~by Don Osborne from INQUARTA

How do you become a medical doctor in the United States? Although it isn’t for the faint-hearted, with planning and perseverance it can be done! Nevertheless, gone are the days when academic excellence only will guarantee you a place in Medical School. Medical School selection committees are looking at a lot more…

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“How Do You Become A Medical Doctor in the United States?”

Ask yourself some questions:

How do you become a medical doctor in the United States? Or – “How you do become a doctor?” Perhaps – “I really want to become a doctor, but what do I need to do to become a doctor?”

…then this report will answer those questions for you.

(At the end of this article I will give you free access to find out how you can go to medical school — for free!)

I will explain what you need to do to become a doctor, including:

• the classes you need to take in high school and college
• the additional education requirements to become a doctor
• how many years it takes to become a doctor
• and all of the other steps to becoming a doctor.

This report will give you guidelines for how to become a medical doctor in the United States, as well as most places in the world that follow an American/ United States approach to education.

Snapshot / Overview

Your timeline will look like this: 4 years of high school, followed by 4 years of college/university in the United States, followed by 4 years of medical school education, followed by 2 to 3 years of medical residency. Now, you’re a doctor.

Fourteen years?!! Well, not exactly. By the third year of medical school, you’ll be working with patients and practicing medicine under careful supervision. And when you start your medical residency, you are actually starting your first full time job in medicine. So your total time will feel more like four years of college, plus two years of medical school.

Let’s break some of these steps down in more detail.

What high school courses do I need to become a medical doctor?

Let’s start with the basics of high school education. There are no specific high school courses that you are required to take to become a doctor in the United States. However, the grades you get in high school will determine where you attend college, and the college that you attend in turn will determine the medical school that you attend.

This is a generality, but a useful one: The reputation of the college you attend will to a small degree impact the medical school you will most likely be accepted to.

What degree do you need to become a doctor?

Most students ask what degree do I need in order to become a doctor. To become a medical doctor in the United States, you are not required to have a specific degree.

Instead, medical schools have a list of prerequisite classes that you must take. Most pre-med students choose to major in Biology and get a Bachelor of Science in Biology,  but they do this because the Biology major contains all of the classes that medical schools require.

You can find the right degree from top schools across the USA using the degree finder at oedb.org

What grades do you need to become a doctor?

To be a competitive applicant for medical school admissions, your grades will need to be at least a 3.5 GPA on the 4.0 scale or higher within your science courses — typically biology, chemistry, physics, math.

How much does it cost to become a doctor?

Let’s look specifically at the cost of medical school. According to the Association of American Medical Colleges,  of 2016, most students will graduate from medical school with a median debt level of $200,00. There are differences in tuition, fees and health insurance between public and private schools. However, looking at your lifetime earnings as a physician relative to the money that you have spent, you will see that your earnings will more than pay for the money that you spend to go to medical school. You can argue that going to medical school does not cost you money, but actually makes you money.

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Also have a look at:

Becoming a General Practitioner

Becoming a Doctor in the USA

Becoming a Surgeon

Well best wishes for success towards your dream of becoming a doctor!

 

Dr Anton Scheepers and Team

I really want to become a Doctor – Is there anything I can do straight away?

Check out the Foundation Medical Course on Apprentice Doctor Academy.

Also, explore the Future Doctors Kit on Apprentice Doctor Kits.

 

Gloves

Gloves are the most common type of personal protective equipment (PPE). Gloves are considered a barrier protecting both you and your patient from the transfer of harmful microorganisms. Always use gloves when you work on a patient. Hygienically prepare your hands before gloving and clean your hands again after removing the gloves and before moving on to your next patient. Gloves are absolutely essential when you have an existing cut or small wound on your own hand and when you are touching any bodily fluid/secretion/excretion.

Boots

Theater boots

The operating theater can be a messy/bloody/gutsy place. Surgeons often wear waterproof boots as a protective measure from contamination with blood, puss, amniotic fluid etc.

Boots for emergency workers

Boots should protect your feet. Steel toe are best for this purpose. It should be water-proof, flexible and they must be exactly the right size. They should also be able to protect you against cold weather and punctures. The soles of your boots must provide good traction to prevent you from slipping and sliding down slopes.

Over-shoes

Shoe covers are important as they help maintain a sanitary environment by eliminating tracked-in dirt and microbes and they protect the wearer from accidental spills and bodily fluids. Always use shoe covers when entering the operating room or Intensive Care Unit.  Alternatively use dedicated surgical boots or shoes.

Surgical caps

Even clean recently washed hair is contaminated with loads of bacteria. The surgical cap minimizes the risk of hair falling into the sterile area during surgery. Ensure that all your hair is covered by the surgical cap before proceeding with scrubbing for surgery!

Masks, Visors/glasses

A face masks is worn as a barrier to protect the patient against the transfer of harmful microorganisms present in the healthcare professional?s saliva, nasal discharge and facial hair, and to protect the healthcare professional from being infected by microorganisms present in puss, blood, other body fluids, secretions (e.g. saliva) or excretions (e.g. feces) by the patient.

