Thursday, May 8, 2008

Daily Dose


  • Arrow in the Mouth (ER Stories)
  • EKG Du Jour - #6 (Dr. Wes)
  • Only in Vegas (airport) (Doctor Anonymous)
  • What makes a good clinical teacher? (DB's Medical Rants)
  • Hey, Hey...I Wanna Be a DNR (Bioethics Discussion Blog)
  • The Myanmar Clone (Dr. Hebert's Medical Gumbo)
  • Topers on the Train (NHS Blog Doctor)
  • Doctor's Unite (Kevin, M.D.)
  • Vampire (Fat Doctor)
  • We Are So Screwed (Ten out of Ten)
  • Photo Credit: http://erstories.net/

    Image of the Week - Fluorescence Diagnosis of Subclinical Actinic Keratoses

    Photodynamic therapy is a noninvasive therapy for nonhyperkeratotic actinic keratoses and basal-cell carcinoma. Photodynamic therapy involves the activation of a photosensitizing drug by visible light to produce activated oxygen species within target cells, resulting in their destruction. Commonly used topical photosensitizers are aminolevulinic acid (ALA) and the methyl ester of ALA (MAL), which act as precursors of the endogenous photosensitizer protoporphyrin IX (PpIX). In addition to its therapeutic uses, fluorescence emitted by MAL-induced PpIX may be useful in providing a fluorescence diagnosis of cutaneous lesions. This permits the detection of otherwise occult areas of abnormal skin (Panel A). Tumor margins can also be delineated with the use of a Woods ultraviolet lamp before surgery, radiotherapy, or therapeutic illumination with a photodynamic-therapy lamp (Panel B). Areas of involved skin exhibit pink fluorescence in the presence of activated PpIX. In this 74-year-old man, an actinic keratosis was diagnosed on the basis of MAL, applied typically under occlusion on the scalp and forehead for 3 hours, and biopsy. Pathological examination of the involved skin revealed actinic keratosis. Photodynamic therapy was administered after the application of MAL with the use of 630-nm red-light irradiation for 8 minutes. Complete remission was achieved, with no recurrence at a 10-month follow-up visit.
    Courtesy of: http://content.nejm.org/cgi/content/full/358/19/e21

    Wednesday, May 7, 2008

    Daily Dose


  • The Medicare Problem (Scalpel or Sword?)
  • Medical School X v. Medical School Y (Medical Student Musings)
  • Interview Advice (M.D.O.D.)
  • Was that my alarm clock making that noise? (Half MD.com)
  • Agents of the State (Dr Rant)
  • A Tsunami of Sorts (The Happy Hospitalist)
  • Dr. April is....TBTAM (Addicted to Medblogs)
  • It's Nurse's Week Again! (DisappearingJohn RN)
  • A Proposal: NHP = DNR (Musings of a Dinosaur)
  • We're Uglier Too (Ten out of Ten)
  • Photo Credit: http://therawfeed.com/pix/hand_grenade_alarm_clock.jpg

    Tuesday, May 6, 2008

    Daily Dose


  • Hang On and Shock'em (Dr. Wes)
  • Doctors Overmedicating Kids (Doctor Anonymous)
  • More on history taking (DB's Medical Rants)
  • Anonymity on the Blog: Bad, Good or of No Consequence? (Bioethics Discussion Blog)
  • Tricks of the Trade (Movin' Meat)
  • Make your mind up, Mr Brown (NHS Blog Doctor)
  • Passing the futile care buck (Kevin, M.D.)
  • Change of Shift, a Cup of Coffee and a Tale of Judge Judy (Emergiblog)
  • The Kid has Issues... (ER Stories)
  • How to tell if you have a problem (ER Nursery)
  • Photo Credit: http://www.popcrunch.com/wp-content/uploads/2007/10/judge-judy-400ds0620.jpg

