THE ONION/FLU MYTH

There are lots of old wives' tales out there: carrying a pregnancy high means it's a boy, drinking water upside down cures hiccups, etc.

One rather odd one I didn't expect to hear quite so much about this year is how an onion will "draw out the illness" and turn black. I am a firm believer in the placebo effect, as well as the importance of optimism on patient health and outcome. Still!

Snopes has a page explaining the origin of the myth; apparently, the superstition has been around for over 100 years.  Not only is there no scientific evidence, there are no studies because it's SUCH a ridiculous claim! (It would go into the same category as testing unicorn horns for a cancer cure.)   Snopes quotes a Wall Street Journal article:

"Biologists say it's highly implausible that onions could attract a flu virus as a bug zapper traps flies. Viruses require a living host to replicate and can't propel themselves out of a body and across a room."

MYTHBUSTERS: RESIDENCY INTERVIEWS

MYTH: Interviewing for medical school, you have to sell yourself to them.  Interviewing for residency programs, they're selling themselves to you.

Generally, the big picture is fairly accurate. There are a LOT more candidates for med school than residency, and the further up the ladder, the stronger the application's correlation with good performance and success. Imagine looking at MCAT scores, college grades, and extracurriculars to decide if someone will be a good doctor one day.  "Lab assistant" could mean anything from washing pyrex beakers (me) or being first author on a publication (not me). Residency applications, on the other hand, are a slightly better representation of one's ability, focusing on medical board scores, clinical rotation grades and recommendation letters from other physicians. 

First, you have to understand the idea of cutoffs....

CHANGE OF PACE

Awhile back, my mom mentioned to me that changing my blog title to “No ifs, ands or buts” demonstrated how much I’d changed over the past few years. I was finally able to appreciate the humor in those trivial but frustrating situations that used to nearly drive me over the edge.

As I rapidly approach another big milestone in life (graduating from medical school!), I feel like it’s time for another change of pace (a pacemaker pun).  Also, I have one more week of vacation and I’m going crazy from boredom. My bizarre penchant for blank slates has now leached into other parts of my life- every few months I’ll buy a new calendar/planner just to start fresh, with one ink color. (I did that last week but only got about halfway through transcribing before I got bored, so now I’ll probably redo the blog.)

So, back to this coming year being full of exciting changes.

REFLECTION ON MORTALITY

People often comment about how close we are to death, as healthcare professionals. When I first started into medicine, I assumed that that constant exposure would make death easier to deal with- whether myself or those close to me. I thought it would be like exposure therapy in psychology, overcoming fear by incremental, gradual introduction.

Instead, it has done the opposite. My experience in medicine has made me feel infinitely more removed from death; paradoxically, because it is so routine. The problem is that I've been conditioned to assume that it's never me or my family. Death is always in the controlled environment of a hospital, and it's usually not unexpected or sudden.  I guess my mind has developed this corollary that if my family isn't in a hospital, then they are immune to death (but when I hear someone close to me has been taken to the hospital, I am immediately overcome with anxiety).

I'm always surprised to hear from others that a death was unexpected (of course there are exceptions, like a car accident)....

ZEBRA HUNTER

One of the first pieces of advice I remember was that the difference between a new doctor and experienced one is the approach to a clinical question. The new doctor starts with a wide differential, gathering information to narrow it down, whereas the intuitive, experienced doctor immediately has a general sense of the answer and gathers information to justify the suspected diagnosis.

I have been keenly aware of my changing perspective over the years, noticing every so often that I've shifted a tiny bit more toward the latter (not only did I not truly understand the true meaning of the statement initially, I didn't understand the timeline- it's not an overnight change of perspective, unfortunately).  My ignorant, egocentric first thoughts were that I, of course, was exempt- I knew it all already....

DON'T BUY ALL THE BOOKS!

Now that I'm 7/8 of the way done with med school, I'm starting to compile some of my better advice, and hopefully one day can publish it.  Here's an excerpt; not that anyone ever comments, but if anyone has suggestions or requests, let me know!

Like college textbooks, medical texts can be outrageously pricey. Embarrassingly, I was “that person” who purchased every single book on the “required book” list.  I think it was probably around $2000. (Yes, I bought them new from Amazon.)  Sitting in orientation surrounded by people complaining about said booklist and realizing that I was literally the only one who had purchased any books at all, I vowed to pass on the word.

PAIN, PART 2

Facts about narcotics that doctors assume patients know (and therefore don't address):

• Narcotic medications are addictive. Period. Even if you really need them, you can still be addicted. There was a big scandal recently which revealed that some drug companies had mislead doctors and patients about the dangers and addictive qualities of narcotics, so everyone needs to be aware.
• "Narcotics" aren't just illegal drugs like heroin. Narcotics are also those "pain pills" you get as a prescription. Sometimes the doctor asks if you've ever been dependent or addicted to drugs- THESE COUNT, and doctors assume you've never had a problem if you say no.
• TOLERANCE: The more narcotics you take, the more your tolerance builds up. Then when you experience even more pain, you need more medication. It's excruciating to watch people who are dependent on narcotics after surgery or an injury experience excruciating pain that we can't control because your body has such a high tolerance....

PAIN, PART 1

Being in a surgeon's office this week has really made me reflect about the wide variation of pain perception. Clearly, assessing and treating pain presents major quandary for physicians- who is really in pain? Whose pain are we missing? Are we killing people by over-managing pain?

I've heard the surgeon discuss narcotic pain medications multiple times with patients this week, and the bottom line is evident: doctors often do a horrible job of screening for pain (I'll place most of the blame on a lack of tools, because there's no magic lab test or xray) but also explaining the proper use of narcotics and the risks of inappropriate or long-term use.

Narcotics are a big pet peeve of mine (not when used "correctly" of course, but even that's not well-defined). Volumes of books could be written on this subject (and have been) so ill try to be brief (and also divide this up into multiple posts).

This is a bit like discussing politics around election time, so I'll try to be as objective as possible (which is impossible)....

TAKE A HIKE, SAVE YOUR BRAIN

Doing crossword puzzles was my "morning coffee" during college- the absolute only thing that kept my forehead off the desk in 8am classes. I justified it by convincing myself that word puzzles were just as important to keeping my neurons happy and healthy as the chemistry I was unable to concentrate on.

Well, it turns out that might not be true....

UNDEADING

So you're driving down the road, and look ahead to see some idiot slowly crossing the road. My first response has always been utter exasperation and wonder- don't they know they're going to get hit?

This morning when I saw that, I had a revelation: Maybe they just don't care.

I never had this thought before medical school, and it still greatly bothers me when it goes through my head (so don't feel the need to call a shrink on me or anything). But long days, hazing, frequent ridicule and a (relatively) bleak near-future, and suddenly you have the occasional fleeting thought that you might NOT care if a car hits you when you cross the road. I don't think that thought even counts as passive suicidal ideation (again, that might be relative), especially If you're on certain rotations in medical school, like cardiothoracic surgery.

Life can be tough....

GREAT MINDS...without chairs

So, a while back I posted about chair hierarchy in the hospital. Someone else (who clearly has better artistic ability) had the same thought!!!

