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lunes, junio 11, 2007

El_Medico_Interno

ESTUDIO EXPERIMENTAL SOBRE LA RESISTENCIA, FUNCIONALIDAD Y TOLERANCIA EN UNA POBLACION DE MEDICOS INTERNOS DE PREGRADO"
Este estudio fue realizado de enero a diciembre durante el periodo de esclavitud por el cual todo médico debe pasar: el Internado (lease: Infiernado). El internado de pregrado es un eterno año de períodos prolongados de ayuno, de interminables guardias, de trabajos forzados, de privación del sueño y de constante aplanamiento del ego y la moral. Este año lo cursan únicamente los médicos internos de pregrado (MIP) que se definen como entes que se desplazan por inercia en los pasillos del hospital dejando un olor fétido característicopostguardia, (se pueden identificar con la triada patognomónica de inyección conjuntintival, halitosis y priapismo) cuya principal función consiste en realizar toda aquella tarea sucia, degradante, tediosa y administrativa.
Generalmente estos MIP están a cargo de otra población sui generis llamada "Residente". El residente se define como todo aquel ser no necesariamente humano cuya labor primordial (además de iatrogenizar lo menos posible) es poder relegar toda tarea al MIP con el fin de mantener intacto su ciclo sueño-vigilia.
MARCO DE REFERENCIA: En la literatura se han descrito diferentes métodos para reconocer especies similares a los MIP con tolerancia sobrehumanaal maltrato constante. Algunas de las especies historicamente reportadas a su semejanza son las mulas de carga y los esclavos.
PLANTEAMIENTO DEL PROBLEMA: ¿Qué características fisico-quimico-biologicas posee el MIP para desarrollar resistencia, funcionalidad y tolerancia al medio hospitalario?
JUSTIFICACION: Es preciso demostrar que el MIP es una población indispensable para el bienestar bio-psico-social de toda institución hospitalaria.
OBJETIVO: El presente estudio pretende dar a conocer las diferentes características y atributos que hacen al MIP un ser sui generis.
HIPOTESIS: Siel MIP es capaz de sobrevivir al internado, podrá entonces funcionar adecuadamente en cualquier medio considerado incompatible con la vida.
DISEÑO: Es un estudio descriptivo, abierto, observacional, experimental, prospectivo y longitudinal.
MATERIAL Y METODO: El universo de estudio consiste en un grupo de MIP´S asignados a un hospital "X" en México, (aunque este estudio creemos puede ser reproducido en cualquier hospital del mundo) Divididos aleatoriamente en guardias A, B y C (en algunos casos solamente A y B).
CRITERIOS DE SELECCIÓN:
A. Criterios de inclusión: - Sujetos mayores de 22 años. -Cualquier sexo. - Atuendo de color blanco obligatorio. - Sujetos sin ataduras familiares y/o sentimentales. - Poseer y portar como mínimo: plumas de todos colores, lápices, corrector en todas las presentaciones existentes, ligadura, vacutainer y/o jeringa, sondas de todo tipo y calibres, pegamento, tijeras, solicitudes de todos los estudios de laboratorio y gabinete, papel carbón, computadora o en su defecto en hospitales de la SSA, máquina de escribir, gasas, tela adhesiva, micropore, aseptojeringas, guantes, cubre bocas, isodine, termómetro, estetoscopio, esfigmomanómetro, estuche de diagnóstico, refescos y cigarros para el residente y/o adscrito, tubos y medios de cultivo. - Disposición para: sacar muestras, llevar cómodos,instrumentar cirugías, llevar piezas a patologia, traer los tacos, refrescos, cigarros, periódico y demás antojos de sus superiores, cumplir cualquier orden, capricho o enmienda asignada, asistir a los traslados y en su tiempo libre aprender medicina.
B. Criterios de exclusión: - Sujetos normales. - Sujetos con cualquier tipo de vida social. - Sujetos sin tolerancia a los bajos niveles jerárquicos. - Sujetos con baja tolerancia a la frustración. - Sujetos con deseos de ganar mas de $1 la quincena.
