Here, hold this...

Getting in Shape for Spring

On Spring break this week. Trying not to think about school too much. Going to have to crack the books starting tomorrow, however.

And since we’re on the subject, Spring has me thinking I need to get in shape.

I’m not really overweight, but my BMI is not where I’d like it to be. I’m having trouble getting rid of the spare tire I developed during my undergrad years.

I run a couple times a week weather permitting, but it isn’t enough. I’ve started riding an exercise bike and climbing stairs on those days when going for a run isn’t convenient.


Also I started lifting weights again this week after several months of letting it go. Used to lift regularly during high school and tried to keep up with it during college, but these past few months of first year it totally fell by the wayside. I just felt I should be using the time more wisely.

I think that may have been a mistake. I feel so much better after a workout that I believe it will help improve my motivation and overall state of mind.

Besides, I don’t want to become an out-of-shape doctor. I feel like if I’m going to be one day counseling patient to lose weight, quit smoking and take better care of themselves, I better set the right example.

Worked back, legs and abs Tuesday and my upper back is nicely stiff and sore the today. Legs and abs not so much except for hamstrings and calves. They are just a teensy bit sore. I think all the running and the exercise bike has kept my legs in shape and that’s probably why they aren’t feeling the weights like my back is.

Have to work them harder next time.

Are You Thinking Primary Care?

A group of us were discussing this very issue this week and out of five of us, only one was considering primary care and he admitted that he would probably go with Emergency medicine or oncology instead.

Dr Kevin Pho has a good article this month in USA Today on the shortage of primary care physicians in America appropriately titled, Shortage of primary care threatens health care system.

By way of introduction, Dr. Pho writes…

Primary care should be the backbone of any health care system. Countries with appropriate primary care resources score highly when it comes to health outcomes and cost. The United States takes the opposite approach by emphasizing the specialist rather than the primary care physician.

Dr Pho (a primary care physician) then proceeds to lay out the problem pretty clearly in the body of his article…

How did we let primary care slip so far? The key is how doctors are paid. Known as "fee for service," most physicians are paid whenever they perform a medical service. The more a physician does, regardless of quality or outcome, the better he's reimbursed. Moreover, the amount a physician receives is heavily skewed toward medical or surgical procedures. A specialist who performs a procedure in a 30-minute visit can be paid three times more than a primary care physician using that same 30 minutes to discuss a patient's hypertension, diabetes or heart disease.

Dr. Pho also addresses this situation from our perspective as students and future doctors…

Medical students are not blind to this scenario. They see how heavily the reimbursement deck is stacked against primary care. Whether they opt to become a specialist or a primary care physician, they graduate with the same $140,000 of medical school debt. The recent numbers show that since 1997, newly graduated U.S. medical students who choose primary care as a career have declined by 50%. This trend results in emergency rooms being overwhelmed with patients without regular doctors.

Not everyone agrees with Dr. Pho. Here is a response to his article that Dr. Pho posted on his blog KevinMD that offers some insight by comparing the medical profession to the rest of the business world. Here is just a snippet of the opinion…

Your description of "fee for service" and how it is affecting the medical community reveals the incredible naiveté of doctors and other medical employees. This fee system is, indeed, how business in general works. Different prices for different products is what is termed "product mix" in the real business world. Every company is subject to this phenomenon Some products are incredibly profitable and some barely cover overhead, or are loss leaders. And many of the "consults" or services that I provided as a manufacturer of foodservice equipment earned absolutely no fees. Unlike you, I could not charge for my "professional time". I hoped that it would bring in profitable business and prepared my presentations and dialogues to bring about this result ,but had many failures or missed opportunities. The last two doctors I saw (for a skin condition and for gall stones) both came up with no diagnosis or proposed solution yet each charged me their "fee" of $110 and $230, respectively

In the end it all comes down to money. Can’t blame anyone really. It’s just a matter of being practical. If you can make more money as a specialist, there is little incentive to opt for primary care.

