Some medical diseases with funny names (not necessarily outcomes) are:
Chinese Restaurant Syndrome
(allergy to MSG, monosodium glutamate)
and
Licorice Intoxication
(for those of you who appreciate this kind of stuff: licorice disables an enzyme that converts cortisol --> cortisone, so you have lots of cortisol around. This excess cortisol binds to the aldosterone receptor. The effects of this are similar to aldosterone (except more) and increase sodium and water retention, increase blood pressure).
and
ACHOO syndrome
(Autosomal Dominant Compelling Helioophthalmic Outburst Syndrome)
which affects somewhere around 10-20% of all people and means that you sneeze when you look at bright lights (like the sun). Sneezing in response to photons (light particles).
pretty cool name, though, right?
February 16, 2010
sucking the marrow out of the weekend
2 of my most favorite people
They say in medical school you're perpetually behind, so the best thing to do is to accept it and keep on keeping on with everything. I think that quality of never being able to feel like we're actually on top of what we have to do may be one of the reasons that lately, everyone is feeling so down on themselves without really knowing why. This is why weekends like this past one - a long weekend combined with a final exam on Friday morning, so that the whole weekend was spent in complete and utter glee - are so important. They let us pursue the other parts of our lives, the other parts of ourselves that we may not have created a space for at medical school - partly because there's just not enough space for full personalities, and partly because there are not enough different situations to bring out very many qualities. Mostly medical students are super bright, uber motivated, incredibly curious, really kind, and very hardworking - but that's because those are the qualities perpetuated by the institution of medical school. But what about the parts of us that are creative? or fun? or daring? or interested in chinese american history, athletic events, knitting? Is there no place for any of these things in our lives during medical school?
Early on, a professor told us to decide on one non-medical aspect of our lives to work really hard to maintain during medical school, because the rest would fall apart. I remember thinking, one non-medical aspect of my life - hah! There are so many non-medical aspects of my life that are vital to my well-being, how could it be possible I would only have time enough for one?
Fortunately, I have been able to maintain more than one - but only slightly and only with incredibly hard work, diligent time management, and impossible energy. And my more than one non-medical aspects are staying in touch with my family and very close friends, as well as working out consistently. That's all I consistently commit time and energy to that has nothing to do with learning medicine. How is it possible that my life went from so full of so many questions and directions to being even fuller with just one big thing.
Side note, I went to the Museum of Chinese Americans this past weekend - and it was one of the greatest museums I have ever visited. It made want to learn more about Chinese and Chinese American history. I'm looking for book suggestions.
February 9, 2010
Prescribing Medication/There is no balance
We had a lecture today on religion and spirituality and their roles in medicine by one of my favorite professors. He began the lecture saying "If there was a risk-free intervention that was associated with >10 years of additional life expectancy, would you be interested in learning about it?" He then proceeded to show us research that supported praying for people who are sick increasing health outcomes, correlations between attending religious services and better health, and that ordained people are healthier then the average non-religious person. The data were very convincing but there were so many questions left unanswered including:
-Is bringing religion into medicine actually "risk free"?
-How do you standardize prayer?
-What efforts were made to control for confounding factors such as the effect of having a community or a strong family structure on health - both associated with religious people and good health; showing a relationship, but not causality (one did not cause the other, necessarily)
-If we do buy into this enough to at least say it couldn't hurt and may help some patients, how do we talk about religion and spirituality with patients?
Our professor left us with the idea to open up the conversation to those questions - to take a "spiritual history" and ask how the patient thinks this will affect her/his medical care and/or health. I'm still not quite sure I could talk about this smoothly, without clouding the conversation with my own judgment about specific religions (and organized religions, more generally). Plus, what if someone has religious beliefs that really don't jive with me? Many religions are patriarchal and even misogynistic - an association with those sorts of beliefs would be a hard thing to support in one of my patients. But maybe prescribing something more general, like meditation - or clearing moments for reflection - or attending a support group or community gathering regularly (regardless of whether it's neighborhood softball or a book club or church).
On another note, tonight I attended a panel of Family Medicine Ob-Gyns who talked about their career paths and the choices they've made. They agreed that there is no balance, only tilting to one extreme and then the other - but that they love it and couldn't imagine being happy doing anything else. One of the physicians brought her ten year old daughter who talked quite candidly about what it's like to have a mom who is a physician, especially one who leaves in the middle of the night to deliver babies. The daughter said that it was hard because she missed her mom, but that there were some times that her mom kept as sacred (her birthday, for example) and that overall, she was really proud to have a mom who is a doctor and thinks it is inspiring her to want to be a doctor too. Hard to argue with that.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
“As Galen says, 'confidence and hope do more than physick – he cures most in whom most are confident’ … Faith in Gods or in the Saints cures one, faith in little pills another, suggestion a third, faith in a plain common doctor a fourth.”
