Sometimes trying to understand nursing can be realwise doubleplusungood

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Before I start on this rant, I want to clarify that I’m not suggesting that nursing be “medicalised,” or that the role of nursing be expanded to include diagnosis and treatment of illness. In fact, I think it’s a good thing that there is a discipline for caring for patients, namely nursing, and a separate one for diagnosis/treatment, namely medicine. These are different and complimentary roles, and I wouldn’t want to be burdened with the responsibility of diagnosing and treating the illness as a nurse. After all, if the nurse is busy doing diagnosis and treatment, who will be doing the nursing?

That said, I’m confused about something that’s come up a number of times in different contexts in nursing school—it’s the fact that nurses have to pretend that they don’t know what’s going on if anyone asks, but they are responsible for acting as if they do. A nurse is not allowed to diagnose an ear infection, a broken leg or a heart attack for example. If a nurse did that, she would be overstepping what she is licensed to do.

I think an example will help to clarify: It is well within a nurse’s responsibilities in certain contexts to triage patients in order of medical priority. Imagine a case in which three patients arrive at the emergency room to be assessed and prioritised by the intake nurse. One patient has the signs and symptoms of an ear infection. The second patient has an obviously broken leg. (Imagine the patient is in extreme pain and the leg is bent at a 90º angle half-way down the shin.) The third patient has all the tell-tale signs of a heart attack, like chest pain, distress, tingling down the left arm, light-headedness, etc.

In such a case, the nurse would be responsible for making sure that the third patient (the one with the heart attack) was given priority and taken to see a doctor immediately. The nurse would then refer the patient with the broken leg to radiology or something, and then a doctor would have the bone set and put in a cast. The first patient, the one with the ear infection, would have to wait until the others were treated before getting what she needs—probably just a prescription for antibiotics. If the nurse gets the order of priority wrong, she will be held responsible for the consequences.

The confusing part about this whole process is that a nurse has to simultaneously think about balancing the medical priority of the three patients while being careful to remain intentionally agnostic about what it is exactly that is afflicting each of the patients.

The nurse can’t just say, “You have an ear infection,” or “You have a broken bone.” Those are diagnoses. Doctors make diagnoses. Nurses can’t make diagnoses. But the nurse has to prioritise and execute her practice as if she did know that the one patient was having a heart attack and the other was having an ear infection.

This is of course, something of a simplification. In certain contexts, nurses can make what are called “nursing diagnoses.” Unfortunately, this concept doesn’t clarify anything for me. I asked a professor of mine to give me an example of one. She said that a nurse could pronounce a nursing diagnosis of “failure to oxygenate” in the circumstance that the patient was having difficulty breathing, complained of shortness of breath and had an O2-sat of 60% or something. The problem with the concept of a “nursing diagnosis” (at least for me) is that I would be more likely to call “failure to oxygenate” a “sign” (an externally observable indicator of the state of a person’s health) rather than a “diagnosis.”

But the point remains that after assessing a patient, if the patient asks, “Am I having a heart attack?” a nurse would have to respond with something like, “Due to the legal constraints on my licensure as a nurse, I can neither confirm nor deny that you are having a heart attack,” but at the same time, she would need to act as if she knew that the patient was having a heart attack and prioritise her care accordingly, on pain of legal repercussions.

I think I’ve heard of this before.

To know and not to know, to be conscious of complete truthfulness while telling carefully constructed lies, to hold simultaneously two opinions which cancelled out, knowing them to be contradictory and believing in both of them, to use logic against logic, to repudiate morality while laying claim to it, … to forget, whatever it was necessary to forget, then to draw it back into memory again at the moment when it was needed, and then promptly to forget it again, and above all, to apply the same process to the process itself—that was the ultimate subtlety; consciously to induce unconsciousness, and then, once again, to become unconscious of the act of hypnosis you had just performed. Even to understand the word ‘doublethink’ involved the use of doublethink.

(Orwell, George (1949). Nineteen Eighty-Four. Martin Secker & Warburg Ltd, London, part 1, chapter 3, pp 32)

Ahh, that’s what it is! Doublethink! Now I remember. This is, as they say, realwise doubleplusungood.