The solution to the problem is to find a way to make primary care a more lucrative field. Dr. Pho offers three suggestions in the conclusion of his original article, which I’ve paraphrased as follows…

1) Pay primary care for their time, rather than per patient
2) Forgive student loans if primary care is chosen
3) Pay primary care the same as specialists (See #1)

Personally, I think point number two is the most viable solution for the short term. I’m sure there are many med students who would seriously consider primary care if they didn’t have to worry about how they were going to pay off the debt.

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References:

http://blogs.usatoday.com/oped/2008/03/shortage-of-pri.html
http://www.kevinmd.com/blog/

Mind if I take a look in the trunk?

Drug Advertisements on TV

What’s up with those drug commercials on TV? Am I the only one annoyed and even offended by Big Pharma’s attempt to manipulate us as physicians?

What ’s the point of having the patient show up at the doctor’s office already asking for a drug by name except to pressure doctors into prescribing that particular product? After all, the patient doesn’t have the slightest idea if that drug is right for them or not.

Is this not an attempt by Big Pharma to coerce physicians into prescribing these products? Aren’t they trying to manipulate us by the shear volume of requests; enlisting the buying public to do the dirty work for them?

The doctor then has to waste exam time explaining to the patient why he or she does not need that med or why he prefers a different product.

This creates a doubt in the patient’s mind that maybe they aren’t getting the best care. They can’t help but wonder if they wouldn’t do better if their doctor would only let them try the new magic pill.

I mean, how irresponsible can you get? Telling patients to ask their doctor if “the purple pill” might be right for them? Since when did the drug company and/or the patient become the one determining what is – or even if – a med should be prescribed?

New isn’t necessarily better. Most of these new drugs have a limited track record. There are far cheaper generics with decades of safety evidence that are probably a better choice for the patient. Furthermore, most of the advertising is for something equivalent, but usually more expensive than the generic alternative.

So what can we as doctors do?

Well, I believe we live in an over-medicated society as it is. I do not intend to add to the problem by writing scripts just because someone saw a TV commercial.

In fact, I plan to make it a point NOT to prescribe any med advertised on TV unless it is clearly the superior choice for the patient. Perhaps I’m being naive. After all, I’m just a med student at this point and haven’t yet experienced the real world of medicine and big business.

Nevertheless, I think the pharmaceutical companies are being totally irresponsible. I think there should be a ban on drug companies advertising directly to the public. I think they should restrict their promotional efforts to medical doctors; the only people who have the ability to evaluate the medication.

I don’t expect to see this happen any time soon. I’m not that naïve.

Dinosaur Sighting

I was back home the past few days because of a family situation that fortunately turned out to be nothing. Drove back to school last night and now I’m trying to get back into study mode.

Had some down time yesterday afternoon and decided to surf the net for a bit and read a few medical blogs. While doing so, I ran across a couple of new ones that I really think would be of interest to med students. (New to me, anyway.)

I made a quick blog post yesterday about one of them (Suture for a Living) and today I’m going to take a study break and tell you about the other one, namely, Musings of a Dinosaur.

Musings is authored by a family doc in private practice; thus his use of the term, Dinosaur. I spent about an hour reading through his most recent posts and I have to tell you it was difficult to drag myself away. His writing contains a nice mix of humor, sage wisdom, and practical advice in a style that is engaging and personable.

I don’t know why, but images of “Doc” from the old “Gunsmoke” television series readily came to mind as I was reading through his posts. (Although it’s obvious he has a modern practice and he’s not that old.)

Still, I couldn’t help wondering if he has one of these.


You know, for house calls.

But seriously, I digress. If it weren’t for my Dad needing help out in the garage, I’d probably still be reading. I’m going to add this one to my regular reading list just as soon as I figure out this whole RSS thingy.

Suture for a Living

Here’s an interesting blog I ran across today written by rlbatesmd, a plastic surgeon out of Little Rock, Arkansas.

When most people (including some med students) think of plastic surgeons they automatically think of Hollywood and bizarre cases like Michael Jackson. However, most plastic surgeons are serious, highly skilled doctors that play an important role in the health care industry.

Here’s how Dr Bates describes her blog…

I am a plastic surgeon in Little Rock, AR. I may "suture for a living", but I "live to sew". When I can, I sew. These days most of my sewing is piecing quilts. I love the patterns and interplay of the fabric color. I would like to explore writing about medical/surgical topics as well as sewing/quilting topics. I will do my best to make sure both are represented accurately as I share with both colleagues and the general public.