– Sir William Osler
-Is bringing religion into medicine actually "risk free"?
-How do you standardize prayer?
-What efforts were made to control for confounding factors such as the effect of having a community or a strong family structure on health - both associated with religious people and good health; showing a relationship, but not causality (one did not cause the other, necessarily)
-If we do buy into this enough to at least say it couldn't hurt and may help some patients, how do we talk about religion and spirituality with patients?
Our professor left us with the idea to open up the conversation to those questions - to take a "spiritual history" and ask how the patient thinks this will affect her/his medical care and/or health. I'm still not quite sure I could talk about this smoothly, without clouding the conversation with my own judgment about specific religions (and organized religions, more generally). Plus, what if someone has religious beliefs that really don't jive with me? Many religions are patriarchal and even misogynistic - an association with those sorts of beliefs would be a hard thing to support in one of my patients. But maybe prescribing something more general, like meditation - or clearing moments for reflection - or attending a support group or community gathering regularly (regardless of whether it's neighborhood softball or a book club or church).
On another note, tonight I attended a panel of Family Medicine Ob-Gyns who talked about their career paths and the choices they've made. They agreed that there is no balance, only tilting to one extreme and then the other - but that they love it and couldn't imagine being happy doing anything else. One of the physicians brought her ten year old daughter who talked quite candidly about what it's like to have a mom who is a physician, especially one who leaves in the middle of the night to deliver babies. The daughter said that it was hard because she missed her mom, but that there were some times that her mom kept as sacred (her birthday, for example) and that overall, she was really proud to have a mom who is a doctor and thinks it is inspiring her to want to be a doctor too. Hard to argue with that.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
“As Galen says, 'confidence and hope do more than physick – he cures most in whom most are confident’ … Faith in Gods or in the Saints cures one, faith in little pills another, suggestion a third, faith in a plain common doctor a fourth.”
– Sir William Osler
January 20, 2010
a return to balance? Bacteria and Broomball
I think we are all reevaluating the balance in our lives lately. Especially as we learn about antibiotics and inflammation - both things that of which you want to make sure you have just the right amount. Too little and a bacteria could take over your body and kill you, but not too much and you could set off a series of reactions in which your body would try to kill itself.
Maybe some of it is because we're in the thick of winter, but the snow has become a washed out gray-brown background as it has melted and refrozen several times over. Or maybe because we feel like we should be in the clear; we have learned the name and function of practically every part of the human body and yet it still feels like we're scraping the bottom of the barrel for knowledge and energy.
I think the point is to remember that we're still scraping something. Yesterday I went to a friends house after the exam with a group of wonderful people and we chatted about the exam a little, but mostly we talked about the other things in our lives. It's refreshing to know we can share those parts of ourselves as well. And tonight I went for a solo night time run and then met up with my broomball team to play our first late night game. We lost - but it was amazingly fun. It's basically impossible to feel anything but playful when you're all running around ON ICE in hawaiian shirts waving sticks in the air. Oh yes, there's still hope for balance.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Be Present. Choose Happiness.
-a quote on a friends fridge
Maybe some of it is because we're in the thick of winter, but the snow has become a washed out gray-brown background as it has melted and refrozen several times over. Or maybe because we feel like we should be in the clear; we have learned the name and function of practically every part of the human body and yet it still feels like we're scraping the bottom of the barrel for knowledge and energy.
I think the point is to remember that we're still scraping something. Yesterday I went to a friends house after the exam with a group of wonderful people and we chatted about the exam a little, but mostly we talked about the other things in our lives. It's refreshing to know we can share those parts of ourselves as well. And tonight I went for a solo night time run and then met up with my broomball team to play our first late night game. We lost - but it was amazingly fun. It's basically impossible to feel anything but playful when you're all running around ON ICE in hawaiian shirts waving sticks in the air. Oh yes, there's still hope for balance.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Be Present. Choose Happiness.
