Shirah Vollmer MD

The Musings of Dr. Vollmer

Medical Students: What Do They Want To Know?

Posted by Dr. Vollmer on July 10, 2013

Below is my post from 2010 about my presentation to UCLA Medical Students in the Primary Care College. Today, I repeated my lecture on ‘Psychiatric Emergencies’ , with the addition of a narrative about the wonders, and not such wonders, in DSM 5. I changed my presentation style, but not my content. I moved my body in front of the podium. I walked up and down the aisles, making me feel like a rock star, moving into  my audience. I made eye contact with each student. Only one person fell asleep. This, being 2013, most of these students were female, young, and enthusiastic. I arrived an hour early, so I could hear the lecture before mine. I learned that the Affordable Care Act is going to focus on patient satisfaction, public health and cost-efficiency. As such, pediatricians will, in all likelihood, not do ‘well-child checks’ as this can be done by nurses. Pediatricians, like in many countries around the world, will be specialists, referred to after the Family Medicine doctor gets stuck. Most doctors will not be self-employed. They will work for large systems of care, like Kaiser. Specialists will have trouble finding jobs in areas they want, as they will need to be “deployed” to where the need is. Primary care will be in demand. Loan repayment was the largest area of discussion. Most students are saddled with large debt. The rate they pay it off, and the type of job they get are influenced by their tolerance to handle such demands. Once again, I found myself in a field that is rapidly changing, feeling like, although I sat in those same chairs, thirty years ago, I cannot connect with the experience of the current students. They are entering in a world which is evolving so quickly, that they do not know what their world will look like when they finish their training, five or seven or nine years from now.

There was then a ten minute break which, quite cleverly, I thought, the physician-coordinator, told us that it was time to do our exercises. All fifty of us got up to do a series of dance steps, swinging our arms and legs, while this physician reminded us that physical exercise will help us concentrate. She transformed from Professor to exercise guru. It was cool.

I began by asking how many students were interested in psychiatry. Three hands went up, but the coördinator reminded me, that primary care has a lot of psychiatry. Yep, I knew that. These are new fourth-year medical students, about to apply for the “match,” meaning they had to rank order their list of residency programs that they were interested in. This is a major crossroads in their lives, and although I don’t know these students intimately, most of them, seemed quite relaxed about their education and their future. I proceeded to talk about the management of a psychiatric emergency, reminding them that there are no objective tests, and so, all of psychiatry relies on informed intuition, based on a thorough history and good mental status examination. I talked about the importance of learning to listen to the patient’s narrative, as listening provides information for a diagnosis, but it is also therapeutic. I reminded them that psychoanalysis helps train people to listen, and so they could consider psychoanalytic training, regardless of what field of medicine they chose. One student after the class, told me they were indeed interested in psychoanalysis. I felt relieved. Listening is not dead in medicine, at least not completely dead.

 

 

From a Post Done on Wednesday, July 14, 2010

What is the Primary Care College?

UCLA School of Medicine: Fourth-year Colleges

Faculty members and students interested in common career activities are grouped into academic colleges during year four. The colleges are designed to

  • strengthen career advising,
  • improve the quality and selection of electives,
  • provide a means of honing clinical skills,
  • stimulate discussion of new findings in the basic, social, and clinical sciences relevant to the future practice of medicine.

College activities include an introductory course focused on advanced clinical skills and decision making, a monthly series of evening seminars, a longitudinal academic activity that can be either teaching or scholarship, and regular advisory meetings.

Academic Medicine — Careers that will include research or subspecialty training programs that require research. The theme is the development of skills in basic and clinical research.

Acute Care — Careers in emergency medicine, anesthesia, and critical care specialties. Themes include time-based decision making, physiologic correlations, and crisis management.

Applied Anatomy — Careers in the various surgical specialties, obstetrics & gynecology, radiology, radiation oncology, ophthalmology, and pathology. The unifying theme is anatomical implications in medical practice.

Primary Care — Careers in internal medicine, pediatrics, family medicine, obstetrics & gynecology, and psychiatry. Themes include prevention, mental health, international health, geriatrics, and women’s health.

Drew Urban Underserved — Members of this college are students in the combined UCLA/Drew University program, which is recognized for its placement of graduates in underserved communities.

5 Responses to “Medical Students: What Do They Want To Know?”

  1. Shelly said

    I really like that you changed your presentation style. One needs to change with the times, and everyone needs a gimmick. In this manner, you didn’t need to change content in order to get people to listen. I will use this myself the next time I give a talk. I wonder though, in your definitions above how is it that OB/Gyn appears both under Applied Anatomy and Primary Care?

    • Thanks, Shelly. Practice is the key to change. The repetition of my presentation causes me to pause and consider how to improve how I package my material. This is the value of experience, which in today’s age, is often minimized.
      You bring up a good point about the lack of clear lines in this “college” system. I think they were trying to address that some people enter ObGyn, primarily wanting to help women, whereas others are more focused on gynecological procedures. The exciting new technologies in medicine have attracted folks who like to work machines, and this is a different personality profile from the folks who want to listen and guide people towards a healthy lifestyle.

