The Half MD’s guide to breeding

December 7, 2008 at 8:02 pm (Uncategorized)

Whenever I encounter a self-entitled individual who presents to the emergency department with the chief complaint of “My shit be painin,” I wondered just how he came to believe that indiscriminate sex would be without consequences. I’m equally surprised by his lack of medical knowledge when he tells me that he has the sugars. I’m also growing more and more concerned over the young children who are taken to the emergency department in which parents don’t understand that a one-year-old cannot feed and bathe himself.

Therefore, as a public service, I am offering a guide to breeding. The illustration below should provide a thoroughly understanding of female anatomy.

The Half MD teaches female anatomy

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An MBA for doctors

December 4, 2008 at 6:44 am (Uncategorized)

While medical school certainly teaches students a lot about treating disease, it falls far short when preparing us to enter the world of medical practice. I regularly hear statements from students, residents and even physicians such as, “I don’t need to know about billing because I have coders for it.” To which I say that is a very stupid mindset. If you don’t know how the money for your business is generated, then you are in no position to take home a substantial size of it.

All doctors could benefit from some business training, but the question is how much of it should they receive. Below, I present a list of MBA’s that are tailor-made specifically for physicians.* As far as I can tell, these universities do not require the GMAT for admission.

Auburn University — 21 months, requires five 4-day trips to Alabama, one week to Europe, and one week to Washington, DC. Total cost is $49,875.
University of Texas at Dallas — There are options for a Master of Science in Healthcare Management or a Healthcare Management Executive MBA. Both require 4-day trips to Dallas every other month. The MSHM takes 14 months to complete, while the MBA requires completion of general business courses in addition to the MSHM curriculum. The MSHM costs $29,700. The MBA costs $47,300.
University of Tennessee Knoxville — 12 months, requires 4 one-week trips to Knoxville and you must take part in online discussions every Saturday morning. Total cost is $59,000.
University of Massachusetts Amherst — The MBA is made available through a partnership with the American College of Physician Executives. No on-campus requirements. Tuition includes $600 per credit plus a $40 per semester registration fee. The program is 34 credits long, putting the total cost at greater than $20,400.
DeSales University — Other than the title Physicians MBA, I can’t find any information about the program, including on-campus requirements, costs, or even accreditation.

There are many universities touting health-care MBA’s such as George Washington University. However, anyone is welcome to pursue these degrees whether they are a physician or not. The list above is meant for people who already have doctorate degrees.

But again I ask the question, how much business training does a doctor really need? For example, is a course in global markets really necessary? Further, you can see from the list above that these programs can be quite expensive. Add in the time commitment and then I start to wonder what payoff is gained from having an MBA. Is business school truly necessary to gain business skills? What would a $1000 class in accounting teach me that I couldn’t learn from a book such as Accounting for Dummies?

One physician recently recommended the book The Physician’s Essential MBA: What Every Physician Leader Needs to Know by Michael Stahl and Peter Dean (ISBN: 0834212447). At $70, I think that it would be well worth the read.

*(The University of South Florida supposedly has a physician MBA, but I cannot find any information regarding this program.)

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Banned at work

November 15, 2008 at 2:59 pm (Uncategorized)

I tried to log into my website this week from a nursing floor only to discover that my hospital has blocked access to halfmd.com, saying that it is “inappropriate for the workplace.” I wonder how they came to that conclusion.

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The unnecessary vilification of greed

October 9, 2008 at 8:28 pm (Uncategorized)

In the movie It’s a Wonderful Life we learned that every time a bell rings, an angel gets his wings. This simple chime of a bell can somehow confer morphological changes to a mystical being. The opposite seems to hold true for politicians. Whenever Barack Obama begins to speak of insurance companies, a little bit of truth dies. In the most recent debate I heard him say that insurance companies are greedy as if to imply they are unethical and have the sole purpose of trying to make Americans’ lives miserable. This rhetoric of greed as applied to Wall Street, insurance companies, big businesses, hospitals, and doctors is a bit off the mark.