It's a bird! It's a plane! No...it's the correct diagnosis!

Excerpts taken from Dr. Bernard Lown's The Lost Art of Healing:

"[The physician] urged us, as beginning medical students, never to prescribe for a chief complaint unless we had come to know the patient well and figured out what was truly troubling the person. A physician committed to healing could not and should not focus exclusively on a chief complaint, or even a diseased organ. If one was to help those who were sick, the stressful aspects of life had to be exposed."

"Limiting history-taking to the chief complaint often initiates fruitless pursuit of irrelevant matters that are quite tangential to the main problems."

Unfortunately, this happens every day- time constraints result in doctors focusing on the one chief complaint, and the underlying problem is never addressed. Medications, "bandaids," often cause more harm than good, and these patients end up undergoing a battery of unnecessary treatment and tests.

A solid HPI is essential to establishing a correct diagnosis but is rarely conclusive, and should naturally lead to a detailed social history which provides context for the "chief complaint."  The easiest and fastest way to handle multiple complaints is to send someone to a specialist.  So the depressed patient who comes in for back pain, headaches and low energy gets referred to an orthopedic surgeon, neurologist and endocrinologist (or cardiologist!), when an extra 10 minutes gathering history (recent death of spouse, or lost job) would result in a logical, easily-managed diagnosis.  In fact, the 2 or 3 weeks of trialing an anti-depressant would likely be faster than making an appointment with a specialist, and clearly would be less stressful and much less expensive for the patient.

Clinicians get sucked into the idea that we have to explore every possible cause (again, thanks to lawsuits), but why are we still looking for zebras??  Modern technological advances have unfortunately created a safety net for poor history-taking and physical exams.  Just because we CAN find more zebras doesn't mean we SHOULD!

My advice to a patient (or potential patient), would be to tell your doctor EVERYTHING! (If your doctor won't listen, get a new doctor.)  Many people don't associate their chest pain with their family feud, or their headaches with caffeine withdrawal.  If your doctor doesn't know about your stress or your quitting coffee cold turkey, they might forget or not have time!  While I'm far from condoning "quick" histories, I think patients have to help out and pick up some of the slack, unfortunately.

Patients are their own best advocates, and it's tough to speak up sometimes. Clinicians have to do a better job of making them feel comfortable asking questions or questioning a medication, procedure or even a diagnosis (within reason).

A Wholesome Gallop

While straining to keep an interested look on my face while "listening" to a resident physician go through a consent for a procedure, I noticed that the patient was also not listening. Rather, she kept a suspicious eye on the nurse setting up for an IV, and finally put her hand on the nurse's arm and sassily told her that last time she was in the hospital, no one could get the IV and she was not going to allow someone to stick her five or six times again. Anyway, it really set up for a dismal outcome and it made me realize what an impact a patient can make on his or her own outcome.

As a paramedic I heard that 20 times a day- "I'm a hard stick, don't even try." Honestly, that made me really angry. During some of my "darker" days I took that as a challenge (I had a good track record, pun intended).

Now I realize how that sort of comment can be horrific- if you set the stage for failure, both in your head and the other person's, you'll probably fail. I know most of the "I'm a hard stick" patients are the frequent flyers and the purpose of the statement was anything but the denotation, but nonetheless....

So that was going to be the blog. But later that day in a lecture, a physician mentioned a story along the same lines and it really made an impact.

Long story short, a well-renowned cardiologist was treating a patient with bad heart failure, and made a point to have all the students and residents listen to this man's "wholesome gallop" (a heart sound usually only heard in heart failure).

No one thought this guy would last long, but within a few weeks this guy's heart function was completely back to normal! The cardiologist asked the patient what happened, and the patient told him that he was encouraged when the doctor told him he had a "wholesome gallop," because he reasoned that only a strong heart could still gallop.

The doctor clearly hasn't meant "strong" heart; in fact, he meant the opposite, but the patient's positive interpretation resulted in complete recovery!

According to the physician giving my lecture, the moral is that you should always find the good news. If they have a nonresectable cancer: "Good news! Your cancer doesn't need surgery! We can treat you with chemo and radiation!"

I've always held the opinion that words are a physician's most powerful and influential weapon. Unfortunately, on a daily basis, I hear them misused. To many, a doctor's words are the be-all, end-all, and sometimes assumptions are made on both the doctor's and patient's sides. Seemingly minute details in a conversation can change someone's view or even possibly outcome.

I think the toughest part of learning to be a doctor is how to use your words. The easy way out is to be enigmatic and vague- a commonly used tactic. Many healthcare providers, it seems, are comfortable with medicine but are unsure of how to talk ABOUT medicine with patients (somewhat justifiably so given all the litigious people out there). We need to better teach how to feel comfortable talking to patients by giving the whole picture. We need to tell people what we know, and what we don't know. Sometimes we don't like telling patients when we don't know the answer yet, and they interpret our silence as a deliberate omission (and patients therefore make assumptions about why information was withheld).

Deferring- "why don't we wait until the test results come back to discuss this-" can cause weeks of angst and worry. Granted, there are probably situations where this wouldn't be the best decision, but I think that talking to patients is comforting to them. Being in the dark is a thousand times more frightening than knowing (again, in most cases).

That same cardiologist whose "good news" cured his patient's heart failure wrote an amazing book which I started today: The Lost Art of Healing (Dr. Bernard Lown). A parting thought from Dr. Lown:

"As the patient is empowered, the doctor's curing power is enhanced."

Life of a med student..per parodies of popular music

Some of the best med student videos out there:


The Doctor's Out Tonight (Dynamite remix): ALL-TIME FAVORITE!

I wear a coat (I'm on a boat remix):

Somebody that I used to know remix (2nd half is best; pretty much about first aid)

I'm at a code (another I'm on a boat remix)...still pretty funny:

Residency Interview Advice

Interview offers are like new pleural effusions. 

You should never let the sun set on one.

Greatest. Quote. Ever.

Moral of the story: schedule your freakin interview the day you hear back!

How highlighters made me bitter for a second

For a second I wanted to be this girl, who I stood behind on an elevator in one of the clinic buildings near the hospital. I saw this girl in baby blue scrubs, and four perfectly-aligned highlighters.

If you know anything about me, you'd know that writing instruments are one of the few things in life I'm picky about. I am extremely particular about the experience of writing (if it isn't a nice pen, you won't write neatly). I once read that neat handwriting is a courtesy to the reader. (Of course, I am in NO way implying an opinion about physicians...)

Anyway, it had been a long day, and I was on my way out when I became fixated on these highlighters. All I could think was, "what does this girl do, that she only needs four pretty highlighters in her pocket?" And then, "since they're so neatly arranged, does that mean she doesn't actually use them?" (Ie, does she actually do anything.)

Clearly med school has warped my thought processes, seeing pretty highlighters and having such a visceral response. Overwhelmingly I was reminded of my own (short) white coat..a few shades off from the bright white when it was new (ok, a lot), jammed with pens (one of each color, a highlighter, permanent marker and penlight!), lip gloss, a few dollars, a radiation badge, a bunch of old patient lists covered in notes that I eventually want to organize and copy into my "little black book," reference charts, my phone and pager, a small bottle of ibuprofen, and probably a bunch of other random stuff.

