Goodbye 2007. In a few hours the year 2007 will be gone forever. Well, from the pictures I’ve already seen online, 2007 has left a number of people on the other side of the world. Right now I’m starting this entry while sitting at church for an End of the Year service. Yes, I know, I should be listening intently to the speaker.

The speaker for the evening is talking about resolutions and such. Pretty typical end-of-year topic, right? Well he is speaking about seeking God first.

At the end of the year people often take time to examine their lives. They look back at the past year with 20/20 hindsight. It’s a time to learn from experience. They also eagerly look forward — some with hope, others with despair, but everyone with uncertainty of what tomorrow brings. Uncertainty, though, should not stop us from making plans. So resolutions are made. Often they’re quickly forgotten. In the spirit of the season, I’ll try my hand and creating some resolutions for myself.

1. Be Intentional

   I’d like to be more intentional with my life. On the spiritual side, it is all too easy to be swept up with the fast pace of modern living. I’d like to be more intentional about my walk with Christ.

   I’d also like to be more intentional in my educational life. At times it was just too easy to become distracted by little things while studying. I need to be more intentional when studying. Study time is study time; ignore the unimportant when I’m with the books.

2. Open My Eyes

   Tunnel vision is something I worry about. I’m worried that the next exam will consume me. I’m worried that medical school will change me — and not for the better. I hope I don’t graduate bitter about a broken healthcare system, cynical about life, and obsessed with making as much money as possible. What I need, I think, is to open my eyes more. I need to look around at those around me. There are people who are suffering. There are people who are hurting. I need to open my eyes so that I can remember the reasons I wanted to go to medical school. I need to open my eyes, and, as I heard one speaker say, witness the Divine in action.

So there it is. I distilled my resolutions to two little statements.

What are you planning for this next year?

Note: While this was posted yesterday after about two weeks of Christmas break, I wrote most of it during the “heat of the moment.” I almost didn’t finish the thought/post, but I thought I’d include it as it was how I felt at the time during exam week. Honestly, I do appreciate the attempts to ease my anxiety. End

One of the phrases that I have come to despise hearing is “Oh, you’ll do fine.” It is often heard when someone is stressing out like crazy about an upcoming exam. Some well-meaning person will simply say, “Oh, you’ll do fine,” or some other variant. As if all the concern and stress over the exam is unfounded.

I appreciate the thought. I’m thankful that some one is attempting to make things better. But I really don’t know how “useful” that statement is. The statement in itself is not going to make me feel better. As well-meaning as it is, the reassurance does little in reducing my anxiety.

The fact is that medical school isn’t easy. The exams are hard. The pressure is heavy. The stress is real.

I’m not sure what to do about the pre-test anxiety. And I’m not sure about what to about the post-test anxiety (after taking an exam but before seeing my score) either.

And well since I’m not sure what I should do about the anxiety, I have no clue what other people can do to help.

But I think if a medical student complains to you about a really hard exam, don’t say, “Oh, you’ll do fine.”

When a panel of doctors was asked to vote on adding a new wing to their hospital,

the Allergists voted to scratch it and the Dermatologists advised no rash moves.

The Gastroenterologists had a gut feeling about it,

but the Neurologists thought the administration had a lot of nerve,

and the Obstetricians stated they were all laboring under a misconception.

The Ophthalmologists considered the idea shortsighted,

the Pathologists each yelled “Over my dead body”

while the Pediatricians said “Grow up!”

The Psychiatrists thought the whole idea was madness,

the Surgeons decided to wash their hands of the whole thing

and the Radiologists could see right through it.

The Internists thought it was a bitter pill to swallow

and the Plastic Surgeons said “This puts a whole new face on the matter.”

The Podiatrists thought it was a step forward,

but the Urologists felt the scheme wouldn’t hold water.

The Anesthesiologist thought the whole idea was a gas

and the Cardiologists didn’t have the heart to say no.

The dentists clenched their teeth and showed their disapproval.

In the end, the Proctologists left the decision up to some asshole in administration.

Adapted from: Nip/Fuct

Simon says was fun for a little while. But looking back, I really don’t understand the appeal of being jerked around like that. That is, after all, what the game is all about — doing everything Simon says, no matter how ridiculous or absurd it may seem. Along the way it gets old. I have yet to see a group of adults playing “Simon Says” in the park. I definitely don’t see medical students playing that game during breaks between classes out on the grass.

Playing Simon Says is kind of like being jerked around by a little girl waving around her rag doll. Simon says put your hands up. Simon says put your hands down. It gets monotonous. It’s also tiring.

I feel like I’m getting jerked around. Sometimes the rag doll is swung up high and other times it drops low. It might be better to compare the experience to a roller coaster. At least the roller coaster analogy is more familiar to people than a swinging rag doll.

