A lifetime of learning, no kidding

I'm in the last week of my month-long outpatient rotation, and I had a long list of tasks to accomplish before entering the CCU next week. In addition to seeing friends and cleaning my apartment, I also wanted to slog through the tall pile of journals that has accumulated since last time I was on an outpatient month. Flipping through the January 17th issue of the New England Journal of Medicine, I was reminded how medicine is ever-changing. There is constant revision of therapies in addition to the social and political aspects of the medical field, and I need to keep up! Here are a few excerpts for those interested in what I've been reading.

I've had the opportunity to work with foreign medical graduates in the past, but this article really describes the sacrifices they make and the hoops they jump through in order to practice medicine in the Western world.

[Foreign medical graduates] must not only relearn the theory, which many of them first studied decades ago, but also master the social and behavioral nuances of being a doctor in the West. Some must do so while supporting themselves by driving taxis or picking fruit; others rely on meager personal savings or small government handouts. They are driven by the dream of becoming doctors again, but the reality can be a nightmare.

I need reminders like this so that I remember how lucky I am to do my crazy job everyday. I've heard about publication bias, but this article really lays the numbers out there.

Among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published ... Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive.

I haven't had an ethics course since I was a first-year medical student, but there are still many unanswered questions. When I read this case about cell lines derived from a patient's splenectomy specimen, I couldn't believe that the law wasn't more clear.

Under ancient Roman law, when agricultural crops were in the ground, they were owned by the landowner, but picked fruits and vegetables were owned by the farmer who worked the land. Trees taken from the land, however, belonged to the landowner. Is a removed spleen more like an ear of corn or an oak tree? ... Since the cells in human tissue are living and reproduce, perhaps they are more analogous to farm animals than to fruits or vegetables. The progeny of animals are the property of the mother's other. Is the cell line equivalent to [the patient's] "progeny"? Similar, an owner wrongfully deprived of livestock is owed the value of the eggs from converted chickens and milk from converted cows. Are [the patient's] immortal cells like chickens, and the protein products derived from them like eggs? The need to resort to cases that involve the ownership of corn, trees, cows, and eggs demonstrates the need to create modern rules that deal directly with the ownership and use of human tissue.

I remember in my medical school application essay I stated I wanted to enter medicine due the ever-change challenges the field encountered requiring a lifetime dedicated to learning. Boy, I don't think I knew what I was getting myself into!

Goodbye, med school notes ... or not!

In preparation for my move across town, I decided that I really needed to get rid of the stacks of medical school notes and journals that crowd my closet and overflow throughout our apartment.

Starting with my notes, I figured it would be easy as I haven't looked at most of those binders for the two years since I have been in the classroom. The information in them is easy to look up in any medical textbook (or with a quick Google or wikipedia search). The first binder was Pathology, and as I pulled out the pages, my hand hesitated to toss them into the recycling bin. Pathology was one of my favorite classes, the one I first learned about most disease mechanisms. Surely, this was the very foundation of my medical knowledge, and when I get confused about the different types of leukemias, there's nowhere else I would rather look. So, I put Pathology back on the shelf.

One by one, I went through the binders, and I was only able to throw out a few subjects. Some I never liked or found much use for beyond basic concepts, such as biochemistry and neurosciences. Others covered specific disease management, which changes every week with the publication of hundreds of medical journals. Looking through those pages, I was surprised to see how much is already outdated.

The journals were next. I had earlier made it a goal to read a journal a day for the last two months, but I realized that wasn't enough. I had at least two years worth of two weekly journals that my husband tries to keep in a few neat piles behind various living room furniture. He pointedly asked a few weeks ago if they were coming with us, and I assured him that they absolutely would not. However, I didn't just want to toss them. Not only had I paid for these subscriptions (albeit at drastically reduced student prices) but I also actually want to read them. They're good journals with great management-changing articles and illustrations, but during medical school, I just couldn't keep up for various reasons. So, I came to terms that I would never read these journals cover to cover and started tearing out articles.

All the medical knowledge I want to take with me is in a pile of 3-inch ring binders and a 3-inch pile of articles. Everything else is overflowing my apartment building's recycling bin. As I become more confident in my knowledge over the years, maybe I will feel comfortable tossing the rest, but I feel better just knowing that I still have with me those eagerly scribbled, multi-colored explanations that served as the foundation of my medical learning.