TSA all over T&A

With all the traveling for residency interviews, the ever-increasing invasion of privacy that is the TSA is starting to become more than just an annoyance. They either get to get to look at you naked (via a body scan) or perform a "heavy" pat down (i.e. grope your genitals... or in some cases, cause your urostomy bag to spill urine all over you). A lot of people are afraid of radiation exposure with the body scans, but (based on how little radiation is emitted by X-rays that can actually see your bones) I'm not so worried about that (though I wouldn't go through them if I were pregnant or had any chance of being pregnant). It's more the invasion of privacy. The government has no right looking under everyone's clothes. It's humiliating and unnecessary. The other option (being groped) is no better. But, if someone is going to take away my dignity, I may as well make them do some work. I'm a little disappointed that the planned pre-thanksgiving protest of refusing to be scanned (and thus, backing up the security line) didn't pan out, but I plan on getting to the airport early just so I could make those useless TSA agents get off their asses and work. Also, I plan on getting them to change to new gloves (who knows how many other people's genitals they've groped with the same glove?).
This is even more upsetting because it really doesn't do much to prevent a terrorist. It's all a show that isn't impressing anyone. It's much easier to do all the work behind the scenes from the moment a passenger books a ticket, but I'm sure the government is afraid that people will think that they aren't doing anything to keep them safe. I'm glad that people are finally starting to protest, but, like with all other steps TSA has introduced, (take your shoes off, no water, etc.), I have a feeling people will fall in line, because it's just easier to.

First interview and rash of rejections

I recently had my first interview. I had a great time, residents and faculty were both very nice. The interview was pretty low stress. One thing, though, surprised me. The institution that I interviewed at is well known for its research, but I had no comments made about my research and when I asked about research opportunities, each faculty member replied with a quick "yeah, we've got research" and seemed to not be so interested. The tone of the response of one faculty member almost made me feel like I asked an inappropriate question. I understand that in residency it's fairly difficult to work on a real research project and I have no intentions of working on a PhD level project, but I expected at least some acknowledgment of their research strengths.
I feel that most residency programs want a token amount of research in your background, but would rather not have your clinical training soiled with research. As such, someone with a background like mine actually has a big disadvantage. With average grades and boards scores my strength is in my productive research (and recommendations). This leads to a strange situation in which some mid-/lower- tier programs decide not to offer me an interview (I assume because they think I will go to a research heavy institution) and many upper-tier programs decide not to offer me an interview (I assume because of less than stellar grades/boards score). I end up with a small number of fairly random interviews with some of the best and some mediocre programs. Of course, maybe I'm just trying to rationalize a (essentially) random process. Anyway, another week or two of potential interview invitations, but I'm feeling a bit more pessimistic now than I did a few months ago.

People are stupid

It amazes me how millions of people can be convinced to vote against their self interest. Healthcare? Who needs that? What America needs is a tax cut for the rich. Also, get rid of the estate tax (even though it only applies to people who make millions and I only make $20,000 a year). Oh, and extending unemployment benefits is unamerican (even though I'm unemployed and collecting unemployment right now).

Rural Hospitals

I recently did a surgery rotation at an outlying hospital. It was labeled a "rural" hospital, but in reality it is only a 30-minute drive from where I live. It was a great experience. Without residents, I actually felt that I was a useful member of the team and in the OR actually got to do more than hold something that I can't see. The hospital only had something like 30 beds and I expected that any patient requiring more than a minimally complicated procedure would make the 30-minute hop to the giant academic center nearby. To my surprise lots of patients there would rather have their complicated multi-organ bowel surgery at the small 30-bed hospital (with only 4 ICU beds). Their main reasoning was that they felt comfortable in a place with familiar faces, where they knew the staff as friends or families of friends, something that they preferred over a giant maze of a hospital where you're known as a diagnosis or a room number. Also, I quickly figured out that the quality of care was the same (if not better, in some respects) than the giant academic center. True, you couldn't get a transplant or brain surgery, but for most procedures that general surgeons (or orthopedic surgeons) do, they're just as good. What's more is that things happen amazingly fast at this small hospital. There were several patients that came in with suspicious breast lumps and within a week had a partial mastectomy with pathology results in and an oncology appointment made. Scheduling several procedures across four different specialties is pretty much not possible in a large hospital. So, even though there's a lot of "outside hospital" bashing in academic centers, for the most part, they're just as good.