Greed is a good thing. The knowledge that harder work leads to more money causes men to put in more hours and complete more goals. Obtaining more wealth is a seemingly reachable prize that can be obtained by creating better products, by developing more efficient methods, and by taking new risks. Greed is the invisible hand that runs the United States. Its roots span back as far as the Declaration of Independence. Our forefathers were not seeking religious freedoms when they broke away from Britain; they wanted lower taxes. It’s the reason the Spanish-American war was fought. It’s the reason Henry Ford developed the Model T. And it’s the reason that doctors are willing to work 80 hours a week.

Whenever an applicant applies for medical school he has to come up with a convoluted explanation as to why he wishes to become a physician. Many of the personal statements I have read in recent years center on helping other people, delivering health care to those in need, and providing access to those who cannot reach. In reality, many people are seeking a $200,000 a year job. An applicant who can say, “There’s no way I would do this for $30,000,” is much more honest. And yes, while there are some people who would deliver healthcare for free out of the goodness of their hearts, enrollment in medical schools would significantly drop, and the number of physicians in the nation would be at a critical shortage if greed were taken out of the equation.

Greed is a wonderful thing. We should embrace it and get people to work harder and more efficiently by dangling this prize in front of them. I know what you’re thinking. “Have you bothered to read the news, Half MD? The whole reason we’re in this economic mess is because of the predatory lenders and the greedy people on Wall Street!” I would counter that by saying the whole reason we’re in this mess is because of unethical behavior and stupidity. Greed did not cause banks to dole out $300,000 mortgage loans to persons making $40,000 a year—but stupidity did. Greed did not cause banks to sell unfunded insurance plans to each other—but unethical behavior did. On the other hand, when greed is contained within ethical boundaries and wise decision-making, it can be a force for good and for change.

Medicare could use its dollars to influence physician behavior for the better. It could offer higher payouts to those doctors that use a centralized electronic medical record system. It could grant bonus money to the lowest 20% of hospitals with nosocomial infection rates. Someone will counter by saying, “But then greedy hospitals will simply not report their nosocomial infection rates so that they can earn bonus money.” And I will respond by saying, “No, unethical hospitals will not report such embarrassing data.” A greedy, honest hospital will develop more safety barriers to prevent the spread of infection.

The next time someone says to you, “Those insurance companies sure are greedy,” usually counter back with, “I hope they are.”

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What if the restaurant business followed the medical mindset, part 2

September 21, 2008 at 1:55 pm (Uncategorized)

I’m sitting here at Tino’s restaurant wondering how much longer my food is going to take. I’ve been here for at least 20 minutes already and no one has taken my order. A waitress has passed by me twice without giving me my meal. In fact, she’s avoiding eye contact because she knows it’s her job and she just doesn’t want to do it.

I had to start coming here because my old restaurant, Great Papa’s, has become too expensive. I can no longer afford my prior chef. He kept raising his rates citing nonsense like overhead and food poisoning insurance. I’m pretty sure that he just wants more money so he can join a country club. We all know how greedy chefs are.

Christ, how long is this going to take? Is he out playing golf somewhere? Just where is my chef? My waitress mentioned something about a kitchen fire. My last chef tried to use the emergency excuse whenever he wanted free time to surf the Internet, too.

Doesn’t he know that food is a basic right? I can’t go on if these meals become too expensive. Why does he keep raising the rates? There needs to be some kind of intervention. A system where food can be given to the good citizens of this nation so that we can eat and know that our bellies will not starve. On top of that, I need everything on the menu, right now, and for free. And I don’t care how many times they tell me that the food won’t mix well together. Don’t let laziness be an excuse.

I don’t trust the chefs and chef assistants anyway. They’re always making mistakes. There needs to be more oversight of their assistants, the food prepares. Lord knows I don’t want them messing up my food. Just last week my friend Joanna got food poisoning from eating the shrimp. She stayed up the whole night vomiting. That crazy ER doctor that she went to see tried to pawn it off on my friend by saying she was throwing up because she had been drinking too much whiskey. I’m pretty sure that the doctor was in cahoots with the chef.

