To all my readers, and visitors of my blog — I would just like to apologize in advance.
As life continues to get busier, while I continue to progress through my third year of medical school — I will not be able to keep the blog updated daily, but I will try to submit a post once a week.
In the meantime I will start accepting guest posts, if you would like to submit something please feel free to e-mail me, or follow me on twitter.
The recipient’s insurance covers the tab for both the donor and the recipient for the procedure. The donor needs regular follow ups for the rest of his/her life to make sure that one kidney is in tip top shape. The recipient’s insurance drops coverage because they can’t cover this tab forever. They cut the donor off. And then the donor is left with the bill.
Only in America. Our healthcare system is embarrassing.
via NPR
Around 1800, Italian scientist Jean Aldini zapped the brains of dead felons with electricity to make their bodies move. He later reported using the same technique to cure “melancholy.” This sounds like the history of electroconvulsive (shock) therapy, but those were actually the first experiments in transcranial direct-current stimulation (tDCS), tweaking the brain with very mild shocks, 1,000 times less intense than delivered by shock therapy. A resurgence in tDCS is now underway. (Experiment “Consent Video” above from the Berenson-Allen Center for Noninvasive Brain Stimulation.) Indeed, neuroscientists at the University of New Mexico are using a tDCS device powered by a 9-volt battery to see if 2 milliamps shocks to certain regions of the scalp can improve cognition and learning. Early results are promising. (In fact, tDCS may even prime neurons to respond to transcranial magnetic stimulation (TMS), a technique we’ve posted about on BB many times in which bursts from a magnetic coil near the head alter brain activity. TMS has been tested as a potential treatment for certain severe neurological and psychological disorders. Scientific journal Nature surveys the tDCS field in its latest issue.
Medicine and diagnosis revolve around collecting information from patients in the form of interviews, physicals, and diagnostics; social and environmental factors, positive and negative findings, and way more lab values than you really need. This plethora of information can be daunting and is often impossible to process all at once. So, we pick and choose and comb through the lengthy histories and constellation of symptoms and pile of results to find patterns.
The reason we do this is because we don’t think in flow charts of “if this, then that,” slowly gathering information; we create differential diagnoses based on all available data at once. This is the reason some impressive physicians can walk into a room and diagnose a patient in seconds.
Now medical school can sometimes feel like memorizing flow charts, but the patterns eventually start to become apparent, e.g.: smoker + weight loss + hemoptysis = cancer. Sure, we collect additional information to confirm, but those three elements put cancer high on your differential because it’s a recognizable pattern. We recognize a pattern and go from there.
This gets to my current, not so intellectualized, experiences on pathology:
“Pathology is all about food.” - Resident
For most of you, it was relatively easy to sail through college. Good grades came easily, and mastering the subject material in your classes seemed completely realistic. Although it was years ago, I remember vividly the first month of medical school when the study methods I had used in college did not seem to work any longer. I barely passed my first test in embryology. The amount of material we had to learn seemed insurmountable. Not only was I expected to know what was in the lectures but also the material in the texts, which I would have to teach myself. I was not quite sure there were enough hours in the day to learn it all.
Early in my medical school education, the dean for preclinical years made an announcement that we should all prepare ourselves for this inevitable fact: No matter how hard we tried, we would never be able to learn everything we were expected to know. It was difficult to process his statement, but as time went on, I began to realize that he was correct. Several all-nighters later, I realized that my friends who went to bed at a reasonable time were doing just as well as me on exams. Either I was doing something wrong or there really was a fixed amount of information a person could process at one time.
So what is the best way to study?
In preparing for the USMLE Step 1 exam, it seemed that the most frustrating aspect was a lack of any sort of feedback about how the preparation was proceeding.
The NBME has recently released data showing the relationship between students’ Comprehensive Basic Science Self-Assessment (CBSSA) Performance Profile Scores and their performance on the USMLE Step 1.
