medical school

i sort of assumed he was billy buffalo

i wish

what a thing for a child to do, to wish that her own father was just a man in an animal suit

Hey Max, would your research extend to the focus on medical errors and evidence-based practice and all that? I think To Err is Human from the IOM came out in like 1999 or 2000, and that seems like it was a big deal. There are a couple of books from a few years ago that springboard off that IOM report that are basically all about how tens of thousands were/are dying because nobody was washing their hands and such (I forget the titles offhand, but one is by a guy named Don Berwick and the other is by Robert Wachter and a dude whose name I cant spell). I think that ties in with Intermountain from that piece in the NYT magazine a couple weeks ago, too.

Also as an orthopedics nerd I have to mention the ridiculous advances in trauma surgery and prosthetics that have been going on since the wars started, and the countereffect of psychiatric disorders in people who would have just died in Vietnam or WWII.

the prosthetics thing is definitely on my list--the evidence-based stuff tends a little bit too much towards "policy" for what were looking for? i think? but i may try including it

C-L,

Where does an ortho nerd go for nerdly indulgences? Aside from a stint in the ER, almost all my clinical shadowing before school was orthopedics, and I'm crazy about it. Not in a nerdy way, since I don't know squat, but in an aspirationally nerdy way. Like, my interest in orthopedics almost makes me guilty, but there it is: I secretly just want to use power tools.

Btw, have you been to a Shrin3r's hospital? They might actually be that despicable application essay reason I decided that medicine was a good idea.

also lol at punctuation and putting on airs to win the esteem of a colleague

Oh, also I remembered that it is now basically impossible to talk to neurologists without them going "Oh man just wait a couple of years and we are going to BLOW YOUR MIND with how much we can do" between Deep Brain Stimulation and stem cells and limiting traumatic brain injuries and generally understanding what the hell is going on in the brain. I am not 100% sure what hospitals are at the leading edge of that, though. Between that and learning about concussions from the NFL it is all exciting enough to make me flirt with going into neurology.

I have similarly also heard such things about Interventional Radiology (although sometimes the Interventional Radiologists just talk about making $$$), since they are taking on procedures that used to be done blindly (or with larger incisions) by other fields. Supposedly talent is draining out of cardiothoracic surgery, since you rarely go open-heart anymore, but you can stent all day long. I still have very little idea what the hell interventional radiology actually entails, though, since the conversation rapidly goes from "look at how we can see EXACTLY where this needle is going" to "Look at how awesome all of our equipment is". To be fair it is pretty awesome.

haha, neurology is hilarious, though, esp since it seems like a great deal of it is pointing to the precise location of the lesion, detailing how exactly it is the pathways are disrupted, and then crossing your arms and looking like a kid who built a model. "see, there it is? pretty sweet, huh!" "so now what? does it work?" "...wait, waht"

i have been very persuaded by the neurologists, if only because i tend to be a person who likes to solve a puzzle and then do ~nothing~ about it

and yeah, IR is also pretty intriguing because it is just so deeply nerdy.

actually knowing and CARING how imaging works + knowing enough anatomy and physiology to be able to read scans like a g + buying sweet computers and lol MRIs and thinking of them like someone else thinks about delivery trucks + doing spaceship surgery w/video games + all of the money in the entire world = profit???!!!!!!

i'm actually just wondering when radiology will change its name to something more specific and descriptive.

Actually my institution puts out a higher percentage of orthos than any other med school year after year, so we are kind of indulged. Although there are many dudes who are more typically ortho-y than me (i.e. very tall dudes who played sports at a high level and call each other "bro"), which makes me slightly nervous. Most of my interest was built up over years of athletic training and physical therapy work going way back to high school, where I got to watch all kinds of horrible knee trauma. But then this summer I was at Children's Hospital LA working on an ortho research project and oh man kids with congenital defects <3 <3 <3 so rad Best Ever. Plus hanging with orthos (and PTs) all day was way less about "I am IMPORTANT listen to ME I am an IMPORTANT DOCTOR" than working with/shadowing the avg surgeon in my experience. Maybe it is just a West Coast vs. East Coast thing, though.

I have not been to a Shriner's hospital. There seemed to be some interaction between the Shriner's in LA and CHLA that I didn't get to be a part of, but it looks like the closest one to DC is in Philly. We do not even get to rotate at Children's National Medical Center in DC because that is apparently GWU's (and maybe Howard's) hospital. We get to go to Walter Reed, and they don't, so there is that.

Yeah it is kind of odd to be super-concerned about the fact that there really ought to be some gigantic expansion of primary care and yet at the same time be like "I want to go into a sub-subspecialty, why because it look interesting". I am part of the problem! Although it could be worse, I could be gunning for that #1 Derm spot.

