Wednesday, December 31, 2008
Sunday, December 28, 2008
5 Most Stressful Medical Specialties
1. General Surgery - perhaps I'm biased by the training, but I think given the career, it seems like a lot of stress, considering the income and hours down the road.
As for the least stressful medical specialty, I don't think you can wrong with the old "ROAD" mnemonic (radiology, ophthalmology, anesthesia, and dermatology). Some people would also throw pathology (heh, PATH / ROAD, get it?) and emergency medicine in there as well. While all are competitive to train for, I think the lifestyle down the road more than makes up for it, leading to less stress overall.
Saturday, December 27, 2008
Books For Surgery Core Clerkship / Rotation
For any rotation, I would suggest starting off by reading a clinical vignettes book initially, to get familiar with the cases seen most commonly by the specialty. Then, read a general textbook or review to learn more details about the patients and procedures. Finally, do practice questions in the weeks leading up to the test to solidify your knowledge. These principles are especially important during the surgery core clerkship, when your time is limited. Here are the books I used primarily:
Essentials of General Surgery
by Peter F. Lawrence
by Eugene Toy
For me, these books either overlapped with the ones I listed above, or were too advanced for my tastes. However, if you are interested in surgery or want to honor the surgery clerkship, then it is worth considering whether you want to obtain these texts. Sorry to those of you who see the list twice; the images do not show up in some browsers.
Find other books useful on your surgery clerkship? What books helped you the most on the surgery shelf exam? Share your knowledge!
Friday, December 26, 2008
Thursday, December 25, 2008
Wednesday, December 24, 2008
Tuesday, December 23, 2008
Monday, December 22, 2008
Sunday, December 21, 2008
A recent post claims that Japanese scientists have discovered how to extract images directly from one's brain.
The scientists were able to reconstruct various images viewed by a person by analyzing changes in their cerebral blood flow. Using a functional magnetic resonance imaging (fMRI) machine, the researchers first mapped the blood flow changes that occurred in the cerebral visual cortex as subjects viewed various images held in front of their eyes. Subjects were shown 400 random 10 x 10 pixel black-and-white images for a period of 12 seconds each. While the fMRI machine monitored the changes in brain activity, a computer crunched the data and learned to associate the various changes in brain activity with the different image designs.
Sometimes I feel like everything important that needs to be developed has been already, but stories like this renew my hope in what lies ahead. Even if we understand how MRI works, we are still far away from understanding how the human brain functions. I can't imagine how such technology will develop over the next 10 - 20 years.
(Image Source: PinkTentacle)
He said their reaction was understandable, given that the museum’s collection includes abstract art, which he disdains. “I am a huge threat because what I have done renders everything they have junk,” he said beneath the glinting chandeliers in his great hall. “I hope that doesn’t sound arrogant but the reaction of people who come in here tells me the power of it.”
Saturday, December 20, 2008
Friday, December 19, 2008
- 12-13 years of primary education
- 4 years of college
- 4 years of medical school
- 1 year of internship
- 4 years of diagnostic radiology residency
- Possibly 1-2 years of radiology subspecialty fellowship
Thursday, December 18, 2008
Wednesday, December 17, 2008
- A Stethoscope - An excellent gift, especially for first or second year students who have yet to enter clinical rotations. Stethoscopes can be somewhat pricey on a student budget, but a nice one makes for a great investment. There's a wide selection of stethoscopes out there though, so shop around for one that makes the most sense for what your gift recepient is interested in. I personally have a Littmann Cardiology III (black) and think it's great. It's high quality, durable, and good for general use (which means, for most medical students). Plus, it looks quite professional.
- First Aid for the USMLE Step 1 2009 - Heh, to the person you'd rather see spend the holiday in the library. Still, I kind of wish I'd started looking at this earlier during medical school, so it really would be practical
- Palm TX Handheld - A nice tool to have around on rounds, especially with Epocrates loaded on it. Any time your patient is put on a new funny-sounding medicine, you can quickly look it up, as well as add notes about the drug. There is a lot of other medically-related software out there for the Palm as well, such as patient tracking software.
