This blog will probably be pretty sparse for the next month, I’m sorry to say. Accept my sincerest apologies, faithful readers, but The Boards loom over my head. I take them on June 1.

It gives me approximately 5 weeks to review everything I’ve covered in the past two years, and even several large gaps in our knowledge that we weren’t taught. (Ahem, embryology and biochemistry.) I’ve got a calendar and everything to keep me on schedule, but the past couple days have been simply overwhelming. I’m basically fitting in 4 weeks of material into 10 hours of studying, if that.

Schedule as follows:
Wake up. Library by 8:30 at the latest.
Study until 12:30.
Lunch for an hour.
1:30 to 3:00, study.
By 3:00, I’ve lost all sense of hope, motivation, and drive, so I’ve been going to the gym then to destress.
Eat a snack, around 4:00?
Back to the library.
Eat dinner at some point.
Go home exhausted, and squeeze in an episode of Reno 911 to remind me that humor and fun still exist in the world.

Random thought collection:

• I think I diagnosed someone in high school with Cushing’s. I feel really bad, because all the people at school used to make fun of her for being fat, but now I’m really starting to think it was a hormone imbalance. She had the roundest moon facies I’ve ever seen. Can’t remember if she was hirsute or not.
• My computer is dead, for like the fifth time, but it’s probably a good thing: less time online to procrastinate and surf the web. The Lord works in mysterious ways.
• This test just seems like another stupid hazing ritual sometimes. Make us work our asses off so we get used to working hard, long hours.
• Other times it seems very valuable. I can’t count the number of times I’ve been reviewing something and think, “Oh, so that’s why that happens.”
• What I wouldn’t give for, like, a day where I could stay up late and play some stupid computer game all night. I miss undergrad.
• I probably would have already had a psychotic break, and be completely lazy and not studying when I’m tired if it weren’t for a special new significant other in my life. As my parents read this blog, they will inevitably start to pester me to find out more, but I’m really not in the mood. He is great, he is smart, he is cute, he’s a he. That’s not a typo, as someone once emailed me confusedly. Get over yourself.

Back to STDs and gynecological neoplasms. Woo.

10 Comments »

Ahh, America. A man with psoriasis considers marrying just to get health benefits . Now who’s ruining marriage, Conservative Christians? The gays, or the uninsured?

2 Comments »

The UN recently had a vote about “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health,” and the measure passed, 52-1. Guess who voted against it? China? Egypt? Saudi Arabia? No, no, no. All of those countries supported it.

The answer: The United States of America. Home of the free. How disgustingly low can we be.

7 Comments »

Comments are now back. Sorry for the long delay. I know sooo many people have wanted to post. (Yeah, right.) Thanks to Nick for reminding me.

1 Comment »

I’m reviewing cardiovascular and respiratory physiology for the Boards right now, and a little self-experimentation goes a long way. I have a little burst capillary in my cornea right now, and I’m pretty sure it’s from doing a Valsalva maneuver to refresh my blood pressure and heart rate physiology. And whenever I start reading about tidal volumes and functional residual capacities and dead space , I have this uncontrolled need to breathe really deeply.

1 Comment »

I have seen the future of medical school training, and it is extremely cool . And extremely expensive.

We went to the Palo Alto VA Hospital’s patient simulator today, and met our patients: two almost-creepily real medical mannequins (one cost $180,000, the other, about a quarter of that). As our professor said, “they can do just about everything but live.” The experience was to give us exposure to how to manage an acutely ill patient, and it was one of the coolest experiences in medical school. The mannequins have pulses (femoral, radial, and carotid), heart beats, breath sounds, and bowel sounds. They breathe in and out (and their chests rise), they can get IVs, chest tubes, cardioversion shocking with paddles, central lines, foley catheters, and just about anything else you can think of. They even have oxygen sensors in their noses: if you give them O ₂ , their saturation increases. And their pupils dilate and constrict. They even talk. (Well, okay, they talk through a speaker in their mouths, and the voice is from the control room person running the simulation, but it’s still a little eerie.)