Yeah it is kind of odd to be super-concerned about the fact that there really ought to be some gigantic expansion of primary care and yet at the same time be like "I want to go into a sub-subspecialty, why because it look interesting". I am part of the problem! Although it could be worse, I could be gunning for that #1 Derm spot.

― C-L, Monday, November 23, 2009 6:14 PM (2 seconds ago) Bookmark Suggest Ban Permalink

this is like the central tension, for me. the us and the world just needs more ppl doing general practice and yet surgery/radiology/etc are just so dang intriguing. like i actually worry that i'd go into GP and feel like i'm working a 'desk job', even though i routinely grouse about the how what the world needs is more GPs and less academics/specialists

obv the best choice is to do the thing to which you are most inclined (for whatever reason), but sometimes i think it'd just be crass and selfish if i was like 'fuck it, ophthalmology is my SHIT'. but then you know i think about how the eye is pretty dope and i can understand why someone might want to spend a lot of time dealing with it

Yeah the guys who can come in and give a lecture of like "Look at all this crazy shit that can happen you guys!" are almost always more fun than "Here is why it is bad that people are so fat now", even though obesity and hypertension and all that are way more of an issue than the crazy stuff that people usually only get on House. And then the specialist guys come in and be all "We can do medicine with positrons and lasers and SCIENCE!" and then an old guy tells you what a 3rd heart sound kind of sounds like usually.

The exception for me is with pharm since it is kind of awesome every time I watch ads for boner pills because now when they say "Do not take Viagra if you are taking Nitrates for chest pain, as it may cause an unsafe drop in blood pressure" I can nod my head knowingly.

http://www.hopkinsmedicine.org/geneticmedicine/

max - not sure how widely your defining "innovation" but these dudes (including most recent nobel laureate) are doing some pretty interesting research in medical genetics. i cant think of one specific breakthrough that might be worth writing about but i bet the have a press office that can put u in touch with someone

thanks lamp thats exactly what im looking for

haha, neurology is hilarious, though, esp since it seems like a great deal of it is pointing to the precise location of the lesion, detailing how exactly it is the pathways are disrupted, and then crossing your arms and looking like a kid who built a model. "see, there it is? pretty sweet, huh!" "so now what? does it work?" "...wait, waht"

i have been very persuaded by the neurologists, if only because i tend to be a person who likes to solve a puzzle and then do ~nothing~ about it.

...pretty much. that's why i went into neurology, some combination of one-upnerdship and fatalism.

in real life, localization problems are mostly put into the cold hands of the MRI machine. not everything works out as cleanly as in brazis or blumenfeld. even aside from localization, neurologists have to face more vague, complex and/or unknowable clinical situations than other specialists except psychiatrists (unlike psychiatrists, we're expected to get the answer right). expertly-done clinical neurology takes more time and care than modern medicine usually allows: it's a bit of an anachronism. so it helps to have a self-concept that's heavily dependent on believing you're the only one who has the brains and willpower to sort through the morass of possibilities to find the shining nugget of clinical truth. self-satisfaction in problem-solving and patient care has to make up for the lack of some of the more tangible rewards that accrue to practice in, say, interventional radiology. therapeutic options in neurology are improving all the time, but i'm afraid we're a long way from the sort of revolution that would make treatment and cure the most rewarding part of the field.

old maxim that will tell you if neurology is right for you:

if you don't understand it, it's psychiatry;
once you can explain it, it's neurology;
once you can fix it, it's neurosurgery.

that's about right. neurology, day by day, isn't about the great unknowns (oliver sacks case studies aside). it's mostly about accurately explaining complex (and often obscure) problems we can do little about. and most of our promising/experimental therapies are really surgical and/or interventional (epilepsy surgery, DBS, endovascular procedures, m-a-y-b-e stem cells). someday neurologists as a tribe might show an interest in learning some of those techniques themselves, but for now we're generally happy to pass them off to NSx or Rad.

bottom line, if you like dealing with people and being the only person in the hospital who can figure out what's wrong with Mr X, you're going to have a lot of fun in neuro.

hello plasmon!

(unlike psychiatrists, we're expected to get the answer right)

I will be stealing that line, thankin' U Dr. Plasmon.

Plasmon, don't neurologists ever work closely with cognitive neuropsychologists on therapies, in or out of the hospital setting?

plasmon what are the answers to my neuropathophys exam tomorrow

hello med-ilx!

