Tuesday, October 31, 2006

The Drip

I got the drip.

I've actually had it for about a month now, and I am upset because it's been a LONG time since I've had it. It is really starting to irritate me now, too ... I wake up and the drip is there, during the day it's there, and it's actually the worst at nighttime. Its green color doesn't excite me much, either.

I don't know where I got it from, but it probably doesn't help that I work in the hospital. I was borderline sick before, but since starting this rotation it's become full-blown ... so I probably picked it up from someone here. If only I knew who ...

Anyway, I finally decided to stop with the over-the-counter stuff and go to the doctor today, who prescribed some sprays and such. I expect results by tomorrow morning!

(By the way, I'm referring to the post-nasal drip.)

Monday, October 30, 2006

Drowning in Estrogen

Attending: female.
Resident: female.
Intern: female.
Me: not so much.

This is a first for me, where my entire team is composed of girls (women?) I have been on many teams where the majority of the team was female, but never where I am the only guy.

I definitely have no problem with this, it is just new for me. The team is just as efficient and competent as any team I've ever been on, but it definitely has a different air to it than when guys are the majority. Everyone instinctively responds with "ohhh" (with sympathetic tone) when a patient says something touching. They all bust out with "he's so cuuuuuute!" after interacting with our little old man patient. And they all show pictures of their children to each other.

Luckily the fellow that rounds with us for our unit (ICU) patients is a guy, so there is a little burst of testosterone for a few minutes each morning. (The interesting thing is that I did not even notice this all-female aspect of my team until he brought it up one morning!)

Anyway, not complaining ... just reporting.

Grey's Anatomy

I have been watching a lot of the TV show Grey's Anatomy on DVD here since I don't have television (but luckily I do have internet).

But what is up with this show? These "general surgery" residents do everything ... they're not just general surgeons, but they deliver babies, they do prostatectomies, they do it all. The cardiothoracic surgeons remove abdominal tumors, the neurosurgeons do heart surgery ... what don't they do?

Well for one, they don't listen to DNR/DNI orders (such as the Asian girl intern who goes about coding a DNR patient like there was no tomorrow), as well as many other orders from their attendings. What kind of intern goes behind their attending's back and second guesses their clinical decisions? I cannot even imagine in real life what would happen to that lowly intern if they were to defy an attending in that way.

Also, at what program do most interns sleep with their attendings? Perhaps I should go there for training ... I do like Seattle, afterall.

And finally, come to think of it, this show is on its 3rd season ... and what kind of interns remain interns for 3 years?

Anyway, time for the next episode.

(I know these post-call posts are lame, but in my delirious state of mind they're pretty damn entertaining.)

Sunday, October 22, 2006

50 Posts

I am post-call and thus a little tired right now, but I just realized that my weblog just broke 50 posts! Might not sound like much, but when I first started this little endeavor -- while I was hoping for many and frequent posts -- I was afraid it would fizzle out after a few posts. But surprisingly I have found enough time, motivation, and topics to write about.

So thank you to everyone who reads this blog, and the few of you who have even linked to it -- I really appreciate it and am flattered.

Time to sleep ...

Friday, October 20, 2006

Updates from the Subinternship

Hello from Northern California.

Well this rotation is keeping me a lot busier than I expected! Apparently it is a subinternship, which means I am being treated as if I'm an intern ... meaning that I have (near) complete control of my patients, I take overnight call with the team and admit about several new patients, and I am also the first one that's paged in the middle of the night when there is a problem with the patient. Some of these are responsibilities I'm used to, but others are completely new duties for me (such as putting myself down for first page on the admission orders).

Plus, they hit me hard and they hit me fast ... I was on call my second day, as I was still slightly shaken up over struggling to learn my way around the hospital, learn their electronic medical system, and just get a feel for the overall culture. (At least I got to sleep for about 1 1/2 hours.)

Anyway, I am pulling pretty long hours so I have very little time for leisure activities. So much for going to the gym and hanging out with family/friends for the remainder of this rotation. My schedule consists of going to work at 6am, coming home, eating, squeezing in some reading, and then going to sleep. Repeat x 28 days. On the bright side, the residents and faculty here are extremely sharp and knowledgeable, and I am learning a lot. I am also getting an appreciation for what next year (i.e. internship) will feel like.

This is a program I really would like to go to for residency, so I'm willing to endure all of this ... but I get a total of 4 days off (today being one of them), so I won't complain too much.

In the meantime, expect posts and comment replies only on my days off ... so until then, goodbye.

P.S. There are noontime talks here nearly everyday, and the first one I attended was one about the influence of the pharmaceutical industry on medical industry. A very interesting talk ... and very timely!

Sunday, October 15, 2006

Away Rotation

I leave today for a month-long rotation in northern California. I will be at a fairly top-notch medical center, working with their housestaff and students, which is a slightly intimidating thought. Then again I will be working in the CCU (Cardiac Care Unit), and when it comes to cardiology I am rock solid ... so I don't worry much.

Northern California is home for me, so I look forward to spending the little free time I have with family and friends. It should be a good month, especially since I think I need to get away from this area to get me away from a certain distraction that has been clouding my thoughts (and sleep) for the past several weeks. Maybe the physical distance will help clear my head.

