I went to LUCHA today, a San Jose elementary school, to teach 5th graders about health and their bodies. A friend from college teaches the class and thought it might be a fun, end-of-the-year activity to wrap-up their health unit.

It was lots of fun, questions ranging from “Why do we throw up” to “Why do we fart” to “How come we can live with only 1 kidney” and a bit of everything else. Not as many S-E-X questions as I was expecting, which was nice. It was a good chance to try to explain medical anatomy and physiology to children, which requires a lot of on the spot translating of terminology to their level, as well as including gross-out factors that will keep their attention.

I was very impressed that they all knew what the pancreas was, and the gall bladder, and where the kidneys are, and the chambers of the heart. Nice work, Ms. McGonegle!

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Was thinking about technology adoption at the gym today (ahh, the thoughts of a nerd) and how we–especially Americans–use technology. Once a technology becomes life-changing and commonplace enough, it’s almost as if culture changes such that one must use it. Freezers and refrigerators started out as a nice convenience–now food won’t spoil so quickly!–so we now buy food in larger bulk quantities. We lay out our suburbs in huge, vast sprawls of land, because we can all have cars to take us from place to place–because we can, not necessarily because we should. And we now often substitute face-to-face contact with friends and loved ones with phone calls or emails or simply instant messages. Because we can, not because we should. I’m not trying to make the argument that we’re worse off with technology, or that I somehow yearn for the days I never knew when life was slower. Just that once we adopt technology, we feel that it should always be used, as if it is always better than a less technological solution.

And I wonder if we’ve applied the same standard to medical technology, namely, that we can now keep many people “alive” indefinitely. But should we? Are we applying a perverse technological standard to life and death? I’ve seen patients make miraculous recoveries–their bodies just needing a little bit of extra support for a bit while they let the tincture of time do its work–but when are we using technology inappropriately: prolonging death instead of extending life?

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Fantastic piece by Matthew Holt on the social insurancers vs the free-marketers.

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How it works in the ER , because it’s all shotgun medicine. Talk with patient, ask questions, feel belly. Most of the time the patient is waiting is either because there are sicker patients, you’re doing a procedure, or you’re playing phone tag or following-up on labs that are pending or didn’t get sent. Great writeup.

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I initially had this inspiration to do this neat-o teaching post about Bell’s Palsy inspired by a young patient I saw who thought he was having a stroke, but eh, I’m just not up for it today.

Did start finding some interesting stuff on YouTube, however–will strangers posting their diseases online be the physical findings revolution?

Here’s a pretty severe (and long) case of Bell’s Palsy from Jennifer:

Whooping Cough from Anna Jane :

And a ton of nystagmus .

Great for rare conditions–or even common ones that young medical students haven’t seen before.

Tongue wag , unfortunately, doesn’t mean the same thing to Youtube users as it does physicians treating alcoholics.

Bring that sexy back, JT:

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I love a good pun:

The findings and impact of nonrehydrated guaiac examination of the rectum (FINGER) study: a comparison of 2 methods of screening for colorectal cancer in asymptomatic average-risk patients.

Digital rectal exam, FINGER study, ha!

(I was searching for something totally unrelated, I swear.)

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Getting burned is another piece of non-medical medical lingo I will try to translate. To “get burned” is to do something incorrectly, interpret something incorrectly, forget to do something, or to generally “mess up” or miss something, generally leading to Badness. “Badness” is usually either a bad patient outcome, or one that is at least delayed or sub-optimal.

Every attending (translation: every doctor) has at least one or two areas where they have previously “gotten burned.” These are issues that they vow to never, ever get burned on again. Issues upon which they rise to their soapbox and emphasize to those listening where things have gone wrong for them, so that the mistake is never repeated again. I would imagine if you ask any doctor he or she can pretty instantly tell you their burn stories. They are usually tragic, sad, and preventable. There is usually an air to the stories of “if only X, Y never would have happened.” They are shocking, and their foreshadowing is horrifying; we the listeners all realize that we ourselves will get burned in our own careers. No matter how hard we try to be perfect, we will represent, and later resent, our humanity, our imperfection. We will do something that will greatly harm a patient.

Only those in positions of responsibility and supervision are able to truly experience getting burned, as I am starting to realize, given that I am starting to have some actual responsibility. I’m starting to see errors and mistakes in my judgment that have luckily always been pointed out to me by a resident or attending that is double-checking it all, and I’m sadly starting to learn something that may explain doctor behavior and frighteningly my own: trust nothing.

The quick anecdote is such: an intoxicated gentleman comes in, found down, complaining of generalized body weakness for which he has been seen on numerous occasions. Nurses know him by first name, and note that this is his typical course–he comes in, sobers up, leaves. Being astute medical student that I am, I want to rule out Other Badness. Sugar normal, exam normal. I draw labs. Just ’cause. Much later my attending decides we should also get an EKG. Just as it’s printing out and I’m noting the U waves and the long QT, the lab calls with his low potassium and calcium results. Ugh. Had I just decided to get the EKG to begin with, we could’ve caught this much quicker. But I decided, “No, he comes in like this all the time, the nurses see him like this all the time, he’s probably just drunk.” Now, nothing bad happened to the gentleman–we fixed him right up–but I can just barely see other versions of the story, and it’s scary.

I’m sure my paranoia and distrust will only get worse when I have my own medical students reporting to me, but hopefully by that time I’ll have most of my close calls under my belt, without a scratch to my soul.

Yeah.

Right.

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Panda’s point is well-taken : namely, that we will always be discovering some better drug that decreases risk from 2% to 1.5%, even though it costs us a lot more money because it’s new and brand name. I often ask myself if there will ever be an endpoint. But using warfarin is a terrible example. Overall, the number of strokes you prevent with warfarin may in general be more cost effective than not using warfarin , because strokes are so damn expensive to have (and not even counting emotional and psychological costs). Yes, I know this study doesn’t look at warfarin adverse effects, but it’s not as cut and dry as his post makes it seem.

The interesting thing is that without coumadin, the risk of forming an atrial clot is about six percent per year.

(Also, just to be clear, since I’m a junior level Afib researcher, the risk of stroke is about 5-6% per year with Afib, not necessarily the risk of clot formation. And this risk goes up pretty substantially once you hit 75. But then again, so do your risks of falls, as we all have seen too well.)

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Thank you to the great attending and residents who trusted me, supervised me, and allowed me to do so much today!

• Intubated a sedated (but not paralyzed) septic patient having a STEMI (my 2nd intubation ever)
• Got an ABG on the first try
• Lac repair of a partially avulsed finger skin flap
• Lead a basic trauma resuscitation
• Put in a foley on a comatose patient
• Stapled a scalp lac

Done most of these before, but it was in such rapid succession–one procedure after another–that I totally felt in the zone. It was great!

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