- Medically-Related Leisure Reading - Sometimes, when a medical student wonders "Why am I going through all this?" it's nice to read a regular book addressed to a general audience about medicine and why doctors do what they do. My favorites are:
- How Doctors Think by Jerome Groopman
- Complications: A Surgeon's Notes on an Imperfect Science by Atul Gawande
- Better: A Surgeon's Notes on Performance by Atul Gawande as well
- USMLE Step I Qbank - If you know your gift's recepient is a second year medical student and about to take USMLE Step I, consider paying for a QBank for them. There are several options out there, but Kaplan is one of the most popular. Have them try out the service before purchase with the Qbank Challenge, which lets them do a sample test of 10 or so questions (the full Qbank has 2000+ questions):
- Amazon.com Gift Card - The reality of medical school is that any medical student will have to study A LOT. To do so, this requires textbooks and review guides. An Amazon gift card will help any student easily purchase the texts and reviews they need, which can be a significant cost of medical education for a student, after tuition.
Tuesday, December 16, 2008
Monday, December 15, 2008
Sunday, December 14, 2008
- If the program has an agreement with a hotel for a special rate, try to utilize it. However, still shop around because you might actually be able to save more if you book it yourself via an online discount site like Hotwire.
- If someone in your family or you yourself has a AAA membership, use it! You can save 5-15% at many hotels with a AAA card.
- If you are a member of AMSA, they also offer savings up to 15% at select hotels.
Saturday, December 13, 2008
Well, two sites I would recommend are Kayak and TripAdvisor. Both sites let you quickly comparison shop between several discount sellers online. Nice features include searching around an address, which lets you enter the address of your interview location in, and then find hotels nearby. Kayak also has helpful mobile apps for iPhone/Android phone useres. Another suggestion would be to try to group your reservations so that you're booking from one site. For example, if you book 10 nights with Hotels.com, you get an 11th night free (with some restrictions, of course).
Anyone else have any good tips or website recommendations?
(Image Source: Airline-Discount-Fare.com)
Friday, December 12, 2008
Sounds like the blogger is a former 'poor' medical student who applied to a competitive field (radiology) and had to really watch every penny because (s)he has a family and three kids to take care of. Anyway, maybe some of you will find it helpful.
Thursday, December 11, 2008
Wednesday, December 10, 2008
In a good mood? Your neighbor, her friends and even her friends' friends should thank you – you're likely infecting them with your cheer. Happiness spreads through social networks about as easily as the flu, according to a new study.
The researchers analyzed data compiled from nearly 5,000 interconnected people over a 20-year period. After establishing a baseline mood for each participant, the team found that when one person became happier, it rippled through the network, increasing the likelihood that others would become happier too.
Sadness, thankfully, is not nearly as infectious. An attack of the blues creates a much smaller ripple than a case of giddiness, said head researcher James Fowler of the University of California, San Diego.
Tuesday, December 09, 2008
The sedated patient, his bullet wounds still fresh from a shootout the night before, was lying on a gurney in the intensive care unit of a prestigious private hospital here late last month with intravenous fluids dripping into his arm. Suddenly, steel-faced gunmen barged in and filled him with even more bullets. This time, he was dead for sure.Hit men pursuing rivals into intensive care units and emergency rooms. Shootouts in lobbies and corridors. Doctors kidnapped and held for ransom, or threatened with death if a wounded gunman dies under their care. With alarming speed, Mexico’s violent drug war is finding its way into the seeming sanctuary of the nation’s hospitals, shaking the health care system and leaving workers fearing for their lives while trying to save the lives of others.“Remember that hospital scene from ‘The Godfather?’ ” asked Dr. Héctor Rico, an otolaryngologist here, speaking about the part in which Michael Corleone saves his hospitalized father from a hit squad. “That’s how we live.”An explosion of violence connected with Mexico’s powerful drug cartels has left more than 5,000 people dead so far this year, nearly twice the figure from the year before, according to unofficial tallies by Mexican newspapers. The border region of the United States and Mexico, critical to the cartels’ trafficking operation, has been the most violent turf of all, with 60 percent of all killings in the country last month occurring in the states of Chihuahua and Baja California, the government says. And it has raised fears that violence could spill across the border, because dozens of victims of drug violence have been treated at an El Paso hospital in the last year.