    Monday, May 5, 2008

    Doctors Shouldn't Marry Other Doctors

    I found an article here in CNNMoney about a husband and wife who are both residents and looking at a huge amount of debt. I know it's early but it is something to consider later on down the road. I think their case is extraordinary because they are both training to be physicians and are shouldering a huge amount of debt from medical school. I love how all these articles always paint doctors as these hard luck cases..."such are the lives of medical residents: med school graduates getting years of on-the-job training, putting in brutal hours for salaries that, on an hourly basis, work out to a little more than they could earn stocking the shelves at Costco." I actually read that the average resident makes 12/hr given the amount of hours they work relative to the pay. And no I am not making this number up out of thin air, I just can't remember where I read this. Another great quote in the CNNmoney article is "for this generation of doctors, and for Meg and Chris in particular, financial security won't come guaranteed with their medical licenses. As health-care economics squeeze physician salaries, rising college and med school tuitions are putting young doctors ever deeper in the hole." Does this mean that doctors will have to be waiting tables on the side? Anyways it's a good read and the take home message here is if you have to get married, don't marry someone that has just as much or more debt than you because not even a doctors salary can get you out of that hole.
    Graphics Credit: http://money.cnn.com/2007/11/16/pf/young_doctors.moneymag/index.htm

    Daily Dose


  • The Nine Circles of Medical School (Medschool Hell)
  • The Horror (Scalpel or Sword?)
  • My Final Day of Medical School (Medical Student Musings)
  • Frankie goes to Holywood (Or how I spent my Economic Stimulus Check) Week 1 (M.D.O.D.)
  • Was that my alarm clock making that noise? (Half MD)
  • Give GP's a Break! (Dr. Rant)
  • The Triple Point (The Happy Hospitalist)
  • So glad I went (DisappearingJohn RN)
  • Deserving (Musing of a Dinosaur)
  • Real Medicine (Ten out of Ten)
  • Photo Credit: http://content.answers.com/main/content/wp/en-commons/thumb/7/79/360px-Hortus_Deliciarum_-_Hell.jpg

    Friday, May 2, 2008

    Thursday, May 1, 2008

    What Does it Take to be Good a Doctor?

    According to the Texas Medical Association there are three personality traits and disorders common to physicians: narcissitic, obsessive-compulsive and antisocial. I think the main question here is whether these traits are endemic amongst medical pratitioners (i.e. the trait makes the physician who he or she is), or does it manifest itself in the individual as they are preparing to enter the medical profession. I believe the later is true. As a disclaimer I am in no way saying that all physicians exhibit these personality traits. I actually googled "what personality traits make a good physician" and this site came up.


    "Three personality traits and disorders will be discussed in this module: narcissistic, obsessive-compulsive,and antisocial. These three are the most commonly found among physicians.

    Personality disorders are pervasive chronic psychological disorders which can greatly affect a person's life. Having a personality disorder can negatively affect one's work, one's family, and one's social life.

    Personality disorders exist on a continuum from mild (traits) to more severe (disorders) in terms of how pervasive and to what extent a person exhibits the features of a particular personality disorder. While most people live normal lives with mild personality traits, during times of increased stress or external pressures (work, family, a new relationship, etc.) the symptoms of the personality disorder may intensify and seriously interfere with emotional and physical functioning.

    Those with a personality disorder possess several distinct psychological features including disturbances in self-image; inability to have successful interpersonal relationships; inappropriate range of emotion; misperceptions of themselves and the world; and difficulty possessing proper impulse control. These disturbances combine to create a pervasive pattern of behavior and inner experience that is quite different from the norms of the individual's culture and that often tend to be expressed in behaviors that appear more dramatic than what society considers usual. Consequently, those with a personality disorder often experience conflicts with other people and vice-versa.

    Narcissistic Personality Disorder
    • Has grandiose sense of self-importance
    • Is preoccupied with fantasies of success, power, brilliance
    • Believes self to be “special”
    • Requires excessive admiration
    • Has a sense of entitlement
    • Is interpersonally exploitative
    • Lacks empathy
    • Shows arrogant, haughty behaviors
    Narcissistic people try to sustain an image of perfection and personal invincibility for themselves, and attempt to project that impression to others as well. Those with Narcissistic Personality Disorder project an inflated sense of self because typically beneath that image of grandiosity is often an insecure person with very low self-esteem.

    Narcissistic Personality Disorder tends to be more common in men than women. Because of their inflated sense of self-importance, narcissists tend to be driven to achieve high levels of accomplishments.