  2. These are truly wonderful ideas in about blogging.

    You have touched some nice points here. Any way keep up
    wrinting.

  3. Reblogged this on The Other Side Of The Stretcher and commented:

    The physician who is the writer of this blog wrote a a piece about what Medical Students would want to know.

    The doctor is quoted here saying:

    “Below is my post from 2010 about my presentation to UCLA Medical Students in the Primary Care College. Today, I repeated my lecture on ‘Psychiatric Emergencies’ , with the addition of a narrative about the wonders, and not such wonders, in DSM 5. I changed my presentation style, but not my content. I moved my body in front of the podium. I walked up and down the aisles, making me feel like a rock star, moving into my audience. I made eye contact with each student. Only one person fell asleep”

    “There was then a ten minute break which, quite cleverly, I thought, the physician-coordinator, told us that it was time to do our exercises. All fifty of us got up to do a series of dance steps, swinging our arms and legs, while this physician reminded us that physical exercise will help us concentrate. She transformed from Professor to exercise guru. It was cool.”

    “I began by asking how many students were interested in psychiatry. Three hands went up, but the coördinator reminded me, that primary care has a lot of psychiatry. Yep, I knew that. These are new fourth-year medical students, about to apply for the “match,” meaning they had to rank order their list of residency programs that they were interested in.”

    ” I talked about the importance of learning to listen to the patient’s narrative, as listening provides information for a diagnosis, but it is also therapeutic. I reminded them that psychoanalysis helps train people to listen, and so they could consider psychoanalytic training, regardless of what field of medicine they chose. One student after the class, told me they were indeed interested in psychoanalysis.”

    “I felt relieved. Listening is not dead in medicine, at least not completely dead.”

    Here was my response to this persons blog. I don’t think the person will approve it, so I am putting it here:

    Hello,

    I became a Registered Nurse in 1985, in NYC, I worked in a world reknown medical center.

    I suspect you are much younger.

    (I stated that she was much younger because.
    When I was active in the field, patients were referred to psychiatrists if the doctor thought there was a psychiatric problem, The interesting thing was, many psychiatrists would tell the patients that psychiatry was not their problem and would give the patients a business card to another doctor for a second opinion.)

    Do you know what the residents out of medical school at that time said about “psychiatry?”

    This is honest, not to criticize you, i’m going to bring up a point on why patient care has suffered because of the psychiatric profusion.

    Residents said, the only medical students who went into Psychiatry residencies (verbatim, exactly what they said) “were too stupid to get into any of the other specialty areas.”

    Because of psychiatric profusion, diagnosis are missed. Patients are told ( I call this the 3 symptom rule), if the doctor cant identify what is wrong with the patient because they cant figure out what the symptoms are, that they are depressed, it is “all in their head,” etc.. Im sure you have heard the rest, because you might have done this.

    I have seen patients, that I have been connected with online because I have been a patient for a long time, who have died because of things such as sudden cardiac arrest because the doctor didn’t investigate the symptoms further and the patient actually had myodcarditis or worse, dilated cardiomyopathy, etc.. etc.. etc..

    I worked in the cardiac care unit at that large medical center in NYC, we saw cardiomyopathy all of the times, and all of the viral cardiomyopathy patients had the “flu” or a “viral” infection just 6 months before, never got better. Today, those patients go to a family practice doctor when they aren’t better, and the family practice doctors who allowed this psychiatric profusion to be part of their practice are probably telling the patients that they are depressed and need to go exercise at a fitness center.

    I was active in the field at a different time than you. Patients were diagnosed and treated. Today, they are “labeled and branded depressed” because psychiatry has found its way into the medical related specialties and even family practice where it has no business being.

    You talk a good speech at those conferences, but you need to think, when you are back in the office, are you following the promise to “Do No Harm”!

    Remember, that what its all about, to Do No Harm. Because medicine is the place where the most help can be done and the most harm can be done and much harm is being done to patients today.

    I know this, because I worked in those early days of the AIDS crisis when those patients were basically ignored and there were theories such as “it must be a toxin in the air.”

    Something to think about….

    I doubt you will approve my comment.

    If you do, that’s great and you are humble enough to take criticism.

    If not, then you are deceived by the pharmaceutical corruption that is going on today.

    The last statement this person made was:

    “I felt relieved. Listening is not dead in medicine, at least not completely dead.”

    Fellow friends and patients, is that not quite the contrary today?
    Its physicians such as these who do not listen to patients and brand all of the patients as “psychiatric,” “depressed,” “bipolar disorder,” etc.. etc..

    A statement was also made regarding the DSM 5:
    “Today, I repeated my lecture on ‘Psychiatric Emergencies’ , with the addition of a narrative about the wonders, and not such wonders, in DSM 5”

    I don’t think I have to say what we know about the DSM 5. There is a diagnosis in the DSM 5 for everything including a diagnosis for biting your nails. The DSM 5 is part of the big money making scam that is going on in psychiatry today thus we have patients who are basically incarcerated against their will in psychiatric hospitals like Justina Pelletier because the institution did not believe her medical diagnosis.

    The “psychiatric profusion” has become quite the disgrace in medicine today!

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