Archive for Education

Motivation

What motivates me?? That question makes me LOL because my motives have changed throughout the years and sometimes sound a little ludicrous to me. 🙂 Initially, I was motivated to go to undergrad both out of ideal beliefs that I could save the environment from the soils of society. I was motivated out of fear, believing if I didn’t go to college, I wouldn’t be happy , have enough money. And I went to college simply because “It was what I was supposed to do” since I was always in the college-prep classes in high school due to my “exemplary intelligence”. I quit college after 2.5 years, motivated by fear and discontent and intrigued by the thought that I COULD quit and steer my life in any direction I wanted. During the winter after I quit school, I worked at Pinkham Notch and met J. After a year in “the working world” aka working at Pinkham notch, on a farm, cafe and greenhouse, I did one semester of adult education at Vermont College, realizing how much I LOVED organic chemistry (I had one semester of it before quiting) and that Vermont College was not were I was going to satisfy my nerdy desires. 6 months later I was enrolled at UNH for a degree in Biochemistry and my eventual disillusionment of the scientific community as the place where all questions could be answered. It was also at UNH where I learned about osteopathic medicine and I thought it was the perfect combination of medical knowledge/practice and an openness to the more spiritual side of healing. Today, my motivations include

1. A desire for basic medical competence to gain/maintain respect by my peers, my patients and my educators as well as for me to feel grounded in the workings of medical practice

2. Enhance my palpation and osteopathic treatment skills to boost my confidence and ultimately help to alleviate the suffering of my patients

3. learn as much as I can about myself and my own health in order to assist others to fully realize their own health. This includes spiritual and physical health.

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Residency, sights and authors, Oh my!!

It is confirmed.  I matched to do my residency in Neuromuscular Medicine (a euphemism for Osteopathic manipulation) in Southampton!!  I think I might take up surfing…

It has been raining for 4 days here in southern California and this afternoon the sun came out and I saw snow on the distant mountains.  As corny as this sounds, it was one of the most spectacular scenes I’ve ever seen!

I saw 2 authors in person this weekend.  One was Noah Levine, the founder of Dharma Punx, an American Buddhist Society that arose out of the punk rock era.  It is also the name of his first book.  I bought the book and hope to have it autographed before I leave LA, preferably after I read it!  Secondly, I saw Eric Pearl, DC who wrote “The Reconnection”.  I read this book about 2 years ago.  He was a good, grounded and funny speaker, even if I’m still a little skeptical…He presents some bizarre concepts.  I’m neither completely turned off by him nor am I jumping on his band wagon with both feet.  I need to do some experimenting.

Home Coming

It is so interesting to be back on campus in Biddeford after being away for a year. I actually came to campus a few times during the year to go to the library or talk to my favorite Neuroanatomy professor. However, it’s different to be back with all my classmates. We had 4 hours of Emergency Medicine lectures this morning. I was constantly reflecting on my own experiences this past year and noticed my critical thinking was a bit different from the first 2 years of lectures. I had more insight into the clinical setting these docs were referring to.

The other interesting issue is interacting with classmates again. It took some effort for me to maintain confidence in my own experience when hearing about what other people have done or are setting up for the future. The most difficult part was talking to a G, classmate who was a bit of a friend last year until I realized the guy I was interested in was interested in her. She’s beautiful, tall, bright eyes, enthusiastic, chipper demeanor: everything I’m lacking except for the bright eyes. She went through a divorce last year and now she’s pregnant and getting married again. Although the divorce was a difficult time for her, I am ridiculously jealous of her. And then she wants to chat over tea. It hurts me to just think about her. I can imagine the torture of hanging out for an hour or so. No thank you. I appreciate the offer, but my heart doesn’t need that kind of abuse right now.

Letter to C

The previous post regarding my frustration with the preceptor I had during family practice rotation was immature and out of control, but one of the purposes of this blog is to vent my anger safely. Below is a more mature and appropriate letter I wrote as a final catharsis for this situation. I’m not going to actually send it to him thanks to feedback from a good friend and my own better judgement. Still it felt good to write it.

