Agraphia Medical Tragicomedy



Seems like our teachers aren't above a bit of bickering. Dr. B is a rather bitter, nasty professor who gets defensive when asked questions in class. She's so awful that half the class stood up and walked out on a review session she was giving because she was so heinous. Dr. M is a relatively slow talking prof who has fantastic, easy-to-read notes. Below are excerpts of an exchange that went on between them and one of our unwitting students, Nehal, who set off this bomb. I've edited only the names of the profs and taken out some of the technical stuff.

[From Nehal]
Dr's M & B:
In the notes, Dr. B, you have defined preload as pressure (referred to as EDP from now on), while Dr. M has defined it as volume (referred to as EDV from now on). I just wanted a clarification/consensus on whether you wanted us to equate preload with EDP or EDV.

The following were simultaneous emails back to Nehal only, and not each other.

[From Dr. M]
As always, we both are right! The main concept to take home is that as Preload increases, performance increases (to a limit).

[From Dr. B]
I don't know what to tell you. In my opinion Dr. M's explanation is short sighted and frankly incorrect. I've raised the issue with him, he sticks by EDV.

Note that at this point Dr. B has actually called another professor out as being short sighted and incorrect... to a student. While you're reading this, keep in mind that Dr. M's way of teaching this material is actually how it is represented on the USMLE, which is the national licensing exam we take in 2 years.

In point of fact, they are both right. In the system we're talking about, EDP and EDV are inextricably linked. Dr. M mentions this several times, both in these emails and in class. Dr. B is the only one claiming that she and only she is right.

[From Nehal]
Dr's M &B:
I understand BOTH of your explanations of your definitions of preload. Both make sense conceptually. Unfortunately, if we were to have a question on the test, at this point the right answer would be dependent on WHO wrote the question. This is somewhat frustrating. Can you please come to a consensus??

[From Dr. B]
(Sent only to Nehal):
Consensus is not to be reached between Dr. M and I on this issue. The question will not be on the exam from me!

[From Dr. M]
(Sent to both Nehal and Dr. B)
Nehal, Please do not concern yourself in any real way about the fact that Dr. B and I do not agree about which is the 'better' indicator of Preload. If this question is asked on an exam, give the answer you believe is the best one. We'll let Dr. K (the course director, who is, by the way, pretty much worthless) be the referee.

Later that day, Dr. B finally sends out an email (finally) to BOTH Nehal and Dr. M

[From Dr. B]
Dear Nehal and Dr. M,
You both might find the attached article very interesting with regard to preload/afterload definitions. I intend to adopt this strategy of explaining preload and afterload in the future. Nehal, this article is probably more than you wanted, but you will find the end point is a great way to understand the important concepts that Dr. M and I would like you to know.

She attaches an article that I took the time to read. In fact, the "end point" does not back her up at all. It claims that both she AND Dr. M are oversimplifying, and then goes on to attempt to define preload and afterload in terms of wall stress... while simultaneously noting that both EDP (Dr. B's assertion) and EDV (Dr. M's assertion) are factors that contribute.

Awesome. The concept of preload was not, in fact, on the test we took today.

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