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SMS Unplugged

Aging, Global Health, Medical Education, Patient Care, SMS Unplugged

After the rain: Experiencing illness as a medical student and granddaughter

After the rain: Experiencing illness as a medical student and granddaughter

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

rainy groundIn India, when the first heavy droplets of rain meet dry earth it releases a particular kind of smell: a dampness arising from sizzling soil that in Bengal we call shnoda gondho. It is raining on the second day we go to visit my grandfather in the hospital.

He has been readmitted to the hospital, after spending a week recovering at home from a hospitalization for rib fractures and bleeding into his lungs. The irony of his hospitalization is not lost on his family: that a renowned doctor, one of the first cancer surgeons in the city of Kolkata and one who spearheaded oncological care in this region, is now gowned and sitting in a hospital bed. This happens frequently, of course, for doctors are not immune to being patients, even if we would like to think so. The problem is that we are little prepared for the unstructured, unscripted nature of experiencing illness rather than treating it.

Certainly for my grandfather, a man who even recently traveled to multiple hospitals each day to supervise surgeries and see patients in clinic, being confined to bed for respiratory treatments and being unable to walk without support feels equivalent to being bound up, tied down, and chained to the hospital. This is the way illness imprisons. For his family, used to seeking his wise medical advice on various things from pesky coughs to unremitting cancers, we are unprepared to now help make decisions for him.

We never stop being medical students, and later we never stop being doctors, whether in relationships with family members, friends, acquaintances, or strangers in emergency situations

Perhaps this reflection is too personal for a forum created for sharing medical school experiences. But I suppose my realization is that medical school is not a place but rather a privilege we hold. We never stop being medical students, and later we never stop being doctors, whether in relationships with family members, friends, acquaintances while traveling, or strangers in emergency situations.

But, as I spend these three weeks with my grandfather and my family in Kolkata, I find that it is important to play both roles: that of medical student, the one who can help translate the staccato of medical jargon into fluid lines, and that of loved one, the one who listens not via an earpiece through the taut drum of a stethoscope but through bare ears and naked eyes, the one who listens for and is moved by the cries of pain, or suffering, or confusion, or desperation, of the ones they love.

In many ways the loved one is the harder role to play, for it is the role with no lines. No chest x-rays to evaluate in the morning. No medications to re-dose for a rising creatinine. No growing charts of oxygen saturation, or heart rate, or urine output. As someone who has recently grown used to doing these things on the medicine wards of Stanford Hospital, I now acculturate to a more improvisational kind of care. Placing a soothing hand on an aching back. Sitting at someone’s bedside while he nods in and out of sleep. Holding down an arm so that it doesn’t tremble like the string on a harp. In Indian hospitals, the family must often arrange to bring the medications that the doctors have prescribed and may often visit the hospital multiple times a day to bring food. We mix rice with soft, curried vegetables or boiled eggs and offer them to our loved ones, hoping to find through these labors some connection, some solace.

As family members we grasp for metaphors. In India, these metaphors of illness are often built around ideas of hot or cold, of water or wind. Perhaps that is why I find it so poignant that it rained today, the dense, gray clouds releasing their water just as the water from the pleural effusion in my dadu’s lungs was drained.

I hope that one day soon, when this rain had cleared, my grandfather will write his own words as he has planned to do. And then he can tell you his story, not I.

Amrapali Maitra is a fifth-year MD/PhD student working towards a PhD in Anthropology. She is interested in the illness experience, the cultural and social basis of health, and practices of care.   Amrapali grew up in New Zealand and Texas, and she studied history and literature as an undergraduate at Harvard. She is a 2013 Paul and Daisy Soros Fellow.  

Photo by Jason Devaun

In the News, Medical Education, Medical Schools, Research, SMS Unplugged

Research in medical school: The need to align incentives with value

Research in medical school: The need to align incentives with value

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

7336836234_05b7e59045_zIt is a truism of American medical education that students should do research. Stanford medical school’s website espouses a “strong commitment to student research,” because it makes us “valued members of any medical field.” A similar message can be found at almost any other institution. It’s not just medical school either. Many undergraduate programs tout their research offerings for pre-medstudents, while residencies and fellowships often encourage their trainees to pursue investigatory projects.