After browsing through her blog archives a bit, it is apparent that (aside from the quilting articles) Dr Bates has a serious teaching blog. Well worth checking out.

It’s not all boob jobs and tummy tucks.

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Reference: http://rlbatesmd.blogspot.com/

Is it worth it?

My previous post about credit card debt and the trouble a couple of my friends are going through right now has me thinking a lot about finances and just how expensive it is to go to med school.

Sure, I added it all up before I ever decided to pursue this career. I calculated the total amount of student loan debt I’d have when I finally got out and just how many years it was going to take to pay it all off.

And I’ve considered the additional years of my life that I’m investing in academics while my friends from college are now out earning a living.

I knew all this going in, but that doesn’t mean that it ever goes away. No matter how involved you get with studying, the cost is always hovering in the back of your mind.

I know it was the right decision. I can’t think of anything else I’d rather do than practice medicine. I just wish it didn’t take so long and that it was more affordable.

Steer Clear of Credit Cards

I still don’t have a credit card. Not sure if I’ll ever get one.

I have two friends here at school currently struggling with credit card debt at a time when they don’t need the added pressures. One, a first year med student, already has accumulated over $5000 in CC debt (part of which he accumulated as an undergrad) and the other, a third year, has racked up nearly $12,000.

It boggles the mind to think about having that much debt hanging over your head in addition to having to worry about school.

Both have admitted that they got in trouble with the cards when they started using them for everyday expenses like pizza and beer.

I have a debit card for online purchases, groceries and other expenses. I think it is a much better choice.

How's your luck holding out?

If it weren't for bad luck, I'd have no luck at all...

TALENT, Ore. (AP) -- Big George Helms had tickets for last weekend's NASCAR race at the Las Vegas Motor Speedway, but died before he got to use them. He still made it to the track, though.

At 6-foot-5 and 400 pounds, Helms wouldn't have been able to fit into a race car. But after his death from a heart attack Dec. 28, loved ones decided to try to fulfill the 54-year-old's dream of participating in a NASCAR race, and arranged for the former logger's ashes to be driven around the track.

That would be my luck. Finally get the chance to take a spin in a NASCAR race car and croak before the big day arrives.


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Reference: Oregon man takes posthumous NASCAR spin

Expensive Placebos Work Better

Ah ha, just as I suspected; cheap placebos don’t work as well as expensive ones. Here’s what a recent study revealed…

A 10-cent pill doesn't kill pain as well as a $2.50 pill, even when they are identical placebos, according to a provocative study by Dan Ariely, a behavioral economist at Duke University.

[snip]

Ariely and a team of collaborators at the Massachusetts Institute of Technology used a standard protocol for administering light electric shock to participants’ wrists to measure their subjective rating of pain. The 82 study subjects were tested before getting the placebo and after. Half the participants were given a brochure describing the pill as a newly-approved pain-killer which cost $2.50 per dose and half were given a brochure describing it as marked down to 10 cents, without saying why.

In the full-price group, 85 percent of subjects experienced a reduction in pain after taking the placebo. In the low-price group, 61 percent said the pain was less.

Very interesting, but not too surprising.

For the record, when Neumed goes to his doctor for a placebo, he wants the real thing. Not a cheap substitute. I don’t think that’s too much to ask.

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Source: Costly placebo works better than cheap one

What were they thinking?

By now I'm sure you've heard about the clinic in Nevada exposing patients to Hep C and possibly HIV by reusing syringes and vials. Here is a follow-up story on ABC's Good Morning America which implies that this may not be an isolated case...

An outbreak of hepatitis C at a Nevada clinic may represent "the tip of an iceberg" of safety problems at clinics around the country, according to the head of the Centers for Disease Control and Prevention.

The city of Las Vegas shut down the Endoscopy Center of Southern Nevada last Friday after state health officials determined that six patients had contracted hepatitis C because of unsafe practices including clinic staff reusing syringes and vials. Nevada health officials are trying to contact about 40,000 patients who received anesthesia by injection at the clinic between March 2004 and Jan. 11 to urge them to get tested for hepatitis C, hepatitis B and HIV.