I know that that moment was one of my "why am I doing this again" thoughts, which seem more frequent but fleeting, the closer I get to graduation.

I had this instantaneous yearning to have a normal, predictable job where all you need in your pockets are four highlighters. As quickly as that feeling came and went, the next brief thought was, "that seems like a horrible job; how boring and unrewarding would that be?"

Then I just felt guilty for having such a cruel thought, and then I remembered how really, really tired I was, and if I hadn't taken the picture I probably wouldn't have remembered it for this blog anyway.

Dominate Step 2 CK

As promised, I will include a few thoughts in reflection of my Step 2 CK (clinical knowledge) exam prep.  First of all, I scored very low on Step 1 (but passed), and that has cast a shadow over my career since.  Knowing that top tier residency programs were now out of reach, I realized I had to dominate Step 2 in order to have a fighting chance at a decent residency program.  My major concern was that I have always wanted to go into cardiology, and in order to get a cardiology fellowship, you need a great residency position (and therefore, great step scores).  So a low Step 2 score would have pretty much been the kiss of death on my cardiology dreams.

This story has a happy ending: I scored a 251 on Step 2!  (My fiance is so sick of me shouting this number out, even a month after the score came back.)  My dean's office adviser told me it was the biggest jump he'd ever seen between 1 and 2 (I'd rather have the honor of scoring the highest on both, but this will suffice).

I feel like I was not prepared for Step 1, and I'll have to explain that to residency programs.  But I keep telling myself: it's a lot easier explaining one bad test score than TWO bad test scores.  I can truly say that I had a bad day.  While I'm still out of the running for a lot of top tier schools (that I may have had a decent shot at, had I done as well on the first one), I still have high hopes for some fairly good programs.

So what happened?

What I did wrong while preparing for Step 1:

• The WAY I studied: the "test taking prep" center at my school singled me out for "help" before my first exam and did a one-on-one session; they concluded that I just didn't know how to do multiple choice questions and gave me a strategy (this method took about 3x as long).  Assuming that my weakness was rooted in the questions, not content, I essentially just did a massive amount of practice questions.
• WHAT I studied: I figured if I did 2000 practice questions (or all of UWorld) I'd hit every topic, so when I got a question wrong, I'd go through all the wrong answers to make sure I knew that content as well. 
• HOW LONG I studied: I took the test shortly after finishing 2nd year (less than a month) and didn't get many full days of studying in

What I did right while preparing for Step 2:

• Taking it seriously: this unfortunately translates into a financial issue; I researched test prep for about a day before hesitantly deciding to purchase Kaplan's online lecture series (yeah, over $2000 for 3 months).  Best. Decision. Ever.   
• WHAT I studied: I realized that the question banks test you on a microscopic fraction of the material, spot-checking your knowledge for massive gaps, and you have to know how to use your performance to study: don't study with the qbanks.  I'll go ahead and do a free endorsement for Kaplan: they concisely presented a massive amount of material making it a finite amount of material (I felt overwhelmed on Step 1, wondering how you could study everything; well, YOU CAN'T, but no one tells you what to study or what not to study- until Kaplan!).  The lectures were cumbersome but memorable (at times I was falling out of my chair laughing).  Best of all, I remembered it when doing questions.  
• The WAY I studied: after doing lectures, I used UW for its intended purpose: spot checks. I literally only did about 500 questions over the 4 weeks I intensively studied, because I was sure I knew the material.  The best part was seeing the questions in a whole different light: with Step 1 I felt overwhelmed with the question (I often didn't even know exactly what the question was asking), and narrowing down to 2-3 choices and guessing randomly. With Step 2, within the first few sentences of the stem I'd know the topic, what 3 questions they'd predictably ask, and often, the answer (yes, before even finishing the stem).  

Step 2 (and maybe Step 1...can't speak on that obviously) is an extremely predictable test.  The problem is no one tells you that, so you prepare for an unpredictable test (studying a little bit of everything, just in case). They really only ask a few types of questions, so you only need to understand those concepts from each topic (for example: what's the diagnosis/what's the best way to diagnose/what's the best treatment are really the only questions asked).  

But again, Kaplan broke things down to the basics and built up from there. They really focused on looking at things that were similar (ex: lung infections: bronchitis vs abscess vs pneumonia vs TB) and looked at the similarities and then the unique characteristics that the test would focus on:

Pt presents with fever and cough: think lung infection (any of the 4 diagnoses)

Keywords for diagnosis: "normal chest x-ray" (bronchitis); "bad teeth" and aspiration risk like seizure history (lung abscess). If they're going to ask a specific question about a specific diagnosis they have to "tell" you what the diagnosis is!

Diagnostic tests: universally a CXR initially; but based on diagnosis know that there are exceptions for definitive diagnosis, like a lung biopsy is most accurate for abscess 

Treatment: know which antibiotics treat which organisms (ie penicillin family for staph/strep) and then know which organisms are commonly causative (ie abscess=anaerobes so therefore clindamycin)

I didn't touch First Aid, but I hear it's a good resource (wouldn't rely on it solely though, unless you just want to pass).

Crush Step 2 (Brochert): excellent summary of high-yield topics. Not very thorough (you'd definitely pass just reading this, but would use it as a review during the last few days to make sure you got all of the important information down)

Step Up to Medicine: love this as a textbook, to look up pathophysiology you don't completely understand; wouldn't use as the primary study aid though (saw some people do that)

Kaplan's notecards: I got these last minute (Diagnostic tests, physical exam findings and a general one) to have something to carry around. I also do better with short, concise points; plus they have great pictures. I think it's a great supplement (although a bit expensive; I will probably try to sell mine later, but they're good for step 2 and 3).  Like Crush Step 2, makes sure you didn't miss any important high-yield topics.

NBME Practice Tests: again, pricey ($50 each I think). I did 2 of them "officially." Great for estimating your progress and score; I took one about a 2 weeks before the exam, and scored in the 220s, then did one a few days before the exam and scored 241. There are always rumors that some of the questions overlap with the actual exam (I didn't notice that, although some questions just have to be asked on every exam and those may be the ones referenced), but I think more than that it confirms whether you're ready for the exam.  They all seem to correlate fairly well with your actual score (look on message boards on the net for how each correlates- some overestimate/some underestimate, but by a predictable amount).

Anyway, hope this helps someone out there.  I really think that if you approach studying (even for step 1) by seeing it as a predictable test with a finite amount of information you'll dominate it.  You just have to be willing to go find a resource that will teach you what is important.

The EXTERNSHIP

I'd like to start by apologizing to my few dedicated readers, between my board exams in July and 4 hectic weeks of an externship I've barely had time to keep up with my health, much less things like updating blogs. I had planned on more detailed accounts of my recent experiences, but given how busy I've been it'll have to be a brief overview.