There are several reasons for the emphasis on research in medical training. One obvious explanation is that schools want to prepare students for a career in academic medicine, through which physicians can combine scientific discovery with clinical insight to drive medicine forward. More broadly speaking, research is a way to develop analytic and critical thinking skills. These abilities not only help students better understand disease – they teach us how to read and interpret scientific literature to keep up to date with the latest advances in the field.

I believe in the value of engaging in research, but I recently came across the work of two prominent academic physicians who question whether it accomplishes these goals. The first is Ezekiel Emanuel. While he may be best known for his work on the Affordable Care Act as a special advisor to the White House, Emanuel’s background is in academics. After completing an MD/PhD at Harvard, he stayed on as an associate professor; he’s now a vice provost and professor at the University of Pennsylvania.

In his book, Reinventing American Health Care, Emanuel discusses how to make medical education more effective, and he specifically targets the research paradigm as an inefficiency. Whether or not it is explicitly stated, many top-tier programs require their students to do research in addition to their clinical training. To Emanuel, this constitutes “exploitation of trainees for no improvement in clinical skills.” He argues that eliminating such requirements can streamline medical education and boost the physician workforce. The physician shortage is one of the most discussed problems in health care. Trimming the length and cost of training can help address it. Reducing research requirements would allow students to prioritize their clinical work or other relevant interests.

“Exploitation” is perhaps an overstatement, but Emanuel addresses a legitimate concern about whether students’ time is best spent on research. And findings from researchers like Stanford’s John Ioannidis, MD, amplify the concern.

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Medical Education, SMS Unplugged

Top 5 reasons medical students should do community service

Top 5 reasons medical students should do community service

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Arbor Free ClinicAs the process of applying to medical school, and then later residency, becomes hyper-competitive, us medical students often feel forced to pursue our passions only in ways that are “high-yield.” It may seem counterintuitive, but the further we go in our medical training, the more inertia we seem to have about giving our time and energy to the every day people in need. We’re so pressed for time from our participation in cutting-edge research, highly scalable health-policy work, and exciting start-ups, that we sometimes lose touch with the very people whose need first sparked our commitment to medicine.

We all know that helping people is the right thing to do. I don’t need to wax on about how we can be the people we want to be – how it’s a choice. This post is for the moments when we succumb to focusing solely on our resumes and our future applications. This post is about how using our skills as medical students to help people will actually help us professionally. It’s like when companies align their triple bottom line. We can do that, too.

And, so, the reasons:

1. To get individualized mentorship. The free clinics run by medical students have doctors who walk one or two pre-clinical students through the entire patient encounter – from taking the history to doing the physical to presenting the patient. This kind of one-on-one training is very rare.

2. To practice applying clinical skills. As a pre-clinical student in a free clinic, you actually get to do a physical exam on real patients rather than actors pretending to be ill. You get to work through a real-life clinical reasoning case and generate a differential.

3. To remember why you wanted to go to medical school. Medical school can be really hard, mostly because it may be the first time that you’re surrounded by peers who work just as hard as you do. But get back in touch with the desire to help people, which is what brought most of us to medicine in the first place, and you can replenish your sense of purpose as a medical student.

4. To figure out what you like clinically. Most of us are either honest with ourselves about not knowing what kind of medicine we want to practice or fool ourselves into thinking we know what we want to do based on a few shadowing experiences. Either way, getting involved and taking an active role in patient care can help you determine whether you like cardiology versus neurology, or it can solidify the hunch you already had.

5. To get a leg up when applying to residency. A Harvard surgery resident recently talked about what gave her an advantage when she was applying to residency; her answer was both research and her involvement in free clinics. She said that because she worked in a free clinic every Thursday evening doing diabetic foot exams, she was more comfortable in a clinical setting, she was more self-guided as a clinical student, and therefore, she was more competent when she did her sub-I’s.

Most medical students have a competitive streak. When you do something, you want to be good at it. So set yourself up to be good at your clinical rotations. Set yourself up to be taken seriously as a doctor whether you plan to pursue research, policy, or entrepreneurship. Set yourself up by volunteering in your community’s free clinics.

Natalia Birgisson is a second-year student at Stanford’s medical school. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.

Photo courtesy of Arbor Free Clinic

Medical Education, Patient Care, SMS Unplugged

An introvert in medicine: Taking the plunge

An introvert in medicine: Taking the plunge

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SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category

Does the profession of medicine favor certain personality types over others?

