Sunday, October 31, 2010

Locum Tenens

Locum is short for locum tenens and is suggestive of a person who temporarily fulfills the duties of another. The fact that doctors, among other professions, can participate in services like this makes finding the best work environment a little easier.

A Doctor's Temp Agency

As a student I wonder what environment I'll be in and what happens if it is not the right fit 6 months after starting there. Locum doctors have an advantage in that they fill in for vacationing physicians or where there is a medical need for a temporary period of time. They can test the waters and if it is a good fit may actually be offered an extended position. The difficult part is organizing the malpractice insurance, credentials, contracts and travel arrangements. Fortunately, there are locum agencies already in place to help facilitate the process for the already busy physician.

These services provide communities and hospitals with the medical help they need while providing unique opportunities for physicians to explore different areas of the country. Locum jobs can be found in almost every state and almost any specialty. Due to the stressful nature of being transient, these positions often pay more than a permanent position would. Conversely, it can be difficult to establish a "welcome" feeling among patients and staff as locums are always on the move. In any case, the idea of being a "substitute doctor" could provide a rather interesting opportunity and is something definitely worth checking out.

Question of the Week

When getting pimped by the doctor, there's always a good feeling after giving the right answer. It's even better when you hit a home run. Apparently, no student had answered this question correctly on my doctor's service...until now. At least it made up for a few of the wrong answers I gave throughout the month.

Considering the Tricyclic antidepressants or TCAs, which are tertiary amines and which are secondary amines?

Answer & Explanation (Page 2; Heading 3)

Sunday, October 24, 2010

Drawing Your Brains Out

All the psychiatric patients this month have been asked to draw a house, tree and person. Until recently I thought this was simple art therapy, but as it turns out, this is a well established test designed in 1947.

HTP Test

What was once an elementary school drawing exercise has now become a psychiatric tool for evaluating patient generalizations of the world around them and how they participate in it. The test has been detailed in a 350 page book and is estimated to take 150 minutes from start to finish. Evaluators are encouraged to ask questions about the details to really understand how the individual interprets their world.

The house tells us about associations at home including intrafamilial relationships and their attitude towards their home life. The tree and person reveal personality through body image and self-concept. Images are evaluated for line strokes, erasing, detail, proportion, and view point among other things. Everything from the roof, door, windows and smoke are interpreted. The branches, trunk, colors and person size have equal importance. Although intriguing, there is more to read than I could possibly explain here. For those who might be interested, check out the Kinetic House-Tree-Person Interpretation Manual.

I only wish I had tried my hand at drawing these before getting a run down of the evaluating criteria. It would have provided a more genuine representation of my psyche.

Question of the Week
A 47 year old woman presents with complaints of malaise and burning upon urination. She has a temperature of 39.6. Urinalysis is positive for nitrites and leukocyte esterase. A feature of the agent most likely responsible for this patient’s condition is:

A. A cell that is purple upon completion of the gram staining technique
B. A cell that is colorless after addition of ethanol during the gram stain procedure
C. An entity unable to live outside of a cell
D. A microorganism whose wall contains teichoic acid
E. A microorganism that requires an aerobic environment

Answer & Explanation

Sunday, October 17, 2010

Professional Membership

One of the joys of coming home from the clinic each night used to be getting the mail. The fun has worn off as much of what fills the box are bills, political advertisements, or those pesky coupon mailers. Recently, however, I have been getting a little more than expected.

Joining the Club

A couple months ago, I signed up for a professional physician organization. My intent was to become a member so I could participate in their conference. I had no idea that I would also be enlisted to receive books, peer reviewed journals, newsletters, and more conference announcements. Since I do have some affinity to Emergency Medicine, this was a perfect organization to join. As a student it was relatively inexpensive and the resources have easily paid for themselves. My problem now is that I have little time to dedicate to their perusal despite the appeal.

From what I gather, the residency programs appreciate knowing that applying medical students are genuinely interested in their particular field. One method of gauging this interest is by learning which professional organizations we have joined. It shows a sense of dedication and desire to know more; things which residency programs tend to seek in applicants.