During my last exam week I heard the following conversation after arriving at the exam location:

Person 1: I got raped the other day.
Person 2: I’m gonna get raped twice today. [We had two tests that day]
Person 3: I’m just giving it to God. Because if God doesn’t intervene, then I’m screwed.

Note: No disrespect meant to any rape victims. “I got raped” is a phrase that has often been used by students. I don’t mean to imply that going through an exam is as bad as being raped. The phrase “getting raped” has been used because 1) it was a quote and 2) to describe the feelings going through a rough exam: a sense of being helplessly violated.

I wasn’t part of the conversation. I just overheard it because it was nearby. It made me grin. Not because I thought it was funny. I wasn’t being mean. No, I grinned because I knew the feeling.

On this roller coaster ride of medical school there are many lows. It can be easy to get down and discouraged. Hearing about the horrors of managed care, malpractice insurance, and a broken American healthcare system. Watching our educational debt accumulate. Being in a committed relationship with our textbooks. Seeing the top scores in the class.

But like a roller coaster there are the highs. There are times when the ride peaks through the clouds. There are the experiences with the patients — warm experiences we will never forget like the little children in pediatrics or the kind, heartfelt thank you of a senior citizen. And we need to hang on to those highs to carry us through the lows.

Early on in the school year we had a speaker talk about the wonderful opportunity we have here at medical school to witness the Divine in action. We learn about life. We learn about healing. Hopefully, we learn about changing lives as well.

It’s possible that I entered medical school naive. A lot of medical students probably do. After all, we are crazy enough to think we can change lives — that we can change the world.

Maybe that’s what we need, though. We need to be crazy. Back in the 1990s, Apple made an incredible TV Ad. It’s called Here’s to the Crazy Ones.

So here’s to the crazy ones; here’s to medical students the world over. To the ones who are crazy enough to go through medical school hoping they can change the world.

Enjoy the clip.

Here’s to the crazy ones.
The misfits.
The rebels.
The troublemakers.
The round pegs in the square holes.
The ones who see things differently.
They’re not fond of rules.
And they have no respect for the status quo.
You can quote them, disagree with them, glorify or vilify them.
About the only thing you can’t do is ignore them.
Because they change things.
They push the human race forward.
And while some may see them as the crazy ones,
We see genius.
Because the people who are crazy enough to think
they can change the world,
Are the ones who do.

The holiday season is here. Are you trying to think of what to get that special someone? Well in the spirit of giving, I shall give a suggestion. For that special scientist in your life, or maybe just science nerd, you can give the gift of knowledge. Knowledge of his or her personal genome, that is.

A company now offers to sequence DNA commercially. Just collect some saliva and mail ship it to them. Oh, and don’t forget your $999 check.

Yup, for less than a grand, a DNA sequence can be bought!

Brave new world.

Oh, I almost forgot. You’ll want the link to the company’s website, right?

It’s 23andMe.com

Sources: New York Times

I am no gunner. Trust me. I might have a gunner-like thought once in a while. You might even say I have some gunner tendencies. But if MTV decided to make Real World: Medical School, it would be irrefutable: I am not a gunner. Because while I might like to have the highest score on the next exam, I simply don’t do enough to turn that passing desire into reality.

Some people do, though. There is always someone who scores the highest. Usually its kind of sickening to see what the top score is. I hope that whoever is getting the top scores is putting hours and hours into studying, preferably over 8 hours a day. If he or she is getting top scores with only one or two hours of studying a day… well I don’t want to know who it is.

Earlier in the year, when our scores were sent home, the report had: points possible, score, class average, and standard deviation. Well, the class gave its input, the people in charge of the reports listened, and now the spreadsheets we receive also have the top and lowest score.

Now, every time I go to check whether I passed the last exam or not, I get to see how some genius missed only one or two questions.

Good advice given to medical students: “Don’t compare yourself to your classmates.”

I agree. I just have to focus on doing the best that I can — even though, at times, finding out my score can be a very humbling experience.

I woke up really groggy last Monday. It was the first day of exam week. The exam of the day was Gross Anatomy & Embryology. As I ate my cereal I watched the morning news. Oprah had been busy over the weekend. She was campaigning for Obama. The New York Post decided it would be clever to talk about Obama’s Oprah-generated momentum by calling it “Omentum.”

That was kind of weird. I was thinking about omentum — specifically greater and lesser omentum. The day’s exam would cover face & scalp, infratemporal fossa, and the gut.

I think I hate the gut. Its just nasty looking. And greasy too. I find the greater omentum disgusting. The greater omentum is this flat tissue-like thing that hangs in front of your stomach. It can move around too. If there is a perforated gut, the omentum might migrate to the site and wrap around it. I also heard that sometimes, as a surgeon is working in the area, the omentum may slowly make its way to the foreign object — the surgeon’s hands.