Medical professionals should wear a mask and eye protection or a visor (face shield) to protect mucous membranes of the eyes, nose and mouth during procedures and patient-care activities that are likely to cause splashes or sprays of blood, body fluids, secretions or excretions. Masks should be worn at all times in restricted areas of the Operating Room – where sterile supplies are opened and at scrub sinks. Masks with face shields or masks and protective eyewear are required whenever splash, spray or droplets of blood or other potentially infectious materials may be generated.

Apron

Some surgical procedures may become really ‘messy’ – thus the surgeon needs to protect him/herself by wearing a waterproof apron. Surgical procedures where a lot of bleeding of spill of bodily fluids like amniotic fluid e.g. during a Caesarian section are examples where an apron is needed.

Surgical gowns

Surgical gowns are considered one of the most important protective items during surgical procedures. Sterile surgical gowns play an essential role in maintaining aseptic conditions by blocking the transfer of harmful microorganisms and chemicals to and from the patient, and reducing the transfer of bacteria from the skin of the surgical staff to the air in the operating room.

Wearing surgical gowns and other medical apparel (e.g. surgical masks, gloves, etc.) is of utmost importance as there will always be microorganisms present on or in the human skin, even after conducting strict hygienic and surgical scrubbing procedures.  The purpose of surgical gowns and other protective clothing is not only to keep bacteria from entering surgical wounds, but to also protect the surgical staff from bodily fluids, secretions or excretions like blood, urine, saline, or chemicals used and during surgical procedures.

PROJECT 00C – HOW TO SAFELY REMOVE CONTAMINATED GLOVES

SURGICALLY CLEAN AND STERILE GLOVES

Sterile gloves are always used in any sterile field/area while surgical clean gloves may be used for more routine medical and surgical tasks – purely as a barrier against microorganisms, contaminants and chemicals while performing tasks in a medical or healthcare environment.

Gloves are the most common type of personal protective equipment (PPE). Gloves are considered a barrier protecting both you and your patient from the transfer of harmful microorganisms. Always use gloves when you work on a patient. Gloves are absolutely essential when you have an existing cut or small wound on your own hand and when you are touching any bodily fluids, secretions and/or excretions.

Method on how to safely remove contaminated gloves

Step 1

Pinch the glove on the inside of your left hand near the cuff

 

Step 2

Pull and slide it inside out towards your fingertips

 

Step 3

“Cup” it in your right hand

 

Step 4

Now take two fingers from your left (ungloved) hand, slide them underneath the cuff

 

Step 5

Pull it off making sure it comes off inside out

 

 

Step 6

Keep on pulling until it slips off your hand.

Step 7

Throw your gloves away in a biohazard bag or bin.

Points of Interest:

• Use non-latex gloves if you or your patient is allergic to latex (take a proper medical history – see Project 0 in the Apprentice Doctor Course)!
• Always use a pair of sterile gloves for all surgical procedures or where contamination with bodily fluids (e.g. blood), secretions (e.g. saliva) or excretions (e.g. urine)  is anticipated.
• Use clean gloves when examining a patient or performing nursing tasks like changing dressings.
• Use gloves once only – never re-use gloves in a hospital setting.
• Wash your hands properly (Project 00A in the Apprentice Doctor course) before putting on gloves and after removing gloves.
• Always remove contaminated gloves using the above method.
• Always discard contaminated gloves in a dedicated refuse bin intended for contaminated medical waste (never place contaminated gloves in the regular waste bin).

I really want to become a Doctor – Is there anything I can do straight away?

Check out the Sterility and Aseptic Techniques on Apprentice Doctor Academy.

Also, explore the Scrub for Surgery Kit on Apprentice Doctor Kits.

 

The time for the arrival of the new addition to the family is here! The first step is to get mommy safely to the hospital and admitted into the maternity ward – and off they go to theater for a Caesarian section under spinal anesthesia – making the operation to deliver the baby by C-SECTION painless for the mother.

Daddy is an integral part of the birth process. He supports his wife emotionally and takes lots of photographs for memory’s sake. Mommy moves onto the operation table and the nursing staff places the necessary monitors and ECG leads to enable the anesthetist to monitor his patient’s vital functions during the procedure.

The anesthetist carefully inserts a needle into the fluid that surrounds the spinal cord and injects a local anesthetic into this space.

The theater is a beehive of activity with the nursing staff, the anesthetist, the pediatrician, the obstetrician and the surgical assistant all doing their little bit in preparing for this wonderful event of safely delivering a new baby into this world.

The registered nurse is preparing the sterile surgical field by cleaning the skin with an antiseptic solution, then meticulously draping the site with sterile drapes and finally placing the transparent barrier drape.

The obstetrician makes final preparations for the procedure and tests the effectiveness of the regional anesthetic block by pinching the skin with a forceps.

