>> Thank God for running. Running, along with lindy hop, serves as a fantastic antidote for anxiety and stress for me. (I’ll be advancing to 25 minutes of consecutive running tomorrow.) Given the sudden onset of autumn in Seattle (we are being robbed of summer!!!), I anticipate that I will become one of those crazy people in blinding fluorescent clothing who go running when it’s pouring buckets out. (Running has also nicely augmented my lindy hop habit—I can keep up with faster songs now with greater ease… although I could easily attribute that to the fact that I’ve now been dancing for about two years.)
>> I will not gouge my eye out with a fork. Although attending eight kajillion meetings increases that impulse. (Hence the “Thank God for running” bit.) I shall have a better attitude about administrative crap obligations.
>> Zen Things Done? The endless pursuit of maximizing my efficiency continues. I haven’t read through the entire series, but I hope that it will be more simplified than GTD. Maybe I’m just not disciplined enough, but GTD consistently seems too bulky for my purposes. For the GTD aficionados out there, I reverted back to index cards and am now operating out of a Levenger pocket briefcase soft plastic-feeling knockoff that I found for a wonderfully frugal price of ~$2.00. Problems I had with using a pocket notebook (like a Moleskine) was (1) the lack of ease of capturing data (have to open the book, etc.), (2) the lack of clarity of tasks I had to get done on a given day (I tucked an index card to the cover underneath a hair band, and (3) the inherent linearity of a notebook. I like this knockoff (I think the official title is an “Oxford Notecard Holder”; I got it at Office Depot) because of its slim profile, its clean simplicity in holding index cards (which I can shuffle around at my heart’s whim), and the two outer pockets which can hold cards for plain viewing (one has my daily “to do” task list; the other one holds a two-month calendar). It even has an elastic loop on the side to hold a pen (I am one of those people who warmly support Pilot G2 gel ink pens—extra fine, of course). I heart simplicity.
>> Gene Kelly. Some people argue that Fred Astaire was a better dancer, but I’m definitely a Gene Kelly gal. When Kelly dances, he’s exuberant; there is something measured and restrained about Astaire’s dancing (compare here). (Plus, Gene Kelly’s smile—that wide, toothy thing that occupies his entire face when he’s singing in the rain—is breathtaking. Kelly also does amazing things on roller skates. Kelly, while dancing, looks the way I feel when I’m dancing, though I’m quite certain that I don’t have his grace or style.
>> The Point of Life. Graham shares another video and reminds us that the point is to “sing or dance” while the music is playing.
21 Jul 2007 | 4 comments.
Just Write a Letter.
Dear _______:
It has been some time since you were here at the hospital, and we hope things are going well for you. If you wish to drop us a note we would be glad to hear from you.
What would happen if that simple letter was mailed on a regular basis—say, every few months—to people who had been hospitalized for depression or suicidality and had declined mental healthcare following discharge? Would this letter—in generic type, somewhat personalized—change anything? Would it decrease the likelihood that the recipient of the letter would die from suicide? Or would this intervention simply be a waste of time, trees, and money? Is the note potentially therapeutic, or is it a piece of junk mail?
The data—from a randomized, controlled study—suggests that people who received these modest notes have a statistically significant reduction in suicide rates for at least two years compared to people who do not receive these letters!
Let me emphasize that point: People are less likely to die from suicide if they receive occasional well-wishing letters from mental health providers. I’d like to think that this means the recipients are less likely to attempt suicide as a result of receiving these letters, but that is not a conclusion we can confidently state from the data.
I know I still think about many of the patients I have met in the past. Have I written them any letters? Nope. Heck, how often do I send notes to my friends through the postal mail to say hello? Not very often.
Why is it so difficult for us to show we care?
19 Jul 2007 | 10 comments.
Extortion in Medical Education.
The MCAT (Medical College Admission Test) is a standardized exam one takes to enter medical school. The SAT is to college what the MCAT is to medical school. Cost: $210. (If one takes a prep course, such as from Kaplan, which unscrupulously advertises, “Your doctor took the Kaplan course,” include those exorbitant fees as well. I can’t bear to link to it.)
