Chest pain, oh noes!
This is not fiction.
Medical students - we're masters of denial.
"I've got this weird wound on my foot, I'm young, so it can't be anything! I'm not seeing a doctor!"
"I'm in the medical field. I'm a mascot of health, gee I can't possibly be unwell!"
And so I woke up last night with a pain in my chest, and then deduced that the sharp nagging pain was indeed NOT from leaving a dinner fork in my bed.
I brushed it off as something inconsequential.
"Hey, it's chest pain, but chances are more likely than not that it's just a muscle strain!"
==
But but it'll be a crime if I just decided to ignore that pain just on that basis. So like any responsible medically-trained individual (trained, being defined by having barely passes all those end-of-posting tests), I went through the 2 most important tenets of medicine that the sleepy-eyed professors kept on drumming into us - clinical history and physical examination.
Clinical history. Male, 22 years old (too old already!), presenting with left lower chest pain for 1 day. A Sunday. It sucks to be in pain on a Sunday.
Oh, I almost forgot. I was coughing for a day before that. I had a sore throat 2 days before. No fever. Upper respiratory tract infection, no? Or lower tract, a.k.a. pneumonia, where I would have to rush myself to the doc stat?
But the chest pain's worrying. All the symptoms point towards an inflammation of the pleura (the lining of the lungs). Pain when I breathe in deeply. The location of the pain. The history of a respiratory infection. That is a Bad Thing.
Actually, it's more of a Bad Thing because I have not experienced this before. Hey, on the other hand it's so easy to delude myself that since it happens to me, and I'm a self-defined Average Joe, it can't possibly be such a Bad Thing because Average Joes don't suffer from Bad Things.
Gee. Medical students are inherently way too biased and self-delusional to diagnose oneself! Or is it just me who's off the rocker?
==
And the physical examination. I'd like to pretend that I did a proper one, but there's really no way to examine the back of the chest if you're not a gymnast from China. But hey, my unreliable ears tell me that I don't hear any obvious signs when I used my stethoscope. No pain when I pressed my chest wall - which means that it's probably NOT a simple muscle strain. Oh noes.
Likely inflammation of the pleura. Not a good thing. It's a sign of pneumonia, tuberculosis, autoimmune diseases such as lupus (where the body's own immune soldiers embark on a bloody civil war), asbestos or cancer.
Ouch.
And like any delusional medical student. I ignored this fact, being too freaked out to even think about it.
==
And miraculously (either a miracle of my physical resilence, or a folly of diagnosis) this very medical student's still walking around chirpy a day later, and the chest pain's getting better.
Sometimes, delusion saves a trip down to the doctor, doctor's fees, the side effects of probably-useless pills and the hassle of having to explain oneself.
The hardest part is, how do us medical students reconcile with our own hypochondria and our own self-denial? Do they cancel each other out? Or do they exhibit a synergistic effect, causing us to be triply delusional?
==
There are stories of a doctor who had died of asthma because he wasn't willing to eat humble pie and seek early hospital treatment. And in the UK, there's the ongoing buzz on how clinicians are often in denial of their own mental disorders. (Somehow, it seems that the UK docs are the ones who are self-absorbbed enough to do all sorts of studies on themselves - rather than on their patients.)
(The author happens to be actively trying to delude himself into thinking that he's normal - ever since taking a look at the DSM-IV .)
9 comments:
common things occur commonly.
Do they still say that in medical school?
Anyway quite sad to hear the term disillusioned medical student.
Used to be disillusioned old doctor.
Then disillusioned young doctors became the new shock phrase.
I guess now that would be disillusioned medical students.
Who knows next time it would be disillusioned doctor wannabe JC students?!!!
wellll... aren't we all disillusioned people
problem with medicine is, we enter with enthusiasm and all, then only when we're in it do we really see the realities behind it
especially the dilemma of healthcare economics - everyone demands the best care but most people do not want to pay for it - who's going to pay the docs then? too much work, too little remuneration
and the difficulties of specialising in a field we want to go into
and all those ethical issues and difficulties of dealing with death - and the relatives of the dead
but all in all, gee, someone has to do the dirty work and i've already signed myself up for it, no?
I can see what you mean.
The problem really stems from this overwhelmingly outdated and ridiculous belief that doctors make a lot of money.
