meus intuitus

Archive for the ‘contemplation’ Category

why psych?

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I’m taking a mental health break (double entendre intended) tonight to write this post about my impression of primary care medicine and my thoughts on my career path so far.

I’m beginning to develop a particular sentiment—a feeling that may progress into a genuine and personal philosophy on medicine.  After working in a fast-paced 20-patients-a-day primary care clinic for a week and a half, I am finding myself somewhat uninspired.  Medicine is just so…  Algorithmic.  Reflexive.  Rote.  Patient complains of X, Y, Z?  Test him with A, treat him with B, failing that try C.  These are what the data tell us to do.  Unlike what I was promised, there is no art here.  The art is lost to the minutia.  It’s not that it should be any other way—evidenced-based medicine is a wonderful thing.  It just may not be right for me.  If there is anything I have learned in the last two years of medical school, it’s how extremely right-brained I am.  The regiments of medicine easily slip through the sieves of my creativity, inspiration, and intuition.  Ambition got me into medical school, but ambition is not enough to build a career, a life on.

Thankfully, medicine provides its own exit:  Psychiatry.  For all the reasons that my colleagues hate psychiatry, I love it.  No obvious right answers, intricacy of personalities, no measurable chemicals.  This is the realm of the intuitive.  Certainly, plenty of measurement and empiricism is present (otherwise it would be quackery), but the cores of the analyses are amorphous.  The mind is complex in a way that we, as complex as our minds are, can not even fathom.  The mind is like the weather—billions of inputs, effects, and endless results; you can make small predictions about it, but bet on what it will do next year and you will lose your wagers.  Indeed, like the weather, but more complex.  It takes a technician (albeit an admirable, dedicated, and high-functioning one) to be a master of medicine, but it takes an intuitive to be a proper psychiatrist.  Internal medicine is checklists, criteria, and algorithms.  Psychiatry is understanding.  The psychiatric patient may fulfill the checklists for depression, but if you understand her well enough, you may yet come to the conclusion that her trials are more chiefly situational and that all she needs is some extensive support and guidance; you must then determine the nature of the support and guidance you will provide—something that, again, requires understanding.  This, at least, is my fledgling impression of psychiatry from the four weeks I spent on it.

More practically, I am just more interested in minds than I am bodies.  As noble and important as it is, I seriously don’t give a damn about managing a 50-year-old’s LDL cholesterol levels so that he can get a little more mileage out of his wretched body.  Life, for me, is not about longevity.  Life is about experience, revelation, and enlightenment.  Life is about growth.  Longevity is merely a conveniently large canvas upon which to paint the progression of our minds.  I want to help people grow—out of their demons, out of their prisons, and into better versions of their former selves.

This past year, there was a psychiatrist who got locked in a cell with a homicidal psychiatric patient.  The patient laughed and advanced towards the psychiatrist.  The psychiatrist, in spite of his horror, analyzed the situation and stated, “you can not hurt me!  It’s snowing outside.”  The patient’s thoughts blocked and his movements ceased with them “…what?”  The psychiatrist repeated, “that’s right!  You can’t hurt me because… it’s snowing outside!”   The patient clutched his head with both hands and began pacing the room, “…what?!”  The orderlies had just enough time to get the keys to the cell and the doctor was freed.  That’s understanding.  ~True story

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August 22, 2012 at 6:14 pm

the plan for now

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Bringing even the basics of modern healthcare to the impoverished and exploited world requires both do-ers and supporters—the men and women on the front lines as well as the mindful many who support monetarily.

It just so happens that I want to pay off loans and grow a few kids in this lifetime.  In the first two decades after entering private practice, I will run my family modestly and give away what I can to one or two global health organizations.  After graduating the kids, I’ll make like a tree, leave home, and join the front lines for the remainder of my capable life on Earth.

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July 8, 2012 at 6:15 pm

broadening medical practice

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It is too easy and common for physicians to be resentful of the poor—especially in America.  The poor have poor eating habits, are less adherent to treatment plans, and compensate poorly (medicaid vs private insurance rates).  However, despite appearances these frustrations are not the fault of the patients.  In our practices, we must remember,  “physicians are the natural attorneys of the poor” [Mountains Beyond Mountains].  If the treatment of a disease is structural rather than pharmaceutical (as it most often is), then physicians must raise their voices in advocation.  If treatment adherence requires more attentive follow up, it is the responsibility of the physician to initiate it.

