Tuesday, June 28, 2005

High yield

So, the first week I thought to myself, "It can't possibly be hard enough to justify all the study time everyone else is putting in." Yeah. Now, I'm putting in that much time, and more. The hackneyed metaphor seems most appropriate - we're drinking from the firehose now. Time to only pay attention to what's helpful, time to start living off of ramen noodles, time to get "high yield."

So, what does high yield mean? Means the source that will give you the answers to the most questions on the boards for the least amount of work.

What are these "boards"? A series of tests you have to pass if you want to be a doctor. The first test (called, 'steps' for whatever reason) is an overarching final for everything in the first two years of medical school.

The class that I am in is high-yield. I will study high-yield materials, and even higher-yield supplements.

I think back to undergrad, a mere month ago. I always thought the question, "will this be on the test?" was so undignified. I was always trying to learn more, to get outside the material, and play around with it. There simply isn't time here. The pace of the curriculum seems to demand memorization (aided by as much anatomical reasoning as I posses). Elaboration is provided by clinical considerations, which are memorization fodder, as well as aides in memorization. One set of material reinforces the other. Anyway, it's all spoon-fed. I guess otherwise it wouldn't be high yield.

Thursday, June 23, 2005


I have a whole new life - new student ID, new swipey RF "ass-badge" to open doors, new bank card, new keys, now - first hostpital ID. Exciting. I am a "student intern." Ooh. Means I can go get scrubs when my laundry is running low. Also means I got a nifty little card that explains what all the hospital codes mean. For instance, at my hospital:

When they say: Dr. Cart
They mean: Cardiac arrest

When they say: Dr. Suess
They mean: Infant / Baby security alarm

When they say: Dr. Strong
They mean: Patient disturbance

They also gave me a handy mnemonic to use whenever Dr. Red (a fire) comes calling... R.A.C.E.R. As if I don't have enough acronyms to memorize.

Don't ask me what any of this means. As I have previously indicated, I am not a doctor (and it would be illegal for me to claim otherwise!)

Legal immunity

Every normal person has been vaccinated. It is a requirement for getting into kindergarten, elementary, middle, and high schools. When I graduated from HS, they gave us empty leatherette cases, and told us to go to the commons to get our diplomas, and our immunization records.

Proof of immunization is also required to enter as an undergraduate. Ergo, an undergraduate diploma is proof of immunization. However, in my packet of 'little things to do in the two weeks before school starts,' immunization forms! No problem. However, they indicate that, rather than proving that I have had my shots, I need to prove that they did some good via blood titer.

Now, I'm not a doctor, yet, but something about this strikes me as odd. Under what conditions could someone be immunized, yet no longer be immune? I'd believe that the polio shot my mother got 40 years ago is starting to lose its impact, but my shots are much younger. The only way I wouldn't be immune would be if I had no immune system whatsoever. Anyway, I am, indeed immune to MMR, do not have tuberculosis, etc. thus I am here, and can get my hospital ID (see above).

Tuesday, June 21, 2005

Body rap

First day of anatomy lab today. First we got our bone sets - half of a body, plus the skull. I was forced to admit that I don't know the names of most of the bones during checkin, but I got some help, and I don't think I'm likely to forget them after this summer. I dropped the skullcap on a dissecting table, and one of the TAs said, "if you had to drop one, that would be the best." The bone was undamaged.

After the bones, we had a quick ceremony to honor the deceased, then wrapped the bodies. First the TAs showed us how. They just unzipped the body bag that it came in, and here was this naked guy, his hands and ankles tied with coarse rope. They lifted the body, whipped out the old bag, and brought in the new one. They didn't give any indication that the body was fragile, or something that could be broken - they moved it around as you would a living body, yet when I tried to splay the fingers on our dead woman, they were stiff.

To keep the bodies from decomposing, we wrap them in a rags (actually cut bits of sheets) that are dipped in phenol. Phenol doesn't smell as bad as formaldehyde, but it still gives you that smell of death. I've taken up swimming in hopes that the chlorine will either react away or cover the phenol. Phenol, by the way, is a local anesthetic that also causes irritation - i.e. it deadens the skin, then messes it up.

After class I went back to the lab and got out my bones - we have reading this week on anatomy of the upper extremety (what normal human beings might refer to as 'the arm'). I figured it would be helpful to have the physical bones in front of me while the textbook talked about them. I was amazed at how the bones articulated... by this I mean, I was surprised at how closely they fit together. Somehow, I had it in my mind that the joints would be large, fluidy things, and thus the marriage between two bones would be more a function of connective tissue, rather than physical connection. This is not the case.

I feel like I should be diving into the more researchy stuff, or getting into some kind of social thing, but I keep telling myself I don't know how busy I will be...

Monday, June 20, 2005

Cruel Summer

I just finished my first real day of classes. The more I learn, the less intimidated I feel, yet the workload is immense. The instructor seems friendly (e.g. he invited us out to his place to watch the fireworks on the 4th), and I guess the lowest anyone got last year in the class was an 82% (which, like anything between 75-100 turns into a P), but I'm still somewhat apprehensive. There's a ton of stuff to learn... At least this is my only responsibility at the moment. Later this summer, we're going to watch an autopsy. Seems like a good review, something I should get a feel for if I intend to hang out with the dead for my whole life.

We had a talk with a woman here who acts as a sort of medical ethics person - I think I'd like to hang out with her a bit.

Friday, June 10, 2005

One good thing

I know what kind of doctor I want to be -

The kind that snorts cocaine off the huge, fake, naked breasts of his female patients.

*, a.k.a. Thoughts on privacy, BS

I'm not sure I want the people in my program reading my blog. I certainly don't want to have my awareness that they're reading my blog cramp my writing. I don't expect to get kicked out of the program, but this business is all about recommendations. If I want my next job to be in Bethesda or Baltimore, rather than Billings or Bismark, I need to get good recommendations. If I'm gunning for a medical residency, do I really need all my skepticism held against me?

