T1 – 001: Reflections on One Week of Medical School

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Christopher Carr

Christopher Carr does stuff and writes about stuff.

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13 Responses

  1. Avatar Stillwater says:

    Wow, what an awesome story. I’m a bit teary eyed about it, to be honest, CC. Thanks for sharing.Report

  2. Avatar Chris says:

    Looking forward to reading about this as you make your way through. And good luck.Report

  3. Avatar Kevin says:

    This was wonderful. As a (fairly) recently graduated veterinarian (3 years ago last month), I’m looking forward to seeing how medical school is similar and how it’s different. Best of luck.Report

  4. Avatar Burt Likko says:

    I hope you keep this series up, Chris. I rather enjoyed the description of the white-coat ceremony.

    As for the legend about the doped-up kitty and his separation anxiety, similar stories are told by and about lawyers; save, no matter what the lawyer does, the bad result is always perceived to by the lawyer’s his fault (as opposed to the proverbial doctor, who is never perceived as being at fault even when he is).Report

    • Avatar Christopher Carr in reply to Burt Likko says:

      Interesting, Burt. During our first ethics lecture we learned about the traditional three professions being law, medicine, and theology. We were told that the lawyer’s duties, the physician’s duties, and the priest’s duties do not end at the end of the workday. The lecturer also asserted that traditionally all three professions were afforded strict and unyielding rights of confidentiality, but that that right only remains inalienable for the priest. I wasn’t really sure about this…do you have any idea?Report

      • The right is not sacrosanct for any of these three traditional professions. California, as always, led the way, with a case presenting truly awful circumstances called Tarasoff v. UC Regents. I’ll leave exploration of the facts and ideas in that case for your medical ethics class, but the law pretty much throughout the USA after that case is such that if there’s a credible threat to life disclosed within a communication normally cloaked by privilege, you’ve got to do something about it. It goes on from there: most states require doctors seeing harm done to children (and possibly other protected classes, varies state by state) to become “mandatory reporters,” so there’s communications that otherwise would be confidential that you need to pass along to law enforcement, and I bet it’ll be a matter of some dread should that happen to you.

        Lawyers have similar piercings to their privilege, and in fact so do clerics in most states. I’ll bet the attorney client privilege is the easiest to waive of these three, but that may be because it’s what I’m most familiar with.

        There’s another privilege you may be interested in exploring: peer review panels. Let’s say Something Bad Happens with a patient and it might be partially your fault. Peer review committees may evaluate your work, and perhaps make a finding that you delivered substandard medical care. Is that evaluation usable in the event of a malpractice suit? Does making it available discourage constructive criticism aimed at making a doctor better at her craft? Again, the wrinkles vary from state to state legally. More universal, but less well-defined, are the ethical principles that run parallel to the applicable laws.Report

      • There’s also one other thing that you need to bear in mind when considering confidential communications. Who holds the privilege? It is not the attorney; rather, it is her client. It is not the cleric; rather, it is the penitent seeking absolution. It is not the doctor; rather, it is his patient. The holder of the privilege has the choice of waving it. The professional who is bound by the privilege has a duty to safeguard that privilege until and unless it is waived.Report

  5. Avatar Shelley says:

    Nothing better than a parable.Report

  6. Avatar Barry says:

    Thanks, and I hope that you’ll keep writing.Report

  7. Avatar KnittingNiki says:

    Great post! It’s the first week of orientation for our MS-1s at our medical school here.

    Your noticing “the paradoxical and potentially dehumanizing nature of gaining extensive knowledge of the human body” reminds me of a line from a Social Science and Medicine article I read recently that catalogued various “functional and non-functional forms of dehumanization in medicine” — enough distance to maintain sharp cognitive and diagnostic capabilities, yet not so much distance to lose the compassion and care connection you referenced in your one-word summation. Quite a razors edge really….

    So appreciating your reflections here and looking forward to your next installment!Report

    • Avatar Christopher Carr in reply to KnittingNiki says:

      Hi Niki. Welcome! I’m glad you enjoyed my first post in this series.

      “…enough distance to maintain sharp cognitive and diagnostic capabilities, yet not so much distance to lose the compassion and care connection you referenced in your one-word summation. Quite a razors edge really….”

      This is a good point. It seems like learning that the body is a machine helps insulate doctors against the psychological horror of, say, cutting open another human being or exposing themselves to disease or parasites or any of the other things that people are normally afraid of.Report

  8. Avatar steve says:

    Good luck. Been over 30 years since I went through this. Sounds like things have changed a bit.Report

  9. Apologies for being so late to this. I am too distracted these days.

    First of all, I’m delighted to have you contributing under the Blinded Trials banner. It’s not like I’ve been doing all that much with it lately. Alas.

    And this was great. I look forward to following along with you in the coming years. My medical school instituted the “white coat” ceremony several years after I matriculated, so it was something I never experienced myself.

    Good luck and all best wishes, as always.Report

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