Plasmon, don't neurologists ever work closely with cognitive neuropsychologists on therapies, in or out of the hospital setting?

there aren't a lot of proven cognitive neuropsych therapies. neuropsychologists help diagnose some neurology patients (doing detailed cognitive testing) and help establish parameters for treatment of others (testing memory in epilepsy patients to see if their baseline level of cognitive function will be severely impaired after temporal lobe resection). cognitive/behavioral neurologists (read: dementia specialists) work the most closely with them. i'm sure there are some promising avenues for therapy, but they aren't established yet.

plasmon what are the answers to my neuropathophys exam tomorrow

path slides? gross or micro? cases and questions? MCQ? short answer?

pathophysiology, all cases and questions. basically: localize!

i just need to know the brainstem a little better

took gross/micro neuro path on monday, did ok :-/

lol exams lol posting 2 ilx :/

good luck bro

Good luck, do not let them catch you on a Central VII lesion that they want you to believe is Bell's Palsy.

i will allow no such thing to happen. if innervation to the forehead is preserved then u kno what THAT means

lol exams lol posting 2 ilx :/

good luck bro

― Lamp, Tuesday, November 24, 2009 5:47 PM (15 minutes ago) Bookmark Suggest Ban Permalink

study time out iirc

haha i was lol'n @ me really - gave up on drinks w/bros 2nite to stay in and "study" i.e. post to ilx

https://www.youtube.com/watch?v=WGgCy-hbp4Q

my downstairs neighbors must haaaaaaaaaate meeeeeeeee

all pacing back and forth to the kitchen, making 100000x cups of tea with a whistling kettle (pro-tip: white or green tea makes for a better caffeine titration than coffee imo)

aren't you guys about to figure out how to cancel sleep anyway

i think i did figure it out, and i think it was a mistake

literally seeing thru time right now

my test went well just fyi thinking good thoughts 4 u future gbx if u can still hear me~~

it is ~*all good*~

http://www.kevinmd.com/blog/2009/11/training-doctor-france-differs-united-states.html

How is everyone doing? hanging in there during exam week?

next week for me. should be pretty chill? our period was only 2.5 weeks

can i post here too? stressed about pharm finals tbh

also genuinely interested in fl3x md and their school of public health/int'l health opportunities

― gbx, Wednesday, December 26, 2007 5:35 PM (1 year ago)

you still heading this direction? public health was the coolest class i took this semester

We had two four-hour exams this week (Monday and then this morning), both of which were absolute monsters. There is one more shorter one on Monday and then winter break. I am so tired, and want 2nd year to be done so I never have to do 2nd year again, but other than that, you know no complaints. If I get a passing grade and it's not so bad that I have to kill myself next quarter to make sure I stay above the pass line, then I am all good.

K3vin I feel it is only appropriate to discuss Pharm here because I spent most of the past two weeks going insane trying to keep track of like, which antibiotics require dose-adjustment in renal insufficiency and which ones in hepatic insufficiency, and then today I got my ass handed to me by the cardiovascular drugs, esp the antiarrhythmics. Like the hypertensives and CHFs and anginas all make sense eventually, and the anticoagulants are comparatively a treat, but then all of a sudden we enter this hellish netherrealm where somehow Amiodarone is considered an agent that it is still OK to use, despite turning your skin kind of blue and having 1 million other toxicities.

Nursing school, not medical school, but whatever: One exam a week for the last month, two 50-75 page chapters a week to read. Two clinicals a week, both of which entails us having to get to the hospital at six in the morning. (It'll increase to three a week for a while after the first of the year.) And just about everyone else other than me works 30+ hours a week. True, it's not even close to what you future doctors have to put up with....

I'm glad I have all of this behind me!

re: Amiodarone, besides all of the potential serious (and potentially fatal) toxicities, I can tell you from personal experience (with an arrhythmia) that it's an extremely nasty drug. What they don't tell you is that it makes you feel like you're having to drag yourself through your life for every second of every day that you have to take it. I'm just glad that my trial with it didn't last very long.

C-L we must be on totally different schedules!

I think you started like a month after we did (we started like the second week of August, or whatever it was 20 weeks ago).

Am kind of envious of nursing school for letting students have some hospital time in the middle of the preclinical sciences. Maybe not so much for the 6 am part, but still. We get to do in-hospital Physical Diagnosis coursework in like March, I think. And then once July rolls around it is 3rd year~

and then once July rolls around it is 3rd year~
and then once July rolls around it is 3rd year~
and then once July rolls around it is 3rd year~
and then once July rolls around it is 3rd year~
and then once July rolls around it is 3rd year~

just saw a screening of Living In Emergency

did u???? i wanna talk about it

what is it abt? i am studying

https://www.youtube.com/watch?v=PMuLdA5AbXM

did u watch it for school gbx or on your own?

on my own

well, went to it w/dad and sis, actually. didn't even know it was showing here, but my dad got tickets. kinda wanted to talk with him about it afterwards, but it's late and i needed to get home.

(he is a libertarian surgeon, btw, and i think sometimes we have pretty different outlooks on healthcare, but he seem pretty affected by it, at least during)