Douleur dans le pouce

Sticking out like a sore thumb. I don’t think I knew the true meaning of that expression until I came to Bordeaux. Not being able to speak French at a university in France is a challenge. Of course, the program I was enrolled in is supposed to be taught in English, yet that didn’t stop the professors from doing everything within their power to avoid teaching so. We were all warned about this, both by former students in our program and the program coordinators themselves.
For me, and my other ‘anglophone’ classmates (a term coined by our lecturers, I don’t even come from an anglophone country!) it was very awkward when the professors would announce to the class (this happened many times): “who here doesn’t speak French? Are you sure? Not even a little? I can speak slowly.” One or two lecturers even defiantly protested the fact that they were supposed to speak English for the sake of four or five students out of forty or so. Despite this, they all eventually switched to English – and most of them were completely understandable. Having an accent, however thick, doesn’t necessarily mean one can’t speak a language properly.
Of course, I’m not really blaming the professors or anyone else – the French are very proud of their language (justifiably so) yet they seem to be reluctant to speak English because of self doubt more than anything else. Perhaps French was once the language of science, as was German, Latin and even Arabic – but nowadays, it’s English. I think that the more willing people are to accept that the further they can progress.

Nostalgia

One of my friends recently asked me whether I missed working with patients. He also asked if the MSc program I’m currently enrolled in at the University of Edinburgh helped remind me of what it’s like to be a doctor.
The first question was easy for me to answer – I do miss working with patients – research is great, and to this day I stand by the reasons why I chose to pursue a few years of research-based training after finishing my primary medical qualifications. However, bedside practice is irreplaceable and unique. For me, it’s the perfect mix of challenge and reward. I’m enjoying all the new things I’m learning about neuroscience, but I still look forward to the day I hang my stethoscope around my neck and return to the wards and clinic once more.
As for the second question, I had to think about that for a little while. It’s true that I joined the program in Edinburgh to keep my clinical medicine knowledge up to date, but I truly feel that it has surpassed my expectations. To be completely honest, before joining the program I had thought (like many other people do) that ‘part-time’ and ‘flexible’ translated to ‘easy’. In fact, however, the opposite is true. Not only does a part-time program like this require an enormous amount of motivation and time management, but it also tests an individual’s resiliency.
I frequently find myself solving cases at three in the morning – just like I used to do while I was a medical intern – after a long day of lectures or lab work. Now, I don’t know if the program is designed to work in this way, but this kind of pressure does in fact remind me of what it’s like to be a doctor. Most, if not all, of my colleagues enrolled in the program at Edinburgh are practicing clinicians, so perhaps they don’t see the program the same way as I do. Being a doctor is a challenge, and working under pressure is a part of everyday life for any clinician. I think the program does a great job of reminding me of that.

À la une

I’ve been neglecting my blogging duties. I say this every month, of course, but a lot has happened over the past few weeks. A lot of blog-worthy things (I will be trying to cover everything in a series of posts over the next few weeks).

I attended the European Society for Magnetic Resonance in Medicine & Biology’s 30th Annual Congress earlier this month in Toulouse, France. The city of Toulouse is only two hours from Bordeaux by train, and I spent four days there. The congress was an incredible spectacle, held in a huge conference facility in the centre of the city. It brought together clinicians, basic scientists, radiographers and physicists from all over the world and ran several (up to seven) parallel sessions each day. The content of the meeting had something for everyone, from teaching sessions for the less experienced folk (like moi), to complex debates and discussions over controversial issues in MRI.

I had the opportunity to watch and meet some big names in the field of MRI – people whose names I had only before seen (at the ends of authors’ lists, naturally) when someone at my lab recommends that I read a landmark research paper. Going to grab a quick lunch in between sessions at the McDonald’s near the conference centre? End up sitting next to a distinguished professor of neuroradiology from a major institute, discussing everything from the awful weather (it was raining, a lot) to the role of dynamic susceptibility contrast MRI in diagnosing cerebrovascular disease. Sigh, I love conferences.

I presented my research (done in Berlin earlier this year) at the conference. The poster, which was in electronic form, was very convenient – no lugging around bulky paper , worrying about creases or spillages. It was available throughout the three days of the meeting for any of the attendees to view on one of the dedicated poster PCs at the congress venue. Online, I could track how many views my poster got, and could take people’s questions or comments during the half-hour time period where I had to be physically present. Speaking of posters, I was happy to see research done at the University of Edinburgh (and specifically from a department which I’m considering applying to for a PhD position next year, if I do apply for a PhD at all, it’s complicated. I digress, we’ll discuss this at a later date) being presented at the conference.

