medical school

You don't want Cipro for a chest infection, poor lung penetration. Moxi is the respiratory fluoroquinolone of choice around here. Cipro's good for GI and UTI.

Zithromax all the way.

if it's really bronchitis, the person likely does not need an antibiotic. dare you to suggest that!

cipro in fact gets into the lungs just fine, it just has poor activity against strep pneumoniae, which is why it's a poor empiric choice for most lower respiratory tract infections (and not considered a "respiratory quinolone" like levo or moxi). if a sputum culture comes back sensitive to cipro, it's a fine drug to which to de-escalate, assuming it's the narrowest-spectrum choice. it's even a part of some hospitals' empiric double-pseudomonas coverage (usually along with a beta-lactam) for ICU-bound PNA patients

when i was on ID rotations, in central connecticut, the resistance of strep pneumo to azithromycin was around 20%, so doxycycline (along with ceftriaxone, if the person was going to be hospitalized) was preferred empirically for most presumed LRTIs, assuming there were no drug-resistant risk factors. for most outpatient pneumonias/bronchitis, azithromycin works as well against the virus that probably caused the complaints as any other antibiotic, though ;)

oh sorry, i didn't really catch the context of the question -- ie for travel. when i traveled to thailand/burma to work last summer, i brought zithromax. either is fine for her purposes really.

ha, just read the other thread! i agree with kate!

Azithro also has anti inflammatory qualities iirc which is why it gets prescribed for COPD exacerbations that aren't clearly bacterial

Thankfully the crap cleared up on its own, but I thank you for the advice and discussion!

Somewhat related question: what do/did ya'll do when you were stoodents and had a messy URI (active coughing/sniffling/sneezing) but were expected to be seeing patients in the hospital (including ICU)? Just drug up, wear a mask, and try not to cough at the bedside on rounds? Or are you encouraged to actually stay away in such situations (ha)?

as a student? stay home. or show up with a mask, have someone notice you're sick, and get sent home.

as an intern, i'm a little too integral to the actual operations of the medical team (ie - if i'm not there someone else has to do a lot more work), so the threshold is a lot higher. i've only taken one sick day all year, iirc, though i probably could've reasonably take one or two more.

tho i haven't done (and won't ever do) an ICU rotation as a resident, i'd imagine the thresholds are even lower for students and maybe just a tad higher for interns (due, again, to the volume of work).

ah, thanks, good to know. I was thinking it was probably NAGL to be a coughing/sneezing/sniffling bug bomb in front of patients and families, especially when the patients are in critical care. Like, even if you wear a mask and are otherwise really careful about infection control.

My roommate is kinda freaking out right now because she got bit by a cat in Myanmar but didn't get her first rabies vaccine shot until 6 days later

She also has been wrestling with a case of food poisoning that is displaying flu-like symptoms

What do I tell her to console her

go to a fucking doctor

Yeah she went yesterday

best consolation is soup ime

laphet ime

If she gets a rabies vaccine before she's symptomatic (and that's assuming the cat even has rabies), she's good.

And if not, send her to Milwaukee: http://en.wikipedia.org/wiki/Milwaukee_protocol

ianad but before i clicked that i was going to recommend putting her into a coma because i heard about that girl on some stupid npr show. before i heard that i didn't realize quite how bad rabies is!

plasmon, you taught kaplan in the past, right? i hesitate to turn this into SDN, but here it goes: what kind of consistency should i be looking for on these practice tests before i have a good idea of what my score will be? i'm doing very well on the practice exams, but the range is so wide i really have no idea what to do with my scores, or how fluky they are. i understand the concept of the bell curve and how once you're a consistent 10/11 test taker, a couple of good guesses makes it much easier to jump up a point or two relative to 7/8/9 students, but the full-length (kaplan #3) just kind of scared the shit out of me. i got a 13/14/15, which i just feel like is not where i am yet (or probably ever, given that my exam is in 3 weeks) -- my last 2 were 11/11/10 (though this was a month ago) and 12/13/10 (earlier this week). i guess it was just a harder test with a more generous curve, but that score is so ridiculously high as to be meaningless to me, bio in particular. i think i'm a solid 11/12/11 right now. i plan on taking the other two required FLs next week, but after that, are there any tests that you think are better than others? i'm not gonna have time to take all 15 other ones or however many there are

