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OMSA Leadership Summit and Lobby Days

Posted on 17 April 2013 by Jimmy Yan (Meds 2015)

About a week ago, the Ontario Medical Student Association hosted it’s 2nd Annual Leadership Summit and Provincial Lobby Days over the weekend of April 6-8th. It was an opportunity for medical students across the province who were interested in the process of government and health care policy (AKA those who are secretly health care systems enthusiasts) to network, learn a few things about healthcare in Ontario, and then work in teams to actually lobby the provincial government on an issue that reflected medical student concerns from all 6 Ontario med schools.  Continue Reading

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Wellness on the mind

Posted on 18 March 2013 by Jimmy Yan (Meds 2015)

I guess it’s just that time of the year. The latter half of our 2nd term is rising over the horizon, March Break (aka vacation time) ending, finished with St. Patrick’s Day and Easter just around the corner, the tax season deadline approaching, and the slow but inevitable lurch forward (like some sort of not giving up…school guyof clerkship, all these things have got me thinking about the whole “work life balance” and wellness.

Again.

Yes, I realize this topic enjoys as much attention in medical school as pictures of cats do on the InterWebs, but with the 1st OMSA Wellness Retreat geared up this Friday, it’s hard not to think on the subject and muse.

The concept of Wellness has developed it’s own curriculum. Through stand-alone lectures, lunch time seminars and workshops, regular emails (while writing this piece, I actually received an email regarding Wellness), and sharing of published literature on the subject, Wellbeing and learner health has become as integral to the medical school experience as anatomy. This has obviously been a great improvement upon the attitudes and culture in the past.

As a side note, an interesting piece of history can be found when examining how one of the longest standing traditional notions in medicine, the superhumanly long overnight on call shifts, was largely influenced by the work habits of a prominent physician who himself was using and addicted to cocaine throughout his whole career (it was not yet illegal at the time). While better regulation for sleep and shift scheduling have finally been implemented, through the goggles of hindsight it is fairly obvious that such a practice was inevitably unbalanced.

But with the acknowledgement that there is more focus on Wellness and Health these days, more than ever, in medical school, there should still be a caution on how the pendulum has the tendency to over swing.

The caveat  that should be mentioned is that Wellness is not simply an ends to reach, or another goal to accomplish, or another role (like the other CanMeds ones) for students to adopt and check off their mental CVs. Nor should Wellness remain focused solely on Physical and Social wellbeing. While these are necessary components to wellness, there are other equally important components that are under-appreciated.

Current Wellness Counseling theory contents that a person’s wellbeing and individual health can be conceptualized to include aspects of physical, intellectual, social, spiritual, emotional, financial, and occupational (or environmental) wellness. Each of these components can be in or out of balance, and it’s important to appreciate what could be missing in one’s lifestyle. That said, I will reiterate that it shouldn’t be about determining that components A, B, or C are depleted and by doing activities X, Y, Z, they will be more in line with the other ones, but rather realizing a lifestyle that can fulfill these aspects to your satisfaction.

I realize that this doesn’t require a total and sudden makeover (are you thinking what I’m thinking?), but is more of a mindset that one adopts over time. And, as one of the more infamous Night Owls in my class, definitely a topic I could use some more appreciation about.

Well, I got a few more days to think about this as I head to the Wellness Retreat this weekend. As overemphasized as this subject is, I still believe in it’s importance and am very excited for a weekend designated especially for learning more about it.

 

 

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The 4-1-1 on Medical Student advocacy on Parliament Hill

Posted on 05 February 2013 by Jimmy Yan (Meds 2015)

The first weekend of February is usually quite a special weekend. No I’m not talking about Ground Hog day here. It’s special because it is generally the time when medical students coast to coast in Canada assemble (much like the Avengers) on Parliament Hill in the 613 (that’s Ottawa, yo) to lobby for political action and greater advocacy. It’s an event that is hosted and organized by the Canadian Federation of Medical Students.

This year, I was part of the Schulich delegation to this CFMS Lobby Days. As such, I’m going to be sharing with YOU the big Cole’s notes of this weekend. I realize that advocacy is an area that is pretty ambiguous during our years of medical training, so I hope that this experience of advocacy work (while by no means the only type of advocacy experience), helps shine some light on how medical student advocacy can work.

So first things first: Ottawa is cold. WAY. TOO. COLD. Especially for a balmy wuss of a Vancouverite like myself. Quickly after arrival at Ottawa, I realized why all the politicians still use Blackberrys: 20 seconds after exposing your bare fingers to operate a touch screen and the beginnings of frost bite start setting in. Truth.

Another immediate impression: try avoiding to schedule the hotel for all your delegates at the same “Official” hotel of Winterlude, the massive annual winter festival in Ottawa during the same period. Essentially the hotel we were staying at was completely overbooked between tourists, med students, even a wedding party.

