Monday, February 1, 2010

As I Chew Off My Tongue In Silence or Please Let This Be a Bad Dream

Today we were doing EKG's on each other and starting talking about our upcomming OCASE (basically it is clinical exams with actor patients who pretend to have various ailments). You go through 12 stations and have no idea what you'll be faced with (as we've covered about 20 examinations/histories).

I was with a small handful of my group members (i.e the 10 people that I spend 8 hours a week with in tutorial and clinical skills sessions) and we started discussing how twisted the sense of humor is with the faculty here. For example, apparently last year one of the stations during the exam consisted of one of our very esteemed the senior professors (and assistant Dean) sitting at a table with a giant red dildo on it and the station was to explain how to put a condom on and safe sex teaching.

Imagine a guy you see every day in a 3 piece suit that you only run into at big med events and you, in your exam nervousness, having to put a condom on a dildo for him. Cruel. Evil. But the twisted part of me gets a chuckle out of how genius it is.

Anyway in this discussion one of my group mates pipes up:

Classmate: Oh I didn't listen to any of that lecture on sexual health because I won't ever have to explain to a patient how to put a condom on, so it didn't apply to me.

Me: Oh yeah, why is that?

Classmate: Because I am only going to provide information on NFP in my practice.

Me (thinking--'NFP' is going to stand for something irritating so I shouldn't even ask...): NFP?

Classmate: Natural family planning. I don't condone the use of condoms.

*Curtain Drops*


OMDG said...

Some people are very weird. Was it a he? It must have been.

Albinoblackbear said...

No dude. She.

OMDG said...

I had a friend who once told me that she used NFP because if she were to get pregnant by having sex before marriage, she would deserve it because that is a sin.

Good thing she never got knocked up by accident.

Too bad her sister did. Twice.

I mean, I know there are wackos everywhere, but do you think this is partially due to going to med school in a Catholic country?

Dragonfly said...

Well if she is going into OB or GP (assuming Ireland does it similar to Australia where GPs do a fair amount of the prenatal care - and very well), she will get a lot of business from it!
But seriously, NFP? Seriously?
I once read a defense of it saying that "families who practice NFP tend to only have on average 5 children anyway". I contend that this is because marital relations cease out of sheer exhaustion (possibly the only time abstinence only birth control really works - when people already have more children than they are able to handle). Some people want a 5 child family and do awesomely with it. But not all. Also, in places like Yemen women have an average of what, 13 children each? (No family planning may be different to NFP but STILL).
Sorry, rant over.

Bongi said...

it shouldn't be about what she condones. it is about good medical practise. the natural method is ok if you are pretty darn clued up but will not work for most people because they are too stupid.

i wonder when someone like that uses the premise of being a doctor to force her personal or religious views on patients. it's like becoming doctor and advertising yourself as a doctor but then prompting alternative medicine or homeopathy. i see it as dishonest. is she going to become a doctor or is she going to become some crazy religious zealot cleverly disguised as a doctor.

Albinoblackbear said...

OMDG--Interesting take on pre-marital conception...hehe. And sadly, no it is not due to the Irish influence, she's a Canadian.

DF--I think your hypothesis on the 5 child number is probably right. I know I'd sleep in a separate room from my husband if I'd sprung forth 5.

Rants allowed here. Encouraged even.

Bongi--This was precisely my problem with her comment. I have no problem if people have strong religious beliefs (in fact I think it is great to have a moral compass--and if yours comes from religious conviction then go for it).

My problem is that I think ignoring part of the medical curriculum because you don't *condone* it is academically irresponsible.

As a medical practitioner, patients will be seeking you out as the expert--so what if one of your God fearing patients' husbands contracts HIV from a blood transfusion* are you going to suggest the 'pull out' method for protection to the wife? Or just abstinence for the rest of their married lives?

Like you said, if you are going to hang a shingle saying "MD" outside your door you will need to accept the fact that during your career you'll see things, hear things, explain things that you are uncomfortable with or don't agree with.

It doesn't mean you have to perform abortions or prescribe the MAP, but you have a duty to provide your patients with evidence-based answers to their questions about BASIC PUBLIC HEALTH practices, and direct them to an appropriate care provider.

*Not a made up scenario to illustrate a point, this actually happened to a close friend of mine.

Ryan said...

God have mercy on our children's souls. You should have said "me neither because I only condone hand jobs as a method for birth control."

Albinoblackbear said...

Ry--I wish I had thought of that response. hahahaha

I had a momentary flash of all the things I wanted to say and then decided that it was not the mountain I wanted to die on. I've got 4 years with this woman after all, and she does have the right to open a practice in Nevernever land if she wants. :)

Rogue Medic said...

NFP - No F'n Plan. Maybe they'll be naming the kids like hurricanes. Alphabetically, so that you can figure out where they are in the birth order. What comes after 27. Double A is easy, a nice religious name - Aaron, but Double B? After 27 there might be some stuttering.

Why do we assume that things religious are moral? With all of the encouragement to stone people for embarrassments, we could just as easily come to the opposite conclusion. Correlation does not equal causation.

Albinoblackbear said...

Rogue--I agree (and nice nomenclature system BTW.)