Checking email

Still checking my email for possible residency interviews. It's a very anxiety-provoking process. I check my email something like 20 times a day (I thought having a smart phone would be great, but it turns out to distract me more than help me). It's getting to be a crazy obsession. The plus side is that I've gotten two radiology interviews and four intern year interviews. It's somewhat reassuring, but it hasn't stopped the anxiety (and I did get one rejection from an intern year program).

One thing I'm really glad I managed to do was to take a large chunk of time off in December and January (prime interview season). With the number of interviews I hope to get (and an equivalent number of intern year interviews since I want to be in the same city for both), I will be traveling all the time. Our school only lets us take off one day per week of class for interviews and (by my calculations) I would have to break that rule to fit in the number of interviews I hope to get. Some classmates who don't have the time off are wondering how to deal with this dilemma. Since the med school administration always strictly adheres to their rules (and no amount of logic will let them change it), the best option is to either call in sick or ask your resident/attending and not bother with the administration. Nonetheless, the administration may find out and you'd have to deal with their fury.

Tips to any future medical student:
1. It's best to plow through 3rd year and free up 4th year for easy rotations/research/time off so that you could focus more on residency applications and interviews.
2. When it comes to needing time off, follow the old adage: It's better to take the time off and apologize afterwords than to ask for permission and not get it (because you won't get it).

PLoS One: Not a real science journal

I love the open-access concept for scientific journals. There is no reason why someone should have to pay $35 to read my papers. PLoS is one of the first and largest open-access science journals out there. Some of their journals, like PLoS Biology, are very prestigious places to publish and have put out many amazing studies. They also have a vigorous peer-review process. Unfortunately, to subsidize publication in their premier journals, PLoS pretty much lets anyone who's willing to pay a couple of thousand dollars to publish anything in their barely peer-reviewed journal PLoS One. Their argument for minimizing the peer-review process (and ignoring the scientific merit of their papers) is that it is reviewed by the global community. Unfortunately, all it does is get a bunch of non-scientists make a big deal of a crappy study for being published in a scientific journal. Don't get me wrong, there have been some nice papers I've read in PLoS One, but they also let in a lot of crap (70% of what's submitted is published), like this recent one about a model for Moses parting the Red Sea, that has absolutely no scientific merit. Because of this, PLoS One made it to my Fake Science list.

The waiting game

My applications are in for residencies. Now I play the always-fun waiting game. Actually, with radiology, an intern year in either an internal medicine, surgery, or transitional (short rotations of everything) program is required, so I've got twice the applications and (hopefully) twice the interviews. The two programs are essentially independent of each other, so all of this is further complicated by the fact that I would like to stay in the same city for all programs. With radiology being so competitive, I've got a lot of programs on my list. I'm happy to say that I've got one interview already, although it's only an intern year interview... nonetheless, it seems like all that effort I put into applications is actually producing something.

Just for those that don't know (and for me when I look back at all this craziness), the whole residency application process starts with completing an application at a central computerized program, uploading a personal statement about why you want to go into the field you chose, and uploaded grades, national boards scores, letters of recommendation by your medical school. The application goes out to any program you want to click on. This makes it really easy (but pretty expensive) to apply to a lot of programs. Once the you choose the programs, the waiting game involves waiting for them to download your application, go over it, compare it with other applicants and decide to send you a short e-mail that they like you enough to see you in person. This process can take from a few days after submitting for some programs to several months for others (which results in applicants agonizing over whether they got interviews all through the fall and into the winter). Next, you interview at the programs that choose you. Then, by sometime in February, you make a rank list indicating where you want to end up the most from the programs that interviewed you. Finally, on March 17th (this year), the "match," based on your rankings and the rankings of their applicants by the programs you interviewed at, decides where you'll end up for residency. I still don't know how the match exactly works, but (like almost everything in med school), I'm sure I'll figure it out when I get to it).

