Old Fashioned

Almost monthly, some or other ancient consultant is decrying (or sometimes promoting!) some archaic practice that hasn’t been adhered to since the Dark Ages when they probably were trained.

Sometimes it’s stupid stuff, like telling students on their first day of a rotation that they will be promptly failed if they are ever caught sticking used needles in the patients’ mattresses between venepunctures–something that I understand was probably done in the 80s or 90s but definitely hasn’t been done this side of the twentieth century if our interns’ eye rolls are anything to go by. We have sharps bins and safety protocols in teaching institutions these days, Prof. Thanks, Prof.

Sometimes it’s more serious things. Things that could influence a student’s entire future, their education, career and health. Like when consultants and professors belittle or dismiss legitimate concerns from a student about personal safety or the barriers to effective learning.

This year I had the misfortune of experiencing a module and a clinical rotation where I felt both my personal and professional future were being put at risk because those in charge were, to put it respectfully, a little old fashioned.

Okay. Very old fashioned.

The first of these was a theory block. Fourth year’s biggest monster academically was this teeny little subject called Anaesthesiology. Of course, I was amped for it. I’m a physiology girl, and anesthesiology is basically applied physiology (in the same way Surgery is applied anatomy, which is confusing because I hate anatomy but love surgery. But more on that some other time). I did all the over-eager things I do when I anticipate that I’ll enjoy a module. Pre-read, spend some time on google, schedule my life so that I don’t miss a single lecture, buy a ring binder. A ring binder, people.

Unfortunately, my first foray into the world of hypnosis, paralysis and analgesia was not as positive as I would have hoped.

The first sign that we were going to be dealing with an old fashioned system was the introductory lecture. The study guide was barely five full pages with no outcomes, no module layout. Just themes and a timetable. We were told outcomes were impractical because in Anaesthesiology, it only helps to know everything. Cue first eyebrow quirk.

Then we were promptly told that any complaints we had about the module and its mode of delivery would be pointless and a waste of breath, because the person we were likely to be complaining about was more powerful than we could know in this faculty and people had been complaining for years. Years. Yet nothing ever changed and nothing ever would change and by the way said lecturer was still in the faculty while complainants were conspicuous only by their absence. But feel free to try. Cue second eyebrow quirk.

Then we were introduced to our other, slightly younger lecturers. Also consultants for the most part, but less grey. They were reasonable, accommodating. Patient when information bore repeating. Thoughtful about the language requirements of our rapidly dwindling number in attendance during lectures. There seemed to be less hostility and stubbornness radiating from them, but that didn’t matter because they weren’t in charge. Yes, they understood that the language policy of the module was restrictive and outdated and mildly prejudiced, but that didn’t matter because they weren’t in charge. Yes, the textbook that was our prescribed examinable material was based on evidence that was half a century old and had often since been invalidated which meant we had to learn one thing for the test and another for the real world, but there was nothing they could do about it because they weren’t in charge. It seemed nobody actually agreed with whoever was in charge but, ehem, there was nothing they could do about it. Cue deeply furrowed brow.

Then came the ultimate sign that we were suddenly studying medicine as taught in the eighties. When time came for lecture podcasts to become available, we were told we’d only get access to them two days before end of block, if at all. Two days. Because apparently podcasts are the devil that binds students to non-attendance. So we would have to either be in class or flop. Cue mask of confusion.

(Three thoughts on the above. Firstly, as someone who regularly attends lectures and makes frequent use of podcasts for consolidation or revision, I find that entire line of reasoning offensive. Who is anyone to tell someone else, especially adult, fully grown students, what methods of study to employ. So what if someone opts to use podcasts in lieu of attending lectures? What business is that of anyone else’s? If someone can find more productive ways to use the five to seven hours of lecture time we get a day, if they choose to spend that time reading through the material, making summaries or even just lying on the beach that is their prerogative. We’re way past the dark days where it was assumed that everyone learns the same way or that there is a correct way to assimilate information. Secondly, screw that. If you insist on delivering scientific content in a language that only a third of those in attendance in class understand to begin with, podcasts are essential for the rest of us to labour through after-hours so that we don’t miss out on all the valuable information that flew right over our heads. It’s only fair. Lastly, students have been bunking lectures for as long as lectures have been in existence, so pinning poor attendance on podcasts is so ridiculously weak. Try again.)

Needless to say, the podcasts were posted and then promptly taken down, accompanied by a message berating us for relying on technology instead of good old fashioned work ethic. Who knew the two were mutually exclusive?

Ultimately, I still loved the subject content-wise (it’s in my top 3 specialities now) but I felt cheated and disappointed by the end of the block. I said as much in the feedback, but nobody seems to read those things anyway. And it’s just so disheartening that in this day and age, ‘important’ professors are given leeway to basically do whatever they want to students with no regard for how that will affect their academic progress or their chances of not only competing the course, but becoming safe and competent doctors.