No. We did not crash the Wedding.

So our first day, Saturday, consisted of just getting settled in and meeting the other delegates. I noticed a lot of familiar faces, I guess these circles are pretty tight knit. Should be something I can expect moving forward. Back in my undergraduate days of student union politics the term we used was ‘hacks’. Well, it’s funny seeing so many med student political ‘hacks’ too. It was doubly funny running into Tahara, a 3rd year at UBC, who was a political hack with me back when we were members of the UBC student union council.

As a side note, this was the first time I got to skate on the Rideau Canal. While it was definitely a fun experience, and OMG MAPLE TAFFY IS DELICIOUS, $16 for a 2 hours of skate rental is definitely a bit expensive.

During the second day, the delegates spent 8 hours of the Sunday night and afternoon being trained on how to approach MPs and what exactly was the best way to frame our concerns and the Ask we are lobbying for (without getting into too many details, our Ask this year focused on improving the level of research and information at the national level on how to project future health human resource demands). There was a variety of speakers from different realms of political experience, and several workshops to practise. In the end of it all, we learned some valuable lessons on advocacy, communications, student leadership, and self-development.

These included points such as:

  • An MD is not an auto leadership indicator, it simply is an opportunity to become a leader
  • One of the best things a person could possibly do as a leader is to surround themselves with smarter people
  • If you want something done efficiently, force a lazy person to do it
  • No mistake or ‘inadvertent’ complexity in a piece of federal policy is done so simply by accident
  • There are differences between simple, complicated, and complex
  • Everyone likes to chirp Mac. Even Mac grads will deliberately go out of the way to beak the Mac medical experience

With all these, and many more points discussed, we were ‘trained’ to disperse and conquer the Nation’s capital.

Monday consisted of over 70 separate meetings between students, MPs, Senators, and Ministers’ Aides. It was very astounding to see the amount of activity that was happening. While I only had 3 meetings, I kept on running into students off to conduct their own sessions. We were everywhere.

Another thing that was astounding: the cold. It got windy. Damn.

Two other shocks, that really shouldn’t have been shocks, came during the day was how prevalent Twitter use among politicians was, and how many security check points I had to go through. I guess Obama made Twitter cool for every politician because they were much more prolific on the social media front than many of the students. The issue about security made sense. I mean it was the nation’s capital. I guess protecting it every now and then would be expected.

Overall, my experience with how our Asks were received was pretty positive. I had a wide range of MPs to speak to, from all the different parties. They all seemed to be on the same page regarding improving health human resources and getting the ball rolling on figuring out what the long term needs of Canadian patients would be. Despite all the grandstanding and overt displays of theatrics in Question Period, the MPs were all very willing and happy to hear from young minds talking about concerns that could impact the health of many citizens.

I guess it’s easy to forget or overlook the fact that many of these MPs started their roles out of desire to serve their constituents and to improve things in their ridings…based off the understanding of what needs to be fixed. In a lot of the way, it’s similar to the way physicians operate. We both are service leaders, and often the second word in that label ‘scares’ the public from approaching us. However, when speaking to the MPs, it became quickly easy to  see that what was really happening was merely two people forming a relationship and starting a dialogue.

So what’s the big deal with Lobby Day weekend? Despite the cold (for the 3rd time yes I know), it was a great experience. Getting to see the capital was a great privilege, as was the opportunity to meet and work with some of the brightest medical student minds from across the country. However, where the real value lies is in seeing how simple the whole advocacy process works. It’s about just getting out there and speaking your mind to someone you would like something out of. It shouldn’t be too difficult, after all, we all went through FIFE.

I highly encourage any student out there with the slightest interest in learning more about the role of politics and health care policy on the practise of physicians to considering coming out to the next set of Lobby Days as they happen nationally next year at the same time, or provincially under the OMSA in April.

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Learning and Grades

Posted on 18 July 2012 by Anurag Bhalla (Meds 2014)

An academic institution is regarded as a place where an individual obtains knowledge to be an informed and contributing member of the society. Medical school is one of these places where students gain medical knowledge and skills necessary to be a competent clinician. Whether a person has been successful in attaining a set standard of proficiency is often measured by a standardized examination. The more time I spend in educational institutions, the more I come to realize the inherent flaw in such an objective measurement of performance. Continue Reading

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The Quandary of Chronic Pain

Posted on 03 May 2012 by Stephanie Gottheil (Meds 2014)

How can we handle a patient in chronic pain? It’s a difficult dilemma. On the one hand, all of our effective analgesics come with long lists of side effects, from constipation to addiction to life-threatening GI bleeds. On the other, we have individuals mired in anger, depression, and hopelessness due to a debilitating symptom.

