Friday, November 23, 2007
This is an expanded version of a previous blog. I hope you are not disappointed:Among the many duties of a physician in a university hospital, is teaching. The main task is to teach medical students in their clinical rotation. I'm reminded of the old television series based on the movie, "The Paper Chase". The crusty old professor declares that the first year law students "come in with minds full of mush, and go out thinking like lawyers" (this is said in a very dramatic Boston Brahmin inflection). During the anesthesia rotation of two weeks, we try to make sense out of the tremendous amount of pre-clinical knowledge regarding physiology, disease processes, pharmacology etc which creates a very thick muck in the gray matter of a typical student's brain. This muck we then turn into clinically relevant information. Often, the students comment, surprised, that they didn't know that anesthesiology was such a complex field.In addition to medical students from the Israeli medical school here at Ben-Gurion U., we also teach students from the Medical School of International Health which is a joint program of BGU and Columbia U. Since these students are fluent in English, I am always tapped to instruct them. But this is only the tip of the iceberg. We also instruct paramedics from the Emergency Medicine Program, nurses in an intensive care nursing course, and pharmacology students (future pharmacists). Moreover, I give formal lectures in various courses including ACLS (Advanced Cardiac Life Support – CPR to the layman). This means that about six months out of the year we perform clinical instruction during office hours. Bottom line, while I'm providing anesthesia I'm also explaining, teaching, grilling the students on their knowledge. This takes great concentration and frankly, is very draining. For all the effort, I enjoy teaching and from the feedback I receive I am a good teacher. (The slapping sound you just heard is me patting myself on the back).I usually try to inject some humor during a lecture, to prevent the listeners from going comatose. This tendency to somnolence is especially apparent when the lecture is scheduled after lunch. The students' blood supply is preferentially directed to the gastro-intestinal tract and almost no blood goes to the brain at that hour. I've found that humor also serves me well during clinical instruction in the OR. I've been surprised when a former student, years later, quotes my clinical "pearls of wisdom". For example, I maintain that the best way to monitor a patient is to use all six senses. Only five senses you say? Nay, six, here they are with their clinical uses:1. Sight – to see the fountains of blood when the surgeon makes a hole in a "small" artery like the aorta. It's also good for judging the effectiveness of a patient's breathing.2. Hearing – to hear the "beep, beep, beeeeeeeeeeep" of the pulse oximeter (measures oxygen saturation in the blood). Also good for auscultation of breath sounds and heart sounds using a stethoscope. A stethoscope is a low tech instrument used for listening to informative noises that originate in the body. However, this piece of equipment works only if there is a minimum of one neuron connecting the ears of the auscultator to each other.3. Smell – to detect fecal contamination of the surgical field when the surgeon makes a hole in the bowel. Also good for judging how long that piece of fish in the cafeteria has been out of water.4. Touch – to feel a patient's pulse. And sometimes to hold a patient's hand in comfort (a radical idea, I know).5. Taste – many years ago, diabetes was diagnosed by tasting the patient's urine. This is no longer in vogue. Also, may be used to confirm that that piece of fish in the cafeteria has been out of water too long.6. Sixth – this self named sense is the one that tells us it's time to consult a lawyer (preferably one with a mushless brain).Imparting such pearls of wisdom is an important part of clinical instruction, and sometimes some of the really important stuff gets lodged in the students' minds along with them. This becomes apparent when, at the end of the rotation, an oral exam is administered to the students.Recently, I took part in such an exam. A few days later, I was on call in the ICU. A senior surgeon came in to check up on the patients from his department that were admitted to the CU. He asked me if I had tested his son. I said "I guess so, but we (there were two other examiners also) didn't ask if he was the son of… to avoid any hint of favoritism." The surgeon told me that he asked his son who tested him. He remembered the names of the other two examiners but not mine. But he described me as "soft spoken, gentlemanly and looks like Richard Gere". Ok, that's a compliment but I have no illusions concerning my outward appearance. Immediately I did two things:1. I told the surgeon to take his son to have his eyesight examined STAT!2. I called my wife to tell her: "Madam, you must thank the Lord that you married a soft spoken gentleman who bears a striking resemblance to Richard Gere.My wife's reply: "what are you talking about, I married YOU!That is a perfect example of a reality check.