Saturday, February 10, 2007

Where are your kidneys?

This is first year anatomy stuff (for anybody who still does anatomy these days). What is the normal position of the kidneys in humans?

a) in the upper abdomen
b) in the lower abdomen below the waist
c) in the pelvis
d) in the sports department (that’s for any Two Ronnies fans out there)*

Many people think the answer is B, including it would seem, Dr Gillian McKeith (read about her PhD here). I saw this bit of news on the web saying that her book You Are What You Eat now tops the non-fiction chart of most borrowed books from UK libraries. Coincidentally a friend showed me this book the other day after a relative tried to convince her of the benefits of kidney massage. It’s on page 198 and encourages you to ‘treat yourself to a kidney rub…..find your kidneys by placing your hands on your back below the waist but above your bum’. If you’ve correctly answered the question above you’ll know this is utter drivel.

Now you’d expect me to know my anatomy. I’d be doing a ******* appalling autopsy if I didn’t know where to find the organs. You’d expect a surgeon to know their anatomy, in fact all doctors need to know their basic anatomy – even psychiatrists have patients with physical illnesses and need to know where organs are and how to examine them.

Yet anatomy teaching is being eroded in UK medical schools. There is a huge amount to learn as a medical student and anatomy cannot be taught in the kind of depth needed to be a surgeon, for example, more advanced anatomy can be learned during surgical training. But medicine is primarily about the structure and function of the human body and mind in health and disease. As doctors we need to understand that structure. We particularly need to understand it when so many other people are reading the kind of book that tells lies about our innards. Leonardo da Vinci knew where the kidneys were by 1508; how can such easily available facts be ignored?

*The answer, of course, is A. If your kidney was previously owned by somebody else it will be in position C. If your kidney is in position B it is abnormal and if it's in position D you're really in trouble.


At 15:31, Blogger HospitalPhoenix said...

Excellent... and to stop myself slagging off 'Dr' McKeith I'll make a suggestion to any students who are keen to learn their anatomy.

I failed anatomy as a medical student, scraped through the re-sit, and had to re-learn the whole lot for MRCS.

For MRCS I planned my study a little more carefully, and used a book called 'Surface Anatomy: the anatomical basis of clinical examination' by John Lumley, in parallel with my other anatomy books. The Surface anatomy book is good because it keeps things in perspective, and reminds you that the gobbledygook you've just learned is sitting right *there* inside the human body. Anyhow, I recommend it.

And I do NOT recommend anything written by that McKeith woman...

At 16:29, Blogger Shinga said...

The National Museum of American History has an informative website about their collection of papier-mache anatomical models, which are being carefully restored. There is a game on the site, Artificial Anatomy's Body Parts. Only 10 parts to it but reasonably entertaining.

I'm remarkably tired of having people quote McKeith's assertions about the medicinal properties of various foodstuffs to me as if they are irrefutable, clinical fact. That plus the value of supplementation.

Regards - Shinga

At 17:52, Blogger Shinga said...

Students and the vaguely interested might enjoy the aide-memoire in the form of an anatomically-accurate latin love song about the heart plus an excellent new blog about medical illustration that focuses on anatomy.

Regards - Shinga

At 13:54, Blogger DundeeMedStudent said...

I am really worried about the quality of anatomy teaching to medical students. We at Dundee at least got to do dissection, but everything seem rushed and simplifed as much as possible. I have studied anatomy previously and was stunned by the amount of times I would mention something only to be told- oh you don't need to know that. Basic things such as neck triangles (yes the basic anterior and posterior) were not even mentioned and hardly any surface anatomy was done.

We haven't done the limbs yet, they are put off to second year, yet we have done venupuncture (on a plastic arm obviously) without knowing any upperlimb anatomy- Only slightly worrying.

At 16:20, Blogger Dr K said...

What really shocked me was that this stuff can be published with such glaring factual inaccuracies. Isn't there a single editor/publisher/proofreader or anybody who might have read this prior to publication who knows where their kidneys are and thought: hang on, that's wrong? It makes me wonder what other errors there are in such books. Lots of the people reading this stuff probably believe it all as well. It really annoys me.

I'm also quite disturbed that you're doing venepuncture without studying the anatomy first. Hint - avoid the structure that pulsates and the structure that is very tough and doesn't bleed! When I was a student (in the good old days....) we did anatomy in some depth. I remember learning the origin, insertion, action and innervation of all the limb muscles. It certainly made it much easier to remember anatomy when I started doing pathology. I know the basic medical sciences aren't 'trendy' and 'tree-hugging' enough for modern medical schools but they are vital for actually practising medicine by using your brain rather than by protocol.

At 16:42, Blogger HospitalPhoenix said...

Dr K, not on topic, but I've always wondered why you have Pink Panther as your profile picture!?