It might be crimethink to say this as a health care professional (am I allowed to call myself that yet?), but I guess I just have an intuition that the world won’t end if nurses are allowed to actually diagnose certain things under certain circumstances. I’m not saying that because I would want to change the role of nurses or to take territory away from doctors, but rather because I want to allow nurses to be able to execute their own practice—that of caring for the patient—without having to go through all that doublethink.

So, how does my claim that nurses should be able to diagnose certain things square with my original disclaimer that I don’t want to change the role of nurses? Here’s how I make it fit in my head: There are some things (like an obviously broken leg) that a nurse would be more than qualified to identify and yes, even diagnose without any further training. (There are other things that a nurse is not capable of diagnosing, and I’m not suggesting that nurses be trained to be able to diagnose cancer or anything so extreme as that.)

When would a nurse go about making a diagnosis? Only when it is necessary for her to do in the context of her role in providing care for the patient as a nurse.

For example, after an assessment, a nurse often needs to perform certain interventions as a part of her role. These may include referring to other practitioners, engaging in conversation, providing education, reflecting strengths, or assigning priority, as in the triage example above. For these interventions, it is often tricky to come up with a rational way to justify one’s actions without reference to the patient’s illness. I would much rather be able to say “the reason for this intervention is the patient’s infection” than “the reason for this intervention is something that I’m not legally allowed to say much about.”

BibTeX

@online{bgcarlisle2012-2664,
    title = {Sometimes trying to understand nursing can be realwise doubleplusungood},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2012-01-14,
    url = {http://www.bgcarlisle.com/blog/2012/01/14/sometimes-trying-to-understand-nursing-can-be-fullwise-doubleplusungood/}
}

MLA

Carlisle, Benjamin Gregory. "Sometimes trying to understand nursing can be realwise doubleplusungood" Web blog post. The Grey Literature. 14 Jan 2012. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2012/01/14/sometimes-trying-to-understand-nursing-can-be-fullwise-doubleplusungood/>

APA

Carlisle, Benjamin Gregory. (2012, Jan 14). Sometimes trying to understand nursing can be realwise doubleplusungood [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2012/01/14/sometimes-trying-to-understand-nursing-can-be-fullwise-doubleplusungood/


Antibiotics and antivirals

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More and more often these days, I come across articles about new anti-viral drugs that look really promising. Further, I’m sure we’ve all read or heard about the phenomenon of antibiotic resistance—strains of bacteria who acquire the ability to survive treatment with antibiotics which would otherwise kill the bacteria and cure the patient.

Since the discovery of antibiotics, bacterial infections have been relatively easy to treat, whereas viral infections have been something that can’t be treated directly. The treatment for a bacterial infection is penicillin, but the treatment for the common cold is bed-rest.

What I find interesting about these developments is that we may be entering an age where this is reversed: Bacterial infections may become difficult or impossible to treat directly, while viral infections can be simply and easily cured with drugs.

BibTeX

@online{bgcarlisle2011-2590,
    title = {Antibiotics and antivirals},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2011-12-22,
    url = {http://www.bgcarlisle.com/blog/2011/12/22/antibiotics-and-antivirals/}
}

MLA

Carlisle, Benjamin Gregory. "Antibiotics and antivirals" Web blog post. The Grey Literature. 22 Dec 2011. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2011/12/22/antibiotics-and-antivirals/>

APA

Carlisle, Benjamin Gregory. (2011, Dec 22). Antibiotics and antivirals [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2011/12/22/antibiotics-and-antivirals/


I made a doctor very angry at clinical last Friday

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Last Friday, I was assigned to give a patient his morning medications. I checked the chart to see who the patient’s nurse was, and I didn’t recognise the name. It was someone new. He was due for a dressing change that morning as well, and so my teacher told me to look out for someone I didn’t recognise to come and have a look at it—that person would likely be my patient’s nurse.

So when a woman without a name tag who was wearing a stethoscope around her neck came to inspect my patient’s dressing, I asked, “Oh! Are you his nurse?”

Her eyes narrowed to slits, and a flash of anger crossed her face.

“I’m his doctor,” she replied, deeply offended.