Stay tuned...

Wanna look stupid?

Burn books.

Edit: Make that, if you wanna look stupid, give attention to a nut that wants to burn books. Seriously, that guy not only just increased his influence about 1 million times, but there will be hundreds of copycat nuts out their trying to get their 15 min. I don't care that it's the Koran, it more that the media and the government has elevated this guy's voice to an international level. A simple "who the hell are you" and "who cares" would have shut him up easily.

Chainsaws in the OR

Nope, I'm not on orthopedic surgery. I am working with a general surgeon who likes some good old heavy metal and his playlist included this classic by Jackyl.

(best quote: [James Dupree - the lead singer] once had been asked, "How the hell can you play a chainsaw?" to which he responded, "How the hell can you not play a chainsaw?")

Just looking at pictures

Julie Rovner, the health reporter at NPR took a little swing at lazy radiologists by saying that all they do is sit in a room at look at pictures while primary care physicians have a lot of high-stress work. Maybe radiologists have a more cush lifestyle (although, I know a lot of people who wouldn't be able to stand doing what radiologists do), but it looks like Julie Rovner hasn't really researched what radiologists actually do and what merely "looking at pictures" actually means (i.e. invasive procedures, deciding whether someone needs an organ removed, deciding if someone needs a brain biopsy, etc.). Wtf, NPR? Maybe you should hire a health reporter that actually knows something about health.

This just points out the fact that most science/health reporters suck. They are trained as journalists, not scientists, but they have no problems making conclusions about science/medicine without actually knowing what they are talking about.

Best line ever

The Daily Show With Jon Stewart	Mon - Thurs 11p / 10c
Mosque-Erade
www.thedailyshow.com
Daily Show Full Episodes Political Humor Tea Party

John Oliver: You can build a catholic church next to a playground. Should you?

This whole ground zero mosque nonstory, noncontroversy is basically right-wingers being racist and trying find a way to get attention from their failures in time for November, the media gladly complying with whatever they say, and the democrats hemorrhaging votes by feebly attempting to make the fake outrage die down.

Nuclear armageddon

This is a map of nuclear bomb detonations (that we know of) between 1945 and 1998.



It's worth watching all 14 minutes of it, if only to make sure you never live in the Southwest (of course, the US kicks ass at this game).

Fake science legitimized

There's a lot of pseudoscientific or grossly biased "studies" out there that pretend to be actually doing real science. That really can't be stopped. Lots of organizations spend a lot of money to come up with "evidence" to back up whatever they like to promote. What upsets me is when these "studies" get published under the guise of actual scientific work. Some of theme are even peer reviewed. The great PZ brought up an example today from the Southern Medical Journal of a study that showed that prayer improves vision by recruiting subjects from a church revival, not blinding and not having a control. If the Southern Medical Journal is a legitimate medical journal, how did this study make it past the editor (let alone through peer review)? Clearly, the scientific process doesn't matter for this journal.

There are a lot of science journals that have been publishing pure crap (I suppose in order to get more readers) and it really diminishes their value. Not quite this bad, but even bigger named journals like the New England Journal of Medicine have been trending towards legitimizing pseudoscience, such as this recent review of acupuncture (discussed by Orac). A few years ago, I actually got in an argument with an editor from the American Journal of Health-System Pharmacy because they published a letter to the editor that used a posting from prolifeblogs.com to support their argument against the availability of over-the-counter emergency contraception. The response I received from the editor was that they can't be selective against the literature their contributors cite (yes you can! And, a blog post can't count as scientific literature).

So, similar to my post on companies that underhandedly promote religion, I want this post to include a (probably) growing list of scientific journals that aren't exactly scientific:

Completely Fake:
Journal of Cosmology
The Open Information Science Journal - accepted a fake paper without review from a couple of people from MIT claiming to be researchers at the "Center for Research in Applied Phrenology" (CRAP) - as long as they sent an $800 check to an address in a tax-free zone in the UAE.

