From paramedic to doctor

Although I've only been in medical school for less than a year, I can already see the way that I think about medicine changing quickly. As a paramedic, you learn what little physiology they can teach you in the year or so that you spend taking classes on 2 nights a week or so. But mostly, you learn that if you see one thing, you've got to do another; patient has a low heart rate, so you give atropine. Yes, they tell you that it's an anticholinergic, but few people know what this means and even fewer will remember (or care) 6 months later. I consider myself a pretty good paramedic, and I think most people who have been on the ambulance with me would agree, but I cannot honestly tell you that I would have known why I was giving atropine for low heart rate, aside from the fact that I new it acted on something in the heart to bring your heart rate up. I also probably could have remembered the word "anticholinergic," although not given you much of an explanation on what that means.

So finally, parts of medical school are becoming interesting. Even though we haven't done any pharmacology yet, we're doing cardiovascular physiology at the moment, and I could easily explain now exactly why atropine is given for low heart rate, why it helps in heart blocks, and why it wouldn't make a bit of difference in a denervated heart transplant patient. It's definitely a huge change in thinking, and one which opens up many more treatment possibilities. Also, I think that this type of thinking has to make you a better clinician. Sometimes, it's easy to forget things that you just memorized. You may not be able to remember, for an extended period of time, every situation in which you should or should not give a drug. But, if you know exactly why you are giving the drug, then you don't really need to bother with memorizing a list. You just have to know the problem, know how a particular drug works, and then you'll know what will and will not work.

Every once in a while, we'll get a good doctor come through the firehouse and teach us something more than what EMS providers typically know, or give us another way of looking at things. There is one particular doctor who volunteered at Arbutus who was very good at this (he's now an assistant medical director for the county) that I always liked to take classes from. And, while it's totally impractical and impossible for EMS providers to have anywhere near the knowledge of a physician, it is possible for them to start thinking more in these terms as they gain more experience. Hopefully, I'll be able to bring some of this back with me. Now, if I could only find a way to make DNA amplification interesting :/

Oh...and i just killed another bug with my tennis racquet/bug zapper. I really love that thing!