Getting Better: 200 Years of Medicine
This 45-minute documentary explores three remarkable stories of medical progress that have taken place over the course of the long history of NEJM. In 1812, we had no understanding of infectious disease, surgery was unsanitary and performed without anesthesia, and cancer was unrecognized. Two centuries later, this film tells the story of research, clinical practice, and patient care, and of how we have continued to get better over the last 200 years.
Tracking The Junk Food The World Eats After Dark
People around the world show remarkable similarity in their daily eating habits: meals start off healthy in the morning, but get progressively worse throughout the day – until by nightfall we’re deep into junk food territory. Just take a look at these images from mobile startup Massive Health. I just downloaded this app and it’s very interesting.
Doctor and Patient: Reinventing the 3rd Year of Medical School
For nearly a century, the third year of medical school has been a pivotal point in training, a crucial step in the development of professional skills and attitudes toward patients. Recently, however, the tradition of monthlong “rotations” – a speed-dating introduction to the major disciplines of medicine and the issues patients face – has come under fire. During their third year, medical students are under constant pressure to perform for an ever-changing group of senior physicians, who in turn must evaluate the students based on brief interactions. Sailing through as many as six disciplines in just under a year, students have opportunities for only transient relationships, garnering mere snapshots of their patients’ illnesses and lives. Not surprisingly, studies have shown that these experiences result in “ethical erosion.” Students’ sense of empathy and bedside manner deteriorate, and many begin to refer to their patients not as people but as diseases, that dehumanizing shorthand of the wards.
This is an important issue. During my third year, at times it felt like I was speed-dating through some of my core rotations. Some rotations like Ob/Gyn, Pediatrics and Psych were only 6 weeks long, Family Medicine was only 4 weeks and Surgery and internal medicine were each 12 weeks. These short-lived experiences can really determine what field you end up choosing. Among my friends, it varied greatly with each hospital. For example, Ob/Gyn at one hospital really deterred most of my friends, including myself, from considering a career in the field. Whereas in a more “friendly,” positively involving program, more people chose that field. With USMLE Step 2 CS and CK hanging over you and preparing your ERAS application at the end of third year, these rotations can make or break what you apply in if you haven’t quite found your niche yet.
Harvard Medical School-Cambridge Integrated Clerkship, which assigns every third-year medical student to a “panel” of up to 100 patients to care for over the course of the year, seems like an interesting concept. I would imagine that following a patient for the course of an entire pregnancy or throughout the course of their disease, would be humanizing and inspiring. But I would worry about what you might miss out on. Part of balancing many patients with multiple diseases, is learning the tenuous balancing act that you will have to practice in your future career. Plus, for me, the more exposure to different illnesses, the better and more confident I became at handling the work-up. Part of this involved learning more about their specific disease or conditionn,which ultimately helps in reviewing for boards as well. I feel very lucky that in my internal medicine rotation and sub-I, I was empowered to manage my patient’s care from admission to discharge (overseen by my resident and attending, of course). While the patient turnover was pretty quick, it was challenging to learn the balancing act. However, I felt that I was able to have more than adequate interaction with my patients. But it certainly wasn’t like this in every rotation. In general, my advice would be to make it a goal to really get to know your patient well, beyond just their disease. Third year is the time to really discover where you might see yourself in the grand scheme of medicine, and help you decide how you want to spend your fourth year electives. It’s a time to learn, connect with patients, get a sense of responsibilities of being a doctor, and hopefully, a time to continue to be inspired along the way.
“Safe Sex for Seniors Is So Hot It Kinda Burns”
Interesting public service announcement for safe sex for seniors via Jezebel. While a very funny ad, this issue is really important. The older, free-love generation is continuing to enjoy an active — if not always healthy — sex life. In fact, cases of chlamydia and syphilis amongst those 55 or older have rocketed 60 percent since 2005 in South Florida.
In Central Florida, where The Villages and other retirement communities sprawl across several counties, reported cases of syphilis and chlamydia increased 71 percent among those 55 and older in that same period. And South Florida saw a 60 percent rise in those two sexually transmitted infections among the same age group, according to the Florida Department of Health.