Sterile instruments ready, suction ready, lights on and the anesthetist subtly nod at the obstetrician – signaling his approval for the show to get on the road.

 

Retractors are placed strategically to help the surgical team to visualize the procedure better and to protect the adjacent important structures like the bladder.

Daddy is holding mommy’s hand in support, and the Caesarian section starts with a horizontal incision through the skin, and then layer for layer – connective tissue, abdominal wall muscle, the lining of the pelvic cavity and finally the lining covering the uterus.

The obstetrician now carefully incises the vascular uterus with bleeding and then suddenly a quick surge of amniotic fluid appearing!

There is an urgency in the air now and the obstetrician identifies the position of the baby by inserting his hand into the uterus – he struggles somewhat to get his hand around the head – but with a bit of persistence he succeeds and safely performs the delivery, then removes the umbilical cords from the baby’s neck.

The baby announces his arrival by taking his first breath and giving a loud cry. The umbilical cord is cut and a sample of umbilical cord blood is collected for laboratory tests.

This is also the opportunity to harvest umbilical stem cells for possible future use.

The baby is handed over to the pediatrician and from this point in time she is responsible for the new-born’s health and wellbeing.

Excess amniotic fluid is suctioned with a small catheter out of the baby’s mouth, nose and throat – but keep in mind that routine suctioning is not recommended anymore.

The newborn baby’s skin is covered with a white-grayish substance called vernix (short for vernix caseosa literally meaning cheesy varnish!) Excess vernix is wiped off the skin.

The pediatrician thoroughly examines the baby before handing him over to be weighed. The baby is now snuggly and securely placed in a blanket and handed to the beamingly proud father – and he shows the baby to mommy – and she again becomes emotionally overwhelmed by this wondrous event.

The obstetrician and assistant are suturing the uterus and the various anatomical layers closed.

The team works calmly now – knowing tht both mother and baby are well. The baby is taken to the new-natal section of the maternity ward.

The wider family all stretches to get their first glimpse of the new arrival – but only daddy is allowed inside.

For most people – receiving a new life into this world is a deeply spiritual experience and all the family and friends bow their heads in gratitude to their Creator for this amazing gift – a new, beautiful and healthy baby!

 

I really want to become a Doctor – Is there anything I can do straight away?

Check out the Obstetrics on Apprentice Doctor Academy.

Also, explore the Obstetrics Simulation Kit with an Accredited Online Course on Apprentice Doctor Kits.

 

Following the successful completion of your Apprentice Doctor Course, you might be wondering what your next step will be.

For many of you, the obvious answer is joining a volunteer medical program at a nearby hospital. Doing volunteer services in the USA, UK or Europe is often a bland experience with students looking at medical procedures at a distance and assisting with cleaning, porter and courier tasks. I bet you would love to get a real close-up experience that will make even medical students envious!

The Apprentice Corporation can connect you with an organization that specializes in sending students aged 16+ from all over the world to work in Hospitals in a number of global locations.

You will be given an opportunity to get real medical experience, learn about healthcare in the developing world and witness a wide variety of clinical cases. Perhaps most importantly you will see what it feels like to work as a medical professional.

All the placements are primarily medically focused, with students spending Mon – Fri in the Hospitals, shadowing doctors in Surgery, Obstetrics, Pediatrics, Internal Medicine and various other disciplines.

The doctors also take time to give clinical teaching sessions to students on various topics such as prevalent diseases in the country and how they are treated.

Your stay will be full of interesting experiences which will boost your credibility and make a big difference in your application to medical school.

The organisation that arranges this will provide you with tremendous support in arranging all aspects of your placement, accommodation and your meals, for the duration of your time away.

The Apprentice Doctor team can assist and facilitate with your placement in a number of African locations:

South Africa

Prepare yourself for the ultimate hospital shadowing experience an African setting!

Click Here for more inforamtion

Zambia, Tanzania and Kenya

 

 

 

Zambia: The world famous Victoria Falls,  and sunset wild-life cruses on the mighty Zambezi river the wild-life safaris.

Tanzania:  It may perhaps be a destination that you are unfamiliar with but the East African country is a heavyweight when it comes to entertainment. Jungle trekking, weekend safaris, visits to the formidable Kilimanjaro, ancient cave paintings, tribal villages and a lazy weekend spent on the beach, it’s hard to think of what Tanzania hasn’t got.

 

 

Hospital placement in Tanzania constantly gets rave reviews from students. You will see some traditional East African medicine as well as more modern western medicine practiced here, it can be a challenging environment and it’s certainly a Hospital experience that will give you strong comparisons to make with the medical facilities back home.

A hospital placement overseas often reaffirms a student’s desire to study medicine and many of our Apprentice Doctor students return from this type of medical experiences with a renewed enthusiasm to persevere on the road of becoming a great medical professional!

Get ready to explore the world of medicine in a most unique way. Live your life to the fullest and make use of these opportunities.

