medical school

^^^Cope's, y'all

i've been checking out some english textbooks (well, oxford handbooks), and they are w/o question 100000x more readable/enjoyable than their knuckle-dragging american counterparts.

nb i was a lol english major, who ended up reading mostly 20th century brit lit but w/e

I was actually thinking to myself today that I should have gotten an iPad for textbooks, since I have gotten in the habit of walking into the hospital without a backpack, and so if I am looking to do some kind of productive studying upon my escape I am kind of at a loss. Today I just ate a sandwich and glanced blankly at the copy of Surgical Recall I jammed in my coat pocket and then I went home and haven't done anything since. (This is basically a running theme during surgery for me.) I am barely keeping my head above water thus far thanks basically entirely to online access to Schwartz's Principles of Surgery, and Sabiston to a lesser extent, which I should go read now.

In the preclinical years I actually went with the strategy I used during grad school, which is very brute force and needlessly time-consuming, which is to try and write/type as much material from my lecture notes out into a module-by-module giant Word Document, and then copy it again before the exam, because I feel like writing it in my own words, and then rewriting my own words over with more of an idea of the whole narrative forced me to use different parts of my brain that are more effective at retaining information than the part that reads stuff. On the plus side all of that can be pulled for a Spotlight search if I'm like "Oh man, what the hell is a Zenker's diverticulum again?"

xp I nearly got a PhD in history (of medicine, but still). I think American books are written for like "Here are science facts" people, which is awesome except I am like so infinitely far away from being one of those people.

oh man, I'm so glad I"m not the only one who uses that technique to cram!

^^^real talk. high yield stuff is only good after I've read actual sentences and/or taken good notes.
xp

this is was my problem with powerpoint lectures---they gave us the lecture slides "as notes" which encouraged lazy ppl like me to make inscrutable marginalia instead of actually following along. cf my med rotation where we had almost as much lecture a day, but from clinicians in front of white boards. my notes from that rotation are impeccable imo, and have served me well.

"Spot diagnosis may be magnificent, but it is not sound diagnosis. It is impressive but unsafe. The deduction and induction from observed facts necessary for the formation of a definite opinion provide good mental discipline for the observer, help to imprint upon the tables of the mind perceptions and clinical pictures that can be usefully recalled in the future, and give a sense of satisfaction that is only slightly diminished if the resulting opinion should prove to be incorrect. One often, if not always, learns more by analyzing the process of and detecting the fallacy in an incorrect diagnosis than by taking unction to oneself when the diagnosis proves correct."

― the only truffuluther on ilx (gbx), Monday, October 11, 2010 7:19 PM (1 hour ago)

man that is a beautiful paragraph

book we use a lot recently in pharm school is DiPiro (ever refer to that one?) - can't say i've encountered a passage as elegant as that but it's a great little (huge) book

i now have 1 stethoscope. don't know how to use it yet

Find a friend with a murmur, and just go bananas. Ideally a VSD, those are the best murmurs (unless they are big, in which case the person is really sick and also they sound less cool).

Also: today I touched a person's still-beating heart with my double-gloved hand. Surgery still sux it raw, though. I had way more fun chatting with him about his illness and whatnot than I did feeling around his thorax, tbh.

yeah big VSDs can be almost silent, iirc.

anyway kev you are supposed to put the shiny disc end up to your mouth, and use the caliper'd end to grasp the afflicted portion of your patient's body. then quietly recite the appropriate incantation (Harrison 14:3 is a good one) and wait for the healing daemon to appear. it is best if you have prepared an offering in advance---conference tote bags are good for this.

this is called 'whispered spectoriloquy' btw

I have awesome PVCs, come steth me anytime.

Oh man arrhythmias! I think I have heard a couple but I am always like "Wait was that me, or them? I should keep listening for longer" and then after like fifteen seconds of normal beating I move and on and write "RRR no murmurs rubs or gallops" like a good lil student. Especially on surgery when they really could not give less of a crap and you see "RRR no murmurs rubs or gallops" in people who actually have really obvious murmurs.

Also a fun thing to do with stethoscopes: next time you find yourself with some gastroenteritis, listen to your bowel sounds. A pissed-off GI system is noisy as hell.

I can't remember if you ever met my gf when you were still in Chicago? Because she's in a grad program right now for international public service and has recently become super-interested in public health. I bet you two would have lots to talk about, or at least books/resources to recommend each other.