    Obsessive-Compulsive Personality Disorder
    • Preoccupation with orderliness, perfectionism, and mental and interpersonal control at the expense of flexibility, openness, and efficiency, as indicated by four or more of the following characteristics:
    • Preoccupation with details and order
    • Perfectionism that interferes with task completion
    • Excessive devotion to work
    • Rigidity and stubbornness
    • Pack-rat (keeps evrything)
    • Expectation of complete compliance
    • Miserly (financial)
    Obsessive-Compulsive Personality Disorder is not the same thing as Obsessive-Compulsive Disorder.
    Individuals with Obsessive Compulsive Personality Disorder (OCPD) often are characterized by their lack of openness and flexibility in their daily routines as well as by problems with interpersonal relationships and expectations. An overwhelming preoccupation with orderliness, perfectionism and control of their lives and relationships makes treatment difficult.

    Individuals with OCPD have difficulty incorporating new and changing information into their lives. Their ability to work with others is equally affected, since they see the world as black and white--their way of doing things and the wrong way of doing things.

    Examples of OCPD would be checking and rechecking dosages; excessive work-ups, etc.

    People with OCPD do not feel embarrassed or shameful because of their behavior, whereas people with OCD have a sense of shame. Behavior of the individual with OCPD affects everyone else, making them feel uncomfortable, while behavior of the individual with OCD affects primarily the individual and not everyone around him/her.

    Antisocial Personality Disorder

    A pattern of disregard for and violation of the rights of others, with three (or more) of the following traits:
    • Repeated unlawful behavior
    • Deceitfulness
    • Impulsivity
    • Irritability and aggressiveness
    • Recklessness
    • Consistent irresponsibility
    The main features of Antisocial Personality Disorder (ASPD) revolve around a pervasive lack of remorse or lack of exhibiting any feelings at all. While it tends to be most common among those who run into trouble with the law, there are those individuals with a milder form. We may know him as the politician who feels comfortable lying continuously to the public or the neighbor who constantly cheats on his wife, gambles away the family money, or runs a shady business operation cheating others out of their money.

    Examples of physicians with Antisocial Personality Disorder:

    Insurance fraud
    1. Medicare/Medicaid fraud
    2. Over-prescribing
    3. Over-utilizing for personal gain (ordering too many tests)
    4. Sexual predators"

    Image of the Week - Nevus Sebaceus of Jadassohn

    "A 14-year-old girl came to the hospital with her mother, stating that a small birthmark on the scalp had recently started growing rather rapidly. It was increasingly pruritic and caused the patient considerable emotional distress. She was otherwise healthy. On examination a large multilobulated, verrucous lesion was seen on the scalp. The findings were consistent with nevus sebaceus. These lesions have a predilection for the scalp and typically appear early in life as a solitary, hairless patch or small plaque. Often they do not cause problems until the patient reaches adolescence, as hormonal factors induce a verrucous or nodular change and the lesion grows in size, occasionally rather dramatically. Given the size and location of the lesion and the risk of malignant transformation, especially to basal-cell carcinoma, later in life, the patient was referred to plastic surgery for excision. The lesion was successfully excised, and histologic examination confirmed the diagnosis of nevus sebaceus of Jadassohn."
    Courtesy of: http://content.nejm.org/cgi/content/full/358/18/e20

    Daily Dose


  • Digitek Recalled (DR. WES)
  • Dr. John Halamka (Doctor Anonymous)
  • Again? (Aggravated Doc Surg)
  • My take: Sharing prescriptions, saving money, adherence programs (Kevin, M.D.)
  • Don't Make Me... (The Happy Hospitalist)
  • What I would (now) consider when looking for a job as a senior resident (EM Physician - Backstage Pass)
  • The Bill of Rights (M.D.O.D.)
  • Photo Credit: http://2.bp.blogspot.com/_c9emRSg3aqE/SBZEkOnpZZI/AAAAAAAAAFQ/dizdVXzBbmA/s1600-h/JobSearchNewspaper.jpg

    Wednesday, April 30, 2008

    How Smart to You Have to be to Become a Doctor?