I really want to become a Doctor – Is there anything I can do straight away?

Check out the Foundation Medical Course on Apprentice Doctor Academy.

 

This is a true story. Only people’s names have been changed

Mr Brown’s Story

 

 

Mr. Brown – let’s call him Jack – was lying on his back in my reception area on a bench, his wife on another chair, and I was unsure if he was quite compus mentis (mentally normal).

He stood up and his wife led as they entered my consulting rooms. They both sat down and the wife immediately started speaking on his behalf.

She briefly stated that he has been treated for cancer of the tongue but that they would like a second opinion. So I interjected,  “Please go way back – start at the beginning.”

The wife started crying and the patient tried to comfort her but couldn’t speak due to pain in his tongue – a tongue that he had very little control over.

A moment late, she regained her composure and explained their situation:

Her husband – I thought it could be her father due to his worn-down appearance – noted a small lesion on the left side of his tongue.

They went to their dentist who immediately referred them to the local Oral Surgeon in the area – Dr Smith.

Dr Smith booked Jack for a procedure and excised the lesion (cut it out surgically). Dr Smith then sent the sample away to a laboratory for histological examination.

The lesion healed well, but on a follow up visit a week later they received the shocking news from Dr Smith that it was a cancerous growth.

It wasn’t all doom and gloom though. Dr Smith informed Jack that the lesion was completely removed and that it will never recur. Mr. Brown was healed. He thanked the surgeon, and the surgeon wished them well and they parted – both patient and doctor very happy at a great outcome!

The Inside Story

 

 

 

Inside Jack’s tongue, all was not well at all!

In Jack’s body, the white blood cell, commander of cancer control and extermination became very concerned. The intensity of their fight against these persistent invaders slowly but surely increased.

The problem was that it was becoming exceptionally difficult for the specialized cancer fighting units to recognize the invading cells – they were so similar to normal body cells!

There was one difference. Unlike normal tongue cells, the cancer cells divided again and again – uncontrollably and persistently!

The commander was unable to bring the state of affairs under the attention of Jack’s consciousness. This is because the specialized cancer fighting unit is part of the immune system and is being sub-contracted by the lymphatic system for the job. But the lymphatic system and the nervous system simply don’t communicate well – often not at all!

Two years later, Jack again noted a similar little ulcer in very much the same spot on his tongue.

Remembering the outcome of the previous biopsy, they promptly made an appointment at Dr Smith’s rooms – and so they met again.

Following the smiles and the Hi’s, Jack, accompanied by his very concerned wife, informed Dr Smith about the lesion.

Dr Smith examined the tongue and said that it was probably nothing more than an ulcer caused by an unintentional biting of his tongue. He prescribed an ointment and asked Mr. Brown to return in a week for a follow-up visit.

A week later the lesion hadn’t healed but looked very much the same as a week before.

So the pair went for the follow-up visit. A now very concerned patient and wife, asking numerous questions, sat in the consultation room.

Dr Smith made immediate arrangements to perform another biopsy. D?j? vu!

The story repeated almost to the letter with Dr Smith reassuring the patient and his wife: “The surgical excision margins was clear – there is nothing to worry about!” and explained that it was one of those one in a million chances that something like would happen twice in one patient – a bit like the survivor of 7 lightning strikes – a extremely rare statistical phenomenon.

A year and a bit later, one good morning, Jack thought he injured his tongue while brushing his teeth. He had a good look in the bathroom mirror, and then the concern grew during the day.

The next morning he asked his wife to have a look.

Sitting in front of Dr Smith for the third time in 5 years, Jack apparently had the same problem, again!

This time no time was wasted – an immediate biopsy – and Dr Smith promising to phone them as soon as he got the results.

Dr Smith sent the note to the histo-pathologist with a note: “URGENT” added to the referral note to pathology.

Later in the week, Jack received a phone call from Dr Smith’s receptionist, “Dr Smith wants you to please come in tomorrow morning…” and “…no I am not allowed to give results telephonically!” – in a way by saying this she gave away the diagnosis.

This time round the atmosphere was tense and the news not good. The result came back as cancer – and the lesion was incompletely removed. There were no clear margins this time.

Very clinically, and emotionally detached, Dr. Smith wrote a note to Dr Kelly – a head and neck surgeon friend of his with lots of experience in treating cancer patients.

The waiting was agony as they could only get an appointment to see Dr Kelly three weeks later. No amount of convicting or manipulation by Tracy could convince this ice cold receptionist to assist with an earlier appointment date.

The first impression of Dr Kelly was that of a well trained and very competent person – the history, the clinical examination and then the discussion. But the sentence that kept on repeating in both Jack’s and Tracey’s ears was, “I will have to surgically cut out about two thirds of your tongue?”.

Now a tongue is a wonderful organ – and one can remove a substantial amount of tongue tissue, and the tongue will recover amazingly well – increasing in size – and patients after speech therapy can talk amazingly well!