We had several different scenarios, the first with the preceptor to just get acquainted to the simulator system: how to give IVs, how to call the code team (you actually dial a number on a real phone, and it links back to the control room), how to get monitors started (ask for them outloud and they magically appear on the monitor screen), and how to ask God things. Unfortunately, the mannequins don’t sweat or react fully just yet , so you sometimes have to say things like, “God, does Mr. Ford have full intact sensation in his face?” (To which God replies from a speaker in the ceiling, “Yes he does.”) The control room can also change any parameters they want on the mannequin in real-time: if you give the patient epinephrine, his heart rate will go up along with his blood pressure. If you shock a patient, they can put the patient back in normal sinus rhythm.

We split into two groups, and I got to watch the first group from a monitoring room next door. We all flipped out when our classmates kept missing some key information, and the patient eventually crashed for quite awhile (luckily God performed a miracle). But we knew it was much easier to watch than to actually perform. When it was our turn, I was a little eager but nervous.

We had a couple ideas initially from the patient’s history and basic presentation, so we started testing hypotheses. The patient kept getting worse, and his oxygen levels kept dropping, so we started to bag him (put a mask on him and force oxygen into his lungs), and then we decided we needed to intubate. As intubating has become my latest procedure of enjoyment (intubating is feeding a tube into a person’s airway while pushing down on their tongue to get the airway and vocal cords into view), I grabbed the laryngoscope and prepared to try it. This was the coolest part: the patient was technically still conscious, so the preceptor told us he was fighting us, and it was making it hard to intubate him. It truly was: when I first tried to stick the scope in his mouth, it seemed 100 times harder than it had ever been on any of the other mannequins-his tongue was totally in the way. We decided to sedate the patient, and magically, when I opened his mouth again, the tongue was down and out of the way. I wish my classmates could have seen it; it was the coolest surprise to me.

A really great experience, and further pushed me toward Emergency Medicine (or maybe anesthesia?); apparently there was an anesthesia resident watching us who commented that I’d make a good colleague.

These simulators are only going to get better, cheaper, and smarter, and I can totally see them entering the medical school curricula in the next 10 years (Stanford’s new med school building will have a simulator room all of its own, and has recently named a new Associate Dean for Medical Simulation ) – the same Dr. Gaba who runs the VA simulator. The simulators mean less experimenting on patients, and more practice before the real thing, which will hopefully lead to better outcomes and fewer medical mistakes, especially for newbies like myself.

6 Comments »

Grand Rounds 30 is up !

Comments Off on Grand Rounds 30!

RoamNoMore, a really excellent blog I just discovered from Carnival of the Un-Capitalists , has a great piece on some of the flaws in free market theory and health care. Wish I had the econ background to write this stuff myself: No More Shall I Roam: Free Markets and Health Care; Part II . Enjoy!

Comments Off on Free Markets and Health Care

Classmate and all-around extraordinaire Cheri Blauwet won the Boston Marathon . Again. Way to go, Cheri!

Comments Off on Cheri Wins Again

Jakob Nielsen’s alertbox on Medical Usability: How to Kill Patients Through Bad Design couldn’t have been timed better for me. Nielsen, a usability expert and consultant, picked up on a recent JAMA article that discussed a number of ways that poor usability and interface design can be significantly detrimental to patients. You might think that this is a little too nerdy for discussion, but the fact is that medical records will be electronic within in the next decade (or at least most of them will be), and unless we do a good job designing the system, and make it easy for medical staff to use, we risk only creating new types of medical errors, as opposed to using technology to eliminate the current ones. The article focuses on prescription drug errors, but there are plenty other systems that need a kick in the usability pants, too.

Take, for example, the radiology software Stanford uses, called PACS . It’s a GE Healthcare add-on to GE’s Centricity product, and has all-digital x-ray, CT, and MRI studies. It’s a network nightmare, and the backend is great, but the user interface is simply horrendous. I was given an introduction to the system, and it seems like it was thrown together at the last minute. Even the head of the Radiology residency doesn’t fully understand how to use the system. She said things like “I don’t know what this button does,” and “for some reason, the system requires that you do X, Y, then Z to locate a patient.”

The most ridiculous part is the fact that sometimes, for no explained reason, a note on an x-ray will disappear, and must be dragged back on screen. If you’re not aware of this “feature,” you can waste plenty of time trying to wish the note back again. It’s a shame that GE couldn’t think of a better implementation of its software-they should talk to Apple now and again.

1 Comment »