Thursday Born

The everyday life of a psychiatry resident (who was born on a Thursday).

Archive for November 2009

Powerful phrases: Sorry and Thank you

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I’m trying to be better about saying I’m Sorry and Thank You. They are fairly essential sentences, and I could write this post from several specific angles. Instead, I’m taking a general approach.

These two sentences are beneficial to any kind of relationship, personal or professional. I’m still having trouble finding the original data, but by now we’ve all heard about how Doctors can avoid malpractice claims by simply saying I’m Sorry to their patients (and meaning it!).  It is also great to get used to saying it to people you care about, especially significant others. When your significant other is upset with you,  no matter how unjustified you may think they are, say you’re sorry. Do not defend yourself first. If you must, say “I’m really sorry that you feel that way, but (insert your defense).”

Side note: Remember to use I statements  (this post is channeling the psychology major in me). I statements are basically just sentences with you as the subject, talking about your thoughts and feelings. Focusing on I statements means you’re not focusing on You statements, which usually means you’re not actively blaming the other person in your defense. You’re defending/explaining yourself; not accusing them.

Saying Thank you is a slightly different thing than saying I’m Sorry, and should be easier to pick up as a habit. Admitting you’ve done wrong is difficult (especially as sometimes you don’t think you did wrong, but you should still say you’re sorry), but being grateful? Anyone can do that, right? Say Thank You as often as you can. Get in the habit. It used to baffle me that my boyfriend would say Thank You for really little things, like returning the Netflix DVDs just like I said I would. Of course I dropped them off! Why are you thanking me? Likewise, I wasn’t always very good about being appreciative about similar things. It’s not that I would never say Thank You, I just tended to save it for bigger things (like after favors or after receiving any sort of gift).

And then I thought about it differently. It wasn’t necessarily about me being incredibly excited and happy that he remembered to send me that email. It’s like a smile that you can hear or read. It’s simple, every day positive reinforcement; you’re acknowledging that they did something nice or helpful. You say it to strangers who hold the door for you. To classmates who remind you that there’s homework due tomorrow.

I’m not great at this yet, but I’m working on it. I’m actively thinking about it, and eventually, maybe I won’t need to actively think about it.

You might say, but won’t they lose their meaning? No, they won’t, because Thank You and I’m Sorry are meant to be the simple, genuine daily phrases. When something really big happens, you add modifiers, you say, “This is amazing! I can’t believe you did this for me! Thank you so much!” or “I am so, so sorry. I don’t know what I was thinking.”

Does I Love You lose meaning? No, it doesn’t. Neither do these two, so long as the tone’s right.

Written by Aba

November 18, 2009 at 5:50 pm

Posted in Uncategorized

Doctors and Obese Patients

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Dissecting Frank’s limbs was not as fun as his abdomen and thorax. Never a sports person, and apparently just generally very oblivious to a lot of things about the body, I had very little base knowledge about the limb muscles. Sure I knew the terms quads and hamstrings, but did I have any idea which set of muscles did which action? No.

To add insult to injury, Franks moderate layer of fat seemed particularly annoying during the leg dissection. Frank was probably not obese, but he was definitely overweight to a significant degree, and this means there’s fat stored all over. After taking the rear approach to the pelvic area, maybe I should’ve been used to digging through fat to find small, delicate structures, but I think it’s one thing when you’re expecting it, and another when you’re trying to dissect the thighs and legs and Why is there fat inbetween all these muscles? Why are his arteries and veins and nerves covered in fat? The painstaking removal of little pockets of fat with tweezers and dull scissors from delicate, stringy structures got old quickly.

But it made me think a lot. I felt bad, being so frustrated because of his fat. I’m still quite fond of Frank (whose face I have finally seen; we started the head and neck last week) and I still treat him with the same respect I always did. I think I managed to keep the line between being annoyed at the fat and not being annoyed at him. I’m hoping I will always maintain this distinction, but I am already aware of classmates who don’t, and I have certainly met many doctors who don’t.