I avoided her for the rest of the day. Now that I think of it, after that interaction, I don’t think she wouldn’t have been such a great nurse anyway.

BibTeX

@online{bgcarlisle2011-2531,
    title = {I made a doctor very angry at clinical last Friday},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2011-12-5,
    url = {http://www.bgcarlisle.com/blog/2011/12/05/i-made-a-doctor-very-angry-at-clinical-last-friday/}
}

MLA

Carlisle, Benjamin Gregory. "I made a doctor very angry at clinical last Friday" Web blog post. The Grey Literature. 05 Dec 2011. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2011/12/05/i-made-a-doctor-very-angry-at-clinical-last-friday/>

APA

Carlisle, Benjamin Gregory. (2011, Dec 05). I made a doctor very angry at clinical last Friday [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2011/12/05/i-made-a-doctor-very-angry-at-clinical-last-friday/


Dr Pacik gave me an honourary medical degree

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When Sex Seems Impossible

When Sex Seems Impossible

This semester, I’m taking a course called “Human Sexuality and its Problems.” On the first day of the course, the professor told us that every year, the term paper is a critique of a pop sexology book. The prof intentionally didn’t tell us beforehand whether the book was good or bad—it was our job to do some research and write a paper arguing one way or the other.

This year, the paper was a critique of When Sex Seems Impossible: Stories of vaginismus and how you can achieve intimacy by Dr Peter Pacik. It’s all about how Dr Pacik treats a sexual pain condition called “vaginismus” with vaginal botox injections.

The paper was due a couple weeks ago, and on Tuesday morning Dr Pacik came to visit McGill and speak to my psych class. Of course, I was in the front row, and I asked the question, “Why haven’t you done any randomised controlled trials of your proposed treatment?”

As it stands, it’s still something of an open question as to whether his treatment would be any better than a placebo procedure.

He responded by jokingly giving me an honorary medical degree and asking what I would do if I were in his position. He even had me stand up in front of the lecture theatre and explain my proposed plan.

If I knew it was so easy to become a doctor, I wouldn’t have bothered with the MCAT or applying to medical school. After the class, I told Pickles that I’m a doctor, and she had me diagnose something. So I picked someone and diagnosed her as diabetic. I later changed my diagnosis to “crazy,” and decided to prescribe insulin laced with anti-psychotics.

I think it goes without saying that I’m the best doctor ever.

BibTeX

@online{bgcarlisle2011-2459,
    title = {Dr Pacik gave me an honourary medical degree},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2011-11-16,
    url = {http://www.bgcarlisle.com/blog/2011/11/16/dr-pacik-gave-me-an-honourary-medical-degree/}
}

MLA

Carlisle, Benjamin Gregory. "Dr Pacik gave me an honourary medical degree" Web blog post. The Grey Literature. 16 Nov 2011. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2011/11/16/dr-pacik-gave-me-an-honourary-medical-degree/>

APA

Carlisle, Benjamin Gregory. (2011, Nov 16). Dr Pacik gave me an honourary medical degree [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2011/11/16/dr-pacik-gave-me-an-honourary-medical-degree/


Things that bother me about university applications

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The cost of applying

It costs a lot of money for prospective students to apply to most university programmes, and if you’re hedging your bets and applying to a lot of different places, the application fees add up very quickly. I dropped between $700 and $1000 in the past 12 months just on application fees. That’s not money going toward tuition. It didn’t pay for my MCAT, to say nothing about the prep materials. The only thing that money did was buy me the consideration of the admissions committees for all those different schools.

Does it seriously cost a university anywhere near $100 per applicant just for their consideration? What could the cost really be?

I have a pet conspiracy theory that this sort of practice is designed mainly to keep money and power within families and a certain social class. There is a serious financial barrier in place, keeping certain classes of students out of medical schools and the more prestigious schools. I have some discretionary income right now, so I can afford to apply to schools, but I feel like there is a justice issue here that should be addressed.

No information regarding when to expect a decision

Whenever anyone asks me about when I’ll know what I’m doing next year, the most truthful answer that I can give them on the subject is, “Whenever they feel like letting me know.”