Just because seniors are older and wiser doesn’t mean they’re not susceptible to the same diseases as everyone else.
When the Chef is Also a Doctor
What a great marriage between public health and medicine. I wish I would’ve known about the Healthy Kitchens/ Healthy Lives conference. I would’ve loved to attend! Healthy cooking is one of my other hobbies, and I hope to incorporate it into my work as a physician as well.
For the Elderly, Emergency Rooms of Their Own
Mount Sinai Hospital in Manhattan has joined a number of medical centers around the country in creating a special emergency room for geriatric patients. This is a really interesting concept, especially considering the growing aging population and health care costs especially in the last year of life. Demography is destiny, as they say.
Are Doctors Happy?
Like medicine, happiness takes practice. But when it comes to happiness, some say the deck is stacked against doctors. Left unchecked, physician unhappiness can lead to major problems, including disruptive behavior, burnout, medical errors, health problems, addiction, depression, and failed relationships. It takes ambition, perfectionism and drive to make it into — and out of — medical school and while those qualities may be very useful for achieving goals, they don’t tend to foster happiness and satisfaction.
Being a doctor also calls for critical thinking and a degree of pessimism, O’Connor says: doctors aren’t trained to look at the sunny side of life. They look for what’s wrong with a patient, not what’s right.
While the people who choose to become doctors may have an abundance of these qualities, “Medical training sharpens them to a needle point,” he says. The result: physicians often graduate from medical school with a degree, a tendency to be brutally hard on themselves, and a profound inability to relax.
So how’s a doctor to find happiness? The same way everyone should, says O’Connor: work on it. Find a way to be happy in the now.
I’m still working on ways to relax. It’s odd that even in this very relaxed fourth year of medical school, I find ways to fill all my time. I have become very used to being busy and utilizing my time efficiently, that it’s often difficult to just do nothing.
I certainly hope that I will be happy at work and outside of work.
IMG Performance in the Match 2012
For the tenth consecutive year, the number of first-year (PGY-1) residency positions offered through the National Resident Matching Program (NRMP) Main Residency Match increased. A total of 24,034 first-year positions were offered in the 2012 Match. This represents an increase of 613 positions compared to last year and an increase of more than 3,400 positions since 2002.
The number of IMGs, including Fifth Pathway participants, who matched to first-year positions increased by 260 compared to 2011. Of the 11,134 IMGs who participated in the 2012 Match, 4,886 (43.9%) matched. In the 2011 Match, 4,626 (44.2%) IMGs were matched to first-year positions.
Of the 6,828 IMG participants who were not U.S. citizens, 2,775 (40.6%) obtained first-year positions. The number of non-U.S. citizen IMGs who obtained positions in 2012 increased by 54, after declining for the two previous years.
Of the 4,279 U.S. citizen IMG participants, 2,102 (49.1%) were matched to first-year positions, an increase of 218 over last year. This is the ninth consecutive year that there has been an increase in the number of U.S. citizen IMGs matching to first-year positions.
Of the 27 Fifth Pathway participants in the Match, 9 (33.3%) were matched to first-year positions.
It is important to note that the total number of IMGs who will fill PGY-1 positions for the 2012-2013 academic year will be higher than the number obtaining positions through the 2012 Match. Although the majority of PGY-1 positions in the United States are filled through the Match, a significant number of IMG applicants obtain positions outside of the Match. For example, while 4,686 IMGs obtained PGY-1 positions through the 2010 Match, 7,023 IMGs entered PGY-1 for the 2010-2011 academic year.
The 7,023 IMGs entering PGY-1 for the 2010-2011 academic year is a decrease of 312 from the prior year but an increase of 950 since the 2002-2003 academic year.
On Match Week 2012
To say that this whole thing started just a few months ago with the start of my ERAS application, interviewing, rank lists and whatnot, would be severely short-sighted of me. For me and for most people, this whole thing began as a child, having some idea of what I wanted to be when I grew up. Match week is a culmination of innocent childhood dreams, struggles and let-downs along the way as “non-traditional” students, late nights of studying, long zombie-like mornings after a rough 24-hour surgery call, and post-exam/end of rotation celebrations with amazing friends. For me, it was week where I spontaneously cried tears of complete happiness, relief and gratitude.
