The Statistics Of Medicine

Guest post by Aaron Schenone MS IV

As medical students, future residents and physicians we’re used to the statistics. Whether it’s to assess for appropriate screening tools, treatments, or patient outcomes, we have experienced the positive impact evidence based practice has and will continue to have in medicine. But are statistics an absolute in patient care, and if so what are we in jeopardy of leaving behind?

As we move forward in a world with greater chronic disease prevalence, diminishing medical resources, and a financial reimbursement system incentivized by statistical outcomes, do patients always benefit? Of course many statistics provide reassurance. A patient with stage one colon cancer may find some solace in their statistical prognosis, but how should we use statistics with more advanced diseases?   After all, even after confronted with bad news, how many patients are still secretly awaiting a medical miracle?

Dilemmas are something we’re used to in medicine. As soon as we open the door we prepare for the battle between costs, outcomes, and the needs of our patients. In many cases these responsibilities are fairly congruent, but how do we approach when they’re not?

On night call I met an 85 year old man sitting in his chair gasping for breath. He had just had an unstrangulated hernia repair indicated for his refractory pain. However he also heart,  liver, and renal disease. He was lucky to have made it off the table and when confronted with these statistics, he wanted to operate. The pain was just too severe. That night we identified ruptured esophageal varices, and pulled more than a liter of frank blood from his stomach. He was intubated, stabilized and passed the next day.

Weighing our responsibilities to patient needs, while refraining from harming them, is absolutely tantamount to medical practice. However, all too often we find ourselves weighing those responsibilities against our inherent desire to ease suffering. Until statistics create a crystal ball, we will need to enter the patient’s room ready to comfort always, cure sometimes, and weigh our abilities to ease suffering against the potential risks of our care.

About: Aaron Schenone MS IV is presently a fourth year medical student applying to internal medicine residency. He is a consultant with a Biotech Company Histogen Inc. where he applies Oncologic, Biocompatibility, Regenerative Medicine, and Tissue Engineering. He is a Siteman Cancer Summer Scholar Recipient, and have continued with the institute investigating both clinical and basic projects within soft tissue sarcomas. He was also the President of the Dermatology and Oncology Clubs in 2012 and finished Ironman New Zealand in 2002 before starting this whole medical adventure.

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By Far The Most Common Conversation In A Hospital Is Complaining

By Tamara Moores, a fourth year medical student at Loma Linda University specializing in Emergency Medicine.

They tell me that I’ll change.

They always do.

In our first two weeks of medical school, freshmen students are assigned to shadow senior students working in the hospital. When I was a freshman, my senior student’s final comment to me was “Wow. You’re really enthusiastic… That will change.”

Now as a fourth year medical student, today’s version of the story was – “intern year will change you. You may look the same on the outside, you may portray that same bubbly, sunshine personality, but inside you’ll be different – harder, less tolerant, mean.”

They say it with confidence, they say it with authority, brooking no disagreement, allowing no doubt. Attendings, residents, nurses – they all deign to tell me my future – “there’s no way you can stay that energetic, it’s incompatible with a medical career.” Over and over I have heard this. As a medical student, I am supposed to listen and learn - to be guided by these wise elders. This morning when I heard the prediction for the 100th time, like always I politely listened with a half-smile. Yet silently my spirit roared “How DARE you smugly tell me the fate of my soul?! How DARE you justify your own insecurities about your passionless heart by attempting to degrade mine?”

Medicine is a unique environment. In my short foray into this time-honored, traditioned society, I have been buffered and shocked by the rampant negativity that oozes through the hospital walls. People seem to even take pride in their ability to bemoan their situation.

“Oh God, another consult from the ED, think they managed to even do a physical exam before calling?”

“That professor has no idea what’s on boards.”

“I can’t believe we have to be here.”

“This computer system is a joke.”

By far the most common conversation in a hospital is complaining. Tomorrow, try something different - stop and listen to the myriad people talking at work. The ratio of negative to positive conversations will overwhelm you.

Why is hospital culture like this? Shouldn’t a place of healing be full of warm emotions, positive thoughts, and uplifted people? Why is a ‘negative nancy’ the most common type of medical professional we meet? What are we doing wrong? These questions often come to mind during my workday. There is no easy answer. At the very least I know my top goal is to NEVER become that stereotypical cynical physician, and instead be the uncommon doctor with true passion for medicine.

So how do I accomplish this in such a caustic environment? Have no doubt, even at my current bubbly baseline, it is a daily war to maintain my heart for this career. So many physicians before me have fought this battle and lost. How can I succeed where they have failed?