Has Ulterior Motive:
Australasian Journal of Bone and Joint Medicine (sham journal for Merck provided by the supervillain of scientific journals: Elsevier).
The Journal of Global Drug Policy and Practice - funded by the Department of Justice and only publishes "research" that shows that punishing people is the only way to reduce drug use.

Ignores scientific process for publicity/money/religion:

An exhaustive list of preditory open-source journals can be found at Scholarly Open Access
American Journal of Health-Systems Pharmacy
American Journal of Surgery
British Journal of Psychiatry
Journal of Medical Hypotheses
PLoS One
Social Science Research
Southern Medical Journal
Psychology Today
Synthese

... and more coming when I get the chance to get to them.

King and King

We've been going to the library and randomly grabbing children's books to read to mxh jr (he has no idea what they're about, so any book will do), and we happened to grab a book called "King and King," about a prince who needs to get married and can't seem to find the right person. All the princesses don't cut it out for him. Finally, he sees the person of his dreams (and from the title you could guess that it wasn't a princess). Pretty cool. It's about time that children get exposed to all types of relationships and learn that love isn't about gender.

Of course, some people aren't happy to see this book in libraries. The Amazon reviews bring out some less-than-enlightened reviews. And someone tried to sue a school for having the book, claiming that "the book in school constituted sexual education without parental notification." Pretty lame... with that logic, you'd better get rid of every other book that ends with "and they lived happily ever after." Luckily, the judge threw the lawsuit out saying, "Diversity is a hallmark of our nation."

4th year and radiology

So, I've decided to go into radiology and am starting the last year (#8 - can't believe I've spent nearly a decade here) with a radiology clerkship. Since I last took radiology before 3rd year actually started, now that I've actually experienced a lot of what medicine has to offer, sitting behind a resident or attending while they look at images actually isn't that bad. In a previous post I complained about how med students don't get the most exciting experience in radiology, but I've learned on this rotation, that you actually can. The best way to enjoy radiology is to do it yourself. With 3rd year behind me, I can actually make a reasonable attempt at reading some images. So the advice that I've been given (which works pretty well for me) is to find a free computer in the reading rooms and look through the new studies on your own and try to come up with a diagnosis. Then when the resident or attending go over them, you'll get much more out of their discussion. Amazing how in a few weeks those images that I could make little sense of actually start being somewhat meaningful (I'm looking at you ultrasound).

USMLE Step 2 CS: A waste of $1000

I recently took the clinical skills (CS) portion of step 2 of the US medical licensing exam (USMLE). It's a whole day of interviewing standardized patients (actors), writing notes, coming up with possible diagnoses and ordering lab tests. It definitely covers what every physician should know. What's upsetting though, is that it's a recently-introduced exam that costs $1295 and has a 96% pass rate (and supposedly 100% at our institution). So essentially, every medical student in the country (something like 15,000 students each year) has to take the exam so that only 600 (most of whom probably also have terrible grades and are unlikely to match into a residency program anyway) could be weeded out. We live in a culture of standardized testing. There are whole industries surrounding it (books, tutoring, computer programs, testing centers, patient actors, etc.). So, its not surprising that the company administering the medical licensing exam would like to add yet another exam for students to take. What's disappointing is that physicians in charge of medical licensing go along with it. Residency programs don't care about your Step 2 CS score and I highly doubt that there will be less dangerous physicians around because of this new exam. My cynical opinion is that someone decided that they could make an extra $20 million each year off of medical students and "convinced" those in charge of medical licensing to go along with it.

Oh well, at least I'll never have to deal with fake patients anymore.

Seven alternatives to evidence-based medicine

Two more days of 3rd year left... can't wait.

This article is a pretty funny (but in my experience true) description of how some doctors justify their treatment plans. My favorite:

Eloquence based medicine---The year round suntan, carnation in the button hole, silk tie, Armani suit, and tongue should all be equally smooth. Sartorial elegance and verbal eloquence are powerful substitutes for evidence.

