Mind, body, and Shenanigans

CONTEXT: My dear friend is in Australia and considering applying to DO school. I’m trying to show him my viewpoint of said philosophy and decided to share it, slightly modified. Here’s a quick excerpt/summary from Wikipedia:

Osteopathic medicine was founded by a man named A.T. Still in 1874, who decided conventional medicine (at the time, allopathic medicine aka MDs aka blood letting and leaches and all that) was insufficient to treat disease after watching 3 of his children die from spinal meningitis. He believed that the body’s health was based on the bones and fascia. The 4 basics of osteopathic medicine are:

1. The body is a unit: mind, body, and spirit.
2. The body possesses self-regulatory mechanisms, having the inherent capacity to defend, repair, and remodel itself.
3. Structure and function are reciprocally inter-related.
4. Rational therapy is based on consideration of the first three principles

 And now, to a wall of text, with some added comments for context:

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Not sure if you know what osteopathic manipulation looks like because I know I sure as hell didn’t before my first OPP (osteopathic principles and practices) class, so here two videos.

Something I would use (start at 1:28): http://www.youtube.com/watch?v=1q70NMsXw2o

Border-line retarded and something I would never use (start at 1:15): http://www.youtube.com/watch?v=lPB9LfYqFMc

(previous part of letter leading into)still on the edge about osteopathic techniques. They might work to relieve “pain,” usually musculoskeletal, but I think it’s only a temporary measure or a placebo effect. I got treated yesterday for my back pain, and it felt good for a few hours, now it hurts like a mo’fo’. That being said, is a temporary relieve from pain enough to justify learning these techniques? Is the possible placebo effect worth it if my patient’s feel like it’s helping? I can’t help but feel that I’m deceiving them, but I’ve always been a skeptic of anything that doesn’t have research supporting it. All osteopathic “research” was done in the 20s-60s and is shenanigans. I think they need a huge study on lower back pain where one group of people receive osteopathic care, one receive medications, one receive placebo medication, and one receive nothing. Then they would have to rate on pain relief, total cost/time for treatment, and how satisfied they were with their healthcare. That would show if all this stuff might be worth it, but the old guard is far too afraid of the implications if their techniques were proven to be shenanigans. Stupid in my opinion, since if the opposite is true and it does prove to decrease pain and increase patient satisfaction, maybe it would be regarded as more of a probable treatment. Right now, the only “proof” our teachers give us is anecdotal evidence of how this one time OMT cured someone of ever pain after they had been to all those silly MDs and their modern medicine. Stupid.

(After further ramblings about my life, my friends responds with an email detailing “that darkest day in osteopathy.” tl;dr: In 1962, DOs in California could buy an MD degree for $65, 86% which did, and the DO school became UC-Irvine. Now my cuss filled response.)

Yeah, we are taught that story the first day of OPP, and are forced to memorize the dates as well. We also have to know the dates of A.T. Still's birth, when he 'threw the banner of osteopathy into the wind and broke from allopathic medicine', when he opened his first school, and when he died. We also have to know who 'invented' the OMT (osteopathic manipulative techniques) we learn and they all have these little back stories too.

Yeah, I guess that is fucked up, but people are scared of change, and those MDs were afraid back then. Now that former DO school is one of the top MD schools in the nation, and I bet they make no mention of DOs. 

In fact, I bet it's safe to say that all MD schools never mention DOs or our philosophies (I almost wrote 'their philosophies'). Why? Probably cause it doesn't matter to them at all, while here at DO school, we are always told about how we are the minority and how we will have to defend ourselves and our philosophies and how we are 'more complete physicians' than MDs since we have better palpatory skills and know OMT. The president of the AOA (American Osteopathic Association) said something along the same lines. Something about maintaining an identity or some shit.

I say FUCK ALL THAT!!! Fuck being divided or separate or unique or whatever. You know how many patients give a shit if you have an MD or DO? Very little. Hell, ask a random person on the street and they'll be like 'WTF is a DO?" You know why? 'Cause there isn't a difference in a clinical setting. You walk around a hospital and you can't tell the difference. You walk around a primary care clinic, and you probably will be able to tell the difference since that's where DOs practice osteopathic techniques and people go for treatment. Why? Probably because manipulation doesn't fix any major medical problem that people are hospitalized for. 