Which brings me to the second experience, which is actually a multitude of experiences that were so uncannily similar that I’ll condense them into one for the sake of space.

During most of my seven clinical rotations this year (and almost all of my rotations in third year) I have had the misfortune of having to deal with multiple sputum-positive TB patients. Now what’s interesting about (most) of these patients is how positive and easy to interact with these patients are. They are usually not difficult about the precautions put in place for the safety of others in the wards and if you take the time to explain things to them properly they are more than happy to cooperate when it comes to things like isolation, adherence to medication and the wearing of surgical masks.

So the ‘misfortune’ usually has nothing to do with them. It’s the outdated, unbelievably stubborn and arrogant consultants that we sometimes have to deal with that cause the majority of problems.

During a very hectic rotation this year, we had to leave ward rounds early in order to make it in time for a clinical teaching/consultant Tut on the other side of the hospital. The premise of these Tuts was to work through the diagnostic process of a single patient with obscure, rare or interesting signs or to be exposed to more common diagnostic dilemmas (like a poorly controlled asthmatic who has a positive TB contact, a positive mantoux but negative smears and an inconclusive chest x-ray). We were more than excited as we bounded through the passages that link the wings of the hospital.

We arrived just in time in front of the designated ward and were greeted by a kind-faced consultant of clearly advanced years who introduced himself as Prof Invincible. Our group of six introduced ourselves to him as he led us into the ward. We walked past all of the open, common rooms and right to the end of the ward where most of the single rooms were situated. Instinctively, we started patting our pockets in search of N-95 masks. Anyone who works in a South African public hospital knows that nine times out of ten, a patient is in a singe room because they have pulmonary tuberculosis. Anyone whose paid attention over the last five years knows that there is no difference in the transmissibility of drug sensitive and drug resistant PTB. You always wear an N-95 respirator.

Unfortunately, by the time we reached the room at the very back of the ward, we realized we’d all run out of respirators. We asked to be excused to find the ward sister in charge in order to get a few and were given such a sharp look that we promptly shut up.

“We’re running late,” Prof Invincible snapped, digging into a box of surgical masks on the trolley outside the patent’s room. He handed a stack to us. “Put these on and come with me.”
“Prof,” one brave soldier said timidly. “Surgical masks keep pathogens in, not out. We need respirators.”
“Let me tell you something, girls,” he said condescendingly, “I have been working with patients for twice as long as you have been alive and I have never contracted TB. People who get TB are the immune compromised and the afraid. If you worry about TB, you’ll get TB.”

Cue screeching of mental tires.

Say whaaaaat???

We all stared at each other with wide eyes as we double-masked ourselves. I’m ashamed to admit that we caved in and followed him into the room, right past the colorful sign pleading with us to protect ourselves and our colleagues, and spent the next half an hour talking to and examining the patient. I spent that time imagining quite uncomfortably how the little TB bacilli leaped gleefully out of the patients airways and into mine each time he laughed or coughed. I refused to percuss him, which annoyed the consultant, but my defiance was too little too late. We’d lost the battle the minute we’d let him bully us into that room.

And all for what? All the latest evidence shows that healthcare workers are actually more likely to contract TB than non-healthcare workers. We spend more time with them, repeatedly, in closed quarters with barely adequate sunshine and ventilation. We percuss them, ask them to cough up sputum for us, tell them jokes that make them laugh so we can build rapport, have long winded conversations about compliance and resistance, suction their airways–all of these leading to higher levels of exposure.

But we let some old-fashioned, outdated superior convince us to put our own Heath at risk because this is how he’s been doing things for the last one hundred years and who the hell do we think we are suggesting that he’s been wrong all this time.

Wow, this post is getting long.

I guess my point is that the system needs new blood. Yes, we learned a lot from Prof Invincible. He has the experience and instinct that every student doctor aspires to attain, and he is actually not a generally difficult man. But his brain, like the brain of our Anesthesiology adversary and so many other older, stubborn members of faculty, is stuck at that stage where you really can’t teach an old dog new tricks (with all due respect).

Times are changing. Medicine and education in general are experiencing such exciting advances in terms of information, technology, best-practice, good old humanity that to those of us at the bottom they feel less like “valuable members of faculty” and more like extremely dangerous dead weight. By making it more and more difficult for students to learn the art of evidence-based practice, they are not only endangering our patients but also directly endangering our lives.

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8 Comments

Filed under Clinical Rotations, guidetomedschool, random, ranting, Thoughts

8 responses to “Old Fashioned

  1. Oh GURL tell me about it! I had to get a TB test last year and I was so sure that I was going to test positive, given the exact same situation you had been in! Also, recently, doctors told me I don’t have to wear lead aprons in radiological surgeries, I could just stand behind them and be protected. Yep. And I was like, I have ovaries thank you goodbye. Still in the process of submitting a complaint about that.

