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What Did You Say?

Jeffreywonoprabowo72x721Jeff Wonoprabowo -- This week I was driving home from Target with my mom. I casually mentioned something about going back to Loma Linda for an autopsy.

"What?!?" she asked. I looked at her, while safely driving down the street, and laughed. The way I said it, it sounded like I was going in for my own autopsy. And for a few seconds she doubted whether she remembered what an autopsy was.

But I cleared it up. I wasn't going in for an autopsy. It wasn't a back-to-school thing like getting a physical. I had to view an autopsy being performed -- not have one done on me.

The whole situation reminded me about the importance of clear communication. Communication is important in daily life; it can be vital in the medical arena.

Last year I had a class called "Understanding Your Patient." During one lecture we discussed giving patients bad news. We watched a video clip of an oncologist demonstrating how he gives bad news, using actors as patients. The actors didn't know what he was going to say and so their reactions were genuine.

He, the oncologist, discussed breaking things down and repeating often. It's not easy to take bad news. It's also easy to jump to conclusions at certain trigger words.

My mom battled cancer a couple years back. To this day, she remembers the moment she heard the word "cancer" from her doctor. I haven't asked her too much about that conversation, but sometimes patients will shut down and come to their own bleak conclusions once they hear a word like that. So it's important to slow down, repeat, and get feedback from the patient to make sure they understand.

I also heard an orthopedic surgeon, Doctor A, talk about one of his experiences with a patient. A patient came to see him and told him what Doctor B had done. In passing, he made some comment like "Why would he do that?"

Well, one year later the patient comes back –- this time with a lawyer. The patient wants to file a lawsuit against Doctor B. And the patient wanted to use Doctor A as an expert witness because Doctor A had made a single comment wondering why Doctor B did what he did.

It turned out that the patient had misunderstood what Doctor B told her. And the patient had given Doctor A the wrong information. And Doctor A realized he shouldn't have made that comment to the patient.

Twisted, I know... but it reminds me that I have to be careful with what I say –- especially when I am around patients and still have no idea what I am looking at. They see a white coat and assume I have some body of knowledge. Well, I do have some body of knowledge, but at this point in my training, it isn't the kind the patient needs.

August 13, 2008 by Jeff Wonoprabowo | Comments (1)

Why Bother Learning Something We'll Lose?

Jeffreywonoprabowo72x721Jeff Wonoprabowo -- During high school I took three years of Spanish. I thoroughly enjoyed it and really wanted to spend a year abroad to become fluent with the language. Unfortunately, when I got to college, I desperately wanted to finish in four years. My year abroad ended being sacrificed. In my final year, I did take Spanish 101 and 102, more for the fact I knew they would be easy A's.

Two years removed from graduation, I'm sad to say that I feel I wasted all that time studying Spanish. I haven't used it at all. Sure, I might remember some words and phrases here and there. I can probably still conjugate the present tense of most regular verbs. But I can't remember the vocabulary. I turn on Spanish television and I get nothing. Well, the actors are pretty dramatic, so I suppose I can get something.

The other day I was standing in line at the Argentinean Consulate when the lady behind me started talking to me in Spanish. I looked at her, puzzled. She repeated her question. I tried to piece together what she was saying but the only thing I got was "Koreano." I assumed she was asking if I was Korean. Well, I finally apologized and told her I couldn't speak Spanish after which the conversation ensued in English. But I couldn't help feeling frustrated that I couldn't even understand a simple question after more than 3 years of Spanish classes.

Language is just one of the things that you have to use, or else you lose it. And this got me thinking about medical training. This year, as with most first year medical students across this country, I took General Anatomy. As far as I know, I won't have any anatomy classes during second year. But Step 1 of the USMLE exam will cover General Anatomy. It worries me that I will go through an entire year without ever having an Anatomy lecture. I guess I am going to have to continually review myself whenever I find myself with that elusive "free time."

I also thought about the practice of medicine. This year, I heard a talk by a cardiology resident. He said that while he was tempted to go into surgery, he found the clinical skills of surgeons to be lacking. Most wouldn't be able to properly auscultate a patient. He had chosen cardiology because the cardiologists he had witnessed all impressed him with their clinical abilities.

One could debate the merits of having surgeons equally competent in wielding a stethoscope as they are with scalpels. It is probably not really important for surgeons to retain this skill. After all, they are called in to do their specific job -- to cut open a patient and fix an immediate problem. If a patient requires auscultation, then his or her internist should be able to do this or refer the patient to a cardiologist.

