Several months ago, I posted Alfred Padilla’s Venn Diagram as a fool-proof means for medical students to decide upon a specialty. I remember how difficult for me to decide upon a specialty–it took me years. It’s been yet another match day cycle and graduation year with newly annointed M.D.’s. Despite the joyous faces of the new grads, I can’t stop wondering how many of us actually made informed decisions in our careers. Given the structure of most medical schools, the majority of our decisions are based on limited exposure to a field. Some medical schools condense the preclinical curriculum to one year (Duke) or 18 months (Baylor), but the majority of them remain at two years.

Two years of textbook education is absolutely unnecessary for medicine. We need early exposure to the hospital with a breadth of specialists. Many of us have no exposure to the surgical subspecialities (urology, otolaryngology, ophthalmology, orthopedics, neurosurgery,anesthesiology) or even medical subspecialties (dermatology, cardiology…etc) before we decide on 4th year electives. The even more obscure fields are shunned (nuclear medicine, rehab, radiation oncology).

If we receive so little exposure to these fields, how do we ultimately decide on them? My theory is that we already have preconceived notions of the field long before medical school. Some of us worked on medical projects in college, and simply decided to pursue a career in that field.

“Chuck wanted to be a neurosurgeon when he applied for medical school because he liked brains.”

“Tony wanted to be a doctor, but he didn’t like to work hard. He chose specialties that he thought had a good lifestyle and/or residency.” Ophthalmology? He’ll be in for a BIG surprise. Dermatology? Tony never knew that dermatology clinic had 40 patients a day (vs 10 for his internal medicine counterparts).

Tony may end up being a miserable doctor. If he had known about Rehabilitation medicine, he may have chosen it. This is an extreme example, but the consequence of choosing a specialty unsuited to you can be disastrous. If Chuck hated neurosurgery after 6 months into residency, he still has 6.5 years to go. He could quit, and his department will hate him forever because now they will have to find a replacement.

The solution? It’s already in the works. Many medical schools like UCSF have preceptorships during the preclinical years to expose students to professional offices. For those of you without formal preceptorships, you can always contact community physicians for help. Your dean’s office will likely have a list of alumni in the area who may be interested in having a student around. Use your hospital. Volunteer for transplant surgery trips. You will be pleasantly surprised what you find.

For those of you who are too lazy or meek to seek (bad pun) out your career path, you can still use my Venn diagram. It is amazing.

medicine humor, medicine

Unless you’ve been hiding in a bubble over the last few years, you’ve probably heard of Electronic Medical Records (EMR), or Electronic Health Records (EHR). Some of you may even have experience working with these systems. Dozens of companies have invested millions into computerizing health records with the notion that digital information will remedy the healthcare system’s multitude of problems. These software frontends have evolved into impressively complex applications, ranging from Visual EMRs to BrainLab’s Digital Lightbox touchscreen interfaces.

One of the concerns with electronic data of any form is security. When the security of health information is involved, we cringe–there is an intangible queasiness to having your health records disseminated to the world. The feeling is worse than having your credit card information stolen. No matter the number of bits we throw into our encryption schemes, health policy pundits will always claim that our data can be hacked.

Well, how secure are paper records? If a file room goes up in flame, that’s the end of it. No backup. No recovery. What about theft? That simply involves old-fashioned robbery. No fancy hacking required. The irony is that paper records ARE secure, because of their inherent flaw that EMRs are designed to eliminate–penmanship.

Physicians have horrible penmanship. There are always exceptions, but the stereotype holds true in most cases. I recently spent 2 weeks at a primary care physician’s office. Making any sense of the chart records was simply impossible to an outsider. Lab results? If they’re not correctly placed under the “LABWORK” tab, good luck finding it. Progress notes? I barely advanced past the date. I was able to interpret a few of the cryptic scribble, like “RRR” (heart exam reveals regular rate and rhythm), but only because I am familiar with the jargon.

Take the image above. To a layperson, the scribble writes, “AFTER…”? To a medical professional, that looks like a medication dosing. Ceftriaxone? Ceftin? Ceftibuten? Who knows. To the skilled medical professional, we can work backwards to guess which medication we usually dose at “1 gram IV”.

Poor penmanship is the security system for paper records. Good luck reading any of the record. In fact, we might not even have a record for our VIPs. The data is all in our heads. Your health information is safe with your doctor. That is, until your doctor becomes senile.

computing, medicine humor, medicine, tech

Remember the days when you were able to perform partial integrals with ease in math class? Or the time you could quote Adam Smith‘s labor theories from heart? It’s amazing how quickly our minds erase knowledge that don’t pertain directly to our careers or interests. Wouldn’t it be nice to be capable of retaining more than just a snippet of our past accomplishments?

I received an email from my former mentor at NASA (They forbid use of their “meatball” logo on unauthorized websites) the other day. He wanted me to stress test some revisions on software I wrote years ago with him. I struggled even to generate a data set for testing…what do I use for the supersonic area ratio? What is the mass ratio? What are expected values for normal chamber pressure, and do I want to calculate it in frozen state or equilibrium? Damn. This stuff really is rocket science. How the hell was I able to do this in college, when I didn’t even know what the periodic table looked like in high school?

I started reminiscing about what had happened in those days. I remember that NASA had many enrichment programs for students. I had been accepted into a college scholars program with the notion of redesigning some internal branch websites and writing TPS reports (read: Office Space). One of the engineers was kind enough to discuss his research with me, and vocalized one of his side projects with me. I volunteered to help out, and somehow managed to write most of the software interface for some engine simulation system. He walked me through whatever chemistry I needed to understand, and the rest was history. I still remember him trying to explain the Chapman-Jouget condition to me and emphasizing that we were working with detonations and not deflagrations!

I still wonder how much I did know back then–it’s all a blur now. Too bad I can’t be both an eye surgeon and a rocket scientist.

computing humor, life

The refrigerator is a great place to extend shelf life of products, whether edible or not. Batteries or film will stay fresh for years in the fridge if kept in proper humidity. Storing preservative-free eyedrops or Forteo (for osteoporosis) in the fridge will also help maintain their efficacy.

I keep chocolate in my fridge. Large amounts of it. Right in the left crisper drawer. Ever since I started counting down the weeks before my move, I’ve been frantically trying to clear out my food items. I’ve amassed a formidable stash of European delicassies in my fridge and cabinet over the last year, and it’s been difficult whittling down my stores. The photo above shows about a fourth of what I had 2 months ago. I simply am unable to consume this stuff in large quantities because the chocolate is overpoweringly rich and it seems like a waste not to savor it. In NYC, the Leibniz cookies sell at $5 for 3.3oz. The Swiss waffle chocolates? $6 for 3oz. I bought 5 boxes of each earlier in the year. (The gold standard for cookie comparison is the Oreo, which usually sells for $3 for 16oz)

I’ve started distributing some of my goodies in the hospital, and they go like hotcakes. A box of Ferrero’s lasted 3 hours. I wonder how long a box of French schoolboy cookies (Le Petit Ecolier) will last…

misc food, humor, life

From what I’ve seen, the most lucrative hospitals are those that you don’t typically consider to be academic powerhouses. On the contrary, many of them appear to provide care that is far from excellent. Based on personal observation and unfounded stereotype, I’ve created an action plot of the ultimate medical provider framework (outside hospital):

Update 5/5/09 18:30: I’ve realized that cardiac cath reimbursements aren’t what they used to be. The big revenue generators these days are the imaging modalities, like MUGA scans, and even ABI’s. Having a nuclear medicine lab would help pull in the big bucks.

medicine humor, medicine