A resident who I highly respect recently told me ‘be careful what you say, because talk patterns become thought patterns.’ This, more than anything, is my first defense against cynicism. It is SO easy to fall into conversation filled with complaints. These tiny conversations seem harmless, but over the course of a lifetime they shape your soul. Now at the end of my medical schooling, and at the cusp of residency, I am awed by the power of the spoken word. It’s undeniable - what we say both molds and reflects what we think.

Overall I believe the best weapon against developing permanent pessimism is to be deliberate in how we react to daily adversity. How do we respond to a floridly difficult, unpleasant patient? Do we moan about how annoying they are? Do we ruminate about how unfairly they treated us? Permit me to suggest a different response. Instead of focusing on how unjustly that patient has treated me, I instead try to feel gratitude. Whether or not it’s right, these difficult patients make me grateful that my life has not put me in their position. They must be really unhappy inside, to so poorly treat the people who are trying to care for them. When I am mistreated by an attending, I remind myself that they are but a momentary discomfort, and soon will be gone from my life. Over and over I find myself fighting to see the positives in my life. It is a deliberate, intentional strategy, which allows me to shine out with joy even in the little moments of the day.

I firmly believe that working as a medical professional can be a path to a life filled with meaning and passion….if we let it. Not all days are perfect, but most days I feel like I’m the luckiest girl in the world to be in my chosen career. The patients are interesting, my skills are stretched, and I feel fulfilled. Beyond these personal reasons, more than any other career, medicine reminds us how short and precious life is. We deal in broken bodies, lives cut short by car collisions, by strokes, by chronic disease. How lucky we are to be able to move our bodies without wheelchairs, to be relatively self-sufficient. Working in the medical field reminds me daily that everything can change in a moment. It is this acute awareness of the frailty of life, which makes me embrace life with so much abandon. It is this knowledge that gives me joy in the workplace, even during the rough days. To put it bluntly, life is too darn short to be grumpy.

So why am I reflecting via this forum? Perhaps because I hope that I am not alone in this fight. Perhaps I hope that by starting a discussion, we might nudge forth a change in the standard hospital culture. Maybe with forums like this, we can shift the caustic paradigm. Here’s to hope.

About:: Tamara Moores is a fourth year medical student at Loma Linda University. She is specializing in Emergency Medicine. https://www.facebook.com/reflectingthelights

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The Top 10 Reasons You Should Go To Medical School... And The Single Best Reason Not To

By Jeremy Weaver, Medical Student and Editor of Uncommon Student MD

Whether you're a first year medical student or a practicing physican, there's a good chance you've asked yourself the quesion, "WHY the @#$% DID I GO TO MEDICAL SCHOOL?" Here are a few EXCELLENT reasons... and one bad one.

Just as the blisses of Christmas break was ending for most of us tortured souls who fly the banner of "medical student," and sail these uncertain scholarly seas, Uncommon Student MD got some serious traction with medical students around the world. I believe timing had a large part to do with the explosion in its popularity. Simply put, after christmas break a lot of medical people were thinking, “what am I doing here?!” - A case of mass buyers remorse.

It is an understandable and laudable question to be sure. If we spent half the time wrestling with the question of what to do with our lives that we spend OMGing and LOLing on Facebook, we would probably all be Nobel laureates (at the very least we wouldn’t use retarded abbreviations as much). There are a lot of bad reasons to go into medicine and there are a lot of good reasons not too… Conversely there are also many great reasons TO pursue medicine as well as a lot of bad reasons not too. Confused? Me too, but I do know that there are two sides to every pancake (perhaps three if you screwed the recipe up).

F. Scott Fitzgerald once said that, “The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time, and still retain the ability to function.” So, even though I happened to agree with a few salient points made in the aforementioned article, I am trying to follow the advice of good old F. Scott and entertain the flip side of the coin. Maybe incite some wrath while I’m at it… one can only hope.

I am not sure, but I am of the opinion that there are as many good reasons TO go to med school as there are NOT to go (we should do a prospective cohort study to find out). At the very least I know there ARE more reasons than the sole example our friend Dr. Ali Binazir espoused. And so without further hemming and hawing… The top 10 reasons you SHOULD go to medical and 1 reason you should RUN WHILE YOU STILL CAN… in no particular order.

1. You will have a HUGE range of options at the end of your medical education.

To me flexibility and possibility in a career are of FAR greater importance than money, girls, fame, cars, illicit drugs, horses, blue suede shoes, kittens, my high score on angry birds, tickle-me-Elmos, or just any other temptation under the sun. Medicine opens up a WORLD of...

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