Monthly Archives: January 2014

Everything Wrong With College

It’s been another busy week of medical school for me. We are preparing for our comprehensive pharmacology exam, along with finishing up final exams in toxicology and microbes. There is plenty of studying to be doing, and I have also been busy working on a final presentation for my clinical elective. Yesterday, in fact, I spent my last day at the dermatology clinic. It just isn’t a Wednesday until I help the resident freeze genital warts. Too much info? That’s medical school for you ūüôā Thankfully, I gave an “superb” presentation (on a subject that isn’t even a tiny bit interesting, so I’ll leave that part out) so it’s safe to assume I earned at least a¬†letter of recommendation from her. Sweet. I take the time tonight to write about education, specifically college, so that I can piece together a short narrative¬†describing not only the problems with college education today, but also what it means to Americans as a whole.

Like most twenty somethings, I grew up with a pretty clear picture of what success in life looked like. It came from teachers, parents, school counselors, and other adults, but the message was the same: successful people went to college, got a degree, and then earned more money and were happier because they did. The not-so-subtle indication was that I, too,¬†should¬†go to college if I wanted to be happy in life. Smart people went to college, I was told, or at least college made people smart. I don’t know when this idea was perpetuated on Americans, but I suspect it was around my parents generation. My dad didn’t go to college, although the pressure to get a degree certainly existed when he graduated high school.

I played the game very successfully. After graduating top of my high school class, I took a full ride scholarship to a good state school. According to the “rules” I was taught when I was younger, I had won the game. I was virtually guaranteed four years of education and a degree of my choice (with no debt upon graduation). Of course, I started college in 2009. This was not a good time for the economy, and college graduates suffered for it. I spent my college years reading news stories about how hard it was for grads to find a job, and feeling secretly glad that I had a few years for the economy to turn around before I graduated. Despite this, my university set enrollment records for all eight semesters I attended. Of course, now I am in medical school and have nearly a decade of school still ahead of me, so take that with a grain of salt.

So now I wonder why people still rush to take out loans and attend school for degrees they may never use. I watched many friends amass huge debts and drop out after 3 years. I saw people waste huge amounts of time, money, and energy, and now they have nothing to show for it. I saw friends take a semester off and 4 years later wish they had stuck with it. So here are some of the things I wish people would really know about college.

1) Colleges Are Businesses

dollar for dollar

We are coming up on the time of year when high school seniors everywhere begin posting acceptance letters on Facebook, listing the college/university they plan to attend. That’s great for them, but it perpetuates a myth that sucks people in every year: that colleges are somehow exclusive. To put it another way, University of _______¬†actually wants you to attend their school.¬†There are a small handful of uber elite schools that are competitive to gain admittance (MIT, Harvard, etc). The other 99% of schools want you to attend because they need your tuition to make money. It doesn’t stop there, either. They need your fees, parking passes, textbook purchases, and other expenses as well. I’m not saying that these schools aren’t trying to give you a stellar education. Just know that they want to give you a great education¬†and also make money. But mostly the money.

2) College Is Not About You

This will be shocking to anyone who has seen any marketing materials for any school anywhere, been to college, or even heard anything about college, but I think it’s crazy that it goes unrecognized. Think about any university advertisement, and it’s usually some combination of the following ideas:

“Follow YOUR passion, pursue YOUR dreams”

“Create YOUR OWN major”

“Classes that fit YOUR schedule”

This was the third result after Googling “University Brochures”.

It’s like the whole school is expressly designed to help you along in life. False. The school wants you to pay money to them, or at least do something awesome later so they can get the publicity. Of course they’ll let you take a semester off. Of course they’ll let you do your degree in six years instead of four. Of course they offer online classes. They are a business and they’ll do what it takes to earn your tuition dollars.

If the version of success I learned in school is to be believed, your degree should show that you are qualified, diligent, hardworking, ambitious, or some mixture of those. If your degree is four years long and you are going to “normal” college (not night school or a non-trad), get it done in four years. Chances are that a marketing degree is not your passion, so don’t pretend like it is. Work hard, get your degree, and spend your extra time pursuing your other hobbies and interests. Those are also qualities that define your character, and while they may not be on your CV they will certainly impact your chances at landing your job/achieving your goals after school. This leads me to…

3)  College Can Be a Huge Waste of Time

College is not hard. You may hate me for saying that, but I’m telling the truth here. My degree was in Molecular Biology and a little bit of Chemistry, and I know that my four years of college were significantly more difficult than any of my peers. How do I know that? Well, I lived with them, and I know I spent way more time in class and studying than they did. So how hard did I work during school? Not that hard. Each semester I attended class for 20 hours a week and studied about 10 hours, sometimes 15 hours. That adds up to less than a normal work week. Also take into account that I lived on campus, so I had no commute. I also ate dorm food from a cafeteria that was 30 seconds from my room. We also went to school for 32 weeks of the year. I spent lots of time exercising, playing video games, and doing lots of whatever I wanted. It was great.