At 16:47, Blogger Dr K said...

I just like cartoons. It was either the pink panther or dangermouse and I look more like the pink panther (yellow eyes, red nose, triangular-shaped head!)

At 20:41, Blogger Dr Grumble said...

Dr Grumble agrees. Like it or not anatomy is very important.

At 19:41, Blogger Potentilla said...

So if nobody teaches anatomy any more anyway, there is not much point in me making the effort to organise leaving my body to medical science ie to be used as a cadaver?

At 13:54, Blogger Dr K said...

It's definitely worth making the effort if you want to donate your body, Potentilla, it's a very generous thing to do. Luckily there are still medical and dental schools that still do dissection and it really is an excellent way to learn anatomy. Even in places where the students don't dissect they often need organs to use as pre-dissected specimens to show to students (these can be plastinated - the organs, not the students!). If I haven't put you off yet, the thing to do is get in touch with the anatomy department at your local/favourite university and they'll be able to tell you how to go about it.

At 11:30, Blogger DundeeMedStudent said...

Donating your body is a wonderful thing to do. we did dissection and it is a far better way to learn anatomy then pro-section (I did pro-section at my first university and dissection at Dundee). Anatomy is taught in a very odd way at Dundee we do all but the limbs in first term of 1st year and come back to the limbs in second term on 2nd year. The only problem is medical schools now only emphasis the core material so all basic sciences are learned in a very basic and undetailed way.

The reason why medical school are moving towards pro-section and plastic models is purely on a cost basis. Please get in touch with your local med school and find out about donating.

At 13:49, Blogger The Angry Medic said...

Dr K: Congrats on the BritMeds mention! I don't know who this Gillian woman is, but she seems to be the latest in a line of so-called "health experts" building commercial empires (mainly in the US, like Dr Phil, Dr Ruth and Dr Laura). Great article.

(And thanks for explaining that Pink Panther bit. I've always wondered too.)

Potentilla: Dr K's right about the body-donating, dear. Here in Cambridge we do dissection too, and at the end of the year we hold a memorial service for the cadavers and reaffirm the generosity of the donors (and their families). It's a very generous thing to do, and one that even I myself am not sure I'd be prepared to do.

At 18:53, Blogger Potentilla said...

Oh, OK (mind you, I expect to need it myself for a while yet). Hah, maybe I will disconcert my consultant by asking her next week, as I think Inverness is an outpost of the medical school at Aberdeen.

Being an ultrational person married to another ultrarational person, it doesn't seem that generous to me! I rather wish I'd arranged it for my father (another u.r.p.) although I suppose some of the other people involved might have been upset.

At 21:51, Anonymous Anonymous said...

"Isn't there a single editor/publisher/proofreader or anybody who might have read this prior to publication who knows where their kidneys are and thought: hang on, that's wrong?"

Probably not. I'm an editor, and we really don't tend to get training in where internal organs are. Any decent editor tries to make sure the content of the document is as correct as they can, but in the end it is the author's job.

Because kidney infections seem to cause lower back pain, I always kind of assumed that's where they were. I wouldn't have thought to check this.

I might have thought to check whether massaging the kidneys was possible, or desirable, but then there is no way I'd choose to edit a document written by someone who seems to be a total quack. People who claim titles they have no real right to (and her 'Dr' does seem to be a title she doesn't really have the right to use) are not people I'm comfortable helping to publish.

At 05:23, Blogger Miss Cellania said...

I knew the correct answer, but I didn't know that transplanted kidneys would be in a different place!

You learn something new every day...

At 16:41, Blogger DundeeMedStudent said...

Raigmore is connected to Aberdeen uni, lots of my medic friends from Aberdeen have had some great times on rotation up there, and due to a cock up with student numbers I think a small number of students are spending all of 4th and 5th year up there. May I be rude and ask where you live? I think Aberdeen may only take local bodies due to costs involved in transporting them, but I'm not sure.

At 19:19, Blogger Dr K said...

Hi anonymous. I would hope the author would know their stuff but lots of people have bits of knowledge unconnected to their job and might spot an error. How do you spot the quacks, do you research their backgrounds, get a gut feeling?

I wouldn't bother 'massaging' your kidneys - they won't notice a thing!

Hi Miss Cellania, the reason transplanted kidneys are put into the pelvis (just in case you're interested) is because it's easier for the surgeon to put it there than trying to put it into the place where the patient's own kidney is (which would also mean removing the patient's own kidney, which isn't normally needed, it can be left where it is), also it's easier to connect the ureter (which carries urine out of the kidney) to the bladder and the pelvis has large blood vessels running through it which the new kidney can be attached to fairly easily.

At 17:32, Blogger Merys said...

I do anatomy intensively here and it's driving me up the wall!

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