Medical State of Mind

Jul 23

Busy Doctors, Wasteful Spending -

There is no more wasteful entity in medicine than a rushed doctor.

Jul 21

Segmental Anatomy of the Liver.
The liver is divided into 8 segments. These are delineated by the 3 hepatic veins, dividing the liver vertically into 4, and then through the horizontal plane for superior and inferior portions.
Posterior (caudal) segment [I]
Lateral segment (lateral superior area) [II]
Left anterior lateral segment (lateral inferior area [III]
Medial segment (medial superior area) [IVa]
Medial segment (medial inferior area) [IVb]
Anterior medial segment (anterior inferior area) [V]
Right anterior lateral segment (posterior inferior area) [VI]
Posterior lateral segment (posterior superior area) [VII]
Posterior medial segment (anterior superior area) [VIII]

Segmental Anatomy of the Liver.

The liver is divided into 8 segments. These are delineated by the 3 hepatic veins, dividing the liver vertically into 4, and then through the horizontal plane for superior and inferior portions.

Jul 19


The echoes of my steps resonated within the expanse of the hospital garage. As I made my way to the end of the aisle to my stall, a couple caught my eye.

A tall man, his hair only beginning to turn grey, faced a woman of similar age, dressed in a beautiful white summer dress. Next to them a car, its trunk agape, half packed with a box of personal belongings and a white plastic bag full of clothes sat waiting. Still, they stood, pausing, ruminating.

They stared longingly into each other’s eyes, a deep seeded pain overwhelming them as tears trickled down their delicate features. A warm embrace as they held each other tightly and wept.

I wondered what terrible tragedy had befell them. Did a loved one’s health take a turn for the worst? Did a loved one just pass away? Did their mother, father, daughter, or son, just perish from this earth? I could not help but wonder.

But it was not my place to ask.

I watched helplessly as they buried their heads in each other’s shoulders and comforted one other.

I continued walking.

Anonymous said: Being a doctor and a writer?


Honestly however, I am not quite following the question.


Jul 18

The Problem With Shorthands

I saw a patient on the ward on call recently where the patient’s complaint was some mild shortness of breath. Upon reviewing the progress notes, one of the issues low down on issues list was titled PE.

My heart skipped a beat.

Pulmonary embolus. My thoughts raced at the possibility that this patient had a recurrence. I quickly went back to see the patient but found that his story and physical exam did not quite add up to what I had imagined. I decided to go back and read the chart notes carefully again.

The more I read the notes in its reverse chronology, the less this PE sounded like a pulmonary embolus until I finally found the source, some ten pages back, buried in the middle of their already thinned chart.

Pleural effusion.

Over time, a relatively benign finding had been unintentionally shortened to a grave and emergent issue by the student writer. I breathed a sigh of relief.

It was yet another reminder of how shorthands and acronyms can cause miscommunication.

Jul 15



To the reader MP who wrote me a message about someone they know and the situation they are facing. 

It looked like there were two parts to your message and I only received the latter half, which makes it very difficult for me to understand the context of the message. However, if you are having concerns about his behaviour around others, then I think it is worth discussing the situation with him first. Have an understanding of his actions before seeking additional help from an outside party. 

Without really knowing this person, I think I am ill qualified to make any assumptions or judgments about him. I think it is still best that you discuss this with someone who can support him or guide him.

Jul 13

A Word with Fourth Year

For the students who have survived their foray into clerkship, congratulations for making it this far. You are only a year away from finishing your medical schooling. Here are some words of wisdom as you draw closer to the end as an undifferentiated stem cell and down the new path as a resident.

  1. Stay healthy. Surely by now you will have managed to find a daily routine that allows you to work hard but also enjoy time away from medicine. However, third year is also a time when one can pick up bad habits. Plan ahead, and take this opportunity before residency begins to really iron out the sore spots in your life.
  2. Explore your interests. Fourth year is really about finding your career interest and honing in on that goal. This is where you can start to expand on your career choice and take electives that give you inspiration, skills, or both. 
  3. Prepare early. Residency applications are meaty things and the deadlines come sooner than you think. Research the programs early, write cover letters early, and think about planning your electives early and in line with the residency matching schedule. 
  4. Have a backer. In third year, I mentioned that making a good impression was important. That trend continues on in the fourth year electives as well. The good will and social capital you accumulate with your attendings are what will fuel good reference letters. For a competitive program, these letters, particularly if they are from respected members of the faculty, can make or break an application.
  5. Study and keep studying. Elective choices can change the entire atmosphere of fourth year. While flexibility is welcome, it is never a license to take the easy road. Still take some time to read and study. At the end of it all, regardless of what program you match to, the licensing exam tests you on all facets of medicine.
  6. Big brother, big sister. When you began third year, you were the fresh face on the ward. There was some stuff you knew back then but a tonne more you had no idea about. Remember how stressful and terrifying it was once.
    Now that you are a fourth year, do not forget how that felt. When you meet a third year student on your team, help them along, guide them, impart your experience to them. Remember the kindness of your senior students and residents and pay it forward.
  7. Have fun. Medical school goes by very quickly. As a student, there is a flexibility and freedom that you will simply never come across again. Enjoy your rotations with your peers. Make the most of your electives. Take the residency interview tour as a nation-trotting adventure. Never forget to have fun on this job.

Related posts: A Word with First Year. A Word with Second Year. A Word with Third Year.

Anonymous said: hope you don't mind the question but around how much does an intern makes?

In actuality, the salary for a resident varies from year to year and from province to province. This website here gives a good summary of how a typical resident salary changes based on those two factors. Once you complete your residency however, a physician’s income becomes dependent on what kinds of services you provide, the number of patients you see, and how you set up your practice.

Jul 12