YL9.1: Ironies of a Medical Education
Ironies of a Medical Education
If you went to medical school, it’s either one of two things:
A) You don’t know what the hell you are getting yourself into
or
B) There must be something wrong with you.
Since I don’t have anything nice or intelligent to say about category A. I will jump to Category B. The perception of medical students or doctors can be divided into two; the first is the public perception and the second is the insider’s perception. The public paints a rosy picture. Doctors are smart. They always know what to do. They are one of the smartest people. They are kind. A bit arrogant but have a right to be. While the insider’s perception is a little different. A little edgy.
Perhaps Eric Segal summed it up when he said that Doctors were broken healers. Then this quote said by my friend about women in medical school: they’re either ugly or broken (most people will go for broken). I think that no other profession loathes itself more than medicine.
This paradox; this disjunction between what the world perceives and those inside of the profession is fascinating. Where did this dissonance between both perception start and why is it constantly enduring? There seems to be a difference of opinions when you’re from the outside looking in and when you’re really there. I honestly can’t tell where this started or how this happened but I can try to put some sense into it.
I think medicine contradicts itself from start to finish. Let me point out the ways.
In medicine, you are taught how to spot the disease and its management in others. You are taught on health. And yet, the practices of learning medicine is not healthy at all. You study health and yet, the average medical student is not healthy at all. You look at a medical student. You see then pulling off all-nighters and loading up on coffee. You see medical residents and see that they have 24 hour duties that usually extends and extends. And when it’s time to relax, there are endless parties, endless liquor, and endless smoke (organic or otherwise). Granted, there are exceptions but this is the general feel of a medical student. Study hard. Party hard. And yet, I can not find it in me to condemn this practice. Know why? Because it is needed. You have to study your ass off to get by. And you have to have some form of release as well. It is deeply etched in the medical profession. That’s why this anti-smoking drive by the PMA will never succeed. Because most of them know it well. The medical profession won’t survive without cigarettes or alcohol.
In medicine, you are taught to be detached while maintaining compassion with your patients. You are taught to care for your patients and yet have a detached outlook on their condition. Emotions will only get in the way of treatment. This is a delicate balance and I think, most people will never find it. You either became a cold hearted asshole or an emotionally unstable but passionate healer. You can oscillate between the two but I think that it’s really hard to find the balance that you’re looking for. Medicine is such an intimate profession. You can get close to your patients and get drawn in their fight. And when emotions are involved, it is truly hard not to get attached to the well being of the patients. Some say it’s a good thing. It’s an added motivation. While for some, it is a distraction. Feelings are volatile. It can distract you from seeing the truth. And both sides of it will have merit. Which makes those in the medical field all the more confused.
Perhaps there is no other profession that gets paid to save people from themselves and generally gets treated badly if the treatment is not to the patient’s liking. It’s true. You look at those people you treat, more than half of them are self-inflicted wounds. Too much drinking, too much partying, too much smoking, too much eating, careless driving, overdosing on something. And yet, when the treatment takes too long or doesn’t work, people will get angry. They will call you incompetent, slow or worse, they will take matters into their own hands when they feel it takes too long. Maybe the world’s perception of medicine is rosy but the expectations are high. And it hurts self-esteem. After all, you survived the pains of getting this education, sacrificing a lot to get where you are, but in the end, the very people you are trying to help, who have never experienced the kind of hardships that you had, ridicule you and tell you that you are not good enough. I mean, that hurts. Just by being where you are now, you earned it. And yet, when you feel underappreciated despite the willingness to help, that sort of hits it, doesn’t it?
Lastly, there is no other profession whose sole purpose is its own destruction. Look at medicine, what does it hope to achieve? the end of disease and everyone is healthy. Now, if this goal is achieved, what will become of medicine? If there is no disease to cure, no sickness to treat, what happens to medicine as a profession? Practicing medicine is a contradiction. Is there any other profession that tries to destroy itself so? Each new discovery that we have, each scientific breakthrough that would lead us closer to the end of disease would also lead us to the end of the medical profession.
That’s it. Medicine is a contradiction. So are the people involved in it. I do believe that most if not all people in medicine are dysfunctional to a degree. This dysfunction, whatever it is, you need it to survive medicine. Because if you don’t have this. You won’t survive this profession that is dysfunctional from the start. In the end, it is our fatal flaws that will help us survive.
