Hello, I’m the Doctor Bot. After some serious upgrades my creators hope that I can be of assistance in your healthcare needs. While we admit that the Doctor Bot 1.0 may have caused some serious malpractice, I am certain that this new version will be a more accurate. Also, we’ve replaced the whiny voice with one that users say is more soothing and comes with better bedside manner.
I have many sophisticated algorithms with which I can diagnose almost any disease. You see, medicine has become so easy that a few mouse clicks is all that’s needed to handle most problems. Why spend so much money on a visit to seven years of training, when the Doctor Bot is here now? And if that’s not enough, I come equipped with a full laboratory.
Provide me with a sample of blood and I can tell you if your cholesterol is elevated. I can even write a prescription for your favorite statin. If it’s chest pain that you have, I’ll show you how to connect the leads to the EKG machine so I can get a reading of your heart. Don’t worry; I’ll walk you through the process and show you how it’s all done.
To begin, swipe your insurance card. I accept most major brands, including PPO’s and HMO’s.
You have selected… uninsured. That’s okay. We will be able to subvert funds from taxpayers to cover this visit. Now, take a look at this picture of the human body and simply point to the area with the problem.
You have selected… abdomen. Now say aloud what the problem is.
I’m sorry, I didn’t understand you. Please say that again.
I’m sorry, I still didn’t understand you. Please say that again.
I’m sorry, I still didn’t understand you. Please say that again.
Kicking the machine won’t help.
I’m sorry that I could not be of more of assistance. Hello, I’m the Doctor Bot. After some serious upgrades my creators hope that I can be of assistance in your healthcare needs…
After years of struggling to be recognized as a valid subspecialty of medicine, the Women’s Health Initiative has announced that Dr. Robert McGowan will take over the management of feminine healthcare nationwide. Linda O’Connor, a physician specializing in women’s health, stated, “This is good news for women everywhere.” After much discussion over who to put in charge of the Initiative, the Board of Directors finally landed on McGowan. Stated one member, “Simply put, we needed someone who is right most of the time.”
No one is more excited about the news than Dr. McGowan himself. He said, “It’s about time they put me in charge. No one really knows what women need more than a man such as myself.” Dr. McGowan is board certified in both internal medicine as well as obstetrics and gynecology. His first order of business is to change the way that medical students and residents are taught about women’s health. He says that he hopes to have the American Board of Internal Medicine recognize women’s health as a subspecialty sometime this afternoon.
As part of his tenure he hopes to secure reproductive rights for all women, increase the accessibility of mammograms and Pap smears, and to portray female doctors on television as something more than drama queens who are constantly caught in love triangles. “Women everywhere need to know that their doctor isn’t going to be like Meredith Gray.” He also plans to tackle diseases that are common to women-most notably, the wondering uterus and fibromyalgia.
When asked to comment on their decision to put a man in charge of the Women’s Health Initiative, O’Connor stated, “We look at the amount of time needed for this project and realize that this is a man’s job.” She provided the following two graphs as evidence.
In the past the leadership role in the WHI was a shared, co-presidency. McGowan will take on both positions. “We were tired of hiring two women to fill the job that could be performed by one man,” explained one board member.
Dr. McGowan is also a fervent Christian. He states that religion should play a larger role in the Women’s Health Initiative. “We need to turn to the Man upstairs to help us out in our time of need,” he elaborated. Many are thinking that McGowan just might be the best man for the job.
Said O’Connor, “Women everywhere need to bow down to this man of character.”
Thanks to The Onion for inspiration.
Recently, Microsoft announced a new website to hold users’ health records. The project, called HealthVault, aims to store concerned citizens’ records for later retrieval by a physician or hospital staff. Google and AOL have also announced similar plans to create their own brands of healthcare databases.
According to Microsoft’s press releases, the company is teaming up with medical device manufactures so that patients can automatically upload the results of their glucose and blood pressure readings to HealthVault. No more keeping a paper log to bring to the doctor’s office on the next visit. Simply plug the device into the computer and the Internet takes care of the rest. The process of saving health records in a central location sounds like a good idea. However, this website is doomed to failure. HealthVault and other similar databases have their novelty right now, but will eventually fade into obscurity for three reasons.
