Archive for the ‘Medical School’ category

Spot the Mistake, brief answers

June 26, 2009

Ok guys, I was hoping to have fully researched answers tonight. Sadly our library was closed and I couldn’t access the appropriate references.  I’ll just try and update this with references tomorrow. Below is the brief rundown, sans the numbers.

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Spot the Mistake (Chiropractic Edition)(updatedX2)

June 25, 2009

Let’s play a game! After my little blurb, I’ve posted something seen in a presentation made by a medical student, on chiropractic. In the comments post all the ways in which the student’s comment is wrong.

Some background: At my med school, there is a senior elective class where one can independently study and research an area of health care that isn’t covered in detail in our curriculum. This student chose chiropractic. Specifically he chose “Evidence based medicine applied to chiropractic.”

Disappointingly the presenter was not up on how to read or understand evidence based medicine.  It’s disappointing because the student in question is an “honors” level student, and will be going on to do his residency at Mayo clinic, in a very competitive speciality.

Among other things, he took Cochrane reviews, and called them biased. He didn’t identify any particular bias. He just picked the author of the Cochrane review and said that this author was against chiropractic. Throughout the presentation he had scattered statistics that “proved” the usefulness of chiropractic.

The worst part of all this, is that his presentation was supposedly reviewed by a clinical professor BEFORE the presentation. I’m hoping that the doctor in question was just busy, because if not, some attending at my school has some ‘splainin to do.

At any rate, I’ve presented the text of the worst slide below. In the comments, post why you think he’s wrong. If possible pop a reference on, but there are multiple right answers that don’t require any research at all!

Chiropractic is, hands down, safer than conventional therapy!

  • The rate of the worst complication (vertebrobasilar artery dissection) is at best 1 in 10000.
  • Compare this to a 0.4% mortality rate with chronic NSAID use.

There are lots of ways in which this is wrong, pick your favorite.

Hint: More than one of the reasons this is wrong are completely independent of the accuracy of the statistics he provides.  That is, the rate of vertebral artery dissection really could be 1 in 10000 (which I doubt, but research to follow with my answers tomorrow) and he’d still be wrong.

 

Answer to follow tomorrow, with a little bit of research blogging thrown in for good measure.

 

UPDATE:

Totally slipped my mind when I initially posted this. There is also a highly entertaining post over at Science Based Medicine on Chiropractic.

If you end up reading through the comments you’ll see that not all doctors understand anything at all about science.

UPDATE 2:

This is probably going to be hard to pick out without the context of the presentation around it. I’m looking for problems with the actual comparison of the rates given. This is not an apples to apples comparison, and he should have known better.

OBGYN: First Cuts

May 6, 2009

I’m two days into Labor and Delivery and haven’t had time to really process any of it. The thing about OBGYN is that it’s a surgical speciality. This is less than stellar for a couple of reasons. 

  • Early mornings: We round on our (more than 20) patients no later than 5:30, of course this means that I need to be there significantly earlier than 5:30 to spend more than 3 minutes with my patients, and not look like an idiot on rounds.
  • Late nights: We get out pretty late, and after I go home I still need to study.
  • I haven’t really had a ton of time to think, so my thoughts here aren’t particularly deep.
  • Unlike Orac I am not a surgeon. Anyone who has seen me in an operating room would never ever mistake me for a surgeon.
  • I’m very tall. Most OBGYN’s at my institution (35 of 40 residents) are female. Most of them are short. That means that I’m spending 3-8 hours a day killing my poor back, holding the bladder blade.
  • Did I mention holding the bladder blade? The bladder blade is the implement used to keep the bladder, and part of the body wall, out of the operating field. This allows the surgeon to perform the C-section. I’m told this makes me an important member of the surgical team…

On the other hand. This is the only service I’ve been on where people are so happy! I love that about this rotation. Sure the women are angry and screaming when they’re in labor, but that is to be expected. These are the only patients I’ve seen happy to be woken up at 5 in the morning and asked if they’ve passed gas yet. Don’t look at me funny! Flatus is very important to surgeons – you can’t go home til we know your gut works.

Heck, today I asked a patient that and they said “Nope, but look at the baby isn’t she cute?!”

You just don’t get that on surgical oncology, no one says “Nope but look at that tumor!”

On a completely different note, I still have not achieved my goal for the rotation. What’s my goal? Well I’m going into emergency medicine. I won’t do C-sections as an EM doctor. But I will occasionally have to deliver a baby. I really want to be ready to do that when the time comes. So my goal this rotation? Catch a baby. More officially, “deliver” a baby. I hope that you’ll all wish me luck in my quest to help bring a bundle of joy into the world.

Moving on to general meta-blogging.

I’m having a tough time focusing on specific blog posts right now so I’ve been simultaneously half working on far too many posts right now, including:

  • Last post on Swine Flu: One more research article on the subject, it’s really more on flu in general, to clear up alot of myths I’ve been hearing repeated.
  • Post on Jadedness in physicians: wherein I discuss apparent jadedness as a coping mechanism, among other things. It’s also kind of  a segue into a series of posts (in the very very long run) about the bad parts of medical training.
  • Parts 4 and 5 of HC:Vaccines and Autism. I can guarantee these won’t come before the weekend. The HC posts are really satisfying for me to write, but the research takes time, and I work hard to get the science right.
  • My first actual, thought out reactions on OBGYN, with some answers for the readers who took the time to comment on OBGYN dreamin’.
  • Two completely random posts that are more for me than all of you, but posts that hopefully some people will enjoy anyway.