But doesn't it seem like a waste of time, money, and -- well -- medical training to just let a skill atrophy? Would time in medical school be better spent training students in the specific specialties they are interested in? Why bother teaching a student proper auscultation skills if the student is heading into Ophthalmology? I wonder, is there a better way to train our doctors of tomorrow?

In his book, Complications: A Surgeon's Notes on an Imperfect Science, Dr. Atul Gawande writes of Shouldice Hospital in Ontario, Canada. The surgeons there are experts at hernia repairs. That is all they do. Day in and day out, the doctors do nothing else but repair hernias. What may be surprising to most American medical students is the backgrounds of those who operate at this clinic. A few of them have never even completed a surgical residency. But they have trained extensively at repairing hernias. This clinic, Dr. Gawande writes, has a far higher success rate for their operations than any other place in the world. Why? Because they only do one thing, and they do it amazingly. Can this be applied to medical school to cut down on the massive amounts of information that medical students are force-fed each day?

July 30, 2008 by Jeff Wonoprabowo | Comments (16)

My Fair Doctor

JeffJeff Wonoprabowo -- My little sister has been on a classic film spree. She announced to me that she wanted to see all the movies that had won an Oscar for best film. She also bought an Audrey Hepburn 3-Pack DVD that contained Breakfast at Tiffany's, Roman Holiday, and Sabrina.

Okay, I'll admit that I too am a fan of Audrey Hepburn, Julie Andrews, and other great actresses of Hollywood's golden era. They seem to convey so much in the subtle facial expressions or tone of voice -– something that I fail to notice with so much CGI/special effects these days. Well, being the awesome big brother that I am, I used my Netflix subscription to order another one of Audrey's famous films: My Fair Lady.

At almost three hours in length, My Fair Lady is a pretty long movie that traces the journey of a poor flower girl as she is transformed under the instruction of Professor Higgins into a genuine Lady. The process is long and arduous. It's filled with frustration as well as comical moments. The audience watches as Eliza Doolittle sheds tears and then as she recites phrases like "The rain in Spain falls mainly in the plain" or some other nonsense about hurricanes in Hereford and Hampshire trying to properly emphasize each syllable to the professor's satisfaction.

It's sort of like the transformation that is required of medical students. They say medical school changes you. It changes the way you think, speak, and act. It changes who you are. And it’s supposed to do exactly that. It takes the raw material in the form of an eager, optimistic, and sometimes-naive college graduate and transforms it into a newly minted MD who is probably more than just a little nervous about starting internship.

During orientation and registration our school administrators told us that by the end of just the first year we would notice things differently. We would see and hear things through different lenses.

I am kind of surprised at how true that statement turned out to be. There are words and phrases now floating around in my noggin that I never knew existed.

Mnemonics wander idly through my mind. Sometimes I don't even remember what they are for. There are words like "LARP" (describing the path of the Vagus nerve) and phrases like "army over, navy under" (suprascapular artery over and nerve under) and "To Zanzibar By Motor Car" (branches of the Facial Nerve).

Prior to the first year, I had never heard of the phrase "differential diagnosis." Well, on second thought, I did often hear Dr. House ask his team what the differential was. But it kind of flew over my head at the time.

Evidence-based medicine now means something. Before, it just sounded cool. I was a science major. I knew that evidence was good. Now, I still think it's good. But I'm not too fond of searching through the literature for the latest studies trying to determine a link between statins and preventing Alzheimer's disease.

Whenever I go to a restaurant I watch the waiters. Why? Because in Anatomy class I kept hearing about a waiter's tip that can present with injury to the upper roots of the brachial plexus. I still have yet to see a waiter walking around with the so-called "waiter's tip." But it hasn't stopped me from trying to find one.

Wal-mart is no longer just a convenient place to pick up supplies. It's also a great place to pay close attention to customers' faces and gaits. I might be able to identify a walking example of some neurological deficit I learned about in lecture.

As far as medical education goes, I'm just a baby. Or, to tie in with my intro, I'm just starting my training with the good professor. I'm still raw and crude. But even after MS1, I'm glad to report that there's progress.

In about a month, right after Labor Day, my second year will officially begin. I'll try to enjoy my last "free" summer. In the meantime, like Eliza Doolittle, I'll try to faithfully recite the precious tidbits of information that the dear professors have imparted. However, it's probably a little bit harder than talking about rain falling on Spanish plains in that oh-so-elegant British accent.