    All of us wonder this one time or another...how smart to you have to be to be a doctor? I actually think about this every hour of every day, but I am a little obsessive compulsive. Well that question came up in YahooAnswers not too long ago and I thought I would share it with everyone. Apparently answerer 2 thinks that you have to be the Gary Kasparov of math to become a doctor. I especially like answerer 1's suggestion that you can't gag when you see blood. And then there is self deprecating answerer 6 who suggests to our young inquisitor that he pursue a Caribbean medical school and even provides a website address...I think he maybe working for them. One person states that their brother was pretty much a complete idiot in high school and now he is a dentist "making loads of cash." I didn't know having loads of cash was the point of becoming a doctor. I think answerer 3 is by far the most helpful and thoughtful not only in her answer but also by the fact that she left an email address for the young lad to contact her. Yahoo answers will never let you down. Click here to see it for yourself. (All those typos btw are theirs, not mine)

    How smart do you have to be to become a doctor and to even get into medical school?
    like i know you hae to be good in math, so would have to be in challelnge math in highschool for the whole five years???

    Answerer 1 I'm not so sure that you have to be a genius or anything. But more of a interest in what a doctor has to do and have a strong passion for it. For example, if you don't like blood and it make you gag I wouldn't go into the medical field. But if you love the idea of being a doctor and are interested but you don't think your smart enough, try as much as possible. Or read books and study up.

    Answerer 2

    You have to be VERY good in science and math especially
    ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~...
    Hope that helped Good Luck

    Answerer 3
    Yes, math and science, do well in those it will take you very far.

    Math really isn't a big deal, actually. The only math you need to get into medical school is general 2 semesters of college math, usually one statistics and one calculus or similar class. Although it is important to do well in these classes, a B probably isn't a big deal (and statistics really isn't hard at all if you go to class).

    You do need to be good at science...biology, chemistry, and physics are all classes you need to take and do well in order to get into medical school, and all three are on the MCAT. The only thing you need to do in highschool is keep your grades up enough to get into a good 4-year university with a good science program. Medical schools don't look at your highschool transcripts, so it really doesn't matter what you take in highschool. That being said, a good solid science background will make your life easier in college.

    In college you need to keep about a 3.5 GPA to get into medical school, and you need to get a 30 on the MCATs (out of 45).

    If you have any more questions about what you need for medical school, please feel free to email me at goodee_2_sandals@yahoo.com.

    Answerer 5
    i would do an internship at a doctors office and see what they actually do... or work as a medical assistant to decide if working in that environment is something u'd wanna do for the rest of ur life.
    i definetly think that you have to be decent in math and science, nothing spectacular though. Also alot of it is memorization... think of ALL the different body parts and diseases that a doctor must remember and have knowledge of at any given time... having a passion and love for the job certainly helps u memorize

    Answerer 6
    It's not necessarily smarts... you have to have good discipline, work really hard and be really motivated. I am a 4th year medical student and personally i don't think i am very smart... but i work hard. You can go to medical school out of high school to a 6 year program. The only thing is you have to go abroad. if you want to go to medical school in US you have to do 4 yrs of premed and 4 years of medical school(total 8). If you go to a place like the Caribbean you can be done in 4 years. here is a site to help you... good luck
    http://www.bestforeignmedicalschools.com

    Answerer 7
    math in high school is there to get you prepared for college math. My brother was never a good math student in high school (C's and B's) but he managed to get by. Now he is a dentist making loads of cash. If you really want to go into the medical field then i would try taking some math courses to the side or during summer for summer school. The only way to like math is to understand it, if you don't understand it then you don't know if you like it. But to answer your question furthermore, i would say that you probably have to get into the basics of calculus to become a doctor. This also depends on the college you choose.
    Courtesy of: http://answers.yahoo.com/question/index?qid=20080330183345AAaonrF

    Daily Dose


  • Cutters (Scalpel or Sword)
  • Great Timing (Medical Student Musings)
  • Can I Get Prior-Authorization to Kick Your Ass? (M.D.O.D.)
  • What I would (now) consider when looking for a job as a senior resident (EM Physician - Backstage Pass)
  • By George He's Got it! (DR RANT)
  • My New Weekend Dress Code (The Happy Hospitalist)
  • Either feast or famine; no in-between (DisappearingJohn RN)
  • I Can't Win (Ten out of Ten)
  • RN-to-BSN - It's The Way to Go (Emergiblog)
  • Pre-TouchyFeely (Fat Doctor)
  • Photo Credit: http://splinteredsunrise.files.wordpress.com/2007/08/ostrich-757855.jpg