Anyway, stay tuned for posting from the Bay Area!

Pharmaceutical Sales Reps

I just came across an interesting article in the New York Times entitled Drug Makers Pay for Lunch as They Pitch, describing how pharmaceutical sales reps frequently bring lunch and other meals to doctors' offices in a not-so-subtle effort to pitch their drugs. They resort to providing meals because recent laws have restricted them from offering the fancy gifts that they used to give in the past, such as free vacations, golfing trips, or tickets to sports events.

Anyone that has spent at least a full day in a hospital or doctor's office knows just how true this article rings. You cannot go one day without having a drug rep -- usually an attractive (or wannabe attractive) woman -- prance in with several large containers of food and plenty of drug-related information. Their objective is straightforward: soften you up with goodies and simultaneously slip in information about their drug. They are the missionaries of the medical world ... but instead of "Here, take some Bible with your hot meal" it's more like "As long as you’re eating, let me tell you about this drug.” Their hope, obviously, is that their drug will be the only one you consider if and when you need it at some point in the future.

Careful observation of these reps will often reveal some pathetic behavior. Since drug reps often come in pairs, one will do the talking, schmoozing, and chat-chitting with the doctors; meanwhile their partner is at your disposal, slaving away by preparing fresh food in front of you: Belgian waffles, ice cream sundaes, fresh fruit smoothies, you name it. It is a little sad seeing a grown man or woman in a fancy suit serving milk shakes in Dixie cups. Silly as their behavior is, however, their goal of the bottom line is serious.

Even more amusing is when they refer to a published study that touts their drug's efficacy over a rival drug (conveniently, they are usually pulling out a hard copy of the article and handing it to you.) I don't think they are fooling many people, since most people know these studies were funded by the drug maker, and the results are necessarily skewed. The frightening part is that many people are probably not aware of this financial connection.

The only reason drug reps and their tactics continue to exist is that drug makers have done studies showing the powerful impact of surrounding doctors by simple items that bear the drug names (some people say the only true science that drug companies study is marketing.) They conclude that if even one in every X people (5, 10, 100, etc.) remembers their drug name, it’s a success.

Attending physicians or those with private practices aren't the only targets, but so are the doctors of tomorrow: residents. It is a genius strategy … bombard them with your drug while they are still impressionable and they will likely remember your product once they are practicing on their own. What hungry overworked resident wouldn't pick a fresh hot meal over a repulsive cafeteria meal, even if it means tolerating a short blurb about the latest anti-hypertensive

My personal opinion is that reps should be forbidden from giving any sort of free gifts to doctors ... or if that isn't possible, doctors should not be allowed to accept such items. It was refreshing to hear that Stanford University recently instituted such a rule for its medical centers, by forbidding any of their doctors from accepting even the simplest of free gifts from reps.

Some people claim that drug reps do some good by bringing free samples for doctors to give out to their patients, which is particularly helpful for poorer patients. But the very reason medications have such high prices in the first place is because they include the costs of marketing, including drug rep salaries. So it's kind of like a drug rep bringing a few free paper towels to clean up spilled milk … but only after they had intentionally knocked over the cup of milk themselves.

In the end, as tough as it might be, I hope more medical centers will follow in Stanford’s footsteps. (Until then, you can find me writing with my Zoloft pen on my Rocephin notepad while I drink from my Prevacid cup).

Thursday, October 05, 2006


Random thoughts ... some related to medicine, some not.
  • I just ate spinach -- not raw spinach, but spinach that was on a frozen pizza. If a week goes by and I still haven't written, consider me dead. (Actually let's make it two weeks ... I'm feeling a little lazy these days.) I am also a few big steps closer to colon cancer. A friend recently brought over a huge 2-pound log of meat to my place to BBQ, and we ended finishing it all off. Not bad for two skinny people. Unfortunately, I'm still suffering from too much meat in my system.

  • Costco sent me a free Gilette Fusion razor in the mail. In case you haven't seen its TV commercials, the Fusion is the monster razor with 5 blades (for the bulk of your shaving) as well as a single blade on the other side (for tricky areas) . I had a pretty good shave with it -- but nothing better than my previous Mach 3 -- but I have to say, the attachment that holds the 5 blades in place is pretty damn big. I feel like I'm running a vaccuum cleaner across my face.

    (Relatedly, I just got myself another one too. On our apartment complex's mailbox there was a free blade (again, from Costco) addressed to a former tenant, and the new tenant scribbed "Does Not Live Here, Return to Sender" on it. So I felt free to take it for myself, since these blades are so expensive.

  • I had a scotch neat this weekend ... my first "neat" drink. Not so neat considering my throat was burning the entire 2 hours it took me to finish it. I guess this really is an adult drink. I'll try again in 10 years.

  • I am suffering from a nasty cold right now. I don't know whether I picked up from "the community" or from the doc that I'm working with right now, one who coughs so violently and frequently, I swear I think I see alveoli shooting out of his mouth every few minutes. That plague is the last thing I need right now, especially since psychologically I don't handle getting sick well.