As a 4th year, you get the opportunity to practice being an intern for a month-long rotation (sometimes referred to as externship, sub-internship or acting internship). I lucked out in terms of my team. In general I had an amazing group of residents, attendings and 3rd year med students, which resulted in a very fulfilling and rewarding month. I was worried that a bad rotation would lead me to question my career choice. 

But it was pretty awesome. Other than the hours (of course I NEVER broke hour limits, 80 hours/week..), it was a whirlwind of fascinating patients, decision-making freedom and responsibility I didn't expect for another year. 

I was allowed to, for the most part, make my own plans for patient care, with only a few suggestions and reminders here or there.

So, by far, my externship (in internal medicine, the most dreaded of externships!) was the best rotation I had so far. Now that I've moved on to my next rotation, I am filled with nostalgia when I see my old team rounding together on the wards without me, but like in any other career it's best to quit and move on during a "winning streak" (ok I didn't have a choice and I was exhausted, really). But I don't actually miss many rotations- and I really miss that one already. 

So my advice for your externship?
-Pour your heart into it, because if you don't care, you probably shouldn't be going into that specialty. 

-Just do the time. It's long hours but people see you there and know that at the least, you're dedicated. (On multiple occasions residents on other teams said I should go home, because I worked too much.)

-Go out of your comfort zone: I knew going into the rotation that I didn't feel comfortable placing orders or calling consults. I pushed myself (it took 2 weeks though!), but now I feel like those are both old hat. Two fewer things to worry about as an intern.

-Lend a hand: help a resident with an admission, let a 3rd year med student in on a few secrets ("attendings don't care about the chloride level" or "don't give a history in the subjective part of your note"). You feel better AND reap the benefits later (residents and other students often return the favors).

-Be an enthusiastic learner! Just because you aren't getting pimped as much doesn't mean you should shut the books (or close google, to be realistic). 

Anyway, glad it's over. On to bigger and better things!

Dissecting homework

I finally finished with all of my med school board exams (barring failure of course, which I won't know about for weeks or months) yesterday.  I was planning on blogging about that first, because I don't think that many people understand the brutal beasts of becoming a doctor- otherwise known as the Step exams.  More on that later.

While trying to relax after my 9-hour exam last night, I stumbled across an article: Homework overload gets an 'F' from experts.  Ironically, this has recently a point of contention between me and my fiance (mostly because I keep bringing it back up).  We both had very different childhoods: he did his homework between classes and played outside after school; I had 3 hours of ballet or music lessons and then 4 more hours of homework (this is MIDDLE school).  We both agree (I do, at least) that there's probably a middle ground that's healthiest (mentally and physically, highlighted by the article "High school kids don't exercise enough, CDC reports" which was posted near the other article).  Four hours of homework in middle school is excessive.  My high school homework experience was even worse.

The other problem with making kids competitive academically is that the parents become crazy as well.  See article: Police: Mom hacks school's computer system to change kids grades.  She changed her kids grades from like 98 to 99, WTF?

I had a unique experience with schools; while in kindergarten, my parents researched top high schools in the area, and figured out I had to go to a certain elementary and middle school to get into that (yes, public) high school.  So I did the "academically gifted" classes, making rhomboicosidodecahedrons (see picture) out of construction paper in 2nd grade instead of doing connect-the-dots. My first grade science fair project compared the efficacy of using dish soap on dishes rather than just water (I swabbed them and plated them on petri dishes, and found that using dish soap didn't reduce the number of bacteria growths- probably a reason why I slack at cleaning these days).  I was in Key Club, Battle of the Books, National Honor Society, All-State honors bands- you name it.

And as predicted, I'm now in medical school.  No big surprise.  I attribute some of my success to the ridiculous measures I was put through early on, but a lot of it was pure drive.  I wanted to be a doctor, so I did everything possible- and 99% of it was just stupid hoops to get where I needed to be.  Sure, you learn good study habits.  But 4 hours of homework does that just as well as 2 hours.  And busy work just results in burned-out children who lose the energy to follow their dream.  Had school been longer than 13 years I probably wouldn't have made it this long.

I would like to point out that some work is definitely necessary.  No work means no structure, essentially.  The article points out that requiring homework "takes the fun out of it."  That lady was obviously smoking pot.  Homework has never been fun, required or not.  If not required, it wasn't done.  Even if your career doesn't require an ounce of academia, having been forced to sit down and complete a task as a child sure sets you up to be more successful (unless you smoke pot and don't have a job, like the aforementioned woman probably does).  It's all about responsibility.

Just a summary of modified milestones to shoot for if you want the next nobel prize-winning offspring:

My experience preparing for Step 2 CS

Note: this blog was written 2 weeks ago before I took Step 2 CS.  I'll eventually follow up with a brief reflection on the exam and how this worked for me, but things are hectic as my CK exam is next week!

As I'm winding down to the final few study days, I thought I'd share some of my study tactics.  No guarantees, but I guarantee it's better than the usual advice of "just go in, introduce yourself and wash your hands" and "speak English."  I ALMOST fell for those!  I realized about two weeks ago that there's a lot of preparation needed for this exam- not because my skills aren't adequate, but because the exam is overly structured.

A few reasons why you should prepare:
-You lose points for washing your hands at the beginning and not in the middle right before the physical exam
-You will probably have a phone call scenario- this could be as crazy as a mom calling about her sick child which isn't even with her
-You must drape the patient. It seems that doing it in the beginning results in fewer people forgetting.

Important things to go over:

-Physical exams: you need to have them down cold.  Memorize each set (HEENT, cardiovascular, pulmonary, abdominal, extremity, neuro), and be able to pick and choose or prioritize maneuvers because you won't have time to do them all.  My full neuro exam takes over 7 minutes (this includes a fairly thorough set: cranial nerves, motor/sensory, reflexes, cerebellar exam, and mental status exam), but you only have 15 minutes for the entire encounter.  Know what's critical. Also know what maneuvers pretty much need to be done on all patients (listening to heart and lungs).

-Difficult questions: most scenarios will require you to address a difficult question.  "Do I have cancer?" and "I can't afford to come in for an exam, can't you just send in a prescription of pain medication for me?"  There are long lists of examples, but it really boils down to 3 or 4 general questions, meaning just have a few sentences ready (usually something like, "I don't know what is causing your symptoms, but I can't rule out cancer and I'd like to order some tests to make sure").  These aren't something you would be prepared for if you hadn't read the prep books (not that you can't answer them, but it seems CS wants some pretty specific answer types).

-Counseling: you're expected to catch and address "bad" health behaviors, like smoking, alcohol abuse, medication non-compliance, etc.  At the end, in your "closing," you need to make a statement or two about why it's bad and that you're there to help quit (list some resources).  This is an easy one to forget.  In practicing, I try to make big boxes around the topics while taking notes during the interview so I know which one(s) to address later.

-The "closing:" this is pretty insane.  You need to summarize the history and physical exam findings, then give a few differentials.  This is a good time to then ask for questions. Then give a general overview of your planned workup (labs, imaging, etc), in LAYMAN'S terms!  Even "thyroid" isn't a good word to use!  Patients will jump on the medical terms and make you explain them.  For example, instead of chest x-ray, say "take a picture of your lungs or chest."  Then you should make sure they don't have questions (this is usually when the difficult questions happen).  Also arrange for follow-up.