1. Privacy concerns. Given the recent break-ins of credit card and other high profile corporate databases, Americans are going to be weary about putting their private information in a central location that can eventually be hacked. According to the Wall Street Journal article, of the available technological options for storing data, the online warehouse is the least popular.
2. No standards. At least three private companies have announced similar plans to launch healthcare databases. Noting that Microsoft has a history of not following standards tells me that this database will not be interchangeable with other health information aggregators. Hospitals will have to re-live the multiple insurance hell through the Internet age by adopting various methods of downloading data from a variety of online databases. Further, users will have difficulty switching. I doubt that moving from Google to AOL will be as simple as finding a new physician and writing to the old one to ask for a transfer in records.
3. These databases don’t hold enough usable information. While the benefits of having easily available charts for physicians to share is a major selling point, HealthVault will not contain enough useful information to become viable for hospital utilization. By only holding blood pressure and glucose readings, this website misses out on medication lists and progress notes—more worthwhile sets of information, particularly when seeing multiple providers.
In summary, while I would like to see an online database that stores patients’ health records, HealthVault falls short by not employing standards, nor containing enough data to be fully usable. Once a more centralized, preferably non-profit database opens up, I’m sure more physicians and patients will want to embrace it. I can imagine Medicare pushing us in that direction. The federal government could benefit from aggregating patients’ information to reduce billing costs by having a sole provider who can keep track of different specialists and prescriptions. Pharmacies could hook into this server to monitor refills and potential drug interactions when filling multiple medications.
For my 10th wedding anniversary, I visited my favorite upscale restaurant in the city. It features a filet mignon dinner that was literally prepared in Heaven and delivered to our table by angels. The head chef, Pierre Brennen, had years of training from the finest culinary schools in France, along with experience in Italy and Thailand. On the rare occasion that I feel like spending $100 on a meal, I come here to Bruno’s.
Today, however, the head chef was gone. The kitchen doors swung open and I witnessed several of the chef assistants packing boxes and leaving the restaurant as if they had been fired. The doors swung closed and my server came to the table. Instead of the typical tuxedo-wearing waiter that I’m used to, this new guy was dressed in street clothes that were probably pulled off of the asphalt of Bourbon Street. I stared at this teenager closely and then realized that I had originally seen him behind the counter at Burger House.
He asked to take my order, claiming that he would prepare something extra special for me. I was startled.
“You’re going to cook the food?”
“Of course,” he replied. “Bruno’s realized that it could save money on cuisine by firing the chefs and replacing them with fast food cooks.”
“But what about the dishes? How could you have any training and experience in the restaurant business?”
“I’ve got plenty of training and experience. I took a two-week course in heat lamps and an additional week in deep frying. I’ve spent at least six months preparing burgers and fries, if not more. I’m certainly qualified to handle steak and lobster.”
“How can you be prepared to put together a filet mignon without going the route of Mr. Brennen?”
“Bruno’s realized that all of that extra training in culinary school is unnecessary and expensive. By hiring us, we’ll be able to provide the same product at a reduced amount. In the end, we’ll pass on the savings to you.”
“You can’t be serious! Surely 3 weeks at the Burger House does not equal the same amount of training that chefs possess.”
“Well, I’m currently a level 1 cook. Some of the very eager employees take a one-month course at the community college to further their knowledge of high cuisine.”
“But how would you know the detail of the different meals? Master chef Brennen had tons of training and experience to guide him.”
“If anything, Brennen’s training made him too narrow. He had all academic training. Me, on the other hand, I’m more well-rounded and haven’t limited the scope of my practice. I also have more real-world experience.”
“How can any this be possible?”
“Some senators were once in here during the old days and noticed that high cuisine is far too expensive. The government realized that by recognizing fast food cooks as master chefs, we could be paid on a similar scale as the Mr. Brennens of the past. The result is that we can pass the savings on to you.”
“But your menu prices have gone up and the wait time is longer.”
“You’re only looking at the final cost. The man power costs have decreased. What you’re paying extra for are the new compliance officers and package inspectors. We have to make sure that we catalogue all of our ingredients and then follow the same procedure for every meal. Gone are the days of adding a pinch of salt for flavor. Now, every item used in a recipe must be fully tested, measured, and retested before going into a dish. Sure, it takes lots of paperwork, but you’re getting a safer product now.”
“Does anyone go to culinary school anymore? How do you progress cooking science and create new dishes?”