― Nuyorican oatmeal (jaymc), Friday, December 18, 2009 4:03 PM (1 year ago) Bookmark Suggest Ban Permalink

So now she is getting very curious about MPH programs -- is passionate about the subject, likes the idea of doing research, etc., but is also reluctant to apply for a number of reasons. Does anyone have any personal experience with them? (gbx, quincie, ENBB?) I should note that she's mostly interested in global health; she just returned from a three-week trip to Kenya, where she volunteered in a hospice for a few days.

i'm also considering getting an MPH with my pharmD - have to do a lot of homework and meet with some people but it's something i've been thinking about for a while now

as someone perhaps in the same boat, are you at liberty to say what her reasons are for being reluctant to apply? i'd be interested but it's cool if it's something personal

i dont have any experience, but my sister is getting an MS in Epidemiology at the London School of Hygiene and Tropical Medicine (which is basically just a public health school), i could ask her about her experience

but yeah: what's yr gf reluctant about?

Ha, well, I mostly just don't want to put words into her mouth.

But, in no particular order:

1. $$$
2. She doesn't have a science background.
3. Mostly, though: she's not entirely sure what she wants to do with the degree. A big part of what appeals to her about the MPH is an opportunity to do research and learn more about a subject she's clearly passionate about. But she doesn't know where that would ultimately lead. And there are pragmatic concerns. Like, she's mostly interested in global health issues, but doesn't necessarily want to pull up stakes and take a job abroad.

my sister is getting an MS in Epidemiology at the London School of Hygiene and Tropical Medicine (which is basically just a public health school)

She's actually very interested in epidemiology, but see #2.

But, in no particular order:

I guess there's kind of an order.

Basically, for the last 5 years, she's worked for a nonprofit that does noble philanthropic work in an international context, but she's in a mostly administrative position and wants to do something a bit more challenging and involving and focused on her specific interests. I think she just kind of wants to know what her options are.

She should figure #3 out. Without a science background, she would be more suited for policy-type stuff, for which there are not a lot of jobs in Chicago; a move to DC would probably be in order.

Yeah, we've talked about that.

If she's really thinking about going a more sciency route, she's probably have a coupla years of prereqs to complete to get her up to speed/make her a competitive candidate; Bio, A&P, microbiology, research methodology, chem, stats, etc.

a very good friend did this program @ columbia & was v v happy with it. the program included a required placement w/ an organisation which i think helped - she ended up getting hired there after finishing iirc

yeah #3 is basically my issue

I was once interested in a career in psychiatry, but decided I didn't want it badly enough to endure medical school & subsequent trials of will & endurance.

I work with and have hired several MPHs--DC seems to be a good market. But I also attended APHA last fall and was pretty startled by the huge crop of MPHs coming out and looking for sjob. Figuring out what kind of MPH she wants to be is a good idea (more "hard" stuff like epi, biostats, etc. or "softer" stuff like heath communications; admin stuff like program management. . . lots of ways to go with that degree).

At least in DC, you don't necessarily have to have an MPH to work on global heath stuff, for sure!

final presentation for my adv phys dx class....planning on presenting the monty hall problem as a way to explain the wtf-ery of bayesian statistics.

place suggestions for a clinical scenario here

j/k i have a cartoonish one, but still

I was just doing Psych and we had a couple sorta-somatizating-ish/hypochondriac-ish patients who thought they had Lyme and that's why they were sad and were just CONVINCED it had to be Lyme. And so I was like "Why don't we just do a Lyme serology, it can't be that expensive" and it turns out that Lyme serologies are reaalllllyyy not great tests and produce a ton of false positives in people unless they already have a moderate-high suspicion of Lyme (migratory arthritis, h/o rash with central clearing).

So basically it turns out that if the pretest probability is low (i.e. a person with depression & fatigue who thinks they have Lyme), you basically would be rolling the dice that the test comes back negative, because a positive test tells you relatively little (since it might still be a false positive) and tells the patient EXACTLY what they wanted to hear. But if you do not address their Lyme concerns then they think you don't care about their input, and can find some other more ridiculous doctor to tell them that YES they do have Lyme and YES all their symptoms can be magically cured using their special (Expensive) treatments. I found this really tricky to navigate, and kinda just want to be like "Look, unless you produce a picture of the target rash I'm not buying Lyme" even though the rash is absent/not discovered in many cases.

This has become my new go-to scenario for feeling diagnostically screwed.

haw

i've been trying to explain sens/spec to anyone who will listen lately, just because i love how aggravating and non-intuitive it is (partic as it relates to prevalence and diagnostic truthiness)

The go-to NEJM debunking of "chronic Lyme" (free full text): http://www.nejm.org/doi/full/10.1056/NEJMra072023

Saw a chronic Lyme patient in clinic awhile back who told me the neuro who gave her the Dx was her "white knight" who "saved me" and that the diagnosis "changed my life". She still gets doxycycline for a month at a time, a couple of times per year.