do you remember FL3 being particularly outlier-y? i've heard stories about #11, but not 3

ime, particularly as a recovering english major, a teensy bit of extra effort and consideration on the language portion paid huge dividends. like, i was getting 11-12 and finishing with loads of time to spare, and once i forced myself to go more slowly and pay attention i was getting 13-14 consistently

otherwise i have no recollection of what happened with the MCAT

i'm sort of perversely enjoying getting into a groove with taking these tests, though, they all unfold the same way. physical sciences i hate, not because it's difficult but just because of all the math/thinking involved. i always use every second of the time there. verbal is actually pretty fun; i find myself enjoying most of the passages and sometimes forget I'm taking a test, so i have to watch my time sometimes there too. bio is just a crapshoot, it seems to be the section most dependent on recall knowledge, so i just go into it crossing my fingers that they test areas where i'm strong.

^^^p much how i felt about it, too

I taught for Princeton Review, and that was >10 years ago now.

I don't know anything about Kaplan's tests, sorry. But if you scored a 42 right after a 32 and a 35 it seems the curve was in your favor on that last one.

Even so, you're consistently scoring in the double digits in all sections. That should be more than enough.

I always found it hard to score more than 12-13 in verbal reasoning, 'cause I'd end up skimming, racing through it, and debating/arguing with the questions. I don't think my scores ever changed much with practice. Many of my students didn't improve much on that section either, once they got the basics of testmanship down.

I didn't bother to re-learn the organic chem in the biology section (which I'd done years earlier), so I never beat 11 there. The rest of bio was easy enough even though I'd never done a biology course, just memorization.

I loved physical sciences, that's what I ended up teaching for TPR along with VR and the essays. That's the section where extra time spent working through problems was most helpful, and I just loved the mental gymnastics.

Do they even have essays anymore? It was a stupidly simple format but I don't think I ever had more fun writing something for marks.

Main advice I'd give is to work toward the big day as a performance. Don't spend too much time drilling the details, and especially don't do too many practice tests, you'll wear yourself down. Make sure you prepare physically for the day, like an athlete getting ready for a competition -- get some sleep, exercise, fresh air, music or whatever you get your mind cleared and focussed. If you have routines for tests, follow them.

Don't stress about your score on the full length practice tests, focus on your performance in that situation as a test taker. Do them under as exactly similar conditions as possible, so you'll be right at home on game day. For you, the goal of a full length practice test shouldn't be to predict ahead of time how well you'll do (for diagnostic purposes) -- you're clearly good enough -- it's to maximize your performance on the real thing.

i luv discrete questions

If memory serves, the test is designed to have a standard deviation of 1 point to either side, on each of the 1-15 sections (fun fact: this is why the essay is scaled entirely differently, because it can't be standardized as well), so in theory it's designed that you could have a 6 point swing in either direction, though it'd be much more likely to float within a narrower range (like 2 points).

Dear Medical School/Medical Ppl Thread,

Can you think of any good reasons to be a hospital social worker that I might be overlooking? Because at this point I am just biding my time to gtfo.

My experience, to date:

Hospitals (at least my acute-care, for-profit, urban teaching hospital) equate social workers with discharge planners

Discharge planning is the ne plus ultra of "social work"

Discharge planning involves very little actual social work

Why hospitals employ licensed social discharge workers is curious on the surface. Below the surface, having LICSWs on the payroll has everything to do with accreditation and billing and zero to do with the actual skills required to do the "hospital social work" job

The situation may be different in inpatient psych? I dunno those social workers are note even in my (Case Management) department.

