Archive for the ‘Personal’ category

Navel Gazing

June 2, 2009

I’m sure by now, some of you are wondering why there hasn’t been another Hard Conversations post. To be honest, I’ve been struggling about how to handle these posts.

If you’re not interested in a rather navel-gazy post, you can skip this one. The summary: Hard Conversations has been delayed because I’m tired of denialists using this as a forum to look respectable. To even the playing field, I’m changing my commenting policy.  

It’s become abundantly clear that by forcing my commentors to be civil, I’ve handicapped the pro-science contingent. Instead of providing a purely educational forum, every post becomes a haven for uninformed, willfully ignorant individuals to post gibberish.



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.

My Motivation

April 16, 2009

I was going to post this later, after HC:Part 4, but I’ve been inspired by the last line of PalMD’s post here. Part 4 is coming tomorrow.

In the short life of this blog a number of commentors and emailers have asked what my motivation is. They usually mean to imply that I’m a pharma shill, or that I don’t care about children. Offensive implications aside, it’s still a good question. The answer is the same as the answer I give to another question: Why do I want to be a doctor?

Why have I decided to spend 4 years in college, 4 years in medical school, and 3-7 years in post-medical-school training just to be a doctor.

 I get asked if I do it for the money. A lot. I don’t do it for the money. In fact right now, I have more debt in student loans than my parent’s mortgage. Since my bachelors is in engineering, I’ve put off earning pretty decent money for 7 to 10 years, which balances out that salary thing quite a bit. So no, not the money.

I get asked if I do it because I have a God complex. Admittedly I’m not the most humble person in the world. This was true long before med school, and will be true long afterwards. But it’s a big stretch to say I have a God complex.

I get asked a hundred other silly questions. Is it because medicine is just cool? Notably one surgical patient said “It must be because yesterday you got to have your hand in my belly, it’s either that, or the nurses… it must be the nurses.” I have the utmost of respect for nurses, and the patient in question did too, I think that was the morphine talking. No it’s not any of those.

I’m in medicine now, because I can’t think of a more beautiful profession. As doctors, we hold the most sacred of all trusts. It is the most intimate of all relationships. In my training, people tell me secrets that they won’t even tell their spouses, or their children. Sometimes I elicit secrets they even try to hide from themselves.

 No one is more vulnerable, more laid bare, than a patient in need. With all of our talk of patient autonomy, in reality, you place your life in someone else’s trust when you go to a doctor.

Patients, and we are all patients – today, tomorrow, some day, we are all patients –  place our lives, and our loved ones in doctors’ hands.

When you see a doctor, the good ones aren’t motivated by that insurance payout, though that’s necessary to pay the bills. They aren’t motivated by how interesting the human body is, though it is more captivating than anything else in existence. The best doctors know that at the end of the day, it is our privilege as a profession to care for the health of  our community, our society, and our world.

Think for a second about what that means. We are not responsible for only our small subset – the few patients we can see in a day. As a collective we are responsible for, and accountable to, the world.

As physicians, it is our responsibility, it is our honor and our supreme privilege to serve people in the most basic, and most important of ways.  

That’s why I’m going to be a doctor.  That’s why I write here. It’s why I demand citations, why the burden of proof is so high. How can we trust the lives of billions to the diseased ramblings of some voodoo practitioner? It’s why I react strongly to the pseudo scientists and pseudo doctors.  How can someone who truly believes that we act for society even suggest the physically impossible, the unlikely, unproven, and dangerous? Offering false hope is beyond the pale, and insulting to the world.

 It’s  why I object when some amateur – and it’s invariably amateurs – cites gibberish to back their brand of nonsense. It’s why I take it personally when someone purports to know the secrets of the universe.  If you possess such secrets, why not prove them? Doing otherwise is not just an insult to my profession. It’s an insult to the public trust – that we hold above all else.  

It’s why I am offended, and infuriated, when a Doctor betrays that trust. When a doctor, through sins of commission, or sins of omission, betrays the very basis of our profession, our covenant with society, that cuts most deeply of all.

To me, there is only one solution to all of these betrayals. Light must be shown on them. Bright lights. We can maintain the public trust only by policing it ourselves, and by policing those purporting to act in such trust.

That’s my motivation.  I want to light a candle – because one blog is no spotlight – to shine a light on these pests that would destroy the foundation of my profession – it is my honor, and my privilege to do so.








