Talking Medicine

There’s something very gratifying about talking medicine with trainees. Regardless of their level of expertise, there’s always some wisdom to be shared.  1st year medical students are completely a blank slate and any  simple clinical discussion greatly augments their expertise.  Clinical discussions with 3rd year medical students are also extremely enriching considering how their heads are usually buried in textbooks for almost 2 years. The conversations about diagnosing and treating actual patients are both challenging and invigorating.  As interns and residents in internal medicine, the conversations about patients start to get deeper. It’s no longer just about diagnosis and treatment, but understanding and applying clinical evidence towards the best course of action in patients they are completely responsible for. This is also the time where we as medical educators who spent countless hours “talking medicine” with our trainees need to start talking about the most difficult questions facing healthcare today.

These difficult questions are aren’t about arcane diseases or curious physical exam maneuvers. We are beginning to ask about how our patients function within our broken healthcare system  For example, instead of simply talking about the different treatment options for a ganglion cyst, we challenge our trainees to ask and think about why a mother would take her daughter to the ER for that same ganglion cyst; a routine outpatient problem. We delve deeper into a patient’s day-to-day existence by trying to understand the myriad of medical and psycho-social reasons behind an elderly lady’s 3 hospital admissions within 2 months in order to identify solutions that will reduce health care expenditures and protect her from the dangers of hospitalization. Instead of simply prescribing medicines that lower blood sugars, we also talk about the cultural basis of an individual’s diet to better tackle the nutritional aspects of diabetes.

These types of issues which have no obvious answer are unfortunately the exact types of questions our trainees are least prepared to tackle. We’ve created a medical education system that emphasizes building knowledge and understanding of healthcare in terms of multiple choice questions and the absoluteness that comes with selecting a one true answer. Part of my goal as a medical educator is to deconstruct this black or white approach to thinking by asking the difficult questions and exposing how truly grey the world of healthcare is. From there, I hope some are inspired to reject the status quo and pursue careers that aim to provide great patient care, while also tackling the most complex systems issues in healthcare. This is just one of the many gratifying and important aspects of talking medicine today.

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