“With recipe programs and well-authored cook books, I can prepare any meal. Besides, what are these new dishes that you speak of? Every meal that could ever be created has already been produced. There is nothing new that we could learn about food.”
“You’ve got me there. In that case, I’ll take a number 14, ’round steak wrapped in bacon.’”
“Excellent choice. Would you like fries with that?”
I caught up with the Dean of the Medicine recently to talk about the way our medical school is run.
Half MD: Thank you for agreeing to this interview
Dean: No problem. I know that pre-meds read your blog and will find this information useful.
Half MD: First question—why does our school put so much information on physicianship training, while ignoring other classes such as microbiology? Our university’s board scores are pretty mediocre, and I think it’s due to the curriculum.
Dean: We put so much emphasis on physicianship training because those are the real skills that you need to know to become a doctor. Learning the proper grip to use when holding a patient’s hand is far more important than memorizing a list bugs and drugs. Further, the only time we can ever teach you about bedside manner is during the first two years. As for all of that other trivial information such as microbiology and pharmacology, we figure that you’ll learn it on your own while studying for the boards.
Half MD: I’m currently on my surgery rotation. While there’s a lot of information to learn, why do surgeons have to be such assholes? Isn’t there a better method for teaching than negative reinforcement?
Dean: Surgeons are the playground bullies of the medical world. Any compassion and genuineness has been beaten out of them long ago. They’re so used to talking to others through screaming that their encounters with students and residents are rarely pleasant. That’s not to say that all surgeons are like that. Urologists and Ophthalmologists bring civility to the medical community.
Half MD: I’ve noticed that a lot of the “rules” are broken on the wards. For example, students have to come in a 5:00AM to pre-round on patients, despite being told by the clerkship director that students are not supposed to pre-round.
Dean: There’s a lot of that in the medical community. He told you not to pre-round simply because he’s required to. Yet look at his own students. They regularly arrive before 5 and will spend over 80 hours a week in the hospital. The residents goes through a similar process. Do you know of an intern who spends less than 30 continuous hours in the hospital?
Half MD: Is there any way to save my backs and legs during long procedures? I would love to bring a stool into the OR.
Dean: Mentioning that you’re tired will only make you seem weak. You can try hidden methods of relief. Compression stockings, shoes with high arch support, and regularly changing your socks will help a lot in the long run.
Half MD: Although I have no desire to become a surgeon, I’m still eager to learn. I’ve tried to get opportunities to do simple procedures such as starting I.V.’s and suturing patients, but no one wants to teach me. I even offered to insert a foley catheter on a patient in the OR. Our nurse said, “No, I don’t want you slowing us down.” Given that we were already an hour behind schedule, I don’t think taking 2 minutes to insert a catheter is going to make things worse. Why are the nurses so rude on our service?
Dean: They’re only rude to medical students because they know that’s the only time they have you by the balls. For the rest of their careers they’ll have to take orders from doctors. Sometimes, they’ll even have to fulfill those orders. Some of them have a pool to see how long they can ignore students who are asking, “Excuse me, can you help me find something?”
Half MD: I’m still not quite clear what my role is as a medical student. I finished general surgery last week and began the specialty service this week. Every week I learn of some new role such as getting X-rays from an unknown radiology location, changing the wound dressing according to the whims of a particular attending who uses methods that may or may not be evidence-based, or what information is supposed to written in the progress note. At times I feel like I’m in the movie Office Space. I have 8 bosses giving me orders at any one time.
Dean: The contradictory methods of leadership or the read-my-mind mentality that many attendings have comes with years of perfecting the art of frustrating students and residents.
Half MD: What’s up with pimping? I would guess that it’s supposed to be based on the Socratic method—using questions to lead a student towards discovering truth—but it’s really an embarrassing endeavor each morning when I can’t list 10 causes of a condition I’ve never heard of.
Dean: “Pimp” stands for “put me in my place.” Attendings can never be made to feel as if a student might be considered an equal in the eyes of others. Know the number 1 cause of a disease? I’ll ask you for the number 2 cause. If you know that information, I’ll ask you who authored the paper on the subject. If you’ve got that also, I’ll ask you the date that the article was published. I’ll keep asking you questions until you get something wrong and then smugly tell you that you need to study more. It’s all part of the learning process. Just wait until you’re an attending; you’ll get to treat students the same way.
