The Air Force’s new advertisement for flight surgeons

January 13, 2009 at 12:03 am (Military medicine)

The military is currently facing a critical shortage in the number of flight surgeons. The Air Force in particular has been struggling over the past few years to fill its numbers with qualified doctors who can take care of pilots and their families. Recently, the Air Force began development of a new advertising campaign in an attempt to draw more flight surgeons. As an exclusive to this website, I have obtained a copy of the first script and will share it here:

Hello, my name is Captain Martin. I’m a flight surgeon for the best Air Force in the world. Just to show you how wonderful things are here in the USAF, let me share with you my previous week.

Monday: I got to meet real, honest-to-God pilots today. They were so friendly… so tough in their flight suits. I think that I’m going to get a flight suit, too. Joy! The colonel says that if I act right, he’ll let me hold the stick the next time we go flying.

Tuesday: I went to the confidence course today. The Air Force uses the term “confidence” because the outdated term “obstacle course” is too negative. I had such a wonderful time. As I was climbing the ropes, rock ‘n roll music was playing and everyone was saluting me. It was awesome!

Wednesday: I went to clinic today and saw patients.

Thursday: I had to get up at 4:00 a.m. this morning for mandatory physical training. I knew that being in the Air Force would be tough, but I guess that all this training is great so that I can buff up and women will stop laughing at me when I tell them that I’m in the military.

Friday: my assistants did not show up to the clinic today until after 11:00 a.m. It was no big deal. I couldn’t find any of the patients’ charts anyway. I just went from scratch like I did back when I was in medical school.

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A plug for the Lucidicus Project

January 5, 2009 at 5:54 pm (Uncategorized)

A few months ago I came in contact with the Lucidicus Project, a group that aims to provide philosophical training to medical students in capitalism and individual rights. Its director, Jared Rhoads, writes regular editorials aimed toward political issues facing physicians. In addition, it freely gives away The Medical Intellectual’s Self-Defense Kit, a collection of books and articles by Ayn Rand and others, to anyone who asks for it.

I got around to reading Atlas Shrugged over the course of my surgical sub-internship last year and now I can see why some of my readers have compared me to her. The book is set in a period of worsening economic conditions and missteps that the government takes in currently the problems. I caution you that reading Atlas Shrugged is not for the faint of heart. At more than 500,000 words in length, you’re going to have to be dedicated to finishing it. But for anyone looking for a new novel to work through this year, I highly recommend it.

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Ask the Half M.D.: grading in med school

December 31, 2008 at 12:54 pm (Ask the Half MD)

A reader asks, “I was just curious if grading in Med-school is like high school or college like letter grades or if its more of a pass/fail thing. I’m sure they use scores for rankings and internship and residency selection, but do you feel that they really represent your progress in becoming a doctor?”

There are two questions that need to be answered: 1. How are students tested? 2. How are students graded?

The majority of medical schools employ multiple-choice tests when examining students’ progress. The questions typically take the form of a clinical vignette such as, “a 34-year-old woman presents with upper abdominal pain of one hour’s duration. She stated that it began after eating chili. What is the first step you take?” These tests do a pretty good job of ensuring that students have properly studied the material. Granted, medical students can generally find reasons to complain about a particular exam, claiming that the wording was insufficient, that there were more than one correct answer choice, or that the material was never taught in class. And while I have seen some very poorly written tests, for the most part they do a good job in representing our progress to become doctors.

The difference occurs with the frequency at which tests are given as well as who writes the questions. You’ll find that some schools give exams every Friday. Others might give tests every two weeks on a Monday. While there are some that give exams only at the end of the semester and use it as the sole determining factor of your grade. Further, there seems to be a variety of sources where course coordinators can draw questions. My own university requires professors to submit three exam questions with each lecture they give. Other universities employ the Shelf exams to test students. Shelf exams are written by the National Board of Medical Examiners, the same group that puts out the Medical Licensing Exam. These tests are standardized and are given all across the country. When you apply for medical school, be sure to ask how students are tested, as there is no universal method employed by all universities.

As far as the grading mechanism, there is also much variability between schools. My own university uses a pass/fail system, where we are merely assigned a P or an F on the transcript. The school has set an exam score of 70 as the cutoff for passing. We are then internally ranked where students are placed into quartiles at the end of each year. No one will ever know his/her individual rank, but will be provided with his quartile standing.

Other universities use the old college system with an A-F grading scale. Using this method, students know exactly where they stand. Other universities use an awkward hybrid system with honors, high pass, pass, marginal pass, and fail that eerily resembles the A-F scale. Again, you’re on your own to discover which method is employed by each school.

Finally, almost every medical school as an honor system known as Alpha Omega Alpha (AOA). The students who belong to this group represent the top 12% or so of each graduating class. To claim AOA status is a universal distinction recognized by all residency programs. In short, if you are a member of AOA, you can pretty much write your ticket to any residency.