My path to medicine has been a long, winding road with rough terrain, detours and it seems that at times, my GPS was busted. From humble beginnings as a child surgeon, medicine meant saving lives by repairing detached limbs and performing (Sharpie marker) “cataract” surgery on Monkey-Key, my most beloved stuffed animal (made of love just like the Velveteen Rabbit). My first grade autobiography clearly predicts that not only would I become a doctor, but I would also find the cure to AIDS and subsequently become BFFs with Magic Johnson, drive a red Mazda Miata and only wear red dresses under my white coat. In fact, this highly predictive autobiography states that I was triple-boarded in pediatrics, neurosurgery and cardiology, while also being the premier hairstylist to the stars. No joke, I was living the dream.
Both fortunately and unfortunately, it wasn’t as easy as my 6 year-old mind imagined. In high school I started working in hospice care, providing comfort and happiness at the end of life. It gave me a completely different perspective on medicine and what saving lives really means. In college and graduate school, I worked part-time as an emergency room technician in Chicago. At first, it was exciting to be in the footsteps of Noah Wyle and George Clooney, but I also learned that medicine can be quick, dirty and often, devastating. I found myself questioning whether this was the right path for me and at that time, it surely wasn’t. After completing a master’s degree in public health, I set off on a journey to improve people’s lives through health education on prevention. Yet, I still felt this strong desire, perhaps calling, that I could make a greater impact with a combined background in medicine.
In hindsight, medical school itself seems to have flown by. Going through the first two years was not without pain and suffering (and seriously, it was emotionally and physically draining at times), yet looking back it wasn’t as bad as it seems. I can say that now since the end is within reach! To say that living on an island thousands of miles from my family and close friends in the most stressful time of my life was rough, cannot even begin to encapsulate this experience as a whole. But throughout the rough patches, I found friends that became surrogate family, whether it was celebrating Thanksgiving dinner, caring for my frequently injured friends, or cutting up oranges as a basketball mom. I found extraordinary future physicians along the way and developed friendships for a lifetime. Without St. George’s University, perhaps our paths would not have crossed and for this, I am ever grateful.
I am thankful for having such a supportive and incredibly patient family that were and are always there for me, even when I was stressed out of my mind and clearly, a huge pain in the ass. My family kept me going with their relentless support, as my mother’s words to “keep going” seemed to play on repeat in my head. They never gave up on me and never let me give up on myself. A worn-out birthday card from my grandfather, continued to remind me of family who have passed before me whose dreams I also carried with me.
It is a strange feeling to think that in just a few months, I will be a doctor. I am thrilled to have matched into a wonderful program where I know I will be happy. While I may not become a pediatrician-neurosurgeon-cardiologist-hairstylist, I know that I am steps closer to fulfilling my childhood dreams. And who knows, Magic Johnson and I may still become BFFs someday!
A Drumbeat on Profit Takers
Dr. Arnold S. Relman and Dr. Marcia Angell, both former editors of The New England Journal of Medicine, continue to advocate against the “commercial exploitation of medicine.”
Chocolate Skulls Cast From Real Human Skull
These Chocolate Skulls by Marina Malvada are available in dark, semisweet or Bone, a signature blend of Belgian white and milk chocolate. Somewhat morbid that someone’s actual skull was used to mold it, but oddly deliciously tempting especially when available in dark chocolate.
Matched for a residency program!!
Woo hoo!
BMJ article: Increasing numbers of "cash-strapped" medical students raising funds through... prostitution?
I’m really not sure about the reliability of the survey method… but at least those students are getting some early experience at getting screwed over by the sad financial state of healthcare reimbursement. :(
Dogma Overturned: Women CAN make new eggs!
A study led by Jonathan Tilly of the Massachusetts General Hospital overturns the decades-long idea that women are born with all the eggs they will ever have. It reports that women of reproductive age carry ovarian stem cells, meaning that they can produce new eggs. Tilly’s team, which made a similar finding in mice in 2004, also discovered that mouse eggs derived from such stem cells can indeed be fertilized.
"Take the world apart and figure out how it works." - Built to Spill, 1994.
