Wednesday, August 31, 2011
Peds: day 3
We had our first 1-on-1 feedback sessions with our attending today. Today being only the 3rd day I'm on his service! It took 6 weeks (of a 8 week rotation) for me to get feedback on my internal medicine rotation. Summary: I still LOVE peds!
Tuesday, August 30, 2011
Peds: day 2
What I learned today is that cranky children can be soothed by continuing with their familiar routines. A crying toddler while obtaining an H&P from his mother may be crying simply because he missed his breakfast, not necessarily because I'm in the room. The same child was a blissed out cuddly monkey, patiently cooperating with this 3rd year medical student haphazardly conducting my first pediatric physical exam; all because I excused myself from the room so he could have breakfast before I proceeded.
A slightly older child required some teasing about having a dragon in his ear, and pretending to look in my ear, before he let me proceed with the otoscope. There is lots of goofing around, taking time to explain things to parents and then again to the child on a level they understand, and time outs to clean up pee or vomit that were projected across the room. It is all about the children when on peds: their schedules, their cooperation, their level of understanding. So far, and not surprisingly, I LOVE it!
What are your tricks for working with the little tykes in both in & out-patient settings?
A slightly older child required some teasing about having a dragon in his ear, and pretending to look in my ear, before he let me proceed with the otoscope. There is lots of goofing around, taking time to explain things to parents and then again to the child on a level they understand, and time outs to clean up pee or vomit that were projected across the room. It is all about the children when on peds: their schedules, their cooperation, their level of understanding. So far, and not surprisingly, I LOVE it!
What are your tricks for working with the little tykes in both in & out-patient settings?
Thursday, August 25, 2011
Let us reinvision institutional norms instead of simple reform
"In 2000, the British psychologist James Reason wrote that medical systems are stacked like slices of Swiss cheese; there are holes in each system, but they don’t usually overlap. An exhausted intern writes the wrong dose of a drug, but an alert pharmacist or nurse catches the mistake. Every now and then, however, all the holes align, leading to a patient’s death or injury. "
This quote is from The Phantom Menace of Sleep-Deprived Doctors which was published in the NYT magazine earlier this month. I finally got around to reading it today. (dearest gf: sorry for letting it sit in my inbox so long) I also happened to stumble across this video today, which is an awesome visualization of a powerful speech given by Sir Ken Robinson. Read then watch, or watch then read. Let the two sources simmer together in your brain.
When watching the video all I could think about is how relevant the issue is to medical education. The standardized testing, the individualization, the pacified boring lectures- yep, that sums up my last 2 years. Sure, schools now are going all out to include group sessions, simulation centers, case-based education; butt it isn't enough. Overall though, they are still working within the old system of education, still limited by the boxed in ideology of our forefathers. There are schools, programs, that are drastically different such as the Program for Integrated Learning (PIL) at Drexel, but they are few and far between.
Looking at the article in collaboration with the video, it illuminates the undertone that drastic change is needed. Passing new work hour regulations may be helpful but it is not actually addressing the underlying problem and is actually causing all new problems with hand off. So now the powers that be need to formalize hand-offs, need to expand the length of residency programs so budding doctors can see all they need to, need to come up with night-time formal curriculum so that those on extended night float don't miss out... and the list goes on. But will filling these holes really solve the problem? Or will it just expose other holes that already exist in the system and create new ones?
I'm enamored by medical education. This interest fueled my decision to do my clinical years at my school's satellite site. We're learning in a new model, one that involves more kinesthetic and team based learning, one that reads more like an apprenticeship than traditional 3rd year clinical rotations. This out-pouching of our medical school also challenges us to be non-traditional, to think outside the box, and to come up with innovative revisions to the medical community in this city.
From being at the satellite site, from watching the video, and reading the article, I'm inspired to think outside the box. I hope that others are too and that we can collaborate to create tangible change in the future. I want to challenge more divergent thinking for those involved in medical education, that is if they (if we) can tap into our inner-kindergartner.
This quote is from The Phantom Menace of Sleep-Deprived Doctors which was published in the NYT magazine earlier this month. I finally got around to reading it today. (dearest gf: sorry for letting it sit in my inbox so long) I also happened to stumble across this video today, which is an awesome visualization of a powerful speech given by Sir Ken Robinson. Read then watch, or watch then read. Let the two sources simmer together in your brain.