Fact is, college classes should not keep you busy. My class schedule was about as bad as undergraduate schedules can get, and I still managed to work all eight semesters, get married, earn my EMT certification, and complete an Ironman triathlon. My most memorable moments from college have nothing to do with school.

In this sense, I think college is actually bad for many young adults. As a country and a society, we are taking our most energetic young people and forcing them into a 4-year holding pattern. The 18-24 age group is full of young, talented, motivated, technologically competent, people who are the future of our nation. We are bright enough to have terrific ideas, and naive enough to not know when something can’t be done. But we¬†have to attend classes for just long enough each week to not actually get a real job, but not enough class that it’s truly “full time”. Those classes can range from being interesting (wine tasting) to being totally useless (most of my humanities courses), and after 4 (or more) years of sitting through classes, they will finally graduate into the real world, often with crippling debt.

This is the hardest part for me. I am (or at least I was) a perfect candidate for college. I’m naturally curious, enjoy learning, and am prone to obsessively mastering new hobbies and subjects. Yet after four years I had only one or two good professors who actually made the class worth attending, and honestly I was a little burned out. I have thought long and hard about what I could have done with those four years if I could have them back.

4) You won’t learn much during college

This might seem like a continuation of my last point, but it’s not. College classes are still largely taught in a lecture format, often in huge lecture halls. One of the few things I remember from Abnormal Psychology was that students typically remember only 5% of the material presented in lecture format (10% if multimedia graphics are used). This is a bad situation, even if you assume that the professor is awesome and the students care. Small wonder that employers are struggling to find qualified applicants among graduates that they interview. What happened? I thought that undergrad degree was the key to landing a good job? Now that everyone seems to get a degree, I guess not.

College has become like bonus high school. More and more people seem to be going to college, and it hasn’t been working out like we thought it would. Maybe this trend will reverse itself in the next few decades. I will certainly think long and hard before I help my future son finance a $80k degree. I get that college will always be required for some professions (hello medicine, law, etc), and that makes sense (sort of, I will someday write about that too).

It’s not that I’m too good for college, or that our generation is too good for college. It’s just that college isn’t good enough for what it costs. It’s not just the huge debt, it’s the years and time being lost as well.

If a college degree is the vehicle for success, it’s a taxi. It works great for getting you directly from one place to another, but if you just jump in and ride around for four years you’ll be broke and lost.

I need to stop writing now, and this seems like a good place to do it.

Thanks for reading!

As always, feel free to comment below or directly to my face at sortadrwordpress@gmail.com

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Let’s Talk About Drugs

Maybe the timing is coincidental. Maybe studying pharmacology so much lately is making me more attuned to notice stories and posts regarding drugs and disease. Or maybe there has legitimately been a lot of really terrible Facebook posts, links, and comments lately (at least on my Facebook page). When someone on Facebook posts a story and claims “this is why I will never get my kids vaccinated!” I sometimes die a little inside. I would love to dissect their claim, present some objective evidence, and state my own claim in a reasonable manner, but we all know how that goes. Instead, I have turned to my blog, where I will be presenting some of the more common statements I’ve seen and the reasons why they are ridiculous. We’ll start with….

1. Doctors overprescribe drugs. They need to stop throwing pills at problems. They put my friend on too many drugs and he developed all of these side effects. Etc.

As seen in:

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Yeah…I’m pretty good at MS Paint

:

First things first: it is very possible to be taking too many drugs. We had an entire lecture on this last week. It’s fine to be on a handful of drugs, but if you have a patient routinely take 10+ pills per day you are going to run into problems with side effects, compliance, and drug interactions. So why is it that patients accumulate so many medications? Why do doctors consistently prescribe drugs for patient complaints?

Probably because that’s what they are trained to do. And because it works. I am not attending medical school to learn how NOT to prescribe drugs. I’m learning how to harness the incredible therapeutic potential available to me and every modern physician. There are so many drugs that work so well at fixing common problems I would be remiss as a physician if I didn’t prescribe.

