Been a while since I have posted much on here. It’s just been really busy lately. I completed the 10 week block of Internal Medicine just over a week ago. Since then I’ve started a 4 week block of Neurology. So far it is a drastic change of pace. I should be posting something here in the next week or so — at least that’s what I am hoping for.

I am also working on replying to some emails. If you have emailed me through the Contact page, I apologize for being slow the reply. I appreciate and welcome all feedback — even the negative ones. Yes, I have had some rather confrontational emails, but oh well. Such is the nature of internet anonymity, right?

Also, if you are a longtime visitor you will notice a bit of a change in the sidebar. I am not sure if it will be there very long or not. I decided to add this site to the Google Friend Connect system. I am still unfamiliar with what it does. I assume it helps you keep up to date with the blogs you follow. At this point I had relied solely on Feedburner to syndicate the blog posts for whoever is interested. But technology marches on — and I guess I will eventually follow.

Other than that, this post is just to update ya’all out there about what’s going on. If you’re interested, I have also started blogging again at The Differential. So stop on over there and say hello too!

Originally posted on The Differential on July 30, 2008

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During high school I took three years of Spanish. I thoroughly enjoyed it and really wanted to spend a year abroad to become fluent with the language. Unfortunately, when I got to college, I desperately wanted to finish in four years. My year abroad ended being sacrificed. In my final year, I did take Spanish 101 and 102, more for the fact I knew they would be easy A’s.

Two years removed from graduation, I’m sad to say that I feel I wasted all that time studying Spanish. I haven’t used it at all. Sure, I might remember some words and phrases here and there. I can probably still conjugate the present tense of most regular verbs. But I can’t remember the vocabulary. I turn on Spanish television and I get nothing. Well, the actors are pretty dramatic, so I suppose I can get something.

The other day I was standing in line at the Argentinean Consulate when the lady behind me started talking to me in Spanish. I looked at her, puzzled. She repeated her question. I tried to piece together what she was saying but the only thing I got was “Koreano.” I assumed she was asking if I was Korean. Well, I finally apologized and told her I couldn’t speak Spanish after which the conversation ensued in English. But I couldn’t help feeling frustrated that I couldn’t even understand a simple question after more than 3 years of Spanish classes.

Language is just one of the things that you have to use, or else you lose it. And this got me thinking about medical training. This year, as with most first year medical students across this country, I took General Anatomy. As far as I know, I won’t have any anatomy classes during second year. But Step 1 of the USMLE exam will cover General Anatomy. It worries me that I will go through an entire year without ever having an Anatomy lecture. I guess I am going to have to continually review myself whenever I find myself with that elusive “free time.”

I also thought about the practice of medicine. This year, I heard a talk by a cardiology resident. He said that while he was tempted to go into surgery, he found the clinical skills of surgeons to be lacking. Most wouldn’t be able to properly auscultate a patient. He had chosen cardiology because the cardiologists he had witnessed all impressed him with their clinical abilities.

One could debate the merits of having surgeons equally competent in wielding a stethoscope as they are with scalpels. It is probably not really important for surgeons to retain this skill. After all, they are called in to do their specific job — to cut open a patient and fix an immediate problem. If a patient requires auscultation, then his or her internist should be able to do this or refer the patient to a cardiologist.

But doesn’t it seem like a waste of time, money, and — well — medical training to just let a skill atrophy? Would time in medical school be better spent training students in the specific specialties they are interested in? Why bother teaching a student proper auscultation skills if the student is heading into Ophthalmology? I wonder, is there a better way to train our doctors of tomorrow?

In his book, Complications: A Surgeon’s Notes on an Imperfect Science, Dr. Atul Gawande writes of Shouldice Hospital in Ontario, Canada. The surgeons there are experts at hernia repairs. That is all they do. Day in and day out, the doctors do nothing else but repair hernias. What may be surprising to most American medical students is the backgrounds of those who operate at this clinic. A few of them have never even completed a surgical residency. But they have trained extensively at repairing hernias. This clinic, Dr. Gawande writes, has a far higher success rate for their operations than any other place in the world. Why? Because they only do one thing, and they do it amazingly. Can this be applied to medical school to cut down on the massive amounts of information that medical students are force-fed each day?

Originally posted on The Differential on July 23, 2008

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My little sister has been on a classic film spree. She announced to me that she wanted to see all the movies that had won an Oscar for best film. She also bought an Audrey Hepburn 3-Pack DVD that contained Breakfast at Tiffany’s, Roman Holiday, and Sabrina.

Okay, I’ll admit that I too am a fan of Audrey Hepburn, Julie Andrews, and other great actresses of Hollywood’s golden era. They seem to convey so much in the subtle facial expressions or tone of voice -– something that I fail to notice with so much CGI/special effects these days. Well, being the awesome big brother that I am, I used my Netflix subscription to order another one of Audrey’s famous films: My Fair Lady.