When I was younger, it seemed like all of my doctors were gregarious, self-confident, and humorous, leaving me to wonder if one can “make it” in medicine without being outgoing. This seemed a natural consequence of the fact that so much of medicine is team-based and demands constant interpersonal interaction with colleagues and patients. For many introverts, a career in which a substantial amount of time is spent interacting with complete strangers — often in a deeply personal context — might seem like an odd choice.

Indeed, my experience in medical school so far has lived up to this idea in many ways. Group learning has been a fixture of our curriculum since day one, as has the fabled tradition of being put on the spot and quizzed by teachers in front of peers. Networking is still the preferred method for finding research opportunities. And the famous learning philosophy of “see one, do one, teach one” has been jarring for me as somebody who likes to take time for deliberation and reflection — a bit like being pushed out of an airplane at 10,000 feet.

All of this would suggest that extroverts might be at an advantage during medical school. And yet, it’s undeniable that a great many people who do not identify this way survive, and even thrive, in medicine, suggesting that there is hope for the rest of us.

For me, one of the most helpful aspects has been the formation of strong relationships during school. Having slowly built my own “team” of classmates, faculty, and mentors over the last several months, the pressure of the more challenging moments of medical school has been eased by our mutual respect and understanding. Being pushed out of the airplane isn’t so bad when you’re strapped to an expert skydiver who is looking out for you.

Sometimes, though, it’s not possible to rely on those relationships. When I have only a few minutes to perform a full exam on a new patient, I’ve had to learn to trust my own strengths. I might not win over patients with personable charm and witty humor, but I’ve found that a warm, but quiet, steadiness can achieve a similar level of connection. I’ve been encouraged to find that there are many different ways to make the personal connection that allows us as doctors to improve the health of our patients.

In fact, this has been one of the most important lessons that I’ve learned so far: learn from others, but don’t feel like you need to be just like them. Instead of worrying about whether I have what it takes to become that funny, charming doctor I had when I was growing up, I’ve begun to chart my own path. This takes time, support, and even some discomfort – but then, like jumping out of an airplane, who ever said that learning to be a doctor was easy?

Nathaniel Fleming is a first-year medical student and a native Oregonian. His interests include health policy and clinical research.

Photo by Lachlan Rogers

Medical Education, SMS Unplugged

Why does “just doing medical school” feel like it’s not enough?

Why does “just doing medical school” feel like it’s not enough?

stethoscope on book - 560

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

A friend from home came to visit me a while back. I hadn’t seen this friend in years, so we traipsed off campus, to a café I love, and nursed our lattes as we caught up on each other’s lives. She told me about her recent travels, highlights from her college years, her plans for the next several months and more. And then she turned to me and asked me what I was up to these days. I described what my typical day was like – workout, go to classes, study, repeat.

When I was done, she asked – “So… outside of med school, what else are you involved in at Stanford? Start-ups? Student organizations? Research?”

I felt a slight flush come over my cheeks and found myself saying, almost sheepishly, “I’m mostly just focusing on med school.” Just. Just med school. 

We continued our chat, but when I came home later, my thoughts wandered back to that “just” and why I felt so guilty about not having many outside commitments in medical school.

I knew part of it was the knowledge that I had never been a one-task kind of girl. In high school, there was debate, science Olympiad, Indian classical dance, and more. In college, there was Camp Kesem, a fusion dance team and research. I poured hours and hours into each and every one of these activities, but something in me shifted when I came to medical school.

That mental transition was and continues to be such a difficult one for me. I know Stanford is an incredible place – with start-ups blossoming every which way and the word “innovation” being uttered somewhere on campus every minute (probably not an exaggeration). Everyone around me seems so impressive – with multiple research publications, various awards to their name, travels abroad to assist with surgeries, and so on. Don’t get me wrong, I love this passion at Stanford, this drive to change the world – it’s why I came here, and why I hope to stay here as long as possible.

But it’s also easy to look at every other person and wonder how they’re doing it all, and more than that, wonder why graduating  not only with an MD (after all, everyone in the class gets one of those!) but also a string of additional achievements, feels like the baseline expectation for med students.

In just a few weeks, my classmates and I are going to be done with our pre-clerkship years and those of us who aren’t taking one or more research years (myself included) will directly transition to clerkships. I can’t wait to spend hours speaking with patients, working in a team to figure out diagnoses, and brainstorming treatment plans. I can’t wait to experience that excitement when I realize what aspect of medicine I want to practice for the rest of my life and feel that puzzle piece slide snugly into place inside me.

