Ask a Med Student

What is your access to drugs like? Are they locked in some huge magic cupboard? Do friends bug you for painkillers and stuff? Do professors/doctors give you One Big Talk about the morals of drug-guarding, and the responsibilities of prescribing, or is it perpetual? Do you know people who’ve given drugs to their friends? Also can you give me some drugs?

Access to drugs is basically nonexistent. In the hospital, residents and physicians can order drugs (med students can’t because we don’t know anything), but only the nurses get and administer them. In clinics and doctor’s offices, I guess students could probably access the free sample closet (I’ve been in them, and another student had a doc offer her some once), but it’s frowned upon if not outright banned.

All this is good, by the way! Did you know that doctors have a crazy high addiction rate? We don’t want them getting their grabby hands on all the drugs. (At the same time, doctors have by far the highest addiction recovery rate – like 95%. Compare that to something like 25% for Alcoholics Anonymous. What this means is that we already know how to “fix” addiction, but society is more willing to give money and support to get doctors to recover than they are for that guy on the street. This is incredibly sad to me … and now probably to you, too.)

Oh yeah, but your other questions: um, I guess drug-guarding is perpetual? But more like they have to teach us not to prescribe one million drugs to elderly people than they have to convince us not to pilfer. I think med students are more into alcohol than valium.

No one I know has given drugs to their friends, and, no, you can’t have any. 

Do you handwash like crazy in your personal life now? HAVE YOU CHANGED ANY HABITS since learning about disease and danger? What should we actually never do, vis a vis activities and injuries?

In the hospital, I foam like crazy (there are antibacterial foam dispensers everywhere … also, I’m really inept and always manage to squirt others, myself, the floor). But, in the bathroom, you kind of counteract the handwashing once you grab the door handle to leave. I still do wash my hands in the bathroom, but I know it isn’t protecting me or others that well! (Unless you are a dude, who is literally touching his genitals when he pees: please wash.)

(Also, did you know the Centers for Disease Control has a guideline for hand-washing that is 2.5 pages long? That’s crazy. TWO POINT FIVE PAGES FOR WASHING YOUR HANDS. Yet it’s important stuff, and only like 40% of hospital workers actually adhere to the guidelines.)

Things I have changed: I exercise more now, because I realize how incredibly important it is for health. Even if you don’t lose weight, even if you just walk medium-fast 30 minutes, 3 times a week. Seriously, this is so good for you on so many levels. You already know this. I did, too, but I was lazy and didn’t need to lose weight, and I hated running. But now I know, so I do the elliptical and bike and sometimes lift an embarrassingly small amount of weights.

Things you should change: okay, so for health itself, there are 3 big areas – eating, exercising, sleeping. All are very important. If you aren’t eating well, my advice would be to cut out all processed foods. If you aren’t exercising, my advice would be to start, even if (especially if?) small. If you aren’t sleeping enough, start scheduling it like you would a meeting.

There are also two huge topics that I’m hesitant to write about since they deserve way more unpacking than is possible in this answer, but I’d remiss not to mention them: smoking and obesity. Everyone knows that both of these things are bad for health, but it wasn’t until medical school that I found out just how bad, and in just how many ways. Both smoking and weight can be really hard to change even if you want to, and, with the latter, obviously there is so much discrimination going on that it can be difficult to distinguish honest medical advice from fat-shaming. Like I said, I won’t be able to give either of these issues the attention they deserve, but I’d be more than happy to unpack in a subsequent column if any Hairpinners want to ask me about it.

I’m curious about whether the increase in specialization in doctoring will eventually result in a big change in the way medicine is taught. Like, if you’re a dermatologist, will you even HAVE some of these rotations eventually? Should we stream people earlier?

Sometimes our professors will put up a powerpoint slide of some complicated mechanism, and they’ll say, “When I was in medical school, I didn’t have to learn any of this because no one had discovered it yet. But now you have to memorize it!” and then they’ll laugh, and we’ll go home to memorize the coagulation cascade or some shit. Point is: I do wonder if at some point our knowledge will outpace our ability to learn, or at least it’ll outpace what is reasonable to expect all medical students to learn.

