2011 April | medaholic

Monthly Archives: April 2011

The Velluvial Matrix

This commencement speech by Atul Gawande at Stanford has been making it’s way around the internet. I enjoyed reading it and it made me think about my future in medicine. Just a sample below.

You come into medicine and science at a time of radical transition. You have met the older doctors and scientists who tell the pollsters that they wouldn’t choose their profession if they were given the choice all over again. But you are the generation that was wise enough to ignore them: for what you are hearing is the pain of people experiencing an utter transformation of their world

Read more http://www.newyorker.com/online/blogs/newsdesk/2010/06/gawande-stanford-speech.htm

Acute on Chronic Disease

http://www.flickr.com/photos/admean/3397496

As a medical student, high acuity cases initially scare you. Nothing like a patient decompensating on the ward while you are on call to get the adrenaline and anxiety going. Intubations, crashing patients, emergency surgeries, life-saving decisions are all big unknowns to a new medical student. Luckily, as you see more and more sick patients, you learn how to manage and treat these cases. In many ways, dangerous and life-ending diseases like DKA, toxic substance ingestion and sepsis are easy cases because they have “quick-fixes.” Either patients get better (most of the time) or things go downhill quickly and they end up in the ICU or the morgue.

What I’m learning now, and after speaking to several preceptors, is managing chronic disease is the real challenge in medicine. For example, it’s not the management of alcohol withdrawal in the hospital that’s hard, which is pretty routine. It’s the treatment that happens outside the hospital which is the big issue. How do you get people to maintain healthy lifestyles where they don’t smoke, drink in excess or eat bad foods. How do you manage an elderly man with 5 different comorbidities that requires 20+ meds in the community and make him self dependent. How do you treat diabetes when the person who has it has no idea how to measure their own sugars, interpret them and administer the right medication.

Intubating and ventilating a patient with pneumonia and hypoxia, though intimidating to the new learner, is quite a straightforward task. However, the challenge comes when you discover that the patient lives on the streets with diabetes, hypertension, liver cirrhosis, HCV and psychiatric illnesses (things that don’t immediately kill someone but may have long term consequences). How do you set up proper followup to prevent another pneumonia from happening?

I believe that will be a major challenge to all doctors who face an ageing population. We have to remember that we are dealing with complexity in another human being. Every doc should know how to manage high-acuity cases because in it works and saves lives. But what would be better is if our management of chronic diseases was given the same sex appeal and coolness factor as our fast paced medicine. Family doctors are under appreciated for the work they do at keeping patients out of the hospital and in their homes.

Ultimately, I would like to find a specialty/job that would allow me to do both high-acuity, hands on medicine and prevention/management of chronic diseases. I don’t think I can see myself as an emergency doctor with no continuity of care, even though I enjoy the quick pace. Perhaps a combined family + 1 emergency residency would work out well. Cardiology and nephrology also has that variety. I still have some time to decide.

I just hope that our medical profession starts to put more emphasis on chronic diseases, that if left untreated would cause greater costs, morbidity and mortaliy. Yes, it’s cool to be a trauma surgeon, but that is ultimately a reactive specialty. For every trauma case, there is ten cases of unmanaged COPD and diabetes. What society really needs is proper followup for all the chronic diseases people have, the true burden of health care.

Premed Exploitation

http://www.flickr.com/photos/38117207@N03/4277320819/

Inspired by the incredible amount of students lining up outside the science library this morning (A Sunday!) as they waited for the library doors to open.

It’s been a while since I have been a pre-med, almost three years to the date. It’s strange how fast you forget sometimes. Looking back, I might have been one of those keen undergraduate students lining up for the library to open and staying until it closed. I remember spending days holed up in a cubicle doing old exams and memorizing every last detail in the class notes. I remember being upset about getting a B on a test or worrying about the MCAT, research, interviews, etc.

Now I’m happy to sleep in when I can, have a good meal and catch some playoffs basketball. I don’t think I work less than I did – I probably put in more hours these days – but I am definitely less stressed about my studies. I suppose I am anxious about CARMS and the upcoming residency match but I do my best and try not to stress about it too much.

The drive of a premed to enter medical school and to eventually become a doctor can become an obsession. It can get to a point that it becomes the only thing you think about day in and day out. And it’s no surprise that there are endless books to sell, MCAT classes/ tutorials and interviewing coaching that is available for people wanting to improve their chances. I’m always shocked by the price these expert “consultants” charge for helping you with your application. You can make a nice profit just catering to this devoted niche market.

My Google Analytics shows that around 15% of my traffic comes to one post I wrote 2.5 years ago. How to Self Study for the MCAT

I’m surprised because the information is probably outdated or incorrect and yet everyday dozens of people will spend a few minutes to read it. And the MCAT is just one aspect of the medical school admissions process! Imagine if I just wrote about how to get good grades, excel in your final exams, ace the MCAT, write personal statements and succeed in your interviews. I would get a ton of hits in no time.

But I don’t. Partly because there are dozens of books/websites/blogs that already do so, probably more thoroughly and eloquently than me.

I’ve helped dozens of friends out with their applications, and seen many of them get in. I’ve taught MCAT classes before. I’ve run interview sessions with handfuls of applicants. I help out on the admissions committee every year. I’ve interviewed applicants too!

It becomes routine quickly. Plus when you’re surrounded by other medical students, residents and academic staff, being a doctor soon becomes normal and not the idealized profession that premed students often dream about.

I’m not here to exploit pre-meds. I’m not selling any products or charging any fees for help. If you email me at medaholic@gmail.com – I usually reply with my thoughts/advice… eventually (might take a week or two, whenever I decide to check). You’re free to take my advice or not, it doesn’t really matter to me.

And why I write here is because I remember as a pre-med I was quite taken back by the hostility of other premeds. A lot wouldn’t share their notes or take time to help you out. They would hide opportunities or resources from each other. I was offended that people could charge thousands of dollars as a consultant.

So my final hope for all premeds out there is this: Help each other. Don’t be selfish. Your games of giving out wrong information or not taking time to explain something to a classmate won’t improve your chances of getting into medical school. Sabotaging someone else chance will not increase yours, instead you’ll make a few enemies if you do so.

Don’t worry about the competition and focus on what you can do for yourself. Getting into medical school is ultimately based on your own efforts

Doctor Nepotism

To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art. – Hippocratic Oath

I come from a family with physicians in it. If I randomly sample my class, I’m sure at least 30-40% of my peers have family members who are medical doctors, whether they be parents, brothers, sisters, uncles, cousins. It’s a common finding all across the country.

Medical students tend to come from families with doctors in it.

The reason for this is probably because children of physicians are more likely to get an exposure into the medical field. Their parents probably encourage their kids to consider this profession. When they do decide to apply to medical school, they are told what all the right things to do are to bolster their application. As a result, a large portion of medical classes are made up of students in upper-middle class.

There’s nothing wrong with a kid wanting to be a doctor like mom or dad. What’s concerning is that there is an over representation of students from better-off families and an under representation of students from lower socioeconomic classes. When graduation rolls around, doctors will be less likely to go to under served communities and help those who have the least access to health care.

It’s a moral dilemma that I have thought about often. I wonder if it would have been better if my spot was given to someone from a rural community, a lower socioeconomic class, an aboriginal reserve? We try to fix this problem by giving preferential treatment (or affirmative action) to those we want to attract in the admissions process. In theory it should help, in reality I wonder if it makes a difference.

Is there a good solution to making medical schools more diverse to include more than just upper-middle class students from privileged families?

Tricks for Waking Up #8

Final tip: Get more sleep!

It’s not really a trick or tip but getting more sleep is the real solution to feeling alert in the morning. As a medical student and eventually resident, I’m will have many nights where I won’t have a good night’s sleep. Even now, there are nights where I get only 3-5 hours of sleep and I have to start the next day feeling groggy. At least when you’re post-call you have the day off, but if you have regular work hours, consistent and sufficient sleep will make or break your day.

Getting more sleep isn’t as simple as going to bed earlier or waking up later. It’s about prioritizing sleep and it’s importance. I’m guilty of foregoing sleep to do a bit more of reading or catch up on some television. I should sleep more. Sleeping is like any other activity we choose. We can choose what we eat and how much. We often don’t give too much thought about our sleeping habits though.

I was sleleping fairly well last month, but I just started a new rotation and find myself needing more hours in the day to do everything. I think I will be cutting back on some hobbies, limiting my internet usage and just getting more sleep. It’s been 9 months of clerkship already. I can see how somehow can get burnt out if they don’t look after themselves.

To all the sleep deprived people out there: “Getting more sleep is a conscious choice you make!” You may need to cutback on activities and responsibilities, but you can’t cutback on sleep. Mother nature gave us three daily needs: Eat, crap and sleep. Make sure those needs are met everyday (having a regular bowel movement everyday is a good thing!)

Too Tired to Post Today

There are some days where you feel on top of the world. You end up working 16-18 hours, you get into the groove, you feel like you know something and all that hard work is paying off.

Than you realize that you have to be back at work in 6 hours. And every minute you spend “relaxing” is another minute less of sleep. Not getting enough sleep sucks, when it’s back to back to back.

Will write something substantial on another day. Not today, haha

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