I spent this past summer studying the medications used by older adults with osteoarthritis, one of the most common conditions that affect us as we age. The average patient was taking 10 medications, which obviously raises concerns about drug interactions and over-prescription. What struck me most, however, was the number of people reporting severe daily pain that were not being treated for it in any capacity. Continue Reading

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Reflections on Chinese Healthcare

Posted on 15 March 2012 by Kenneth Lam

When my friends ask me how medical school is, I explain to them that the human body has been written about with zeal for millennia and that I’m spending a paltry four years catching up on as many stories about the body as I can. In every scientific paper and report and publication I read, I ask myself: what did this researcher observe? How did she come to terms with what she observed? What story is she trying to tell me, and how is she wrapping her head around what she saw?

Sometimes the stories affirm one another, and other times the stories conflict. Here’s an example: in the past, Western medicine used to say that peptic ulcers were caused by stress and excessive acid production. But when Barry Marshall and Robin Warren entered the scene in 1982, they told a different story: peptic ulcers are largely caused by an organism known as Helicobacter pylori. I absolutely believe it to be true, but I also understand that the story they tell is about a small creature that few will ever have the privilege of seeing first hand and that doctors recommend their infected patients to vanquish this little beast by consuming small yellow pills.

The point here is that I take information on faith by the authority of those teaching me, which is the same way my teachers learned from their teachers and how they continue to learn from their colleagues. And so I need to make a disclaimer before I begin this article: I know precious little about medicine of the Western variety and even less of the traditional Chinese variety– only what I have been told and what I have seen.

I spent the past summer in China with four friends on a very non-systematic tour of hospitals and other care facilities in five different cities. On three or four occasions, we saw traditional Chinese medicine (TCM) being practiced. Sometimes, it was in TCM hospitals: six story complexes divided into departments with teaching faculty and nurses and the same aura of legitimacy of any hospital, but devoted to a system of medicine that I had been told lacked evidence. Other times, we visited the TCM department nestled within a larger public hospital or community care centre. These departments seemed just as busy as the outpatient departments providing Western medicine.

The presence of these well-funded and well-visited complexes was evidence with which I grappled. The first thing I conceded was that traditional Chinese medicine was doing something. At the very least, it did enough to get people to change their behavior and spend money. Some patients traveled hours by train to see a doctor. Others were following through on doctor’s recommendations to live closer to the hospital so that the doctor could provide more regular care and update their herbal regiment more closely. And every TCM patient we asked gave us a testimony of how it really worked for them: their asthma was better, their cheeks were less flushed, their hematuria lab results came back negative, their diarrhea was relieved. We had a case where a patient reported having Duchenne’s muscular dystrophy (an irreversible genetic condition) improved with TCM.

Confused, I wanted to learn more about the principles behind TCM, and the opportunity came in our last week. We were shadowing Dr. Sun in his clinic at the Shanghai Children’s Medical Centre and his students brought in some bilingual textbooks on Chinese medicine. They were a series of four books published by the Nanjing University of Traditional Chinese Medicine and translated in Shanghai and they covered the basic theory, diagnostics, science of prescription, and science of curative properties. So in between patients, we each read a little.

Two theories govern Traditional Chinese Medicine, but before I get into them, I need to expose the underlying premises in Western medicine. Western medicine is generally built on a theory of reductionism and causality: we break the body up into systems and then the systems down into organs, tissues, and cells, and we then find out what everything causes in order to predict how we can change things. I’ll give you an example: if someone comes in looking jaundiced (yellowish in colour), our explanation is based on how abnormal function of the smaller parts of the body add up to this overall appearance. Jaundice is caused by the excess build up of bilirubin in the skin, and bilirubin is cleared by the liver and produced when red blood cells are broken down, and so the problem must be with the liver or with the break down of red blood cells. It’s a remarkably systematic and rigorous approach to the body.

By contrast, the theories in Chinese medicine are primarily theories of dynamic equilibrium– that the whole body is in a state of balance that’s established by conflicting forces. That balance is thrown off if one side becomes deficient or too strong. One theory asserts that the balance is always between two forces; the second theory asserts that the balance is a complicated web between five forces. Note that these ways of thinking aren’t foreign to one another. The Western notion of water balance (homeostasis) in the body has the same philosophical underpinning– you’re not drinking enough or you’re sweating too much. Similarly, Chinese medicine does break the body down into different functional systems. But in Chinese medicine, the concept of balance comes first, and the concepts of reductionism and causality occur WITHIN the framework of these forces that need to be balanced.

