Posts tagged article

The Art of Pimping by Dr. Detsky

The term “pimping” was popularized by Brancati in 1989. As he defined it, pimping occurs when an attending physician (the Pimper) poses a series of difficult questions to a resident or medical student (the Pimpee). Pimping usually occurs in settings such as “morning report” or “attending rounds,” in which trainees at various levels convene with a faculty member to review patients currently under their care. Among surgeons, pimping may occur when students and residents are a captive audience observing a patient undergoing an operation. Brancati described the origins of the term, which date back to 17th-century London. Koch’s series of “Pümpfrage” (pimp questions) were used on his rounds in the 19th century. The practice migrated to North America in the 20th century and was documented by Flexner while observing Osler making rounds at Johns Hopkins. Brancati outlined suggestions for attending physicians to further hone their pimping skills and methods for students to defend themselves from it. He posited that the art of pimping would disappear in the future with increased specialization and educational reorganization. This commentary revisits the art of pimping 20 years later and provides an update for faculty members and students alike on modern methods in this important skill.

Read more… 

Providing for Those Who Have Too Little by Dr. Margaret Seton

In the New England Journal of Medicine, tucked away in the September 2011 issue, is a perspective piece by Dr. Margaret Seton. In it, she recounts her time as a student from Boston practicing a rural rotation in Arkansas. It vividly portrays the stark contrast between rural and urban care, the necessity for quick thinking, and the challenges of bridging a cultural gap. Things that may be taken for granted, such as MRI and CT scans, tests that are readily available in a larger urban centre, are absent or hard to access.

These differences are imposing to new doctors, especially those who have trained in a larger centre and she reflects on both the challenges and the rewards that have come from such an experience. I would highly recommend everyone to read it if they can.

An excerpt:

At other times, the biggest problems were not in diagnosis but in finding a farm truck that was free for a day to take a child into Little Rock for emergency surgery. Vaccinating the children born uncounted on the islands in the Mississippi, learning about “gigging” frogs by flashlight in the night, eating barbecued goat for the Fourth of July — such activities marked a time of transformation for us.

In the little houses clustered by the fields, there was a rural violence that I’d never seen before, bred by poverty and ignorance. Bullet holes pockmarked every signpost along the road. I learned to recognize the old black men who worked in the cotton gin by their missing fingers. I learned about hard lives and about children who died or disappeared. I hadn’t known that so many black Americans were still living without running water, that physicians could be on call every night, that one could eat squirrel, or that long, well-embroidered country stories could make one double over with laughter.

jayparkinsonmd:

THE “fact” that junk food is cheaper than real food has become a reflexive part of how we explain why so many Americans are overweight, particularly those with lower incomes. I frequently read confident statements like, “when a bag of chips is cheaper than a head of broccoli …” or “it’s more affordable to feed a family of four at McDonald’s than to cook a healthy meal for them at home.”
This is just plain wrong.

As a student, it can be extremely easy to fall into the trap of buying foods from the cafeteria and other fast food vendors, given the ease and availability. At the end of the day though, what we make ourselves is more often than not cheaper and healthier than anything that you could get from an outside source, packaged and ready to serve.

jayparkinsonmd:

THE “fact” that junk food is cheaper than real food has become a reflexive part of how we explain why so many Americans are overweight, particularly those with lower incomes. I frequently read confident statements like, “when a bag of chips is cheaper than a head of broccoli …” or “it’s more affordable to feed a family of four at McDonald’s than to cook a healthy meal for them at home.”

This is just plain wrong.

As a student, it can be extremely easy to fall into the trap of buying foods from the cafeteria and other fast food vendors, given the ease and availability. At the end of the day though, what we make ourselves is more often than not cheaper and healthier than anything that you could get from an outside source, packaged and ready to serve.

Doctors Discover the Benefit of Business School

From many of the doctors I have spoken to, from tutors to preceptors, they have all described one thing that you just do not learn enough of or at all in medical school: business. While we love to believe that health care is a universal service, it is still at its core for a lack of a better term, a business. When you take on the helm of a general practice, you effectively take on the role of not just the physician, but the manager and the entrepreneur. There are a lot of logistics and management skills that come with those roles and can lead to a learning curve for many of the fresh up and coming physicians. Unfortunately for these kinds of practices, what good is it to be a great doctor if you are unable to maintain and operate an efficient clinic?

In pharmaceutical sciences, one of the last mandatory courses taught is the business management side of the dispensary as a way to prepare students for roles as managers and associates. A full on M.B.A would give a fantastic repertoire of skills that would be advantageous in any situation but certainly even a little background class can go a long way to helping produce a more effective and efficient practice. Having said that, I wonder if schools like the ones describe in the article are the way of the future.

Maximizing Rural Medicine Output

It’s no surprise that rural practice has always lagged behind of its urban counterpart. An important part of recruiting to these sectors has always been the incentives and how the government can promote it. This article gives a glimpse at the difficulty of offering additives while maintaining an already stressed health care system.