I am, at best, an infrequent cook. Nevertheless, cooking gives me the feeling of having stepped gently on the brakes and taken a luxurious detour from life in the fast lane.
For the past several years, I wouldn't call what I've done "cooking" so much as "eating at home." The hot deli and salad bar at Whole Foods kept me fed for days on end. Most of my chicken came home already roasted. The frozen food aisle at Trader Joe's has been my friend. I've bought meat pre-marinated. I've never made soup in my life, but I've certainly had it frequently. And this year I even discovered the convenience of ordering sushi online by credit card and having it delivered to my doorstep.
What do you cook (or what do you obtain by other means) when on the run?
Since I've recently discovered that I am indeed a "grown-up" (how that snuck up on me I'll never quite know), I thought that I would also discover what it is that I want to be during this period in my life. Unfortunately, what choice to make on my future state of employment still eludes me.
I'm coming up fast on the end of my third year of medical school--I've completed all of my clerkships save for Surgery. I've switched my fourth year electives twice now, and I'm considering doing it a third time. The fact that I need to have ERAS and San Francisco applications spewing forth by September 1st is daunting to say the least.
This is why I'm here talking to all of you fine people. I'd love to hear some advice. At this point in the game even bad advice would be better than none at all. The administration seems to think the answer, "You'll figure it out," is enough to relieve my anxiety. What did you do? What made you go into the fields you did? What made you pick one residency program over another, and to how many residencies did you apply?
Do you fancy yourself as a writer? Do you think you know something about International and Developing World Health?
Here's your chance to get published!
Send us an article to put into the “topical topics” section of our Conference Book.
So far, our topics include things like….. • Economics – free trade vs fair trade. • Climate change and it’s effects on 3rd world health • Role of local traditional medicines and public health • Student Electives • Water/sanitation • Aid vs development • Politics – governance, the efficacy of the UN, etc • UN – overview and structure, how to organise an internship. • International Law • Medical Tourism, the ethics of electives – are you a burden or a help? • Media influences on health • Pharmaceutical companies
Don’t like writing Articles? How about filling out a Questionaire…
Have you recently completed an elective in a developing country? Let the medical students of Australia and New Zealand in on your experience! Name (Optional): Medical School: Where Did you Go: How long were you there: Why did you choose that place: Highlight: Lowlight: Memorable Moments: What do you wish you packed: What did you wish you left at home: Advice for others wanting to apply to your elective: Anything else you’d like to add: Please attach a photo if you have one: Permission to use to you photo in this current DWC and future development workbook committees: Answer as many questions as you want, in as much or as little detail as you want. And if you know anyone else around the county that has done an interesting elective let them know!
We at the conference book team will be accepting articles from anyone around the world but HURRY! Submissions close April 10th 2007!
A little Promo. The AMSA Developing World Conference - Adelaide 2007
The 2007 AMSA Developing World Conference committee has some special news and updates we would like to share with everyone.
Firstly, we are very proud to announce that Dr Rowan Gillies, International President of Medecins Sans Frontieres (Doctors without Borders), will deliver a keynote address at the conference. Secondly, we'd like to tell you that website has been extensively updated in the past week, and there are a lot of changes - Have a look at www.amsa.org.au/dwc2007. We have updates on the academic and social programmes, including the titles for some of our lectures and case reports. You can also download and watch the hilarious promo DVD.
And finally, OnlineRegistration opens on March 28, and it will sell out. If you want to be first to receive updates and registration information, please join up to the mailing list (on the registration page), and you'll go in the draw to win a heap of free textbooks.
Please pass this email on to any of your friends that might be interested in coming.
Do you know the difference between Free Trade and Fair Trade?
Do you know what the Geneva Conventions are?
Do Pharmaceutical Companies make the world go round?
Is Something better than Nothing?
The Adelaide 2007 AMSA Developing World Conference:
June 28 - July 1
350 medical students.
World-renowned Keynote Speakers
Two massive Debates
Small group Case Discussions.
Workshops run by people on the ground, getting their hands dirty.