Noticed recently that the phrase "extreme fatigue" (either in the history or the referral letter) is highly predictive of a normal exam and normal scan. The chronic Lyme patients I've seen have all had "extreme fatigue".

Actually, I was trying to explain out to one of them that I got her interest in Lyme because everyone (including us) likes it when there is a discrete, easily treated thing with an essentially magic fix that results in an end to all the fatigue and pain and mood change, and was thinking to myself "I wish I could just give everyone that thing Plasmon wrote about autism on ILX that one time".

Also my Psych resident (who was rad) was v much convinced that anybody who throws out the "Oh this doctor SAVED ME" stuff has a high suspicion of being on some Cluster B Personality Disorder ish, especially if they start talking about how before that doctor they had been to a parade of the Worst Doctors of All-Time.

P.S. Neurology, you guys. NEUROLOGY.

Your move, PM&R and Infectious Disease.

oooh neuro is next for me

Yay, post your neuro questions itt and I will reveal the secrets of the neuroniverse.

Guys, am I imagining it or does cardiology attract the most un-fun people ever?

Question - how old are the oldest people in your classes? Or maybe a better question - what the average age?

xpost

I mean I used to work with cardiologists and now I work with ID docs and the difference is night and day.

Please expound upon other personality/specialty associations here. I think we already did derm.

average: 27-28?
median: 24?

oldest: mid to late 30s. i'm near the old-ish end as a 30yo 3rd year

one of the 4th years i just had a rotation with is in her late 30s (maybe early 40s?)---she brought her 13 yo daughter to lecture a few times

ENBB---you thinking about medical school???

POSSIBLE NEURO QUESTION

last year around this time i noticed a weak grip in my right hand that prevented me from playing tennis (well). i attributed it to intramural water polo; i play goalie and part of what that entails is holding onto the back wall of the pool with my arms behind me back (not describing this well...). it went away after several weeks.

fast forward to this year - intramural water polo just ended last night (we won!). tonight i go to the gym to play basketball and i have no strength in my wrist/forearm again...i can't shoot a jump shot more than 15 feet. WHAT THE FUCK?

Wait, so is it weakness more in like wrist flexion/extension, or finger flexion? Is it more prominent on one side of your hand (thumb vs pinky?) Any pain or numbness/tingling?

Also:
The only cardiologist I have worked with thus far was a Peds Cardiologist guy who was insistent that the stethoscopes they give us and we all carry around are garbage, even though like every other doctor I mentioned this to was like "Uh, those are really good stethoscopes, like, it's better than the one I use". I think some of it may just be that ID people usually pretty rad, also. Most of the particularly challenging personalities I encountered this year were in and around general surgery; there are some really awesome surgeons, also, but there were a lot of dicks, and many general surgery residents seem to hate their life a little. (Might just be our program, I dunno.) Ortho is trying to break the stereotype of being exclusively for big jock dudes who forget everything else about medicine, but there are some big jock dudes who send out for consults a whole lot quicker than any other service. Psych attendings can be a lil, uh, "quirky". Most of the rest I am not sure if it is just our hospital/school or if this is a more common thing. I have a theory about Family Medicine, but I don't know if it's just exposure to a specific subset of people here, since unaffiliated Family Med guys all seem to be pretty cool.

The most common thing in my class seems to have been to take 1 year off from undergrad before starting med school (Class of '07, so like 25-26ish now). I think the oldest people in our class are like 32-33. But when they gave us the class demographic breakdown during orientation, they mentioned it was unusual to have nobody older than 30. I know a person at GW who was going to start at age 36 but had to take a year off because she had a baby, so she'd be a 38 yo 2nd year now. I'm a little older than average and it's generally not an issue, if you don't mind that many of the class-wide social events early on will involve a keg, and that people three months out of undergrad seemingly do not get hangovers of the intensity/duration that you will.

numbness/tingling in my pinky. and it's...definitely more in the wrist/forearm.

i noticed tingling up my arm during the water polo game - i seemed to be irritating my ulnar nerve as i was playing, then the next day this happened

If you're numb in the pinky (and maybe the outside edge of your ring finger too?) and weak in wrist flexion (as used in a jump shot) and grip strength (which involves the intrinsic muscles of the hand), you've most likely got an ulnar neuropathy. The ulnar nerve is the "funny bone" at the elbow. It can get pinched at the elbow or at the wrist (or rarely, between them). The nerve is probably being damaged at the elbow if you've noticed some weakness in the forearm.

The most common reason for ulnar nerve damage is compression or stretch, either from resting the elbow for a long time on something hard (like a desk) or sleeping with the arm folded under you. I'm not sure how playing water polo would damage the nerve, but if it was already irritated/affected it might tingle or feel weird when you flex/extend your elbow.