Bad science in clinic

I was very disappointed by my recent preceptor, who's pretty good with practicing evidence-based medicine (even when it contradicts the current trends), at recommending an unproven treatment to a patient. We had a patient with reflux disease who was well-controlled with a proton-pump inhibitor (PPI). He suggested that acupuncture might be a good alternative. Then went on to describe this study, in which patients who failed standard therapy with a PPI were randomized into one group that received a double-dose of PPI and another group that received acupuncture in addition to the standard dose. Surprise, surprise, the acupuncture group got better. This is a terrible study that is doing nothing but comparing apples to oranges. First of all, if patients failed standard therapy, the chances of failing a double dose is pretty damn high. Second, where is the control for acupuncture? How do we not know that the acupuncture group is getting a placebo effect? They could have easily placed needles in the wrong places as a control. Third, this doesn't even apply to the patient we were talking to, she was responding to PPIs. Overall, terrible advice by an otherwise well-informed doctor. At least he described the methods to the patient. Luckily, the patient preferred sticking to her trusty PPI.

The one thing I learned from the paper: In the UK, GERD is called GORD (gastro-oesophageal reflux disease).

In the donut hole

Ms. X is a 80-something year-old woman with congestive heart failure, high blood pressure, diabetes, rheumatoid arthritis and asthma (among other things). She on about 15 medications that adds up to nearly $4000 a year. Unfortunately, this falls right in the middle of the famous donut hole of Medicare Part D (the prescription coverage part of medicare). I never really thought much about it until I saw how this affects Ms. X. Here’s Medicare Part D’s payment schedule from 2010:

If your drugs cost between $2830 and $6440 per year, you get no coverage, but if your drugs cost more than $6440, you get 95% of it covered by medicare. This makes absolutely no sense to me. I was wondering how the hell this came about and it turns out that it’s the consequence of two separate coverage plans (one clearly made completely independently of the other). There’s Medicare initial drug coverage that covers 75% of all drugs on the formulary from $310 to $2830 (there’s a $310 deductible). Above $2830 there is no additional coverage by Medicare’s initial drug coverage. However, if you have to spend (out of pocket) more than $4550 (that’s your prescription drug costs go over $6440) Medicare’s catastrophe coverage kicks in. At this point, Medicare pays 95% of anything that goes over. Medicare does have an “Extra Help” program that includes coverage of the donut hole, but you have to make less than $16245 a year to qualify (not really much). Ms. X is a widower who rents an apartment in town. She has an income of about $18000 a year. She makes too much to qualify for the extra help. She can’t really afford to pay an extra $60-$80 a month that the extra “gap coverage” insurances cost. Now, I don’t spend much money, but I know that you really can’t do much on $18000 a year, especially if you have numerous chronic medical problems. Ms. X has gotten to the point that she is not eating well, she’s not filling some of her prescriptions and has even resorted to taking her son’s albuterol (he has private insurance) for her asthma.

Luckily, the healthcare reform package that recently passed will start closing this donut hole, but it looks like it won’t be until 2020 before the gap is completely closed. I’m not sure why it should take 10 years to fix it. I’d bet that none of the people who set this system up or who decided that it's ok to wait 10 years before closing the gap have an 80 year-old grandmother who steals their albuterol.

4th year will be sweet

Just about done scheduling 4th year and it looks like it'll be nice. Right now I actually have 22 weeks off! Of course some it will be taken up by taking the boards and interviewing for residencies, as well as research (and maybe I'll add a few more rotations later on), but it sure will be less hectic than 3rd year has been. What I'm really excited about is the end of working for grades, good evaluations, exams, busy work, etc... I will finally (with few exceptions) be able to spend 100% of my time in the hospital on learning what I am interested in. I kind of wish all of med school was like that.