NFP could also be, No F'n Point.
No Flaccid Penis. Nubile Female Please. Naked Farmer Penetration.

Oh dear, I better stop now I sense a downward spiral of smut.

Rogue Medic said...

Rogue--I agree (and nice nomenclature system BTW.)

I'll bet you say nice nomenclature to all the boys.

I forgot that the nomenclature would actually be more likely to go to Aa, Ab, Ac, rather than Aa, Bb, Cc. I am so embarrassed.

NFP could also be, No F'n Point.

Good point. ;-)

No Flaccid Penis.

But flaccidity would be much more effective contraception.

Nubile Female Please.

You had me at Old, prudish, and curmudgeonly.

Naked Farmer Penetration.

. . . she types with a sheepish grin.

Oh dear, I better stop now I sense a downward spiral of smut.

As opposed to an upward shaft of purity?

The local culture is growing on you. I sense a Limerick forming.

Lorelei Armstrong said...

There's plenty of wacky everywhere. I asked my doctor for a trial prescription of Lunesta for my insomnia. Her response? "I don't believe in insomnia."


Albinoblackbear said...

Lorelei--Case in point! Wow. That is um...rude.

She clearly missed the "validate the patient's concerns and explore treatment options" day of medical school!!!

As an insomniac, I believe!

Rogue Medic said...

Insomnia is something that only affects people who have trouble sleeping, so many people who do not have this problem will doubt its existence. It ain't fibromyalgia, folks. People fall asleep at the wheel. Some of them die, and it is probably not good for your insurance rates, if you survive.

Nah, they probably just have Sleep Munchausen's.

Lorelei Armstrong said...

I must have given her my extra-crazy insomnia look, because she did write me a script for Lunesta, which promptly kept me up all night long. Less entertaining than Ambien, which gave me amnesia until lunchtime the next day.

Albinoblackbear said...

Rogue--"sleep Munchhausen's". Hilarious.

One of the few times I actually slept on my break during night shift was when I was studying for the physics section of the MCAT (go figure). I was sitting upright in a chair with one leg on the desk and *BOOM* out like a light.

Maybe I'll try that the next time I am wearing a hole in my carpet during the middle of the night.

Lorelei--"I must have given her my extra-crazy insomnia look" hahahaa. Nice. I know that look. I get it after 6 12h night shifts in a row.

Ever try zopiclone?

Ambien makes me legless and I usually wake up when it wears off.

Lorelei Armstrong said...

I have a nice benign facial tic below my left eye that makes me look crazy if I don't blink. Grrrr... She prescribed just to get me out of her office, I think.

So would zopiclone work differently than Lunesta? Wishful thinking, really. My new insurance doesn't cover any prescriptions.

Albinoblackbear said...

Apparently the two (eszopiclone and zopiclone) have not been studied "head to head" to compare the differences in side effects, efficacy,etc.(according to the always accurate and reliable Wikipedia). :)

Very similar drugs--one is a mixture of two molecules the other is pure, zopiclone has slightly higher amount of the active substance. So yeah, likely the same in terms of pharmacology.

Bummer that neither ambien or luensta work for you.

Lorelei Armstrong said...

Well, the good news is that insomiacs at least have one reason to look forward to dropping dead someday. There's always a bright side!

Albinoblackbear said...

Hahahaah, I hadn't thought of it that way before.

Rogue Medic said...

My drug of choice is diphenhydramine, the generic of Benadryl. It is cheap, over the counter, and can be safe and effective. Many sleep medicines contain diphenhydramine as the sole active ingredient.

Unfortunately, some people have significant side effects. The side effects usually are exactly the opposite of the sedating effect that you want, such as agitation and delirium. For most people, these effects are only present with large doses, but a friend of mine cannot take even a partial dose of diphenhydramine without experiencing agitation. That is an uncommon, probably rare, reaction - at least at standard doses. At high doses (toxic doses) anticholinergic syndrome is to be expected.

I recommend trying this when you do not need to work the next day, to see if it produces side effects at the doses you would use. One theory of the effect of sedatives in helping people to sleep, is that they do not actually induce sleep - they only sedate you to the point where you do not remember being awake. Benzodiazepines would be more effective at that due to their amnestic effect. I think this may be true for some people, but I have my doubts that it is common.

I like to get the children's liquid. It is flavored. The taste has a bit of a Pavlovian synergistic effect of encouraging me so sleep.

I also like to listen to audio books or music (but definitely not Brahms's Lullaby. The 1812 Overture is generally not a good idea, but Beethoven's 5th works for me.) while trying to go to sleep. If the audio book is too interesting for me to sleep, I have not just been tossing and turning, but doing something productive. If it is less interesting, or just keeps me from the distracting thoughts that tend to keep me awake, then I get some sleep. Movies can be good, too. If the volume is turned down and the closed captioning is on, I can follow the dialogue at a level that is not likely to wake me up later if there is a louder section of the movie.

Lorelei Armstrong said...

I shall definitely try the Benadryl again. Not the liquid, since the azo dyes haven't been banned here and they always give me a migraine. But a vacation in the land of nod? I'm on it. Good thing I'm a novelist and never have to be anywhere the next day. Mahalo!