I remember when one of my patients with coronary artery disease suggested that he be given a course of an antibiotic to lower his future risk of a heart attack. The patient quoted literature that pointed to a possible infectious link to atherosclerosis. He also was aware of the theory that aspirin’s benefit had less to do with blood thinning than reducing underlying inflammation.
Fast forward to …
Is the doctor of medicine degree vulnerable?
Growing up, I rarely had a steady primary care physician. Every school-physical, immunization, sports injury, and sore throat was addressed with care and diligence at a family clinic affiliated with a major suburban hospital.
I opted to visit the clinic a few weeks ago for a minor concern but as I drove-in, I was attuned to the fact that the clinic I visit—my clinic—is a teaching site.
Before entering medical school I …
Medical students need to learn to be patients
The gall, you might think to yourself as you click on this link in disgust.
Before you write that brutal retort which I may/may not deserve, some simple disclaimers before we tackle this subject:
5 reasons why you shouldn’t go into medical school
No one knew just how long Freddy had been homeless nor what circumstances had brought him to the doorstep of the Baltimore Rescue Mission shelter. As far as Dr. Dalton – our physician supervisor – and his students knew, Freddy had been there forever. Residents of the shelter were required to help out, sweeping floors or cooking for the other residents. Freddy always volunteered for clinic duty and was charged …
What draws me to primary care: Building relationships
When I was in medical school in the 1990s, students were given a bleak picture of the life of a subspecialist. We were told that there would be few job opportunities and that the only way to ensure a job was to pursue a career in primary care. Many of my classmates did go into primary care but the majority of us accepted residency positions in surgery, neurosurgery and other …
Medical education: Reform the investment of tuition and time
“Doctor, could we have a copy of your most recent CV.”
“Sure,” I said, realizing it hadn’t been updated recently.
It is interesting how I approach my academic pursuits now. It used to be that it was “publish or perish” in the world of academic medicine. Of course, even now the only “publishing” that counts to the academic world is that of conventional peer-reviewed journals with high impact factors (or grant applications that …
Academic promotion criteria should include social media
A technical standard is a formal document establishing requirements in several aspects of medical care which all physicians-in-training candidates must possess. Most medical schools require that all candidates meet these requirements in order to receive their doctor of medicine (MD) degree. Some schools require students to sign that document when applying to a program or as a condition to matriculate into medical school.
I took a closer look at different technical …
The deaf medical student: Why technical standards need updating
There is a strong relationship comparing sports to the military, business, and also to medicine. Young athletes, in their late teens and early 20s, are mostly brawn and use their strength and speed to achieve success early in their professional careers. As the athlete matures in their late 20s and early 30s, the physiologic processes slowly decrease and efficiency and maturity and other cerebral skills emerge.
There are 2 rainbow arcs …
Part of medical education is to learn limitations
Spring season is still many months away, but residency programs are in early heat as selection committees across the country buckle down to nominate the next batch of interns for the upcoming academic year.
Spread across these institutions’ tables one may find headshots, board scores, recommendations and interviewer comments of top candidates interested in training at their respective programs. Often, faculty members of esteemed medical centers will have only a few …
Questions to ask when selecting medical interns
When listening with a stethoscope to a patient’s heart, one sometimes hears a deviation from the typical “lub-dub” rhythm. Sometimes the “dub” is too loud, or the “lub” too soft. There might be a rubbing sound, or a harsh blowing sound. By interpreting subtle characteristics such as the location, pitch, and timing of these sounds, one can sometimes diagnose things like a diseased heart valve or congestive heart failure. Read more…
Medical students: Be sure to thank your patients
I recently had the opportunity to read Daniel Pink’s Drive. I read it partly to understand why pay-for-performance often fails to accomplish its goals for complex tasks, such as patient care. However, the thing I found most interesting about this book was the way in which creativity is deliberately inspired and cultivated by industry.
I could not help but think about why we don’t deliberately nurture creativity in medical trainees. Why …
Why we should nurture creativity in medical residents
Mexican medical residents have been submerged in a bygone system for decades. More than 100 work hours a week, scanty pay and psychological warfare are the everyday burden for residents in our country. You can read more about the working conditions of Mexican residents in my guest post, “The life of a medical resident in Mexico.”
Gradual progress is being made thanks to 30 years of pushing …
A view from Mexico: Reforming resident work hours
When I was in medical school in the 1990s, students were given a bleak picture of the life of a subspecialist. We were told that there would be few job opportunities and that the only way to ensure a job was to pursue a career in primary care. Many of my classmates did go into primary care but the majority of us accepted residency positions in surgery, neurosurgery and other …
Reform medical education to fix the primary care shortage
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My mom wrote me the following letter during my first semester in medical school. She has been a patient, and a mother/wife/sister/daughter of patients. She has been around countless doctors. Here is her take on what makes a great one.
Dear Son,
I am so very proud that you are becoming a physician and that you chose this profession, not for the prestige or the financial advantages, but because you want to …
From Mom: Here’s what it takes to be a great doctor
An excerpt from Pet Goats and Pap Smears.
After two decades of formal education, today I’m finally set loose with real patients. It’the actual moment I’ve been waiting for my entire life.
We’re each assigned to a family doc for the month. I scroll down the list of third-year medical students, place my right index finger beside my name, slide …
Learning about human relationships and the art of medical practice
“Sometimes, how you feel at the end of an interview can be clinically revealing,” my preceptor says. “How does this patient make you feel?”
***
“Mr. M?” I ask gently, knocking on the hospital room door. “May I come in?”
“Hello? Hello?”
I enter at what I think is an invitation to me, but see that 79-year-old Mr. M is speaking into the phone instead.
“I’m sorry, I can come back…” I start to say. …
Countertransference is a reality that must be grappled with
Back in the day, legend has it that when space programs were just developed, NASA soon discovered that ball-point pens will not write in zero-gravity. Unfazed, NASA spent a large amount of money developing pens that will work in space, while the Russians simply used pencils.
It turns out that this legend is only half true, but the lesson remains – sometimes, we get bogged down trying to solve …
Building residency training from scratch: What would you do?
A friend was working an overnight shift in the ER for one of her mandatory rotations, so I popped in to observe. The ER was surprisingly quiet. A classmate was also observing that night, and like me, he was standing around, bored. We spotted an electrocardiogram (EKG) readout lying on a desk where a resident was working, and we asked him …
The strong tradition of mentorship is unique to medicine
Today’s medical students will care for tomorrow’s patients, and future physicians need to be prepared to thrive in a rapidly changing health care environment. Future physicians will need to be able to navigate new and increasingly complicated health information technologies, understand and use advances in personalized medicine and many will need to know how to lead accountable care organizations.
Gaps between …
AMA: Accelerating change in medical education
“You’re not sorry.”
Within two days two different patients said this to me, each with hatred in his voice. Each time I was alone, each time I had known the patient for only a few minutes, and each time the rage was directed at me and only me.
For seven months, I had avoided being the bad guy. When a patient got upset, he accused my superiors, and I hid behind their …
Be the bad guy with good intentions
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