Universities never give a straight answer about when one can expect a decision regarding admission. I realise that there is a bit of flexibility that is required, in that many of the students who are first offered positions in university programmes do not accept them, because they have also applied to many programmes at many schools, and a student can only accept offer of admission, and so multiple rounds of admissions-offers must be made. Not a big deal.

That said, if you’re in charge of deciding who does and does not get in to a university, you’ve probably got some pretty smart people who work for you, and I bet if they made it a priority and thought hard enough, you could probably give a date by which all decisions would be made, or a schedule for when rounds of admissions offers will be released.

(I haven’t thought this through, but it might be interesting for competitive university programmes’ admissions committees to get a Twitter account, and release information by tweeting. Something like: “Second round admissions done—4 more spots to fill,” or “All admissions decisions for autumn 2011 have been made.” Sort of a random thought.)

When I was admitted to McGill, I didn’t get the letter until May. That’s a long time to wait to find out what’s going to be happening in the next year. It’s hard to live like that—hoping that you get into one of these programmes, while they’re stringing you along, keeping your eye on viable alternate plans, but not being able to commit one way or the other to any of them. Housing is up in the air; one can’t commit to employment either. I really don’t mind waiting, but it is a really disrespectful way for universities to treat people—not knowing when or if you will ever get a response, and feeling like one has to be ready to pick up and run at a school’s whim.

Vague questions on the application itself

In contrast to undergraduate admissions, which are very straightforward by comparison, graduate and professional school applications always have essay questions that are very vague, and there is almost never a way to get clarification on what exactly is being asked for. I hate trying to play the “guess what I’m thinking” game. That is no measure of whether I am well-suited for your programme, unless I’m applying for some sort of school of clairvoyance, and if that was the case, then I would expect that the administration of such an establishment wouldn’t need an application to divine who would be a good student.

Bad feedback regarding receipt of application’s supporting documentation

When you have completed an online application, it is not uncommon for universities to provide an online “supporting document checklist” which is supposed to indicate which documents required for your application have and have not been received by the university.

I have yet to see one of these that is updated on anything close to a timely basis. I sent in all my supporting documents for my MSc(A) over a month ago, and yet none of them have shown up as having been received on the “supporting documents checklist.” I remember the same thing happening for my Memorial University MD application. It was over a month after everything was due that the checklist was finally updated to reflect that it had been received on time.

If I’m paying an average of $100 to each school I apply to, then I think the least they could do is spend a couple minutes when my transcript arrives to update their websites.

BibTeX

@online{bgcarlisle2011-1268,
    title = {Things that bother me about university applications},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2011-02-15,
    url = {http://www.bgcarlisle.com/blog/2011/02/15/things-that-bother-me-about-university-applications/}
}

MLA

Carlisle, Benjamin Gregory. "Things that bother me about university applications" Web blog post. The Grey Literature. 15 Feb 2011. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2011/02/15/things-that-bother-me-about-university-applications/>

APA

Carlisle, Benjamin Gregory. (2011, Feb 15). Things that bother me about university applications [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2011/02/15/things-that-bother-me-about-university-applications/


Check this out

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Coolest thing to happen to me today.

  1. First, refresh your memory of a post I made a long time ago, on the subject of James McGill. Look at the photo I have posted there.
  2. Next, you gotta download the PDF for the McGill Medicine Alumni newsletter.
  3. Turn to the last page, page 22. Compare.

Yes, I am now a published photographer. :D

BibTeX

@online{bgcarlisle2010-923,
    title = {Check this out},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2010-09-27,
    url = {http://www.bgcarlisle.com/blog/2010/09/27/check-this-out/}
}

MLA

Carlisle, Benjamin Gregory. "Check this out" Web blog post. The Grey Literature. 27 Sep 2010. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2010/09/27/check-this-out/>

APA

Carlisle, Benjamin Gregory. (2010, Sep 27). Check this out [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2010/09/27/check-this-out/


Plan B

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I’m nearing the end of my Masters degree in bioethics at McGill. All I’ve got left is my thesis, which is coming slowly. It’s a fascinating project, which I’ll blog about a little bit later. But right now, my thoughts are consumed with what I’m going to be doing next year.