That’s just gross.

Incidentally, when I was looking for a picture of the NY Post cover up above, I found another picture of Oprah. She was actually holding someone’s omentum in her hand.

Sources: MSNBC.com, Oprah.com, and NYPost.com.

I walked out of anatomy lab a few minutes ago. Tomorrow is the lab practical exam. Earlier in the week we got an email that said the lab would be open today from 8-10 AM and 3-5 PM. I though the 8-10 AM time slot was kind of odd. All of the first years had a Cell Structure & Function exam at 8:30. Eighty-seven questions and two hours allotted. Even though you could leave whenever you finished, I don’t think many people actually got to squeeze some lab time in before 10.

So I go into lab at 4 PM and figure a good hour reviewing my cadaver and radiographs would be helpful. That place was packed! Shouldn’t be surprised. The day before practicals, the lab is always packed. But it seemed like there was a panicked frenzy… People were going here and there quickly. Stress levels were pretty high — higher than usual.

Monday was the anatomy written exam. I think the class average was about 71%. Of the 3 anatomy exams we’ve taken, this was the lowest average. That might explain the commotion.

In forty minutes, one of the biochem professors will hold a review. That exam will be on Thursday (along with a Pulmonary Physiology Exam).

Alright, off I go to do some more studying…

Related Posts: Doctor Salaries, A Problem Overseas Too

Sources: American Medical Association, American Medical Student Association, Center for Studying Health System Change, New York Times

Last year (2006) a story published in the New York Times reported something troubling. Physician salaries are on the decline.

the average physician’s net income declined 7 percent from 1995 to 2003, after adjusting for inflation, while incomes of lawyers and other professionals rose by 7 percent during the period.

Some people do not think that this decline is a problem at all. Even with the decline, physicians are still making a decent salary. They aren’t going hungry. Maybe they have to forego a brand new S-class, but doctors don’t live off of welfare. And with the ever-increasing costs of healthcare, physician salaries just don’t seem as important.

It is very important. This country is headed towards a severe physician shortage. New medical schools are opening up and existing schools are expanding their freshman class sizes in response. Producing more physicians each year is not enough. Physician salaries must increase as well.

The shortage we are expected to go through is in the primary care segment. As it is, the current state of healthcare encourages doctors to enter high-paying specialties. New graduates are not flocking to Pediatrics, Internal Medicine, and Family Practice. Take a survey of any freshman medical class in the country. Many will share their desire to go into radiology, surgery, orthopedics, plastics, or dermatology.

Why? Frankly, for most, it’s because that is where the money is. Those specialties are the quickest way to get out of the enormous debt incurred during medical training. According to the American Medical Student Association (AMSA), the median debt for students at a public medical school is over $119,000 while those that go to a private medical school will carry a median debt of nearly $150,000. On top of debt, physicians make approximately $48,000 during their years during residency — which lasts at least 3 years. It could take up to 8 years for a thoracic surgeon to complete his/her training.

The stereotype of a lawyer is someone whose focus is on the number of billable hours. On the other hand, the stereotype of a doctor is one of compassion for a patient. While stereotypes can be dangerous, it is possible that in some ways they may give us a glimmer of reality.

The kind of people that go into medicine are usually people who truly care about the health of their patients. It is not a career chosen solely based on financial reasons. Today’s medical students are aware of the huge costs of training and the low reimbursements from insurance, medicare, and medicaid.

But there are many people who would make excellent doctors. They have all the right qualities but choose to go into other fields. They are discouraged from pursuing a medical career by working doctors tired of rising costs of malpractice insurance, declining salaries, bureaucratic hassles, and long workweeks. A career in medicine just does not seem “worth” the time and effort (see AMA Response to declining physician salaries).

Declining physician salaries are a big problem. It’s a big problem for the medical community and a big problem for the patient. If they continue to fall more and more prospective medical students will decide not to go into medicine because it is not “worth” it. Medical school graduates will continue to avoid primary care for higher paying specialties. And doctors will continue to order diagnostic procedures that bring in more revenue.

Shakey went to a psychiatrist. “Doc,” he said, “I’ve got trouble. Every time I get into bed, I think there’s somebody under it. I get under the bed, I think there’s somebody on top of it. Top, under, top, under. “you gotta help me, I’m going crazy!”

“Just put yourself in my hands for two years,” said the shrink. “Come to me three times a week, and I’ll cure your fears.”

“How much do you charge?”

“A hundred dollars per visit.”

“I’ll sleep on it,” said Shakey.

Six months later the doctor met Shakey on the street. “Why didn’t you ever come to see me again?” asked the psychiatrist.

“For a hundred buck’s a visit? A bartender cured me for ten dollars.”

“Is that so! How?”

“He told me to cut the legs off the bed!”