I have not really followed the whole immigration / border security debate, but if we start drug wars in our hospitals, perhaps I should pay more attention. What was that talk about a wall again?
Monday, December 08, 2008
At any rate, I have a humble proposal: Interview Day(s). Initially, the idea was to mirror Match Day and have a single day on which all programs release their interview invitations. Since Dean's Letters go out on November 1, a date like November 15 would seem reasonable. However, one can imagine the chaos that would ensue on that day. Discussions with friends led to an evolution in the thought. Instead of having a single day, perhaps the 4 Mondays in November could each be a single wave of interviews. Each wave would represent a region of the country, and all the programs in that region would release their interview invites on that day. While this may stress some programs, I would imagine applicants would find this beneficial for two main reasons. First, it would remove some of the uncertainty regarding when one should expect to hear from a program. Second, if you hear from all the program in one region at the same time, it makes it MUCH easier to coordinate your travel plans so that you are not repeatedly traveling back and forth across the country. Of course, the region going last would be at a disadvantage but possible remedies include rotating which region goes last every year. While I'm sure programs would not be in favor of this system because of institutional inertia, I cannot see how it would significantly change how they decide who to initially interview. If applicants benefit, and the cost to programs in terms of effort is relatively minimal, such a change should be made. I'm sure I'm missing something here, but the idea seems like it is worth consideration.
Sunday, December 07, 2008
In a study recently accepted for publication by the Journal of Cognitive Neuroscience, scientists at UC Berkeley's Helen Wills Neuroscience Institute and the School of Public Health report that normal 9- and 10-year-olds differing only in socioeconomic status have detectable differences in the response of their prefrontal cortex, the part of the brain that is critical for problem solving and creativity.(Lee Michael Perry/UC Berkeley)Brain function was measured by means of an electroencephalograph (EEG) - basically, a cap fitted with electrodes to measure electrical activity in the brain - like that used to assess epilepsy, sleep disorders and brain tumors.
"Kids from lower socioeconomic levels show brain physiology patterns similar to someone who actually had damage in the frontal lobe as an adult," said Robert Knight, director of the institute and a UC Berkeley professor of psychology. "We found that kids are more likely to have a low response if they have low socioeconomic status, though not everyone who is poor has low frontal lobe response."
Saturday, December 06, 2008
For the skeptics:
Friday, December 05, 2008
Almost one-third of the world’s people don’t get enough iodine from food and water. The result in extreme cases is large goiters that swell their necks, or other obvious impairments such as dwarfism or cretinism. But far more common is mental slowness.When a pregnant woman doesn’t have enough iodine in her body, her child may suffer irreversible brain damage and could have an I.Q. that is 10 to 15 points lower than it would otherwise be. An educated guess is that iodine deficiency results in a needless loss of more than 1 billion I.Q. points around the world.
It's sad to think how so many things we take for granted, like iodized salt or chlorinated water, are luxuries in other parts of the world. It frustrates me when people knock government or public health initiatives and completely ignore all the benefits that such efforts have brought us. Hopefully articles like this one will spur philanthropic organizations like the Gates Foundation to pay more attention to this issue. As much as AIDS is a global health issue, one wishes that causes like potable water or adequate nutrition would receive equal attention.
Thursday, December 04, 2008
Wednesday, December 03, 2008
While reading random blogs online (Daily Dish, if you must know), I came across an interesting story about a woman with "perfect memory":
Price can rattle off, without hesitation, what she saw and heard on almost any given date. She remembers many early childhood experiences and most of the days between the ages of 9 and 15. After that, there are virtually no gaps in her memory. "Starting on Feb. 5, 1980, I remember everything. That was a Tuesday."