C. Criterios de eliminación: - Falta de adaptación al medio. - Muerte no relacionada con el experimento o por lo menosno comprobable
DESARROLLO El estudio se realizo al analizar las reacciones de los sujetos en diferentes grados ante las siguientes situaciones: "Préstame a tu interno", "pediatra a la toco", "echando a perder se aprende", "sácale BH, QS, Tiempos, ES, PFH y EGO con sonda", "baja al paciente al Rx porque el camillero esta comiendo", "instrumenta la colecistectomia laparoscopica", "cultívalo a todos los niveles", "esta taquicardico, tómale un ECG", "signos vitales cada 15 minutos", " y a mi que?", "dialízalo de entrada por salida toda la noche", "¿dónde andabas?", "no, no tienes chance de ir a comer", "si no te apuras, seguro y no acabas", "muestra coagulada, repítela", "no te le despegues", "en 10 minutos me buscas para ver pendientes","cuando me dijiste?", "no hay", "para mañana a mas tardar", "te vas, hasta que termines", "ya le hiciste la historia clínica?", "pide la interconsulta a cirugía, no importa que se enojen", "tienes guardia de castigo", "no has terminado?","encuentra al residente", "sabes o no sabes??","pero si es muy fácil!", "no te pasa nada, en serio", "llénale el certificado", "acabando las notas te metes a quirófano", "nada es gratis en esta vida", "tres curaciones al día","desimpáctalo", "Dale ambú en lo que los de mantenimiento traen otro ventilador", "tenías fin de semana libre?"... etcétera. Los grados se establecieron de acuerdo a los siguientes criterios:
GI: Ligera reacción adrenérgica, con sensación de vaciamiento gástrico, diaforesis, taquicardia, palpitaciones, perosin respuesta externa aparente con desarrollo adecuado de la tarea solicitada.
GII: GI mas contracción de la musculatura facial, y pensamientos agresivos.
GIII: GII mas repulsión a la población residente y pseudodesarrollo de la tarea.
GIV: Liberación incontrolable de catecolaminas y otros neurotrasmisores, incapacidad para desarrollar cualquier tarea fuera de las funciones básicas vitales y labilidad emocional.
RESULTADOS PRELIMINARES: Se espera que el 100% de los MIP haya desarrollado aptitudes y capacidades indispensables para el desarrollo posterior de sus vidas como profesionales. Y que a pesar de todo loantes mencionado, opinen que el año de internado es uno de los mejores años de su vida.
P.D.: Cualquier similitud con la vida real es pura coincidencia.
NOMENCLATURA
INTERNOMA: Tumoracion benigna que se encuentra deambulando por hospitales de segundo y tercer nivel, responsables de TODAS las iatrogenias causadas en estos, aunque ni se aproximen a los pacientes. Tienen dos estadios, M.I.P. 1 y M.I.P. 2, los cuales tras un periodo de inactividad puede evolucionar a malignidad llamándose...
RESIDENTOMA: Entidad maligna bien diferenciada, encontrada en casi todos los hospitales, causante de la mayoria de los estados morbidos de pacientes sanos, (sobre todo en pacientes quirúrgicos), tiene de tres a cuatro estadios; a saber, R1, R2, R3 y R4 en algunos casos, pero en situaciones graves pueden ser hasta R5y R6, los cuales son ya incapacitantes.
PASANTOMA: Tumoración indiferenciada e intermedia entre el internoma y el residentoma responsable de toda morbi-mortalidad de una comunidad (generalmente rural) la cual se caracteriza histológicamente por un fenómeno de apoptosis cerebral y manifestada psicológicamente por anhedonia, ideación suicidida, delirios de grandeza, demencia, abuso de alcohol e incontinencia de esfinteres. Metabólicamente presentan alta afinidad por los radicales OH, colesterol, triglicéridos, carbohidratos, presentan mejoría parcial ganando peso (generalmente llegan a la obesidad) recuperándose de la caquexia producida en su estadío de internomas. Con psicoterapia, TAC, decidia y si la apoptosis es masiva se puede evitar llegar al estadío de residentoma.

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