I remember going to an infectious disease lecture some time ago and hearing the specialist paint a grim portrait of the future: the rapid resistance bacteria is developing against our weaponry will make antibiotics obsolete in the next fifty years. Unless we do something about it, we will be propelled back into the dark ages.
This article is a good snapshot of where we stand now in the search for novel therapies.
I recently had the opportunity to work with a medical student while on call. I had received notice of a ward issue to see that sounded appropriate for his level. I asked him to go first and that I would join him shortly thereafter.
When I arrived, he briefed me on the problem at hand. When I asked what his thoughts were and what he wanted to do, he supplied me with a full and extensive workup for a simple case of pain.
At one in the morning, I reminded him that our job was to make sure nothing life threatening was happening, that we have done enough investigations to aid us in that cause, and to keep patients alive until the morning.
Without the backup, manpower or support, we were not in the best position to start investigating and treating everything fully, unless something truly worrisome was suspected.
When the emergency department is inundated with people, every service feels the pressure. Consults are requested, teams are pressured to admit or move patients. The night seems endless.
Last night, the emergency department was packed to the brim. I had never seen it so busy. There was no particular cause for this influx, no mass casualties or public event gone wrong; people just got sick at the same time for different reasons.
The night was steady until three in the morning. Many of my classmates on other services were present as well seeing patients. In those hasty moments between cases, we caught our breaths and checked on each other.
The key word to all of our conversations was “surviving.”
This quote comes to mind when I think about the new addition in my toolbox. I now have the authority to prescribe narcotics with my triplicate prescription pad. These are highly regulated substances for obvious reasons.
I must ensure that I dispense them appropriately. More crucially though, I must keep my prescription pad safe from theft.
In a previous post I highlighted some positive feedback I received about my history taking. I received a lot of comments about sharing what I was doing. I think that history taking is a very individualized process. In all honesty, there is no right or wrong way to take a history. Each person’s style is a reflection of their thinking process, their knowledge base, and their comfort level and that naturally evolves over time.
Having said that, this is what I generally do now.
I don't even know where to begin or how to feel but I received an email today that after 5 years of medical school I was being dismissed. I'm completely blindsided & I don't know where to go from here. I would appreciate any knowledge you could share on being a dismissed international medical student & what my prospects are. I don't want to give up on this dream, I've dedicated everything in my life to this, I'd appreciate any advice I can get from you. Thank you very much.
I am very sorry to hear that you were dismissed from your school. While I know people who were unsuccessful in matching into residency, I do not know anyone who was dismissed before completion.
I think that your best course of action is to go to your school and ask for the reason and have a better understanding of what led to this decision. If any grievances they have with your training can be corrected, then you can appeal to return to class on the basis that those issues are addressed. However, if this is not the case, then I do not know how this may affect your prospects in other schools.
I think it is important to know what led to this dismissal before considering future plans towards medicine either at the same school or elsewhere.
Whatever comes from that discussion with your school, I wish you best of luck and hope everything turns out. Take care.
To everyone who had written a message to me in the last little while, I want to first start by apologizing for taking me such a long time to get back to you. It has been a busy couple of weeks. With that said, let us get started on the big mailbag.
Pendere:My pen of choice. I use a Lamy Safari Vista, which is fully transparent so that I can see where I stand ink-wise and refill in advance.
I have to check the tiny window on opposite sides of my pen that allow me to see how much ink remains. Generally once it appears empty, there is about 20% left in the converter.
Ashenmemories:Agreed. The Safari is pretty durable and a smooth writer for a reasonable price as far as fountain pens go. Have you thought about turning any of the disposables into eye dropper pens? You wouldn’t have to worry about ink as much while at work.
I have not thought about it but perhaps that can be a future project of mine. I am actually considering getting another fountain pen for a different purpose at the moment. Perhaps I can shed some light on that if I get a chance to review it.
Rarelyposts:Resisting the urge to buy, but slowly losing…
Resistance is futile. In all seriousness, if you have thought about getting into fountain pens, I think this would be a decent one to start with. There is an investment up front - there are definitely cheaper pens out there - but it was built as a trainer and it writes fantastic.
Wayfaringmd:Only a doctor could write such a thorough review of a pen.
I should have become a dermatologist then. Then I could apply that level of scrutiny to a mole. I kid. I kid.
I have always found fountain pens to be intoxicatingly beautiful, but I never brought myself to buy one. Partly I simply did not know where to look, partly I was also lazy. I had grown up using throwaway pens and they worked fine for me. But I was inspired to consider them more seriously when I saw my attending writing with not one but four fountain pens on the ward. “Why?” I asked him. He told me: because his hand ached at the end of a long day of writing page after page of notes; the fountain pens had put an end to all of that and they got rid of the callouses on his fingers.
I looked down at my right hand, thick callouses along the side of my three fingers. I decided it was time to get a fountain pen.
Polyacrylamidepensieve:Woah can you use the credits for anything? I have no idea how many hours I’ve spent on uptodate, but my account’s not a personal one so it’s awesome to know they have that feature!
UpToDate does have a CME credit submission tool that allows you to describe how you applied the information you reviewed in practice. At this time, because I am not in a practice of my own just yet, I cannot submit them. That will have to wait until after residency.
