Today’s Medical Lesson - Withdrawal
So today I’m reviewing Gynecologic and Breast Disorders/Topics.
Now reviewing contraception. It’s been a while since I have had to deal with them. Also, when you spend time at a VA hospital, you really don’t have much need to know these things.
When I did my OB/GYN rotation, though, they gave every medical student a pocket book on contraception that listed the available kinds along with their risks and effectiveness.
Anyhow…. on to today’s lesson.
Or maybe it is really more of a factoid.
Did you know that the “Withdrawal” method for contraception has an ideal efficacy rate of 96%? Compare this to oral contraceptives that have an ideal efficacy of 98-99% (depending on the formulation). The problem is that typical efficacy is always lower than ideal. For instance, oral contraceptive pills have a typical efficacy of 92%.
As for the withdrawal method, the typical effectiveness comes in at about 73%.
Listed associated side effects include “decreased pleasure” and “difficult to conduct in effective manner.”
You’re welcome. Now be safe, everyone.
New JeffreyMD.com post: Doctors & Nurses
Unfortunately, it seems that many nurses have a bitter feeling towards doctors. I can’t say I know why. But only because I don’t know their perspective. I can only speculate. But I’d venture to guess that at the core, it is an issue of feeling unappreciated and disrespected by doctors. Those feelings can then easily turn into resentment….
Source: bit.ly
Been trying to work out some really simple biostatistics. Rote memoization of the formulas for sensitivity, specificity, false positives, false negatives, etc doesn’t seem to be working right now. I was hoping that if I could derive them from scratch, then I wouldn’t have to memorize as much. I figured I’d try to put the mathematics minor to use. Unfortunately I’ve forgotten almost everything math related from undergrad. I’d like to think, though, that I can still work a 2x2 table and basic algebra.
Just Got An Email
Just received an email reminding me that I have an exam next week on Wednesday the 13th. I am instructed to remember to show up because failure to do so will result in a make-up exam that could cost up to $800 or a delay in my graduation.
Now THAT’s how you lay the pressure on!
Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.
Standardized Patients
suzytaco replied to your post: suzytaco replied to your photo: Just came back…
So it’s like that episode of Seinfeld where Kramer and his friend get paid to do the same. That sounds like a rad job. How much did the breast exam lady get paid? ;)
I haven’t seen that episode. But it sounds like it. Many of the actors, I hear, are active in the local theater and so they usually do a very good job with their roles. There are also other standardized patients that do more than just play a role of patient. Some do the teaching.
I’ve heard from med students from other schools that they have men who are paid to help teach prostate exams. Part of me is glad I don’t have this fine opportunity at my school.
At my school, though, they do have a pelvic lab. The women who who serve as patients in pelvic lab have a dual role as teacher as well as patient. They teach us how to do a pelvic exam. And once they are situated in the stirrups, they are equipped with a mirror so they can see exactly what you are doing. And they offer you direction and tell if you if you’re doing it wrong.
As you can imagine, the above scenario is fraught with situations that are uncomfortable and provide some good laughs afterwards. However, most of them will never be repeated in any public forum. It just ain’t professional.
But I will share one story from Pelvic Lab. On this day, I was in the exam room with the instructor (who we would be examining) and about 4 other classmates. Before beginning we discussed etiquette and what one should do before actually performing a pelvic or breast exam. We also discussed things not to say. For example, one never wants to comment that things look “good.” Always use “healthy and normal,” we were instructed.
When we began the practical part of the lesson, I stood up behind a classmate who was ahead of me. The instructor, who was sitting with her legs spread apart, was walking the student through the process. She told him to make a V with his index and middle fingers and to use those fingers to spread apart her labia in order to visualize the structures.
My classmate was sitting on a one of those stools that are common in this setting. I stood behind him trying to pay attention and learn so that I would know what to do when my turn came.
As he raised his two fingers and approached her labia, I couldn’t help but notice that his hand was trembling — violently. At that point, it took all my self control to keep from busting out laughing. I had to turn around and stare out the window for a few seconds to regain composure.