C,
I feel like I need to talk to you. I realize email is not the same as
talking, but it’s the best I can do right now and besides, I have a very
difficult time talking to you directly. You tend to talk “at” me rather than
with me, not recognizing what I’ve said and this causes me to shut down. Not
to mention the fact that I tend to cry easily, which is due to both my low
threshold for crying and your approach to personal encounters.

I am still in pain from how you confronted me on Wednesday. I was already in
a precarious position in regards to my confidence about my chosen profession.
You say you want to help, but then you offer medication, a band-aid. You
admit to not understanding me, so then how can you help me? I purposely chose
not to share myself with you because I knew you wouldn’t understand and my
sharing was not a required part of the rotation. I was supposed to learn
family medicine from your perspective. That’s it. If we had connected, I may
have shared more about myself, but we didn’t connect. I admit that breaking
down crying before seeing a patient is not healthy, but would you rather me
walk around like a robot and have no feelings? I’m a sensitive person and
most of my patient encounters were very positive with people wanting me to be
their doctor. I obviously connect with patients. It didn’t seem like you
perceived that in me. You only saw my faults and the first step in helping
someone is seeing what they are good at and what they have to offer.

I am also angry about your perception of Osteopathy. Healthy skepticism is
important to maintain integrity in our profession, but you completely
disregard everything about Osteopathy that I hold dear. It would be one thing
if you were just my FP preceptor, but you are also our OMT preceptor. I have
a hard time forgiving this. Since beginning school 3 years ago I have
experienced so much disappointment in the Osteopathic profession that I have
reached my limit. I can forgive DOs who spend their lives completely immersed
in the allopathic world, becoming experts in their fields who do not use OMT
(i.e. Dr. O, nephrologist). And, I have a huge amount of respect for FPs who
try to incorporate OMT into their practice even though my imagine of an ideal
FP DO is one who only uses OMT for all issues.

I am stubborn, idealistic and possibly delusional, but there was a time when
Osteopathy thrived and I am on a quest to find that “essence”. I don’t want
to settle for mediocrity. Much of my depression and anger stem from this
disappointment and then having to traverse the medical school jungle anyway
because I’m so completely in debt.

I have my issues and I am constantly working on them. Every counselor I have
ever seen has said I have great insight and if I had felt comfortable enough
to talk with you, you would have noticed this too. C, there were a few
moments I actually learned something from you. However, those moments are
overshadowed by me learning to interact with you without being completely
overcome by insubordination. You are the first person I’ve worked with where
I felt so strongly. I may be part of the problem, but you have also
contributed to the dissonance in our relationship.

MG

Correct response?

Is it better to cry or hold it in?

Should a person with depression take antidepressants if they don’t want to?

Is it healthy to receive feedback from someone you don’t get along with?

I consider myself a fairly mature person.  However, when it comes to interacting with one of my preceptors, I became very immature: passive aggressive, non-communicative, angry.  He’s often telling patients with psych problems that they need to let out their emotions and then when I cry he says I’m depressed and need to try medication.  I refuse to discuss my issues with him because he’s a complete ass and yet thinks he knows what’s best for me.  We last worked together and he gave me feedback on Weds.  I’m still upset by what he said to me.  There was no way to win.  I hated him and yet he was my primary preceptor.  I couldn’t exactly be honest or else I’d be called insubordinate, which wouldn’t be the first time in my life.  So I played the passive aggressive game, which makes me hate myself and him that much more.  I know I have issues.  We all have issues.  I don’t want to do pelvic exams and I get overwhelmed with emotions when I have to do it.  I used my reaction as an indication NOT to go in to family practice and yet he says there is something wrong with me and questioning me belonging in the field medicine.  Would it be better if I was a robot and did everything I was told without feeling a god damned thing???  Besides, I don’t WANT to be an MD.  I want to be a DO.  I want to analyze problems based on the anatomy, the blood/nerve supply and venous/lymphatic drainage.  THAT IS WHAT I WANT and yet he (the DO hired to teach us OMT) doesn’t fucking believe in Osteopathy!!   IT makes me want to scream so loud that I burst my own ear drums.  There’s something wrong with me?  He should look at his own lazy ass and say the same fucking thing.  Thank goodness there were some DO’s throughout the year who were able to teach me something and give me their thoughtful feedback regarding the present state of Osteopathy.

