Glad we're vaccinated

Passenger on flight from Baltimore to San Diego had infectious measles, officials warn

With all the recent flying, I'm glad my one-year-old is fully up to date with his vaccines. As the San Diego County health officer said, "Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected."

By the way, I had an interesting discussion with an autism expert recently and he concluded that with more and more evidence that signs of autism are detectable well before the age of one (and the likely development of techniques to detect autism in infants in the near future), the anti-vacciners will have to come up with another excuse for putting their kids at risk of getting terrible communicable diseases.

Computer overlords

Oh, no. NPR, you did it again. I've said before that journalists make terrible science reporters, but this is just bad. A computer beat two Jeopardy champions pretty easily. It was an interesting game to watch and an amazing feat of technology, but Martin Ford, a computer programmer and writer decided that winning at a game show is enough evidence to show that computers can take over medicine, emphasizing on radiology. He said, "Radiologists basically focus on looking at visual images from medical devices — things like X-rays or CAT scans, that type of thing. Now, machines are getting much better at analyzing that type of visual information."

Arrgh! Radiology is not just looking at images. It isn't even just pattern recognition. It's putting together information from a vast number of sources (patient history, previous scans, pathology, physical properties of the imaging technique, variances in image acquisition, positioning of patient, etc.) To be an effective radiologist, you can't just look at every image with the same formula (if you can, who needs a radiologist?). That's a start, but personal experience at interpreting images and intuition about what the image and patient history points to adds a lot. It's that intuition that looks more closely at an image or orders a different view that makes the diagnosis.

I don't doubt that computers will eventually able to do this, but just because one won at Jeopardy, doesn't mean that it can start replacing radiologists. In reality, if computers get good enough to accurately interpret all types of images (at least with the same accuracy of radiologists), then they'll be good enough to take an effective history, perform a physical exam, order and interpret appropriate lab tests, perform procedures or even surgery and prescribe medications. The only medical specialty that would be safe is psychiatry (that is, until it starts using real science also). I don't see that happening in my lifetime, and if it does, we'll be living in a pretty different world.

Looking back at the match process

It is not necessary to read this book.

OK, so we're finally getting towards the end of this crazy "match" process to get into a residency program. I think I've got my rank list down and I'll find out where I end up in March. Now that I've got about a month to wait, I could reflect back on the process. Here are some general thoughts:


1. Interviews
Interviews were a lot of fun and, at least in radiology, almost completely stress free. Those interview preparation questions that the school provided us with were pretty much useless. The conversation-like interviews I had with faculty really helped me get to know a program and helped me let them know the kind of person I am. The few "standard" interviews I had were very awkward for both parties and probably not very helpful for either (especially, the one where one faculty member was interviewing two applicants at once). Some quick points: At first I started reading about the faculty at the institution, but I gave up on it pretty quickly. I never had to bring it up and the casual conversations we were having were much better. Buying and carrying a leather portfolio was useless. I never had to pull out a CV or research paper. I lost it half-way through the interview process and never bothered getting another one. There will be "illegal" questions (especially, "where else are you applying?"). I also once got asked what religion I was ("none" was the response, in case you were wondering).

2. Traveling
Holy crap this is expensive. I went to 10 radiology interviews and 9 intern year interviews. Some I drove to, some I flew to. A few places provided a hotel room, most didn't. I kept track of the total cost and I just hit $3000. Add to that the application fees and it gets close to $4000. That's why most people take a loan. A couple of tips: Southwest is awesome (cheap, free bags, can cancel/change without a penalty; it doesn't get better). Renting a car is often cheaper than taking cabs everywhere and it gives you a chance to explore the town. Signing up for frequent flyer and hotel loyalty programs pays off, even if you end up not using the points. I got nice hotel upgrades and free perks (drinks, snacks, higher floor) just because I attached a number to my name. Trying to cluster all the interviews in one region together is nice, but will probably end up to be impossible. TSA sucks, though, I found out that if you freeze your liquids, you can take more than 3 ounces.

3. Research experience
With 10 years of research under my belt, I thought I'd get most questions about my work. Unfortunately, most radiology programs don't care about it (some even see it as a liability in residents). They just want you to check off that box. For example, a top-tier program that has amazing research claimed that all their residents complete a research project during their stay. When I asked how much research time they get, the answer was "7 days a year" (really? It takes me 7 days just to pick a background for my computer station). Something like 75 to 80% of radiology residents go into private practice, so it doesn't matter to them. However, it really hurts the field. With procedures and image interpretation being constantly taken away from radiologists by other fields (cardiologists read echos, vascular surgeons do interventional procedures, ER physicians perform and interpret their own ultrasounds), the future of radiology as a field depends on innovation. When research is shunned by training programs, the innovation will be taken by other departments also.