Medical professionals, much like the general public, are constantly being told that obesity is the #1 healthcare problem in the US. Medical students are not exempt from this. I did a public health pre-orientation program and obesity (in and of itself, and in the sub topics of racial health disparities, nutritional issues, diabetes and heart problems) came up often. During our general orientation, one faculty member began his little speech by talking about the obesity epidemic and how it is probably going to become a more serious problem and is going to concretely affect the way we will practice medicine (and the medicine itself).

Then there’s another side to it. The general public might be less familiar with thinking about this beyond hoping that the person they’re sitting next to on the airplane is relatively thin. The larger size of overweight people has all sorts of more practical implications. As I am intimately aware of, their cadavers have more fat for us to dissect through, and their live bodies are also more difficult to operate on.

This also comes up in radiology (a component of our anatomy lab). It’s harder to get an accurate x-ray in a bigger person; more fat equals more tissue between the film and the target organ or bone equals less accurate results. Some people may simply be too big for certain measures. Have you seen an fMRI machine before? There is a limit on how big of a person can fit inside one. And then there’s physicals. It is simply, dare I say it?, more cumbersome to examine a significantly larger person.

So here we have doctors, and here we have fat patients. Fat patients are apparently prone to all sorts of medical complications (that may be caused by the fat or may cause the fat; it can go both ways) and on top of that, they are somewhat more difficult to examine and operate on and diagnostic tools may not work as well on them. And then you add on society’s general “You did this to yourself!” attitude, and you have the doctor’s disdain for fat patients.

And it is still inexcusable.

I think there’s no excuse for showing a judgmental attitude toward your patients. It is not our place. First do no harm, right? Well, being rude to your patients is harmful. It certainly isn’t helping them. Even if they eat ten cheeseburgers a day and avoid physical exertion like it’s their duty, you are their doctor, and being rude or showing contempt helps neither of you, especially not them. I know it can be hard sometimes, to show even a neutral face when you disagree so strongly with some aspect of a person, but we have to try.

Written by Aba

November 14, 2009 at 9:39 am

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What to do about lectures?

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Whether or not to go to lecture is something I struggle with on a day by day basis. From talking to my classmates, I know I’m not the only one.

Reasons I have heard for going to lecture:

“I learn better from lecture.”

“I feel guilty if I don’t go.”

“I know I won’t get around to watching the videos if I don’t actually go to lecture.”

Reasons for not going:

“I learn much more efficiently from textbooks.” (or the internet/the lecture notes; a good deal of my classmates don’t buy all or even any of the textbooks).

“I learn from the lectures but I can use my time better when I get to speed up the playback, and I can pause whenever I start to lose focus.”

“I could be doing other things, like shadowing.”

Professors themselves are not necessarily in love with lecturing, or at least, with having a live audience. One of my professors said she actually wouldn’t mind just being a presence on a screen for us, someday. Although right now it’s a little annoying (not her exact words) because she doesn’t have the option of not coming in at 8:30 in the morning, or of having lecture only take a half hour instead of an hour.  I particularly like this professor, and I like interacting with her, but there isn’t really that much interaction through lecture itself. We get a good deal of face time with our anatomy professors during anatomy lab, which is great, and I feel much more valuable than watching them lecture live.

I’m not sure what big changes are coming on the horizon. I know there are problems with the current model, but it’s hard to please everyone. There’s been a lot of back and forth with our curriculum; one class asks for a change that the next class wants changed back. Too much of that and eventually the professors get confused and tired of changing.

I like having the videos recorded, that’s for certain, but what’s the future of live lectures? Is it worth it to have them if only half, or less, of the class shows up? Could recorded lectures be better quality learning tools than live lectures if they’re intended to be such?

For now I’ll continue doing what I do. Attending most lectures but skipping when my time is more immediately needed by something else (sleep, studying for an upcoming test, travel). And I am incredibly grateful for the resource of the recorded lectures. I didn’t have them during my undergraduate career, and I know they would have been immensely helpful.

Written by Aba

November 10, 2009 at 5:03 pm

Posted in Uncategorized

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