A Food Fiesta, A Formal Dinner , and a Buffet Brunch.
And a 160 page Conference Book to expand the experience.
Sign up for the mailing list, REGISTRATION OPENS March 28th! See you there
Hey i'm a 4th year medical student in the Chicago area...I was just curious if anyone else was from around the Chicago area as well. What hospital are yall at, and how do you like it? Basically just saying hi....
Perhaps this is an inquiry with no value to it, and harbors an answer which is painfully obvious to those wiser than I. However, it can't hurt to at least pose the quandary, in the event there is much to learn.
I have a quick question. We're required to buy an oto-ophthalmoscope, even though I'm pretty sure they will be in most hospital rooms and outpatient clinics. I'm pretty sure we'll just be using it for a physical diagnosis class. My question is whether the off-brand oto-ophthalmoscopes are ok or not. I'd much rather spend 80 bucks instead of over $500. Any opinions would be greatly appreciated! :)
Hi all, I'm a nursing student graduating this December. Behind the cut is the subject of my latest obsession - excessive ocular divergence... Basically I'm stuck and looking for a more or less definitive answer, or at least some professional opinions. I emailed the question to an ophthalmologist, got initial response (he asked to clarify the "clinical situation"), but then something odd happened to subsequent emails...
Hi I'm a pre-med student and I'm having second thoughts that I'm sure a lot of other women going into the medical field have had before me. I know that I would love to be a doctor, but I'm really concerned about being able to start a family around the same time I'd be starting my residency. I was wondering if any of you have had any experience with this. How did/are you deal/ing with it? How did/is your spouse deal/ing with it? How do the demanding hours affect your pregnancy? Any feedback would really help me out. Thanks in advance. -Andie
Just thought that I'd introduce myself as a new member of this community. I'm a final year med student in Australia and will graduate at the end of November this year. I'm due to begin work at the start of Jan 2007, which I'm looking forward to after many years of student-ship :) Currently I'm interested in physicians training, and am considering a double career in nephrology and intensive care (woo!)
Hi all! I am no resident, but my husband will be applying to an IM residency at the upcoming match. Right now he is stuck on his personal statement. It is decent, but it seems to lack any personality or "voice". I am the editor of the family, but unfortunately suck at creative writing. All my school essays emphasized the importance of being factually accurate instead of being creative. Oh well.
Now, my plea for help. Does anyone know of any websites or books with sample personal statments we could look at for inspiration? I know the hubs is on Freida (or whatever it is called, sorry) and I have found a few through the magic of Google. Did anyone have any great resources? Can you tell me about your statement-was it a by the book "Here are my qualifications, skills, why I want to be a dr." or was it something else? I know it is near impossible to stand out in hundreds of applicants, but I just want him to have a fighting chance!
I appreciate any and all help. I know how busy you guys are! I am soooo nervous about where we will match and what that residency will be like. But, we have almost made it through med school and that brings me much joy. : ) Thanks!!
Importance of Sexual History Taking in Elderly Patients.
Extent of the tyto alba pandemic
Introduction Despite the importance of sexual history taking, fewer than 15 percent of elderly patient visits include an adequate sexual history. Elderly patients often do not specifically discuss sexual concerns unless prompted by their clinician, but a patient’s failure to mention a sexual problem does not mean that he or she has no sexual concerns. The clinician may be reluctant to raise the issue of sexual concerns as well, but has a responsibility to do so. By following some simple guidelines to increase the patient’s comfort level and using a standard protocol that increases their own comfort level most primary care providers can become skilled at obtaining a basic sexual history and making appropriate decisions about diagnosis and treatment or referral to other clinicians with specialized training.
Creating a Positive Atmosphere An atmosphere of acceptance and respect for every patient is essential to ensuring an environment in which all patients feel free to discuss issues of intimacy that they may not discuss with anyone else. A number of steps will contribute to this kind of positive environment, even before the sexual history is initiated:
Ensure a quiet, private meeting place, and avoid interruptions.
Have the patient remain dressed, and sit at eye level with the patient. These measures will help foster a sense of acceptance and respect for the patient and reduce the patient’s possible feelings of intimidation.