When watching the video all I could think about is how relevant the issue is to medical education. The standardized testing, the individualization, the pacified boring lectures- yep, that sums up my last 2 years. Sure, schools now are going all out to include group sessions, simulation centers, case-based education; butt it isn't enough. Overall though, they are still working within the old system of education, still limited by the boxed in ideology of our forefathers. There are schools, programs, that are drastically different such as the Program for Integrated Learning (PIL) at Drexel, but they are few and far between.
Looking at the article in collaboration with the video, it illuminates the undertone that drastic change is needed. Passing new work hour regulations may be helpful but it is not actually addressing the underlying problem and is actually causing all new problems with hand off. So now the powers that be need to formalize hand-offs, need to expand the length of residency programs so budding doctors can see all they need to, need to come up with night-time formal curriculum so that those on extended night float don't miss out... and the list goes on. But will filling these holes really solve the problem? Or will it just expose other holes that already exist in the system and create new ones?
I'm enamored by medical education. This interest fueled my decision to do my clinical years at my school's satellite site. We're learning in a new model, one that involves more kinesthetic and team based learning, one that reads more like an apprenticeship than traditional 3rd year clinical rotations. This out-pouching of our medical school also challenges us to be non-traditional, to think outside the box, and to come up with innovative revisions to the medical community in this city.
From being at the satellite site, from watching the video, and reading the article, I'm inspired to think outside the box. I hope that others are too and that we can collaborate to create tangible change in the future. I want to challenge more divergent thinking for those involved in medical education, that is if they (if we) can tap into our inner-kindergartner.
Friday, August 19, 2011
Old school
Ugh! I find myself really frustrated with old school attendings who are sarcastic and rude to the nurses and office staff, snarky towards med students and residents because they believe us to be slackers, and then spend hours complaining about being a doctor.
A fable was told to us about how old school surgery residents would move into the call room of the hospital they worked at. When asked why, the response was that they spent 1 day on and 1 day off. And you know what? They were extremely upset that they had to miss half the cases.
But you know what? When I'm told by my clerkship director to leave at 2pm on Friday, and given the opportunity to go spend the weekend with my long-distance girlfriend and to get there before shabbos begins, that is exactly what I am going to do! And I am not going to let these old school attendings make me feel guilty about it... (or at least try not to.)
A fable was told to us about how old school surgery residents would move into the call room of the hospital they worked at. When asked why, the response was that they spent 1 day on and 1 day off. And you know what? They were extremely upset that they had to miss half the cases.
But you know what? When I'm told by my clerkship director to leave at 2pm on Friday, and given the opportunity to go spend the weekend with my long-distance girlfriend and to get there before shabbos begins, that is exactly what I am going to do! And I am not going to let these old school attendings make me feel guilty about it... (or at least try not to.)
Wednesday, August 17, 2011
Using religion to negotiate arbitrary borders: helpful or dangerous?
During my first year of medical school I went to a talk organized by our Jewish Medical Student Organization on the separation of conjoined twins. The talk focused on the 1977 Pennsylvania case of thoraco-omphalopagus twins born to an Orthodox Jewish family. These girls were born with a combined 6 chamber heart that would be incapable of sustaining their developing bodies. The case brought up the ethical debate of whether it is acceptable to separate the twins in order to save a single life, knowing that the other would die in the process. To sum of the full story, a unanimous decision was made on behalf of the medical team, rabbinical court, and American legal system that separation was justified. It is truly a fascinating case though and worth the read.
I was recently reminded of this case when a friend, a classmate, brought my attention to the this week's New York Times Magazine cover story: the two-minus-one pregnancy. Reading the article I realized that I have an arbitrary border placed between abortion and selective reductions. I fully support a women's decision to abort a pregnancy, and believe that it is not my place to judge such decisions. I believe that it is never an easy decision for any woman to make, it is never arrived at lightly, and that my role is provide supportive, quality health care to help her live her life in the way she chooses. Yet, as confident as I am that I WILL provide abortions as part of my career, I can't imagine that I will be comfortable providing selective reductions. Or at least not comfortable performing the procedure when there is not a medical indication behind it. Analytically, academically, I support a women's decision to reduce just as I support her decision to undergo an elective abortion but emotionally I feel very differently. When distilling this discomfort down in discussion last night, I realized that it stems from my religious doctrine. My understanding of Jewish text is that it is not for human's to decide whose life is of more value. It is one thing when comparing the life of a living mother to the potential life of a fetus, but seems to be a totally different matter when weighing equal-ish [potential] lives against each other.