Now that I have started residency, I have also invested into an UpToDate subscription. This online clinical resource logs the time you spend researching and reading different topics. In less than three months’ time, I have already amassed 42 continuing medical education credits.
A single credit is the equivalent of an hour of additional reading.
In essence, I am averaging roughly 12 hours of reading every month on UpToDate. This is in addition to some other bits of reading I do here and there on guidelines, position statements, and textbooks.
However, it just goes to show that a little bit every day goes a long way.
A woman living in China’s Shandong Province got a bit of a surprise recently when doctors at the Chinese PLA General Hospital told her that her brain was missing one of the most important centers for motor control: the cerebellum. She had initially checked herself into the hospital because of a bad case of dizziness and nausea.
Her diagnosis helped explain some of the challenges she had experienced through the course of her life, including slurred speech, delayed onset of walking until the age of seven and troubles with maintaining balance her entire life.
This time, I answer questions about alternative medicines, the challenges of medicine, the feelings of inadequacy, the unease of dissections, disclosures of personal illness, and late blooming interest in medicine.
I apologize for the delays in replying. I have been very busy lately in my personal life and have not had as much time to read and answer them. I will try to get to them as quickly as I can. I thank you for your patience and understanding.
In the span of twenty minutes while seeing a child in the emergency department, we had bonded over a variety of characters including Spongebob Squarepants, Transformers, Toy Story, Wall-E, and Justice League.
Suffice it to say we spoke the same language and operated on the same wavelength.
As a European non-med (Faculty of Medicine - Speech and Hearing Pathology) student, I was wondering if you have any thoughts about the European system of not having pre-med, high school graduates going straight into 6-or-7 year med school instead.
I think there are pros and cons to both systems. I feel that it certainly streamlines the process for people who already have an inkling that they are going to pursue medicine in the future but I feel that it comes at the cost of exploring other experiences, youth, and just overall maturity level.
Medicine is a physically and mentally demanding field. I think that having a certain amount of life experience and maturity that only comes with age can give you some level of resilience.
While the more indirect admission system can take longer to complete, I think it works to the benefit of people who may not have realized they were interested in medicine until later on. The age demographic for my class is quite broad, with some members being in their 40s. That level of flexibility and that understanding that not everyone has that epiphany at a young age normalizes the experience. In addition, their added wisdom and experience becomes quite apparent once the educational journey begins.
Yesterday was special. A classmate and dear friend of mine who has been out of province for her residency came back for a weekend getaway. We had an opportunity to meet and catch up on how our respective residencies have been thus far.
While war stories were exchanged, the focus was never about the medicine side of things. It was more about how life has been and what we were up to. It was a nice change of pace from my regular conversations nowadays.
For four hours, we were able to disarm ourselves of our ward personas and talk about regular, “normal” things. From the movies we watched, to my recent vacation stories, to her relationship challenges.
At four hours, that mental vacation seemed too short.
Just when I thought I was out of the woods, I was re-exposed to the most dangerous paediatric affliction of all:
Contrary to its name, this troubling and traumatic condition is just damn hard to let go. It infects the motor and memory recall systems and results in people unconsciously humming or singing to its tune. It has the potential of infecting other people. Prognosis: Very contagious. A full recovery is possible but in the order of weeks so long as you are not re-exposed to it.
The challenge of my current schedule is that I must juggle my responsibilities between my core rotation and those of my clinic, to which I am obligated to spend time as well.
Sometimes it means missing out on some good learning opportunities due to conflicting schedules. Other times, the days off of one schedule coincide with the days on of another. I can be particularly hit hard if, like today, the day could have been spent sleeping post night shift.
Thankfully these scheduling anomalies are few and far between. However, when I think about how well established the challenges of balance are in residency, having an awareness of these issues can go a long way towards improving resident resilience.
I'm 19 and I'm on the track to becoming an RN. Do you think having nursing experience will help me become a better general surgeon. That's my ultimate goal
I think that your nursing background gives you a different perspective on health care and that is always to your benefit. Adding new schools of thought into the culture of medicine helps breeds progress and change. It allows others to consider approaching a problem differently. Ultimately that is a good thing.
In my last community survey, I asked how you assess your stress level. The responses demonstrated just how diversely and how uniquely each person’s stress manifests.
This time, I would like to ask a follow up question and allow everyone to share how they deal with stress.
Beyond identifying and dealing with the source of the stress, I personally take more time to spend with my wife. I try to sleep earlier to catch up on rest. I take a step back from studying at home and instead take up sketching and drawing again while listening to music to help me relax. At work, I try to meditate during my breaks.
How do you cope with stress? Share your tips with everyone.
Whenever I am stressed, there are some subjective markers I look at. I find myself more tired, I have a harder time concentrating, and I feel less motivated.
Objectively however, I also have something to gauge my stress level. I have a tendency towards grinding my teeth at night, a condition known as bruxism. It is brought on by stress and goes away in its absence. The more stress I have, the more I grind my teeth. From inspecting my mouth guard every morning, I get a decent idea of how stressed I am.
So how do you gauge your stress level? Let me know in the comments and discussion below.