And so the balance between two forces is known as the Yin-Yang theory, while the balance between five forces is known as the Five Elements theory. All disease always goes back to Yin-Yang or the Five Elements. These are abstract concepts: yin-ness is exemplified by the moon, the shade, the internal, the cold, downward directions, etc. while yang-ness is exemplified by the sun, heat, the external, upwards-ness, etc. So, if you’re too hot and feverish, it goes back to either too much yang or too little yin. And the treatment (whether herbal or pharmaceutical) is, by definition, a yin-strengthener or a yang-inhibitor. The Five Elements are also abstract concepts: fire, water, metal, wood, and earth, and they have a relationship of either strengthening or restraining another element. This is where things got strange for me.

TCM believes that the Five Elements get mapped to five systems in the body based on traditional abstraction. The Fire element is mapped to the Heart– but not just the anatomical heart. The Heart includes the blood, the vessels, and the tongue. So perhaps it is better to say that the Fire inside the body is manifested in the blood, the vessels and the tongue. Metal in the body is mapped to the Lungs: but the Lungs also include the hair, the skin, the nose, and sweat. So far so good– maybe TCM simply regroups organ systems along different categories. But I balked when the book made an assertion about the relationships between these categories. Why should Fire necessarily restrain Metal? Sure, I could interpret the sweating from a heart attack as Metal becoming overactive once Fire failed to restrain it, but it didn’t seem like a particularly rigorous or well-founded association.

I tried to put my skepticism aside as I watched Dr. Sun apply these theories to his practice. Like a primary care physician during a routine checkup, he’d ask questions about how the patient was doing and whether there have been any changes recently. But I wondered about the credibility of his diagnoses when I saw that his physical exam consisted chiefly of inspecting a patient’s tongue. The reasoning goes as follows: childhood illnesses tend to be problems of too much yang, the Heart is a yang organ, and the tongue is a window into the Heart. From there, he’d make a conclusion (many of which were lost in translation and understanding), and then he’d tailor a herbal recipe based on each herb’s yin or yang property and its elemental attribute. After that, the next patient.

So over this backdrop of a very unfamiliar medical system and cultural and language barriers, I watched as patients poured into Dr. Sun’s office and sometimes paid a little extra to get a bit more time and attention from him. I mean, what was he doing for them? Was he improving their health? Or if not their health, was he improving their wellness? Was he offering the reassurance of his white coat? And if so, was the reassurance powerful enough to make them well? I grappled with the possibility that he was a charlatan and a quack, selling them the promise of better health but being unable to deliver it.

Calling Dr. Sun a quack is a heavy criticism on both the integrity of his character and his beliefs, and there are a few things that keep me from laying down such a pronouncement on him and by extension, TCM practitioners in general:

Firstly, as squeamish as I am about the theories behind TCM, it could be a working medicine of inaccurate theory but accurate associations. There is some evidence where traditional remedies outperform placebo: Chinese herbal medicine works for irritable bowel syndrome (Bensoussan 1998), and acupuncture is indicated for chronic pain (Manheimer 2005). In this situation, it may be that certain treatments were documented to have a positive effect on certain conditions and out of a desire to create a unified system of thinking, TCM used opposing elemental categories to record which treatment was effective against which condition. And when I reflect on the history of Western medicine, I concede that oftentimes, we are also a medicine based on association rather than bulletproof theory, but still we practice.

Secondly, I found that the TCM students were just as motivated by altruism as I was, and putting myself in their shoes, I couldn’t accuse them of any insincerity or quackery. They gave the same response that I would give if I were asked why I wanted to study medicine– they want to help people. And it’s hard for me to fault them for what they believe: the same way I usually don’t question whether clarithromycin works against H. pylori so long as my professor tells me it works, I imagine they don’t question the usefulness of a herbal remedy when Dr. Sun tells them it works. My convictions regarding the efficacy of Western medicine are founded on the trust I have for my teachers. If Western medicine is superior to TCM, then isn’t the validity of my belief only the result of my privilege to be told true stories about what makes people healthy and sick?

Thirdly, TCM is neither a small nor static field of study. Dr. Sun’s students will be learning TCM for the next four years. Just as they respectfully acknowledged that their field is complementary to the massive body of knowledge that is Western medicine, I have to admit that there is so much about TCM that I don’t know and never will. The total index of herbs is in the thousands (though less than a hundred are used regularly). They pick up new techniques from other naturopathic schools. And they are starting to use Western diagnostics to quantify their practice.

So, as China continues to grow economically, it will be interesting to see how their medical system negotiates between TCM and Western medicine. If patients substantially switch over to Western medicine as the medicine of preference, perhaps it suggests that traditional medicines were a compassionate cushion for those who couldn’t afford better care. But at present, I’m more inclined to withhold passing judgment on TCM. I think it is easy to pick on alternative medicines from within a North American medical fortress, to come to a rash conclusion, and to develop a hostile us versus them mentality and in doing so, create conflicts where there are none.

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