I imagine this issue, and similar ones, will be revisited many times in my future. I have no idea what choices I will make if actually put in such a position. Yet, I imagine that these are the times I will turn to Jewish text. These defining moments in my career will be when I seek rabbinic advice and reflect on the precedent set in ancient text. However, I hope to be learned in the surrounding issues, comfortable in my own decisions, and cognoscente enough of my arbitrary borders that I will be able to support my patients regardless of where we both stand. If there comes a point that I am not comfortable performing a procedure, I pledge to help bridge the gap. I will refer them out to someone who can provide the comprehensive care and also to realistically help them access that care; much the same as I hope/expect from providers who refuse to provide abortion care.
I was recently reminded of this case when a friend, a classmate, brought my attention to the this week's New York Times Magazine cover story: the two-minus-one pregnancy. Reading the article I realized that I have an arbitrary border placed between abortion and selective reductions. I fully support a women's decision to abort a pregnancy, and believe that it is not my place to judge such decisions. I believe that it is never an easy decision for any woman to make, it is never arrived at lightly, and that my role is provide supportive, quality health care to help her live her life in the way she chooses. Yet, as confident as I am that I WILL provide abortions as part of my career, I can't imagine that I will be comfortable providing selective reductions. Or at least not comfortable performing the procedure when there is not a medical indication behind it. Analytically, academically, I support a women's decision to reduce just as I support her decision to undergo an elective abortion but emotionally I feel very differently. When distilling this discomfort down in discussion last night, I realized that it stems from my religious doctrine. My understanding of Jewish text is that it is not for human's to decide whose life is of more value. It is one thing when comparing the life of a living mother to the potential life of a fetus, but seems to be a totally different matter when weighing equal-ish [potential] lives against each other.
I imagine this issue, and similar ones, will be revisited many times in my future. I have no idea what choices I will make if actually put in such a position. Yet, I imagine that these are the times I will turn to Jewish text. These defining moments in my career will be when I seek rabbinic advice and reflect on the precedent set in ancient text. However, I hope to be learned in the surrounding issues, comfortable in my own decisions, and cognoscente enough of my arbitrary borders that I will be able to support my patients regardless of where we both stand. If there comes a point that I am not comfortable performing a procedure, I pledge to help bridge the gap. I will refer them out to someone who can provide the comprehensive care and also to realistically help them access that care; much the same as I hope/expect from providers who refuse to provide abortion care.
Monday, August 8, 2011
Jokes for an extra 10 points
One of my friends swears that going into an exam laughing helps to boost your score. He claims that reading a few jokes before going into step 1 added an extra 10 points to his score. Being the supportive, wonderful, awesome person that he is, he sent me the following e-mail last night to read before the exam this morning. Enjoy!
Doctor: Nurse, how is that little girl doing who swallowed ten quarters last night?
----
Doctor: Did you take the patient's temperature?
GOOD LUCK!!!
(I apologize that I don't have citations to give proper credit!)
Laughs worth at least 10 extra points!
Doctor: Nurse, how is that little girl doing who swallowed ten quarters last night?
Nurse: No change yet.
----
Doctor: Did you take the patient's temperature?
Nurse: No. Is it missing?
----
Doctor: Well, I have some bad news and some really bad news.
Man: Well, give me the really bad news first.
Doctor: You have cancer, and only 6 months to live.
Man: And the bad news?
Doctor: You have Alzheimer's disease.
Man: That's great. I was afraid I had cancer!
Man: Well, give me the really bad news first.
Doctor: You have cancer, and only 6 months to live.
Man: And the bad news?
Doctor: You have Alzheimer's disease.
Man: That's great. I was afraid I had cancer!
----
Patient: Doctor, I think I need glasses.
Teller: You certainly do! This is a bank.
Teller: You certainly do! This is a bank.
----
“ Hello. Welcome to the Psychiatric Hotline…
If you are obsessive-compulsive, please press 1 repeatedly.
If you are co-dependent, please ask someone to press 2.
If you have multiple personalities, please press 3, 4, 5, and 6.
If you are paranoid-delusional, we know who you are and what you want. Just stay on the line so we can trace the call.
If you are schizophrenic, listen carefully and a little voice will tell you which number to press.
If you are manic-depressive, it doesn't matter which number you press. No one will answer.
If you are anxious, just start pressing numbers at random.
If you are phobic, don't press anything.
If you are anal retentive, please hold.”
----
The seven-year old girl told her mom, "A boy in my class asked me to play doctor."
