The Medical Thread

Here we have a 6 years-long uni course (though it's not at all unusual to take longer because of burn-out, and in fact the average time it takes has grown steadily in the last ten years), and afterwards we do an exam which determines the speciality slot picking order. The speciality training itself lasts 4 or 5 years and from the third one. onward you can start a thesis\phD, which is one possible avenue to get into research (depending on your speciality pick odds are you'll take part in clinical trials anyway), not least because its required to opt for a position in an university. After that comes.... unemployment or migration. Things are not looking good for the medical profession (they're looking even bleaker for the others, but still....)

I'm about halfway through the last course of this year. We're learning about neural diseases and cancer at the moment. It's...fascinating, but very depressing. There's so little we know or can do. It's hard even to diagnose most of the neurodegenerative diseases.

There is this one time I was being a jerk.

My little brother, in a most arrogant way possible, said: "I am a human so I know about my body well enough."

Then I smacked him and said "Then explain exactly how that hurts."

I can't remember what happend before and after that. :/

edited 22nd Oct '12 8:38:11 PM by dRoy

Damn straight that was jerkish. Remembering neural pathways is hard.

He decided it would be easy just to show you and punch you back?

Yeah, it was during my Big Brother Bully phrase.

Firstly, it really wouldn't explain my question. Also, if he did, I would have remembered what happened next.

edited 23rd Oct '12 8:03:38 AM by dRoy

Not if he punched you hard enough...

Okay, this is positively one of the most terrifying things I've seen. I can't even finish.

One of the things I feel very grateful is that I didn't born in time where there was no such thing as anasthetics. Well, maybe old timey people compensated it with a better pain tolerance, I don't know.

Hi guys. I didn't know this thread existed. Boy, I suck.

Stuff from way back when:

• They'll put an expiry date on your meds sometimes, but it's not called a "half-life". That usually refers to the rate at which the drug is metabolised or excreted from the body.
• We try not to use those derogatory terms these days. I'd like to think that we still have a little bit of empathy where our hearts used to be.
• The "Orthopaedics vs Anaesthesia" video: . It's not so much about the difficulty of qualifying for orthopaedics or anaesthesia (the competition is rather stiff, but let's just say that the financial aspect plays a small factor), but it's a perception about how the surgical disciplines tend to know or care relatively less about the non-surgical aspects of patient management, and vice versa. (It's complicated.) In a more general sense, this is the result of overspecialisation taken to ludicrous extremes.
• Dislocated shoulders: Okay, this really depends. If you're a first-timer, it hurts like hell when it pops out, and it usually hurts a little less when it pops back in. However, recurrent dislocations tend to result in chronic joint instability - the shoulder joint is predominantly held in place by your rotator cuff muscles as well as the other muscles of the shoulder and forearm - so you get lax ligaments and occasional damage to the rim of the socket. Those injuries tend to hurt a little less overall, but if it reaches that point, you should really consider surgical repair. (The ankle joint is generally more rigid and held in place by many more ligaments, which is why Yuan's father's ankle dislocation was associated with fractures.)
• Broken sternum... Uh, ouch. Yuan's got that one covered, more or less.
• Heart failure Heart attack HHHHNNNNNNGGG-: Never played Katawa Shoujo. A rough breakdown of the differences in presentation (and yes, they all intersect in one way or another):
  • Congestive Cardiac Failure ("Heart Failure"): Shortness of breath on exertion (or worse, at rest), shortness of breath on lying down ("orthopnoea"), shortness of breath while sleeping, and occasionally waking up gasping for breath ("paroxysmal nocturnal dyspnoea", or PND). That's for left-sided heart failure, which tends to cause pulmonary oedema (or fluid congestion in the lungs). If there's right-sided involvement, you tend to see a raised jugular venous pressure / pulse, congestive liver involvement (sometimes) and lower limb oedema, among other things which I can't recall off the top of my head. (I suck.)
  • Acute Myocardial Infarction ("Heart Attack"): Classically, central or left-sided crushing chest pain radiating to the left arm, neck or jaw, associated with shortness of breath and cold sweats. Atypically (more commonly in women, diabetics, and the elderly): nausea and vomiting, non-specific chest or upper abdominal discomfort, shortness of breath and cold sweats without the chest pain, palpitations, no symptoms at all (a "silent MI"), etc.
  • Arrhythmias: Usually palpitations - usually tachycardias, so fast heartbeats which may or may not be irregular. Sometimes, giddiness / fainting; others, sudden death.
• Knee injuries that prevent people from running fast: The typical scenario would be the Anterior Cruciate Ligament (ACL) injury, which has claimed the careers of many promising sportsmen. As Maddy rightly points out, these are usually sustained through twisting your knee and tearing the ACL, which stabilises the joint. Without surgery, the joint will eventually heal, but if the ligament is torn, the joint remains inherently unstable and persistent strenuous activity may result in arthritis of the joint later in life. You want even more suffering, make it the triad of an ACL tear, an MCL tear, and a meniscal injury - the last one causes the knee to lock up occasionally and hurt when in use, if you really don't want to give your character osteoarthritis yet.
• Genetic diseases: Genetic counselling is usually a good idea if you have any hereditary diseases running in the family. Helps you plan ahead especially if you're thinking of starting a family.
• Blindness: Yuan's got that one covered too.
• Analgesia: I swear by alcohol. Takes the pain away... (I jest, of course.)

edited 3rd Nov '12 1:35:48 AM by Pyrite

^Hurrah, someone who actually knows what they're talking about is visiting this thread!

I think I'm going to refer to all heart failure-attack confusions as HNNNNNNNN Gs now. Also a note that silent M Is, despite being called atypical, are actually very common and a real worry. If only patients could present classically with everything.

