We have a class called PBL (problem based learning), which is a small group of 8 students and 1 professors. We meet weekly for two hours to discuss a case (the cases always correlate with what we are learning in class). Each case last us for 2.5 sessions over a three week period. In that time, we decide based upon the case what we would do if we were responsible for the patent's care. We have to diagnose the patient, come up with a care plan, and justify everything we are doing by using sound evidence based medicine. Each week we also have to research a topic that the group wants more information about. Some examples of things we research:
- "How to stage a small cell carcinoma? Which is the preferred imaging technique? How much does an MRI and CT cost and will an insurance company pay for a patient with small cell carcinoma to have an MRI or CT ?"
- "What are the leading causes of Lung cancers? How do they differ pathologically? What are the prognoses"
- "What is the mechanism of action of drug X and what are it's indications, counter-indication, drug interactions and other important pharmacological data?"
To some extent PBL is like the children's book series "Choose Your Own Adventure" for medical students. Anyway, one day we were having a discussion about small cell carcinoma of the lung (extremely bad lung cancer) and some of the causes. Obviously, a huge risk factor is smoking and our fictional patient was an ex-smoker so I was discussing it. Here is a recap of the discussion:
Nicole: ....thus, we can conclude that Mr. Doe's smoking contributed a significant role in his development of small cell carcinoma.
Medical Student 1: I think that is a just the doctors way of not having to do any research. Why is everything blamed on smoking. Perhaps we are missing some great advancement in the treatment of cancer by blaming the majority of cases on the patients' smoking. It just seems like a cop out.
Nicole: Well, the research I found all concluded that ... (stopped mid sentence by Medical Student 2)
Medical Student 2: (looking Medical Student 1 right in the eye) Just cause you smoke doesn't mean that smoking is not bad for your health. There are decades of research to back this up. It isn't just lung cancer, it is bladder cancer, oral cancers, emphysema, and cardiac diseases just to name a few health problems. Oh and it makes your teeth yellow and gives you wrinkles!
Medical Student 1: How did you know I smoke?
Medical Student 2: You have been smoking in front of the library throughout the day, seven days a week since January.
Medical Student 1: But I'm a closet smoker, no one is suppose to know. Does anyone else know I smoke?
All Medical students: Yes
Professor: (with Caribbean accent) Perhaps you are leaving the door to the closet a little too open. You better close the closet door tight, if you don't want people to know you are a smoker.
Medical Student 1 continued to defend smoking through and though. Most students down here who smoke at least admit they know it is bad for them but they are addicted or that they are having a hard time stopping because of the stress of medical school. Medical Student 1 made me laugh week after week because he fought every time it was brought up (and seemed to believe) that smoking really wasn't that bad. Maybe he should go work for a cigarette company rather than finish school. He could make a great lobbyist--he really believes in the product!
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