    Speaking of complaints, the Anaesthetics department was lying to you. It is possible to lodge successful complaint about them, just very difficult. I speak from experience. I did have the head of the department telling me that “little girls like you should stick to playing with their dollies”, but I still got the result I wanted.

    ANYWAYS, YES. I’m so tired of all this “old” blood. They have their contributions, but they need to learn to allow modernity to take its course, before South African medicine grows cold and irrelevant.

    • “I have ovaries, thank you goodbye”

      I have the giggles, thank YOU. Goodbye.

      Before you leave though, there was an interesting situation that I was nervous about including in the post at the time (I have paranoid tendencies) where a classmate of mine brought all the necessary evidence required to qualify for a sick-test and was told “This department does not set sick-tests. You will write the exam as your test and the rewrite as your exam.” After going through the channels to complain, they received an e-mail from VERY high up which when summed up said: “So-and-so is a very valuable member of faculty.” Yup.

      Yup.

      In retrospect, they should have forwarded that email to the rector.

  2. Ah, one more thing: I have actually seen the needle-in-the-mattress thing. Back in 2011 though. Almost got an IOD from that when I was changing the sheets of an obstetric bed. I’m glad if it seems to be diminishing though!

  3. inuttimcapple

    Yes a new post!! The abuse of power, in my opinion, is THE most disgusting thing in all the universe. It literally makes me sick. All the above-mentioned people could easily use their power to bring about change…yet they choose not to. Why? Just ’cause they don’t feel like it. All that potential to change the lives of the students under their care and thus the country, down the drain…not in 2013 I guess. They choose to take their chances with the future medical doctors whom they have inadequately trained, at their mercy, to prescribe the wrong dose of anesthesia, cut the wrong limb or even put their loved ones in danger. It seems they are still in denial of this fact…or maybe they have made euthanasia life plans that we have no caught up to. Who really knows. Either way some one else will suffer because of their sins; not using the opportunity to train world-class doctors and leaving a life-long impression on the young minds they come across. I call them killers. Cause that’s what they are. Murders of dreams and people, futuristic-ally speaking. It sucks for the language challenged people because as much as you would want to be successful in a module, the language has a huge impact on your even connecting with the subject and even trying your best coupling in with the extra effort you have to put just to stay on class average. Above average yo.

    I remember being in the same situation about a year ago and I hated Anesthesiology. I bunked almost half of the classes because I just felt literally sick being in the presence of this one particular lecturer. Sick.

    I just read an article recently stating that in a few years time we will be facing a shortage of specialists. I am currently on my Orthopedics block right now and I literally screamed, “That makes sense.”, just because I could not believe how arrogant and uneducated about acceptable human behavior some of these specialist where. I literally wanted to stick my gloved finger(safety first) up their inferior orifice and pull whatever was stuck up there to make them glide so high in space over other people that it seemed so acceptable to do so. Pull it out. The nerve really.

    I just hope this generation of doctors changes their approach to medicine. We really can do so much for the people we have pledged our lives to serving. We don’t have to be like these glorified “psychopaths”. Let’s change the world yo. Make it flat. Round is overrated.

    The TB scare is as real as Beyonce’s curves though, six months of chemotherapy for a preventable disease is something no one should go through. We really must be more assertive when it comes to our safety, as scary and as wardmark-potentially-decreasing as it is. You only have one pair of lungs to take with to those overseas trips once you qualify. I am guilty of this caving in because…who does not enjoy caves; they are dark and scary and adrenalin raising. This comment is longer than your post. Rant done.

    • Wish I got notified whenever I get a comment, especially essay length ones with so many good points I’m considering posting the comment as a separate post. (Yes, I nodded that many times.)

      “The TB scare is as real as Beyonce’s curves though, six months of chemotherapy for a preventable disease is something no one should go through.”

      I don’t even know what to think anymore as far as the power a users go, buuuuut you are right about them not thinking about the big picture. One day, when their children are in our care, they’d better just HOPE we were diligent enough to discover other ways to integrate the information they refused to help us learn.

  4. charoo iyer

    Great post ! I just came across ur blog šŸ™‚
    I am an Indian medical student and let me tell you, our education
    system is so archaic it makes me cringe. I wasn’t even familiar with the term “podcast” until I started reading international med student blogs. We hv no such arrangements here …you just get to here a lecture once ! What I cant understand is if we do hv great technology to aid us ..why not make use of it ?

    • Charoo I’m so glad u commented, it gives a little perspective as well because sometimes I think we get the worst of it in South Africa and it’s difficult to remember to be grateful! Your question/point really is the crux of the issue, though, isn’t it? If the resources are available at no additional inconvenience to anyone, why not use them???

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