Be ready to use the same language the elderly use when talking among themselves. Familiarize yourself with the meanings behind words like: tallywacker, gam dinglers, flivvery, and The French Muffin
Initiating a Sexual History Asking the first question is perhaps the most challenging part of taking a sexual history. Some clinicians find that most elderly patients respond fervently to a statement of interest in learning about their sexual activity with vivid descriptions of their erotic exploits. Do not avoid asking clear, direct, and unambiguous questions because of your own discomfort imagining their frail withered bodies contorting themselves into advanced sexual positions like the reverse butterfly or the Hindenburg press. Unclear questions only produces inaccurate or incomplete histories that can result in poor or inadequate screening or treatment of potentially life-threatening conditions. A kind and straightforward assessment is not only professional but compassionate as well.
Making Referrals Many primary care clinicians are fully qualified to diagnose and treat certain commonly encountered sexual problems for which there are well-established treatment protocols. However, due to the elderly's special needs, referral to a specialized clinician may be indicated. When making a recommendation for referral, couch it in terms that will reassure patients that the problem they face is not unusual, and that referral to a therapist or other specialist is common practice.
Common sexual disorders in the elderly The most common ailment among elderly patients is infestation by the Tyto alba, or the common barn owl*. Although the preferred "natural" nest sites of Barn Owls include hollows in high trees, rock crevices and holes in cliffs However, their ever shrinking habitat has caused barn owls to take up residence in any warm dry place that provides shelter from rain. Consequentially, it is not uncommon to find up to a dozen barn owls living inside the vagina of a sexually inactive elderly woman. While this condition is not harmful to the patient, it can cause some discomfort and embarrassment should she ever choose to become sexually active again.
*Picoides borealis or Picoides villosus infections are also common in elderly men.
Diagnosis Often an inexperienced clinician's first instinct will be to peer into the vagina using his or her otoscope. This can be dangerous to both the patient and the clinician as barn owls are nocturnal creatures who are easily startled by bright lights. When facing an intruder, barn owls spread their wings and tilt them so that their dorsal surface is towards the intruder. They then sway their head back and forth. This threat display is accompanied with hissing and billsnaps that are given with the eyes squinted. If the intruder persists, the owl falls on its back and strikes with its feet. The safest method of diagnosis is to place a stethoscope on the patient's abdomen and listen for the Tyto alba's distinctive calls.
Treatment In 1844 Dr. Horace Wells preformed the first successful owl extraction at the Harvard Medical School, and his technique has been left largely unchanged until this day. First the physician should try to entice the owl out of it's nest with tootsie pops. If this treatment is unsuccessful then the vaginal cavity should be completely filled with nitrous oxide. Once the physician is certain that no hooting sounds are being emitted from the cavity, the owls should be firmly grasped with obstetrical forceps, given a 90 degree clockwise twist, then removed from the cavity. Care should be taken to grasp the owl by the body, not the head, as it can turn a full 180 degrees. Also, one should never attempt to turn the owl counter-clockwise as this will cause tissues tearing and vaginal bleeding. Sadly, Dr. Wells was never recognized for his contribution to medicine. After he preformed the first successful Owlendectomy his patient died from a rare secondary infection. After the owls were removed, there was no longer any system in place to check a population of Macrotus bavarici, or Barvarian Pine Voles, which had been living in his patients upper left fallopian tube. When she died a week after the operation, Dr. Wells was humiliated in front of his colleagues, and was forced to abandon his practice. For the next sixty years the medical community used the medieval practice of Badger Baiting instead of the Wellsian Pelvical Owlendectomy. Horace Wells would later enter the field of politics and served as the Postmaster General under President Taft in 1909.
Prevention First of all, the patient should be made aware of the fact that frequent handwashing is the best way to prevent infectious diseases of all kinds. Secondly, the vaginal opening should be covered with a fine wire mesh whenever one is sleeping or traveling through owl infested areas. Finally, the elderly patient should be encouraged to have sex as often as possible, with multiple partners, in well lit rooms with no windows. Also they should know that owls should never be inserted into the vagina except under the guidance of her primary health care provider.