4. Intern year
So useless. From every radiologist I've heard that it has had no impact on their ability to be an effective radiologist. I applied to lots of intern year programs (some easy, some tough) so that I could live in the same city for both intern year and the radiology years, but it's unlikely that I'll be able to pull it off. That's OK, though. A brilliant comment I heard from a resident was "It's better to lose a weekend moving than to lose every weekend because you chose a tough intern year so that you could stay in the same city." I got some great intern year interviews, but if I could do it again, I wouldn't take location into consideration.

5. Rank lists
People really talk as if there's a strategy to it. There is none, just put the programs in order of your preference. It makes no difference if your number one is a long shot.

6. It's a big game.
By that, I mean that there are specific things that you should do to get an interview or to be considered for a position. These things have no relation to your strength as an applicant, but if you don't do it, your chances at matching may be hurt. For example, there are letters of interest, sending thank-you notes, sending "love letters". Towards the end of November or early December comes a point when you start getting worried about the number of interviews you've gotten and you haven't heard from some of your favorite places. At this point, sending a letter of interest can get you an interview. It really makes no sense (I mean, you applied there, so you're interested, right?), but it makes a big difference to some people. I've heard of a program where they won't interview anyone who doesn't send a letter of interest. I suppose it's to separate people who really want to go to the program from those that are applying to every program in the country (it happens), but if there's an unspoken rule that you must send a letter of interest (after actually applying) to be considered by a program, you might as well make it part of the application process. "Love letters" can go either way. Applicants can tell a program that they will be ranking that program first and programs can tell applicants they are raking them high. What either party says, however, from what I've heard, means absolutely nothing. Programs want to tell lots of applicants that they're ranking them high to get applicants to rank them high, so they can brag about getting their first choices. ... I could go on and on about this, but suffice it to say that the whole process leaves me with a bad taste in my mouth.

7. Med school
It falls to the background. There is no way I'd be able to go to all these interviews and still be on a clerkship. I'm glad I set up my schedule to maximize my time off during 4th year. Speaking of 4th year, the great thing about it is that pretty much everything is self-run. Your grade doesn't matter anymore, so it's all for fun and interest. The bad thing is that, unless you want to have a horrific 3rd year-like schedule, it consists of an awful lot of shadowing. It makes you burn out pretty quickly. Oh well, only a few more months.

Revolution fever

A lot of people are excited about the overthrowing of dictators in the middle east. Tunisia did it and Egypt is in the process. Some (idiots) are crediting the U.S.'s policy of trying to "spread democracy" in the middle east (starting with Iraq). A called on NPR wanted to credit Bush for Tunisia's revolution, but luckily, the guest shot him down quickly. The guest said that it actually proves the opposite of what Bush was trying to do. You get effective regime change when you don't interfere (Tunisia) and you get failed regime change when an outside force is interfering (Iraq). Whatever the cause, these revolutions are exciting. Although, I fear that something very similar to Iran in the late 1970's will happen. A popular, largely secular uprising will pave the way for an Islamic Theocracy. Let's hope it doesn't.

Not another "miracle"!

Crazy interview season has kept this blog quiet. Well, I'm done with radiology interviews and only one more intern year interview left. I'll have an update soon. I'm sure no one is left to read the blog, but whatever... I'll vent about the latest "miracle" I heard about. This is from NPR:

BRADY: At times during today's briefing, Drs. Rhee and Lemole were almost giddy. And in undoctor-like fashion, Lemole said Giffords' progress may be partially attributable to outside forces.

Dr. LEMOLE: Miracles happen every day. And in medicine, we like to very much attribute them to either what we do or others do around us. But a lot of medicine is outside of our control, and we're wise to acknowledge miracles.

Dr. Lemole, sir, you are an idiot. A lot of medicine may be outside our control (especially when it comes to recovery from brain injury), but there is no such thing as a miracle. Just because you don't know how something works, doesn't make it a miracle. This is an even less appropriate thing to say when you have no idea what her long-term condition will be. I move that any doctor who attributes the recovery of any of their patients to a "miracle" should not receive any monetary compensation for taking care of that patient. Clearly, they admitted that they didn't do anything.

It's bad enough that an imaginary deity gets all the credit when the hard work of a physician saves someone's life, but it really upsets me when physicians go around accepting that.

(A real miracle would be if the right wing nuts who have been spitting out violent rhetoric for the last few years actually admitted that what they say can affect what another nut does.)

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.