Archive | August, 2016

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#RealTalk: Cultural Facts & Perspectives that will make you a better doctor-

Posted on 21 August 2016 by Tammy Wong (Meds 2018)

The #RealTalk series allows our fellow students to share their ideas about how healthcare intertwines with their cultural and/or religious background. Check out this interview with 2nd year medical student Tammy Wong:

What is your background?

I was born and raised in Canada by Chinese immigrants from Hong Kong. My parents are Buddhist and raised me with traditional Chinese values.

What aspects of your culture differ from the stereotypical norms?

Family values: Chinese families focus largely on respecting and caring for elders and often decisions are made as a family, especially in relation to healthcare plans for patients. Furthermore, it may be hard to elicit patient wishes from the family’s wishes if they differ, but if physicians were perceived to ‘go behind/around’ the family then it would cause distrust in the system.

Food: One tradition when family members are in hospital or are ill, is that families will bring lots of cultural food to the patient so physicians should keep this in mind if there are diet restrictions for inpatients (i.e. NPO, low salt, etc).

Perspective on death and dying: Many Chinese immigrants, especially elders, are very superstitious. There is an idea that you will jinx something by saying it aloud so often patients avoid talking about death or risks with procedures. As a physician, you need to talk about these so you have to elicit it somehow from the patient. There is also a feeling of duty from remaining family members that they need to do everything that they can to ensure the patient’s survival, so a discussion about palliative care may be harder to approach but is necessary, especially if it coincides with patient wishes.

Perspective on mental health: There is usually a stigma regarding mental health among Chinese families. Many Chinese people do not really believe in the concept and think that you should just ‘get over it’. They also worry about being labelled with a mental health condition and often refuse to address it. This is something that physicians should be aware about and should try to educate to reduce the stigma.

Language barriers: Like with many other cultures, there may be a language barrier when speaking with Chinese patients. Furthermore, in Chinese culture it is common to nod or make sounds of agreement as a symbol to show that the listener is paying attention and as a form of respect. However, in contrast with Western culture, ‘nodding’ doesn’t always mean understanding and agreement; it is just to show respect and listening. Ask if they need clarification and summarize to check if patients actually are understanding.

Paternalistic view of medicine: Particularly with the elderly Chinese patients, they may be used to doctors telling them what to do and not really asking questions about their wishes or opinions because this was the format they were brought up with. Patients are also taught that doctors deserve respect and should know what is best for you. It is important to ask for patients’ wishes and values and to explain risks to help them make informed decisions, rather than just having them follow what you recommend.

Tell us a bit about Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) is still largely used by the Chinese community under the view that it can treat the body holistically and strengthen the body. Often patients will use TCM while also being treated with Western medications. In some cases, private insurance companies may require prescriptions for acupuncture, etc in order for the treatments to be covered. Without the prescription, the treatment can be very expensive and patients may need to go to ‘sketchier’ or unlicensed providers to save money which is more dangerous. Consider prescribing these treatments even if you don’t really believe in it to help out a patient pay for this, especially for a chronic disease that may not be curable with Western Medicine.

When performing a physical exam, what should be done that differs from what we are taught at school?

While there isn’t anything specific to ask about, many Chinese citizens are very modest so proper draping is very important, especially with elders. Ask if the patient would like anyone else in the room (i.e. spouse or family members) and explain what you are doing very clearly.

If you could give one piece of advice to us future doctors on providing care for your population, what would it be?

Always ask for clarification/understanding and take a bit of time to ask if there are any other issues when speaking with Chinese patients. They may not discuss their true fears or opinions until later on in the interview, especially if it is something embarrassing, sensitive or worrying to discuss. Mental health issues also fall into this category because it is often brushed under the rug. Be sure to ask and also suggest lots of supportive resources for these patients.