So yes, probably, there will be a big change. But since there is a shortage of primary care physicians, right now it’s not dermatologists who might see a change. For instance, Texas Tech is currently the first school offering a 3 (instead of 4) year medical degree for people who want to do family medicine.

I could go on and on and on about how medical education should and might change, but the short answer is: I don’t know, and I also don’t know what would be best.

Can you explain the hierarchy of scrubs? Is there a hierarchy of scrubs? Are you going to wear those “fashion” scrubs with balloons on them? (No of course you’re not.) (Right????) What about footwear, is there a Croc vs. clog hierarchy? Fashionnn. Also why are stethoscopes so cold? Brrr.

No, I can’t, because it’s different everywhere. But there definitely IS a hierarchy. One thing I can tell you is that you will never see a medical student, resident, or physician EVER wearing those “fashion” scrubs.

Also, ladies tend to wear Danskos (because they are AMAZING), whereas men tend to think those are not macho enough (I guess?) and wear far inferior shoes.

Stethoscopes are so cold because they keep us so cold, which is also why our hands are always freezing. Seriously, I am always cold, always, and it’s like 105 outside right now.

IS TOXOPLASMOSIS A THING CAT LADIES REALLY NEED TO WORRY ABOUT?

Hahahahaha, not really! Toxoplasmosis is mostly asymptomatic in adult ladies, but if the fetus is infected, it can cause “severe mental retardation, chorioretinitis [swelling, irritation of the eye, blurry vision], blindness, epilepsy, intracranial calcifications [can cause mental & emotional problems], and hydrocephalus [build-up of CSF in the brain, compressing structures and causing various problems]1.”

However, all of this is undercut by something the above-quoted book emphasizes: “Only cats that hunt and kill their prey are reservoirs for infection; those that eat prepared cat food are not.” And just how many of you have cats that actually kill rats? None, that’s how many.

But, if you’re pregnant and have a bad-ass, rat-killing cat, don’t clean its litter box. Someone else needs to do it.

Do you have any rules of thumb for the uninsured along the lines of “when you need to go to the emergency room and when you can wait it out”?

This reminds me of when my father-in-law told me that he went to the ER for a cut on his thumb, and he was totally indignant at having to wait an hour and a half to be seen. I laughed and laughed. An hour and a half is like 0.5 seconds in ER time. Don’t go to the ER for a cut on the thumb. Unless your thumb is like about to fall off. Also, did I mention none of this is binding medical advice, and I can’t be prosecuted for it?

I’ll answer this as if you are young and relatively healthy, because, if not, if you have congestive heart failure or chronic obstructive pulmonary disease, and you have chest pain or you can’t breath: GO TO THE ER. Otherwise, young and healthy peeps: if you haven’t been stabbed or shot or seriously, like seriously, injured, chances are you can go to the urgent care clinic instead. (And keep in mind that the urgent care folks can tell you if you actually should go to the ER.)

That being said, sometimes you really need to be at the ER because they can diagnose something surprising, so there is no good rule of thumb. If you feel something is really wrong, and you have insurance, or even if you don’t but something is REALLY wrong, go to the ER.

1 Beckmann, et al. Obstetrics and Gynecology. 6th ed. Lippincott Williams & Wilkins, 2009. Print.

Disclaimer: The Hairpin is not a doctor! Please see a doctor if you need medical assistance.

Elisabeth Askin is a medical student who loves earrings, snail mail, biking, and avocados. She’s interested in ob/gyn, primary care, health policy, economics, and having too many interests. She also just wrote a book with another med student called The Health Care Handbook: A Clear and Concise Guide to the U.S. Health Care System, which you can buy as an e-book here, read about here, or pre-order as a paperback here. You can email her questions at elisabeth@healthcarehandbook.com. She also tweets @healthhandbook, which posts one health fact a day.

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