  • In other news: I went to a dinner at someone's place last night, and the friend was there. We ended up hanging out together till well past midnight, which was really enjoyable. But then when I went to bed I couldn't sleep at all during the night, as I was thinking about her. My mind is a mess now ... this ain't healthy.

Monday, October 02, 2006

Advice for USMLE Step 2 CS

I just took the USMLE Step 2 CS today (see previous post). It was a long and tiring day going from station to station and putting on the same enthusiastic act ... 12 times over.

So, dear readers, for your benefit I have put together a list of how to prepare for the Step 2 CS. Read on ...


Get First Aid

If you've dealt with standardized patients before for school, the test is not very difficult. However, you should be familiar with the large variety of possible chief complaints the patients will present with and the possible diagnoses you could give them. I recommend getting First Aid for the USMLE Step 2 CS to prepare; it is a thin book and has many practice cases to review for the appropriate questions to ask, the physicals to perform, and sample patient notes. Just spend four or five days reading through this book and you'll likely do well.


Take the 405
(This is specifically for the LA testing center.) To reach the center, I had to drive on the (in)famous 405 freeway. I never take this freeway, and so with everything people have told me about the horrendously slow traffic, to arrive there at 8am I decided to leave home at 7am. I don't know if these aforementioned people were hallucinating, but there was no traffic on this freeway. None! I got to the center at 7:20am, and spent the remainder of the time sitting in my car, in the dark, 2 stories underground, counting down the minutes. Do yourself a favor and don't arrive too early.

Bring your own food
(I'm kind of a picky eater, so this might be particular just to me.) The testing center does provide you with "lunch", but in reality what they provide are some gross looking pre-made sandwiches. I swear, they must have spent only $50 total on that meal ... for all 24 people. Do yourself another favor and bring your own lunch.

Beta-block with bananas
While I don't get full-blown test anxiety, on big test days my stomach usually does some pretty crazy internal gymnastics. I heard that eating bananas helps musicians with performance anxiety. I thought it might be an old-wives tale, but they followed up by saying bananas have beta-blockers. Hm, now that's something I could get behind. So I went and bought bananas last night, and ate a boatload of them throughout today. I don't know if it was the bananas or the placebo effect, but I actually didn't feel too bad. (Note: after searching the web, there seems to be confusion as to whether this effect is due to beta-blockade or high amounts of potassium.) Either way, I ate so much potassium, it was coming outta my assium ...

Bring parking money
The cheap USMLE bastards have no problem charging you $1000 for this test (not to mention the airfare and hotel costs some poor people have to pay to travel cross-country to reach the testing center). Then, they stick it to you again and make you pay $8.75 for parking. Come on, that's just low. I'd rather they simply make the test fee $1009 and let us have "free" parking. Keep the change.


Don't eat Thai food the night before
I love Thai food. I eat lots of it. I've even been to Thailand and tolerated the food just fine. But, there's something about eating Thai food the night before important events that makes me regret it. I thought my system could easily handle the Thai noodles I ate last night, but I was mistaken. The moment I came within eyeshot of the testing center, I experienced some ... um, unusual ... "GI symptoms". I don't know what it is about Thai food, but somehow it's spicier on the way out than on the way in. This made for a stressful morning, as a few times I had to cut in front of people in line for the bathroom in order to make it.

Lock the bathroom door
Continuing with the bathroom theme, please lock the door to the bathroom when you use it. While we were all sitting quietly in the waiting room before the test began, a woman went into one of the bathrooms. Maybe it was because she was foreign, but for some reason she forgot to lock the bathroom door. A few minutes later another guy got up to use the bathroom. He walked to the same bathroom door, opened it, and then jumped back yelling "I'm sorry!" It was great! But the reason I bring this up is because I replayed this scene in my head during one of my patient encounters, making me laugh at an inappropriate time. So spare your fellow examinees potential embarassment and lock your bathroom door.

Go easy on the tongue depressor.
I suppose this one was my fault. I was doing a physical exam on a patient who was supposedly in lots of pain, making her very subdued and quiet. At one point I used a tongue depressor to push down her tongue. I guess I pushed down a little too hard, because she then gagged, started laughing, and worked quickly to correct her behavior. I really don't think I pushed down that hard, but whatever its cause, it was funny watching her break out of her role for a minute.

If all else fails ...
If for some reason you completely forget what to ask or do next, rest assured you can’t go wrong if you do one of the following: 1) wash your hands, 2) drape the patient, or 3) ask “Do you have any questions?” I feel the only thing the USMLE people care about is the patient and their safety, modesty, and input. So, if you’re hot on the trail of asking the patient about hematuria and you freeze up ... simply drape them (if they are already draped, take off the sheet and just re-drape them). If you’re auscultating the heart and forget the next heart sound location ... just walk over the sink and wash your hands. Don’t know how to respond to a patient who says, “Doc I’m scared, what do I have?” ... just say “I see. So do you have any questions?” What you lack in content will be more than made up by professionalism.

That's it. If even one of these suggestions helps you, I'll consider them a success.