And I can’t wait for the moment when I can leave out the “just,” to see that same friend and happily say, “I’m mostly focusing on med school. And I wouldn’t change a thing.”

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo by Dr.Farouk

Health Disparities, Health Policy, SMS Unplugged

Minimum wage: More than an economic principle, a driver of health

Minimum wage: More than an economic principle, a driver of health

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Gallegos minimum wage sketchI admittedly don’t understand much about the intricacies of economics. But I don’t have to in order to recognize the significance behind Wal-Mart’s decision to raise the minimum pay for its lowest paid hourly employees. In the week following the company’s announcement, plenty has been written about the impact that such a move will have on the company’s success and on local economies. It goes beyond that, however. What I see is the impact that an increase in income can have on the health of working individuals making a minimum wage.

Let’s do some quick math. Current guidelines list the poverty level at $24,250 for a household of four. Federal minimum wage is $7.25/hr. A full-time employee earning minimum wage therefore brings home $15,080. The working class individual, whose spouse stays home to care for their two children since childcare is unaffordable, incredibly falls $9,170 below the recognized poverty level.

This April, Wal-Mart will increase hourly pay to $9.00 and follow this with an increase to $10.00/hr in February 2016. Even then, a family of four with only one working parent will still fall more than $3,000 below the federal poverty level. Yet, the true hardship of poverty can’t be quantified so easily.

What can’t be measured is the stress that surrounds a working family’s paycheck – especially in matters of health. The difficult decision that my patient makes to skip work in order to bring their sick child to clinic, sacrificing a day’s pay, and – worse – their job security. Weighing feelings of worry for their ailing child against the stress of providing financially for the family. Or my patient who struggled through an upset stomach because she couldn’t afford both the medication and the food that she should be taking it with. Choosing health while enduring hunger.

A raise in minimum wage has direct impacts on health. It means the ability to deal with an unexpected expense without risking basic living standards like food, shelter, and transportation. It means having the luxury of buying fresh peaches instead of canned fruit. It means having a warm coat and shoes for winter. It means buying that prescription that’s been pending for months. It means securing the monthly bus pass to get you to work in the first place. For many, however, even the near 38 percent raise announced by Wal-Mart will not lift their families above the federal poverty line. In a situation where pennies and dimes add up, there will still be a significant deficit that will continue to make it improbable (read: impossible) to earn a way out of poverty.

Countless articles can be found online and in print about the need to increase minimum wage. Recently in the political sphere was a push for a $10.10 minimum wage under the Harkin-Miller Bill (Fair Minimum Wage Act). Unfortunately, the bill didn’t pass the Senate. While the bill may not have represented the necessary increase, it was an acknowledgement by some of the direction we need to take- and not just for economic purposes. We must recognize that reductions in financial hardship through fair wages provide a pathway for addressing health disparities and improving health outcomes.

Moises Gallegos is a fourth-year medical student. He’ll be going into emergency medicine, and he’s interested in public-health topics such as health education, health promotion and global health.

Sketch by Moises Gallegos

Patient Care, SMS Unplugged, Technology

Why technology won’t destroy the doctor-patient relationship

Why technology won't destroy the doctor-patient relationship

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

doctor in iPadMany aspects of medicine have changed over the course of human history. Schools of thought shifted from humorism to evidence-based medicine, while the standard of care evolved from bleeding to our modern cornucopia of interventions.

Yet across centuries, the doctor-patient relationship has remained relatively constant – a physician would physically interact with the patient and then come to conclusions on how to treat him or her. However, new technologies and innovative delivery models have begun to erode this cornerstone of medical practice, raising questions about whether they are ultimately helpful or harmful.

I was first introduced to non-traditional models of medical care the summer after my freshmen year of college. I worked with a doctor who has an extensive background in telemedicine, which broadly implies the use of technology to expand access to medical care. In practice, that might mean seeing patients via videoconference, having patients take pictures of lesions, remote monitoring, or a number of other applications. Moving forward, it may even allow patients to conduct their own physical on a smartphone.

Inspired by my experience, I started to explore other ways we can reach patients without bringing them into the doctor’s office. One strategy is to use social media to engage patients. Another is to make use of retail health clinics – clinics in shopping centers or pharmacies that are equipped to handle one-off, minor medical complaints. (If you’re interested, I have written in more detail about each of these models here, here, and here).

