Sunday, September 26, 2010

Resident Fair

Perpetual planning is starting to get on my nerves. If it's not a test, quiz or assignment, it's setting up a rotation or more importantly the rest of my career.



Schmoozing

Normally you would think the opportunity to rub shoulders with resident program directors was a great thing. And it certainly can be in the long run, or at least when applying for programs. When I did it, my stress levels went through the roof. Putting on a best-in-show performance and asking smart questions was on everyone's mind and whether I obtained the information I needed is yet to be determined. Overall, the directors, residents and assistants made for very pleasant conversation. The type A personality in me, however, wonders how I measure up.

At least the forum lectures were exactly what I was hoping to learn; how to approach interviews, medical schools and stay strong during those crucial experiences. Despite the simplicity suggested, the emotional, financial, and time commitments are intense. Perhaps I am just exhausted from hours of study preparing for my upcoming shelf exam. Perhaps I am feeling exactly how all students would in this position. In any case, this year of planning is going to be more taxing than I initially imagined.

Question of the Week

In what state should I consider doing my residency and why? If you have the answer, I will gladly entertain your suggestions and reasoning. Otherwise, it may be some time before this question finds a solution.

Sunday, September 19, 2010

Progress

Having attained a certain level of knowledge as a student, I wonder if it is adequate when the rubber hits the road. Exposure to the community and patients gives plenty of opportunity to find out what I really know.

Doctōris

It's easy to forget just how far we've come. A little over two years ago I was starting medical school and now I am being trusted enough with private medical information that leads to the decision making process in patient care. I often feel that my knowledge base is not strong enough or lacks in certain departments, and the truth is that it really does. But when interacting with the general public I realize the wealth of information that I have accumulated in such a short span of time.

It can be expected that friends, family and others will inquire about their health at any given opportunity. Just recently, during a community blood pressure screening, I fielded many medical questions. The information that I take for granted in my education is easily foreign to those not in the medical profession. From medications to physiologic processes, there is so much to know. I remember just a few years ago thinking how fascinating it was that someone could see your symptoms and differentiate between virus and bacterial origin. At the time, it was a mystery to me. Now it seems that the "secrets" are being revealed and it's my turn to share that information. This task, although daunting, is what being a doctor is all about. According to the translation of the Latin word doctōris, a doctor is a teacher. Curious to say the least.

Question of the Week

After weeks of observation, seeing patients on my own and asking my own questions my attending physician decided to "pimp" me out of the blue. Unprepared and with my head wrapped around the circumcision just performed, I failed to provide the correct answer. Introduced with discussion about the effects of injecting Lidocaine into a neonates vein, he instructed me about the risk of inducing methemoglobinemia. In his calm demeanor the question came as a surprise, "What is the treatment for methemoglobinemia?" The answer was in my head somewhere, just not where I thought I left it.

Sunday, September 12, 2010

Rehabilitation

With great power comes great responsibility. Physicians are among some of the highest educated individuals and yet they are at an increased risk for drug abuse and addiction. Despite their "power", there is a responsibility to lead the way in safe practices.


Medicinal Pitfall

Employment in an environment where medicines are routinely used and available can have deleterious effects on clinicians and other health care providers. Studies have been performed to learn what fields of medicine are at greatest danger of drug abuse and the results usually show increased potential in those that distribute medications frequently. In school we are taught about the signs of addiction, where to seek help if needed, and tactics to overcome the problem. Despite this training, many physicians become addicted as a result of stubbornness, pharmacologic education, and ease of access. Check out some of these addiction facts that may shed a different light on drug abuse.

During a rotation I was surprised to work with a physician who openly discussed his past history with pain killers. He told me that the rehabilitation program he finished was one of the best things to have ever happened to him. For a long time he was in denial that there was even a problem until it interfered with his job and the patients he treated. Some addictions may seem minimal, but the psychologic drive to obtain more is very powerful. Chemical impulses can make even the most mundane stimulus phenomenal.

Addiction can happen to anybody. Fortunately, there are resources available for those who want to find freedom from chemical dependence. Whether it is a private facility, land-based hospital program or an online resource like this Vicodin rehab guide, help is available. As for physicians, most are able to keep their licenses and continue the career they have established once rehabilitation is achieved. Sadly though, it continues to be a problem. We may never know the problems others are facing, but if they come to us for help, wouldn't it be nice to have the right tools?

Question of the Week
A 35-year-old woman is found unconscious in her apartment next to an empty bottle of pills. She is brought to the Emergency Department and given flumazenil, and shortly thereafter regains consciousness. Which of the following drugs did she likely ingest?

A. Diazepam
B. Eszopiclone
C. Hydromorphone
D. Oxycodone
E. Zolpidem

Answer & Explanation

Sunday, September 5, 2010

Pediatrics

There is something about the contrasting palm trees against the Las Vegas sky that makes this building look so inviting. It might be compensating for the fact that if you are a youngster, you have a good chance of getting shots here.

Youthful Medicine

The waiting room's row of low-rise chairs and toys keep the children engaged before their visit. Patient rooms are decorated with animals and cartoonistic art. This clinic is using whatever it takes to keep the young patients happy long enough to be examined from toe to head.

The change from a patient population that is older in years to one that commonly has only days or months has been a drastic one. I have to explore new methods of examination to keep the children from crying incessantly before I even touch them. Fortunately, my preceptor is a veteran in the field and has taught me some of the finer points of the pediatric approach. Although I must say that any child being circumcised is bound to have some aggression towards their doctor.

For the most part these little patients are generally happier and less demanding than the adult population. Their looks of intrigue mixed with fear are something to appreciate and more often than not, they are bewildered by the technology of bright lights and shiny objects. If they can brave the barrage of the doctor's exams, nurse's shots, and foreign environment the reward of a sticker is usually enough to encourage a return visit.

This will certainly be an interesting month. Since the pediatric population will be encountered in the majority of medical fields, it is imperative to hone my clinical skills now. I just hope we don't run out of stickers any time soon. 

Question of the Week
You went to visit your friend from college who recently had a baby. She named him Johnny. As the mother was gently letting you hold Johnny, he appeared really anxious and started crying once you reached to hold him. Johnny's age is most likely to be:

A. 2 months
B. 3 months
C. 5 months
D. 7 months
E. 4 years

Answer & Explanation

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