Last day of vacation

After nearly 3 months off, I'll finally be getting back to the medicine mindset with the start of intern year tomorrow (actually, it's just orientation tomorrow, the real intern year won't start for another week or so). I'm a little worried (ok, terrified might be a more accurate description). I've been calming myself down with the thought that lots of people have been through the same thing and have done fine, but with a 3-month break, I'm sure I'll be a little rusty. I suppose I took a 4-year break from medicine during graduate school and did ok when I got back into things, but med school is not the same as being an actual doctor who's orders actually get carried out. I was thinking of spending some time studying medicine, but there's little motivation to pick up a book and I figure that anything I could have learned on my own during the break would be minimal compared to the vast amount of information I'm about to get forced down my throat.

My mindset right now consists of many conflicts: I'm looking forward to actually starting work (I'm getting tired of being home all day), but at the same time, I know I won't have much of a chance for a break for a long time. I'm excited to see patients, apply my knowledge, try to help people and maybe have some fun along the way, but I'm also terrified I might make a mistake and hurt someone. I'm looking forward to meeting new people, but I'm afraid that they actually might know medicine. I'm terrified that I won't be able to handle the workload, but I'm calm because life at the community-hospital based intern year that I'll be going through won't be anything close to that of the academic-hospital based interns that I got to vicariously live through during my recent sub-I. I'm hoping for starting with something light so that I can get my bearings before getting slammed, but at the same time, I want to get the tough months over with before I get burnt out.

I figure it's no use worrying too much about it. It's not like I can change anything.

Setting up shop in a parking lot

So, after a crazy month, I officially have my MD and have moved to where I will spend my intern year. I'm excited (and scared) for it to start. Orientation is next week, I'm sure you'll hear about it.

In the meanwhile, Mrs. mxh has started her job as a pharmacist. She works one day a week at a pharmacy in a sketchy part of town and it turns out that the doctors there are more sketchy than the patients. There are a few doctors in that part of town that are notorious for prescribing large amount of narcotics, a lot of the times without even seeing the patients. The only thing that comes out of their primary care clinics is narcotics prescriptions and their patients have a suspicious pattern of getting new prescriptions too soon. What really makes it bad, though, is that one of the doctors has a habit of just hanging out at the pharmacy and writing prescriptions for narcotics in the parking lot! Yikes! This isn't something new either, it's well known among pharmacists in the area. Why do these people still have jobs? Why isn't the state medical board stripping their licenses from them? Why aren't they arrested?

Part of the problem is that not too many people report them. But, I think, a major problem is that medical boards are notorious for not punishing their own. Medical schools emphasize fitting in and keeping the status quo. If you bring up a problem, it's better that it is discussed quietly. I think this attitude carries on to medical boards. If they punish a doctor, it'll make the news and that type of attention is something that medical boards don't like. If they ignore a problem, then everything will go an as it has. So far, it's been working, but some day, the narcotic ring that these two physicians are running will make front page news and the state medical board will wish that they have dealt with it sooner.

More bad journals

Synthese - Apparently criticism of intelligent design is frowned upon.

Psychology Today - Racism dressed up as science in the form of an essay by a regular contributor to their website called "Why are black women rated less physically attractive than other women?" Yes, it was quickly removed, but the fact that it was written in the first place is disturbing. How can this guy have evidence that "black women are objectively less physically attractive than other women"? Has he seen Halle Berry?

Both are added to the list.

Torture still doesn't work

I expected the right to give all the credit of Bin Laden's death to Bush (even though he said he doesn't care about finding Bin Laden), but I'm pretty upset that they would try to rewrite history by saying the information leading to it was because of "enhanced" interrogation techniques. Torture is inhuman and the fact that half the country supports it is the most worrying sign about our future. This analysis shows how Cheney and the rest of the criminals in the Bush administration are completely wrong about torture helping the US get Bin Laden.

If your doctor is praying to heal you...