Almost invariably, the first criticism brought against these strategies is that they’ll interfere with the doctor-patient relationship. It’s true that they can influence the dynamic between a patient and physician and should be evaluated carefully. But in my experience, critiques tend to overlook three major aspects of technology that actually improve the doctor-patient relationship.

First, new tools in health-care delivery don’t replace the physician with a technological brave new world. To the contrary, they create a doctor-patient relationship for patients who otherwise wouldn’t have a doctor at all. Many of these tools are targeted towards patients who live in underserved communities and give them an effective way to communicate with a doctor.

Take rural populations as an example. Suppose a patient has a condition that requires a specialist consult. Do you think the patient would rather: (1) take a day off from his or her job and drive three hours to a tertiary care center; or (2) remotely connect with a specialist who can clear up the problem? Most patients would likely prefer the second scenario, and may defer care if they don’t have that option.

Second, the doctor-patient relationship is especially relevant to patients who have complicated medical issues. If patients are able to handle minor complaints outside of the doctor’s office, physicians will have more time to spend with the patients who need the most help.

Finally, these approaches empower patients to take responsibility for their own health. Once again, let’s consider this in in the context of an example. One common stereotype in medicine is that of the non-compliant patient – maybe someone who has high blood pressure, high cholesterol, etc., but doesn’t take his or her medication, make diet modifications, or exercise. At present, a doctor might require this patient to come in for a check-up every few months. And yet nothing changes.

But if the doctor gives that same patient the tools to monitor their health on a day-to-day basis, the patient may take on a greater sense of ownership for their well-being and start making some changes. As medical students, we regularly hear that we’re in an era of patient-centered care. Technological tools that give patients more health information don’t hurt the doctor-patient relationship; they serve as another means to connect us.

Medicine is a constantly evolving field. New strategies have the potential to change the way we practice. But it’s worth remembering that a different doctor-patient relationship can be a better doctor-patient relationship.

Akhilesh Pathipati is a second-year medical student at Stanford. He is interested in issues in health-care delivery.

Photo by NEC Corporation of America

Pain, Patient Care, SMS Unplugged

Comfort care: “We always have something to give”

Comfort care: "We always have something to give"

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

15952622460_20fb32e76a_z A hospital can be full of discomfort. My patients tell me that the food is unappetizing. The beds hurt their backs. The noise echoing through the hallways at night makes it impossible to sleep. And for those patients near the end of life, the treatments being offered may no longer be of benefit, causing more pain than good.

The answer to discomfort for those who are very ill is comfort care, the use of palliation when life-advancing measures are no longer indicated or desired. These measures include things like giving morphine to dull the pain and ease the breath, applying lip balm over cracked skin, offering ice chips to revive the mouth, adjusting blankets or fans, deciding not to press on someone’s chest, to stifle their airways with tubes, if their status declines. The decision to turn to comfort care often means that a patient can receive a private room in the hospital for family to stay close, to feel sunlight through a window. The triumph of comfort over the many indignities of being away from home.

Death does not need to happen in a hospital, yet too often it happens here. In January, I saw two people die. One was old. He had lived a full life; his room was decorated with photographs from his youth, his tall form in a service uniform, or in a tuxedo on his wedding night, half-cropped face suspended in a laugh.

When I met him, he was on a morphine drip, no longer able to speak. To gauge the adequacy of his pain control, we looked at his heart rate, his blood pressure, scouring for signs of bodily agony. He was tucked into a warming blanket, yellow hospital socks on his feet. Every morning we circled around him, whispering hello into the room where he slept, taking stock of the fluorescent etches of the vital signs monitor, the coolness of his legs.

When he passed, we pronounced him after checking for a pulse and listening for a heartbeat. I felt solemn, but also grateful for his smooth passage.

The second person I saw die was young. She had been full of life and her death ripped up all those who loved her. As she became more ill, and more confused, her family made the brave decision to transition to comfort care. There was nothing gratifying about it, her loss was unspeakable. But perhaps the final moments, free from the blinking of machines, the infusion of drugs that upset her bowels and irritated her veins, carried a dim current of peace.