Please pardon my profanity.  It took me 2 days to recover my shattered self-esteem and now I’m just writhing with anger.

Real?

For all my ranting about the medical community/school, etc, I wonder how my analytical side would have faired in a more rigorous environment, challenged to hone my skills and answer pimping questions.  Today I sat through almost 4 hours of touchy-feel-ly discussion between the residents (mostly the international medical graduates-IMGs) and the faculty of the Maine Darthmouth Family Medicine Residency.  The program has become known for its laid-back, open-minded program.  The IMGs were concerned that people were excited next year’s intern class had no IMGs, which turned into this huge discussion on ethnic diversity, benefits of IMGs and disadvantages, blah, blah, blah.  Some points were valid and interesting, but I was not interested in sob stories.  I feel like such a hard-ass.  I greatly admire the IMGs for coming to the US for their training despite being away from their home culture and familiarity, but why are they so upset if the patients can’t understand them or ask where they’re from?  I wonder what it would be like in a place that doesn’t allow this kind of belly-aching.  Where the goal is teaching/learning and patient care.  Would I feel just as alienated because of the lack of human relating or would I be more comfortable?

Last thought (has to include Osteopathy, right?): there was some discussion about the prejudice against DO’s and I was wondering if ANY of the DO’s or OMS’s feel discriminated against because they want to treat a patient (regardless of disease) with manipulation.  To be honest, I feel like my education has discriminated me against Osteopathy because we have to behave and think like medical students.  And yet one of UNECOM’s goals is innovation in health care.  Did they ever consider that returning to our roots would be an innovation at this point???  It kind of makes me laugh and cry and go insane, but I have to be careful because I’m on my psychiatry rotation and they might not let me go home!!!

It is completely ironic that I have to “get through” my education without getting the education I really want.  Although, maybe next year…maybe I’ll find people who treat all diseases with manipulation and can talk to me about the anatomy…maybe next year…

Input to our new Dean..

Lastly, I have to make a statement about Osteopathic incorporation into our curriculum. I’m a huge advocate of Osteopathy and was dismayed by the lack of integration during our courses. OPP covers the basics and I appreciated our lab time. UNECOM also provides 1hr of OPP for each system, which is much better than nothing. The one hr provides reminders about Osteopathic philosophy, but it is impossible to cover ALL the diseases of a system in one hour. Doctors are forced to resort to generalized philosophy, which is useful, but quick to lose a student’s attention after hearing it for 100th time.

90% of our time is devoted to learning about diseases as they are classified by the allopathic world. For diseases where the etiology is well-known, this is a fine approach. However, when a disease has an unknown etiology, all possibilities should be presented, including Osteopathic philosophy. Example: Asthma is “thought” to be caused by inflammation and spasm of the bronchioles. We “know” this because biopsy specimens show inflammatory cells and we provide antiinflammatory and bronchodilator medications that help with exacerbations. Why did NONE of the DO instructors discussing asthma ever mention the possibility that the patients could have somatic dysfunction of their upper ribs, thorax, OA? This is not a big leap of reasoning and any sensibly person who thinks to ask about the MSK system’s possible contribution to bronchospasm will see a possible connection and thus have another way to go about trying to help their patients via OA release to normalize the vagus, treating T1 and the ribs in general. I don’t think we should only treat all asthma exacerbations with OMT. I just think it is the responsibility of the school to encourage [require] all DOs who lecture to include Osteopathy in their lecture. Students of ALL Osteopathic medical schools deserve this type of instruction. Secondly, the disease index cites pathology and internal medicine sources for further reading. It should also cite Osteopathic resources, so students at least see there is Osteopathic literature regarding specific ailments and where it is if they have to desire to look it up.