My plan A is that I’m applying to as many Canadian medical schools as I can. However, medical school admissions is a competitive process. There is a significant chance that I may not get in this year. In fact, most likely, if you were a betting man, you’d do well to bet against me getting in. You can get 1 to 30 odds against me personally getting in at the local casino. :P That’s not a problem. I’m okay if it takes a couple years for me to get in.

The question is, what do I do in the meantime, that will help to make me a better candidate, and not just be a terrible waste of time, while I wait to start doing what I really want to do?

My first thought was that I could get a second bachelor degree and try to boost my GPA a bit. I spoke to an academic counselor just this morning, and he told me that I might want to consider another option: The Master of Science in nursing programme.

This plan has a number of benefits:

  • It doesn’t take away from me being a “unique” medical school applicant.
  • It gives me clinical experience, which will be an asset to a future medical school application.
  • I will have something worth putting on this year’s medical school application under the “What will you do if you don’t get in?” section.
  • I’m likely to get in because I’m male-bodied. Is this morally questionable? Discuss.
  • I may never get in to any medical school, and this will provide a good job, salary and a respectable career in my field. Alternately, I may find that I just enjoy being a nurse, and don’t want to go into medicine. Who knows?
  • This may allow me to move into medical ethics later on in my career, being a medical professional with a bioethics background.

BibTeX

@online{bgcarlisle2010-912,
    title = {Plan B},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2010-09-21,
    url = {http://www.bgcarlisle.com/blog/2010/09/21/plan-b/}
}

MLA

Carlisle, Benjamin Gregory. "Plan B" Web blog post. The Grey Literature. 21 Sep 2010. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2010/09/21/plan-b/>

APA

Carlisle, Benjamin Gregory. (2010, Sep 21). Plan B [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2010/09/21/plan-b/


Academic vs corporate study materials

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While studying from the privately-produced MCAT study guides that I bought, I’ve noticed some differences between the way material is presented in the study guides as opposed to most academic material that I’ve consumed over the years.

I suppose that the Kaplan study guides are the product of different sorts of pressures than the textbooks and course notes produced by academia, and that’s not necessarily a bad thing.

Academia is designed to produce freedom of thought and allow discourse at the highest level. It is supposed to be a no-holds-barred intellectual brawl. That’s why universities have the institution of tenure. It’s so that professors can pursue their research along whatever lines it takes them, without worrying that they’ll lose their job if they discover something that their employer doesn’t like.

The Kaplan study guides, on the other hand, were designed for one purpose: to make profit for Kaplan’s shareholders. The Kaplan company thinks it can make money by producing MCAT prep materials and services and selling them. The pressure for the Kaplan guides to be good is so that they don’t get sued for publishing misleading MCAT guides, and so that they have customers with good experiences, who will recommend Kaplan study guides and prep courses to others.

Both academia and the commercial preparatory systems are set up such that they (generally) produce good curriculum, but I’ve noticed some differences between the two, which I think demonstrate some characteristic features of each one.

For example, the Kaplan study guides are written with mnemonics in the margins, silly analogies that are intentionally carried too far so as to be memorable, and the guide’s text is written with humour.

Academics are often guilty of making the material difficult to learn, or at the least, there isn’t nearly the same emphasis on trying to help the student pass the test.

The Kaplan guides are written engagingly, even soothingly. They are specifically trying not to scare you with the amount of material you need to know.

I had a physiology prof who stood at the front of the lecture theatre, held up the course package on the first day of the course, and actually did try to scare us with the sheer size of the volume.

I don’t think I’d go so far as to say that the Kaplan guides are entertaining, but they are certainly better to read than that physiology course package was.

The Kaplan guides have each of the articles rated out of six stars. The higher the number of stars, the more frequently it is examined on the MCAT, and the easier it is to learn. So a one-star concept would be one that is tested very infrequently, and that is difficult to master. This is to help students focus on the pieces of information that will best help them score well on the exam.

I have had courses (and textbooks) where the most insignificant detail is dwelt upon ad nauseum, because it is the professor’s favourite subject. This sort of thinking is encouraged in the academic world, since new developments in science and philosophy often come about because of attention to the details of seemingly insignificant problems.

Such ways of thinking do not help students pass exams, though, so the Kaplan guides are very focussed.