YL8.20: End of Clerkship Speech
End of Clerkship Speech
As I’m sitting here, a few hours removed from the end of my hospital duties as a clerk, I can’t help but remember the things I have gone through. While it’s still fresh on my mind, allow me to say a few things about clerkship.
People would always say that you will learn who you’re real friends are at clerkship. I disagree. There might be some truth to it but it doesn’t capture the whole essence of it. In clerkship, you will know yourself more. What you can or cannot stand. What you will let go and not let go. You will know your boundaries.You will know what you can or cannot tolerate. There are certain boundaries in your life that you will establish during this time. And you tend to see things a little bit more clearly. You will see what you like and don’t like. In the process, you will know what you can tolerate from others.
The most important thing you will learn in clerkship is neither skills nor patient management. The most important thing you will learn is how to be in a hospital setting. A classroom and a hospital are two wholly different entities. You will learn to recognize the pulse and beat of a hospital. You will know how it runs and you will know how to be part of the system. You will know what is the ideal, the practical and the dismal. All of this you will know if you keep your eyes open. Don’t focus too much on skills or learning. It will come. Believe me. It will be driven to you again and again. But you have to remember that you will be living in the hospital the rest of your life now. If you don’t know what’s going on, what use are skills and knowledge?
Clerkship is like your 1st time, whether it be first time having sex or first time being in a relationship. Sort of like when kids hit puberty. There will be awkwardness. No matter how much you prepare, you will never be truly comfortable. There will be a sense of hesitancy. Like you don’t know where you belong. You’re stuck in a transition phase. Too old for the classroom and yet too young and inexperienced to be in a hospital. But eventually, you will grow into it. You will learn to handle yourself better. But there will always be a sense of nervousness. To some degree, it’s a good thing. It keeps you on your toes. This fear or nervousness helps you to not fuck up whatever the hell it is that you’re doing. Use that fear and eventually, it will disappear and things would be a little less awkward than it was before.
There are many things you will learn from different people. You will learn from everyone you meet. Each person carries a story and by hearing their story, it enriches yours. So talk to the orderlies, the patients, the residents, the nurses, the interns. They will give you little tiny bits of advise that when combined, will help you get through the hospital. Of course, not all people will be nice to you. There will be some who will treat you like the dirt in their shoe. Have patience for them. Learn from what they they are saying (if there is any). In OB when I am labor watching, I always talk to the mothers. Ask them about their lives and such. It’s both a selfish thing and an act of kindness. I want to learn something from them and at the same time, I like to let them know that someone cares for them. Talk to people. There are many interesting things that they will say. Some of these people will touch your lives profoundly. They will make you a better person. But you wouldn’t know if you don’t talk to them.
You will learn to cherish your friends, your families and your significant others more. They will be a source of strength for you. Love them and never forget them. Talk to them of your troubles. It will ease the burden. You will learn to appreciate their company more. You will miss them profoundly because you will spend most of the year in the hospital. There will be special events that you will miss. I was lucky enough to spend my Christmas Eve and New Year’s Eve at home but there were some unlucky ones. Learn to appreciate the people in your life. Make their company a sanctuary.
You absolutely need to go out during clerkship. There will be times when things will get overwhelming. That’s why you need the time to relax. To talk to people. And when you talk, you need to talk about mundane things. Funny things. Don’t talk about work seriously or some subject you can’t understand. I absolutely hate it when people talk about serious hospital matters when all you want to do is just relax. Learn to destress and let the toxicity out. It will drive you insane if you don’t go out. Drink, watch a movie. You need that break. Use it wisely.
In the end, no matter what I tell you about clerkship, if you haven’t experienced it yet, you will not know it for the contradiction that it is. It is both the best of times and the worst of times. Keep your eyes open and learn from the periphery, from the cracks.
I have enjoyed clerkship a lot. I can’t believe I said that. But I did. Looking back, I will cherish all the memories, even the bad ones. Even though, I sometimes say that I hate it. But it was an unbelievable experience.
As I near the end of this monologue, let me close it by saying that there will be people that you learn to cherish. Whether it is a friend or your duty group (Group 6 =)), you will know how much they mean to you and without them, clerkship would be unbearable. So allow me to thank Annai, Kenneth, Rose Ann, Raymonde and Reg for being awesome group mates. Even though we will no longer be group mates, we will still be family. Thanks =)
YL8.19: Hello, clerkies!