July 23, 2008 by Jeff Wonoprabowo | Comments (5)

A Thank You Note

JeffJeff Wonoprabowo -- Dear Professor,

Medical school is filled with plenty of defining moments. During my first year, one of those moments was meeting you. I’m not quite sure what word I’d use to describe that time I first met you. Odd? Eerie? Creepy? Awesome? Inspiring? Solemn?

I remember looking at you, a little intimidated. You were the expert in what you were going to teach me. I was a little lost as to what I needed to do. I noticed your wrinkled skin. You could probably tell me a whole bunch of fascinating stories from your lifetime.

A classmate mumbled that you were old. But you looked calm and composed –- not at all like a rookie teacher. It was reassuring. I knew I’d learn a lot from you during the course of my first year.

I remember staring at the muscles of the neck in Anatomy lab. I was confused about which muscles were which. Was this the anterior scalene? Or was that the anterior scalene? If this one is the anterior, then that must be the middle. But wait, what the heck is this muscle here? Staring into a human neck for the first time can be disorienting. And it often only barely resembles the drawings in Netter’s Atlas. I lamented, but you offered no answer. Instead, you remained silent, forcing me to figure it out on my own. And when I finally figured it out, I thought I could make out the beginnings of a smile on your face.

Because I struggled, I remembered. And I did well on that first anatomy lab practical.

The rest of the year followed in similar fashion. I was stuck and confused. You stuck to your teaching method. At least you were consistent. Regardless, you stayed right beside me all along.

I came to accept your method of teaching and even found your silent presence calming -– even if I often wished for you to just speak up and point out what I was looking for.

I just wanted to write this note to say thank you. I’m sorry you will never get to read this. At the memorial service we held for all those who had donated their bodies to our Anatomy program, I sat quietly and looked around. There were plenty of family members there to remember and celebrate their loved ones. I couldn’t help but wonder if your family was there.

Was it that old lady wiping away tears? Was it the young lady who sat proudly as her loved one was appreciated by so many students? I don’t know; I’ll never know.

I never knew your name. But I knew your face. I knew your arms, your hands, and your legs. I knew you inside and out. And I know that you have give 100% of yourself so that I could be a better doctor. Thank you, Professor.

July 17, 2008 by Jeff Wonoprabowo | Comments (28)

It's High School -- With Scalpels

JeffglassesJeff Wonoprabowo -- It’s lunchtime at the hospital cafeteria. Patients stand in line, their IV stands in tow. Children from the pediatrics hospital sit in pillow-lined wagons while their parents pick out food. Doctors, nurses, and other staff members file through the cashier, scanning their cards so as to avoid the hassle of carrying cash. The first year medical students eat and talk about their morning experiences on the wards, some more excitedly than others.

A phone vibrates and its owner chuckles as he reads the text message. And that’s how the lunchtime gossip starts. Or maybe that’s just how the morning gossip transforms into lunchtime gossip. He leans over to his neighbor, who then gladly moves the info down the line. A first year fainted during rounds that morning. Everyone smiles, then desperately tries to find out which one of their classmates fainted and on which service.

A character from Grey’s Anatomy said that the hospital is “high school with scalpels.” That could probably be said about medical school, too.

Watching at least one of the medical dramas on television seems to be a requisite for every medical student -– regardless of how little medicine is actually on the show. When the new season of Grey’s was starting, there were a bunch of my classmates who got together to have Grey’s Anatomy nights. (For the record: I don’t care for E.R., I have no comment on Grey’s Anatomy, Dr. Gregory House fascinates me, and Turk and J.D. never fail to, in the very least, put a grin on my face.)

In medical school you can find the nerds, the jocks, the popular kids, and the bullies. They’re just called by different names. For example, bullies have graduated to being called gunners. The really mean ones have an even cooler name: snipers (as previously written about by Anna here on The Differential). Even the class elections, where interesting promises and platforms can be found aplenty, seem like popularity contests. It’s just tough to grow up.

On the other hand, I’ve heard plenty of stories about the workplace being so much like high school, too. Maybe it isn’t adults acting like teenagers, but teenagers acting like adults. And then we just have a bunch of really mature teenagers in high school. But this is a topic of a whole ’nother post.

The difference between medical school and high school, though, is more than just scalpels. It’s, uh, about… Well, it's like… It’s about learning to save lives!

Wow. Now I’m even writing like a high schooler.

July 9, 2008 by Jeff Wonoprabowo | Comments (2)

Do I Really Want To Do This?

JeffJeff Wonoprabowo -- Throughout the year, one question loomed over me, haunting me like a bad dream: "Do I really want to go through all of this to become a doctor?" It's a question I think is harder to answer now than when I was in college, especially now that I’ve started to see what I am getting myself into.