While my trips to the mailbox still gives me plenty to recycle, at least I now have some decent mail worth keeping. To any student who may be reading this, I would strongly encourage joining a professional organization in your field of interest. In addition to filling your mailbox with more literature than you can handle, it may actually serve you well come interview season.

Question of the Week
A 57-year-old obese man with a history of smoking, hyperlipidemia, and hypertension presents with pain in his legs while walking. On further questioning, he reveals that the pain starts in his buttocks and extends down his thighs and into his calves. Previously, the pain disappeared with the cessation of activity, but lately it persisted in his feet even at rest. His symptoms can best be explained by which of the following?

A. Decreased permeability of endothelium
B. Narrowing and calcification of vessels
C. Peripheral emboli formation
D. Thrombus formation
E. Weakening of vessel wall

Answer & Explanation

Sunday, October 10, 2010

Reading - The Mental Exercise

Somehow I was lucky enough to have all the physicians that want me in the clinic 5-6 days each week and enjoy giving assignments during the time off. It's not a bad thing for learning all the material, but it has become rather draining. At least it makes time go by quickly.

Are we there yet?

There is only so much that can be learned at the bedside of a patient and in one month there is no way we are going to see everything related to a particular specialty. Hence the nightly reviews that occupy our time and remaining energy. The texts are usually inches thick and chock full of medical tid-bits. Rather than purchase a book I may never read again I access the electronic version from our online library . Now in addition to physical inactivity from hours of sitting, I am taxing my vision by staring at the glowing screen of my laptop. Yet another reason medical school has deleterious effects upon one's health.

Nonetheless, it is nice to review the materials learned in my first two years of school. Combining the black and white type with a patient who has this or that disorder turns concept into concrete explanations. For example, all the pharmacology I learned last year that slowly leaks from my mind is now coming back stronger than before. Prescribing medicine and witnessing symptom resolution as a result finally highlights some of the pesky unrelated facts associated with pharmacology. Better yet we are building a mental library of cases that will serve as examples in patient care.

Even though I may come home exhausted, at the days end, there is always more to be learned. One thing is for sure...this year, finally seeing patients, is much better than last years never ending lectures.

Question of the Week
A 22-year-old man is admitted to inpatient psychiatry after an attempt to strangle a stranger on the street in order to "squeeze the demons out" at the command of a voice in his head. He was put on a standing dose of haloperidol. Which of the following long-term adverse effects can be attributed to haloperidol?

A. tardive dyskinesia
B. Excess salivation
C. orthostatic hypotension
D. Nausea
E. Pruritus

Answer & Explanation

Sunday, October 3, 2010

Rotating Rotations

The inter-rotational weekend has finally arrived. That point where exhaustion and anxiety collide to signal the change of clinics could not have come at a better time. The weather is great and I was in need of a quick breather.


Making Room for Change

Leaving one rotation and moving to the next always has a sense of tension about it. Meeting the new attending, observing clinical procedures and working with a new patient population inherently brings an unsettled feeling of the unknown. Yet as medical students, we move forward and give it our best shot. I have no idea what to expect on my psychology rotation. Maybe that's why my anxiety levels are elevated. It certainly seems fitting that this rotation elicits such an emotional reaction.

The best part about experiencing various specialties is the opportunity to really understand those patients and the doctors that provide for them. We see first hand how physical or mental illness affect the individual and learn a proper response to that condition. The attendings we work with have a significant impact on our perception of their field. Despite continued encouragement that their specialty is the best, we still have to gain enough exposure to gain an appreciation for a particular line of work. Although I am not quite sold on psychology, I will approach it with an open mind and see where I end up four weeks from now.

Question of the Week
A 6-year-old child is brought by ambulance to the emergency room following an automobile accident. She is covered with blood and unconscious secondary to hemorrhagic shock. Her parents urge the physician to do everything possible, but implore that no blood products be used to treat their daughter. What is the best course of action for the physician to take?

A. Administer blood without delay and contact child protective services
B. Convene an urgent meeting of the hospital ethics board
C. Engage the parents in a discussion of why they hold these beliefs
D. Transfuse blood as needed, explaining the situation to the parents
E. Treat the patient without using blood products, per the request of her parents

Answer & Explanation

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