I got an email today from John over at The WikiPremed MCAT Course – An Open Access Learning Program for the Premedical Curriculum.. In the email he shared with me about the WikiPremed MCAT Course website that he and his team have been working on for a few years now.

I thought it sounded interesting so I clicked on over to check it out.

It really looks to be like a great resource for pre-med students who are trying to study for the MCAT. Even better, it’s a whole lot more affordable than the Kaplan or Princeton Review courses.

In addition to their online learning modules, they do provide written materials, flash cards, etc.

If you’re a premed student, consider checking them out. Even if you do go ahead with one of the more well-known review courses, it looks like this could be a really nice addition to your study regimen.

Also, another idea would be to read through the modules covering the sections you are learning in your Physics, Biology, Chemistry, or Organic Chemistry class.

You can click on over to the Wiki by using the link above (at the beginning of this post) or the link to the right under the “Student Resources” section.

Article: MSNBC.com: Facebook misconduct: Med students cross line

Sometime last year there was an article about students posting inappropriate things on Facebook and having to deal with administrative consequences from their school or lose out on a job because some potential employer decided to check up on the job candidates online.

Well in this latest story, medical students across the country are getting reamed for being inappropriate on Facebook. What kinds of things? Offenses included “posting unprofessional content online, including photos of drug paraphernalia and violations of patient privacy.” Even posting YouTube videos of practical jokes with a cadaver.

While I agree that medical students should conduct themselves appropriately with the dignity expected of someone in the profession and that some of the offenses should never have taken place (like being disrespectful with a cadaver or violating patient privacy), I will point to one section of the article:

Medical students are no different from other young adults, said Anastasia Goodstein, a San Francisco-based marketing expert who tracks youth trends on her Ypulse Web site. The generation that first embraced social networking still considers Facebook merely a way to connect with friends.

“Now they’re waking up to the reality of older people and people with authority over them, like deans, seeing their Facebook pages,” Goodstein said.

And I don’t mean to point that part out to make an excuse for the behavior, but just to offer an opinion (that isn’t necessarily mine) from the other side.

However, I do strongly believe that all patient-identifyng information should never be posted online. And that was a line young and old never have a right to cross.

Oh, and one part of the article kind of pointed out something else. One medical student was in trouble for friend-requesting a patient on Facebook. I understand the ethical dilemma. We discussed this in class — that physicians and patients need to keep the relationship professional. But as Facebook has become more and more commonly used as a means to communicate (in addition to staying in touch with friends), I think this is a gray area.

Why can’t doctors add patients as a facebook friend? Is it because the patient will be exposed to the physician’s less guarded, non-professional moment? Or what if the physician had a dedicated professional account? Anyways, not everyone who is a “friend” on Facebook is really a friend (i.e. people who add/approve anyone regardless of whether or not they know them personally).

And now, I must go dig through both this blog’s archive and my twitter account and selectively purge entries…. lol Kidding. Kind of.

It’s funny, the things we do to avoid certain people. You know what I mean. You’re walking through the supermarket and, spotting someone you’d rather not talk to, you jump into the nearest aisle and pretend to be interested in the displayed products even though you’re really looking out of the corner of your eye to make sure that person doesn’t walk by and notice you. And then you feel eyes on you because you’re the only guy in an aisle filled with feminine products. You look up and realize that while trying to fake interest in the products in front of you, you have been “staring” at a large selection of pads and tampons.

Or maybe, standing around at an event you see someone you want to avoid. Thinking yourself the stealthy type you gracefully glide through the crowd towards the door and mentally pat yourself on the back for an evasion James Bond would be proud of. That is, of course, right before you throw your weight into pushing open a firmly looked door. Why is it that people seem to never have both doors unlocked at the same time? They’re double doors for a reason, but maybe the reason is to make unsuspecting people look utterly foolish.

I am not saying any of the above situations have ever happened to me. But there are times when I just don’t feel like being friendly and outgoing.

Are physicians required to “put on a happy face” at all times? Do they have to be ever-joyful, always-friendly, bubbly people?