What they don't tell you on wikipedia is that the DO match is 2 weeks before the MD match for residencies. If you get matched into a DO residency, you are automatically pulled from the MD match. So I have shitty choice ahead: do I even bother applying for DO residencies when there are only 4 in Colorado (none of which I care for), or forego the DO match and hope like hell I can match in MD? Isn't it wrong that MDs can't match into DO residencies, but we can take theirs? Why is there a difference? Why shouldn't they all be the same? Because DOs want to keep their uniqueness or some bullshit like that.

MDs and DOs should be united in helping patients, yet the current DOs in charge of both LECOM and the AOA are soooooo caught up in being unique and holding a grudge, I think they are hurting patient's in the end by trying to plant these seeds of distrust and making it more difficult for all doctors to become practicing physicians. 

I'd say over 90% of the students here are not here because they 'believe' in osteopathic medicine, but because we didn't get accepted to an MD school. Do people believe in it after being treated or learning the techniques? Sure. Hell, I've treated (my roommate) for back and rib pain, and he felt better. I've been treated and felt mildly better. That being said, I've NEVER had back or neck pain until I got 'treated' here. I think the body strikes a balance with your life style, and being treated with OMT shifts that balance, causing pain somewhere else, which once treated, will lead to pain somewhere else. Eventually, will you get all the musculoskeletal problems (called somatic dysfunction), but without lifestyle changes or posture changes or even your normal gait changes, your body is going to try and reach that balance again and then you have to be fixed again.

It’s like if I gave you a drug that you can only get with an office visit. You had no/mild pain but I told you that you had somatic dysfunction (because everyone does). Once treated, that causes pain somewhere else, which can be treated with the same drug. Eventually, you have no more somatic dysfunction. But the pain/discomfort comes back, and you have to return to me to get the drug every time you have the same pain, which is probably every week. Every office visit and treatment with this drug costs money. Aren’t you better off not being treated in the first place? Wouldn’t it be better for your body to strike that balance again?

Of course, if a patient comes in with musculoskeletal pain, and it can be ‘cured’ with OMT, I’ll do it, but I’ll try to find the root of the problem first or teach the patient how to treat themselves before I tell them to come back every time (and pay money) when they have neck pain.

I have A LOT of problems with osteopathic medicine, but it’s my personality. Unless I see it myself, or see peer reviewed evidence of it, I’ll keep questioning its validity and be skeptical when the professor tells me that this technique can help with blah blah blah or this one time no MD could help so all this DO did was crack her this way and it was all ok.

True story, one question we had on an OPP test was: a patient is having left sided chest pain which is radiating to their arm. They are also in respiratory distress. Do you: A) crack their cervical spine B) take them to the ER C,D,E)foils. You know what the answer was a couple of years ago? CRACK THEIR FUCKING CERVICALS! BECAUSE THAT’LL HELP WITH A HEART ATTACK APAPRENTLY. I say a couple of years ago because one of the non-OPP professor was like “Are you serious?!?!?! If you said you did this in front of all your fellow physicians, MDs and DOs, they would remove your license in a heartbeat since that’s not what is 1)proven 2)any other doctor would do 3) incredibly dangerous to the patient.

It’s shit like that which pisses me off. They think that OPP is this miraculous, magical, cure all when it’s not. Sure, it can help with everyday pain. But with SERIOUS medical issues? Not even close. Fuck man, not even in the same universe. I’m leaning towards ER medicine, you can bet your ass I’m not going to use OPP on my patients. Friends, family with back pain? Sure, I’m down to try and treat them, but I don’t feel like OMT is something that people should have to pay for.

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/end rant

First year is done in 6 weeks. Can’t say I feel any smarter or anymore prepared to have strangers trust me with their lives. I also can't say I feel any close to my peers here, but that another post (which is likely not happening anytime soon).

Time heals all wounds or wounds all heels?

Yes, I’ve been absent since April 4^th. You can also expect my posting frequency to be about the same aka only when something is bothering me and I need to let some steam off. Sorry I guess, updating this blog hasn’t been number one on my list of priorities.

