jerome groopman, m.d.. on a sweltering morning in june 1976. jerome gets ready for his first day of...
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Jerome Groopman, M.D.
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On a sweltering morning in June 1976. Jerome gets ready for his first day of internship…Despite the heat he walked along Cambridge street to the entrance of
Massachusetts General Hospital
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Phillips
BakerBulfinch
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After checking the floor, Jerome went to visit his next patient..
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Suddenly! when Jerome was about to leave, Mr. Morgan
was moaning in pain. His eyes enlarged, his chest heaving violently, and he could not talk at all.
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I try to think but couldn’t, my index card was no help. My feet was stuck to the floor.
\\ 囧 //OMG
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what I’ve heard was not taught in school!!
I was an A student, I feel so helpless!!
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COMMENSING
BATISTA
OPERATION
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Fortunately, Mr. Morgan survived the surgery…but he is now at a mental hospital after being traumatized by the aggressive nurse who gave him CPR.
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If you apply to a medical school…You need to finish pre-medicine academic
courses. (usually 4 years)Your grades need to be pretty excellent.You have to pass the Medical College
Admission Test.You have to pass the interview.
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Good job!! Now you are a medical student!!
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ResidencyFamily doctors, pediatricians: 3 years Surgeons: 7 years
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Congratulations! You are a doctor now!
After you pass the third license exam, you are a doctor now!
Becoming specialists or PhD may take more time to study.
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America. Vs. Taiwan1. Pre-medicine
courses2. MCAT and
interview3. 4 years medicine
courses4. 3 ~ 7 years
residency5. Three times
license exams
1. CEE2. 7 years medicine
courses3. 3 years residency4. Two times license
exams
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Jerome Groopmana staff writer in medicine
and biology for The New Yorker since 1998
Professor of Medicine at Harvard Medical School
Chief of Experimental Medicine at Beth Israel Deaconess Medical Center
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Jerome GroopmanDina and Raphael Recanati Chair of Medicine at
Harvard Medical Schoolone of the world's leading researchers in cancer
and AIDSHe was at the Massachusetts General Hospital
for his internship and residency in internal medicine.
The Measure of Our Days 1997 Second Opinions 2000
Anatomy of Hope 2004 How Doctors Think 2007
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Anne Dodge’s case historyShe suffered from stomach ache and vomiting
after she ate for 15 years.Internist’s diagnosis nothingPsychiatrist(精神科 ) anorexia nervosa(神經性厭食症 ) and irritable Colon Syndrome(大腸激躁症 )All doctor focused on the two diagnosis.
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Anne Dodge’s case historyHer problem didn’t be solved. However,
worse.Dr. Myron Falchuk question,
listen, and observe. Coeliac disease.
Coeliac disease is caused by allergy to gluten(麵筋 ).
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ComparisonIntuition in the
statue doesn’t look right
Spontaneous reaction caused by our brain.
Often without knowledge.
Intuition in the how doctors think
Result from experiment and knowledge in mind.
Must be trained.Being called “pattern
recognition” and “heuristic.”
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ComparisonEmotional detachment
in Indian campPut emphasis on the
lack of compassion of doctor
Ex. The doctor ignored the lady’s screaming and didn’t prepare appropriate tools for the operation
Emotional detachment in how doctors think
Put emphasis on the nervousness when dealing with patients’ problem.
Ex. The author was too nervous to do anything for Mr. Mogan.
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Anne’s case Physicians had fifteen years to ponder Anne
Dodge’s case Too emphasize on case historyDr. Falchuk successfully cured Anne, why?Avoid the negative feelings/presumptions of
patients.Communicate properly.
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Mr. Morgan’s caseIt took Dr. Burnside few seconds to figure out
what was wrong.What’s wrong with the intern?Knowledge?Emotional detachment? (not really)Nervous? (suppressing the panic feeling)
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Yerkes-Dodson curve
a state of heightened physiological activity
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The major reason of errors made in medicine. -Too nervous. -Affected by inner feelings.
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The keys to avoid making mistakes. -Calm down. -Eliminate our inner feelings/presumptions.
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Our minds are easily influenced/confused by our senses. Try to stop the moving wheels.
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Doctors are still human.
What if the mistake has happened? -Admit the mistake and learn from it. -Show sympathy.