She can also date events that were reported in the media, provided she heard about them at the time. When and where did the Concorde crash? When was O.J. Simpson arrested? When did the second Gulf war begin? Price doesn't even have to stop and think. She can effortlessly recite the dates, numbers and entire stories.
"People say to me: Oh, how fascinating, it must be a treat to have a perfect memory," she says. Her lips twist into a thin smile. "But it's also agonizing."
In addition to good memories, every angry word, every mistake, every disappointment, every shock and every moment of pain goes unforgotten. Time heals no wounds for Price. "I don't look back at the past with any distance. It's more like experiencing everything over and over again, and those memories trigger exactly the same emotions in me. It's like an endless, chaotic film that can completely overpower me. And there's no stop button."
She's constantly bombarded with fragments of memories, exposed to an automatic and uncontrollable process that behaves like an infinite loop in a computer. Sometimes there are external triggers, like a certain smell, song or word. But often her memories return by themselves. Beautiful, horrific, important or banal scenes rush across her wildly chaotic "internal monitor," sometimes displacing the present. "All of this is incredibly exhausting," says Price.
Based on other research I have read casually, it seems that we evolved the ability to selectively remember items because it helped with learning. Having too much information was not beneficial. As the article notes, Price's episodic memory is nearly flawless, but her semantic memory (the memory associated with learning facts and concepts) is average, which is why she did not stand out in school. Still, if she exists, there are likely people with nearly flawless semantic memory, right? The whole thing makes one wonder where the true limits of human ability lie.
Monday, December 01, 2008
When Donna Campiglia learned recently that a genetic test might be able to determine which sports suit the talents of her 2 ½-year-old son, Noah, she instantly said, Where can I get it and how much does it cost?
“I could see how some people might think the test would pigeonhole your child into doing fewer sports or being exposed to fewer things, but I still think it’s good to match them with the right activity,” Ms. Campiglia, 36, said as she watched a toddler class at Boulder Indoor Soccer in which Noah struggled to take direction from the coach between juice and potty breaks.
“I think it would prevent a lot of parental frustration,” she said.
In health-conscious, sports-oriented Boulder, Atlas Sports Genetics is playing into the obsessions of parents by offering a $149 test that aims to predict a child’s natural athletic strengths. The process is simple. Swab inside the child’s cheek and along the gums to collect DNA and return it to a lab for analysis of ACTN3, one gene among more than 20,000 in the human genome.The test’s goal is to determine whether a person would be best at speed and power sports like sprinting or football, or endurance sports like distance running, or a combination of the two. A 2003 study discovered the link between ACTN3 and those athletic abilities.
The whole thing seems like a money-making scam to me. I say scam because the entire concept discounts the notions of practice, a work ethic, and intelligence in athletics. Except for certain endeavors, like weightlifting perhaps, raw athletic ability will only get an athlete so far. Beyond that, other factors come into play to determine success. I worry that children with "good" results will face even more pressure from their sports-crazed parents to perform up to expectations.
Thursday, November 27, 2008
Harry Houdini died of peritonitis secondary to a ruptured appendix. It has been speculated that Houdini was killed by a McGill University student, J. Gordon Whitehead, who delivered multiple blows to Houdini's abdomen while he was in Montreal.
The eyewitnesses were students named Jacques Price and Sam Smilovitz (sometimes called Jack Price and Sam Smiley). Their accounts generally agreed. The following is according to Price's description of events. Houdini was reclining on his couch after his performance, having an art student sketch him. When Whitehead came in and asked if it was true that Houdini could take any blow to the stomach, Houdini replied in the affirmative. In this instance, he was hit three times, before Houdini protested. Whitehead reportedly continued hitting Houdini several times afterwards, and Houdini acted as though he were in some pain. Price recounted that Houdini stated that if he had had time to prepare himself properly, he would have been in a better position to take the blows. Although in serious pain, Houdini nonetheless continued to travel without seeking medical attention. Harry had apparently been suffering from appendicitis for several days and refusing medical treatment. His appendix would likely have burst on its own without the trauma.
