some good things in my med ed this week:

history of psychiatry - our dynamo resident chair in the hx. of med put things in perspective this week. i wish this type of discussion ++ (extending to include a critical analysis of what our starting point is and where our assumptions lie) was a bigger part of these formative years. instead, we spend such a lot of time on details that we will soon forget.

care of the elderly - geriatricians must be in it because they care.

films - one of the experience of a young woman with schizophrenia, and another on sue rodriguez: a woman here in canada who fought try to have the legal right to assisted suicide as she was dying of ALS. with svend robinson! both showed the face of medicine that is too often burried by our heavy tomes.

i appreciate psychiatry (in spite of some distrust with the way we model illness - though i see this field as a lens through which to see this phenomenon in all areas of medicine!) for it's awareness of it's own limitations, assumptions, and social construction.

action everywhere - a great, student-organized session on 'right to choose' this eve, and over 160 signatures on our petition to have the word genocide applied to recent events in sudan.

Today I get an introduction to "Geriatric Medicine". I'll spend the afternoon at a long-term care facility, interviewing a person with cognitive decline, and then chatting over tea and cookies. I think it's supposed to make approaching elderly patients less intimidating.

So I'm realizing that I am a little apprehensive. My own experience with long-term care, and dementia, and depression in the elderly (grandmothers of my once-partner) made me feel sad. But what I'm thinking of this morning is that I'd like to extend patience. I remember that his family sometimes became frustrated dealing with the dementia of one grandmother - and I know that care-givers are under a great deal of strain. I just want to remember what that was like to see, and to try to keep that somewhere with me always - to apply to my patients, and to hang on to if I have to deal with dementia and cognitive decline within my own family.

Just try to remember what it was like before I was becoming a doctor.

white coated and cold
he doesn't know it snowed
outside the hospital

okay. so here's one: a few weeks ago, this specialist is telling us all about headaches and migraines and such. and about drugs, etc., etc. but then it gets a little interesting - he's telling us about this 'experimental' injection of drug into muscles at various points around the neck - new, but promising. and so i ask him if they've done any trials against 'sham' injections as 'placebo' (because i'm interested in acupuncture). he doesn't think so (but that's okay with him - he brought this to lecture for us anyhow). of course, this is a bit unusual, to hear specialists prattering on about non-evidence based stuff. so i ask about acupuncture - what's the evidence (since i know that 'needling' - much like sham injections - is sometimes used too). and he's all "that's not accepted" - total shut-down, keep your hokey CAM-crap away from me kind of attitude. funny - there is evidence for acupuncture's efficacy in treating pain, yet he wants nothing to do with it, but add some drug to a needle that is held in doctor's hand, and lack of any evidence notwithstanding, rah, rah, rah!
take-home message: some facts aren't welcome here!

So this is where we, doctor and doctor-to-be get to hold court on some of the follies, and some of the fun, of learning the art, and learning to be the artist.

If you've something to add, we'd like to read it!