Example: If a 48 year old man comes into my practice for a check up, and I notice he has high blood pressure, I have two options. I can tell him he needs to eat healthier, exercise, and drink less alcohol. Over time, this would make him healthier and lower his blood pressure. Of course, very few patients will actually do this. He is most likely to walk back into my clinic a year later and tell me that he was busy at work, tried walking but hurt his foot, and otherwise didn’t get any healthier. And he was exposed to an extra year of uncontrolled high blood pressure, increasing his risk for serious problems later on in life.

I could also give him a prescription for Lisinopril. He could take a pill every morning, his blood pressure will go down, whether or not he improves his lifestyle, and I improved his chances of living a longer, healthier, happier life.

The trap of this example is when a patient comes in with an upset stomach, so I give a script for that. They take it and their stomach is better but they feel dizzy and sick, so I give another script for that. That’s usually when people start experiencing really bad symptoms from taking too many drugs. Do people think that the doctors were intentionally trying to hurt people with these medications? There’s nothing nefarious here. The intention was always to treat.

2. If I vaccinate my kids they will get autism. It’s unnatural. I don’t want to expose them to those terrible things. It’ll do them more harm than good.

As seen in:

This has come up a few times lately, especially after we watched Jenna Mccarthy on the Rockin New Years Eve a few weeks ago. I’d like to start by saying that if you are taking healthcare advice from a Playboy model, please re-evaluate your life and see an actual physician immediately. Vaccinations do not cause autism. I’ve looked at the evidence for it, and its pretty slim. For the rest of this article, however, I’ll assume it could (I’m feeling generous).¬†People who don’t vaccinate their children are susceptible to two fallacies. First, that by avoiding vaccination they are somehow protecting their kids from exposure to the pathogens that cause disease. Second, that vaccination is primarily intended to protect their child specifically.

Ever heard of a kid with polio? Rotavirus? Smallpox? Probably not in recent memory. How about whooping cough? Few Americans (or none, in some of those cases) ever develop these diseases. The reason isn’t that the disease doesn’t exist anymore, but instead that vaccination has prevented the pathogen from causing disease. Viruses and bacteria are everywhere. Always watching. Always waiting. Just kidding, but there are way more of them than us, and our immune system clears them very efficiently ever day. If you don’t vaccinate a child against a disease, that doesn’t guarantee that they will never see that pathogen. It just handicaps their immune system if they should ever come across it.

Second, vaccinations aren’t exclusively intended for your child specifically. The key here is a concept called herd immunity. If you prefer to think of the human race as something different than a herd, call it population immunity. When the herd is vaccinated (say 95%) against a disease, only 5 out of 100 members will be susceptible to developing a disease. Should one of them acquire the disease, their chance of spreading it is low, because only 4 of the remaining 99 members can acquire it. If the herd is unvaccinated against that disease, however, one member acquiring it will cause a rapid spread through the herd. There will be a few members who are naturally resistant (there is always a small percentage of people with natural resistance to some disease), but the rest of the herd will be devastated. Getting your child vaccinated is less about their protection than it is for the rest of your kids class. Some vaccines don’t matter for kids, but for adults. Children don’t develop symptoms when infected with Hep A, but they can spread it to adults, where it causes serious illness.

This is what comes to mind when I think of “herd immunity”

3. I’m so worried that I have the swine/avian/llama flu! Everyone is going to die!

Actually probably so. If there is a total disaster to worry about, it would be a mutated influenza virus. We all remember the H1N1 outbreak a few years ago, and ever more recently new mutations like last years H7N9 virus caused concern. Should a strain of influenza develop easy transmission between humans as well as the ability to easily cause disease or death, it will be scary. Influenza changes and evolves quickly enough already, which is why there is a new flu shot every year. Millions of people died in 1918 during an influenza outbreak, where massive global troop and refugee movements allowed it to ravage the world. Despite the present lack of a world war, we have a constant state of travel and mobility, both internationally and regionally. Scary scary.

4. Have you heard about all of these new resistant bacteria? MRSA, VRE, CRE? It’s going to be the end of medicine!

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Surely you have heard of these new “super bacteria”. Are they scary as well? Yup. Are they the end of modern medicine? Nope. That link above was shared by a friend but written by a lawyer. Antibiotic resistance is certainly a problem, but it’s one that we will solve. I have had antibiotic resistance pounded into my head for the last six weeks. When to use antibiotics, when to hold them, how to identify resistant strains, combination drug therapies, etc etc. I can remember a high school teacher from years ago talking about MRSA, how terrible it was, and how that would be the end of modern medicine. Multiple resistant bacteria have developed since then, nastier than MRSA, even. Why am I not worried as much about CRE? First, because its nosocomial (acquired while in a hospital). These super bugs don’t exist everywhere around the world. They usually only infect people with extended hospital stays and invasive therapies (like catheters). Second, they will be beaten as well. People far smarter than me are always working on drugs to combat these resistant strains that develop. A resistant infection is never a good thing, but in order to find yourself developing one of these you would probably already have had something pretty serious going on.