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A call for questions

December 29, 2008 at 8:39 pm (Uncategorized)

Dear readers,

I’m reaching a point where I’m grasping for new material to write about. As a person once mentioned, I’ve ranted on everything that can be ranted on. I’m now asking for your help for ideas for new articles. You’ve probably noticed that I’ve been answering people’s questions recently. I feel that some of you have come up with some pretty good questions that others want to know the answer to. For example, my posts on the best stethoscope, the best pre-med program, and the Life Raft series have all come from emails that I have received from my readers. If you come up with an idea, send it to halfmd [at] yahoo [dot] com. Good questions are general enough to be researched and then written about in 500-1000 words. Anything too broad like “What’s med school like?” will go unanswered. Also, don’t make your question too specific. If you’ve got a 3.1 GPA and a 27 on your MCAT, don’t ask me what your chances are for getting into medical school. You can formulate your own answer to that question using already available resources. Moreover, other readers aren’t interested.

I’m also willing to answer “How Stuff Works” style questions. I’m thinking that I can re-use some of my old notes on the coagulation cascade and steps in stomach acid production for the benefit of current medical students. By writing these articles, I’ll be able to keep the information fresh for when I start residency.

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Results from the military match are in

December 17, 2008 at 11:20 pm (Military medicine)

There are a few people who were using my website to find the military match results that were released on December 17. The results from the Air Force and Navy are available on publicly accessible websites. However, I believe in the privacy of the applicants. Therefore, I will not post those links—although I’m sure you can find them elsewhere. The Army will not publicly release the results at this time. I will, however, list the number of people at matched into each specialty for the Air Force. These numbers include both medical students as well as physicians who are transferring into these fields.

Anesthesiology 23
Emergency medicine 35
Family medicine, flight medicine 6
Family medicine 46
General surgery 29
Internal medicine 34
Neurology 4
Neurological surgery 1
Obstetrics and gynecology 17
Ophthalmology 6
Orthopedics surgery 13
Otolaryngology 6
Pathology 7
Pediatrics 31
Psychiatry 10
Radiation oncology 1
Radiology 18
Urology 7

There were 63 people who matched into PGY-1 years only. Most of these people will be forced to go into flight surgery or GMO routes in the future. There are several specialties that I did not include in this list such as aerospace medicine and dermatology because medical students are not allowed to apply for these positions.

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The Life Raft for ob/gyn

December 17, 2008 at 8:00 pm (Life Raft)

Along with surgery, the obstetrics and gynecology rotation is one of the most fear-inducing clerkships that a medical student will encounter. It, too, is filled with long hours in which lots of patients have to be seen, prepped for surgery, and then operated on. I took my ob/gyn rotation after family medicine. Making the switch from getting up at 8:00 a.m. to getting up at 4:00 a.m. hit me pretty hard.

The inpatient gyn section of the rotation is very similar to surgery. The attending yelled at residents for not knowing minutia. The residents in turn yelled at the intern for not anticipating the desires of the superiors. And the medical students got ignored and were forced to stand in the back of the room when examining a patient. While a simple hysterectomy can be performed in under two hours, some of the oncology surgeries would go well beyond the eight hour mark as we removed the entire pelvic anatomy of a woman stricken with ovarian cancer. And I use “we” in a loose sense. In reality, I sterilely stood to the side and watched as an attending muttered profanity under his breath with each blood vessel and ligament encountered. So long as you remember the details and advice from the Life Raft for surgery article, you should be fine on the gynecology section.

The real highlight and breakaway comes when you do obstetrics. Obstetricians have vast medical knowledge regarding drug effects on fetuses, the day-by-day timing of embryonic growth, and carry with them enormous patience for a woman in labor to finally hit the delivery point. At my hospital, medical students are required to deliver at least one baby during the rotation. Unfortunately, there is a turf war going on between midwives and obstetrics residents for delivery time. I may spend an evening on call working with a patient in labor in the hopes that I might get to perform the delivery, only to have a midwife shove me out of the way and tell me, “She’s mine, bitch!”

It’s kind of like when I’m at a party and trying to pick up the attractive girl, only to have her fat friend show up and say, “We’re leaving! No one wants to talk to me.” And just like that, all of the work on my behalf is gone. But so long as you are persistent, you should eventually get to catch a baby on your own.

Some advice:
First, never examine a patient on your own, even if you are female. There are lots of nutty people who come to the hospital with their own expectations. You might be performing an internal exam to check for STDs, positioning of a baby’s head, reasons for vaginal bleeding, or whatever else you can think of—only to have the patient accuse you of sexual assault. Find a nurse for another medical student and have that person chaperone you when you are performing a physical.

Second, when you find a patient that you want to perform the delivery on, introduce yourself many hours in advance. Granted, some women who choose to go to county hospitals for delivery don’t care who delivers her baby, much less who knocked them up, but it’s still the polite thing to do.

Finally, make sure everything is ready to go for the delivery—even if the baby isn’t due for another six hours. I had everything laid out on a table in case of an imminent delivery because there really is no way to predict when the baby will arrive.