Wait, you actually think I know what I'm talking about? At this point, I'm pretty sure you can remember certain parts of Medicine better than I do. (Yeah, not helping the medical profession's reputation at all here...)

(Again: Haven't played Katawa Shoujo.)

It's tricky, because I wouldn't expect the protagonist of Katawa Shoujo to have either heart attacks or heart failure at his age, when he's described as having congenital arrhythmias - logically, you'd expect lightheadedness and palpitations. (It's still possible, I guess, but you'd require a different set of diseases.) Now, if he had cocaine-induced coronary vasospasm, that would fit the picture... but that would be a completely different story altogether.

^Aren't you still a student? Though with any medical profession, I don't think you can say you know what you're talking about until you have at least ten-fifteen years experience...

Joey: I'm pretty sure you know what you're talking about from the nursing aspect of things. Have you graduated yet? (Also, we are not natural enemies, contrary to popular belief.)

For the record: I don't have 10-15 years of experience. And the thing is that when you start specialising, you start to lose the ability to deal with general problems if you don't keep up to speed, which leads to things like orthopaedic consultants who can perform incredible surgery but can't remember how to manage fluctuating blood sugars in the ward.

edited 3rd Nov '12 2:54:54 AM by Pyrite

^Well, if you add up six years of school plus internship, registrar and residency...you're getting close to ten years.

I know you don't have 10-15 years experience, but you have a heck of a lot more than I do.

Hey... somebody say arrhythmia? That'd be me: with borderline POTS (postural orthostatic tachycardia syndrome) and CFS (chronic fatigue syndrome). And, probably facing further heart-related issues as I get older, like my dad's two bypass surgeries thanks to weirdly twisted blood vessels around the heart leading to easy furring. Wooty: we blame Gran and Granddad. Second cousins shouldn't marry if they know they've got heart issues, as they might just compound the problem.

In short, I feel absolutely horrible if I try to move too quickly or for too long. And, I've steadfastly refused to have kids. Wonder why?

edited 3rd Nov '12 3:07:09 AM by Euodiachloris

Fair point.

@Pyrite: I know we are not natural enemies, but as a profession we are different. One of us is dedicated to caring the other is dedicated to curing. We're one, but we're not the same We get to

Carry each other

Carry each other

Ooooonnnneee....

Anyway I not sure I agree with you with genetic counseling. Sure it has the potential to vastly improve treatment and prevention but what about the greater social effects? Case to point Euodiachloris^ decision to condemn his lineage.Good luck with that by the way Euodiachloris

edited 3rd Nov '12 3:55:52 AM by joeyjojo

Oh, come on. It's not like we doctors don't care either... Wait, who am I kidding? (Nah, it's just a personal peeve of mine - doctors will bitch about the incompetence of nurses, and vice versa. It's not healthy, and we can probably get a lot more done if we treat each other with respect and exercise due diligence.)

You're right in saying that genetic counselling is tricky business, mainly because of the ethical issues involved - off the top of my head, insurance would become pretty controversial if you have certain predispositions to cancer, or ischaemic heart disease or diabetes, for example. Even for "clear-cut" situations, e.g. clearly-hereditary diseases, it's rarely simple - what do you tell a couple who both have, say, sickle-cell trait and the wife is 3 months pregnant?

I personally believe that patients should be equipped with the right information to make their own choices, hence genetic counselling. But it's what we do with said information that's the problem.

edited 3rd Nov '12 4:10:43 AM by Pyrite

^^Have you come here for forgiveness? / Have you come to raise the dead? / Have you come here to play Jesus / to the lepers in your head?

I think one of the big differences between nurses and doctors is time. Doctors might spend fifteen minutes with a patient in a consult. Nurses are with patients in nursing homes and hospitals all the time. That's an amazing thing to do.

Did I ask too much?/More than a lot./You gave me nothing,/Now it's all I got

I could be a smart arse and say the biggest difference is pay, but it really is having the time to get to know and care for your patients.

All decent doctors care about their patients Pyrite. But it's not their job to care for them. It's their job to cure them. Which is just as important, and takes a degree of emotional distant.

That much is true, I guess. I have nothing but respect for competent nurses who can establish a good rapport with their patients. Sadly, you don't see many of those these days.

Alas, I tend the find the older nuses are the worst in that regard. Empathy is a finite resource I guess..

How is things going for you anyway. Is the Army starting to look good yet?

Why not spot the problems and head them off at the pass? Of my Gran and Grandad's grandchildren, two of us have CFS/ME, another one has other heart-related problems (and, possibly, unrelated Spina Bifida, although that won't have helped the thoracic side of things, either) and another has Crohn's. Out of seven of us from three children (one of which suffered multiple failed pregnancies). That's not good going. Oh... and one has SAD, but that might be related to the other side of the gene-pool.

Oh... and I'm female, thanks.

PS — None of those conditions are doubled up and found in only one person, by the way.

edited 3rd Nov '12 5:17:12 PM by Euodiachloris

Hell yeah, Pyrite!

Now this thread is more awesome by 200%.

Ooh, I see. Thanks!

edited 3rd Nov '12 5:33:35 PM by dRoy

@joey: I don't know whether a doctor's job is necessarily to cure. A lot of the time, it's trying to relieve suffering and improve quality of life (though in a different way to nurses, it must be said). Especially for geriatricians, palliative care specialists and neurologists - there's not a whole lot you can do, in terms of curing patients. Likewise, my parents, who are GPs, can't really cure the chronic conditions of their elderly patients, but the patients really value my parents doing home visits and managing their care.