The format of the progress note and grading have changed subtly in the past month; do your research!!

I think a week of intensive studying or two weeks of moderate studying is plenty; I wouldn't start early, as a lot of it is rote memorization and will be quickly forgotten.

Two good books so far:

First Aid for the Step 2 CS
Kaplan's USMLE Step 2 CS: Complex Cases

Good luck!

Update (12/28/12): I forgot to mention that I passed!  I don't know the exact percentiles but I scored at the top of all three categories!

Med school's a bear market, and lucid dreaming masks

So in a recent post I mentioned nightmares.  I was pleasantly surprised while writing that entry that I hadn't had any within the last week or so, and I thought that since my 3rd year was finally wrapping up that maybe I was on the down-slope of the stress and anxiety.

SO WRONG!  After writing that post, that same night, I had another nightmare.  I know this is a totally weird topic to do a blog on, but just having finished my psych rotation, and learning about Freudian and Jungian dream interpretation, I felt the need to share how applicable that is AND how much med school is affecting my subconscious.

If you want to know more about the nitty-gritty of psychological dream interpretation, this site is a good place to start.  It's honestly pretty fascinating.  Anyway, the point is that they both theorized that dreams are/can be manifestations of your subconscious problems, frustrations, etc.

You'll have to research on your own to learn more (highly recommend it!), but back to my nightmare.  Like I mentioned, mine usually involve me in life-threatening situations (makes me wonder if I have nightmare disorder because adults aren't supposed to have nightmares much at all).

So this time I was camping with a bunch of med students (so unlikely on every level: I hate camping/outdoorsy things and I don't really hang out with my fellow med students at all outside of class), and all of a sudden there's a huge, ravenous bear tearing through our campsite trying to kill and/or eat us.  At first we were all working together to find places to hide or escape, but after a while of having to keep moving and hiding, we all get to the point of "ratting out" other students to save ourselves.  It turns into a Hunger Games/Lord of the Flies hybrid but without the gore and without the killing each other part.

I know at one point the bear was kind of also a really evil person and I got caught and somehow escaped (can't remember those details) but I remember running like h*** when I did.  It was also nighttime and it was hard to see where you were going but I remember considering the bear having the advantage because it could still smell.

Anyway, this is a pretty obvious example of my (sub)conscious revealing my true feelings of med school: (in the MOST BASIC SENSE) that they're out to get us and that they are (kind of?) pitting students against each other to "survive" (ie get a good residency).  I think it's been extra tough lately because I've been told that I don't have the best application for residency and may not ever achieve my lifelong dream of becoming a cardiologist.

I know it's not really like that, and that my school is way better than a lot of others (they really do want to help), and the students, on the med student spectrum, are on the compassionate, normal-people side if that's even possible.  Regardless I'm obviously stressed about this whole residency thing!!

Regardless, I'm leaving for a tropical vacation tomorrow for an entire week and hopefully that'll alleviate some of my worries.

On a brighter note, I've been contemplating getting one of these amazing lucid dreaming sleep masks.  That's not exactly the one I was looking at - there's a new one being advertised for about $100 and it's made some of the bigger news outlets.  I'd never spend that much on a sleep mask (I'd have to try that one out before spending that much!), but it's such an amazing idea.  I read about it as a kid and have only been able to lucid dream once or twice (you know, where you're almost awake and can control what you're doing).  The mask somehow detects REM sleep and flashes lights so you eventually are supposed to be able to recognize the flashing lights and know that you're dreaming.  There are a lot of techniques out there to train yourself to be able to recognize that you're dreaming and this happens to be a sort of "cheat."  Anyway, it's pretty neat.  If I could do that I'd fly or sit on a beach or something instead of being chased by a bear.

Lessons from an addiction clinic

One of the really great lessons I learned from my experience in the addiction clinic is that of forgiveness.  I know that one of the 12 steps in Alcoholics Anonymous (wow, I've been to way too many of these groups, as a med student of course!) is about forgiveness.  When the group started discussing it this time, I thought, psh, this isn't something I can apply at all.  I had been able to use a lot of the behavioral techniques in other areas of my life- controlling anxiety, restructuring my assumptions so I have fewer irrational "girl moments," etc.  But forgiveness??  I didn't have anyone to forgive or ask for forgiveness.

Boy was I wrong.  Looking back, I've had a pretty amazing life.  It's been a struggle- I've worked for most things I've gotten (a least the big stuff, and the recent stuff, like med school).  But one thing that I'd pushed from my mind was my last relationship.  I'm so thankful for a wonderful relationship right now, but I realized during this group that I still hadn't really forgiven my ex.  The relationship turned my life upside-down at the beginning of medical school, right when I needed stability the most, and although I've "gotten over it," I don't think I ever had closure.

These days I'm so busy, so I choose to ignore or suppress memories and events that are unsettling.  I am aware that this is an immature defense mechanism, but honestly I guess I think "I'll deal with it when I have more time."  Which by the way, in the life of a med student, is never.  So I think I'm getting out easy.  But then it just builds up, a million of these "I'll just forget it" moments, and I'm full of anxiety again.

The idea of forgiveness isn't easy.  And even more, how do you freaking accomplish this?  You don't usually just wake up one day and think, my conscious and subconscious has forgiven this person!  So I guess part of my problem was not knowing how to start.

The counselor, one of my new heroes, made it really simple.  AA is Christian-based, but it doesn't have to be religious (you pray to your HP, or "higher power" for all of these things).  Anyway, for it to work, he told us, you have to get down on your knees and pray.  (I'm not super-duper religious, for those of you who don't know me.  This was kind of awkward.)  You ask for all the things you want for yourself- happiness, closure, a good relationship, success, money, whatever.  Then you finish at the end by saying that you wish all of those things for whoever you are forgiving.

The thing is, you don't have to really mean it. That's why you say that at the end- that it's for that other person.  You can better reflect on what you want (or what any other reasonable person would want) and then stick that on the end.  And again, you don't really have to mean it.  But it you do it over and over again- 14 days to be exact- the counselor said that you would forgive the person.

I still thought this was crazy.  But I had realized that I needed to forgive my ex.  So I tried it.  I asked for all the things I wanted, then threw in a few that I already had (good relationship specifically, since that was my big issue with him), and asked for it to be given to him.

I didn't feel any different.  And I have to confess I only did it one day.  But the craziest part was that night, I had a dream where we met face to face and I was able to verbalize my forgiveness and I had an overwhelming sense of peace about that part of my life for the first time.  The reason this kind of dream is so weird is that for the past couple of months I've only had nightmares where I'm about to die.  (That's a whole different blog unto itself...obviously my stress has manifested itself in my sleep.)

Anyway, I probably should have finished out the two weeks but I figured at least my subconscious had at least partially forgiven him.  (This is a great example of how my life is full of "I'll do it later" thoughts.)  So the point is, if you have someone you are still angry with, or even someone who doesn't like you for some reason and you can't figure out why (the counselor suggested that scenario), and you're willing to try this, it might help.