    Tuesday, April 29, 2008

    Daily Dose


  • Conflict of Interest?: The Researcher has the Disease Under Study (Bioethics Discussion Blog)
  • Sampler (Surgeonsblog)
  • Ancient Wisdom (Movin' Meat)
  • Vitamin and Enzyme Supplements (NHS Blog Doctor)
  • some things... (Med School and Beyond)
  • Doctors Crying with Patients: Appropriate Bedside Manner? (Clinical Cases and Images - Blog)
  • Watcher on never events (DB's Medical Rants)
  • Praying Parents of DKA Child Charged (Doctor Anonymous)
  • 1984 (Dr. Wes)
  • This Blog's For You (Emergiblog)
  • Photo Credit: http://www.emergiblog.com/2008/04/this-blogs-for-you.html

    Monday, April 28, 2008

    Residency Salaries

    I started obsessing about how many years it takes to become an MD, so I was comforted by the statistics I found for the mean salary of residencies nationwide. It's not as bad as I thought. Although residencies are the equivalent of hell-week spread out over 3 plus years, at least we are compensated for our work. I found out there are also many perks besides just the salary. I know this is premature, but it is something to look forward to following four or more years of school. The 2007 Mean stipends in United States for a MD Resident (also called house-staff) from any specialty were as follows:

    • 1st Year (PGY1 / Intern ): $44,000

    • 2nd Year (PGY2): $46,000

    • 3rd Year (PGY3): $48,000

    • 4th Year (PGY4): $52,000/-

    • 5th Year (PGY5): $54,000/-

    • 6th Year (PGY6): $54,000/-
    Note: These are means based on a national survey by the AAMC - the actual figures can vary by $3,000 to $4000 on either side of the mean, an at times more.
    Info Provided By: http://mdsalaries.blogspot.com/2005/10/residency-salaries.html

    The Day in the Life of a Physician

    It's really hard to grasp what a doctors life is like day to day. There are people out there that make it sound like your personal life is over once you are a doctor. You will have no time for family, friends, hobbies...nothing. It sounds pretty bleak right? I know that shadowing a doctor is supposed to provide a premed with an honest view of what it is like to be an MD, however, I doubt that any shadowing program allows you to go whom with the doc and see what their life is like outside of the hospital. We are made to believe that their entire life is the hospital when in fact we all know that there are doctors who have happy functional fulfilling lives outside of medicine. I grew up not knowing any doctors. I didn't even have a regular pediatrician because we moved around so much, so my idea of what it is like to be a doctor is completely skewed. All I can go by is the advice that has been given to me by adcom members and advisors who all suggest that you are pretty much giving up your life as you know it. Maybe it is just their way of weeding out the dedicated individuals from the slackers. Either way I am beginning to think that doctors maintain this monastic lifestyle devoid of any kind of joy. I set out to find out what life is really like for a doctor on and off of work. So I did what any self respecting blogger would do...I googled "a day in the life as a physician." One of the first things to come up was a series of articles on a website called The Next Generation. They highlight what life is like for four different MD's from different specialties. Question two in an interview with an internist named Dr. Douglas Kelling asks:

    2. What is your schedule like? How much time do you spend with each patient? When I am not on vacation, I work 7 days a week. Monday through Friday I start my hospital rounds between 5:30 am and 6:30 am. Rounds are usually completed by 8:30 am. I then go to my office, which is attached to the hospital. Monday through Thursday I see patients from 8:30 am until 6:00 pm. I take about 1/2 hr for lunch. I eat in the office. On Fridays, I see patients from 8:30 until noon. Friday afternoon is devoted to education and paperwork. After my office is closed, I go back to the hospital to work up new patients. About 7:00 pm I go home for supper. I return to the hospital about 8:00 pm and stay until 10:00 to 10:30 pm to see patients and do paperwork. On Saturday and Sunday I work at the hospital from 9:30 am until 5:00 pm rounds on patients and do paperwork.

    This guy sounds intense. Maybe everyone was right about a doctors lifestyle. Someone please correct me if I am wrong in my assumptions.
    Photo Credit: http://www.nextgenmd.org/vol1-5/kellingv1i5.html