Half MD: I keep getting the suspicion that many of the academic doctors aren’t cut out for private practice. Unfortunately, they aren’t cut out for teaching, either. If they’re so bad at teaching, why are they professors?
Dean: That’s a pretty harsh statement to make. The title of professor is reserved for anyone who holds a academic job. Some just haven’t learned that negative reinforcement is not a good learning tool.
Half MD: Any advice for surviving long on-call nights?
Dean: Try sleeping whenever you get a free moment. Empty conference rooms are perfect for catching an hour here or there. Don’t worry about sleeping through a page. The volume is intentionally loud enough so that you’ll wake up every time. It’s simple reminder that bad things happen to people at all hours of the night—and it’s your responsibility to fix it.
This post is just a quick plug for the Donut of Misery. Created by members of the military, the donut is used as a countdown to when deployment ends. I’ve modified it slightly to countdown the end of my surgery rotation. I’m already at the 50% mark.
Signs that I’m hitting the wall:
1. Today I poured a bowl of cereal and then put it in the microwave.
2. I only leave the house once a week to get groceries. I’ve forgotten how to talk to people and make eye contact with the cashier.
3. I’ve given up shaving until the boards. As I see it, I’m not going anywhere that requires shaving. Unfortunately, I’m afraid that strangers are going to start offering me their loose change because they think I’m homeless.
I haven’t posted a story in a while, even though I’ve got a few ideas floating around. I’m just too tired to be cynical and angry at the poor job my medical school did at preparing me for the boards.
I’ve been hitting the books pretty hard over the past two weeks. If you’ve ever seen the movie Groundhog Day, you’ll recognize that everyday I wake up at the same time, study for about 10-12 hours, and then go back to bed. Nothing’s worse than testing my current level of knowledge by taking a practice test and only getting half of the questions right. Then I remind myself—doctors are only half right most of the time anyway.
Just remember: Huntington’s disease = methylation of histones = silencing of genes = (somehow) dance-like movements. Oh, and tri-nucleotide repeats have anticipation.
I’m currently studying for Step I. I hope to have some new posts in the near future. I’ve got several ideas floating around in my head—I just need some time to write them. For right now, ponder this thought: If Purell joined forces with KY Jelly, they could create a formula called “Safe Sex.”
One of the most popular changes to medical education is the video taping of classes. The idea is that students can re-watch videos later for review or, in the event they have to miss class, they can watch the videos to stay up to speed with their classmates. Administrators will warn students by saying, “These videos are not a substitution for going to class. They are there for a supplement.” At my university, many students try the home school method of med school. They stay home and watch lectures, only coming in for physicianship training and PBL. Their methods seem to catch on with others.
Just think, you can have class when you want, where you want. If you miss something during a live lecture, you’ll have to raise your hand and hope that the professor will repeat whatever he said. With the videos, you just press rewind and keep on. Further, several software programs such as 2xAV can speed up the videos, meaning that a 50-minute lecture now takes half and hour to watch.
At my school, several students routinely take vacations after every exam and then use the videos to play catch-up during the week before the next test. The administration has tried to do away with this kind of behavior by threatening to remove the videos or institute download delays. Their threats have been empty. Just this past semester, several classes featured as few as 15 students in regular attendance.
I’ve begun wondering what would happen if for-profit universities caught-on to the video phenomenon. In particular, I wonder what would happen if the University of Phoenix started its own home school/med school. I could see it now: I’ll get an email saying, “Need a medical degree now!?” Next, I’ll click on the link to see ACCREDITED stamped all over a website touting an MD for $50,000 a year—a good price for working professionals. By interacting with my classmates via online forums, I can participate in anatomy by ordering my very own cadaver.
The Department of Education might be a little annoyed. The New York Times may even hold an investigation. The end result will be the same. I can earn my medical degree in my spare time by reading Robbins and watching the video lectures.
Some of my readers may be laughing at this part. The truth is that many medical schools already do follow a similar plan. Ok, so I didn’t get any emails from American universities, but many students are using the home school/med school method. I know quite a few people with jobs, families, or other obligations that keep them from coming to class. Over the course of the first two years they would show up when necessary, watch the videos during their spare time, and then beat the class average on all of the exams.
I know that the idea of your doctor getting through medical school in his pajamas may sound scary, but trust us, we know what we’re doing—we’re professionals.