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Aboot Medical School

Posted on 21 August 2016 by Kevin Dueck (Meds 2016)

With the move to residency I thought I would try and share some practical tips from my time in medical school. I already shared a few clerkship tips over at the OMSA Blog (http://omsa.squarespace.com/blog/2014/11/9/aboot-clerkship), so I won’t cover previous items such as stocking up on pens or picking up compression stocking.

25 Med School Tips

  1. Access support services early.
  2. Share in each other’s struggles and accomplishments. Look out for each other.
  3. Early on medical school is much like high school. Cliques, rumors, and all that goes with it. Be careful how much you share or of sarcasm/humor that may be taken as offensive out of context.
  4. Don’t be afraid to spend a little extra to have a comfortable and convenient place to live.
  5. Exercise
  6. Study for the care of patients, not to pass the test. For dry material try to picture someone coming in with the condition. What questions would you ask? What would you see? Feel? Hear? Etc. Also, try think few steps beyond the multiple choice answer, not simply the name of the top diagnosis or first line treatment. Find a way of studying that works for you.
  7. Get a mentor, preferably mentors.
  8. Mentor others.
  9. Get involved. There are many clubs, interest groups, academic opportunities, research options, chances to travel, innovate, collaborate and more. Take advantage of them, but know your limit and how to say no. There are only so many hours in the day.
  10. Calls for interest and elections close very quickly. Often there is a single opening to fill and it is given to the first interested student. Related, have a decent smartphone so you can see and respond quickly.
  11. If you want to do a larger project, one that requires substantial funding, try to secure it by the end of first year. Team projects with classmates become more difficult when everyone is on clinical rotations. Similarly, with research projects, get on them early to get a lot of the legwork done during pre-clerkship if possible. Also, as a med student people/organizations will give you an ear; you can do big things.
  12. Alcohol is used as a primary means of social bonding and coping with stress. Try to develop healthier means of coping. Ex. Exercise/athletics/yoga, mindfulness, art, journaling, weekend road trips, etc.
  13. Med school interviews don’t filter out a-holes.
  14. The top reason you get kicked out is for professionalism, not for grades. The belief seems to be that knowledge gaps can be rectified, but character gaps can’t be salvaged. Be careful on social media.
  15. You will meet many interesting, accomplished people in medical school along with impressive faculty. Enjoy it; try not to feel intimidated.
  16. Attend talks on finance; it is important. Your line of credit isn’t a blank cheque.
  17. Don’t lose yourself.
  18. Explore topics outside of medicine. Read books that aren’t medical, listen to fun podcasts, have friends outside of medicine, etc. It keeps you grounded. Most of your patients aren’t doctors; varied interests help you connect.
  19. When working in the hospital choose your attitude. You can choose to be annoyed by calls from the floor, the demands, lack of respect, etc. or you can know that there will be ridiculous calls, frustrating experiences and more and choose to maintain a positive and professional attitude. Try not to become cynical.
  20. Medical school makes your hair go gray, and in some cases fall out.
  21. Try not to lose your motivation for becoming a physician. Focus on the patient and helping them. This can be difficult with looming exams, expectations of productivity, paperwork, dictations and other responsibilities.
  22. If you choose to be a part of student government or academic committees, please keep up with your portfolio and contribute. The person before you likely put in a lot of work, don’t let it fall away.
  23. Keep on top of the required police records checks, serology, first aid/CPR, N95 testing, etc.
  24. Organizational skills are important. Being involved in multiple clubs, doing research projects, exams, deadlines, and more—you need a system. If this is the calendar on your phone, a to-do list app, a Hobonichi Techno (I’m a fan), folder system, a paper calendar, whatever. Find what works for you and stay on top of things. When things get hectic, it is key.
  25. If your school offers podcasting of lectures, it is a great resource and can save time watching them at 1.5-2x speed. At least for the first few months, I believe it is best to attend class to make social connections. Also, if a professor is lecturing in a topic of interest, it is much friendlier to walk down and introduce yourself than sending an email to connect with them.

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