Our instructor didn’t comment at all about his shaky hand. I’m sure she that she has encountered many a scared medical student in her time teaching a pelvic exam. And she could probably so many more stories about us students.
Sure she got paid to do what she did. But I don’t believe she did it with money as her motivation. She really did care about making sure another generation of physicians would learn to respectfully and properly perform such invasive and private examinations.
Just came back from my surgery OSCE. Which means I had to wear a tie under my white coat. It’s probably the only time I wear a tie these days in a clinical setting. Even though I’m technically supposed to wear a tie in the hospital when I’m not wearing scrubs, I don’t. Not cause I’m a huge rebel. But because I don’t want to dry clean my dry-clean-only ties every week. Ties are a horrible source of infection.
Saw 3 standardized patients. Did an abdominal exam on a patient complaining of abdominal pain. She was a pretty good actor. Did another exam on a patient complaining about calf pain. He was a pretty good actor too, joking about his alcohol and smoking habits. And the 3rd patient I saw was a woman who needed a breast exam.
I didn’t like my performance on the breast exam. It felt rushed. At least I got a chance to drop some knowledge at the end. By that I mean that I was able to discuss breast cancer prevention and current recommendations regarding mammograms. Oh, and I’m glad that I didn’t tell her that her breasts “looked good.” I correctly stated that they looked “healthy.” I also suggested she do monthly breast self exams (BSE). Yes, I know the studies and statistics saying that BSE don’t really reduce mortality/morbidity. But whatever. I think it’s important and I will continue to recommend them to patients for now.
Anyways, she was either a great actor or she felt uncomfortable. Or maybe I was nervous because I felt rushed and so she felt nervous. But I loved her accent.
“You’d be surprised.”
Not long ago a classmate and I were told that there was a patient who needed his chest tube removed. The intern said one of us would do it. Initially I was going to do the pulling. But it really didn’t matter. Neither of us had ever done it.
Before we reached the patient’s room, our intern verbally walked us through the steps we needed to do in order to safely remove the chest tube. After all, you don’t want to be giving instructions at the bedside while the patient is awake and afraid.
It turned out the patient was very afraid. He had just experienced having a chest tube removed a few days ago. For reasons I was not familiar with (as I had never met him before and never looked at his chart), he had required a second chest tube. Now, though, it was time for the second one to come out.
As I bent over the bed cutting off the sutures the patient continued to express his fear. It had been very painful the last time it was done. He also wanted to make sure that we waited long enough for the pain medication to kick in (he had received some IV pain medication from the nurse right before we came in).
I finished cutting the sutures and the patient looked at me and asked if I had ever done this before. For a split second my mind froze. I didn’t want to say no. But it is bad form to lie to a patient. After gathering myself, my answer came out: “You’d be surprised. This is actually fairly common in the hospital.” At this point my classmate chimed in that chest tubes were fairly common and it was pretty routine for them to be taken out.
It worked. The patient seemed to find comfort in the fact that his procedure was simple — and in the process he appeared to move away from the question he initially posed of whether or not the two medical students in his room had ever done the procedure before.
My classmate ended up pulling the chest tube. The patient was actually quite happy about the whole ordeal; it hurt a lot less than the previous one. He even said that he wanted us doing his chest tubes next time he needed one pulled.
The way I answered my patient when he asked if I had ever pulled a chest tube was not something I came up with alone. I actually heard of it from a pediatrics attending physician. She recounted a similar incident that occurred to her while she was in residency. She told us that the patient looked at her and asked her if she had ever done a procedure before. And her answer was, “You’d be surprised how many of these I’ve done.”
By the very nature of medical education, there will always be a patient who is our “first.” Our first intubation, our first blood draw, our first whatever. Sometimes, we have to, as my attending told us, “fake it” until we make it. That’s the only way we can learn.
And for those readers who are not familiar with medical education, this may sound terrifying. But the intern, who had pulled many chest tubes, was by the bed when the time came for the pull. Should something have gone wrong, we were being supervised.
