All this work, only to be outdone by a bag of Oreos
When Claire got admitted to the hospital for pneumonia, I knew we were in for quite a long hospital stay. Claire was morbidly obese (her BMI was 51) and although 31-years-old, she had more damage done to her body in the previous three months than most members of the AARP had experienced over their lifetimes.
At my hospital we have a diagnosis known as the “trifecta” in which a patient has hypertension, high cholesterol, and diabetes. Claire had the trifecta. Everyday we tried delicately to manage her sugars; unfortunately, we were losing the battle. Each morning I read off her chart as her blood sugar measurements from the day before were 262, 280, 230, 305. We tried desperately to get her sugars down and threw insulin at her as if it were I.V. saline. Her body was impervious. It was as if the cells in her body were made of Teflon and no insulin could ever penetrate them.
We scratched our heads over her predicament and wonder just how someone can build up a tolerance to insulin. We had her on a no-carb diabetic diet throughout the day and gave her only water and coffee to drink. Finally, on the fourth day of admission, I asked her why her sugars were so high and if she’d been sneaking food. She confided in me that her friends and family visit her at night and bring in cake, cookies, brownies, and anything else they can get their hands on. As she said, “I like to eat.”
We were all greatly annoyed. Here we’ve spent all this effort on trying to manage her diabetes, only to be outdone by a bag of Oreos. Likewise, many patients throughout the hospital are grappling with similar issues of neglect. A lifelong smoker comes in to the clinic to be told that he has lung cancer and then cries out, “How could this be? Was it something that I did? I feel like it’s all my fault.” Naturally, physicians have to put on a professional air around their patients and passionately explained to them that there are many factors which go into causing cancer. In reality, I just want to scream out, “Did you ever bothered to read the side of the box? It says right there it causes cancer.”
I’m constantly amazed by politicians who claim that we need free, universal health care available to everyone in the United States. And somehow, all Americans will instantly become healthy, will give up high fructose corn syrup, and will take up jogging three times a week. Presidential candidates from all political spectrums tout preventative medicine as if it’s some kind of cure to all of the country’s woes. As Claire demonstrated, if people want to eat, they’re going to eat.
How to make money off of the HPSP program
The military’s HPSP scholarship program pays for all expenses related to medical school training including tuition, books, and necessary supplies such as a stethoscope. The scholarship fund also provides money for room and board in the form of an annual salary. Currently, the military pays us just over $21,000 a year. While this amount sounds like a lot for a student, it is hardly enough to get by when attending a school in a major urban area. A few weeks ago I had a realization that military students can use the HPSP program to their benefit and generate additional income through investing.
The Department of Education currently allows graduate and professional students to take out federally subsidized loans up to $8,500 each academic year. That’s a free loan. And for students who can invest the money, all of the profits made off of the interest is theirs to keep.
Let’s say I withdraw $8,500 annually and invest the money, for a grand total of $34,000 borrowed over the course of four years. For this scenario, I will pay back all of my student loans the day I graduate medical school. I started running some numbers and here’s what I found:
If I invest in a relatively safe mutual fund that has a 7% gain each year, I’ll graduate with just over $40,000. That’s $6,000 for free. Now that may not sound like a lot, but six grand can pay for quite a few toys leading up to residency.
If I invest in a high yield mutual fund and it brings in 20% a year (and there are quite a few of those), I’ll finish with $54,000-a total profit of $20,000! Now that’s a new car.
I wish I had thought of this scheme when I first started medical school. I’ve already filed my FAFSA and am waiting to hear back on withdrawing a lone starting in the spring semester. If my calculations are correct, I might be able to pull in between $1,000-$5,000.
I wonder if anyone else has thought up this idea. I haven’t seen it online anywhere, but I’m sure that other students have tried it before.
The military match results are in. No one cares.