So everyone thinks wah...
Let me share with you something. When I was younger and preparing for A levels I had a discussion with my father about what to do in future.
He always wanted me to be a doctor. I wanted to go to business school.
So he told me that business is dirty, got to lie, got to backstab etc etc.
And then we discussed the typical image of the good doctor, the more sincere, the more genuine, the more warm and caring the better doctor he was. And the better he was, the better he would be paid.
Well I can say now that all those things we thought about doctors and the industry are LIES!
I remember a very prominent professor telling me as a young trainee "You think the government cares about your training? All the government does is see healthcare as a waste of resources and money! Spend on defence is an investment. Spend on education is investment. But spend on healthcare is a waste to them. Spend the lower the better. In fact best no spending at all!"
That woke me up as a young doctor. That was the year John Hopkins started their wing at NUH and all research funding for that year was given to them and all SG drs had $0 for research funds.
At the end of the day, Singapore is about money. And someone has to pay. The problem is that our government doesn't believe in spending on healthcare. And people are also following their lead. Don't spend on healthcare.
So you're right. No one wants to pay.
Ok I'll have to go back to seeing my $5 per consult patients...
ouch. humbling, sobering and shocking all at once
much of the public thinks that thinking of healthcare as another commodity (as per food, electricity, etc) is ethically wrong. but this is the real world and that's how it is.
cruel as it may be, maybe it's time the profession works only as hard as they are paid. too many doctors are, uh, spoiling the market by oversupplying and under-charging for healthcare.
someone has got to pay for healthcare, and i for one am not going to pay (in time, sweat and blood) for the healthcare of the strangers i will see
My friend....actually if you are already at this state of mind now....it's going to get far worse when you finally do become a doctor.
Actually it isn't too late to switch right now. What year are you in now?
A big problem of course is the bond which traps many of us.
You can never win in medicine. You don't earn a lot people say you earn a lot! You earn a lot people say you earn too much and you are a doctor supposed to be altruistic, charitable etc.
We do no favours telling people we are in medicine not cos of the money etc.
GPs undercut each other. Specialists undercut each other. Polyclinic undercut GP clinics.
Actually I dunno what's going on anymore.
Aiyah there is still hope actually. Maybe you can go into pathology. SOme non clinical specialty would be good.
finishing up my 3rd year, so it's sorta too late eek
if it's any consolation, i trust that if i do indeed end up hating the field, i'm versatile enough to jump ship once my bond ends.
well, renting a stall and whipping up good char kway teow ain't that hard eh? work hard enough at it, and there's a good chance i'd get to drive a merc (unlike, say, an overworked reg working in a gahmen hospital)
but prolly not. i like medicine as a science. i'm probably more passionate than most of my classmates in terms of academic interest (as opposed to the drive to do-well-and-suck-up-to-enough-people-to-get-a-good-surgical-traineeship )
at least, i hope my interest spurs me on. i'm trying to convince myself that the enthusiasm i see in some of the profs i meet does indeed stem from an interest in medicine itself.
and pathology's just boring. currently looking into haemato or psych. or at least, just int med. no surgery.
I also like medicine. I like science.
But clinically, seeing patients is not about science. It's more customer service. Sales. Sweet talking. Handling complaints. Dealing with difficult people and trying to make unhappy people happy.
That's what clinicaly practice is about after you've been at it for a long time.
The science bit is why we are there but to the customers they view that area as something to be expected. What they focus on is the stuff I mentioned above. It is probably less so in very specific specialties eg surgery. But then you would get those people complaining how the surgeons are cold etc etc.
People want everything lah. I used to hear that NHS surgeons list 1 case per day. Cos they aint paid more for doing more ops. Of course that way a lot of free time to go chit chat with patients, make them feel you are friendly etc. But they wait 1 year for their TKR! LOL!
Sigh can't please everyone. And pleasing people is the name of the clinical practice game.
arrrgh sigh
*collapses into despair*
Aiyah even if you sell char kway teow it is also about pleasing people.
It's not that bad actually once you accept it.
But don't be taken in by all the noble talk those academic professors talk about. Most of these academic people are out of touch with market situations.
Or they simply don't want to tell you the truth cos then everyone will be disillusioned and depressed and commit suicide.
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