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Introducing the EBM calculator

September 20, 2008 at 2:38 pm (Uncategorized)

I recently began working on a calculator for biostatistics and evidenced-based medicine. While there are certainly valid complaints about the field—I’ll let others be the complainers—EBM has pulled medicine out of the dark ages into a more scientific discipline. To help with calculations regarding diagnostic procedures, I’ve put together this Excel chart that can give sensitivity, specificity, predictive values, likelihood ratios, 95% confidence intervals, and a graph of the pre-test vs post-test probabilities.

Simply enter the appropriate information into the 2×2 table and the program will take care of the rest. If you wish to print the form, only print the first page. The rest of the chart contains a series of calculations.

In the future I plan to continually add to the EBM calculator to include exposures.

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Ted Newley, running for Congress

September 15, 2008 at 4:57 pm (Uncategorized)

Hello, my name is Ted Newley, and I am running for Congress as a representative of the Enchanted Forest.  I want to represent all woodland creatures such as elves and dwarves.  In short, I want your vote.  I’m a reformer among reformers and I think that I can do the best job for the Forest.  Let me share with you my platform.

I have big plans for the little citizens of this area.  My major goal is to reform health care with the following actions:

1.  Extend Medicare’s drug plan to include magical potions.  Far too long western medicine has come in with its mass-produced medicines that do nothing but cause rashes and diarrhea.  I would force the federal government to open up its coffers to the healing power of the eye of newt and wing of bat.

2.  Allow benefits for trips to gypsies and fairies.  American physicians may have many years of training, but they still don’t know how to properly predict the future or heal a broken heart.  Through the power of tarot cards and palm reading, a soothsayer can accurately tell you when you’re going to die.  Further, there is no pain like that from a broken heart.  A fairy should be able to enchant your heart and find your one true love.  Once you have that, there is not much more that can harm you.

3.  During the Great Depression the chant was “a chicken in every pot.”  I advocate for pot of gold at the end of every rainbow.  We need to ensure that healthcare provides a holistic healing for the patient.  What better way to do that and to provide the necessary funds for getting a taxi ride, hiring a babysitter, and purchasing pet food?

If you agree with me on my plans for the future, vote for me this November.  You can meet me in person on October 8.  Food will be supplied by the Keeblers.

Ted Newley

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Doctors, the smartest and dumbest people alive

September 2, 2008 at 6:59 pm (Uncategorized)

The public seems to have this dual perception of physicians as if we are the smartest, yet stupidest people in existence. For instance, there is a certain infallibility that doctors are expected to have when it comes to medical care. You didn’t diagnose a rare presentation of a disease? You’re going to get sued. You failed to order a CAT scan on a person with a chief complaint of “mild headache,” yet has no fever, no neck stiffness, no focal neurological findings, and is perfectly awake and oriented, only to later find out that the person has a hemorrhage? Time to hand in your license. That non-smoking, white collar worker has a cough and you didn’t bother to check for mesothelioma? I want you to meet my two friends Cohen and Cohen.

At the same time, however, the public has a perception that physicians are easily swayed by marketing gimmicks. Somehow if a drug rep gives me a free pen with the word Seroquel written on the side, I’m going to start prescribing the product to everyone that has a chief complaint of “feeling happy.” Those shining members of ethical practice known as Congress have decided that come January, drug reps can no longer supply free gifts to doctors. The thought is that physicians are too easily swayed by the cheap gifts given out by drug reps. Meals are still fair game because “they can be educational.” Textbooks, on the other hand, are no longer allowed because they are considered big ticket items. Somehow, a fancy dinner that costs $100 is considered more appropriate than a book with the same price.

How do doctors to get this dual reputation of being the most educated yet easily persuaded members of society? And where am I going to start getting my pens?

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Matriculation speech for Half University

August 3, 2008 at 6:00 am (Uncategorized)

For all of you who are starting medical school this month I wish you well in your future endeavors with your medical career. As part of orientation week, the dean of your university is going to give a heart-warming speech about helping others and heeding the call of duty. At the end of the day you’re going to feel like a real member of the team and that your purpose at this school will be to become a scholar, a healer, and a gentleman.