Conclusion Sexual history taking is an important part of a comprehensive history. It affords the physician the opportunity to evaluate for STDs, contraceptive history, sexual abuse, and sexual dysfunction. In addition, it gives the physician the opportunity to administer appropriate diagnostic tests, treatment, and prevention counseling. Sexual history taking and increased interaction between the physician and patient are vital to combating the Tyto Alba menace in the United States.
I love stories. I love hearing stories. I love telling stories. There's nothing better than a good story, well-told. I realized today how much of residency is stories. These past few weeks on Trauma I've been laughing about the stories I hear on service, remembered stories from services past and today, hearing stories from my Attending that remind me how great medicine and surgery can be.
My favorite patient to present that we admitted recently is a 26-year-old guy that is legally blind who was riding his bike at night and crashed it.
ER: I've got a guy down here who crashed his bike. We need a trauma eval. Me: What's the story? ER: He's 26 and he's legally blind. Me: Did you say he was riding a bike? ER: Yes. At night. Me: And he's legally blind. ER: Yes. Me: Okay. ER: Yeah. Me: I guess it didn't matter that he was riding at night. ER: Right.
His one-liner on the list is almost as good as the "hoof versus face" for the last guy that got kicked by a horse and "MCC vs mailbox" for one of the motorcycle crashes.
Our Attending today was telling stories about when he was a resident about a thousand years ago. It never ceases to amaze me how different things were for them as housestaff. He was telling us about how when he was a resident he used to pour the electrolytes into the TPN solution before running it in. There was a hood on the floor and they'd put it in themselves after they got the labs back. Our old chairman, who helped develop TPN, used to mix the whole bag himself when he was in Vietnam before giving it to injured soldiers. I can barely order the stuff for pharmacy without a nutrition consult and these guys were boiling the stuff in pots and sewing the bags they hung it in.
My favorite story he told us today was about one the attendings here from long ago and the very first patient to get a vagotomy for ulcer disease. Dr. Dragstedt was a pioneer in definitive ulcer operations. He did a lot of procedures on dogs and figured out that vagotomy helped eliminate acid secretion which led to ulcers. He had this one patient who needed a gastrectomy for ulcers, which was the procedure of choice at the time until vagotomy became a widely accepted alternative. The gastrectomy was pretty morbid and people would be miserable afterwards. They'd be running to the bathroom after a bite of food and getting flushed all time from dumping syndrome. This patient had had a cousin that had the procedure and a neighbor that had the procedure.
The resident went into his room to tell him the operative plan and the patient said, "No way. I'd rather die from ulcers and bleeding than have a gastrectomy."
They told Dr. Dragstedt and he went in to talk to the guy. "If you don't have this done you'll probably end up dying from the ulcers."
He didn't budge, "I don't care. I'm not going to have a gastrectomy."
To this, Dr. Dragstedt pulled a chair up to his bedside, leaned in close to his patient and said, "Let me tell you about my dogs."
I'm on Trauma night call now. The overall theme on this watch is pretty similar to the operative approach to Trauma... get in and get out. From the time I come in at 6PM the overwhelming feeling is that I'm being chased by a wild animal - a big one - pretty much until I leave the next morning at around 8AM. This rotation is the one that really makes you hate the pager.
My sister just started a year-long trip, biking through South America and Asia with her husband. I get the e-mails from them at night with all their pictures and two unfortunate realities sink their fangs mercilessly into my soul: 1) what she is doing is about fifteen thousand times cooler than what I'm doing right now... and 2) I brought this on myself. I made this decision. And now I'm in a smelly call room getting calls about people who aren't breathing and protecting people, with so little sense that they use lighters to assess how much fuel they have left in their gas tank, from themselves.