"Oh, dear," the mother nervously sighed. "What happened, honey?"
"Nothing, he made me wait 45 minutes and then double-billed the insurance company."
"Oh, dear," the mother nervously sighed. "What happened, honey?"
"Nothing, he made me wait 45 minutes and then double-billed the insurance company."
----
A urologist’s license plate: 2 P C ME
----
Q: Why did the doctor tell the nurse to walk past the pill cupboard quietly?
A: So she wouldn't wake the sleeping pills!!!
A: So she wouldn't wake the sleeping pills!!!
----
The redneck dictionary of medical terms
Artery…………………………..The study of paintings.
Bacteria…………………………Back door to a cafeteria.
Barium………………………….What doctors do when patients die.
Benign………………………….What you be after you be eight
Cesarean Section…………….A neighborhood in Rome.
CTscan………………………….Searching for kitty.
Cauterize……………………….Made eye contact with her.
Colic…………………………….A sheep dog.
Coma……………………………A punctuation mark.
D & C……………………………Where Washington is.
Dilate……………………………To live long.
Enema…………………………..Not a friend.
Fester……………………………Quicker than someone else.
Fibula……………………………A small lie.
Genital…………………………..Non-Jewish person.
G.I.Series……………………….World Series of military baseball.
Hangnail…………………………What you hang your coat on.
Impotent…………………………Distinguished, well known.
Labor Pain……………………….Getting hurt at work.
Morbid……………………………A higher offer than I bid.
Nitrates………………………….Cheaper than day rates.
Node……………………………..I knew it.
Outpatient……………………….A person who has fainted.
Pap Smear………………………A fatherhood test.
Pelvis……………………………Second cousin to Elvis.
Post Operative…………………..A letter carrier.
Recovery Room…………………Place to do upholstery.
Rectum……………………………Darn near killed him.
Secretion…………………………Hiding something.
Seizure…………………………..Roman emperor.
Tablet……………………………A small table.
Terminal Illness…………………Getting sick at the airport.
Tumor…………………………….More than one.
Urine…………………………….Opposite of you’re out.
Varicose………………………….Near by / close by.
Bacteria…………………………Back door to a cafeteria.
Barium………………………….What doctors do when patients die.
Benign………………………….What you be after you be eight
Cesarean Section…………….A neighborhood in Rome.
CTscan………………………….Searching for kitty.
Cauterize……………………….Made eye contact with her.
Colic…………………………….A sheep dog.
Coma……………………………A punctuation mark.
D & C……………………………Where Washington is.
Dilate……………………………To live long.
Enema…………………………..Not a friend.
Fester……………………………Quicker than someone else.
Fibula……………………………A small lie.
Genital…………………………..Non-Jewish person.
G.I.Series……………………….World Series of military baseball.
Hangnail…………………………What you hang your coat on.
Impotent…………………………Distinguished, well known.
Labor Pain……………………….Getting hurt at work.
Morbid……………………………A higher offer than I bid.
Nitrates………………………….Cheaper than day rates.
Node……………………………..I knew it.
Outpatient……………………….A person who has fainted.
Pap Smear………………………A fatherhood test.
Pelvis……………………………Second cousin to Elvis.
Post Operative…………………..A letter carrier.
Recovery Room…………………Place to do upholstery.
Rectum……………………………Darn near killed him.
Secretion…………………………Hiding something.
Seizure…………………………..Roman emperor.
Tablet……………………………A small table.
Terminal Illness…………………Getting sick at the airport.
Tumor…………………………….More than one.
Urine…………………………….Opposite of you’re out.
Varicose………………………….Near by / close by.
Sunday, August 7, 2011
1st is the worst, 2nd is the best
(G!d willing!) I will take any blessings the world has to throw at me in the next 30 or so hours. Praying that 8 weeks on medicine clerkship followed by 6 weeks of full time studying plus a little bit of hypnotherapy and positive thinking will do the trick...
Now all I have to do is pass! (After which, hopefully, this blog will become more interesting.)
Now all I have to do is pass! (After which, hopefully, this blog will become more interesting.)
Monday, August 1, 2011
Prolonging (step 1) agony
After doing very poorly on 2 practice tests taken over the past 3 days, I'm beginning to think that there is no way I'll be ready to (re)take this exam a week from today. I don't understand why my score is beginning to trend steeply downwards instead of maintaining stable or continuing to climb?! I just want to be done with this all and back on the wards, back to what I came to medical school for in the first place; yet I also can't afford to fail again.
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