This image is 100% accurate.

That being said, I felt inclined to share a disturbing thought I has while in a neuroanatomy lecture today: I relate a lot more to engineering student that I do to med students.

What prompted this thought? I dunno. It’s been a rough week and a half and it’s been completely school unrelated.

I just don’t relate to the majority of med students (here in Erie, but I’ll keep just saying med students). Straight up. I find most of them….childish. Concerned about what others think about them or trying to be friends with everybody or bitching about the amount of work or having to learn new material. It’s like fucking high school and it makes me want to vomit.

What that fuck do you think medical school is???? It’s work!!!! Awesome, great work about learning new things concerning the human body. “But that subject is hard!” they say. “I fucking know, welcome to real life. Why did you come here? Because it was going to be easy?”

This came up when I tried to find a relevant picture. It describes how I feel when I enter LECOM

On top of that, a lot of students here just lack common sense or a logical thought process when it comes to PBL cases. I know this is an engineering thought and mentality, but goddamn, I fear that some people won’t be able to look at test results and interpret what it means.

I think it comes down to one person here, who happens to be in my PBL group and I think is poison. I think she’s smart (maybe?) since she survived first semester and has a master’s in medical genetics, but she’s 29 years old and I can’t believe how childish she is.

First image googling childish. I lol-ed

We have to critique other group members about their performance on the previous case, and I told her that if she felt lost on cases (which she admitted to our facilitator about 2 minutes for I critiqued her), she should participate more in giving differentials and lab test to disprove those differentials so maybe she won’t feel lost. I admit, my choice of words was pretty poor, but instead of accepting/denying my criticism, she silently flips a FUCK and proceeds to be mad at me. Normally, I don’t give a flying shit, but the problem is that this girl is the center piece of most of the girls in PBL. She’s this blonde, Sothern, “nice” girl that I think plays dumb and innocent to have people help her out because that just what she grew up with. I also think that she is used to having guys go head-over-tail to help her in every way possible and go out of their way to please her, but you know me: no fucks given. I don’t give a shit if you have a pretty face and smile and are a sweet southern girl. I bet it annoys her to no end.

This level annoying

It’s not to say I refuse to help her; in fact, 90% of our interactions start with her saying: “Can you help me?” and I have no problem with helping her academically. (The other 10% is “Do you hate me Andy?” to which I reply “No, I just don’t emote. Get over it.”)

So what did I do with regards to the present situation? I knew she would come talk to me and say that I bothered her with my critique, so I prepared my apology in advance. When she did come talk to me a few days later (most people are predictable), I apologized for my delivery (not the content, but I didn’t tell her that). I thought it better not to ostracize all the girls in PBL so early in medical school.

Future me, but without the lame expression and paper holding. I have a backpack for that shit 

I’m still not sure how I feel about this move. I’m a blunt person, but I don’t consider myself malicious. Am I playing a part? Am I a bad person for not telling this girl that I’m not sure she should be a doctor and the only real reason I apologized to her was to ease my future group interactions?

I think one of my favorite parts of this is that on the round of critiques, one of the guys (who I found out is one of those guys who will do anything for the “popular” group of girls) said to the group that we should be more sensitive in our critiques, and seeing how I’m the only one who critiques people in areas of improvement anyways, I couldn’t help but smile. I just wanted to look at him and say, “Just tell that to me man; don’t hide by addressing the group.”

Then today, there was just a lot of underlying tension and cattiness towards other people in the group. I think I’m in the clear, but I might jump right back in the shit hole by telling the group that their high school-esque drama shouldn’t be a part of the PBL room. Act like fucking adults. You’re going to be doctors one day; you think other doctors or your superiors give a shit about hissy fits you’re having with coworkers? The patient is your main priority, not something someone said this one time that made you real mad at them for like a week.

THIS

Fuck man, I’m 22; the average age here is 26 (I’m one of the youngest student, for sure the youngest in my current group), and I’M pissed about the behavior.