But somehow this was not communicated properly – whether Dr. Kelly didn’t spell it our well or whether emotionally perturbed patient and equally perturbed wife didn’t receive the information properly is not clear – but a critical miscommunication occurred.

Note: It is so important that one should ensure that the patient received the medical facts in a humane way – the truth – but soften it down a bit – be truthful but don’t be harsh with the facts!

The patient and wife start discussing the issues and decide that they are definitely not prepared to go for the radical tongue surgery – they cancel the appointment for surgery with Dr. Kelly and start to research the Internet for alternative options.

The world-wide-web of information in their case became a world-wide-web of misinformation. After a couple of days they came across a medical practitioner treating cancer with a special from of chemotherapy.

We all know that chemotherapy sometimes causes some nasty side-effects like hair-loss. But this practitioner used a special technique called IPT – this must be the miracle cure that they had hoped and prayed for, if the information and promises given on the website was anything to go by.

IPT is an acronym for “Insulin Potentiation Therapy”. The doctor doing the IPT was very friendly and had a ready answer for everything – even why Jack’s tongue and general condition kept on deteriorating.

It is a pity that these desperate people didn’t scroll down a bit further on the Google list for IPT – then they would have noted a serious caution about IPT by a website called “quack watch”.

Let’s read what they have to say about IPT…

Why You Should Stay Away from Insulin Potentiation Therapy by Robert Baratz, M.D., D.D.S., Ph.D.

Insulin Potentiation Therapy (IPT) is one of several unproven, dangerous treatments that is promoted by a small group of practitioners without trustworthy evidence that it works. It is claimed to be effective against cancer, infectious diseases, arthritis, and many other conditions.

After attempting this treatment and failing, eventually the couple ended up coming to me.

In front of me sat two devastated and desperate people – the man on the verge of madness by constant excruciating pain – and a woman drained to the bottom by worrying and consequent emotional breakdown.

Well time for action. Let’s do what we can do – basic principles – lets deal with the pain and sepsis as our first priority!

Orders – Admission (first, we fight with the healthcare plan to allow admission into hospital)

Hydration – Intravenous fluids, antibiotics and strong pain medication and frequent lukewarm saline mouth rinses

Consultation with a physician, a radiation oncologist and a dietitian

Arrange for X-rays and blood tests, and so the list goes on…

Off goes the precious couple to the admissions section of the hospital.

After decades of experience in clinical medicine my eyes filled with tears – Thank You God that I can still have compassion for the sick!

Thank You that my heart hasn’t hardened or gotten used to suffering!

Thank You that I can still see the man and the woman – not just another patient – and not just a source of income.

And so the story ends with an irreparable mess – the result of a number of poor clinical judgments by doctors and wrong decisions by the patient and his wife.

The best we can hope for now, based on sound scientific evidence, is palliative radiotherapy – or in simple terms, making his life as easy as possible for the next couple of years until he dies.

The radiation oncologist asked me to remove all Jack’s teeth – they were in poor condition – in preparation for the radiotherapy.

I take him to operating theater the next day, remove the teeth, and do a couple of biopsies, all confirming the diagnosis of unrestrained progressive oral cancer!

I really want to become a Doctor – Is there anything I can do straight away?

Check out the Medical Terminology: Decoding the Language of Healthcare on Apprentice Doctor Academy.

 

It was spring, a lovely warm spring morning like any other with the sun’s rays shining brightly through the bathroom window, but all was not well.

Henry stood in front of the bathroom mirror, “Oh no, not again!” He exclaimed.

Like a lot of teenagers, Henry has been suffering with acne. At first it was just the odd one here and there, but lately it really has become a big problem and, clearly in the mirror, a pimple right on the side of his nose!!

This could not have come at a worse time because Henry has big plans for this weekend. He is taking his new girlfriend out on a date Saturday evening. “This can’t be happening,” Henry thinks to himself.

His parents have been very supportive with the acne problem and he is being treated by one of the best dermatologists in his town, but despite medication and facial cleansing agents, he still gets a couple of zits.

This is especially so when he becomes stressed, and this date with Cynthia has been stressing him out BIGTIME!

He frantically cleans the pimple, but this small pimple is getting bigger in his mind. He knows all too well that he shouldn’t squeeze the pimple, but impulsively his hands and fingers closes in; but pressing just makes it uglier and bigger.

 

 

“Henry! What on earth happened to you?” His mother exclaims as she approaches to have a closer look. Henry is somewhere in between seriously unhappy, cross, sad and at a loss of what to do with this THING on his nose.

This was not the time for his sister Angie to jokingly say, “Hi Rudolph!”, referring to Santa’s favorite reindeer with the red nose!

Mom, examining the bruised pimple, reminds Henry not to squeeze his pimples, to take his medicine, drink lots of water, and use the medicated facial soap that the dermatologist recommended.

 

 

What mom can’t see is under the pimple. An aggressive war is raging – a microscopic war with a formidable enemy and equally formidable soldiers fighting the enemy.