-a quote on a friends fridge
January 13, 2010
Can We Agree on SOMETHING?: Increasing Medicaid Reimbursements
I read an article today on the The New Republic that made a great case for one issue that is being toyed with in the health reform debate on which we could potentially all agree: increasing the amount Medicaid reimburses physicians, specifically primary care physicians. For anyone who isn't quite sure what Medicaid is, it's our federal and state program that covers the medical expenses of people whose incomes are near or at the poverty line. Except that "federal and state program" implies that it's pretty much the same across the country (it's not), and "near or at the poverty line" skirts over the huge discrepancies with what qualifies in some states versus others - and don't even get me started on what the poverty line actually means and how it's a horrible measure of anything.
Back to Health Care Reform: Currently, Medicaid reimbursements to physicians (ie how much physicians get paid by insurance) are much lower than the reimbursements physicians receive from private insurance companies. This divergence is most notable in how Medicaid pays primary care physicians. The result of all this is that many physicians have to limit the number of patients who have Medicaid or stop seeing patients with Medicaid altogether (see a Washington Post article on the Mayo Clinic discontinuing all Medicaid Pateints). With the economic recession and health care costs climbing, decreasing the number of patients with medicaid is becoming a way for hospitals and physicians everywhere to reign in costs. From the Post article about the Mayo Clinic: "These decisions aren't based on timing with what's going on with the legislation," said Mayo spokeswoman Shelly Plutowski. "It simply is the reality of the health-care business, and how are we going to be able to continue our mission when these payments are so far below what it costs to provide the care."
This should be a wake-up call to anyone who is worried about the "rationing" of health care with any movement towards a system that covers more people that we already do ration health care. The only difference is that right now it is rationed away from those who cannot afford to pay for it (and who, coincidentally, have the highest likeliness of needing health care).
I'm hopeful that this could be one change that we could all get behind.
**Addition on 1/18/10: Letters to the New York Times about their article on increasing Medicaid reimbursements. It includes some from internal medicine physicians, directors of Medicaid offices, etc. Check it out here.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"It's not about rationing care-that's always the bogeyman people use to block reform. The real problem is unnecessary and unwanted care."
-Dr. Fisher, Professor, Dartmouth Medical School
Back to Health Care Reform: Currently, Medicaid reimbursements to physicians (ie how much physicians get paid by insurance) are much lower than the reimbursements physicians receive from private insurance companies. This divergence is most notable in how Medicaid pays primary care physicians. The result of all this is that many physicians have to limit the number of patients who have Medicaid or stop seeing patients with Medicaid altogether (see a Washington Post article on the Mayo Clinic discontinuing all Medicaid Pateints). With the economic recession and health care costs climbing, decreasing the number of patients with medicaid is becoming a way for hospitals and physicians everywhere to reign in costs. From the Post article about the Mayo Clinic: "These decisions aren't based on timing with what's going on with the legislation," said Mayo spokeswoman Shelly Plutowski. "It simply is the reality of the health-care business, and how are we going to be able to continue our mission when these payments are so far below what it costs to provide the care."
This should be a wake-up call to anyone who is worried about the "rationing" of health care with any movement towards a system that covers more people that we already do ration health care. The only difference is that right now it is rationed away from those who cannot afford to pay for it (and who, coincidentally, have the highest likeliness of needing health care).
I'm hopeful that this could be one change that we could all get behind.
**Addition on 1/18/10: Letters to the New York Times about their article on increasing Medicaid reimbursements. It includes some from internal medicine physicians, directors of Medicaid offices, etc. Check it out here.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"It's not about rationing care-that's always the bogeyman people use to block reform. The real problem is unnecessary and unwanted care."
-Dr. Fisher, Professor, Dartmouth Medical School
January 9, 2010
How To Teach Everything
Do not try to satisfy your vanity by teaching a great many things.
Awaken people's curiosity. It is enough to open minds; do not overload them.
Put there just a spark. If there is some good flammable stuff, it will catch fire.
-Antole France, Nobel Laureate in Literature
My mom and I were talking the other day about the extreme skill of people who can synthesize lots of information and break it down into just what's important and just what you can remember. It came up because we had been talking about translation and culture in my Medical Student Leadership Group and I told them about an experience I had with translation over break:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
One of my mom's friends who is a Somali refugee had just had double bypass surgery in the hospital. Bypass surgery involves having at least one, but sometimes more of the major arteries that provide blood to the heart replaced, in this case with a vein from his arm, which is very atypical. Usually a vein from the leg is used because you have so many more of them) only to discover a few days after his discharge that he was almost seizing in pain. He returned to the hospital to learn that he had fluid building up in his pericardium (the sac of tissue that surrounds the heart and keeps it separate from the rest of the contents of your abdomen), which he had to have drained over the course of a few days in the hospital. He was then discharged again with a list of nine medications to take.