... you haven't got long to live (or you should find another doctor). Time to add to the list of science journals that have little regard for science. Here's a presidential address published in the American Journal of Surgery entitled "Can prayer help surgery." Unfortunately, the answer is "yes" (or more like, "No, but I'll say yes anyway"). Despite the fact that the author acknowledges that there is no scientific evidence that prayer works, he decides to add the old religious line of "What if those results are the will of God?" Really? Hell, I should have just responded to all the tough questions I got from reviewers by saying "It's the will of God. Who are you to question it?" This presidential address makes a mockery of science. The field of surgery is already decades behind the rest of medicine and Dr. Schroeder of St. John Hospital in Detroit (along with the American Journal of Surgery) just sent it back a couple of centuries. (uggh, I'll be working in a Catholic hospital next year, hopefully I don't run into these types)

Once again, I have to say that if any physician claims that their successfully treating a patient was God's doing, they should give up their salary.

Gotta bring back the Jesus surgeon picture. It makes me wonder why a surgery residency is 5 years. It must take that long to not get creeped out by Jesus giving you a shoulder message while helping you with surgery.

(PZ Myers has a better evisceration of the address and Orac discusses how ethically and scientifically inappropriate it is).

Stupider than I thought

I already mentioned how Arizona sucks... but this new bill (that was just passed) that requires presidential hopefuls to "prove" their US Citizenship to get on the state ballot is incredibly stupid. Accepted forms of proof includes a "long-form" birth certificate (because Hawaii only releases the short-form to the millions of nuts that have been asking for it) or, get this, at least two other forms of accepted proof such as early baptismal certificate or circumcision certificate. Are you serious? Some shady religious nut can forge those in a second. I keep on thinking this country can't sink any lower, but I get proven wrong over and over again. Let's hope that the next piece of legislation doesn't do away with the whole birth certificate thing and instead require a baptismal certificate.

Translation: A black man with a funny-sounding name couldn't possibly be an American.

House of God

With my time off, I recently started rereading Samuel Shem's House of God (must read for any medical type that hasn't read it yet). A novel about an intern learning the truth about how things work in the hospital. It has a lot of dark humor in it, but there's a lot that (even as a med student), I could tell is based on a grain of truth. For example, the type of patients you see at the hospital. You'd think that they'd be a cross-section of the population, but they aren't. I assume it's because those with repeat hospitalizations aren't exactly your average Joes. Upon meeting the patient who hides under the covers whenever his discharge is discussed or the patient that wants to keep his rectal tube in because he's too lazy to get out of bed to go to the bathroom, I was immediately reminded of the characters in the book. I wouldn't like to get to the point where I think about my patients as GOMERS or follow the Fat Man's Laws, but at least some of my experiences with medicine so far say that I may have to face days where it'll get close.

Here are the Fat Man's Laws (courtesy of Wikipedia):

1. GOMERS DON’T DIE.
2. GOMERS GO TO GROUND.
3. AT A CARDIAC ARREST, THE FIRST PROCEDURE IS TO TAKE YOUR OWN PULSE.
4. THE PATIENT IS THE ONE WITH THE DISEASE.
5. PLACEMENT COMES FIRST.
6. THERE IS NO BODY CAVITY THAT CANNOT BE REACHED WITH A #14G NEEDLE AND A GOOD STRONG ARM.
7. AGE + BUN = LASIX DOSE.
8. THEY CAN ALWAYS HURT YOU MORE.
9. THE ONLY GOOD ADMISSION IS A DEAD ADMISSION.
10. IF YOU DON’T TAKE A TEMPERATURE, YOU CAN’T FIND A FEVER.
11. SHOW ME A BMS (Best Medical Student, a student at the Best Medical School) WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.
12. IF THE RADIOLOGY RESIDENT AND THE MEDICAL STUDENT BOTH SEE A LESION ON THE CHEST X-RAY, THERE CAN BE NO LESION THERE.
13. THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE.

I would really like to think that #12 isn't true.