We need a broader definition of medicine—one that includes therapeutic interventions that are, unfortunately, not compensated for.  Medicine is more than throwing pills and orders at patients.  Medicine is about healing.  If the scripts aren’t working, then there is no healing, and it is the duty of physicians to find out why.  Our curiosity needs to extend beyond the scientific.  We need to be investigative, not just of the pathologic, but also of the sociologic, psychologic, and economic.  Systemic barriers, misunderstandings, and financial barriers are not the fault of our patients—they are the responsibilities of the informed.

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July 2, 2012 at 6:37 pm

nihilism apparently

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I don’t know where this nihilism came from, but it permeates every bone in my body.  Today, I find myself cognitively decrepid.  I talk a lot of big talk—to others and to myself—about how “passionate” and “deep” I am, but in actuality, I have just become extremely lazy and fatalistic.

I’ve done enough ranting, whining, and puttering around.  It’s time for a change.  I need something I can really sink my teeth into—something I can sink my life into.  I need something I give a damn about.  I’ll explore global health more earnestly beginning today.  I just bought Mountains Beyond Mountains for my Kindle.

Stop complaining and do something about it, buddy.

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June 26, 2012 at 8:20 am

Posted in contemplation

the aging of a word

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Today’s kids may not apprecaite how the word “rewind” relates to music and film.  Only the etymologically inclined will know that, once upon a time, music and film played on pieces of tape wound up inside little boxes–and to listen or watch again first required a turning back or “rewinding” of tape.

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April 9, 2012 at 9:19 am

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cabin fever

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I find myself tonight with a terrible longing for the world.  I contemplate this path that I am on and it frightens me how swift and unrelenting it is.  Medicine is not a road to be taken lightly.  At its worst, it will batter and embitter you.  At its best, it will swallow everything you have to offer—including your identity.

We work incomprehensibly hard to acquire a massive skill and knowledge set.  With it, we are privileged as the curators of wellness, of life.  With this privilege, we have a responsibility to our brothers and sisters—we must practice, we must work, we must help and heal.  If we do not, it is not only a waste of our own prior efforts, but also a loss to our patients who need us whether they be ones we have met already or not.

Yet.  There is more to life than duty.  There is exploration.  There is perspective.  There is wonder.  These virtues I satisfy with travel, but travel and duty are somewhat exclusive of one another.  One can not simultaneously be a nomad and a pillar of the community.

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March 25, 2012 at 7:07 pm

meditations on anxiety

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I am almost always in a state of mental tension. To make matters worse, negativity often invades my thoughts and further aggravates my tension—turning it into a more overt anxiety. This is actually quite odd because I am also a confident and socially deft person. Thus I pondered: How can such contradictory traits manifest so seamlessly in one psychology? An answer hit me (in the shower) the other day. My anxiety is not an autonomous one nor is it one born of any real ineptitude. No, my anxiety is a product of my perfectionism. So in response, I evolved my conceptualization of perfection.

Conventional perfection is a relativity, not an absolute. If humanity were “perfect,” biologically, socially, evolutionarily, it would only be relative to a current situation. If humanity were “perfect,” any force of change applied to competitor organisms, our environment, or our societies would find, in humanity, eight billion equally susceptible victims; a population of the “perfect” would be, by definition, homogeneous—and as such, maximally inadapatable. Indeed, conventional perfection is annhilation. Imperfection, on the other hand, is the reason humanity exists today. Imperfection is adaptibility. Imperfection is beauty. Imperfection is strength.

Imperfection is perfection.

So whenever my mind turns on me and sends me into a tailspin of anxiety, I remind myself that whatever I am ruminating about is not evidence of my deficit, but of my inherent perfection. I then say to my ruminating mind, “fuck you, I’m allowed to be imperfect,” and I smile.

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March 22, 2012 at 5:23 pm