One day while I was in high school, I was sitting on the couch in front of the television. I’m not sure what I was watching. I do remember my mom calling me away from the tv set. She called me into the living room because she wanted to talk. I found it rather odd; it seemed totally out of the blue. But, I suppose, this shouldn’t have come as a surprise. Conversations with mom sometimes seem, at least to me, to come right out of left field. That evening my mom defied the stereotype that all Asian parents want their children to become a doctor or a lawyer. She sat me down to tell me she didn’t want me to become a doctor. That conversation was in high school.

The thing is, I was never the child who grew up with dreams of becoming a doctor. When my mom found out she was pregnant, she decided that in order to stay at home with me she would have to start her own business. She started a data entry business. As a result, I grew up around computers and decided that one day I wanted a career that involved computers.

But here I am, now a medical student. Although I have only completed the first year, I’m on my way towards earning the right to add the initials M.D. behind my name. Not that I need any more letters; my last name is long enough.

It’s scary, though. I have put myself on a path towards becoming a physician -– a path that is long and quite expensive. Should I continue down this path, I know I will find myself in a very rewarding career with enough money to keep a roof over my head and food on the table.

It's a frustrating journey. There's a ton of information that is force-fed during the pre-clinical years. At times it's a challenge to see how some of it is even relevant to patient care. More than once during my first year, I wondered if I really want to do this. It was almost a monthly cycle; it coincided with exams that came about every five weeks. I hated exam weeks. Actually, I still do. But those were the times when I wondered, considered, and longed for being somewhere else. I enviously think about friends who have finished school and are earning a good paycheck. Then I take a look at the numbers on the statements I receive from my lender. It is always a little shocking to see how quickly those numbers grow. Sadly, the balance of my checking account has the opposite trend.

Yet there are times where I am truly grateful for the chance to be where I am. And there are many more times where I am excited about the possibilities of where I’m headed. Because medicine -– being invited into the depths of patients’ lives –- is exciting. I wouldn’t blog about medical school if I thought it was boring, depressing, and monotonous. On second thought, I probably would. But if you're reading this site, you probably wouldn't be my target audience.

Sure, it can be hard and time-consuming. Obviously it can be very frustrating. But after having spent six weeks in the wards with attendings, residents, and medical students (2 at the beginning of the school year and 4 after), I think I have found a source of inspiration and motivation. It's not about the prestige; I don't think all the training is worth what prestige is left in the profession. It's not about the money; there are easier and shorter paths to earning a decent living. It’s not about being your own boss; the current medical system has made that terribly difficult. It's all about the patients.

And now I think I've found the answer to that looming question. I just hope my answer doesn't get lost in the deluge that will come in the form of my second year...

July 1, 2008 by Jeff Wonoprabowo | Comments (81)

Um... Hello?

Jeffreywonoprabowo72x721_2Jeff Wonoprabowo -- Hello, everyone. My name is Jeff. I don’t think I’ve ever been great at introductions. I’ve always preferred meeting someone while doing something. It seems easier -– more casual. I always cringed when a teacher or group leader insisted that everyone in the room take turns to say hello, introduce themselves, and then say something interesting about themselves. It just felt kind of forced. I remember mentally scrambling for something to say before it was my turn. What can I tell them that is unique about me, but at the same time won’t make me sound like a total oddball?

But I’ll try my best; so here goes. I was born and raised in Southern California. In high school I enjoyed English, history, and Physics. I didn’t enjoy Biology (no interest in plants) or mathematics (didn’t see how it was applicable to my career). During high school, my mom also pulled me aside and told me she didn’t want me to go into medicine because she worried I wouldn’t have time for my family.

After high school, I attended Walla Walla College (now Walla Walla University) in Walla Walla, Washington. When I began college I was a computer engineering major, but I switched majors during my sophomore year. I ended up receiving a B.S. in Bioengineering with a minor in mathematics. I have just completed my first year at Loma Linda University School of Medicine, and I should be graduating from medical school in 2011. In the free time that I do have, I enjoy playing basketball, ping pong, tinkering with my computer, reading, watching movies, and practicing martial arts. I also write on my personal blog at JeffreyMD.com.

It would be foolish for me to think that my experiences in medical school are unique. So many students are currently going through the same things (and a few have been so eloquently writing about it here), and many, many more have gone through it before me. But maybe I can share with you my perspectives on my journey. And hopefully, somewhere in the words that I type, there will be something that will have made the post worth writing and your time worth spending here.

June 24, 2008 by Jeff Wonoprabowo | Comments (26)