The enemy is aggressive, microscopic, disease-forming microorganisms called bacteria, and the soldiers are brave single cell units called white blood cells.

New soldiers arrive in their millions, and there can be no doubt: the enemy is aggressive. It is secreting deadly toxins.

Even more worrying to the commander is the fact that these bacteria’s numbers seem to double every couple of minutes! This is a strategic battle. The bacteria just want to invade the body, but the white blood cells are frantically defending.

 

 

Some white blood cells attack with chemical missiles called antibodies while others engulf the bacteria and start to literally eat them one by one.

Small blood vessels in Henry’s body called capillaries have doors that open up and are offloading new white blood cell soldiers to wage this war in their millions.

 

 

The battle is fierce and has been raging for a number of hours now. Dead bacteria and dead white blood cells are lying in heaps everywhere!

The bacteria are slowly but surely getting greater amounts of toxins to pass the security checks of the defense army. More and more bacteria are able to join the war and extend the borders of this battle well into the night.

 

 

At three in the morning Henry slowly drifts into consciousness. He feels dreadful! Despite the warm springtime temperatures, he’s freezing cold.

Moaning from a dull headache, he drags himself out of bed and gets his winter blanket from the drawer.

For a while he feels too cold, and then he starts sweating. And so the night goes on, from him feeling freezing to sweating in a torturous loop over and over, until he mercifully falls asleep again.

But it’s a restless sleep. He dreams of little green monsters, a vague though grim reality of what was happening inside his body!

“Wake up Henry. You are going to be late for school!” The first, second, and third call for Henry to get up fall on deaf ears, but then dad walks in sternly demanding action.

 

 

Henry is red with fever, confused and dizzy. Mom measures his fever. “There is no way he can go to school like this,” she informs dad.

Mom makes an appointment with the Doc. Henry is very feverish and as if that wasn’t enough, that dull headache has developed into a splitting headache, sitting just behind his eye sockets, or so it feels.

Meanwhile, the battle in his body has reached fever pitch. Hordes of bacteria have slipped past one of the weak areas of the defense and landed up in a dangerous area.

They somehow got lost and were carried by a small vein from the nose to the eye socket, and from the eye socket to the blood channels around the brain, all the time emitting toxins and increasing in numbers.

The Defense System Commander declares DEFCON 1 in the body and the full weight of the defense system is brought to bear on this battle now.

It’s being fought on a number of fronts, the most dangerous of which is in the blood channels below the main frame computer, the brain.

At first Henry hears a vague voice – that of his mother saying his name softly – her whispering prayers for his recovery, and then it fades.

 

 

Over the next couple of days in his confused, semi-conscious daze, he hears the voices of doctors and nurses and constant beeps of medical monitors.

Henry doesn’t know it, but he was rushed to the hospital after his alert doctor diagnosed a rare condition.

The blood in the spaces below his brain clotted and the infection started flowing over into his blood stream – a condition called “septic shock”.

Within the depths of Henry’s body the body’s defense force is virtually beaten, but the white blood cell marines persist, consistently and accurately shooting their antibody missiles into the bacteria, and then engulfing and digesting them.

The doctors decide to employ an intelligent weapon of mass destruction designed to kill the bacteria in hoards while sparing the white blood cell marines.

This secret weapon, an antibiotic, starts to turn the battle in favor of the defense system and Henry starts to recover – slowly at first – but then faster and faster as the marines’ efforts gain the upper hand.

His condition is critical, but gradually Henry is hauled back from the edge of death by strategic treatment, dedicated doctors and nurses in the hospital’s intensive care unit, and his mother’s prayers.

 

 

Henry is back at school – and the biology project he is handing in today is titled:

“The Dangerous Triangle of the Face”

The project tells about a young man who suffered from a sinus infection, and developed the same medical condition that Henry did.

It is the true story of an 18 year old young man who came to the same intensive care unit a year before Henry did, but the difference was, this young man tragically died.

He also told his own story and explained how important it is to respect the area from the corners of the mouth to the bridge of the nose – the dangerous triangle of the face.

 

Background Information:

The human body needs to fight off many enemies every day. Most of these enemies are way too small to be seen with the naked eye, and are called microorganisms.

Bacteria refers to a large group of different strains of microorganisms. Most of them are quite innocent, and some of them are actually quite friendly and helpful, but occasionally the body encounters harmful bacteria, and it is the defense system’s task to protect the body by destroying these invaders.

Bacteria can enter the healthy cells of the body and destroy them or they may produce harmful chemical substances called “toxins” killing the body’s cells.

The battle between bacteria and the body’s defense system is called infection.  If the body wins the battle, the bacteria are removed and the person recovers but if the bacteria win the battle the person will remain ill or die.

The soldiers of the defense system of the body are the white blood cells. They kill bacteria by literally eating and digesting them. This process is called phagocytosis.

