Wednesday, March 31, 2010


I just started psychiatry this week and so far, it's been pretty good. I feel pretty comfortable talking to the patients I've had so far (although, they really haven't been out there, so I've got plenty of more chances to feel uncomfortable). Although I'm glad that we don't see much of it in medicine these days, in the 3 short days that I've been on psych, I've been exposed to the psychoanalytic model (Freudian stuff) more than I'd like (including part of our formal lectures). As a scientist who believes in theories based on objective experiments, I find it incredibly hard to believe the ideas in the psychoanalytic model. I mean, it's hard to believe that there are actually trained physicians (though decreasing in numbers) that actually believe stories about things like the "oral phase," the "id versus the ego," or the un(sub or whatever)conscious. It all really sounds like the quack cult psychology books (like The Secret) that Oprah and other daytime talkshow hosts promote. I know that the mind is difficult to understand and we essentially know nothing about where psychiatric disorders come from, but do we really need to make up colorful stories about some sort of hidden internal struggle in the brain? Some ideas may be useful in developing a treatment strategy, but still using outdated ideas and teaching untestable stories seems a little backwards to me.

Thursday, March 25, 2010

Patient confidentiality vs. Public safety

A 19 year old woman came to the ED reporting that she had been raped by a taxi driver. She wanted emergency contraception and wanted to be tested for sexually transmitted infections. She said that she was alone in the taxi, the driver took her to secluded park, raped her and left her at the park. She would not describe the taxi driver, say which company he worked for, or give any details about what happened. She did not want to press charges because she did not want to questioned by the police (she stated that her sister had been sexually abused and went through a terrible time having to relive her experience over and over again after she reported to the police). The attending (and I) were in a conundrum. If what happened to her isn't reported to the police, a taxi driver can very well rape (or murder) someone else. If what happened is reported to the police, we'd be breaking her confidentiality (and making her go through a lot of grief). Eventually, the nurses contacted the hospital lawyers who (probably to save their asses) said that legally we can't break her confidentiality. So, even though it gave both the attending and I a terrible feeling, we let her go and didn't report anything.
Later in the week I talked to a medical ethicist at our institution about this. He didn't say anything clear cut. But, he reminded me that confidentiality can be broken if the information we reveal has a high probability of saving the patient's life or the lives of others. So, assuming she's telling the truth (not sure if she is) and there is a high probability that the taxi driver would rape again (and statistically speaking, it is), ethically we should have reported the incident. Is that right? I'm still on the fence about this. I just hope I don't hear anything about a cab driver raping someone else on the news.

Friday, March 12, 2010

Take back our textbooks

As expected a bunch of nuts in Texas decided that reality is too liberal and will rewrite history and make up scientific facts to teach students in their public school system. I could say, "who cares it's only Texas", but the publishers don't want to make multiple versions of a textbook and since Texas is one of their largest purchasers of textbooks, the right-winged fake textbooks that they'll make for Texas will be used in other states also. However, I believe we could fight back. The same publishers sell college and professional-level textbooks, and with the insane number of textbooks that I've had to buy in my college and professional school career, I'm sure a huge chunk of the revenue for these companies come from people just like me. So, if professors, researchers, and college students boycott the companies that are complacent in the brainwashing of public school students, I believe we could stop these 11 crazy Texans from robbing the educations of kids from all over the country. (I've tried to find a list of the textbooks that the Texas school board uses, but haven't been successful so far.)

Thursday, March 11, 2010

Jenny McCarthy as my pediatrician?

As I expected, in pediatrics I'd run into some anti-vaccine parents. They were beyond convincing (and perhaps not coincidentally, many of them were chiropractors). However, the other day we saw a patient bring her child for her two-month check-up, when the first shots are given. The mom brought up her concern about vaccines causing autism. The pediatrician said that there isn't any evidence that it's the case. Grandma then walked into the room and said, "oh yeah, I heard that the original study that showed a connection between vaccines and autism was a fraud." (yay! word is going around). The pediatrician then said, "Whenever you hear things like that you should ask yourself, if my child had an ear infection, would I ask Jenny McCarthy for advice or would I go to my pediatrician?" The mom and grandma laughed and said, "pediatrician." The baby got her vaccines and the story had a happy ending... but as I was leaving the room I thought, even though it sounds like a silly question, a lot of parents wouldn't think it's such a funny question. There are plenty of people who would be happy to take the advice of celebrities (and quacks) on their kids' health (not just vaccines) over their pediatrician's.

Monday, March 8, 2010

4 Stages of a 3rd year med school rotation

1. Confusion: You don't know when to be where. You don't know what you're supposed to do, what you're allowed to do, and what you can't touch. You don't know the right terms for anything. You don't know who to talk to. You don't know where the patients are. You don't know when to leave.

2. Productivity: You got the logistics down. You've gotten to know how the system works. You're actually being useful to the team. You're actually learning from your patients. You know when to go home without asking.

3. Burn out: You're getting tired of the routine. You're getting tired of the busy work. You're less excited about the day. There are less learning opportunities during the day. You look forward to going home.

4. Numbness: Your mind is elsewhere and your goal is to just get through the day. Unless something really exciting happens, you're not gaining much from the rotation. You find ways to get out early.

This is kind of a tongue-in-cheek thing, but for some rotations it's definitely true.