(Edited for grammar on 4/18/09)

Science Based Medicine, and Hard Conversations

April 10, 2009

Before I disappear for the holiday weekend, I wanted to put out one last post.

Firstly, go check out Science Based Medicine – a blog about the battle against pseudoscience. Go check it out! I’ll wait right here. I promise it’s relevant to the rest of this post.

Secondly, through the short lifetime of this blog my goal has been to educate people about science and evidence based medicine. This has proved more difficult than I initially hoped.

In my initial posts I at least try to keep the language understandable to the generic educated lay person. Sadly by about comment 3, a pseudoscience advocate cites 3-10 articles that they don’t understand, or that are thoroughly out of date. Then by comment 10, multiple scientists have appropriately responded, but the thread is no  longer in reach for the very people I was hoping to reach with this blog.

Unfortunately, journal articles are just as easy to manipulate into pseudoscience as any other resource. Google-fu now makes it easy to put multiple citations and some 10 dollar words between a loving family and the appropriate evidence.

I’m going to try to make some changes going forward to make this blog still more accessible, and hopefully keep the discussion more relevant and understandable. Unfortunately, to do so I’m having to make some hard decisions. I banned my first poster last night, which greatly disappointed me. I was hoping by keeping a respectful tone I’d be able to have an open engaging discussion with both sides of the aisle.

I was warned before I started that affording respect to those who will abuse it would burn me. Some sites don’t have this problem – without the courteous tone I’ve encouraged, it’s very easy to burn the pseudo-scientific offenders out. Sadly, until now it’s been very easy for someone to just keep citing random articles and throw out a few “I don’t understand”‘s to sound reasonable enough, yet derail any progress.

Now after the holiday weekend – I’ll be swearing off the Internet from when this post comes up on line until Monday – I will post updated guidelines for the Hard Conversations series, and for this posting on this blog in general. I’ll continue to be soft on patients, but I will be much Harder on Woo. I apologize if that makes this blog feel less open, less free of speech, but I now think it’s necessary to ensure we are not hijacked by the unscrupulous minions of ignorance.  

So how does this connect to the Science Based Medicine blog? The post series in particular is by the wonderful Kimball Atwood, “Harvard Medical School: Veritas for Sale” . I have linked to the first post in that series. It may not be entirely appropriate reading for one segment of my audience – the parents/patients  among you will find it dry. The scientists and doctors may find it an entertaining, and disturbing look at the big business of medicine. I find this relevant because if Harvard can’t get it’s business in order on science based medicine, how in the world can you?!

The reality is that, it’s a complicated task to keep up with what is science and what is pseudoscience. I will endeavour to cover and explain science based medicine to the best of my ability. Please continue to let me know where I can improve guys, I really appreciate your input.

For now, enjoy!

-Whitecoat Tales

Blogging vs Mainstream Media and Other Digressions.

April 9, 2009

I’m sad to announce that my life is getting pretty busy from now through the end of the month. I’ll still be posting pretty regularly. Howeveras the Hard Conversations posts require a lot more time to write, a good bit of research, and some time moderating or participating in discussion, I’ll be interspersing some other posts along the way.

As I’ve written elsewhere on this blog, part of my interest in blogging stems from the opportunity to respond to the mainstream media. In my meager experience, medical journalists in the mainstream media are journalists first, and vaguely medical second. The writing is often excellent – crisp, succinct, and well presented, far better than my admittedly amateurish style here. Sadly the science and medicine are often misstated, or distorted to have more shock value, or “pop”. I’d like to think that despite my stylistic demerits I make up some ground on accuracy.

Lately parts of the blogosphere have been a twitter with responses to a review of Openlab 2008 published by New Scientist. The general discussion is on the merits of the blogosphere vs the main stream media. Personally I think they both have their place.

It’s far too easy to use the blogosphere to confirm all of your own viewpoints rather than learn anything – something we’ve seen quite regularly in the comments on this blog! I think of the blogosphere as a whole as a supplement to the mainstream media, rather than it’s replacement.

In roughly that vein, today I’d like to direct your attention to an interesting post at Not Exactly Rocket Science. Ed Yong has a great perspective on this, since he writes both in the mainstream media and on his blog. I think he presents a balanced, accurate, and succinct view on the subject.

For now, enjoy!

-Whitecoat Tales

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.
-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.