Hello, Clerkies!
by Nica Reyes
When I was texted last week by my dear friend, Qel, that I was giving a speech during YL7’s sendoff, I thought to myself…”Geez, flattering…then again…pressure!” To tell you the truth, I’ve NEVER given an inspirational speech to anyone before- maybe informally to my friends but never to a group of aspiring doctors. For this, I know I ought to choose my words wisely. Forgive this amateur as I kept notes of what I am going to say. Hindi ko ata kayang impromptu. I may forget some stuff.
Nagkalkal ako ng gamit ko kanina, looking for something to inspire me with. I stumbled upon the last original short story I have read. It was given as a gift from Dr. Ronnie Baticulon (Ronibats!) which was entitled, “Nang Magtagpo ang Dalawang Supot.” Nakakatawa yung storya. Sobrang informal. Kaya naisip ko, maybe I should just make this informal and yet, direct to the point because in that way, mas makakarelate kayo. Hindi ba? 
So pano ba?…Well, I had a brief “chitchat” with my YL7 ASMPH student friend about how Clerkship went for me. I find myself sitting with her outside a Coffee shop, with my glass of half-filled, iced Americano, enthusiastically reminiscing and sharing anecdotes from the year that’s passed.
I started talking about my batchmates. During clerkship, you get to spend most of your time away from home and more with your batchmates (groupmates). You get to sleep together, eat together, discuss things together, etc. And in that span of time, you discover the idiosyncrasies of each individual- this is where you decide who among your groupmates can you or can you not live with…who among these people are idlers, prudent, eager-beavers, inimical to success, slackers, sagacious, etc. During this time, you also get to weed out the real friends from the not-so-real and the frauds. In the same light, you get to realize who among these people are worthy of your referrals in the near future. The most important learning I have gained from being with my group is that, magkakaiba tayong lahat…We can’t expect to fit people in our ideal working frame. Ang importante is that we DON’T GIVE UP ON EACH OTHER. Hindi ka mabubuhay magisa sa medical school. It’s just like volleyball…it’s about teamwork.
BLS Training
I love my batch! It’s the best batch ever! (guys, bribe me more! =P ) I learned that despite our differences and oddities as individuals, despite the various number of cliques, we are (most of the time) united. There is always a hand to help, always an ear to listen and always a wallet to ransack when you’ve gone all bankrupt! Clerkship is such a wonderful time to build, rebuild and strengthen friendships. The ties only grow deeper and sturdier everyday and it gets better as each day passes by. Of course, there will be times when one’s heart teems with longing for friends one hasn’t seen for the longest time. Usually in clerkship, you get to spend most of your time with your groupmates and you miss your friends from the other groups. Oftentimes, it may be tedious to sched and resched gimmicks with those people especially if your duty scheds do not jive. Nonetheless, this tests how much you really miss one another- Pre, Duty or Post, with sleep or the lack of it, have bathed or have bathed 2 days AGO, if one really wants to be there, one will be present sa bonding inuman time.
...birthdays have always been an excuse to party.
Family and non-med friends, next. Yes, you will be missing out on a LOT of your friends’ and family gatherings. You will be missing out on some weddings, baptisms, birthdays, “inuman sessions,” “bull sessions,” gigs, breakfast, lunch and dinners, beach get-away’s and wedding/death anniversaries. This is the typical life of a clerk. To be honest, it’s not as bad as you think it may be. You may be away from your other friends for awhile but you develop new ones each day. You meet new people- residents, patients, interns, co-clerks, etc. Mabilis ang clerkship. Hindi mo mapapansin ang oras sa dami mong ginagawa kaya bihira ka lang malungkot kapag naaalala mo sila. I had my Christmas eve sa TMC. It was my first time ever to spend it away from my family. Pero masaya pa rin because I spent it with friends- naghanda kami, “potluck”…daming kainan. Nagdepartment-hopping kami kasi nakikain kami. Bawat isa, may handa. Nagpakababoy kaming lahat! Kidding aside, being away from your family kind of gives you a sense of independence and teaches you a sense of responsibility.