Feel free to vote for which of those posts you want to come out first in the comments. No guarantees, but I’ll try to take into account what my readers actually want to read rather than my own randomness alone.

OBGYN dreamin’

May 4, 2009

So I have just started on obstretrics and gynecology. I’ll have less free time over the next 6 weeks, so more of my blogging is going to be of the personal variety this. I feel the need to post pretty regularly, and the research heavy posts demand more time than just telling you what my life is like.

Tomorrow will be my first clinical day on OB. I’ll be starting on Labor and Delivery(L&D). I suspect a good number of my readers have seen L&D from the other side of the awkward-chair-with-stirrups. I’m going to try to put down some quality posts about how things are from the medical student side of things.

I’d love to see everyone out theres thoughts on OBGYN in general, and L&D/birth specifically as we get started here. Actually, I’m relying on you guys to help provide me with patient perspectives I may not get in the hospital. Feel free to post your thoughts, questions, stories (both good and bad), and whatever else you think is relevant!

A side note: direct you guys back to the disclaimers page on the side bar. Skip down to the part about patients. Whenever I post about life in the hospital, I will always change any potentially identifying details of any people involved, and whenever possible I’ll be using patient pastiches (combinations of multiple patients) rather than real single patients. This is out of respect to the people involved, and in compliance with the variety of patient privacy laws in force.

Starting off strong

March 29, 2009

One thing I’ve learned in the last year is the importance of starting out strong. So today, starting out my blog, I’d like to talk about starting in the hospital, consider this my prototypical “Behind the curtains of medical school” post.

I started my clinical rotations in July. Clinical rotations are basically where a third year med student, enters the real world of medicine: the hospital. I’d just spent the last six years of my life in a variety of classrooms. Initially it was four years of college, concealed from reality in the ivory towers of my engineering degree. After that, two years of med school learning basic science, blissfully unaware of real people. But in July I stepped into the hospital for the first time, with more than a little fear in my eyes.

We enter the scene on my first(ish) day of my first rotation – vascular surgery. It’s 4:30am, and I’m in the hospital, and groggy. Why am I groggy? I’m post-call1, which a story for another day entirely, suffice to say that it’s my first day, but I’ve been awake and in the hospital all night, and I just got a page on my shiny new pager saying to go to a random floor in the hospital.

I wandered about aimlessly for a bit before a vaguely familiar face- another med student- flags me down and directs me to our lair. Once I stop looking like a stunned duck, one of the interns tells me all about this rotation, what to expect, and to this day, I have no memory of anything she said besides “now go pick up a patient and get ready to present – just ask the nurses what happened overnight if you don’t know what’s going on.”

The basic morning routine in the hospital goes something like this: Get to the hospital, check on your patients, and then, rounds. On rounds, the whole team (Attending doctors, residents, interns, med students, discharge planners, and other members of our medical entourage) goes room to room and discuss what happened to a patient overnight, how they’re doing/what is going on (your assessment), and what’s going to happen next (The Plan).

Early on as a med student, you’re first responsibility is to “present” them on rounds – give that brief summary, assessment and plan, along the way, residents or attending physicians will “pimp” you – ask you questions about what you’re presenting.

Unfortunately, on day one, I knew about as much real medicine as your average house plant, and while the fourth year student was trying to help me out, my first rounds was a disaster.

“What’s the method of action of heparin?” – “umm something to do with antithrombin?”

“Wrong “, (I later found out I was not wrong, as much as incomplete) “What is the most common cause of post operative fever on day 1” belted out another resident.

“Atelectasis” – This one I knew (later I found out that the evidence for this surgical truism is weak at best)

“Good at least you’re not completely incompetent”

Then, my resident asked me the one question no med student wants to hear on day one – “So what do you want to do with this guy?”

You have you understand, once you’re deep in third year, that’s your cue to unleash all your knowledge, impress the heck out of everyone, today, that question is where I earn my stripes… but that day, I had no clue. The very idea that someone would ask me this seemed preposterous.

“Physical therapy?” I tentatively replied, hoping that’s what the sympathetic fourth year student was trying to silently hint to me. “Good, maybe we’ll make a surgeon out of you after all.”

We moved on, I was off the hot seat, and afterwards my intern sent me home to sleep. To this day, I’ve never felt more off-balance than I did then. I’d like to think my trial by fire then, has made me prepare better, and hopefully will make me a better doctor.

So today, as I start this blog, and you wonderful readers start this journey with me, lets hope we’ve gotten off to a much stronger start.

That’s all for now folks. Feel free to post or email me comments, thoughts, anything else you think of.
Enjoy!
-Whitecoat Tales

1In an amazing job of mismanagement, I received my call schedule at surgery orientation, and immediately I discovered I was on call DURING ORIENTATION. Trust me that this first night will be blogged about at length eventually. For now, all that is relevant is that on my first non-orientation day, I hadn’t slept all night, and hadn’t eaten in 16 hours.