The article quotes Dr. Julie Gerberding, head of the CDC...

"This is the largest number of patients that have ever been contacted for a blood exposure in a health-care setting. But unfortunately we have seen other large-scale situations where similar practices have led to patient exposures."

I can't believe this happened at even one clinic, let along is going on elsewhere. Furthermore, I can't help wondering if this is just a case of the news media attempting to milk this story for all it's worth.

In any event, this should never happen in a contemporary health care facility.

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Reference: CDC Warns of Safety Problems at Clinics

How to Keep Motivated

I hate studying.

Seriously, it’s the pits.

I don’t mind learning. I love to learn. If there’s something I want to know, I can read about it for days and not grow weary of the hunt. But when it comes to just cramming in knowledge for the sake of passing exams, forget about it.

So you see, no matter how badly I want to be in med school (or how badly I want to become the best doctor I can be) it’s hard to stay motivated day in and day out. I just don’t like to sit and study for hours at a time.

I’m just not made up that way.

So to deal with this problem, I decided to compile a list of the various things that motivate people to keep going when the going gets tough. And since we’re all pretty much in the same boat, I figured this list my help you.

Here’s what I’ve come up with so far…

1) Love

Don’t laugh. The dudes that came up with the phrase, “Behind every great man, there’s good woman” knew what they were talking about.

Love is the most powerful motivational force known to the human race. Many a man has been driven to move heaven and earth all for the heart of fair damsel. And if you have any doubt, just consider how devastating a broken heart can be.

Unfortunately, love is a rare commodity. If you can find a way to harness the motivational power of love, you will have the keys to greatness within your grasp. Without it, you will have an uphill battle all the way.

2) Financial Gain

Say what you will, but next to love financial gain is probably the second most powerful force in the universe. Few people do anything without some thought of reward or benefit for their troubles at the end of the day.

Don’t get bogged down with platitudes. Personal gain is a tool. Use it. If a picture of a Porsche or a Ferrari helps keep you focused, then go for it. You can decide what to do with your money AFTER you get out of med school. For now, you just need the energy to spend another hour on path.

3) Hero Worship (or if you prefer, “Self-improvement”)

This works for athletes, musicians, dancers, actors and other skilled artisans. There’s no reason it can’t work for you in your quest to become a great physician.

Find a mentor or role model; someone you admire and that you would like to emulate. Find someone you can look up to; someone who has accomplished great things and use that inspiration to help you strive harder.

It may not be a medical professional. If the work ethic or accomplishments of Tiger Woods or Michael Jordan inspires you to greatness, that’s all that matters.

4) Fear of Failure

I don’t really see this one as a very good study motivator. It apparently works for some people and it may work for you. Personally, I prefer to focus on positive rewards rather than negative consequences. I think positive thoughts yield a stronger motivation than negative ones.

5) Revenge

It’s often been said, “Success is the best revenge.”

I couldn’t agree more.

Of course, it doesn’t apply to every situation, but those situations don’t have anything to do with getting through med school so we can dispense with them for our purposes.

No, if you’re best girl dumped you in high school for some dumb jock with a Camaro, she’ll be kicking herself when she sees you cruising by in your Jag and pulling down six figures. ‘Nuff said.

Are You Into Medical Podcasts?

If you’re into the ipod and specifically medical podcasts, here are some good ones you should check out. I prefer to listen to them while I’m driving or when I go for a run.

I don’t listen to all of these, but I thought I’d list them for you to check out.

http://www.medpod101.com
http://www.icurounds.com
http://www.burndoc.com
http://www.instantanatomy.net
http://www.pusware.com/


Additional podcasts (several are on iTunes):

NEJM This Week
Annals of Internal Medicine Podcast
Learn Internal Medicine by MedPod101.com
Albany Emergency Medicine Lecture Series
MedicinePod101
Listen to the Lancet
MUSC Neurological Health Podcast
Neurology (the journal) Podcast
OR-live
Surgery ICU Rounds Podcast
Survey of Pharmacology
QuackCast
The Medkast
UTHSC Internal Medicine Residency Podcast
Goljan lectures
Dr. Jeff Guy