Religious companies

There are some companies, fairly well-known ones, that I never knew attempt to push their religious beliefs on others. I find it pretty frustrating when I'm trying to purchase something and I get a religious sermon. Or an ad for car batteries is talking about God's love. I find it worse than religious organizations and televangelists, because, with them, you at least know what you're getting yourself into. But, I was looking for plane tickets recently and a wandering google search taught me that Alaska Airlines regularly distributes Bible verses with their meals. When common everyday companies, like Alaska Airlines, pushes religion when providing the service that you pay them for, it's insidious and not only offends me, but leaves a bad taste in my mouth. I mean, if I were to give my business to Alaska Airlines or Interstate Batteries (which I have before), I have donated to a religious cause (something which I try to avoid at all costs). They are private corporations and can do whatever they want... I'd just like to know about it so I can avoid giving my money to them in the future. So here's my list that may be growing, of companies I will try to avoid because I'd rather not have my business with them fund proselytizing. A good starting point is from a list made last year here. Another good list is here, but I'm not considering companies that just have owners who are religious and have a spiritual way of making decisions. It's more when employees or customers are exposed to religious propaganda, nonreligious employees/customers are discriminated against or the profits from the company goes to religious organizations.

Alaska Airlines
Anthem coffee shop in Tacoma, WA
Chik-Fil-A (aah! Making employees pray and Christian-themed toys in their children's meals... that's pure evil!)
Chymorvah bed and breakfast in Marazion, Cornwall, England
Delta Airlines
Domino's Farms in Ann Arbor, MI
Eden Foods
Hobby Lobby
In-and-Out Burger
Interstate Batteries
Florists in Cranston, RI 
Forever 21 (owner likes to demonstrate his faith by putting a bible verse on bags)
Oklahoma Joe's Bar-b-cue in Broken Arrow, OK (breaking its agreement to donate to Camp Quest after taking profits from supports).
Prometric (testing center was playing Christian radio in the waiting room... not what I want to hear just before I start taking Step 2).
Korte & Luitjohan Contractors in Highland, IL
Sting Ray Cafe in New Bern, NC
Trijicon (Hidden Bible verses written on military weapons).
Tyson Foods (thousands of chaplains "serving" their employees)
United States Postal Service (somehow packages that say atheist on them tend to get lost)
US Plastics sends religious messages to their customers
Voss Lighting Company of Lincoln, NE
Weingartz Supply Co. in Ann Arbor, MI
Wyndgate Country Club in Rochester Hills, MI

This is a slowly growing list. If you have any additions, please let me know.

Burnt out

It's official, I'm totally burnt out with 3rd year of med school. The primary care rotation is pretty relaxed, but I just can't get myself to study much or do any of the mind-numbing busy work that we are assigned. I'm glad I don't have something more intense like internal medicine or surgery scheduled now. Luckily, it looks like I'll have a pretty chill 4th year (though I'm not looking forward to taking Step 2 of the boards) and I'm looking forward to the adventure of applying for residencies.

How to lose innovation in your state

University of Virginia and Virginia Commonwealth University are two other places I am looking into for residency. But, I'm hesitating now because there seems to be a witch-hunt against scientists. The attorney general of Virginia is a grade-A nut who is wasting taxpayer money to "investigate" (i.e. go on a fishing expedition) a climate scientist to see if there was "any breach of ethics" (i.e. can we find anything that makes scientists look bad so I could say my twisted version of reality is right). Besides being completely unethical on the attorney general's part (is he really working for Virginians?), this is a great way to lose scientists in your state. For example, if I go into fetal imaging - something that I really am interested in - I may find something that would not fit with the attorney general's ideas about when life begins, and as a result I risk getting "investigated." You lose scientists, you lose scientific discoveries. You lose scientific discoveries, you lose new and exciting companies. You lose that and you've lost jobs, greater tax income, and a better future for the citizens of your state. But who needs all that, it snowed 60 inches in Virginia last winter, so clearly global warming is a fraud.

Two places I could cross out now

I am thinking about the long list of places I will apply to for residency in a few short months. The list is growing by the week, but two just got crossed out: The University of Arizona and St. Joseph's Hospital in Phoenix. I figured I don't want to spend 5 years living in a place where I'll be asked to "show my papers."

Out of the psych ward

Just got done with psychiatry. I had a great time. I was in a general adult ward where most patients were voluntary. The staff was great and the patients were very interesting. What was really cool was that in their short stay of 3 to 5 days, most patients actually got better... not something I thought would happen quickly. What was even cooler was that there were no residents, so I was actually a useful part of the team and my patients were my patients. I got to interview them first, I got to write their admission notes, I got to do their discharges. This is probably the closest I've felt to a doctor.