Oddities, tics and analogies

I apologize to my two or three dedicated followers for the long hiatus; this last rotation of this year is like a sprint to the finish. (unfortunately, like my real-life sprinting ability I feel like I'm expending a lot of energy and still moving at a slow trot.) 

My other excuse is that I got engaged last weekend to the guy who literally keeps me going. I am so fortunate to have a life built around a strong foundation of a relationship. Plus he's very tolerant, forgiving, and patient.

Being in a relationship with him while going through the stress of med school has brought to light some new (yes, new, although my fiancé strongly disagrees) quirks:

-Abuse of analogies: apparently I severely overuse (no- slaughter) this grammar tool (I deleted one from this post already). I am very skilled at "turning a stupidly simple concept into even more stupidly simple pieces of a concept."

-Inability Too lazy to screw on caps.  Rather than screwing a lid or cap back on, I place it on and give it a half of a twist. This results in a lot of spilled cranberry juice. I can't convince anyone else that (except for soda) the lid is more of a courtesy, and that if you live with me and just assume that no lid is tightly secured, nothing will get spilled.

-I have a list-making addiction. I attribute it to a poor memory. If it's on a list it'll probably get done; if it's not on a list it probably won't get done.  Hence, honeydo lists are made by me (list-maker addict) for my fiancé (forgetful anti-list maker). But seriously, it alleviates my anxiety (blaming it on poor memory). Plus The Checklist Manifesto says lists are good.

-I have weird sleep issues: apparently I can sleep through my dog licking non-stop for 8 hours, or a loud train horn, but the light from the alarm clock or my fiance using his phone light to find something in the middle of the night will completely ruin my sleep cycle (and therefore my whole next day).  I'm too broke to get a new alarm clock, so I put a scarf over it at night.  I went the cheap route on the sleep mask and it lets in a lot of light so I haven't really been sleeping well these days...

-A few specific aversions to water: the oldest one is having wet hair on my back after a shower.  This is incredibly repulsive for some reason...it used to just be because I hated the feeling of a small area of soaked shirt around my neck, and now I just can't stand it at all.  My fiance also thinks it's weird that I won't put my face into water (washing my face, in the shower, or anywhere), although I don't mind swimming.  My explanation is that my eyes don't close all the way and the water burns when my contacts are in.  He still thinks it's crazy.  (I've lost enough contacts while swimming to know that it's not fun...and now that I have to pay for them I squeeze my eyes even tighter!  This is only applicable right now because I'm leaving for HAWAII in two days!!)

Shocking medical mistakes and how to avoid them!

CNN's headline article right now, "10 shocking medical mistakes,"made me REALLY angry for like, 5 seconds.  Until I read it, and realized it could have been summarized in two words:

AVOID SURGERY.

Ok, there are lots of great examples of necessary surgeries- heart attacks, exploding bowels, gunshot wounds, etc.  But I also see a lot of patients having multiple surgeries for absolutely ridiculous reasons.

Plastic surgery, you say?  Nope, I'm going to lump that into the "I-wouldn't-do-it-but-at-least-you-have-a-reason" category, even if the reason is vanity.  Seriously, a lot of people have surgery because of absolutely ludicrous reasons.  (By the way, I spelled "ludacris" hoping spellcheck would help, but apparently it's so different from the real spelling it doesn't recognize the incorrect spelling at all.  In fact, I had to use thesaurus.com and look up ridiculous synonyms.)

Some of my favorite:
1. Loneliness: you get a LOT of attention in the hospital.
2. Boredom: apparently patients get ipads and satellite TV..
3. It's free: why turn down free surgery??
4. I like being in the hospital.

Here's the article, notice the overriding themes:

(CNN) -- When you're a patient, you trust you're in good hands, but even the best doctor or nurse can make a mistake on you or someone you love.

Here's a list of 10 shocking medical mistakes and ways to not become a victim:

1. Mistake: Treating the wrong patient
• Cause: Hospital staff fails to verify a patient's identity.
• Consequences: Patients with similar names are confused.
• Prevention: Before every procedure in the hospital, make sure the staff checks your entire name, date of birth and barcode on your wrist band.
• Example case: Kerry Higuera

2. Mistake: Surgical souvenirs
• Cause: Surgical staff miscounts (or fails to count) equipment used inside a patient during an operation.
• Consequences: Tools get left inside the body.
• Prevention: If you have unexpected pain, fever or swelling after surgery, ask if you might have a surgical instrument inside you.
• Example case: Nelson Bailey

3. Mistake: Lost patients
• Cause: Patients with dementia are sometimes prone to wandering.
• Consequences: Patients may become trapped while wandering and die from hypothermia or dehydration.
• Prevention: If your loved one sometimes wanders, consider a GPS tracking bracelet.
• Example case: Mary Cole

(This is probably more common on surgical services, because surgeons prefer being in the operating room to chasing dementia patients.)

4. Mistake: Fake doctors
• Cause: Con artists pretend to be doctors.
• Consequences: Medical treatments backfire. Instead of getting better, patients get sicker.
• Prevention: Confirm online that your physician is licensed.
• Example case: Sarafina Gerling

(I would prefer a fake family doctor over a fake surgeon...think potential damages.)


5. Mistake: The ER waiting game

• Cause: Emergency rooms get backed up when overcrowded hospitals don't have enough beds.
• Consequences: Patients get sicker while waiting for care.
• Prevention: Doctors listen to other doctors, so on your way to the hospital call your physician and ask them to call the emergency room.
• Example case: Malyia Jeffers

(This is probably because people with colds go to the ER. And seriously...they advise calling your doctor before going to the ER???  Maybe I'll start calling McDonalds and placing my drive-through order so it's ready when I pull up to the window.)

6. Mistake: Air bubbles in blood
• Cause: The hole in a patient's chest isn't sealed airtight after a chest tube is removed.
• Consequences: Air bubbles get sucked into the wound and cut off blood supply to the patient's lungs, heart, kidneys and brain. Left uncorrected the patient dies.
• Prevention: If you have a chest tube in you, ask how you should be positioned when the line comes out.
• Example case: Blake Fought

(Again, surgery.)

7. Mistake: Operating on the wrong body part
• Cause: A patient's chart is incorrect, or a surgeon misreads it, or surgical draping obscures marks that denote the correct side of the operation.
• Consequences: The surgeon cuts into the wrong side of a patient's body.
• Prevention: Just before surgery, make sure you reaffirm with the nurse and the surgeon the correct body part and side of your operation.
•Example case: Jesse Matlock
(My expert advice: give your surgeon a literacy test prior to surgery.  Or at least make sure (s)he can tell right from left.)

8. Mistake: Infection infestation
• Cause: Doctors and nurses don't wash their hands.
• Consequences: Patients can die from infections spread by hospital workers.
• Prevention: It may be uncomfortable to ask, but make sure doctors and nurses wash their hands before they touch you, even if they're wearing gloves.
• Example case: Josh Nahum

9. Mistake: Lookalike tubes
• Cause: A chest tube and a feeding tube can look a lot alike.
• Consequences: Medicine meant for the stomach goes into the chest.
• Prevention: When you have tubes in you, ask the staff to trace every tube back to the point of origin so the right medicine goes to the right place.
• Example case: Alicia Coleman

(Again, surgery.) 