At almost three hours in length, My Fair Lady is a pretty long movie that traces the journey of a poor flower girl as she is transformed under the instruction of Professor Higgins into a genuine Lady. The process is long and arduous. It’s filled with frustration as well as comical moments. The audience watches as Eliza Doolittle sheds tears and then as she recites phrases like “The rain in Spain falls mainly in the plain” or some other nonsense about hurricanes in Hereford and Hampshire trying to properly emphasize each syllable to the professor’s satisfaction.

It’s sort of like the transformation that is required of medical students. They say medical school changes you. It changes the way you think, speak, and act. It changes who you are. And it’s supposed to do exactly that. It takes the raw material in the form of an eager, optimistic, and sometimes-naive college graduate and transforms it into a newly minted MD who is probably more than just a little nervous about starting internship.

During orientation and registration our school administrators told us that by the end of just the first year we would notice things differently. We would see and hear things through different lenses.

I am kind of surprised at how true that statement turned out to be. There are words and phrases now floating around in my noggin that I never knew existed.

Mnemonics wander idly through my mind. Sometimes I don’t even remember what they are for. There are words like “LARP” (describing the path of the Vagus nerve) and phrases like “army over, navy under” (suprascapular artery over and nerve under) and “To Zanzibar By Motor Car” (branches of the Facial Nerve).

Prior to the first year, I had never heard of the phrase “differential diagnosis.” Well, on second thought, I did often hear Dr. House ask his team what the differential was. But it kind of flew over my head at the time.

Evidence-based medicine now means something. Before, it just sounded cool. I was a science major. I knew that evidence was good. Now, I still think it’s good. But I’m not too fond of searching through the literature for the latest studies trying to determine a link between statins and preventing Alzheimer’s disease.

Whenever I go to a restaurant I watch the waiters. Why? Because in Anatomy class I kept hearing about a waiter’s tip that can present with injury to the upper roots of the brachial plexus. I still have yet to see a waiter walking around with the so-called “waiter’s tip.” But it hasn’t stopped me from trying to find one.

Wal-mart is no longer just a convenient place to pick up supplies. It’s also a great place to pay close attention to customers’ faces and gaits. I might be able to identify a walking example of some neurological deficit I learned about in lecture.

As far as medical education goes, I’m just a baby. Or, to tie in with my intro, I’m just starting my training with the good professor. I’m still raw and crude. But even after MS1, I’m glad to report that there’s progress.

In about a month, right after Labor Day, my second year will officially begin. I’ll try to enjoy my last “free” summer. In the meantime, like Eliza Doolittle, I’ll try to faithfully recite the precious tidbits of information that the dear professors have imparted. However, it’s probably a little bit harder than talking about rain falling on Spanish plains in that oh-so-elegant British accent.

Originally posted on The Differential on July 9, 2008

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It’s lunchtime at the hospital cafeteria. Patients stand in line, their IV stands in tow. Children from the pediatrics hospital sit in pillow-lined wagons while their parents pick out food. Doctors, nurses, and other staff members file through the cashier, scanning their cards so as to avoid the hassle of carrying cash. The first year medical students eat and talk about their morning experiences on the wards, some more excitedly than others.

A phone vibrates and its owner chuckles as he reads the text message. And that’s how the lunchtime gossip starts. Or maybe that’s just how the morning gossip transforms into lunchtime gossip. He leans over to his neighbor, who then gladly moves the info down the line. A first year fainted during rounds that morning. Everyone smiles, then desperately tries to find out which one of their classmates fainted and on which service.

A character from Grey’s Anatomy said that the hospital is “high school with scalpels.” That could probably be said about medical school, too.

Watching at least one of the medical dramas on television seems to be a requisite for every medical student -– regardless of how little medicine is actually on the show. When the new season of Grey’s was starting, there were a bunch of my classmates who got together to have Grey’s Anatomy nights. (For the record: I don’t care for E.R., I have no comment on Grey’s Anatomy, Dr. Gregory House fascinates me, and Turk and J.D. never fail to, in the very least, put a grin on my face.)

In medical school you can find the nerds, the jocks, the popular kids, and the bullies. They’re just called by different names. For example, bullies have graduated to being called gunners. The really mean ones have an even cooler name: snipers (as previously written about by Anna on The Differential). Even the class elections, where interesting promises and platforms can be found aplenty, seem like popularity contests. It’s just tough to grow up.

On the other hand, I’ve heard plenty of stories about the workplace being so much like high school, too. Maybe it isn’t adults acting like teenagers, but teenagers acting like adults. And then we just have a bunch of really mature teenagers in high school. But this is a topic of a whole ’nother post.

The difference between medical school and high school, though, is more than just scalpels. It’s, uh, about… Well, it’s like… It’s about learning to save lives!

Wow. Now I’m even writing like a high schooler.