I sure hope not. Cause I sure don’t feel this way… In fact, most of the time I feel pretty drained, tired, sleep-deprived, and stressed out.

This year I had a course called Evidence-Based Medicine. The point of the class was to educate us on how to use the medical literature to determine the best treatments. Medicine has definitely come a long way from bleeding patients as a form of treatment. Now, we have evidence to lead the way.

But I recently overheard my parents talking about drinking EPSOM salt as part of an alternative to surgery for removing gallbladder stones. The treatment involved drinking fresh-squeezed apple juice for a number of days, drinking a 1/2 cup of Virgin Olive Oil, and then drinking an EPSOM salt and water mixture.

The treatment is supposed to flush out your liver/gallbladder and cause gallstones to be excreted with your stool. The site Curezone.com has a page dedicated to this treatment with a list of the various different “recipes” for the treatment. (Click here to see the liver flushing page.) Oh, and for all the skeptics, the pages come complete with pictures of gallstones people removed from their own stool!

Well I was a skeptic. I realize I’m just a medical student. But the idea didn’t sit right with me. Then I found a website called Science-Based Medicine that contained an article titled “Would you like a liver flush with that colon cleanse?”

The author, a surgeon, rips apart this treatment. If I were to paraphrase him: The treatment is absolutely ridiculous. You can check out the details at his post.

Even in this day and age, there are still plenty of strange treatments that are blindly followed without any evidence to support it. My parents heard about this treatment from a church member who was told that she had gallstones and needed a surgery to remove them.

I wish we could educate the public. Maybe a course on evidence-based medicine should be taught at the high school level. I mean, reading a site like the one listed above (Curezone) can be very convincing. You see all these testimonials by people who have “flushed” their livers. You see pictures of these supposed gallstones that were fished out of the toilet. And you think, hey, that’s proof it works!

I guess this was one moment where I saw the value of my Evidence-Based Medicine course — a value I failed to appreciate at the time I took it.

Reference: MSNBC.com: Hip surgery in India? Insurance may pay

In the past few months I’ve been hearing about this medical tourism thing. It sounds really cool — maybe even exotic, doesn’t it? You go see the Taj Mahal, one of the seven wonders of the world, and stop by the local medical center for a tummy tuck, face lift, and skin peel. It gives the notion of someone coming back with that “vacation look” a whole new meaning.

If you read the article, the American medical experts warn that this isn’t the safest option. They feel that the United States is the place to receive some of the top healthcare in the world (in terms of quality, not price). And I’m inclined to believe them.

It’s rather sad that so many Americans are forced to seek healthcare outside our borders. It just illustrates how badly things have become.

I’ve been hearing a lot about these quick-stop clinics staffed by nurse practitioners. I hear about them in the news or read about them online. They seem to be on the east coast or midwest. Or maybe I’m just not paying any attention to them here locally.

As someone going into a medical career, this is somewhat discouraging. I don’t see how a family physician can compete against an NP based solely on costs. It seems like the scope of nursing just keeps getting expanded more and more. I’m sure the nurses are elated about this. And their paychecks continue to rise as they get more specialized.

I don’t think we need to go back to the days were the doctors were kings of their wards and nurses stood whenever one came in the room. But I do think that scope of practice of nurses and doctors cannot overlap too much. Because let’s face it, the nurses will always be able to offer their services at lower costs. And, more often than not, they (nurses) have less debt coming out of school.

Amy from RNCentral.com sent me this post titled 20 Surprising Ways Wal-Mart Clinics Will Affect US Healthcare. It’s a good read discussing the pros and cons of Wal-Mart entering the health service industry by opening up clinics at their stores.

Courtesy of MichaelMoore.com

I guess I’m slow. I’ve heard that before. But I finally got to see Michael Moore’s documentary on the American Healthcare System. This was my very first Michael Moore documentary. I didn’t watch bowling for Columbine or Fahrenheit 9/11.