10. Mistake: Waking up during surgery
• Cause: An under-dose of anesthesia.
• Consequences:  The brain stays awake while the muscles stay frozen. Most patients aren't in any pain but some feel every poke, prod and cut.

• Prevention: When you schedule surgery, ask your surgeon if you need to be put asleep or if a local anesthetic might work just as well.
• Example case: Erin Cook

(Wouldn't advocate for local anesthesia during major surgery.  But again, surgery.) 

Defense Mechanisms

Part of my Sunday tradition involves reading Postsecret.  Having just gone over defense mechanisms yesterday while studying for psych, I realize that a lot of the secrets are perfect examples...(some are more of a stretch of course)

Denial

You're just a DEA number

Yesterday I found myself sitting in group therapy for addicts- no, not what you're thinking- as part of my psych rotation.

No one had given me a heads-up about what I would be doing, and the first few minutes were a blur.  I was snapped out of it by an older gentleman pointing his finger at my face (I soon figured out he was moderating the group).

"YOU.  Tell us WHY WE SHOULD LET YOU STAY HERE. IN 10 SECONDS."

I'm still not sure what I said, but I know I stuttered through my name like 5 times, and that I was a student.  I wasn't really nervous, so to speak, I just had no idea what was going on and what was about to happen.  Was I going to have to get up and sing and dance next?

The others obviously understood my embarrassment and they all voted to let me stay.  (Otherwise I may have had to sit outside the classroom for three hours.)

Experiences like this are an untapped resource in the battle against the lack of empathy in medical students.  I walked into an AA meeting my first year, thinking it'd be interesting to see what kind of patients I would eventually treat.  I walked out of the meeting with the feeling that I had mentally exposed and scrubbed raw every single one of my personality flaws.  Ironically, it was absolutely cathartic.

Not that I have any "addictions" as defined by society- drinking, drugs, etc.  But everyone has dysfunctional ways of dealing with things in life- whether as simple as ignoring a problem or as serious as shooting someone.  Being in the group yesterday, and being forced to participate in my own way, made me really face my own deficiencies.

Medical students have terrible coping skills, in my opinion.  Not that we don't know what is appropriate, it's just that with the amount of constant stress we're under, everything else seems trivial.  It seems ok to use nicotine patches or caffeine pills (at the LEAST!) for marathon studying, or not finding time to eat and hydrate your body during a busy admitting day.  Those aren't necessarily addictions but they're definitely dysfunctional.  During the meeting I had to come up with my own "denial statements," or reasons you give yourself to justify your addiction, like "I'm not going to drive after I drink" or "I had a bad day" or "No one else will know."  Medical students' denial statements would be something like, "Everyone else is doing it..or worse," or "If I don't, I'll fall behind," or "If I fall behind, I'll be a bad doctor and might hurt someone later."

Dysfunctional is an understatement.

I also heard stories of how the healthcare system failed these people, which broke my heart.  How the doctors who gave them their first prescription suddenly abandoned them when their medication regimen exploded into full-blown prescription drug addiction.  How no one had explained to them how bad life could get.  And how families, hurt and betrayed by addiction, stayed quiet in the background feeling helpless to save their loved one, at the time they needed support the most.

The facilitator again walked over and looked down to me sternly, telling me, "YOU'RE JUST A DEA NUMBER." I'm still trying to figure out if he was suggesting a deeper meaning, possibly a reminder that physicians are merely pawns in an era when reimbursement has more impact on clinical practice than outcome.

There are a million lessons to learn here, but at the least:

It's important for us as students and future doctors to realize how we are judging addicts and non-compliant patients for the same poor coping mechanisms.  I would advocate requiring med students attend similar meetings at least yearly, both to be reminded that addiction has a face, a family, and a story, but also to remind ourselves that we can't be the best clinician possible until we fix our own issues.

Personality Disorders

In honor of my last rotation, psych, beginning tomorrow:

Not for the faint of heart

Comments from a cnn.com article written by a doctor arguing that physicians are NOT overpaid, in response to the recent public outcry regarding physician discontent with salaries. I had to stop reading after 2 of 12 pages because it was so infuriating.

I've heard sooo many people argue here that doctors are under "so much stress!!" –

If that's true, then what good are they? I mean seriously, I thought our medical schools weeded out these weaklings in the first place. Secondly, I thought that after "all of this training" and school, doctors would know what the blanky-blank they were doing, no matter what.

If doctors still feel "so much stress" after making it through the selection process and 12+ years of school, then one thing is for certain: the med school chose the WRONG PERSON!

If performing medicine, surgery, or what ever is stressing you out after all of the riggors of traininng, then get a clue: the job is beyond your natural capacity and somehow you squeeeeeked through anyway. You should resign yourself to picking weeds out of gardens instead.

Doctors are not the only professionals who are forced to work for free. Attorneys can be ordered by a judge to take pro bono cases. Teachers often spend 20 hours per week of their own time planning and grading papers; they also typically spend a week or more of their own unpaid time prior to the beginning of the school year preparing classrooms and lessons.

I began working with doctors 9 months ago. Before that, I had a good opinion of them. Since that time, my estimation of them has dropped significantly. The childish behaviors – I was once a teacher – I found astounding. They would often leave the doctor's dining room worse than I ever saw children leave a cafeteria. We – as a society – have put doctors on a pedestal and it isn't working. Even as residents, they except to be treated as "special" instead of realizing that they are part of a medical team. I think we need to stop expecting doctors to work miracles and be perfect. We need to limit the awards on malpractice insurance and then expect doctors to act like people. They deserve respect but no more or less than anyone else.

There is a lot of people pulling the same hours and stress for less money. Doctors do earn their money but when someone complains of not making enough money when they are in the 99% of earning professions it rubs everyone the wrong way.

Shoot if I earned just a fraction (per year) of what these Docs do, I wouldn't complain one bit. When you are used to earning less than 20k while supporting 2 kids, even 5k more per year sounds grand.

Response: If you earn $20K a year, you obviously haven't put enough time or effort in training to enter into a more lucrative career, or you don't have the intelligence to practice in a highly skilled field. Look at all that time and $ you haven't spent–you got to start earning a lot earlier. Hence, average or below intelligence, or little effort applied, and no education above high school = $20K /year. Quit whining about how little you earn –they only hand out free, unearned money from the welfare lines. Why moan about people who do work hard to earn their money and then begrudge them that?

The symptomatic treatment of incurable conditions is the ultimate business. You never need to market, never need to worry about lack of customers, or the end of disease. Its the perfect most sound proof business model. The profit stream is endless, the only problem is there are too many cups in the river and the docs are mad. 


This story is wrong on so many fronts. I mean especially when you consider that I have never met a doctor that wasn't driving a mercedes or a BMW. I don't want to sound like a dick but you could easily have reasearched the field you were entering and not done it if you thought the compensation wasn't fair. So i guess every doctor should take stock in there career and decide why they became doctors? Was it to help people and promote the general welfare of the population or did they become doctors to fleece society and make a ton of money and play golf all the time. In todays economy I am sure there are a million people who wouldn't scoff at the meager 130,000 dollar income. As far as saying well you should have gone to college who can afford 11 to 16 years of school on my meager 30,000 dollar a year salary or the meager salary of my parents?