The AMCAS (American Medical College Application Service) application is used to apply to medical school. Cost: One school costs $160; each school thereafter costs $30. (Most of my peers applied between ten and twenty medical schools. Also include the costs of purchasing a suit, travel expenses, and the alcohol consumed to quell the nerves. Just kidding about that last part.)
Enter medical school and pay for tuition (hooray for state schools with lower tuition!), books, caffeinated beverages, road trips, and class parties.
The USMLE (United States Medical Licensing Exam) has three parts. Part I is taken between the second (“pre-clinical”) and third years of medical school. Cost: $480.
USMLE Part II is taken during the beginning part of the fourth year of medical school to accompany residency applications. There are two sections to part II: a written exam and a clinical skills exam. (I did not have to take the clinical skills exam.) Cost of the written exam: $480. Cost of the clinical skills exam: $1025. (Also include travel and hotel expenses for the clinical skills exam, as it is held in a few select cities in the country.)
The ERAS (Electronic Residency Application Service) is used to apply to residencies. Cost: To apply to ten residencies or less, $60. Between 11 and 20 residencies, add $8 for each program (on top of the base rate of $60). Between 21 and 30 residencies, add $15 for each program (on top of the base rate of $60.) For over 31 residencies, add $25 for each program on top of the base rate.
You must transmit your USMLE scores along with your ERAS application. Cost: $50.
Congratulations! You’ve matched into a residency and have graduated from medical school (after consolidating your loans, of course). Include costs of relocating for residency.
One must have a medical license for the state to practice medicine. Cost: $335 (in the state of Washington—this is less expensive if one obtains a limited license, which permits the license holder to only practice within the purview of a residency training program.)
One must have a DEA (Drug Enforcement Administration) license to prescribe controlled substances. If one only practices within a residency training program, the fee is waived. I have no idea what the fee is if you apply for a license independently (though I will find out soon enough).
After completing an internship, one is eligible to take USMLE Step 3. Cost: $655.
One must renew the medical license to maintain the privilege of practicing medicine in the state. Cost: $470 (which covers two years in the state of Washington). (Again, renewal is less expensive if one has a limited license.)
To become a board certified psychiatrist, one must take exams for initial certification in the American Board of Psychiatry and Neurology. The exam has two parts. Cost for Part I: $700 application fee, $950 examination fee (!!!).
Holy cow!
18 Jul 2007 | 11 comments.
Ideas in Search of a Post.
I am going to steal Lance Mannion’s category of “ideas in search of a post”. The spirit is willing to elaborate on these ideas, but the flesh is weak and does not want to pontificate tonight:
>> A significant problem with medical education is the lack of context. Some medbloggers suggest that the business of medicine ought to be a required course in medical school—while this perspective holds merit (as, indeed, healthcare is a business, though that grates against our idealistic tendencies), medical students often learn about medicine as if it is totally in a vacuum. This is why many surgeons and internists distill the social history into three topics:
- tobacco use
- alcohol use
- other substance use
In psychiatry, we delve much deeper into social history, though even we often reduce it to a few bullet points (born here, raised there, this many siblings, parents involved, possible abuse, graduated this grade, worked these jobs, married this many times, this many kids, currently living where, living with whom, relationships, financial support…).
We don’t learn that medicine is practiced within the context of economic demands. We don’t recognize that the patient may hold certain cultural beliefs (where “cultural” doesn’t necessarily refer to ethnicity) about their minds and bodies that may significantly impact his healthcare. We isolate diseases as solely conditions of an internal organ and exclude how the environment may have affected the condition and, conversely, how this condition affects how the individual interacts with the environment.
When we finally practice out in the “real world”, context whisks us off of our feet and we’re bewildered—you mean money plays a big role in healthcare? you mean medications don’t grow on trees? you mean patients don’t have endless resources to follow our recommendations to the letter? what?