When Houdini arrived at the Garrick Theater in Detroit, Michigan, on October 24, 1926, for what would be his last performance, he had a fever of 40°C degrees (104 F). Despite a diagnosis of acute appendicitis, Houdini took the stage. He was reported to have passed out during the show, but was revived and continued. Afterwards, he was hospitalized at Detroit's Grace Hospital. Houdini died of peritonitis from a ruptured appendix at 1:26 p.m. in Room 401 on October 31 (Halloween), 1926, at the age of 52.After taking statements from Price and Smilovitz, Houdini's insurance company concluded that the death was due to the dressing-room incident and paid double indemnity.
Anyway, case solved. Happy Thanksgiving!
Monday, November 24, 2008
Soon after Antonio Torres, a husky 19-year-old farmworker, suffered catastrophic injuries in a car accident last June, a Phoenix hospital began making plans for his repatriation to Mexico.
Mr. Torres was comatose and connected to a ventilator. He was also a legal immigrant whose family lives and works in the purple alfalfa fields of this southwestern town. But he was uninsured. So the hospital disregarded the strenuous objections of his grief-stricken parents and sent Mr. Torres on a four-hour journey over the California border into Mexicali.
For days, Mr. Torres languished in a busy emergency room there, but his parents, Jesús and Gloria Torres, were not about to give up on him. Although many uninsured immigrants have been repatriated by American hospitals, few have seen their journey take the U-turn that the Torreses engineered for their son. They found a hospital in California willing to treat him, loaded him into a donated ambulance and drove him back into the United States as a potentially deadly infection raged through his system.
By summer’s end, despite the grimmest of prognoses from the hospital in Phoenix, Mr. Torres had not only survived but thrived. Newly discharged from rehabilitation in California, he was haltingly walking, talking and, hoisting his cane to his shoulder like a rifle, performing a silent, comic, effortful imitation of a marching soldier.
“In Arizona, apparently, they see us as beasts of burden that can be dumped back over the border when we have outlived our usefulness,” the elder Mr. Torres, who is 47, said in Spanish. “But we outwitted them. We were not going to let our son die. And look at him now!”
Antonio Torres’s experience sharply illustrates the haphazard way in which the American health care system handles cases involving uninsured immigrants who are gravely injured or seriously ill. Whether these patients receive sustained care in this country or are privately deported by a hospital depends on what emergency room they initially visit.There is only limited federal financing for these fragile patients, and no governmental oversight of what happens to them. Instead, it is left to individual hospitals, many of whom see themselves as stranded at the crossroads of a failed immigration policy and a failed health care system, to cut through a thicket of financial, legal and ethical concerns.
While one can empathize to some degree with hospitals that do not have the funds to adequately care for patients with questionable legal status, knee-jerk deportations are certainly not the solution. While deportations may be necessary in some cases, they should clearly be a last resort and even then, only instituted by the proper legal authorities, not in an unregulated manner by hospitals. The problem is systemic, but it is one we should all be ashamed of.. Patients, legal or not, deserve better.
Wednesday, November 19, 2008
In February 2005, Rita Miller, a party organizer in Chesapeake, Va., felt exhausted from what she thought was the flu. She was stunned to learn that persistent high blood pressure had caused such severe kidney damage that her body could no longer filter waste products from her blood.
“The doctor walked over to my bed and said, ‘You have kidney failure — your kidneys are like dried-up peas,’ ” recalled Ms. Miller, now 65, who had not been to a doctor or had her blood pressure checked for years.
“The doctor said, ‘Get your family here right away,’ ” she said. “They were telling me I might not make it. I was in shock. I started dialysis the next day.”
Ms. Miller, who has since moved to Connecticut to be with her children, was one of the millions of Americans unaware that they are suffering from chronic kidney disease, which is caused in most cases by uncontrolled hypertension (as in her case) or diabetes, and is often asymptomatic until its later stages. The number of people with the disease — often abbreviated C.K.D. — has been rising at a significant pace, thanks in large part to increased obesity and the aging of the population.An analysis of federal health data published last November in The Journal of the American Medical Association found that 13 percent of American adults — about 26 million people — have chronic kidney disease, up from 10 percent, or about 20 million people, a decade earlier.