Every year medical students in the HPSP program as well as students from the Uniformed Services University (USUHS) must participate in the military’s residency match program. The military’s match program is loosely based upon its civilian counterpart. For example, program directors take into consideration grades, board scores, research publications, interviews, etc… However, just like everything else in the military, the armed forces has found away to formalize the process to such a high degree of micromanagement that the entire system is no longer meaningful. For medical students entering in the military match program, they have to wade through a confusing point system that churns out an score for all applicants based on factors such as class rank, prior military service, and “ability to become an officer.” Further, residency program directors have no control over who actually gets selected to attend their particular institute. Instead, a group of the three services’ top leaders convene one week during the fall and decide the fate of all military medical students. The whole process is rather nerve-racking for those of us in the HPSP program. This past week, the military once again held its annual match and crushed the dreams of many people seeking to enter their desired specialties.
The Air Force released its results on a public website in the form of an Excel spreadsheet. Out of privacy concerns for others, I will not reproduce that website here. However, I’m sure that he do some searching around you can find it yourself. Looking over that chart I noticed that over 25% of medical students are matching into flight surgery. For those of you who don’t know, flight surgery involves a one-year internship, six weeks of flying lessons and aerospace medicine, and then it’s off to the clinic to work as an attending. Certainly, anyone reading this blog will instantly realize that flight surgeons are missing out on a lot of valuable training in residency. By granting only one year of training, the military is creating an entire generation of physicians who aren’t fully prepared to become doctors.
For the Air Force, flight surgery is a wastebasket to force all non-matching students into a particular field of medicine. The title “flight surgery” is a misnomer. It has little to do with flying, and nothing to do with surgery. While I will grant that some people are willing to enter this field, surely 1/4 of applicants do not want to have an internship serve as their terminal training.
For the rare student who did match to his chosen field, he can breathe a sigh of relief as his senior year in school is over. But for those students who did not match into their chosen field or location, the next 5+ years are going to be very difficult. Each year that passes I grow more and more nervous about not getting the field that I want, and getting forced into flight surgery. While the prospect of learning how to fly is appealing, more than anything I just want to be a practicing physician. I’ve mentioned earlier on this website about the problems of taking the HPSP scholarship. However, money is not the only issue. Upon learning that I have no control over my future training, I feel as if the military has led us all into one great big lie.
I’m bound to get hate mail from the “patriots.” I signed up with every intention to serve. However I didn’t think that the military would deceive me over the amount of education that I would receive. Further, my role in the military is to be the best doctor I can be. And without that extra training, I’m doing a real disservice to the nation’s soldiers.
1-800-IDEA-MAN: Requiring work experience before entering medical school
Before entering graduate business school, applicants must spend a minimum of two years in the corporate world gaining experience and applying the knowledge earned from the undergraduate career. I’ve been thinking more and more recently that medical schools should take the same approach. For starters, we have too many immature people that enter medical school. For example, in my class, the vast majority of the students were accepted directly out of college and were only 22-years-old. Their lack of leadership and work experience showed from the very first day of classes. However, that ignorance and inexperience is now more apparent during the third year than ever before. Now I’ve come to the realization that medical schools should require several years of postbaccalaureate experience before even considering applicants. My take on it is that the whole dynamic of the medical profession would change simply by requiring work experience as an entry to the field.
In my case, I used to be an engineer before coming to medical school. I can use my engineering mindset as a problem solver to get around many issues that I come across on the wards. I can anticipate problems based on prior incidents and adapt to become more efficient in the future. One of my classmates was an investment banker. His knowledge of finance is astounding, and I would gladly trust him with the school’s budget so that he could deliver to us better health fairs and an outstanding graduation party.
Unfortunately, the vast majority of medical students have no touch with the outside world. For them the half study/half party life of college gets translated into the half study/half party life of medical school, which then leads to disastrous results. In addition to the disenchantment that so many medical students experience, there are a small minority that leave the field altogether before completing the four years. Many students feel as if they are being abused-and rightfully so. This dissatisfaction with the American medical schools is at an all-time high. However, requiring work experience would change several things:
Students would no longer accept inefficiencies. The current method of training involves long class hours, Physicianship Training sessions, and endless rounding on the wards, that only leads to scutwork and a secretary-like lifestyle. A new breed of medical students with real-world experience in hand would never tolerate this bullshit. They would demand that class be run more efficiently. They would realize that courses in ethics and professionalism are unnecessary because either students are ethical and professional before school starts, or they are not ethical and professional, and no amount of lecturing will ever change that. They would not accept scutwork as a method of “training.” They would demand that techs be hired to take the place of holding retractors, calling consults, and fetching old medical records.