Students tend to complain about schools not preparing them for the board exams, so the schools design their curriculum to prepare students for the boards. However, while board exams are a very real obstacle that we have to overcome, the slow deterioration of Osteopathy is rampant. If schools do not protect the teaching of Osteopathy by sprinkling it into the fabric of our curriculum in practical ways, it is going to continue to be lost and students who really want to learn Osteopathy are going to have to leave the country to get it.

The way it should be!

Big BIG sighhhhhhhhhhhh.

I am in heaven.  Working with a DO in and hospital doing OMM.  Life is Beautiful.  Now, if only every single Osteopathic Medical Student could experience this, our whole profession would be revamped.  The thing is, we are not doing rocket science.  First year students could do these techniques after their first few OPP classes.  It gets students comfortable with doing OMM in the hospital, around IV lines, ventilators, urinary catheters, etc.  The most important part is having an attending who is humble (maintain a low profile in an MD world), committed to treating and teaching and have good people skills to communicate what we do with patients, doctors, nurses, etc.  The patients LOVE it once they experience it.  Unfortunately, there is so much red tape to get to the patients that very few students get to do OMT in the hospital.

Dr. Kenneth Graham makes an excellent point in his “OMM Guidelines for the Hospitalized Patient”.  He says that treating inpatients is about prevention (secondary infections, venous stasis, etc) and promoting recovery: restoring physiologic functioning, decreasing sympathetic over-stimulation, etc.   It almost makes me want to cry for joy because we a doing what I’ve read about in so many books, but was too scared to try on my own in the hospital.  Plus, you really should have a doctor to order the OMT and supervise you, but this isn’t always practical.

Osteopathy LIVES!

Osteopathic Neurologist

Well, goodness it is lovely to receive compliments about this blog. I have not been writing much lately, mostly for various reasons. I had a devastating holiday fighting with my sister and my leaving, spending the holidays alone. On the positive side I’m enjoying my pediatric rotation. The Dr. I work with is extremely knowledgeable and he has laughter-lines on his face (a sign of a good person). He makes me want to study, which I’ve been doing and that’s a good thing.

My extreme distaste for OB has placed my career on a new trajectory. I was planning on family practice with OMT, but even if I didn’t do OB, I’d have to deal with contraception, STD’s, etc and I just don’t want anything to do with sex. I also want to be able to spend time with patients and not 15min appts, constantly writing notes. My most favoritest class in my first 2 years was neuroanatomy, followed by anatomy. I’m fascinated by the complexity of the nervous system, its interconnection to all parts of the body. In my mind it is absolutely necessary to understand the nervous system to adequately practice and explain Osteopathy to patients and MD’s.

So, my new career path has found me heading towards becoming a neurologist, an Osteopathic Neurologist of course. There are only 6 AOA Neurology programs and the BEST one is located in Dayton, OH. I’ll be heading out there to visit in March. I really believe I’ve found my calling, which is incredible and scary. I still need to talk to more people in the field, but I’d be hard-pressed to find any reason NOT to pursue Neurology. Besides all the procedures I’ll learn (LP, EEG, EMG, etc) in residency, I plan to take an extra year after residency to do a fellowship in OMT, so I can help my patients beyond simply providing my “expert” opinion, poking and prodding them and adjusting medications. I can help them function optimally.

Gentleness in an Aggressive World

I hear the new student on OB has caught at least one, maybe 2 babies in her first week.  I semi-caught one my first week and that was it.  Am I a bad student?  I hated OB so much by the end I went to the library to read during 2 deliveries.  I feel so guilty about it, but I hated it and no one really cared if I was there or not.  Now the next student comes along and she’s a rock star because she enjoys procedures and can nudge herself into any situation and get a chance to do it.  I hate her, admire her, hate myself and move on…

I moved on to Pediatrics and I love kids.  I love the gentle interactions I have with children because they are usually open to the world and brief experiences of connectedness.  The worst part about being a pediatrician is the perception of being the big mean doctors that look in your ears and give you shots.

I think I still want to do family practice where I will get to see kids as well as old people and pregnant ladies.  And I’m going to do OMM on as many as I can!

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