The further I progress in specializing in medicine, the more I realize how much my daily abilities deteriorate.

Take language, for example. Aside from the broken Spanish I acquire from my Hispanic patients, I rarely invoke English dictum beyond the eighth grade. Our vocabulary in the office is limited to a defined collection of complex medical terms strung together with linking verbs and qualifiers describing outcomes (hemorrhage, blindness, infection, inflammation). Outside of  the office, I’ve struggled to identify common objects like “spoon” and “basket” without using hand gestures.

Is this shift simply a result of natural selection (adaptation on steroids!)? French naturalist Jean Lamarck coined terms like “use” and “disuse” for adaptation spanning generations. Are professionals contributing to their own extinction by being good at their job?

It would be interesting to measure cortical function throughout the course of medical school. This could be followed with serial PET scans to localize metabolic activity in the brain. Areas that fail to sustain signal can be used to correlate with mapped cortical regions. Indeed, a spatial correlation in such an experiment would be damming to future physicians-to-be…

misc euphemisms, humor, life

I had the chance to meet ophthalmology residents from Europe recently, and it’s fascinating to hear about their medical training experiences.

In particular, I learned about ophthalmology training in Portugal. As with most professional training outside of the United States, specialization begins directly after high school. Medical school totals six years of schooling, although they do not have an equivalent to “college” as we do in the U.S. During the last year of medical school, students rotate through certain medical specialties much like we do in our 3rd year of medical school.

During this 6th year, students prepare for a cumulative exam on Harrison’s Principles of Internal Medicine. It is a 100 question exam on minutiae. Several of the Portuguese residents have told me they studied for over six months for the exam. Others have taken it 3 times. Your score on the exam allows you preferential ranking into the specialty and hospital of your choice.

That’s right. No application essays. No interviews. No traveling. Your career is determined by how well you do on one single exam. Mind you, this isn’t like the SAT’s that Toby-the-school-jock (who happens to have a reasonable grasp on English) can get a 1600 (or 2400 now) without preparation. Any sort of all-inclusive exam on internal medicine borders insanity.

As far as I understand, ophthalmology training in Europe has great variability. What you learn is certainly dependent on which hospital you train at. It seems to me that much of the cerebral knowledge comes from independent learning from textbooks. Surgical training, however, can be impressive. One of the first year residents I spoke with had already performed over thirty pterygia and over ten phacoemulsifications! I would be fortunate to clock even 15 pterygia this year. A vitreoretinal fellow from India had told me he did over 500 phaco’s in addition to hundreds of extracapsular extractions during his residency.

In a way, it is humbling to hear about experiences outside of the U.S. Indeed, we have an overwhelming amount of funding and resources, yet our training isn’t necessarily superior. Where do our investments go? Research labs? Lawyers? Administration and unionized workers? The abyss?

medicine ophthalmology

Even if you aren’t tech-oriented, you’ve probably gotten wind of the ongoing Consumer Electronics Showcase this weekend in Las Vegas. Every winter, electronics and computer companies get an opportunity to dazzle us with the latest technological breakthroughs. I’ve never been to any of these conventions before. I’m not there now, as I am on call this weekend. It does amaze me that some innovations are simply spectacular, while others appear impractical.

It seems like the common theme this year is digital screen technologies, like OLED televisions and E-books. The concept of e-book readers like Kindle and Sony’s Reader is enticing, but the weak .pdf support and huge restrictions on certain file formats makes the device an imperfect scientific reading device.

I wonder how many of these devices have application in the medical community. Portable readers? Not really. See-through OLED screens? Nice, but not a necessity. Portable dictation devices? Absolutely. We need to transcribe our referral letters. I will be following Android’s dictation engine closely. Since Google has been harvesting 411 voice data onto its Voice system for the past few years, I can only expect things to improve. It will be an exciting year.

computing rant, tech

I know little about non-western medicine (ie acupuncture, herbal medicine), but the moment I saw this jar of powder in a local store, I knew I needed a photo of it. Unfortunately, the photo came out fuzzy as the pharmacist shooed me away from the aisle. The jar reads:

“Stomachin: Chang Kuo Chou Strong Stomachic Powder”

I found an online store that sold an equivalent concoction of health. It appears that this medicine is intended to remedy gastritis, given that licorice and sodium bicarbonate account for the bulk of the powder. I assume that this medicine may actually be effective, given that almost a billion people have probably taken it at one point in their lives (This is a Chinese medicine).

*Note: I am not affiliated with this product. I do not endorse the use of this product either. I have neither prescribed this product nor used it myself. *

medicine humor, medicine

When I told one of my friends that many ophthalmologists operated without wearing shoes, she responded with an insightful remark: “Isn’t that dangerous?”

In medical school, we were forbidden to wear open toed shoes while in the hospital. After all, who wants to have ascites or a bloody mess on your feet? The potential consequences of walking barefoot in the operating room are even more severe. Imagine delivering a C-section without proper gowns! With needles and other dangerously sharp equipment lingering around the OR, who wouldn’t be wearing shoes?

Indeed, I was uneasy the first time my attending told me to take off my shoes when I was operating as primary surgeon. Since then, I’ve realized that it’s nearly impossible to control the microscope and the Infiniti (I’ve only used the cautery mode) while wearing shoes. The pedals for the operating microscope control the focus and zoom on the operating field. A four-way joystick is situated above the pedals. An additional four buttons are also on the platform surrounding the pedals. All of this is controlled using ONLY your LEFT foot. A similar configuration to control the phacoemulsification machine is  located on a separate platform for your RIGHT foot. Having tactile sensation on the pedals eases the difficulty of learning the machine, especially for newbies like me.

Still, I cringe every time we lose a needle (or #57 blade) on the ground.

medicine humor, ophthalmology