Some previous artcles:
Was that my alarm clock making that noise?
Birthing: the miracle of life or “don’t drop it”?
The fake surgeons

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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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A letter to the patient’s wife on the fourth floor

November 29, 2008 at 10:47 pm (Clinical rotations)

Dear Mrs. Canseco,

You and your husband have had a long, fulfilling life together. Ever since your marriage over 50 years ago, you have stood by his side through good and bad times. And when he was diagnosed with end-stage lung cancer this year, you were there ready to support him to his last breath. However, there comes a point when devotion gives way to fanaticism—and you cross that line a few weeks ago.

When your 75-year-old husband was admitted to the hospital two months ago in respiratory failure, the admitting physician was not being cruel when he inquired about Do Not Resuscitate status. He had nothing personally against you or your husband when he brought up the idea of seeking Hospice care.

You wouldn’t hear any of it. You demanded that your husband be placed in the intensive care unit and be given round-the-clock supervision by nurses and physicians. When I spend five minutes with your husband every morning pre-rounding, followed by another 30 minutes telling you that nothing has changed in the past 24 hours, stop accusing everyone on the staff of “not explaining what’s happening.” Your weekly family conferences where my attending and I sit down with you, your three children, your brother, and two of his kids are really getting to be a drain on our time. I just don’t know how many other ways I can tell you that after being in a coma and on a ventilator for the past two months, your husband really doesn’t have a shot in hell of living through this. You have refused pain medications, saying that we are, “Killing your husband.” You have declined a Hospice evaluation, stating that, “We are turning our backs on your husband.” When we brought in a pulmonologist to reevaluate the situation, only to have her agree with us, you accused her of, “Not knowing your husband.”

But expertise be damned. Your daughter, the massage therapist who has had extensive training in medicine, told you that she believes your husband will make it off the ventilator without any problems if we just wait a little longer.

You’ve treated our hospital like it’s a hotel, having moved in and spent 61 consecutive nights sleeping in your husband’s room. You have refused to leave the room under any circumstances, claiming that bad things would happen to your husband if you walked away. You have demanded that the hospital provide you with meals from the cafeteria three times a day. You have demanded that nurses be forever present in your husband’s room so that they can respond to your every beck and call. You have neglected that these hard-working nurses have four—sometimes five—extra patients who are also very sick and must be seen. I wish I could just put a white coat on a mannequin and place it in your room to try to give you some kind of solace. He could have an outstretched arm to hold your hand with an audio tape on continuous replay saying, “I am here for you.” Because in the end, that’s all that I can offer you at this point.

And then there’s the issue of the money. Don’t act like it doesn’t exist. The combined hospital bill from your stay so far is going to run well over $200,000. But you have never cared how these services are going to be paid. You proudly flaunt that you have no insurance and since you’re not an American citizen, you are ineligible from Medicare. Neither you nor your husband own any property. When it comes right down to it, we’re all really working for you for free.

You have shown us that you know more about the pathophysiology of a coma than any physician ever could. You have taught us that living on a ventilator is better than dying with dignity. You have pointed out that our nurses are incredibly mean and lazy for not dropping everything they’re doing in another patient’s room to come see your husband, whose condition has not changed in two months. Thank you for giving me the opportunity to learn by having your husband as a patient. Thank you for teaching me that everything my attendings tell me is wrong, that medical care is free, and that nurses don’t care about people in a hospital.

Sincerely,
Half M.D.

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Who’s on first?

November 20, 2008 at 2:58 pm (Clinical rotations)

Sometimes I encounter patients who are so inept that I wonder how they can remember to breathe and feed themselves. I occasionally have people show up to the emergency department who give a history that closely resembles Abbott and Costello. The following is a real honest-to-God encounter I had recently.

Me: what brings you to the hospital today?
Her: I fell and hurt my arm.
Me: how did you fall?
Her: I slipped in a chair.
Me: did you fall on the floor?
Her: no, I was in the chair.
Me: did you fall into the chair?
Her: no, I was already sitting there.
Me: so let me get this straight: you were sitting in a chair and then fell into that same chair.
Her: exactly.
Me: and you hurt your arm?
Her: yes.
Me: where on your arm does it hurt?
Her: right here on the inside.
Me: how did you hurt the inside of your arm?
Her: I fell in the chair.
Me: did you hit something?
Her: I hit the chair.
Me: on a scale from 1 to 10, how bad is the pain right now?
Her: it’s a four.
Me: I see here that you have a previous history of arthritis. What is your pain level usually?
Her: it’s a four
Me: so let me get this straight, you’re in the same amount of pain right now that you are always in?
Her: yes.
Me: what’s different about today than any other day?
Her: I hurt.
Me: is this a new kind of hurt?
Her: yes.
Me: what’s different?
Her: I fell.
Me: I see. How about I just send you out on some ibuprofen?
Her: okay.

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