Prior to watching this film I thought that Michael Moore was pretty obnoxious. Not that I’ve ever met the guy. He just came across that way to me. He seemed confrontational. But maybe you need to be that way to produce an effective documentary.

Throughout the film, Michael Moore introduces the audience to various Americans. We get to meet them and find out about their difficulties in the system of medicine that Americans seem to have accepted.

As a documentary about the atrocities of the American healthcare system, one would expect to see the negatives. And Mr. Moore does not fail to deliver. He presents one tear-jerking story after another and with his sarcasm points out how broken our system really is.

At one point he brings a group of Americans who have health problems resulting from their work at Ground Zero of on 9/11. These rescue workers had many problems that they just could not afford to deal with back home. Moore took them to Cuba where they were treated free of charge.

I consider this film to be an argument for Universal Healthcare. As an argument, I didn’t expect an unbiased view. Even so, Michael Moore did point out some of his critics. And one can easily find the opposing viewpoints with a quick Google search.

Without getting into a debate about the merits or pitfalls of universal medicine, I previously wrote that there are two entities that keep America from going the route of universal healthcare. Those two are (1) doctors and (2) Big Pharma. (see my post: Reforming the U.S. Healthcare System for more).

Overall, I think it was an excellent film for anyone interested in healthcare in America. Is it a good generalization of the state of things in this country? I don’t know. My mother had cancer a couple years ago and was very well taken care of by her insurance (not going to name them, but the founder is briefly mentioned in the film). Maybe my mom was the exception and not the norm? I just haven’t been in and around the hospital system to know. Nevertheless, the film does offer one viewpoint and its probably that we should take a look at.

I recently saw an episode of The Daily Show with Jon Stewart. It’s always an interesting way to get my news. But he did one segment which I’ve included below. Check it out.

I was gonna write about how surprised I am to hear that increased gambling was listed as a side-effect. But I figured that any way I found to convey my disbelief in such absurdity would kind of be overshadowed by Jon Stewart.

If anything, just remember to know what the side-effects are of any medication you take.

In a previous post (Physician Salaries on the Decline) I wrote about declining physician salaries and how that is bad for healthcare.

I recently found a post from a medical student in the U.K. The system is kind of different there. He talks about the salary a newly graduated doctor would make out of medical school. Here in the States, I’ve found some residency brochures that advertise paying their residents somewhere between $45,000 and $50,000 USD.

Anyways, the post talks about how the financial benefits of a career in medicine might not be enough to entice the “cream of the crop” into medicine. And, the author points out, wouldn’t you want the best and the brightest to be the ones taking care of you when you’re sick?

From the post:

Where would you want the brightest people in the country to work? Would you have them making you money as stockbrokers; defending you in court as lawyers; writing your next headline as journalists; or would you have them saving lives as doctors? Most people would rank their health as one of the most important aspects of their lives, but is medicine financially attractive enough to entice the cream of the crop? I am not sure. In financial terms medicine might not be the best choice for the bright young future of tomorrow.

The post is at sBMJ – Viewpoint: Deterred by the doctor’s salary?

Related Posts: Britney Spears Now In Doctors’ Hands

Copyright 2008 Brad Barket / Robyn Beck / Getty Images

News on the street, and by street I mean Internet, is that Dr. Phil paid a little visit to a certain celebrity (whom I’ll refer to as Ms. S) on Saturday (January 5) at Cedars-Sinai Hospital. She had been there since Thursday after her standoff with police.

Well after his meeting with Ms. S, Dr. Phil released this statement to Entertainment Tonight:

My meeting with Britney and some of her family members this morning in her room at Cedars leaves me convinced more than ever that she is in dire need of both medical and psychological intervention. She was released moments before my arrival and was packing when I entered the room. We visited for about an hour before I walked with her to her car. I am very concerned for her.

I am neither a doctor, nor a HIPAA expert, but I did sign the form and take a little class about it. Isn’t this situation a breach of doctor-patient confidentiality? Dr. Phil, shame on you!

