gross anatomy
Vitum Medicinus makes a good point about how differently physicians and nurses are trained, but I think it's oversimplifying in some ways. The differences in training aren't just the material (ostensibly, we do cover the exact same material) but the focus. But that's another rant entirely.
I kind of think that the importance of gross anatomy is overstated. I'm really not all that convinced that cutting up a dried-up, chemically-preserved cadaver was all that helpful.
For one thing, all I remember about anatomy lab was leaning over a mutilated cadaver with beads of sweat dripping down my face, never mind the fact that the lab was the temperature of a meat locker. I'm spending like 30 minutes trying to dissect out a single nerve, hoping to God that I won't ruin the structures so that I don't have to face the wrath of my lab partners. But sure enough, the nerve snaps like an old, overused rubber band.
Ironically, I think I learned more helpful things about anatomy in physiology class, and from a sacrificial pig at that. If you think about it, most mammals have roughly the same structure as we do. And because we got to cut the pig up while it was still alive (barbaric, I know), you got to see how nerves aren't these fragile stringy things. Rather, they're robust, shimmering ribbons. They stand out a lot more from the muscles and the tendons when they're not dried out.
I don't know. I'm an internist. Maybe surgeons find gross anatomy far more useful. Then again, maybe not. The luxury of cutting up a cadaver is that you don't have to worry about putting anything back together again. I kind of wonder how you adapt your memories from a flayed-open cadaver to the frequently incredibly limited visual fields you get when you're operating laproscopically. Even when you're doing an open surgery, you only open up so much, and the incision is never the same one you did on your cadaver.
Then again, maybe I have defective parietal lobes and have problems with three-dimensional rotations. After all, when I was a third year med student and they let me drive the camera, the attending half-jokingly asked the circulating nurse for some Zofran.
Again, especially as an internist, you really don't have the luxury of slicing and dicing up live patients. So it kind of doesn't matter that you've held a liver in your hand, or know how big a spleen is when you're doing a physical exam. Your metrics are entirely different. Even if you can feel the edge of the liver about 4 cm below the costal margin, it tells you nothing about the overall dimensions of the thing (and without the clinic history, you have no idea whether this completely normal, or if the guy has a scarred-down cirrhotic liver that's been invaded by metastatic colon cancer, pushing down the liver edge to where you can feel it.) And it doesn't matter how much of the spleen you feel. If you feel anything at all in the left upper quadrant, it's abnormal, unless, maybe, we're talking about a really skinny kid. And even then.
And gross anatomy does almost nothing to help you with interpreting CT scans and MRIs. For one thing, with digital images, you can scale the image as much as you want. (Is there even a standardized conversion factor for an unscaled image? Like, what does one centimeter on the body correspond to on the PACS machine? Or do you just have to pull out the measuring tool on PACS and have it calculate it for you?) Learning how to look at an abdominal CT is an entirely different discipline, but most of the time, this is the most invasive you're allowed to look until the surgeons decide to take 'em to the OR, or unless your patient dies and the pathologist gets to slice 'em up.
In contrast, I found Body Works to be a much more useful way to learn the relationships of various structures. Maybe it isn't so much gross anatomy itself that's useless. It's probably more the actual dissection. After all, if you had enough time to get the dissections perfect without mutilating any structures, then it would be pretty nice. My favorite exhibit was the one that consisted entirely of vasculature. Despite the fact that they had meat-strippin g dung beetles eat everything that wasn't plastinated, you could still make out the outlines of the human body. Just from looking at the vascular structures, you could tell where the major organs were. You could even tell if the subject was male or female just from whether there were testicular arteries or ovarian arteries.
As for what a prostate looks like, I can only conjecture. It wasn't exactly an organ that I had a lot of attention for when I was a med student. That, and the fact that our cadaver was female.
On the other hand, I deal with BPH disturbingly often. From sticking my fingers up enough people's butts, and from dealing with guys who have to pee like 27 times in the middle of the night, I have a pretty damn good idea about the disease process. But I can only tell you things about it that I learned out of the textbooks. Like, it's supposed to be only the size of a walnut, but in BPH it can get as big as a grapefruit. (Again, why do pathologists love food analogies?)
But treatment is pretty straight-forward. You try meds (alpha-blockers and androgen antagonists) and if all else fails you send them to the urologist, who'll suck the thing out of their pee hole. (Man, just writing that made me cringe.)
11:00 · permalink · 2 comments
comments
Name/Blog: Vitum Medicinus
URL: http://blog.vitummedicinus.com
Title:
Comment/Excerpt: While your memories of anatomy lab may have been standing in a room with the temperature of a meat locker with sweat dripping down your forehead, thanks to the poor maintenance in the building at my school, one of my experiences this year involved standing in a room with the temperature of a tropical beach with human fat dripping down my leg.
Of course, you don't notice it on your skin until enough time has passed for it to drip down the length of your pants and then seep through.
Not fun.
Name/Blog: Sara
URL:
Title:
Comment/Excerpt: I agree. Gross anatomy was one of the most useless things in medical school.
add a comment