One of the main ‘controversial topics’ being debated on during the congress was the topic of my upcoming master’s thesis. As I sat there watching six months of my life being lambasted mercilessly before I had even started working on it, I couldn’t help but feel a bit disheartened. It’s not every day that you witness your efforts being prospectively criticized (I joke of course, I’m not that egocentric – I’ll be writing a 50 page report on the topic, it’s not my life’s work). The truth is, I actually enjoyed it – I like dismantling things and critiquing what others accept as-is (including my own work – although sometimes that’s a little counterproductive). In the spirit of critical self-reflection, I realize that this is a somewhat long post. I’ll try to keep my posts short (but frequent) in the future!

I leave you with some pictures from the meeting:

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Sunday in the city

I realize its been exactly a month since my last blog post. I feel awful, I should be dedicating more time to writing! But I digress … I’m here to give you a synopsis of the past month and the coming days.
It never ceases to amaze me how quickly I get bored when I have no work to do. I just finished my lab report (which I’ve been working on for six weeks now) and handed it in this afternoon, and having moved to a new city just two weeks ago I really should have some more fun things on my todo list. Alas, it is Sunday. And this is France. Bordeaux is very quiet on the Sabbath, the bus that usually passes by my building thrice an hour to take me to the city centre is nowhere to be found. I’m not complaining, that gives me the chance to lie on my couch and write.
The city is beautiful, although I haven’t had enough time to see all of its beauty. It’s relatively small compared to Berlin, and it has a nice historic feel to it. Classes have been interesting so far, the French professors have so far kindly stuck to teaching in English (phew). Most of my classes involve addiction or psychopharmacology in some way, and I’m finding the material intriguing.
Tomorrow my new academic year at the university of Edinburgh starts again, with a course on clinical history taking and examination skills. I’m excited, as I’ve missed the online learning platform over the past couple of months. Later this year we get to take some specialized elective courses, which I’m really looking forward to!
I’ll be traveling this week, to Geneva first to see my sister who’s attending a workshop there, and then to Brussels for a negotiation and communications seminar organized by the Erasmus Mundus association. I’ll be posting more about my travels soon.

Quote of the week

“Medical instruction does not exist to provide individuals with an opportunity of learning how to make a living, but in order to make possible the protection of the health of the public.”
Rudolf Virchow addressing medical students in Berlin.

The thin line between art and science

Over the years, my mind has been moulded to think that when it comes to how living things work, there are no absolute truths. In medical practice, this mentality is usually revered, however, the same cannot necessarily be said about basic science. I sometimes find myself having to defend why I question everything – even the ‘facts’ that I am taught come with a mental post-it note placed in the back of my mind that the ubiquity of exceptions is the only rule I accept. Today’s fact is tomorrow’s misguided observation, and what applies to one person may be irrelevant for the next. This post is my personal attempt to find the reason behind this difference in thinking between those who practice clinical medicine and basic science.