U.S. healthcare is so fucked up I mean can I even

Fuck this I am in no way inclined to pursue a job as a hospital social worker but hey I just wanna put it out there to see if anyone might have a counterpoint

Also I had not anticipated this AT ALL but I find the hospital environment rather dull tbh.

i can only speak from my own limited experience, but social workers as bona fide discharge planners doesn't seem like an outrageously unfair assessment of their work in hospitals, at least on medical floors. if you've got your heart set on working in hospitals, as you said it might be worth your while to look into providing your services on specialty floors; gbx might be able to tell you more about inpatient psych work, but i can tell you there is probably a lot of interesting and possibly fulfilling end-of-life and family meeting type stuff on oncology floors as well

also personal update i have my first interview in november, woo-hoo!

we have LICSWs that do ED assessments of psych patients as part of the admissions process

btw gratz, kk, lemme know if you get up to g3isel

great news, kk! And yeah, I am seeing that IP psych/ED psych SWers have a different job than floor SWers, who I mean c'mon why do you need an LICSW to do discharge planning? Answer: you don't. Why this is a requirement is one of many things that is so fucking fucked up with hospitals. If anyone works in a hospital where this is not the case, please tell me!

Anyhow I have been accepted as a fellow in a geriatric social work program and this is where I wanna be, so all is good. My next internship will be in a non-profit hospice where I will have my own caseload with home hospice clients, which I think will be way more social work-y than my current hospital ICU placement. What I've learned in this setting is awesome, but also that I need not hang out here much longer.

also hey I see now that as an ICU patient you are a bag o' chemicals to manage; it is so rare to find a critical care doc who thinks otherwise. My time on the ICU has just so turned me off all of U.S. medicine that spouse and I are no shit moving to Finland to retire and die.

That's the scariest thing I've read in a long time.

godwilling I won't find myself in an ICU anytime in the next 50-odd years but if I do I sorta think I'd prefer that the people keeping my systems functioning are as unemotional as possible.

compose yr advance directives, ppl

and gbx thanks, and i will! my first interview is at UVM (i live here) but i did apply to g3isel too. btw if you ever find yourself calling in a prescription to a k1nney drugs in vermont and the person you talk to is kevin then that is probably me

oh i guess this is as good a place as any: last night a guy with a diabetic foot infection walked in with a prescription for vanco capsules. don't do that, doctors

dude i write for k1nney in VT all the dang time

yeah i'm all over the place but that's who i work for right now. funny small world story i actually have a pharmacist coworker who's an M1 at g3isel now, she works at the lyndonville store. i used to work at that store a lot but not so much lately

I spent this week on the inpatient psych ward!

As a social work intern, not a patient.

Also shadowed the ED psych social worker.

my 2 cents of observation/lyfe experience is that psychiatrists are either totes cool dudes/chicks or ppl who have er challenging personalities that some might suggest are Axis II ish

not a lot of "meh" people i.e. ENT dudes/chicks

also most social workers are not very good

also should I be a transplant social worker, word on the street is that this is a sweet gig.

should I check into an inpatient psych ward if all I really want is to have people pay attention to me and make sure I eat for a couple days?

NOOOOOOOOO

at least not the psych ward at my hosptial

protip if you decide to go that way: plan to spend 20+ hours in the ER and then you'd better have a convincing story of suicidal or homicidal ideation and/or delusions that interfere with your activities of daily living. Otherwise you'll be sent back home. If you have no home, you will be sent back to the streets with a suggestion to check in on shelters tomorrow before they get full.

You may get a shitty boxed lunch after 8+ hours in the ER. Guy I saw in the ER and then the next day on the psych unit remembered me as the person who brought him a sandwich but could only offer diet ginger ale because we only had regular coke, not diet.

I spent this week on the inpatient psych ward!

As a social work intern, not a patient.

Also shadowed the ED psych social work

my 2 cents of observation/lyfe experience is that psychiatrists are either totes cool dudes/chicks or ppl who have er challenging personalities that some might suggest are Axis II ish

this seems about right

I have finished my internship in hospital social work (primarily ICU, some med/surg floor experience, some ED and inpatient psych).

I will not do hospital social work ever again.

I will not willingly be hospitalized.

I think our (U.S.) hospital system is irreparably fucked.

I start as a home hospice social worker next month.

Surely this will be better.

Favorite quote from an Esteemed Psych Attending: "these people don't need our compassion, they need our intellect."

Fuck. You.