An idea for a meme that the medbloggers could start: bloggers posting their wishes/advanced directives/durable powers of attorney. As with the Terry Schaivo mess, everyone was talking about people writing out (or discussing) their wishes with loved ones. With a simple blog entry, a person could provide a written document of their wishes. There’s 5 million bloggers out there , maybe it’d help?

Medbloggers could draft a template, define terms, and explain some possible scenarios, and then people could copy->paste and link to other people’s? Whatchya think? (I realize a durable power of attorney form would be more useful, but this could be a start?)

People post their five favorite songs, or favorite book, or favorite quote, why not something a little deeper? (They could password-protect the entry if they felt that it was too private for the general public.)

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Man. I forgot how nice it is to actually see human beings patients again. Staring at films and CTs and MRIs (oh my!) made me forget that there’s actual people that surround those images, not just bone structures, opacities, densities, consolidations, and strictures. We started out today at a local nursing home, rounding on some patients. Kind of wish I had already had my Medicine clerkship, but I’m usually a quick learner.

Depending on the patient, sometimes the surgical service will send a patient to the nursing home for long-term recovery, and it just so happened that I got to see a surgical patient from many months ago at the nursing home. It was definitely some delayed continuity of care, and he had no idea who I was, but it was great to see the spectrum and time-course of healing.

The great thing, I’m hoping, about this rotation, is its variety. We rotate through a nursing home, an inpatient ward, a hospice unit, a palliation clinic, a geriatrics clinic, hypertension clinic, and andrology clinic, as well as attend Internal Medicine conferences, so I get exposure to a lot of different geriatric sub-specialties.

Today we had an inservice from the hospice chaplain discussing how to take a spiritual history, how to understand some of the spiritual/religious concerns of the dying or elderly patient, and some advice on how to answer patients’ questions that are religious in nature. (I’ll be the first one to admit that I’m struggling right now with figuring out my own spirituality and belief system, with my interests in religion and spirituality a seemingly distant memory from college.) I’d feel much more comfortable dealing with patients’ questions about living and dying and the Unknown and God (or god(s)) than questions directed toward my personal belief system (I get a knee-jerk reaction to questions like, “Do you believe in Jesus,” or “Have you found Christ,” mostly because of obsessively-persistent Christians from my undergrad). As one of my residents pointed out, however, most often questions like these are efforts by the patient to feel out the physician–to see if the physician is “safe” to talk with about spiritual matters. It’s actually probably pretty similar to how LGBT folk try to feel out someone to see if they’re LGBT-friendly before opening up.

I couldn’t help but compare this service to Neurology and Surgery, and initially feel like the others were leaving out this spiritual component. I can see how in some cases, it’s probably a back burner topic: people want their gall bladder out, not a discussion of the Universe. (Or maybe they do?) Or perhaps it’s just that there’s not time on those other services to discuss these matters? At the least, however, I would think asking one or two questions about it (“Do you have any spiritual beliefs you would like to be respected during your care?”) might be useful, especially in cancer surgery or terminal illnesses.

On to clinic, where I saw one patient, an elderly, World War II veteran who had just turned 95. He has terminal cancer, but refused treatment, and two years later, still has no symptoms from it. We caught a previously undiagnosed problem with incontinence, but otherwise he was in reasonably good health for his age and condition. He said he didn’t fear death; he’d been a rifleman in the War and noted that “If you worried about dying while you were out there, it didn’t do you any good.” Kind of a privelege that I have the time to worry about death at all.

If anything, I can tell that this will be a month of lots of thinking about ethics, living, dying, and Life in General. Good for the soul.

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Two weeks ago, I was sitting down on a bench to eat some cheap Chinese food with my messenger bag around my shoulder, and I got a sharp, stabbing pain in middle left back. I get this once every couple months or so, somewhere in my back, but I either stretch or twist or bend over and everything fixes itself magically. This time, however, it wouldn’t go away. If I bent or leaned the wrong way, the pain would hit me–so hard it would stop me inhaling if caught off-guard. If I turned my neck, it hurt; even if I stepped the wrong way, the pain would hit.

Over the next couple days, I tried stretching, massage, IcyHot patches, and hot showers to no avail. Ibuprofen dulled the pain a bit, but obviously didn’t fix the muscle.

Lucky for me, the boyfriend’s brother-in-law is a physician in the area who learned acupuncture while he was in residency in LA, and kindly offered to acupuncture my back (is acupuncture a verb?). Now, I’m not afraid of needles, but I was a little nervous and skeptical, but willing to give it a try. (The physician has mentioned “opening up my chi” before with acupuncture, so it started to sound a little new agey, but I think I was just confusing “new age” with “non-Western.”)

