Reflection on first week

So the first week is almost over, and its a little hard to get a sense of the semester ahead. Right now, I'm spending about an 1-2 hours reviewed material just lectured upon and 1-2 hours previewing the next week. Those numbers are probably going to double in a few weeks when things pick up. You start feeling entrapped by the curriculum: you can tell your life the next few years will be dictated by the school work. Your activities won't be dictated by what you WANT to do as much as what you CAN do. I'm not complaining; the information itself is pretty empowering.

We've also been introduced to ECM, or Essentials to Clinical Medicine. The course is supposed to teach us how to become counselors and partners of patients, a departure from the paternalism of the past. Instead of dictating orders to repair a disorder, we learn about working with the patient to understand their values and needs and to tailor their treatment to those ends. I agree with it in theory, but there's a lot of bullshit you have to wade through once you get past the basic principles. For example, one chapter in our required reading discusses different words to express emotions (use "infuriate" for intense anger, "irritate" for minor anger, and "anger" for moderate anger).

One term that gets thrown around a lot in our reading is "value." While I like that they're being brought up, I'm interested to see how they address values. How do you address the values of your patient if they're a child? Do you use the parents' values as surrogate? What if you patient is mentally invalid or masochistic? What if they're inherently wrong (maybe a man feels like its his right to have unprotected sex with non-consenting women)?

Right now, I feel like "values-based medicine" is a term academics throw around to make themselves feel better or more sensitive towards the patient. The bottom-line is you can't be an insensitive jerk, with each case being unique. There's no one paradigm for patient care. I don't know if that can be taught in a class, but I guess they're going to try. We'll see how it goes.