Anatomy and Rectums

Well I wasn't surprised by the lecture exam. It was as challenging and pedantic as the lab. In many ways, I am vindicated by the fact that no matter how hard I look at anatomy and study the infinite details, my clinical knowledge just gets in the way of sorting the important from the unimportant. I constantly get in the way of myself in the search for practice-based knowledge. Example, a question about the average locations of swollen rectal veins...nice to know, but in reality, you examine, locate and treat. If someone presented with complaints of hemorrhoids that didn't fall into the average location descriptions it would be inappropriate to say..." I'm sorry sir, I can't treat you because your problem falls outside of the description for the average location of this malady your are suffering from." Sometimes we are so consumed with the language and definitions in the practice of medicine that we miss the mark...those skills we need to practice. Another example...nice to know that a foreign body will likely fall to the superior segment of the upper lobe of the right lung when a patient aspirates laying down...but in practice, you go find it...WHEREVER it is! I get the "prediction" piece, but the practice of medicine is about taking care of the how things present, not falling into bad habits related to general rules and descriptions. I am overall pleased with my performance. I'm pretty sure I beat the class average and understand the material pretty well. I get where this is all leading and I'm sure that my core understanding is solid so I can transfer these skills to my history, physical examination and assessment skill set. It would be nice to be able to practice those skills at the same time.  Call me crazy, but laying a stethoscope on a chest when you are learning the locations of cardiac valve auscultation is a reinforcing and positively educational experience. It will only require many to go back and review what we just did when we get to that point in our education. Dr. Stead was right...this process has really degraded over time. Remember, medicine was an apprentice "sport" way back when...you learned by doing as well as reading.  Onward to Histology... As a parting thought, I wish other students would realize that if they would get out of the way, the process will reveal itself and that fighting it only ruins the process, and makes it bumpy at best. We have at least one person in the class who thinks he knows better than everyone else about everything. The fact that he is a total antisocial idiot and only gets in the way of our learning is my latest mental challenge. Ahhhh nammmmm....I can only hope that he is blessed with rotation attendings that not only aren't tolerant of his behavior, but publicly rebuke it. For if it continues, he will become one of those physicians who disrespects nurses, is in conflict with administrations and colleagues and treats patients as objects of his knowledge and skill. We don't need any more like him in medicine. Where do these people come from, and how do they end up in the healing arts in service to others?