Lots of other things could mimic this picture, but that'd be the most common explanation for what you're describing.

Protecting the compressed / stretched nerve allows it to heal itself, which can take some time. This came up awhile ago on the carpal tunnel thread.

(Note: I am a real doctor but the above is not official medical advice for you, use at your own risk for recreational purposes only.)

i actually misreported a bit - my grip isn't weak like it was last year; i can still hold my wrist firm on a backhanded volley in tennis and can still palm a basketball - two things I couldn't do w/ last year's injury. i think the ulnar nerve is probably the culprit too, though, it just seems to be presenting differently this year.

i can still hold my wrist firm on a backhanded volley in tennis

...this would be the work of extensors, no?

If you're numb in the pinky (and maybe the outside edge of your ring finger too?) and weak in wrist flexion (as used in a jump shot) and grip strength (which involves the intrinsic muscles of the hand), you've most likely got an ulnar neuropathy. The ulnar nerve is the "funny bone" at the elbow. It can get pinched at the elbow or at the wrist (or rarely, between them). The nerve is probably being damaged at the elbow if you've noticed some weakness in the forearm.

I had asked about this on the other thread and it's definitely what I had. I can't remember what it was called but the doc called it something similar to but not exactly carpal tunnel. I think it was some other syndrome. I stopped sleeping with my arms bent under my head and it has mostly gone away.

GBS - maybe. I really really want to but it is a very daunting thought. I'd have to do a lot of pre reqs and I don't know how I would actually go about it logistically but I'm sort of toying with the idea of maybe doing it very slowly and just accepting that it would take a long time but be worth it in the end. Might also look into PA programs as that would be at least a little less time.

Cubital tunnel syndrome, maybe?

The ulnar nerve can also get pinched in the wrist in Guyon's canal, but that doesn't cause weakness inn the forearm.

Tennis backhand volley is mostly wrist extensors, which are radial nerve innervated.

...

Several people in my class started med school in their 30s. I was 27, median starting age was 23-24.

Being a little older is quite helpful in terms of having a broader perspective about patient care, the role of doctors in society, etc. The hardest part of it is doing the first year or two of residency with (possibly/probably) more commitments to the outside world. Depending on where you're at in terms of a relationship, having kids, buying a house, etc, being ridiculously busy and tired and in debt for several years in a row can be a huge challenge. I don't exactly regret the time I spent doing other things before med school, but there certainly were times in residency where I wished it was over with already so I could get on with the rest of my life. Of course you could always do a shorter residency -- quite a few of the older med students I know opted for a 2 yr family med residency plus a 3rd year of anesthesia, ER, or what have you.

Yes! Cubital Tunnel Syndrome! :)

Thanks for sharing your experience. It's definitely interesting to hear from someone who has gone through it.

Cubital tunnel syndrome: the forgotten tunnel syndrome (along with tarsal tunnel syndrome)

I decided I wanted to go to med school shortly after I was in grad school (to do something entirely other), but I wasn't totally SURE I wanted to do it (the whole story takes like 45 minutes to tell properly, it is full of ridiculousness), but I figured I would sign up for an MCAT prep course to see if that'd be OK, and then sign up for the MCAT once I felt like I had a chance to do pretty OK at it, and from there just see how it went. I've heard other stories of people shadowing a doctor or volunteering in a hospital to slowly feel out whether they really wanted to do it.

There's a couple ways to take care of the prereqs. There's a handful of places that have year-long intense post-baccalaureate programs that cram in all the pain of organic chemistry et al. There are also less organized, but also at-your-own-speed options through university extension programs. I had been a pre-med in undergrad and had put like 95% of the stuff behind me, but I wanted to add a little extra stuff to my transcript, so I ended up taking undergrad statistics at UC Davis the summer I lived in NorCal and had no real job to prevent me from driving an hour each way four times a week, then a couple quarters of extra biochemistry night courses at UCLA Extension once I moved back down to LA. This way tends to be cheaper (UCLA Extension was like $500 a course for me, whereas I think if I had needed to go do everything, there was some other place in Southern California, either USC or one of the Claremont schools, that had like a $15,000 intensive year). This is also a good way if you're kinda-unsure and don't know that you definitely want to commit a dedicated year and a lot of money towards the strange, epic journey that is trying to get into medical school.

If your GPA sucks there's also additional post-bacc programs that are designed specifically to give you something to say "OK I was bad at physics as an undergrad, but NOW I am taking classes with med students and doing very well"; my school has a "Special Masters in Physiology" thing where you take like half of the first year courses with the first year med students. These are also expensive, but they do seem to work pretty well if you can fight off a horde of your fellow students.