And here is the real problem: the discharge paper wrote the medicines as their brand names, whereas the pharmacy gave him the generics. I'm not sure if the pharmacy explained it to him but I know he didn't understand and they gave him no written material with any explanation of which drugs are which and which to take for which. When I got to his house, his son (who speaks and reads more english than his father) showed me the sheet that he had created from what he heard the doctors say the medications were for. We googled the medications to find out what they were - but we still weren't sure which were important for keeping him from having another heart attack and which were for discomfort (one of the medications he was prescribed was zolpidem, which is an anti-anxiety medication that is used to make you sleep).
So we called the cardiologist on call (a different one)and asked him which medications were absolutely vital and could he please tell us the generic names of them. He immediately said three medications were absolutely vital (in the true sense of the word), but the others were more flexible. There were even a few that he only needed to take if he was in lots of pain (oxycodone) or couldn't sleep (zolpidem) or had heart burn (omaprazole). When we explained to the doctor that he had an incomplete grasp of the english language, the doctor totally got it and just broke it down into the most basic (and like he said, most vital) components.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
When talking to my mom, we were recounting the best teachers, doctors, lawyers we knew and how all of them shared the quality of not giving people information to look more knowledgable but in a way where they knew it was being absorbed. I used to think that professors that simplified things were less expert, but in medical school my favorite professor yet spent an entire class talking with us about a bathtub metephor he had for homostasis, the ability of the body to re-balance itself after being thrown out of whack.
Plus, I like the part in the quote about a spark.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I could teach a monkey calculus - you just have to find a way of relating it to something someone cares about. For example, so you like the WWF, right?..."
-my favorite quote about education, from the movie Road Trip
Awaken people's curiosity. It is enough to open minds; do not overload them.
Put there just a spark. If there is some good flammable stuff, it will catch fire.
-Antole France, Nobel Laureate in Literature
My mom and I were talking the other day about the extreme skill of people who can synthesize lots of information and break it down into just what's important and just what you can remember. It came up because we had been talking about translation and culture in my Medical Student Leadership Group and I told them about an experience I had with translation over break:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
One of my mom's friends who is a Somali refugee had just had double bypass surgery in the hospital. Bypass surgery involves having at least one, but sometimes more of the major arteries that provide blood to the heart replaced, in this case with a vein from his arm, which is very atypical. Usually a vein from the leg is used because you have so many more of them) only to discover a few days after his discharge that he was almost seizing in pain. He returned to the hospital to learn that he had fluid building up in his pericardium (the sac of tissue that surrounds the heart and keeps it separate from the rest of the contents of your abdomen), which he had to have drained over the course of a few days in the hospital. He was then discharged again with a list of nine medications to take.
And here is the real problem: the discharge paper wrote the medicines as their brand names, whereas the pharmacy gave him the generics. I'm not sure if the pharmacy explained it to him but I know he didn't understand and they gave him no written material with any explanation of which drugs are which and which to take for which. When I got to his house, his son (who speaks and reads more english than his father) showed me the sheet that he had created from what he heard the doctors say the medications were for. We googled the medications to find out what they were - but we still weren't sure which were important for keeping him from having another heart attack and which were for discomfort (one of the medications he was prescribed was zolpidem, which is an anti-anxiety medication that is used to make you sleep).
So we called the cardiologist on call (a different one)and asked him which medications were absolutely vital and could he please tell us the generic names of them. He immediately said three medications were absolutely vital (in the true sense of the word), but the others were more flexible. There were even a few that he only needed to take if he was in lots of pain (oxycodone) or couldn't sleep (zolpidem) or had heart burn (omaprazole). When we explained to the doctor that he had an incomplete grasp of the english language, the doctor totally got it and just broke it down into the most basic (and like he said, most vital) components.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
When talking to my mom, we were recounting the best teachers, doctors, lawyers we knew and how all of them shared the quality of not giving people information to look more knowledgable but in a way where they knew it was being absorbed. I used to think that professors that simplified things were less expert, but in medical school my favorite professor yet spent an entire class talking with us about a bathtub metephor he had for homostasis, the ability of the body to re-balance itself after being thrown out of whack.
Plus, I like the part in the quote about a spark.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
"I could teach a monkey calculus - you just have to find a way of relating it to something someone cares about. For example, so you like the WWF, right?..."
-my favorite quote about education, from the movie Road Trip
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