Quit your whining. I was premed at an Ivy League college and went the route of business. Life is about choices. If you don't like your path and how much you make, quit and become a banker. Let me know how much you'll like working 19 hours a day 7 days a week and travelling all the time and having clients yell at you. I've never read a more pathetic whiny post.


2) Don't expect your patients to thank you. YOU should thank US. You have chosen a profession in a service industry. We are your customers. We should be thanked for bringing our business to you. No different than a banker or lawyer.''


I love it when I have my blood checked every 6 mos. for cholesterol levels and then have to see the doctor for the results. Am there for perhaps 3 mins. while she reads off what it says and then Medicare is billed $245 for something that could have been sent to me via mail! However, am told they will not do that and I need to come in. There are doctors out there that are really abusing their profession.

Think medicine is bad? Try architecture. 5 years of undergraduate work, 3 years of graduate work, 3+ years of internship, 1-2 years to pass your exams. Tens of thousands of debt. Less than a third of new graduates finding work right now. Starting salaries (if you are lucky enough to find a job): $35,000. 50+ hour work weeks are the norm, all-nighters common.

While the statistics for doctors are bad, they aren't even close to having a monopoly in the undercompensated, overworked department. Stop whining guys – compared to the rest of the middlle class you are princlings.

MD Response: Your profession is not equal to medicine, your argument is flawed... You do not save lives, your liability is unequal, you are not in a service sector, to name just three.

Rebuttal: Really Bob? "You do not save lives" – What do you think architects do? Spend 12 years learning how to build buildings that fall down? They prevent doctors from having to save more lives. "Your liability is unequal" – perhaps you should research this. Architects also are liable for their work & can be & are sued. They do have to take licensure exams & have liability insurance. "You are not in a service sector" – Who do you think architects design buildings for? Architects serve private & public clients everyday. Where do you think the hospital came from? An architect designed it. 

I have an idea why – medical doctors really aren't that smart. I see them as cogs in the wheel; technicians at best, if you will. Show them a medication and they'll prescribe it like it's going out of style. Show them an implant and they'll put it in without question. Then, when it proves deadly or harmful, they say, "oh........well that can't be our fault!"

Show me the last disease stricken from Earth and I will show you a team of Ph.D. researchers that made it happen, not M.D.s. Medical doctors never cure anything. They simply use what other fine minds have designed and then hey extend no credit whatsoever. Nacissistic parasites doctors are. It's always, " I " suffered, or " I " saved the life, or " I " did this, that, and the other. It's never, "Hey, that nurse saved the patient's life when I was away." Or, "Hey, without that lab girl finding my patient had an abnormal pap smear, I wouldn't have caught that cancer in time." Or, "Hey, I sure am glad someone else designed this life-saving medication, so I can have the pharmacy get you some."


Doctors take credit for everything (biggest narcissists ever) and claim they're not in it for the money.....right. Three trillion dollars in U.S. healthcare each year is going to fall off a cliff and the doctors have the most to lose. Rightfully so – their selfish greed knows no bounds. 

How many doctors could actually perform their own MRI? There own microbiology from a wound culture? Know where to begin for meds? The hospital would grind to the same halt, just as if there weren't any doctors.

BUT, even though others are just as crucial as doctors, it is the doctors who GET PAID. They are greedy narcissists who believe they are the only important critical part of the health system. They'll suffer the most in our looming economic downturn.

"Medicine is also the only profession where its members are required to sometimes work for free." I hate to break it to ya buddy...But I work in Medical Sales, right next to you guys, and we do everything from service to device evaluations where we don't get paid a dime for our time *or* for many of the products *you* surgeons love to demo. So, I hate to break it to you, but that statement might require a minor revision. 


There will be a time soon, when our country stops the insanity of $3 trillion per year for health care and then you'll be told to stop whining when doctors like you are only paid $65,000 like so many M.D.s in other countries. If anyone's salary will fall in the coming years, it's medical doctors. Get used to it.

Doctor Response: Funny! You are right, if my salary falls to "$65,00 per year" I'm retiring to a cabin in the woods and spend my days fishing and I am only 42! So will about 3/4 of all U.S. physicians. That's ok, you can diagnose yourself with a Google search and put in your own chest tube, spinal tap, etc. etc. That is hilarious! Say good bye to healthcare in the U.S. Maybe we can outsource it. LOL

Rebuttal :Good, then we can all assume if we cut salaries to $65,000 per year, we'd finally be rid of the money grubby physicians that bilk the system with superflous visits, meds, tests, tests, and more meds.

 Doctors are more crooked than not; mixed in with a spot "saved life" here and there. By and large, you're ordering tests, meds, tests, meds, tests, meds, over and over and over and suddenly we're at $3 TRILLION. That's 3,000 Billion Dollars every year, because you "need" to make $200,000+

 I'll see to my own health, eat right, exercise, treat myself with over-the-counter items, and stay away from doctors. In fact, I'm 43 and haven't needed a "life saving" doctor yet. I skip my yearly physicals, blood work, and haven't had an x-ray in all my years. Oh, yea – I've never been prescribed any meds. Don't want them. I think most of our $3 TRILLION is spent on so many unnecessary items, it's unreal.

 Hope you enjoy the econemy taking a whack at your salaries. You deserve it. Hope your funeral provider gouges your family for an $800,000 casket – you deserve that, too, you price gouging lunatic.

Best refute from a physician:
It's so sad to see the decline of American Medicine. It's also disconcerting to see how much animosity the public has towards physicians in general and their salaries. The system is broken, and there is unfortunately no easy fix. Whether people like it or not, altruism only goes so far, and if you want to attract the best and the brightest, you have to pay them accordingly. There's obviously a breaking point in terms of salary, below which, the best and the brightest will opt to go into other career fields. And I say best and the brightest, because when it's you or your family member that's having a medical emergency at 2 am, who do you want attending to you? It's sad to see the public constantly trying to devalue the services that physicians provide. As physicians, at least we provide a valuable service to our community. What are the wall street & hedge fund guys doing to better their communities? The writing is on the wall. Unless things change, medicine in this country is doomed. Why would anyone want to jump through all the hoops and the BS that is required to become a physician and practice in an environment as dysfunctional as the one that exists today? Look at the time committment and opportunity cost of becoming a physician in comparison to what awaits you in the end these days. Anywhere from 11-16 years of college, medical school and residency/fellowship training while accruing over $200K + Debt, Working upwards of 80hrs/wk in training, no work hour restrictions as an attending, frequent call, life threatening emergencies at all hours of the night in many fields, frequent time away from family, exorbitant malpractice premiums, constant fear of litigation, constant threat of declining reimbursement, non-compliant patients, insurers that deny and delay payment, patients that steal from you without thinking twice. It's great. Really it is. What young, intelligent, highly-motivated college student wouldn't want to sign up right now?