Just for fun, here's something amusing that happened during the rotation:

Attending (while talking to a crack addict that didn't want to stop): You need to stop smoking rock and get addicted to something else. Like this (shows a picture of his cat). You can start getting high off of this.
...
Me (later): Dr. X do you watch South Park?
Attending: Yes
Me: Do you remember the episode where they get high off of cat urine?
Attending: It's called cheesing.
...
Attending (later, to patient): You should probably ignore what I said earlier about getting high off your cat. It's called cheesing and it's bad.

Taking Oaths

I thought that the only oath I'd be taking in med school is the Hippocratic oath. But, in more than one rotation, I've had to sign papers that certified that I really did read the reading I was assigned or watched the video I was assigned. It's frustrating on two levels. One is that I find oaths in general kind of useless. If someone is going to do something wrong or illegal, they're not going to have much of a problem lying about it. What's more upsetting though is the paternalistic approach that medical schools have towards their students. If there is a reading or video that is recommended, it should be up to me to decide whether I think it's useful to my education. If I don't find it useful, actually doing the assignment will only waste my time. I believe that we're mature enough to decide what the best way for us to study is. I've had hundreds of exams and know pretty well what works for me. The school shouldn't care (and shouldn't make me sign oaths) that I didn't do a particular assignment.

Of course, the administrators don't really remember being students, so they've implemented things like quizzes that ask questions about topics that were in the readings, but not exactly important to clinical practice or (rumor has it) actually make sure that you've clicked on and watched the entire 26 minutes and 13 seconds of the video that is posted on line. This is what happens when you lose sight of priorities... so, if you'll excuse me, I've got to play another video at 2X speed with the sound muted in the background.

Best burger in baseball?

I was watching the travel channel and saw this beauty:



A bacon cheeseburger with a Krispy Kreme donut as buns. Looks like I have a good reason to apply for residency in St. Louis.

Someone who shouldn't be a doctor

Florida doctor opposed to health care law turns away Obama voters

This sickens me. I would hope that other doctors in the area realize that he's an asshole who won't treat his patients equally and refer their patients with urological problems elsewhere.

(part of me thinks, I'm glad that he's advertising his idiocy and losing patients)

Psychobabble

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.

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.

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.)

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.

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.

How not to treat your students #3

Another one for the series.

Resident: You guys can do whatever. But stay in the hospital. We're getting an interesting patient soon. I'll page you guys when she gets here
Students: OK, thanks.

5 hours later, no page... students page the resident... no response, students go home

The next day:
Student: Did the patient get here yesterday?
Resident: Oh yeah, she cam at one (2 hours after he said he'll page us).
Student: Did you get my page?
Resident: Yeah, I already took care of the patient by then.

I know the resident has more important things to think about, but med students really, really appreciate it when someone keeps them in the loop (especially when they say they're going to).

Credit Cards Suck

The Mrs. just got a letter from her credit card company saying they're starting an annual fee unless she spends a certain amount per year. And, I've heard rumors that my credit card will start charging if you pay your balance in full each month (wtf?). It'll definitely be canceled, but it sucks that our credit suffers because the credit card company decides to be assholes.

How not to treat your students #2

I was talking with a few students in the hallway when a resident, who was in no particular hurry, walked down the hallway and literally pushed us away while saying "Outta the way kiddos!"
WTF? Just because you have an MD doesn't make you any more worthy of the hallways than us. (I replied with "Kiddos? I'm probably older than you!")
Later that week we were all sitting in a room with other residents and attendings, when the same resident walked into the room and said, "Med students, get out of your chairs. I need to work." Granted she may have been doing some important work, but she could treat the students like human beings and ask nicely, rather than ordering us to give up our seats as if we're second class citizens.

There are lots of simple things that residents and attendings could do to make med students enjoy their time in the hospital better. The easiest one is to treat them like normal human beings. I hope I'll treat my students better.

How not to treat your students

I recently worked with an attending who completely ignored my presence. Not too unusual in med school. But,I got pretty upset when the attending responded to every question I asked by turning to the resident and replying to him. He didn't want to stoop so low as to talk to a med student. Arrogant ass.