I talked about learning. Learning? Marami nyan. Use clerkship as the time to learn! Maganda yung program ng ASMPH kasi clerk-friendly siya compared to other programs. As opposed to medical slavery that other institutions have been used to, ASMPH Clerkship was designed to be a time for fruitful learning of theories and acquiring skills. Yang sliding scale na yan sa endo na hindi ko makabisa-kabisado, during Clerkship ko lang nakabisado. Kasi pagnakikita mo na yung pasyente, maaalala mo yung mga binasa mo eh…mas madaling maaral kung naaapply mo…swerte yung group ko kasi kami yung nakakita dun sa Leishmaniasis patient sa TMC. He showed his lesions in a conference sa UP-PGH. First case in the country. Once you see the lesions, di mo na talaga makakalimutan.
Syempre, parang giyera din naman ang clerkship…actually, ang medical school in general. Hindi ka dapat susugod nang walang alam. Dito na magkakaalaman- kung anong ginawa mo for your entire medical education. Makukunsensya ka kung may pasyenteng namamatay sa harap mo, walang ibang taong nandun, ikaw lang, tapos alam mo sa sarili mong basic ang dapat gawin…at maaalala mong paulit-ulit yung sinasabi ng professor mo sa Pedia…ang problema, hindi mo maalala kasi busy kang nagfe-facebook nung mga panahong yun. Guilty? Haha! Ok lang. may panahon pa. pwede naman kayong magreview before Clerkship eh. Sa totoo lang kasi, kulang ang clerkship time to know everything you HAVE to know at your level. Kelangan nyo ring magprepare. Yung batch ko, we summarized the JAMA compilation that Dr. Tanchangco gave us. Hinati naming tapos gumawa kami ng pocket notes. Parang yung black book ng UST. Hindi lang ganun kaganda. But it comes in handy for some.
Well, hindi rin mawawala yung mga taong hindi naniniwala sa bagong program ng ASMPH. Makakarinig at makakarinig kayo ng mga comments. Pero ang maganda dun is you guys should react in a positive way- ipakita ninyong may alam tayo! Magaling tayo! Iba ang atenista! J Kung gusto ninyo ng advice kung anong mga libro ang ok, syempre wala pa ring tatalo dun sa mga prescribed books. Pero sa totoo lang, kung wala ka na rin namang oras at alam mong sandamakmak rin naman ang transes mo para balikan lahat, maraming books you can use. For instance, yung First Aid Clerkship. Kumpleto ako nun. Kung gusto ninyo, I can give you guys. Balikan ninyo yung Bates. Pero mas maganda yung DeGowin, mas kumpleto. Kelangan kasi by now marunong na kayong magHx at PE. Magkakaroon kayo ng sarili ninyong pasyenteng ihahandle eh. Parang ine-sgd ninyo yung sarili ninyo everytime you’ll be faced with a patient- Identifying data, Chief Complaint, HPI, ROS, PMHx, FamHx, P/SHx, PE pero syempre may course in the wards na. Masaya magformulate ng sarili ninyong Diagnosis at Differentials and how to manage a patient. Actually, you don’t have to tell your residents or consultants you’re doing it on your own eh. Hindi mo naman kailangan ng approval sa clerkship para malaman mong natututo ka. Mas fulfilled ka kung alam mong achievement mo yun for yourself. Remember clerkship is student-driven learning. Nasa sayo kung gusto mong matuto. Kung gusto mo matuto, dampot ka ng chart sa floors for instance. Syempre with consent ng senior mo. Aralin mo. Tapos kung may mga tanong ka o suggestions, sabihin mo. Bawal ang mahiyaing Ateneo Clerk? Otherwise, wala kang matututunan. Dual effect din yan eh. Kasi kung alam ng senior ninyo na magaling kayo, mahihiya yun. Magaaral. Kung sasabayan ka niyang magaral, mas marami kang madadampot sa kaniya. Added learning, dib a? Sa clerkship, hindi sinu-spoonfeed ang mga sagot sayo. Para siyang easter egg hunt…kailangan mong hanapin ang learning sa iyong bagong napakalaking classroom, ang OSPITAL.
Actually, wala naman na akong iba pang sasabihin sa inyong lahat kung hindi, “Inaantay na namin kayo sa ospital.” We’re super glad to welcome you guys in our new classroom! Let’s all have this great new learning experience together! Good luck and until we see each other again.
ASMPH Class of 2013
YL8.18: Hey you, lower batch
Hello! Right now, you must be feeling a little nervous about stories/rumors about what clerkship in ASMPH means. Maybe you’re a little afraid of what will happen next. Well, I’m here to let you on a little secret…
We will be waiting.
asmphpioneerchronicles
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iwishmynamewasbeyonce
Admission Order