So I lift up the back of my shirt, find the exact knot in my back, and he puts a couple needles in the spot, as well as around it. He also puts two in my trapezius muscles right over both my scapulae. Most of the needles go in without any pain at all–the most I feel is some pressure–and with one or two I feel a sharp pain for a second or two. I’m sweating pretty bad, I think mostly because I’m nervous; my palms are in hyperhidrosis . He asks me if I feel any ache, and at first I say no, but as I adjust myself ever-so-slightly in my seat, I feel what he’s talking about. The muscles just feel incredibly achy, almost sore. It’s so achy that it’s just mildly painful, so I sit pretty still for the next 30 minutes until he removes the needles.

After he removed them, I felt maybe 10% better. Nothing too impressive. I thanked him for doing it, but figured it didn’t do much for me. Oh well. Over the next day or two, however, I noticed my pain and tenderness had all but vanished. I can turn my head fully, twist my back, stand on one foot–with no pain at all. Was it the acupuncture, or just the tinctuer of time? I’d like to think the former. If you push on the spot where it used to hurt, it’s definitely more sensitive than the rest of my back, but it’s nowhere near as tender as it used to be.

Color me impressed. I should get my chi opened up more often.

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Economists say that we respond to incentives–carrots and sticks. What’s it say about us as a nation, then, that people with serious illnesses consider stopping treatment under the constant onslaught of confusing paperwork? The New York Times writes today about the paperwork nightmare many hospitalized people return home to in Treated for Illness, Then Lost in Labyrinth of Bills .

I wonder again how long it will be until we wake up and realize what a waste of peoples’ time, energy, and effort these redundant bureaucracies are.

I had a similar experience on a much milder scale several months ago; I presented to the student health service with some unexplained bruising and petechiae (I personally think it’s a stress/psychosomatic thing, but who knows), and the ICD9 diagnosis code was, of course, billed as… bruising. (I imagine there’s probably a “Bruising, Non-Traumatic” variant that should have been checked, but it wasn’t.) Two months later, I got a statement, then a “mandatory claim form,” then a bill (all separate envelopes, arriving separately, costing $1.00 right there) stating that in order for my health service visit to be covered, I needed to explain my accident in order for my x-ray (??) to be covered.

I had *no* idea what they were talking about; I’ve never had an x-ray in my life. I somehow found a chunk of time during my surgery rotation, tracked down the date, and called the customer service representative. Then I spent 20 minutes enlightening her to my personal medical history, the fact that my bruising and petechiae were totally idiopathic, and that I never had an x-ray (her records indicated that I had had an x-ray and a fracture).

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is up at doulicia . Go read!

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I haven’t written much about radiology, namely because there isn’t much to write. Our clerkship has, unfortunately, been less than productive. I don’t know if it’s just poor scheduling plus lots of conferences and flus, but we’ve had a number of classes cancelled, and the morning readout sessions seem more focused on getting through the images than teaching about them. A number of us think it would have been better to just get a textbook, some websites, and take the month off to study. Most of the other clerkships I’ve had so far at least had some component of teaching during the physicians’ work day.

I’ve also become pretty frustrated with the constant radiologist obsession with income. It’s definitely more prominent in the younger docs and residents than the older physicians, but more than anyone else so far our lecturers have expounded the virtues of radiology for the amount of money one can make. Maybe I’ll feel the same way in one year’s time–I’m not above saying that I won’t–but as a third-year student, still fairly new to clinics and not-so-jaded, it was really unattractive.

I spent 45 minutes one day waiting for a fellow and an attending to start reading films while the attending whispered to the fellow about his new job, how much money he can make a month, and how much time he gets off per year. After being told “we’re about to start reading” 5 or 6 times, I finally got up and walked out of the room, feeling so frustrated. Had I spent another second in the room I felt like I would have started to turn jaded and bitter down to my core. (This was in addition to the fact that the radiologists in the room had described clinicians as “annoying” when they ask the radiologist for help reading a film.)

We must, of course, remind ourselves that this is not all radiologists, and maybe it’s not even a fair representation of the radiologists about which I write; maybe they had a bad morning, or didn’t get any sleep last night, or who knows what. But their effect on me was the same. Just another personal reminder that my behavior, attitude, and actions do affect the way other people see the world.

In light of the lack of time spent in the classroom, I have come up with a great list of radiology online resources, which are truly excellent:

LearningRadiology – My favorite, by far. Talks specifically for medical students, quizes, cases of the week, all in really easy to understand format. I thank this website for helping me to get a general understanding of the chest radiograph.

Yale Cardiothoracic Imaging – A beautifully-designed website, easy to use, with great images and illustrations, all annotated. Has normal anatomy plus a number of basic diseases.