I got the same speech when I started medical school three years ago. And indeed, I did feel mighty confident in my university’s ability to teach me to become a fantastic doctor. What I wish had happened is for the dean to have told us the truth. Had he done so, that speech would’ve gone something like this:

Welcome everybody to Half University! I’m happy that you’re all here with us to embark an endeavor to become a physician. Although four years sounds short, this will be one of the most time-consuming and hardest experiences you’ll ever go through. When you interviewed here we told you that each and everyone of you are a valued member of our team. That was all a lie. You are really nothing more than a burden to the residents and the attendings at this institute. Oh sure, you will run into some fantastic teachers during your first two years here. But the vast majority of staff members will see you as nothing more than a nuisance. You will get in the way of their ability to see patients quickly. As punishment you’ll have to endure hours of torture through a humiliating process that we call pimping. Be prepared to be asked any and all questions regarding your patients—including their astrological sign, what their dietary habits are like, and what’s the half-life of the medication we’re using to treat their disease.

We’ve really got you by the balls now. There’s no other way to become a physician in the United States than to go through one of the AAMC member schools. While I don’t doubt that anyone of you is smart enough to learn all the basic sciences on your own in one year, we’re going to make you spend two years to learn the same material because instead of giving you time off to study, we’re going to make you come in for Physicianship Training so that you can learn about everything from Medicare reimbursements, to how Hispanics think, to our political views on health insurance and the non-insured—all in your first year of medical school, where none of this information will be applicable for many years to come. All the while, were going to charge you an excess of $60,000 to learn something that you could teach yourself for free.

Look to your left; look to your right. In years past one of those two individuals would have flunked out of school because of the academic demands placed upon them by this university and others. However, we currently have a doctor shortage in this country. Therefore, we are forced to find ways to advance everyone of you through each year until you finally graduate. Now look to your left; look to your right. One of those individuals will sink into a horrible depression over the next four years in the realization that he or she should not be here. However, due to economic and familial pressures, that individual will stay on and possibly kill a few patients before getting their M.D.

You are a burden. Let me reiterate to you that neither the residents nor the faculty truly have any desire to teach you. The residents will dislike you so much that they will have you go down to the radiology suite to fetch x-rays just so you they can be without your presence for several more minutes. The residents will threaten you and say things like, “I evaluate students based off of their enthusiasm. If you aren’t willing to go that extra mile and get my x-rays, I must question your commitment for this field.”

All of you have your own individual reasons for coming to medical school. Many of you use your personal statements and your interviews as a chance to try to fool us on the admissions committee that you have nothing but pure intentions of serving others. For some of you, this statement is true. Unfortunately, our system will find a way to wear you down. For others, this statement was utterly false—and the only reason you’re here is to either make money or to win the affection of your parents who never paid attention to you while you were growing up. Whatever your reasons are, they don’t matter anymore. Your desire to work in South America or Africa as a medical missionary is not going to help you when you’re trying to memorize anatomical tables of muscles. Realize that this is going to be hard no matter who you are.

All of you were at the top of the bell curve when you were in high school. And then you went to college where you continued to be at the top of the bell curve. Now that you’re in medical school, we’ve got to remake the bell curve. I can assure you that half of you will be on the bottom side. So study hard and do your best. That is all you can ever give.

Your medical school experience, particularly in the third and fourth years, will be shaped entirely by the people you are around. For some of you, you will hit the jackpot and have a team where the interns are on top of everything, the residents love to teach, and your classmates are eager participants. Others of you will be stuck with ignorant interns, student-hating residents, and classmates that you will constantly cover for. Those four weeks will be your private hell.

That is all I can tell you at this point. But trust me on the studying.

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Took STEP 2 this week

August 1, 2008 at 7:46 pm (Uncategorized)

I took STEP 2 this week. Four cans of Red Bull, six bathroom breaks, and nine hours later, I’m one step closer to getting a license. It’s just like STEP 1, except I actually knew what questions were talking about this time.

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