What do you think? Let me know in the comments below or at sortadrwordpress@gmail.com

Thanks for reading

Floating Along

Welcome back to my blog! In reality, I was the one who took a brief hiatus over the holidays, and I don’t regret it at all. I would love to say that I spent my two weeks off deep in thought, drafting blog posts, and learning all of the things I forgot immediately after taking my final exam on December 20th, but that would be a lie. Instead, I spent most of my break at home with family and friends, and the rest of it being as lazy as humanly possible. On the plus side, I am refreshed and ready to tackle another semester of medical school.

Just kidding…I actually laughed after typing that last sentence. Let me do a little catching up on what medical school has done to me recently. In late November we started Pharmacology and Microbiology. I prefer to call it “Bugs and Drugs”. The courses are taught simultaneously, which is actually helpful because we get to learn the organisms that cause disease around the time that we learn the drugs that can treat said disease. I use the word “learn” very loosely here, because really they just throw hundreds of drugs at us and we get to sort out what they do for a few days before the exam. In the week before Christmas we covered around 220 antibiotics, antifungals, cancer therapies, and other drugs in about 4 days before taking an exam on Friday before break. That was my hardest week of medical school yet. While attempting to learn all of those drugs, we also had to learn information on bacteria, viruses, their associated structures and pathology, some information about other organisms (mycobacteria), and take an exam on that the same day as pharmacology. Have you seen Christmas with the Kranks? Remember the scene where Luther is leaving the shop in the beginning and the water canopy breaks, drenching him in water even as he stands in the pouring rain? That was a pretty accurate description of me during this course.

This is not an area of strength for me, either. I had great undergrad anatomy experience to support me during med school anatomy. I did take immunology and pharmacology as well, but both courses were incredibly easy. Most of what I remember from immunology was “viruses are scary”, and I don’t think I remember anything at all from pharmacology. So learning information at the insane pace set by the course directors required long, long days of studying at home. In the winter. In the cold. By myself. Very depressing. But hey, I have passed everything so far, and am 1/8 of the way toward completing my MD.

While talking to an actual doctor, I learned the dirty secret of pharmacology. None of us will remember all of these drugs after this year (I already knew that part). We will really learn them again during third year and beyond, when we begin to prescribe and work with drugs in a practical setting. The goal of this class is to make sure we have heard of these drugs at least once.

In other news, I have now interviewed and presented my own patients. The dermatologist I have been shadowing is letting me see patients (with a resident keeping a close watch). This allows me to demonstrate my complete ignorance of dermatology for both the patients and the residents, but has helped me start to develop my all important “bedside manner”. I have a feeling I will be much better at interviewing and taking histories when I know roughly what I am hoping to find.

Of course, this is kind of what I expected from medical school. I’m busy and I’m challenged, and I like it. At this point in undergrad I was already bored (and still on winter break). The pace is grinding, but is also what keeps school interesting. It’s like sightseeing from a bullet train. While it’s impossible to see everything that flashes by, there are so many interesting things to see that the view is still captivating. Some semesters of undergrad felt like sightseeing from a snowplow.

I have been sending Facebook messages back and forth with a friend who is considering medical school. Most of his questions centered around the difficulty of the classes and exams, the pace, the hours, etc. I understand the worry from potential students, but I don’t understand the doubt. I have never once, even for a second, thought I would fail/drop out/give up during medical school. I would say that trend is strong among my friends as well. Despite the deluge of information and massive investments of time and money, I don’t think anyone is legitimately worried about dropping out. It’s fine to ask “how”, but counterproductive to ask “what if”. ¬†To be honest, most of my classmates are generally happy people. Maybe this is because of our pass/fail system. Maybe our class is different. This is just an honest opinion from what I see on the days I go to class (instead of watching lectures online from home). If you think you can do it, you probably can. Just my opinion. Of course, it wouldn’t hurt to read up on this before you go applying, just in case ūüôā

I have other topics I want to write about (vaccinations, antibiotic resistance, books and movies, and a stunning realization I had ordering dinner over break), but I really need to wrap up this little update of a post and call it day.

Thanks for reading!

sortadrwordpress@gmail.com