What does privacy have to do with the claim that my institution invented the white coat ceremony? Well, if my institution really did invent the white coat ceremony, all of a sudden the pool or people I could be narrows considerably, from the ~16000 incoming MD students, to the much smaller number at my institution. It would be like saying our dean is a woman, or that I can't wait to count all the sunny days and see if Phoenix really does have more than 300 per year.

I'm vaguely confidant that I wont get found out because I'm sure that half the medical schools in the country are passing out the same palaver to their students. Most aspects of medical practice are like the internet - everyone says they invented it, no one says they control it.

Please treat this as a formal request for privacy. I don't want to be found, don't look for me, the momentary satisfaction that you gain is not worth the possible damage to me.

Bad news on the medical front III

I haven't had a single medical class yet, and already I'm acting like a doctor. I told my uncle (the one from BNOTMF1) that he should look into taking two more drugs - just pulled them out of my ass. I know like, 10 drugs - what are the odds that I know one, much less two, that will help him, especially absent anything other than talking to him?

Second, I suggested that two of my other family members might have some kind of social anxiety disorder, and recommended that they consult with mental health professionals (while hinting that drugs could 'make them better').

Third, I have been getting giddy about my white coat ceremony. Some things, they celebrate when you leave, like graduation. For medicine, they celebrate when you show up. They put on a big pseudo-religious (or religious) ceremony, administer the hippocratic oath and symbolically induct you into the priesthood with your white coat (the modern oath is a bit more PC).

With all my heart, I realize I should just forget about it, collect my white coat when necessary and get on with my life. But then I said, "don't I want to meet my classmates?" Of course! And what better opportunity? (Don't answer that). So I was like, "Oh, I'll invite my mom!" (She'll be in town, moving me in). And then I got an admitted student mailer, and they're like "You can invite up to five people - they get really nice invitations." And I'm thinking, "cool, nice invitations." By they way, my institution claims* to have invented the white coat ceremony, so you just know it's going to be overblown.

Then I spent all afternoon trying to figure out if I want a size 38 or a 40, and whether I should get long, or standard size. Yeesh. The final answer, by the way, is 38 long. Why? 1) I'm probably not going to be wearing the coat over my winter jacket and 2) When I was a little kid, I always wanted a cape. In fact, my entire fascination with science and medicine might be traced to the fact that these people get to wear cape-like things every day as a matter of course. A longer 'cape' enhances the super-hero experience. Although, if I were to pick a super power, it would be "making people do whatever I want by scratching them behind the ears"** as opposed to, "pushing drugs."

** We're going to have a facebook, and one of the questions was, "What super power would you have, and what would your name be." I'm 'catnip' if you must know. It was either that or have the super power of always having tea no matter what, and the tea is really good (I was going to call myself, 'The Teabagger' so this one obviously wins on the name). Seriously.

* This is getting it's own post, as it sprawls into a larger issue.

Bad news on the medical front II

And I think, maybe we're just toys of the pharma industry... they obviously know what they're doing. They wouldn't be bombarding us consumers with ads if they didn't think it would have an effect on sales.

To kind of fit in with this, here's a look at things from the perspective of a drug detailer (i.e. a sales rep)

What if I'm just one of this guy's stereotypes? Somebody hold me.

Bad news on the medical front I

I've been asked (in comments below) why physicians in general are unwilling to 'stand up' to their patients. That is, when someone sees an ad on TV and they come to the doctor's and ask for the drug, why does the doctor roll over and give them the drug?

I actually ran into a counter-anecdote, in that my uncle's physician refuses to perscribe drugs that he suggests, apparently for the bloody-minded reason that my uncle has suggested the treatment.

I'm going to disregard this anecdote, partially because it's an anecdote (even if true it proves nothing), and partially because there's a question of whether my uncle's ideas for treatment are good - he goes in for alternative medicine treatments that are untested, both in terms of safety and efficacy.

So... let's go to the literature:
Mintzes B, Barer ML, Kravitz RL, Kazanjian A, Bassett K, Lexchin J, Evans RG, Pan R, Marion SA. Influence of direct to consumer pharmaceutical advertising and patients' requests on prescribing decisions: two site cross sectional survey. BMJ. 2002 Feb 2;324(7332):278-9., PMID: 11823361 (free full text here)

In summary:
1. About 74% of patient visits result in a drug being prescribed - this is the accepted figure.
2. Patients that ask for drugs in general are more likely to get drugs
3. Patients that ask for advertised drugs are likely to get the drugs they ask for.

So, the observation that physicians bend over backward for their patients checks out. However,

4. When patients asked for drugs, in general or in particular, the physician was more likely to be 'ambivalent' about the treatment.

What's going on here? I can't find a study on that. The establishment guess would be that it's either business or law at fault. If I won't deal to you, you'll find someone else who will -> I lose business -> I starve. If you suggest a treatment for X, I don't treat you for X, and then you die from X, I get sued.

Of course, the study is all self-report, which causes all kinds of difficulties. Still, this is a definite plot hole in the 'physicians think they're gods' story.

Friday, June 03, 2005

A man walks into the doctor's office

The doctor says, "It gets really boring doing physicals on healthy guys."

Seriously, though, I had to get my immunizations updated for med school, so I went in. I have nothing of interest to report. They're letting me rate my own TB test - apparently my medical student status qualifies me to feel my arm for a bump. Also, the nurse was telling me how to do the various shots (e.g. a TB test is subdermal and only to produce a weal).

I did not badger or bully my doctor, though I should have... I guess in situations where nothing seems wrong I'm not excited to go looking.