I suppose he might claim that he is not her doctor and she isn’t his patient. So in that case, he is not bound by doctor-patient confidentiality.

According to one article by TMZ, Ms. S was totally “blindsided” by the visit:

People on the 7th floor at Cedars-Sinai Medical Center say the doctor arrived about 7:30 AM Saturday. We’re told [she] did not invite him in; she didn’t even know he was coming. Sources say it was [her] parents who told Dr. Phil to go to the hospital. When he walked into her room, we’re told, a blindsided Britney walked out — and eventually came back.

Maybe Dr. Phil’s defense can be that he was an invited family guest? I don’t think so. Further reading of that article reveals that Dr. Phil would like to do a television intervention of the pop-star anonymous celebrity patient.

Hmm.. so Dr. Phil comes in at the request of the patient’s parent. And then he decides to use this opportunity to generate some publicity for his television show?!? Who in the world got him on the air?? Oh, wait.. Oprah! Oprah needs to pull him in for a little sit-down.

I’m glad to see that I’m not the only one thinking that this was inappropriate. Another article at TMZ reports that many psychiatrists have criticized both Dr. Phil and Cedars-Sinai.

the hospital should not allow any doctor who does not have in-patient privileges into a patient’s room, unless that patient has given prior consent. TMZ has learned Britney had no idea Dr. Phil was coming to her room and indeed when he walked in she became agitated and walked out.

The psychiatrists were pretty much unified in their opinions. One claimed to be “outraged and disgusted” about the whole situation. Another called Dr. Phil’s actions “intrusive and inappropriate.” Yet another criticized the Cedars for allowing Dr. Phil, who doesn’t have practicing privileges there, to see one of their patients without her knowledge or consent.

Out of line. The whole situation was absurd from a patient confidentiality standpoint. When dealing with any patient, their privacy is so important. Which is why every single medical blog (at least that I know of) has a very clear privacy statement. No patient identities are to be compromised. Doctors, in order to do their job well, must be able to get the complete story from their patients. And patients, in order to open up, must feel confident that what they share to their doctor will stay between them. Its a simple ethical issue, and a legal one as well.

*****

Update (January 7, 2008): Today (January 7) MSNBC.com is reporting that Dr. Phil has decided to pull his special on Ms. S. He said that the situation is “too intense” for him proceed.

Dr. Phil’s statements and actions have sparked a lot of criticism in the media. He defends his actions by saying he was not acting in a professional capacity when visiting Ms. S. You can check out the article at E! Online – Dr. Phil Defends Britney Visit, Calls Off Special.

Update (January 12, 2008): A complaint against Dr. Phil has been filed with the California Board of Psychology. The complaint, filed by another psychologist, claims that in going to counsel the pop-star, Dr. Phil was practicing psychology without a license. This is a serious charge, and one the board might hand over to the District Attorney for review because practicing psychology without a licenses in California is a felony.

Dr. Phil has never been licensed to practice psychology in California and retired his Texas license in 2006.

The complaint also says that a petition to remove Dr. Phil from the air is going around.

More can be found at TMZ.com: Psychology Board Investigates Dr. Phil.

Update (January 18, 2008): USA Today is reporting that Dr Phil still believes his meeting with Ms. Spears was appropriate. However, Dr. Phil says, that he regrets making a statement about it afterwords. Quoting from the article:

“Was it helpful to the situation? Regrettably, no. It was not, and I have to acknowledge that and I do,” the talk show host told his audience Thursday during taping of a Dr. Phil episode that will run Monday.

“I definitely think if I had it to do over again, I probably wouldn’t make any statement at all. Period.”

More can be found at USA Today – Dr. Phil says he regrets statement on Britney.

Sources: TMZ.com: Brit Blindsided by Phil — Hospital Acts Curiously, TMZ.com: Psychiatrists Slam Phil, Cedars, Entertainment Tonight, E! Online – Dr. Phil Defends Britney Visit, Calls Off Special, TMZ.com: Psychology Board Investigates Dr. Phil, USA Today – Dr. Phil says he regrets statement on Britney.