>> Psychiatrists are much more attuned to human behavior than I realized. A group of residents from a variety of specialties convened this evening to learn about administrative tasks, managing conflict, team dynamics—middle management, essentially. As the speaker (a skilled administrator who is a physician) elaborated about the craft of bridging administration with medicine, I realized that so much of my training is directly related to this type of diplomacy and management of people. Many of the other residents found these concepts novel—these are issues they do not routinely consider.
This is probably totally obvious to everyone else. But just because I think about human behavior a lot doesn’t mean that everyone else does, too. (Hear that buzzing noise? It’s the lightbulb over my head flickering to life.)
>> Grand Rounds is up. This summer’s literary medblogging project (thank you, fellow blogging bards!) made it onto “Vitum’s Top V“. Sweetness.
16 Jul 2007 | 4 comments.
Stories Behind the Stories.
Instead of working on a medical student lecture on neuroleptic malignant syndrome (to contrast it with serotonin syndrome, a lecture I dutifully completed yesterday), I futzed with LibraryThing (now also located under “Trifles” in the sidebar).
And, now, instead of directing my energies on the above lecture, I am now writing about my procrastination.
My LibraryThing catalog does not include all the books I have ever read, as I frankly cannot recall all the books I have ever set my eyes upon. I am no longer the ravenous reader I once was; I fondly remember many summers wandering the aisles of the public library, running my fingertips along the worn spines of the books neatly arranged on the steel shelves. I consumed a lot of fiction (much to the chagrin of my father), though I also read many books about biology. I distinctly remember reading a book that, amongst other things, shared the amazing tale of the dung beetle and its talents in rolling balls of fecal matter around. It really was pretty amazing.
LibraryThing includes a box for comments about books. For some of the books I have read recently, I included how and why I encountered them. In addition to the pleasure that comes with organizing things, I indulged in the warm and fuzzy memories of the circumstances that led me to these books. There is usually a story behind the story, yes?
For example, the medical student (who is now a resident herself) I mentored when I was an intern loaned me her copy of Palahniuk’s Choke at the end of her rotation. Tucked within the pages of the book was a small card that featured a black-and-white photograph of a rose. Inside, she penned a few kind lines about our relationship. It was nice. I blushed.
And now, whenever I see that book, I think fondly of her.
Jane Eyre was undoubtedly my favorite book in high school (though, these days, I find it a bit too mushy—I now find greater delight in the more restrained and witty Pride and Prejudice). I remember curling up with the novel on the aged sofa at home, eagerly turning the pages while engrossed in the covert drama unfolding between Mr. Rochester and Jane Eyre. How my heart panged for Jane who, though smitten with Mr. Rochester, tried to stifle her affections for him! Jane Eyre was, for me, a wonderful, literary soap opera.
I included books I have read/am currently reading for work on the list and even a few of them have special stories behind them. I purchased a copy of Shawn Shea’s Psychiatric Interviewing at the suggestion of an attending who I greatly admire. Not only is she intelligent and actually more empathic towards patients than people may realize, but she is also highly fashionable. Many of us who have worked with her readily admit that we dressed up “more” while on service with her. Otherwise, we’d look slovenly, even though we actually weren’t “disheveled”.
After starting the text, I had praised Shea’s text on this here blog… and, to my surprise, Dr. Shea himself sent me a note thanking me for publicly praising his book. That, too, was nice.
I just finished reading Freakonomics (right on the heels of The Tipping Point—I need a break from that genre) and would like to start another non-medical book, though I ought to dedicate my efforts on books related to work—there’s so much to learn and so little time.
But enough about stuffy books. If you’d like YouTube to suck away precious minutes of your life, watch Graham’s Clerkship Video Workout Guide. It’s more amusing if you’ve ever been a medical student, but entertaining nonetheless. And, if for nothing else, Graham is nice to look at. (Hi Graham!)
15 Jul 2007 | 3 comments.