In some ways, academia could learn something from the focus that the corporate world brings to their prep materials. I mean, really, who in their right mind (except an academic philosopher) would recommend studying the works of Immanuel Kant in an attempt to learn the discipline of rigourous thought?

BibTeX

@online{bgcarlisle2010-795,
    title = {Academic vs corporate study materials},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2010-07-28,
    url = {http://www.bgcarlisle.com/blog/2010/07/28/academic-vs-corporate-study-materials/}
}

MLA

Carlisle, Benjamin Gregory. "Academic vs corporate study materials" Web blog post. The Grey Literature. 28 Jul 2010. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2010/07/28/academic-vs-corporate-study-materials/>

APA

Carlisle, Benjamin Gregory. (2010, Jul 28). Academic vs corporate study materials [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2010/07/28/academic-vs-corporate-study-materials/


Medicine admissions is big business

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I have been studying for the MCAT using a set of books from Kaplan, an MCAT prep company, and I’ve realised a few things.

First off, medicine admissions is big business. I’m not even talking about medicine. I just mean the admissions process. Imagine you just wanted to apply to all the medical schools in Ontario, for example. First you would have to write the MCAT. This will cost you $230. Then, you will need to pay for the application, and to apply to every school in Ontario through OMSAS, it will cost about $660.

That’s $890 just to apply and take the MCAT.

Now imagine that you want to take a prep course for the MCAT. I went shopping around for MCAT prep, and someone from Kaplan tried to sell me a comprehensive package which included one-on-one tutoring, online lectures, books, and practice exams. All told, the tutor would have been making roughly $180 per hour from me, and the package would cost me $2799.

There is a whole industry built up around the fact that there’s huge competition to get into medical school. I ended up spending $150 for review books and practice exams, myself.

I can understand companies like Prep 101 and Kaplan charging huge sums for their expertise and time. They are, after all, in the business of making money, and people (generally) are willing to spend money on investments that they think will bring a greater return in the long run. I have no problem with them.

That said, there’s no way they are getting $2700 from me! I don’t care how good their tutor is. There’s no way he’s worth $180 an hour. Imagine knowing that your MCAT tutor is coming, and that you’re paying that much for him. I imagine I would spend as much time prepping for my meeting with the tutor as I would spend prepping for the MCAT, so that I would be sure to get my money’s worth, and that sort of mentality might not actually best help one to prepare for the MCAT.

Anyway, I was thinking, and of course, I can understand wanting policies that make it difficult for someone to get into medical school. You don’t want an unqualified person committing surgery against a patient, after all. So you would want to produce a high intellectual barrier, or a high skill barrier, or otherwise make it difficult, but in ways that elminate the greatest number of people that should not be doctors.

What’s confusing though, is why medical academia would have policies that produce such a high financial barrier to entry. The $890 is what you would pay if you were going for a bargain-basement medical school admission. That’s the minimum you would have to pay. You’re not buying any extra review material on that budget. You’re not getting any practice exams, tutoring or classes. That’s just what it costs to apply, and nothing more.

Maybe it’s to weed out those who might just apply on a whim. Or maybe doctors don’t want new applicants to be spared any hardship they themselves had to suffer. Maybe it actually does cost that much to ensure that the process is fair. I’m not sure what the real reason is.

BibTeX

@online{bgcarlisle2010-793,
    title = {Medicine admissions is big business},
    journaltitle = {The Grey Literature},
    author = {Benjamin Gregory Carlisle},
    address = {Montreal, Canada},
    date = 2010-07-27,
    url = {http://www.bgcarlisle.com/blog/2010/07/27/medicine-admissions-is-big-business/}
}

MLA

Carlisle, Benjamin Gregory. "Medicine admissions is big business" Web blog post. The Grey Literature. 27 Jul 2010. Web. 29 Mar 2017. <http://www.bgcarlisle.com/blog/2010/07/27/medicine-admissions-is-big-business/>

APA

Carlisle, Benjamin Gregory. (2010, Jul 27). Medicine admissions is big business [Web log post]. Retrieved from http://www.bgcarlisle.com/blog/2010/07/27/medicine-admissions-is-big-business/


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