IT'S A SUNNY Saturday afternoon, and you have brought your youngest son to his older brother's little league game.You're all enjoying the day, when suddenly your son drops his hot dog and turns to you with a look of sheer terror and absolute panic. You realize he can't breathe; he got a piece of the hot dog stuck in his throat. You scream in panic, not knowing what to do. Luckily, your family physician is also at the game, and he runs over to help. He, of course, knows the Heimlich maneuver, but the piece of food refuses to budge no matter how hard he tries. You cry uncontrollably as you see your son go limp, passing out from the lack of oxygen. The doctor then tries to reach in the boy's mouth to pull out the food, but it is just beyond his reach. He feels helpless, wishing there was something else he could do, and decides to let the rescue squad take over when they arrive. Your son dies on the way to the hospital. If only this physician, with all of his medical training, could do something else.
I am writing in response to the recent controversy about the School of Medicine's optional third year laboratory, the Emergency Life-Saving Techniques Laboratory. My purpose is to present a few facts and offer my opinion as to why I believe this lab provides invaluable skills to all those who aspire to be Doctors of Medicine. On Jan. 31, the president of the Physicians' Committee for Responsible Medicine spoke at a forum held at the School of Medicine and offered his opinion as to why this lab should no longer exist. I attended the talk but was definitely not convinced. Here's why.
For most of the meeting, he showed a video of several Harvard medical students explaining why they thought their dog lab was inappropriate and how they got rid of it. I would have too. Their lab was used to teach physiology and pharmacology; it consisted of injecting drugs into dogs and seeing how the dogs responded. The information learned could have just as effectively been taught in the classroom, in a textbook, or in the OR watching real surgery. So understandably, they got rid of the lab. Our lab here at the University is not a physiology lab, but rather teaches life-saving procedures such as tracheotomy, chest tube placement and splenectomy.
In the story above, the doctor could have saved the boy's life if he knew how to do a tracheotomy. I realize this is an extreme example, but here's a more realistic scenario. An ER resident trying to put in his first chest tube doesn't realize he has to push so hard to get the tube through the chest wall, or he pushes too hard or at the wrong angle and punctures the lung itself, or he gets too close to the rib above and severs the nerve, artery and vein running beneath it. Any of these complications can seriously affect a patient's outcome or even survival.
At the forum there were alternatives presented, such as surgeon shadowing and a mannequin simulator. The fact is, these skills are all about feel. They cannot be acquired by watching someone else do it or by learning on a plastic model that is "realistic" just because it squirts red liquid at you when you cut it. Real muscle, real connective tissue and real blood vessels have unique texture and consistency that can't be simulated. They argued in the forum that we shouldn't be using dogs because their anatomy is different.Obviously, we're not learning anatomy on the dogs (we learn anatomy first year), we're learning manual skills.Another argument was the cost.It was stated in an earlier Cavalier Daily article that the dogs cost $5,000-$6,000 each.According to the University's lab manager the correct figure is $200.
One of the main arguments presented at the forum was that most medical schools across the country have gotten rid of their dog labs.While this is true for the medical schools, they all still have the dog labs for their surgical residents.So what if you go into family medicine or pediatrics?You're out of luck; you cannot learn these procedures. True, a procedure like removing a ruptured spleen would only be done by surgeons in an operating room, but it is easy to come up with a scenario where a chest tube or a tracheotomy would have to be done in the field or in a primary care office by a family physician in an emergency situation.That is why these skills are something every physician should learn, or at least have the opportunity to learn.So don't take away our Life-Saving Techniques Lab -- that life could be yours.
(Scott Alan Eisenhuth is a second-year student in the School of Medicine)
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