Maybe I’m just homesick. Maybe I just miss my friends and family. Maybe I miss people who understand that just because I’m not smiling or declaring my never-ending love and happiness that OMFG YOU’RE MY BEST FRIEND FOREVER AFTER A SEMESTER OF MEDICAL SCHOOL doesn’t mean I hate you or anything like that; I’m just not one to emote. I’m not one to choose friends casually. Why I am required to be best friends with every person I meet in medical school? Or life? Some people just don’t click; get the fuck over it.

Irrelevant? Eh, I love this picture anyways

Or maybe I’m the real asshole here. Maybe I’ve become to prototypical, arrogant, piece of shit med student who looks down on others because they don’t think the way I do or read as fast or comprehend as quickly. Is this what medical school has done to me? Or rather, what I’ve let medical school do to me?

I don’t have the answer; currently that means I should start flipping through every textbook I own to try and find one.

This is one that I think only time will reveal the truth.

Like Emotional Origamy

As with most men, it is easier for me to give hugs than to accept them,
Let the truth be known that men are nothing more than emotional skyscrapers,
Built with glass infrastructures, spray painted the color of steel and nicknamed "Strength"

Strange, isn't it?

What walking contradictions are we called men...

Men are taught to colonize at the age of 5 through games like cops and robbers, cowboys and indians
At the age of 8 we are given helmets and told to hit each other on the head with it,
Bleed but do not bleed,
Cut but do not cry,
Be a man, join the military,
Die for your country, and if death comes to you,
Look it in the eye and say:
Bring it on, mother-fucker, I fear nothing but intimacy.

When it comes to intimacy men quiver like fault lines, crumble like cities

What walking contradictions are we called men...

Men, take note, this is how you give love,
This is how you receive hugs.
Press flesh to flesh till breast crumple,
Like emotional origami.
-Mark Gonzales, As with Most Men

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Someone recently told me that I express myself not with words, but through my hugs (which reminded me of the poem above). I’d say there is a bit of truth to that, since I’m not one for talking about my emotions. Multiple people have told me that I give great hugs, though I can’t say what the difference is since I can never not (GASP double negative) be a part of my hugs.

Maybe that my form of emotional conversation.

Wish Upon a Clock

As childish as it may seem, every time I look at the clock and I see that it’s 11:11, I do make a wish. Today though, I had to pause and think about it.

For the past few months, EVERY 11:11 I saw, I wished the same thing: Please let me get into medical school. And now I am. That was my ultimate desire at the time, the only thing on my mind, so it was easy to come up with a wish.

For the past week, I’ve been wishing that my uncle and cousins have enough strength to get through my aunt’s imminent passing with terminal cancer. I wished my mom to help out as much as she can while she is in Japan for an indeterminate amount of time. I wished that death was easier to deal with and that one day, no one has to hear the word “terminal” outside of the airport.

After reading my mom’s e-mail that my aunt is unlikely to make it through the weekend, I wished that much harder today. But I selfishly paused, and thought, “What would I wish for now if it were different circumstances?”

And I didn’t know. Happiness? Companionship? A time machine to get through these next few weeks? Is what you wish for at 11:11 the main thing on your mind?

Honestly, I still don’t know, but I do know that feeling helpless to help a loved one is a shitty, and the feeling like I am trapped in Pittsburgh only makes it worse.

Interview and life

For all none of you who didn’t know, I had an interview at LECOM this past Friday, and here’s how it went down.

It looked like this, but with 2 feet of snow and 8 degree weather.

It was a group interview with six total people. There were 2 undergraduates, the rest had been out of school from 1-6 years, one with masters in forensic science and the others doing lab work. First question was introducing yourself, blah blah. Then the rest of the interview was more of a discussion, so forgive if it seems unorganized, because that’s how the interview felt.

During introductions, one girl mentioned that she thought preventative care was the next step in medicine due to the healthcare bill. So the “bad cop” interviewer asked her if primary care physician should be reimbursed for preventative care (exercise, proper diet, don’t do drugs, etc.) compared with a doctor who orders 10 test and get reimbursed for them all. For those of you unfamiliar with the scandalous nature of medicine, if a doctor orders a $100 test, they can tell the government to reimburse them for $200. Yes, that was an awful example but that is how it works.