This new breed of students would lead to a new breed of residents which in turn, would lead to a new breed of attendings. Those would be the type of attendings I would want working on me.
The type of people you meet in medical school, part 3
In the past I’ve written about characters you’ll come across in medical school such as Patient Killer and Surgio. This week I want to address the God Squad, a group of fundamentalist Christians who are so hard-core in their beliefs that they make Billy Graham seem like a Pagan.
This is the group who schedules Spring Break trips to Latin American countries in an effort to convert the Spanish-speaking savages to their way of thinking. Awkwardness abounds when they finally realize that 99% of the residents are already Catholic. As witnessed, “You must turn from your god Haysus and believe in Jesus!”
In class, these people are the groaners whenever a lecturer mentions evolution, abortion, or women’s equality. First, women started wearing pants. It’s straight to devil worship from there.
Anatomy lab becomes problematic when they see a naked person for the first time. (I actually know a girl in my class who sincerely wished that she had been married before beginning medical school so that the first penis she would have to see would have belonged to her husband.) If paired with one of the prudes, expect a conversation like this:
Her: Is that the penis?
Me: Yes.
Her: Do they all leak like that?
Me: Yes, all penises leak embalming fluid. But it usually occurs only during ejaculation. That’s why women are so stiff after sex.
Luckily, schools are able to put a dampening on prostletyzing patients so things don’t get too out of hand. But watch out when Dan Brown’s Angels and Demons comes out in theaters…
The puppets of medicine
I got my evaluations back today for internal medicine. On the whole I did well… except for the eval from my resident. She’s a fresh-off-the-boat foreign medical graduate who doesn’t understand how grade inflation works in the United States. She pulled me aside and said, “You did very well. I gave you a C.” Her comments section was loaded with praise, saying, “Very knowledgeable, works well with the team.” Under the needs to improve section, she had only one word: “unenthusiastic.” She told me, “I know you don’t want to do medicine, but you need to smile more on rounds.”
What!?! Rounds take four hours. I’m not some cheerleader who can come in and say, “Hooray medicine! Goooooo team!” Faking a smile is difficult when my job of pre-rounding is done by 7:00am and the rest of the morning is spent standing in the back of a crowd while my attending opines on starting another anti-hypertensive medication on our patient with the blood pressure of 140/80. Most of my time on rounds is spent fantasizing about having a threesome with my resident—who, might I add, is only minimally attractive at best, yet holds a lot of power over my evaluation.
In medical training we use the Socratic method to teach students. While the method is to find knowledge gaps and fill the holes in a young doctor’s education, the whole ordeal gets to be rather intimidating when the attending is interrupting the student and saying, “What are the components of Ranson’s criteria for pancreatitis?” or “What’s the half-life of labetolol?” Students call this method “pimping” because it’s such a humbling experience to have your ignorance broadcast to the entire team.
In a classic example of pimping this week, my attending wanted to see the differential diagnosis of pancreatitis. I admitted a woman to the hospital with severe upper abdominal pain. My attending asked, “Why don’t you think she’s having pericarditis?”
Me: Because the EKG is not consistent with pericarditis, she has not had any recent illnesses, she has no chest pain, and there isn’t a friction rub heard on physical exam.
Her: That’s right, she doesn’t have pericarditis. I just wanted to make sure that you knew that.
Well she’s not having a stroke, either. Would you like me to tell you why?
The good news is that I put together a patient tracking form to simplify my life on the wards. You’ll notice that I used the medfools card as an inspiration. Their card isn’t very useful for me because (1) it’s two pages and I can’t print double-sided, (2) the cards are too busy and loaded with too many forms I wouldn’t find useful, and (3) the checkboxes take up too much space for a medical student. Only an intern would need to accomplish that many tasks.
In the future, I’m going to make the boxes editable so that users can print out a nicely printed tracking sheet.
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