Radiology as a med student: Not always fun

Radiology is great and is still on top of my list for what I want to be when I grow up. However, as a med student, it can be pretty boring. Last week I spent some time in the neuroradiology department. My two favorite fields, neuro and radiology, combined. Yet, my 2 1/2 days with them were pretty dull. The problem is that to enjoy radiology, you have to look at and interpret images on your own. Shadowing a radiologist doesn't really make much sense. Basically, you end up looking over someone's shoulder as they quickly scroll through scans and talk to themselves (into their dictation programs). There is very little opportunity to figure things out for yourself. Luckily, during neurology and my other rotations, I've gotten plenty of chances to go through images on my own. So, this post isn't about how I stopped wanting to be a radiologist. I'm just venting about my disappointment about the neurorad week.

About damn time

The Lancet retracts Andrew Wakefield’s article.

Ten of the original 12 authors of the study retracted their support for the study and its interpretation. In 2004 the Lancet published a retraction. However, it was only a partial retraction, and the study remained as part of the published literature.

10 out of 12 authors wasn't enough to fully retract it?

Peds neuro: Can it tear me away from radiology?

On my neurology rotation I was assigned to pediatric neurology, and that random assignment might have changed my career plans. I loved it almost immediately. The patient population seems great. The diseases are often very challenging. And each patient is completely different. Granted for a lot of patients there is no treatment. Although, figuring out the mystery of why something is wrong with someone's child does a lot for both the parents and the child. For those kids for whom a difference can be made, the difference is dramatic. It could change a potentially severely disabled child to a normal, healthy child. Also, adding the normal changes that a child goes through as they get older along with the neurological problems they face is an added factor that makes the field interesting. Finally, the research opportunity is limitless. There is a lot that is not known about the conditions that these kids can suffer from. For many of them there is no treatment available. Also, their disorders shed light onto my field of interest, how the brain works and how the brain's plasticity can be used to overcome their deficits.

Will I go into it? Not sure yet. Radiology is still winning, but peds neuro is a quick second. The training in peds neuro is a little strange (for most people, 2 years of peds, 1 year of adult neuro and 2 years of peds neuro - you have to go through two different matches). Also, I'm not completely sure if I really like the pediatric population... we'll see, my peds rotation is next. Stay tuned.

So we've had a national referendum on gay marriage also?

Apparently the fact that the people of Massachusetts chose a Republican to take over Ted Kennedy's seat means that everyone in the US is against health care. So, by that logic, since Massachusetts has legalized gay marriage, we've had a national decision already made on that also.

I'd rather not do that to my child

With our new baby came an instruction manual (well, maybe a book that my in-laws got us). It has some good advice, it's mostly fact-based (i.e. it does a pretty good job shutting down the anti-vacciners), but one thing caught me eye. It's about soothing a fussy baby:

Dan, a chiropractor father of a fussy baby, came up with this fuss fixer. Hold baby at his hips and swing him upside down at sixty beats per minute, like the pendulum of a grandfather clock. According to chiropractic research, upside-down swinging has a calming effect.

Yikes... how did that research get IRB approval?

Holy crap!

I'm a father.

Oh, no! We've qat another target!

With all the recent talk about Yemen (and Fox News telling everyone that Despite Al Qaeda Threat, US Not Planning to Expand Terror Fight in Yemen - don't click on it, it'll go to Fox News), reminds me that we may be on the verge of "liberating" yet another country that we don't understand. Yemen is a pretty interesting place, the history and politics of which does not fit any of the other oil-rich middle eastern countries. I recommend reading "Motoring with Mohammed" about life in Yemen (it's an awesome travel book by Eric Hansen). Plus, you'll learn a lot about qat (a euphoria-inducing stimulant used daily by the Yemeni).

Gotta love the qat break

At least we're not elephants

Still waiting for mxh jr. Mrs. mxh is getting pretty tired of being pregnant... but I guess he'll get here when he gets here.

10 month elephant fetus... only halfway to birth

See National Geographic's In The Womb specials for more cute animal fetus pictures.