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Health Policy, Medical Education, Patient Care, SMS Unplugged

The downside of a free lunch: Incentives and the medical student

The downside of a free lunch: Incentives and the medical student

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

money on hook  smallDoctors are people, too, and they respond to incentives. That was the message we got from a recent health-policy class session that discussed various ways of paying doctors for their work, and how this can play a role in patient care. In an ideal world, physicians would be motivated only by what is best for their patients; however, the reality is that doctors, like all people, can be influenced by external factors such as money, autonomy, and time.

This got me thinking about the incentives that currently shape my life as a medical student. While we would all like to say that the choices we make are determined only by our own internal desire to maximize our learning and become the best future physicians possible, even the most idealistic student among us would have to admit that incentives, big and small, influence our decisions every single day.

On a day-to-day basis, incentives determine how we budget our time and focus our efforts. For example, given the huge demands on our time and our budgets, the promise of a free lunch provides a strong incentive for us to attend lunchtime seminars and panel discussions – even if the subject matter is not of immediate interest or relevance to us.

In class, because of the Pass/Fail grading system during our pre-clinical years, our external incentives are not our class grades, but instead the standardized board exam that will play an important role in our residency applications. Our collective ears perk up every time our professors say “This always shows up on the boards,” even if we are told that the particular information is rarely (if ever) applied in real-world clinical practice.

In the bigger picture, as we begin to explore various specialties and avenues for practicing medicine, it is impossible to ignore the reality that average salary, lifestyle, and autonomy vary hugely from one specialty to the next, and from one type of practice to another. Not feeling very passionate about private-practice urology? Does that change when you find out that urologists make about twice the annual salary of a family medicine doctor?

The reality is that our intrinsic motivations to make the world a better place by becoming the best possible physicians do not always align with the incentives that medical school, and the larger health-care system, provide. We are incentivized to spend time and effort on things that will not help us be better doctors, and in the long run we might even be incentivized to make decisions that will reduce the amount of good we can bring to the world. Is it the job of policymakers and medical educators to better align incentives to create the desired outcomes for our health-care system? Or do we, as future physicians, need to shoulder more responsibility to do the right thing, passing up the literal and figurative “free lunch” in the process?

Maybe there is an ideal middle ground for each of us – a place where the incentives align at least reasonably well with our own internal goals. In that case, one of our tasks as medical students for the next several years will be to find it.

Nathaniel Fleming is a first-year medical student and a native Oregonian. His interests include health policy and clinical research.

Photo by Tax Credits

Infectious Disease, SMS Unplugged

The bacteria that nearly killed my grandmother

The bacteria that nearly killed my grandmother

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Staphylococcus aureauMagnification 20,000“Hefur þú lært um Staphylococcus aureus?” I almost don’t recognize the bacteria name because my grandmother pronounces it differently in Icelandic.

“Já–” I’m about to translate my microbiology flashcard for her when she interrupts, her hands busy kneading the cookie dough and her eyes on my little sister near the oven.

That’s the bacteria that almost killed her eleven years ago, she tells me. I can hear her words building up. This is a story that has been waiting to be told often enough to be reconciled.

They did not know what was wrong with her. They thought maybe cancer, maybe tuberculosis – and I almost interrupt her story to tell her about Pott disease. That’s when tuberculosis from the lungs goes through the blood to the vertebrae and causes back pain, fever, night sweats and weight loss. I memorized the flashcard a few weeks ago.

My little sister stops doing handstands in the middle of the kitchen and comes to stand next to my chair. Together we watch Grandma roll the cookie dough as she continues talking.

It took the doctors a whole long time to figure out what was wrong with her. In the meantime, she was in so much pain from her back that she had to be on high doses of morphine. Codeine.

She could hear them yelling at each other in the next room, my great uncle and the other doctor. The two internists had very different approaches. My great uncle wanted to identify what was going on before putting her up for surgery. The other doctor yelled at him that he was going to wait so long the woman would die.

My grandma stops her cookie cutting and sits across from me. She looks at me for a moment over her glasses and tells me how terrifying it is to know that your doctors don’t know what’s wrong with you.

My poor great uncle, I tell her – he was just trying to make sure that they didn’t make you worse by operating.

My grandma nods and describes how when they finally did agree to have her undergo surgery, my great uncle called the best surgeon in town and had him come back early from vacation to operate on her the next day. And good thing too, for when they did, they found that three of her vertebrae had been turned to dust.

With an infection like that, the surgeon said she was hours away from death.

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