Your third year of medical school can be exciting and also daunting. Many students ask what the “best” schedule is for their third-year clerkships. Although there is no right answer, there are a few guidelines that can be helpful.
First, try to determine your chosen field of interest. Take some time during your first and second years to shadow physicians, talk to residents and faculty, and make an educated decision about your future plan. This is especially important if you want to go into a field that is either competitive or not a core rotation (such as dermatology, ophthalmology, or emergency medicine).
You don’t have to be a Buddhist monk to experience the health benefits of meditation. According to a new study, even a brief crash course in meditative techniques can sharply reduce a person’s sensitivity to pain.
The Infectious Diseases Society of America recently released a list of policy suggestions aimed at combating the growing threat of antibiotic-resistant bacteria. One of their suggestions: Charge wholesale purchasers of antibiotics a user fee. Most of the money would go toward funding development of new antibiotics—something that Big Pharma doesn’t pay much attention to, because it isn’t terribly profitable. It’s an interesting idea, and one that Maryn McKenna (a journalist who specializes in antibiotic-resistant superbugs) thinks has merit.
At the DC event, Dr. Brad Spellberg, author of Rising Plague (about resistance and drug development), likened the fee to something you’d pay at the gate of a national park. “We need to think of antibiotics as a precious, limited resource, the way we think of forests and fisheries — something we protect and restore,” he said.
The interesting thing I see here: The proposed fee would be aimed at both medical andagricultural users. That’s a big deal. As several people pointed out during the Conference on World Affairs, the routine use of antibiotics on healthy animals is a major contributor to antibiotic resistance. So is the unnecessary use of antibiotics by humans—who often take these bacteria-centric drugs in response to viral disease, such as colds. Maybe a user fee would discourage people from using precious antibiotics as placebos. Maybe a higher user fee for agricultural users would discourage the frivolous use of antibiotics, and force farmers to find safer ways of raising animals.
It’s 3 in the morning. You’re a third-year clerk, and you’re 21 hours into your on-call day on a busy internal medicine service. Suddenly, a page from the emergency department; “Mrs. J, a 78-year old woman with a history of heart disease, is coming in with what sounds like a CHF exacerbation, and it looks like it’s going to be a direct-to-medicine admit.” You kick into gear, grabbing your stethoscope and your iPhone, and head down.
Because you’re feeling lazy (or tired, or whatever: It’s 3am), you take the elevator intstead of the stairs, which affords you a couple moments to think. “Wait a minute,” you think. “I’ve never seen anyone with CHF before, and I know I’m going to get pimped like crazy on this by my evil resident, Dr. X. I should read up before I get down there, or else I’m going to look like I don’t know anything.”
So you hit the emergency stop, pry open the elevator doors, and crawl out, sprinting to the nearest computer, and pulling up your go-to source for easy-access medical information: Wikipedia.
Recent studies have highlighted a problem that many medical students know about all too well: the prevalence of depression and burnout in medical training. On student discussion boards, the stories put a human face on this troubling issue.
One medical student writes that she experienced severe depression during exams a few years ago. “I couldn’t stop crying, couldn’t sleep, I stopped seeing all my friends, I just used to sit and stare at books with nothing going in, it was horrible,” she notes in a comment on Medscape’s student blog, The Differential. After going to counseling, she was able to look objectively at her abilities and stop putting so much pressure on herself.
Medical students are exposed to a host of new, stressful experiences during their training, and they often process these moments in isolation. Although it has been studied considerably,[1] the effects of depression and burnout on attitudes and actions are still being realized.
Depression is more common among medical students, residents, and physicians than in the general population, though estimates of its prevalence vary.
Remember when you were a premedical student in college? It seems like a century ago for many of us who have just completed the first year of medical school. It feels that way because our lives have changed dramatically. Normal life seems to have vanished, and suddenly, 24 hours in a day are not enough to get through the enormous volumes of information that we are expected to learn for every exam. It seems virtually impossible. We barely have time to eat or sleep.
