Week 5 - McKellar

This week I wanted to reflect on my time in the clinic and briefly discuss some of my experiences. This summer I am working with the rheumatologist Dr. David Fernandez. While shadowing him, I have gotten to see a variety of patients, including those with rheumatoid arthritis, myositis, and a variety of other autoimmune disorders. We are setting up a project to study clonal T-cell expansion in myositis patients, so while here I am mostly focusing on these patients. This disease has begun to fascinate me because of the interplay between immune cells and muscle cells, but I’ll try not to go down that rabbit hole.

My time in the clinic with Dr. Fernandez has led to a few thoughts that I’d like to share. The first is that physicians are way better at treating patients than any abstract would lead you to believe. As a scientist who spends all of my time in the lab, my most common interaction with clinical statistics is usually in the introduction of papers where the authors are trying to justify the reasons for their work. Quite often this justification is built on a gloom-and-doom picture of current medical practices. Poor life expectancies, anecdotes of patient suffering, and missing tools/treatments are constantly described. I didn’t realize until recently how much those descriptions have shifted my views on modern medicine. There are a lot of conditions that doctors are really good at treating, and I think for the sake of all of our (biomedical scientists) psyches and mental health, we should try to remember that more often.

Of course, at the same time, watching Dr. Fernandez meet with patients for the first time has shown me how hard doctoring can be. The detective work required to fish out important symptoms from people who know absolutely nothing about physiology or pathology is incredibly difficult. With the amount of paper work physicians have to do these days, they seem to be getting less and less time to conduct these investigations too. I listened to a great interview with Eric Topol recently (https://a16z.com/2019/06/13/ai-doctor-deep-medicine-topol/) where he described some fascinating computational work that is being done to carry that load, but those tools are not here yet.

Lastly, I wanted to mention one semi-scary realization I had while watching an injection Dr. Fernandez did for an arthritic patient the other day. As he sterilized the patient’s knee and prepared the needle, it felt eerily similar to the last time we did notexin injections back in Ithaca (the Cosgrove lab uses a snake toxin to mimic muscle injuries so that we can study muscle regeneration). I mentioned this to one of my fellow students and we couldn’t decide if that reflected positively on the quality of our mouse injections, or negatively on modern medical practices (in terms of sterility and the casual nature of injecting drugs). I’m hoping for the former.