This is the second year I'm playing this role on the Trauma Service. It's also the second year I'm doing this rotation as the junior resident for the first rotation of the academic year. I took call with the chief that I started on with last year. She's pregnant now, but you couldn't really tell by how fast she moves or talks. We were in the trauma bay last week waiting for a guy who shot himself in the chest with a shotgun. She was wearing her surgical gown and gloves and pulled herself up onto the stretcher to rest her feet. There she was, semi-reclined and breathing sort of heavy the way people do when they gain 20 some odd pounds in six months. The mound of her unborn son making the green gown billow out. Almost reminded me of pictures I saw of my mom when she was pregnant with me wearing maternity dresses. It occurred to me that with her due date coming up, there is a real possibility that she could break her water in the middle of one of our traumas.
That would be something. "Skeeter, my water just broke... what did the FAST show?" "Really? You should probably go then. It's negative."
She's one of my favorite chiefs and working with her that night reminded me a lot of how much fun I have working with her. She grows bigger by the day. Yesterday morning in the SICU both our teams were rounding in the same pod and someone was getting an X-ray. We all moved away and I instinctively headed towards the door to make sure she got outside before they shot the film. We sort of laughed about it and she said, "At this point I'll get radiated if it'll make this thing come out." Gotta love that kind of honesty.
Would anybody like to share their favoite method of getting code status/DNR?
I seem to be giving unrealistic expectations to 80 year olds who should be DNR. I try to convey the good aspects of allowing a natural death versus the futility of chest compressions when you're old and sick, and all I get is the "I just don't want to be a vegetable, but do what you can to save me" conumdrums, which, at least here, makes them full code.
Anyone else out there getting ready to start residency? I'm in the midst of my orientation at the moment, but then have the rest of the month off. In that time I'm going on a short trip and otherwise plan to lounge by the pool.
I'm new here so I should give you a bit of an introduction. I'm a family med. doc and graduated from my residency almost two years ago. I am interested in this community because I would like to make new friends and find other people on LJ with interests similar to mine. I did my residency in family medicine at the St. Anthony's Program in Denver, CO. Residency was hard, as you all know, but I really had a blast. They were an amazingly cool group of people there at St. Anthony's. I really miss them. Being out in the real world is very different. My first job out of residency has been errr, well, not quite what I expected. After graduating, I moved back to my home state of Texas. I was going to have a baby so I figured it would be better to be closer to family. So I am currently working in a clinic in the Northeast Dallas suburb of Rockwall. I work for an older doctor; lets just call him Dr. L. I hardly ever talk to the guy. I mean I try to but most of the time he'll just whoosh past me in the hall and all I get is a wave. If he actually takes the time to talk to me I never get more than five words out of him at a time. So really I don't even know him. All I know is that his a powerful person in the Rockwall community, he plays golf with the CEO of the hospital, and it is rumored that he knows everyone who is anyone around here. The patients certainly can't get enough of him. This clinic is hopping. He sees about 40 patients a day and that isn't counting the extra 80 or so per day that his numerous PAs and NPs see. I also know that he can't practice medicine. One of my biggest pet peeves is that he gives antibiotics and steroid shots, yes STERIOD shots to anyone with a URI. I was so shocked by that when I first came here that I really didn't believe it. I had to see it over and over again, documented in chart after chart before I believed it. Last year I actually confronted Dr. L on that issue. I was still to naive to know any better. He sputtered out some explanation about how oh no, they don’t do that any more. He has been trying to tell the PAs and NPs not to do it but they just don’t listen. Whatever, it’s still happening. Well I could go on an on about this guy, I haven’t even started on the crazy shit he does with his inpatients; but I’ll spare you.
Hi I'm a grade 12 highschool student in Canada and I'm about to enter my first year of university. I was accepted to a nutritional science program and I was really excited about the program but a lot of people have been telling me that it's a bad field to go into, namely my science teachers, my dad, my cousins in the medical field and even my dentist! What do you guys think? My dad said that radiation sciences is a good field to go into because they usually have a difficult time hiring radiological technicians and it pays well. I've never even HEARD of radiology until he mentioned this, I tried doing some research to figure out whether or not this is something I should get into but it's hard to say just from reading brochures and surfing on Google. Has anyone here studied radiation sciences before? I need all the help I can get.