational training

Over here, it’s commonly said that ‘medicine is just like vocational training’, meaning that a lot of emphasis is placed on practical skills instead of science / university-level teaching. Sometimes, this isn’t far from the truth, as it seems as though some teachers don’t understand what university-level education is about. Sometimes, however, I think that they severely underestimate medical students.

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Quote from the Manager of Research Internships: ‘What sets the study of medicine apart from vocational training, is that you’ll learn how to do research.’ Er… right. I thought it also had to do with the fact that we’re supposed to learn a lot of theory and basal science?

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Halfway year one, we had to do a practicum (wiki says it’s an English word as well?) on how to read a scientific publication. The practicum wasn’t even about methodology, we had to answer questions like ‘what is the subject of this article’ etc. So, they think we can’t read?

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Overheard a lab supervisor: ‘It’s always so funny to watch the med students fumble with pipettes…’. We got about 8 lab sessions of 2 hours, how do you expect us to learn lab skills? (and of course, you could help, instead of gossiping about us)

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Neuroscience professor, in our third year, just after Brain&Nerves II: ‘This is a nerve cell, perhaps you’ve seen one before’.

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Supervisor of Research Internships: ‘You might want to skip the Basic Science lectures, as they’re about difficult stuff, like genes and DNA.’