It is clear why CKD has a great impact on patients' lives, but why does chronic kidney disease have such a large impact on the system?
In 2005, more than 485,000 people were living on dialysis or with a transplant, at a total cost of $32 billion. Medicare pays for much of that, because it provides coverage for patients needing dialysis or transplant even if they are not yet 65. In fact, kidney disease and kidney failure account for more than a quarter of Medicare’s annual expenditures.In other words, unlike almost any other disease, the federal government fully covers treatment for nearly everyone requiring dialysis, due to a quirk in the law. Therefore, moreso than any other condition, CKD becomes a disease that society as a whole must grapple with, especially as its incidence rises.
Tuesday, November 18, 2008
Jules the Robot is the first humanoid robot (see video at bottom of the page after the jump). This isn't particularly related to medicine, but I just found the video so eerie I thought I should post it:
Scientists have created the first 'humanoid' robot that can mimic the facial expressions and lip movements of a human being.
'Jules' - a disembodied androgynous robotic head - can automatically copy the movements, which are picked up by a video camera and mapped on to the tiny electronic motors in his skin.
It can grin and grimace, furrow its brow and 'speak' as his software translates real expressions observed through video camera 'eyes'.
As I said, this isn't directly medically related, but one can envision this technology being used to make more realistic robots for students and residents to train on, with the "patient" robot grimacing if students examine it too roughly, or laughing if they're being tickled. Advances like this also make me wonder whether medical ethics can keep up with the pace of innovation.
Image Credit: The Daily Mail
Monday, November 17, 2008
There is a new common symptom of the flu, in addition to the usual aches, coughs, fevers and sore throats. Turns out a lot of ailing Americans enter phrases like “flu symptoms” into Google and other search engines before they call their doctors.
That simple act, multiplied across millions of keyboards in homes around the country, has given rise to a new early warning system for fast-spreading flu outbreaks, called Google Flu Trends.
Tests of the new Web tool from Google.org, the company’s philanthropic unit, suggest that it may be able to detect regional outbreaks of the flu a week to 10 days before they are reported by the Centers for Disease Control and Prevention.
In early February, for example, the C.D.C. reported that the flu cases had recently spiked in the mid-Atlantic states. But Google says its search data show a spike in queries about flu symptoms two weeks before that report was released. Its new service at google.org/flutrends analyzes those searches as they come in, creating graphs and maps of the country that, ideally, will show where the flu is spreading.The C.D.C. reports are slower because they rely on data collected and compiled from thousands of health care providers, labs and other sources. Some public health experts say the Google data could help accelerate the response of doctors, hospitals and public health officials to a nasty flu season, reducing the spread of the disease and, potentially, saving lives.
Seems like a smart idea. I wonder if Google will apply this to other diseases as well. Going beyond infectious diseases, what if Google were to track search queries related to other potential 'trends' like teen pregnancy? Should raise some interesting questions about how to utilize this technology for public health issues while respecting the privacy of Google users.
Friday, November 14, 2008
The cult of popularity that reigns in high school can look quaint from a safe distance, like your 20th reunion. By then the social order may have turned over like an hourglass: teenagers who were socially invisible have emerged as colorful characters, confident, transformed. Others seem preserved in time, same as ever, while some former princes and queen bees are diminished or simply absent, now invisible themselves.For years researchers focused much attention on those prominent teenagers, tracking their traits and behaviors. The studies found, to no one’s surprise, that social dominance in adolescence often involves an aggressive, selfish streak that may not play well outside the locker-lined corridors.The cult disbands, and the rules change.Yet high school students know in their gut that popularity is far more than a superficial, temporary competition, and in recent years psychologists have confirmed that intuition. The newer findings suggest that adolescents’ niche in school — their popularity, and how they understand and exploit it — offers important clues to their later psychological well-being.