When I was in medical school, countless professors would tell us how medicine is more art than science. We were told how, although we did not understand the difference then, we would soon realize this fact after we graduated and began to practice. Now, one year into my masters in medical neuroscience course, buried under a never-ending pile of experimental data, I find myself thinking about what they said.
Clinical medicine involves much more than memorizing facts or remembering the details of drugs and diseases. It requires a special type of skill – an analytical and critical mind-set which is unique to the profession. Recalling long lists of symptoms and signs is one thing, but the ability to form connections between various observations, synthesize this knowledge and turn it into something practically useful and beneficial to patients is what lies at the heart of medical practice. Akin to solving a puzzle, going from the first encounter with a patient to being able to manage them as a whole is why medicine is often described as an art.
Experimental medicine is entirely different. I’m not saying that it lacks creativity or relies less on the analysis and criticism of observations at hand, but the discipline is firmly based on hypothesis testing – it depends on the use of statistics to make somewhat rigid yes or no decisions. I am currently reading Claude Bernard’s An Introduction to the Study of Experimental Medicine – Bernard’s representation of physiology and its study is entirely distinct from the way clinical medicine works. Observations are either present or not, they always mean something specific and can be manipulated to influence other observations in a predictable and consistent manner. Clinical medicine to me seems much more, for want of a better word, flexible – symptoms and signs are often out of place and there are always exceptions to every rule (an idea that Bernard criticizes in his book, referring to practicing physicians in particular).
Of course, the way that experimental medicine works is by simplifying everything to its most basic components – cause and effect are isolated and studied in a bubble so to speak, excluding other factors that influence the processes under study. I wouldn’t dare criticize this approach, but it is one that has no place in medical practice. The human body is an infinitely complex interplay of systems that interact with the external environment (an idea proposed and propagated by none other than Bernard himself). Thus, it is easy to imagine that those who deal with human beings as a whole and those who aim to dissect the intricate details of how the body works in health and disease do so in completely different ways. Let’s not forget that the immediate aims of these disciplines are quite different, and so it only makes sense that their approaches differ too.
The question comes up – does its complex nature make medicine an art? There are other, possibly more obvious reasons, to consider. Depending on their specialty, doctors rely to varying degrees on manual skills – be it something as simple as giving an intravenous injection or performing delicate surgery. This may be a part of what places medicine in the realm of art. However, one may argue that this also applies to basic scientists – stabbing a neuron with a tiny micropipette without damaging it probably requires at least as much manual dexterity than removing a tumour from the spinal cord (I have attempted neither, but that’s my impression!). Of course, we have to consider that the stakes are higher in the latter.
Thus far, I have only practiced clinical medicine for one year, but my memories of my time working in the hospital bring me to the same conclusion as my former professors. Sitting in the emergency room as patient after patient pile in, what I learned from lectures was of limited benefit. What truly made a difference was my experience – the further I was into a specialty rotation, the more able I was to take appropriate action and manage patients effectively. Recalling medical facts becomes less of an issue when faced with a clinical problem – second nature kicks in and takes over, usually for the better.
Here are a few quotes that I found relevant to the topic:

“Take care not to fancy that you are physicians as soon as you have mastered scientific facts; they only afford to your understandings an opportunity of bringing forth fruit, and of elevating you to the high position of a man of art.”
“Medicine consists of science and art in a certain relationship to each other, yet wholly distinct. Science can be learned by anyone, even the mediocre. Art, however, is a gift from heaven.”
Armand Trousseau

“No human investigation can be called true science without passing through mathematical tests.”
“Those who are enamoured of practice without science are like a pilot who goes into a ship without rudder or compass and never has any certainty where he is going. Practice should always be based upon a sound knowledge of theory.”

Leonardo Da Vinci (he was both a scientist and an artist)

“Even in the hands of the greatest physicians, the practice of medicine is never identified with scientific (laboratory) medicine, but is only an application of it.”
Rudolf Virchow

“The main cause of this unparalleled progress in physiology, pathology, medicine and surgery has been the fruitful application of the experimental method of research.”
William H Welsh

Above the clouds: Literally and figuratively

Hello!

I finally wrapped up my year in Berlin with an intense, five-week long stretch of experiments, data analysis, bureacratic tasks and packing. I spent my last few weeks in Berlin crossing off tasks from a colossal and ever-growing checklist and getting very little sleep. In addition to my lab work, the first year of my MSc Internal Medicine course at the University of Edinburgh ended recently with the final exam of the last module before the summer break. The year at Edinburgh ended with one of my favourite topics – radiology. We had a tough but exciting hands-on exam where we were required to interpret clinical images and make management decisions based on radiological investigations.

I had to move all my belongings not once, but twice this past month – within Berlin to a new apartment and then back home for a well-deserved three week vacation. My priorities for the coming weeks are first and foremost to spend some quality time with my family before heading off to Bordeaux in early September, although I will also have to write up my lab report (due in a month) and work on some presentations (including my upcoming poster in Toulouse!).

I must admit that his year has been a challenge for me. Despite having gone through the mental massacre that is medical school just a few years ago, handling two postgraduate degree courses at once was a difficult task. Especially since one was an online distance learning course that required immense motivation and commitment on my behalf and was heavily based on self-study and personal time management.

The program at Edinburgh has exceeded my expectations so far. I had initially joined to keep my clinical knowledge ‘fresh’ while studying for my masters in a non-clinical discipline. I ended up not only learning an immense amount of new information, but also dramatically changing the way I approach the practice of medicine for the better.

Exhausting as the past year has been, I’m trying  to think of things positively, albeit by quoting a cliché in medicine. In the words of the Roman poet Vigil: Miseris succurrere disco (I learn to relieve the suffering). 

 

More posts to come soon, once I’m at home and settled – I’m writing this at a height of 30,000 feet above sea level (I won’t be posting it until I hit the ground, in-flight internet costs WAY too much!).