Radiologyeducation.com and medicalstudent.com have a huge number of links; the UCSF Radiology website also has a great number as well.

I’ll be adding more as the week goes by; I have a number that are bookmarked, but I’m not ready to give the full Over My Med Body stamp of approval.

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I wanted to solve a problem I’ve seen on the wards and in clinics, as well as mess around with some new web technologies, and thus Medslist was born. Simply, it’s a way patients can store their list of medications online, email a copy to themselves, update them later, print a copy out for their physicians, etc. Sometimes people come in with lists of medications, which is great, but often they’re illegible or hard to follow.
Medslist allows people to list a good number of facts about their medications–including the reason they’re taking it–and perhaps this may encourage some patients to learn why they’re taking it, and have a more active role in their treatment, management, and health.

For now, it’s only working on PC Firefox, Mac Firefox and Safari. I’m having trouble reproducing a bug where the login feature doesn’t work in PC Firefox; if you have this problem, try reloading the site a couple times, and it should work.

How did I have time for this? I’m on Radiology right now, which provides a certain amount of free time (I think they’re trying to get us to be radiologists based on the radiologist lifestyle.)

Please post your criticisms, comments, and suggestions here. If you have bugs, post’em. Feature ideas? Post’em. Right now the feature set is limited, I know: No way to get your password if you lost it, no way to edit medications, etc. But please brainstorm and go wild; what would you like to see on a medication list that your patient carries into the clinic for you?

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I don’t know where MedPundit went to medical school , but her experience couldn’t be different from mine. Other med students, are you on my side or MedPundit’s? Comment below.

It shouldn’t be surprising – medical school is a crucible of change.
Students leave their homes, their families, their friends.

It’s definitely a big change, and not without its stressors, but most of us have gone through this before when we went to college. Clerkships are, without a doubt, lonely. It’s nice to be on a service with a classmate, but I barely see anyone these days. Just more encouragement for me to do a better job with time management and setting some time aside for a mild, tempered social life.

They lose the academic standing they had in college and high school, and with it sometimes, self-esteem and respect.

Yet another reason to make things pass/fail like we are here.

They see and learn things they’ve never seen or heard of before. They learn, in fact, a whole new way of being. It is a completely transformative process in a way that few other processes (except perhaps joining the military) are.

Absolutely, but what an amazing transformation it’s been! There’s good parts to it, and bad as well, but I think my mind has been made 100 times sharper.

It is not a pleasant process. I remember one of my medical school classmates describing it as “the shrinking of her soul.” The reasons for this are all those mentioned in the above article, with the exception of one glaring omission – the role of the teaching process. The third year of medical school, when students enter the hospitals and see patients, also marks the moment that their teaching is handed over entirely to practicing physicians – and they are brutal. The brightest and best students are treated as know-nothing scum and burdens to be born by the rest of the medical team. There is never, never, any praise – only denigration. At least, that’s the way I remember it, with few exceptions. It’s like being stuck in a House episode.

This sounds like some other world she’s describing. Are clerkships hard? Yes. Do some of them suck? Yes. Is there some degree of scutwork involved? Sure. Do they turn your view of medicine on its head, and teach you the frustration of paperwork, hierarchy, and difficult patients? Absolutely. There are definitely days where I feel down, feel like I’ve worked hard and haven’t felt appreciated. There are days that I think, “ This is medicine? I seriously signed up for this ?” But my soul is not shrinking, and the attendings are not brutal. I’m given praise by attendings and residents, my family and boyfriend, and I dole out some healthy self-praise, too. Do I feel stupid for not knowing things? Sometimes. Do I feel loved and needed by the attendings and residents? Not always. But more often than not, I feel like I’m respected as a member of the team, feel like I contribute and can teach residents and attendings things they’ve forgotten, and I get feedback that is constructive about how I can do a better job. It’s natural for me (and probably med students in general) to beat myself up over not knowing an answer to pimping session question, but that’s because we have such high self-expectations. I don’t think the attendings are purposefully trying to shrink our souls or denigrate us.

So, how do we get through it? Our hides grow a little thicker (or is it that our souls shrink?); and if we’re lucky we meet some good roll models along the way. But, at some point, we come to the realization that our teachers are not gods, but frail, flawed men and women with bad management and teaching skills.

My skin is definitely thicker after 2 months of surgery already, and I’m thankful for it; I’ve been through the worst already. I’m less intimidated, and more willing to just do my best, keep up on my reading, and accomplish the goals I have set for myself during the rotation. My attendings are not gods either, but they’re hard-working, incredibly intelligent men and women with somewhat-decent management and pretty good teaching skills.

Let the record show that I’m in between clerkships while writing this, and just finished a relatively low-intensity month on pediatric neurology. This is also not to say that there are no depressed students here; I know of several.

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