Certain white blood cells produce very special missile like chemicals called antibodies, and when these antibodies attach to bacteria, it makes it easier for other white blood cells to recognize, eat and digest these invaders.

Some bacteria have thick cell walls and occasionally slimy coats making it difficult for white blood cells to eat and digest them, but the ultimate weapon for bacteria is that they can reproduce very fast and sometimes so fast that they literally overwhelm the body’s defense system by mere numbers!

I really want to become a Doctor – Is there anything I can do straight away?

Check out the Medical Microbiology on Apprentice Doctor Academy.

 

A severe infection with aggressive flesh eating bacteria

The video clip below documents an interesting case of an uncontrolled diabetic patient. He had a severe infection with aggressive flesh eating bacteria causing serious tissue damage and sepsis with an abscess forming.

Diabetes is associated with an increased risk of infection as well as slower wound healing. In uncontrolled diabetes these problems can get out of hand – as you will see in the following video clip

Notice a couple of basic principles of treating this type of infection from watching the video clip:

1. The basic treatment for an abscess is “Incision and drainage”. Even some qualified doctors wrongly believe that an abscess will clear up with antibiotic treatment only. Now you know something about medicine that some qualified doctors don’t. How cool is that?
2. Surgical Debridement The body can get rid of minute microscopic amounts of dead tissue or foreign material. Bigger pieces of dead tissue must be removed surgically.
3. Sterilization and Safety. Always work as aseptically as possible with sterile instruments and use all the barrier techniques available, e.g. gloves, visor or glasses, surgical gowns and drapes etc).
4. Be aware of the importance of the dangerous triangle of the face.

In destructive infections use aggressive intravenous (into the vein) antibiotic therapy.

Ensure that a pus swab is taken so the lab can test it and determine antibiotic sensitivity (how well the antibiotic fights the germs).

Adjust the antibiotic treatment according to the antibiotic sensitivity results coming back from the lab.

As indicted in one of my previous newsletters, infection is a very serious condition and often a life threatening condition, especially if it occurs in the dangerous triangle of the face.

Cavernous Sinus Thrombosis is a deadly condition as you would have noticed in that newsletter.

 

 

 

The danger triangle of the face consists of the area from the corners of the mouth to the bridge of the nose, including the nose and maxilla (upper jaw).

Due to the special nature of the blood supply to the human nose and surrounding area, it is possible for infections from the nasal area to spread to the brain via small communicating veins traversing the base of skull, communicating with the venous sinuses surrounding the brain.

Always treat infections promptly and aggressively. There is a saying among surgeons – “never let the sun set on pus” (always drain an abscess on the same day – don’t book it on tomorrow’s theater list!)

I trust you have learned something – if so please let me know by leaving a comment!

I really want to become a Doctor – Is there anything I can do straight away?

Check out the How to Suture Wounds on Apprentice Doctor Academy.

Also, explore the Suture Kit (Right-handed) on Apprentice Doctor Kits.

 

I often get questions from students on how long it takes to become a doctor or an anesthetist or a surgeon – and the answer is: Forever!

Let me explain?

When you commit towards a career in medicine, you will have to study a certain number of years in medical school before you are qualified.

Then follows a number of years of residency, and you will still be studying.

Even when you qualify, you will have to keep abreast with the latest treatment modalities and medication in your field of practice.

You will have to study articles in medical journals and you will have to attend medical congresses.

You really owe it to your patients to only offer them the best and latest technologies, and therefore you will have to keep up with the latest developments and information in your field of practice.

So, to some extent, you will be studying for the rest of your life!

Recently I had the privilege to attend a great conference on Maxillofacial Surgery:

 

 

 

…in the beautiful town of George in the Southern Cape in South Africa:

 

 

Have a look at a video clip of a world expert speaking on repairing malformations of the mandible (lower jaw)…

That covers the first part: “always remain a student!”

 

Now, the second part: “Always remain a teacher”

Share your knowledge. In medicine new methods and developments are published – not patented.

You want patients and doctors all over the world to share in your knowledge and new discoveries and benefit from the new information.

Be liberal with your teaching and help your juniors to be exceptionally great doctors. By giving you will receive back in multiplication!

In medical school there is a saying: “See one, do one, teach one.” So learn from the experts. See what and how they are doing things (more than once!), then do the procedure under supervision until you are comfortable with the amount of experience that you have.

Then start teaching. Share the knowledge and information liberally.

Teaching makes the knowledge stay. You will retain your knowledge permanently by teaching it.

As a private doctor, keep a morning or an afternoon open to teach new students at your faculty. Since you have received so much, start giving back!

Aren’t we lucky to be able to study medicine? A lifelong opportunity of getting new knowledge and information, of pioneering and discovering new breakthroughs, new methods and ways of treating and benefiting our patients!

I really want to become a Doctor – Is there anything I can do straight away?

Check out the Foundation Medical Course on Apprentice Doctor Academy.

 

On rare occasion I have had the unpleasant task to go to family members waiting in front of the operation theatre and inform them that a loved one has passed away on the operating table.