Medical school is not the end of the world. Take it from us, students who have been there, when we say that medical school is what you make of it. Do not let medicine define you; instead, you should tailor medicine to your lifestyle. Otherwise, you might become overwhelmed by the demands of your new life and lose the sense of why you chose medicine in the first place.
How do you survive medical school?
One pill makes you larger
And one pill makes you small
And the one that mother gives you
Don’t do anything at all
Go ask Alice
When she’s ten feet tall— From “The White Rabbit” by Jefferson Airplane
And I thought that tune was dated. But not after I saw “Limitless,” the film starring Bradley Cooper (Eddie Morra) and the legendary Robert DiNiro (Carl Van Loon), and directed by Neil Burger.
A writer, Eddie, who cannot put two words in a row on a page finds himself unable to deliver on the book he somehow has had an advance on, his beautiful and talented girlfriend (Abbie Cornish) hands him back his apartment keys and says goodbye, and dishes and debris pile up around him in the shambles of his apartment in New York’s Chinatown. He has been drinking too much and now has cause to drink more. But chance happens upon him as his ex-wife’s brother spots him on the streets of New York, asking if indeed that is his address. Vernon (Johnny Whitworth), a former drug dealer we learn, looking quite dapper and well to do, takes the sad sack Eddie out for a drink, not hard to do, and offers him a pill that will change everything. One pill makes you larger. What the hell, what does Eddie have to lose?
And so begins his adventure, as Vernon supplies him with NZT (why does my mind go to AZT, an antiretroviral medication for HIV/AIDS?), a drug that takes his limited brain functioning — we use a fraction of our brain’s capacity — and delivers it to its totally unharnessed power. He becomes limitless — soon making a fortune and is featured in the NYC tabloids as its latest phenom.
I’m not saying I’m as bad as Howard Hughes, but I will confess to always tearing a bit of toilet-roll of paper towel off and using it to open public bathroom doors with on my way out.
At $50 a pop, these Toepeners would surely end up saving shopping malls, offices and other public venues money over the long-run, with less paper wasted and thrown on the floor. Not to mention the debt to society they owe, with 999,999,999* different types of germs transmitted on bathroom handles every day. Public bathrooms of the world, please unite and buy a Toepener or two now! (Toepener via Marginal Revolution via OhGizmo)
*I could’ve just made that stat up. But I wouldn’t be surprised if it were true!
A multitude of factors drive students towards, or away from, the path of family medicine. Much has been made recently of reimbursement schemes that incentivize specialty practice. Certainly, medical students strapped with debt are showing preference to more lucrative fields for residency. But is there more to this choice beyond the surface of financial incentive? What about the very environment that cultivates the growth and decision-making of our medical students? Does an underlying, or perhaps hidden, bias to specialty care exist within the modern academic community and curriculum?
Read More at: Future of Family Medicine
These secrets are 100 of the top board alerts. They summarize the concepts, principles, and most salient details of neurology.
1. The first step in treating patients with neurologic disease is to localize the lesion.
2. Myopathies cause proximal symmetric weakness without sensory loss.
3. Neuromuscular junction diseases cause fatigability.
4. Peripheral neuropathies cause distal asymmetric weakness with atrophy, fasciculations, sensory loss, and pain.
5. Radiculopathies cause radiating pain.
6. Spinal cord disease causes a triad of distal symmetric weakness, sphincter problems, and a sensory level.
7. A unilateral lesion within the brain stem often causes “crossed syndromes,” in which ipsilateral dysfunction of one or more cranial nerves is accompanied by hemiparesis and/or hemisensory loss on the contralateral body.
8. Cerebellar disease causes ataxia and an action tremor.
9. In the brain, cortical lesions may cause aphasia, seizures, and partial hemiparesis (face and arm only), while subcortical lesions may cause visual field cuts, dense numbness of primary sensory modalities, and more complete hemiparesis (face, arm, and leg).
10. The brain is isolated from the rest of the body by the blood-brain barrier.