Anyways, she rambled for awhile about being an idealist and in an ideal world, doctors could be reimbursed for said preventative care. I, trying to give my opinion and distinguish myself as you are supposed to do in interviews, said that 1) patient compliance would be a huge issue and 2) how do you quantify preventative care. If you tell someone to stop smoking, the most common response is “you can’t tell me what to do,” so how could you get anyone to actually follow your advice? On top of that, how can we quantify preventative care? We can see the results of 10 tests, but not 10 pieces of advice.

Then we progressed onto “is healthcare a right or a privilege?” I said that it is more of a privilege than a right, though I emphasized both perspectives. My analogy was that we would normally say freedom is a right, but if you murder someone, then you go to jail, hence your freedom is taken away, therefore freedom is also more of a privilege since it is something that can be taken. The same way that if healthcare is a right and a person abuses that by smoking, drinking, drugs, should their right be taken away?

This guy probably should have it taken away

Next was if you ever had a problem with a professor, and I said some shit about one class where the professor didn’t know the material well and there was a gap between what we were learning and what was applicable in the real world.

Then there was an ethics question about seeing someone cheating on a test, which I responded that I would talk to the person I saw cheating first, then if I thought they had a legitimate reason for why they were doing what I would consider cheating, then I would let it go but keep an eye out. Then the “bad cop” asked what if someone asked you to sign them in for a residency shift, which I responded that I would definitely not do that since other people are depending on that person to be there for his shift.

The last question (that I remember) is to describe a difficult time in your life and how you dealt with it. I described my first few weeks in Korea since that brought up both my international experience as well as my new appreciation for being a minority, being in a foreign country, how I can adapt to a foreign situation, etc. We go around the table and I’m kinda listening, but this one guy had a rambling story about his life, and then he says “I had to choose between becoming a doctor and my family, and I decided to pursue my dream.” He said that his fiancé did not want him to become a doctor since it would probably mean that they would not be able to see each other for a large amount of time, which is a reasonable response if you are about to be married. He ended his blurb with “we have separated since then.”

And I’m yelling in my mind, “WTF?????? You gave up your fiancé for a career?????” I wanted to ask him, how can anyone give up family for a career, but I decided not to since that would expose my dick-itry to the interviewers. That man either has dedication to becoming a doctor that I do not possess, or a cold heart to ignore his fiancé’s wishes. Regardless, I don’t think that he is getting in.

No idea if this is legitimate. Small y-axis though.

So now I play the waiting game. They said 30 days, but it’ll be 30 days from when my D.O. letter gets in, which I don’t think it has yet. Never been so nervous to receive news about something. If I don’t get in there, I will apply to their Florida campus probably, and then sign up for my next MCAT simultaneously. How depressing a thought that is…. One whole year of waiting, having to reapply again to everything…..

This picture is pretty accurate of how I feel about that.

Other news with my life is that I’m incredibly sick of Pittsburgh and bioengineering and eagerly awaiting to get the fuck out of here. It definitely feels like I’m just waiting around to receive a paper saying I did some shit for four years that makes ejumacated enough to have a B.S. (I think it stands for Bull Shit) degree.

2 and a half more months until I can leave, permanently, from Pittsburgh. I will be leaving behind a city a do not care about, a major that I will not use, and a whole heap of memories and bad decisions that I won’t be reminded about as frequently without the visual cues everywhere.

I will miss the people here, definitely, and this is the last few months that we will all be together in the same area. That is a depressing thought; the day I say good bye to all the great friends I made here. I’m sure I will see a few of them (and some I would rather never see again (I’m not talking about friends though (you know what I mean (I hope)))) after college has been over, but definitely not as frequently. That’s life I guess, moving on to other cities and careers, but it still makes me a sad, almost enough to put a sad emoticon (almost).

I’m ready for my next adventure, but damn it if school is getting in the way.

P.S. Suggestions for posts are always welcome. I find myself with an unnatural amount of time on my hands and there are only so many video games I can play before my head hurts (with joy).

You paid for parking.... For me?

If you have 16 mins to spare (don't lie to yourself, you know damn well you do), you should definitely watch this.

The Year in Pictures

Recap of the year, in pictures only: