Friday, February 28, 2014

Review: Sawbones (A Marital Tour of Misguided Medicine) the Podcast

Something that I've very recently discovered are Podcasts.  I realize this is about a decade late but I never quite understood the concept of podcasting.  To be honest the reason I started to explore is because we could subscribe to our course podcasts and have them automatically be downloaded when they were ready.

After clerkships began I had to spent a considerable chunk of time in the car and after a while the same four songs on the radio start to be more of a headache than any kind of enjoyment.  Some of my favorites include Radio Lab, 99 Percent Invisible, Stuff You Missed In History Class and of course Sawbones: A Marital Tour of Misguided Medicine.

I only happened to find this podcast more recently when a fellow medical student mentioned it in passing.  Sawbones takes a casual and comedic approach to some very serious medical history.  The hosts are a husband and wife pair Dr. Syndnee McElroy and her husband Justin  The two of them have amazing chemistry and their episodes are always well researched. . The topics they choose are essentially well intentioned but wholly incorrect, understanding and treatment of disease from back in the day.

One of my favorites episodes thus far has been one entitled Self Surgery that discussed some historic instances of people taking a knife to themselves, essentially performing self surgery.  Other topics have included: bloodletting, lobotomy and weight loss.

Overall I give it five stars for being both entertaining and intellectually stimulating simultaneously.If you're a semi-history buff and have any inclination towards medical history definitely check this out.

Now that my surgical rotation is over I just gained about 6 hours a day back into my life and am hoping to get back to my reading list which includes a fair handful of medically oriented texts including Cutting For Stone by Abraham Verghese, Arrowsmith by Sinclair Lewis and Complications by Atul Gawande.

Any other recommendations for this pseudo-Medical history buff?

Thursday, February 27, 2014

Notable Quotables: MH

"A lot of it is a process of elimination, but when you pick your specialty that better be a process of selection.  Pick something that really just turns your wheel. " 
- M.H. [General Surgeon]

Its dawning on me that I have about a year to figure out exactly what I want to do with the rest of my life. Sometimes people say things to you in passing that really stick with you so keep an eye out for more Notable Quotables, the initials just help to maintain anonymity but still allow me to mentally catalog who it was for future reference.

 Have any of your own from mentors, friends, family or famous folks?

Wednesday, February 26, 2014

Tidying Up

I think a little blog dusting/reorganizing was in order.  New updated title, reshuffled the layout and added some gadgets. 

Thanks for reading.

The M3 Merry Go-Round

As an M1 and M2 everyone's ultimate goal is to finally wade their way out of the swamp of basic sciences and into the fairyland of clinical skills.  Now that I'm a majority of the way through my M3 year my understanding of its purpose has most certainly shifted. 

At the most basic level third year clerkships allows medical students a taste of all of the core rotations: Ob/Gyn, Surgery, Family Medicine, Internal Medicine, Psychiatry and Pediatrics.  Different schools have different time periods allotted to each but for the most part each of these lasts between 6 and 12 weeks.

There is a massive amount of variability associated with clerkships experiences based on many things.  The residents and attendings you work with and other members of your team have a tremendous impact on your experiences as does the actual hospital where you are working.  Some medical schools have their students rotate in house (at their own institution) for most of their rotations while others do a combination of in house and alternate sites.  This too significantly impacts a student's experience because the latter set up requires the student to consistently readjust to a new environment quite literally like a different hospital and likely a new electronic medical record and a variety of other infrastructural differences.  This is all layered atop the obvious difficulty in constantly being moved from one rotation to another. 

One of the biggest challenges for M3 years is being flexible and readjusting quickly to an ever changing environment.  The clerkship experience is built to show you a little bit of everything, something of an sampler platter of medicine and thus by the time you become comfortable and mildly adequate in your role you're whisked off to another place where you are once again a deer in the headlights.  

When I started out this year I thought the purpose of these clerkships was to see a wide array of medical practice and see what we liked.  Like walking through a restaurant kitchen and sampling a bit of what each chef is whipping together.  As I make my way through this process my understanding of it is starting to evolve and readjust.  

We aren't going to chose 90% of what we see, that is the nature of it.  We will choose one field of medicine and pursue that thus making a majority of our rotations useless.  But they infect will have taught us something even more valuable which is how to effectively communicate with our colleagues who will each pursue their own speciality choice. 

Communication is moving to the forefront of medicine, being able to communicate effectively with each other is the key to excellent patient care.  In 20 years when I'm an attending and have to call another physician for a patient for one thing or another, I hope I can hone my message in a way I know will make the most sense to that specialist.  This is the only time in my career I will so fluidly be able to move from one speciality to another and after just a few days come to be accepted as part of the team vs. a visitor. 

Saturday, February 22, 2014

Surgery: 4 AM Wake Up Calls, The List and other Assorted Drudgery Pt. I

Im sorry. I really want to keep up with this blog, I have so many things I want to say but sometimes it just falls off my list of things to do.

The past few months I have been dealing with some significant family health concerns coupled with my surgery rotation I've had little to no time for anything extra.

But the show must go on! Just as with everything else on this blog these are my personal thoughts and opinions--not meant to offend but merely to inform and present one naive young person's perspective.


Surgery.  Those of you who are not in medical school probably don't know but the moment this rotation comes up in conversation it strikes fear into the heard of 98% of us.  There is that bizarre little group of people who are giddy with excitement and actually electively choose to spend the rest of their lives doing this.

To be honest before I started this rotation I thought it was what I wanted.  I love working with my hands.  I've always been a tinkerer and I thought surgery would be the perfect way to merge my personal passion and strengths with my career.

I was wrong.  Lets first discuss how awful the hours are.  For the last 8 weeks I've been waking up at 4 am everyday, barring the one day a week we get off.  I arrived at the hospital between 4:45 and 5 and am expected to see my patients and have my notes completed before 6 when the team will round with the senior resident.

That wouldn't be all that horrible except for another menial task that is assigned to students: The List. What is the list you may be asking yourselves?  Let me tell you.  It is a print out of the list of patients the team is responsible for that day it includes the name and age of the patient in a grid like format.  You would think with the electronic medical records (EMR) that we use (the hospital I was at had the cadillac of EMRs, EPIC) there would be the option to say right click all the things you wanted for the patients and have them come out in list format. WRONG.  Every morning myself and the other two students on our team would by hand have to fill in for every patient in the 1 cm row like space the following information: reason for admission, overnight events, vitals [temperature, heart rate, respiratory rate, blood pressure], total intake, total output, urine output by shift, medications, diet status ([NPO (if they can't eat anything], clear liquid diet, full liquid diet, pureed diet, heart healthy, general, etc).  That is completely absurd.  It would take between 30 and 40 minutes every morning to make this list and to be honestly most of the time nobody even used it.

After pre-rounds with the residents were completed we were expected to split up the surgeries on the board for that day and scrub into those and keep an eye out for when attending rounds would happen.  Thats another disaster.  As students nobody really ever remembers us and attending rounds occurred on a pretty haphazard basis so we had to rely on our interns to let us know when and where they were happening.  This led to one too many occasions where we would run into one of our team members somewhere only to have them let us know that rounds had just finished.

Frustratingly enough there was a second list we were asked to make during the day too.  Sometime between pre rounds finishing at 7 am and attending rounds occurring whenever the attending decided to show up we were expected to record the labs values for every patient.  This entailed printing out another blank list and filling it with hemoglobin, hematocrit, platelets, WBC, sodium, potassium, Cl, bicarb, BUN, creatinine, glucose, calcium, phosphorous, magnesium and any other assorted values that were recorded such as PTT, PT, INR, CEA, etc.  The worst is when we would scramble to finish the labs only to find out we missed rounds.

Although there was a lot of busy work involved with it being in the OR was quite a unique experience. The excitement of holding the camera during laproscopic procedures did start to wear off but I can definitely appreciate the fact that surgical interventions are kind of mind boggling.  More on the woes of scrubbing in and accidentally touching your face and other comedic moments during my surgical clerkship.