To witness the shock, pain, suffering and sorrow of the wife and children who have just heard that they have lost a beloved husband/father is indescribably sad.

Let me assure you it is not pleasant. The emotions that you have to deal with are immense.

The introspection that inevitably plaque you over the next few days, weeks, and sometimes years later is very hard on you. What if I did things differently. Should I have operated sooner or should I have delayed it longer? Should I have used different drugs? Should I have utilized the services of another anesthesiologist? Question after question!

A young man came into my rooms recently. He was referred by another doctor for the removal of impacted wisdom teeth.

Following my clinical examination, I admitted him to hospital, I got a series of blood tests and x-rays and placed him on high doses of antibiotics.

Inexplicably, his condition deteriorates overnight and he is transferred to the ICU the next morning. CT Scans are ordered. An Otolaryngologist and Neurosurgeon is consulted.

The patient developed an extremely rare condition: cavernous sinus thrombosis (blood clotting in the venous draining system surrounding the brain).

He suffered from an acute sinusitis and the infection spread via small veins through the skull base into the blood drainage system of the brain and the blood in this system started to clot.

The increase of pressure in the skull cavity pushes the eye forward and causes the membrane covering the eye to swell a lot.

 

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I tried more and higher doses of antibiotics, anticoagulant therapy (blood thinning medication) and cortisone to reduce brain swelling.

The patient had the benefit of the best clinicians, the best intensive care staff, and a variety of tests, monitors, as well as a tube in his trachea (main windpipe) ventilating him with Oxygen enriched air.

 

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For the next two days the patient improves, but then suddenly on the Thursday morning,  he deteriorates.

He is brain dead a few hours later – a vegetable only useful as an organ donor, for somebody who needs kidneys, a heart etc.

He was only eighteen. Eighteen years of nurturing and dedicated parenting ends in a disaster – a painful emotional disaster.

Somebody needs to tell his parents, and then to make things worse, that person must ask them for their son’s organs. Death for one person often means life for another.

Is this the type of thing that you will be able to handle?

Medicine is immensely rewarding – but be sure you can deal with the moments of exhilaration as well as the moments of sorrow.

Be prepared for it so it doesn’t catch you by surprise.

I really want to become a Doctor – Is there anything I can do straight away?

Check out the Control Bleeding on Apprentice Doctor Academy.

Also, explore the Control Bleeding Simulation Practice Kit on Apprentice Doctor Kits.

 

Would you like to become an anesthetist? Or would you like to become a surgeon? Or how about becoming an oncologist, pathologist or registered professional nurse? Then pay close attention to this letter.

This was my last patient on the operating list today: a 39 year old AIDS patient with a large cancerous growth on her upper jaw.

I took some pictures of it for you guys…

Now I need to take a biopsy (remove a piece of this growth surgically). Then I need to send it to my Histopathology colleague who will examine the tissue under a microscope and then give a report on the type of growth so I can offer the patient options on the treatment.

 

I will probably have to send this patient to an oncologist (a cancer specialist) for chemotherapy (cancer killing medication) and radiotherapy (cancer killing radiation).

This patient is presenting a great challenge to the anesthetist. He will have to give her a general anesthetic.

The patient is very obese, and this is making the anesthetist’s job quite difficult. Adding to his problems is the cancerous growth which is extending all the way into the back of the throat. He needs to ensure that the patient receives enough Oxygen during the anesthetic.

“Maintaining the airway” is the anesthetist’s main objective, so he first takes a preview while the patient is sedated. The monitors give him information about the condition and status of the respiratory and cardio-vascular systems.

He injects some induction agent (medication that makes the patient asleep) intravenously (into the vein).

The anesthetist has to see the vocal cords and place a tube in between the vocal cords into the trachea (main windpipe) to transfer Oxygen into the patient’s lungs. Looking at the video clip above, you can see how he skillfully intubates (places the tube into the trachea).

Now the professional theater nurse will prepare the patient for the operation.

My job is to debulk (make it smaller surgically) the tumor and place some of the tissue in a special solution. That will then be sent to the pathology lab.

This is a vascular tumor (the tumor is full of blood and blood vessels) so now it is my turn to stress.

Will I be able to stop the bleeding? I have to be very, very careful with sharp instruments as this is an HIV+ AIDS patient. Even the slightest slip with a sharp instrument can have drastic consequences for me or my assisting nurse!

The operation was a success. The following morning in the ward, I meet the smiling patient, “Thanks Dr Anton! You have given me my smile back!”

Although I know that it is only temporary, I also know that for the limited time that she will be alive, I have increased her quality of life and made her feel good about herself. Isn’t this a great reason to become a doctor or surgeon?

I really want to become a Doctor – Is there anything I can do straight away?

Check out the Pulse Oximetry Mini Course on Apprentice Doctor Academy.

Also, explore the Scrub for Surgery Kit on Apprentice Doctor Kits.