Cookbook medicine

There is a phrase that is used in EMS called 'cookbook medicine.' It means that the paramedic refers to and blindly applies written protocols or algorithms without thinking about what is really going on with the patient. Any patient who does not present with a problem in a textbook fashion is therefore not treated correctly. For example, a patient who complains of shortness of breath gets Albuterol and Atrovent, even if the patient is not experiencing bronchospasm. To call a paramedic a 'cookbook medic' is an insult, meaning that he or she is clueless, and simply following the protocol as if it were a cookbook.

This phenomenon is not limited to paramedics, and I have often taken medical providers to task for this way of practicing medicine. This is where we begin today's post, and is also the reason behind the lack of posts over the past week and a half:

As regular readers of this blog know, in November I retired from my job as a fire medic so that I could move to Missouri and attend graduate school, so that I could become a physician assistant. We were taking seven classes in the first semester: Radiology, Anatomy (with cadaver dissection), Behavioral Medicine, Molecular Pathophysiology, Clinical Assessment, Physiology, and Problem Based Learning. There were problems within the first month.

Don't get me wrong, my grades were good. I had an A in pathophysiology, a C in anatomy, and a B in the remainder of the courses. I will use several examples, but please understand that this is not a comprehensive list:

We were being taught to ask questions of the patient from a long list of questions, then we were to use software to search for diseases that match the abnormal responses in order to reach a diagnosis. Staff members would play the part of patients, and the students were literally reading questions right from their notes, without even knowing what they were asking. For example, a woman having epigastric pain radiating to her shoulder that is elicited by eating fatty food (obviously gall stones) was being asked about whether or not she had pertussis vaccinations as a child. I was not up for paying $50,000 to learn how to use WebMD.

Then there was the cluelessness of the faculty, one of whom insisted that all arrhythmia were caused by a malfunctioning SA node. I pointed out that AV blocks, VT, and AVNRT all occur in the presence of a normally functioning SA node. He told me I was wrong. I showed him evidence, including texts and studies. He still told me I was wrong. Another professor (who teaches cardiology) agreed with me. He still insisted that I was wrong.

Strike three was behavioral medicine. Our syllabus was a list of political topics, instead of medical ones and belonged in the poli sci department, not the medical. Here are some of the lectures we got:
Week 1: Using the musical arts in patient care: This was a guest lecturer that showed us how playing harp music would make patients happier
Week 2: "Stress, disease, and the AIDS pandemic" How Reagan and other white males are in a conspiracy to kill gays and discriminate against women. This is not an exaggeration. This is what the professor said.
Week 3: "Let me down easy" this was a video of a one woman play, a liberal look at healthcare and how unfair it is that the rich get better care
Week 4: "Domestic Violence: Vulnerable patients" This was a lecture on how men victimize women and children.
The class was separated into 6 groups, and each group was assigned a topic to research and present to the class as a lecture. Examples of the topics covered: Theories of personality development: male Hetero versus homosexual; Theories of personality development: Female hetero versus homosexual development; Working with and caring for lesbian, gay, bisexual and transgender patients.

So I decided that one semester was enough. I didn't think that I was getting my money's worth. I am back in Orlando, and I have some job interviews this week.