Between not knowing how the team works, who the patients are, where to
put my coat and how not to look like an idiot in front of my new
consultants it's absolutely exhausting.
Monday, May 31, 2010
Sunday, May 30, 2010
Saturday, May 29, 2010
This is a prescription from the prohibition in the USA
It's for 6 Tbs whiskey q3h. Good to know physicians have been political for a long time.
Shozu doesn't seem to be sending my posts
I apologise for the crappy mobile blogger format until I can get to a
computer to fix these.
computer to fix these.
today is my last day of surgery
I really think I'm going to miss it. Especially the OR staff. They've
become friends and are wonderful to work with.
become friends and are wonderful to work with.
Luckily I'll still see my chronic baby pts on the floor when I switch
to peds CTU next week.
let's say you're a baby who was born addicted to crack
Would you think it was fair to blame the baby?
These babies are often aprehended from their mothers so they need someone extra to snuggle with them and make them feel loved. They need patience and care while they work through their withdrawl (with some medical help). They may start of as screaming sick kidlets but can
become absolutely beautiful infants.
So why do their nurses seem to be angry with these wee ones? It's very upsetting to me.
Wednesday, May 26, 2010
today was a slow surgery day
I decided to take some time to play with the sister of a patient. She wanted to play Barbie. I hate Barbie. We tried to see how many outfits we could put on her at the same time. Weird game, but better than being treated like garbage on Gen Surg.
Tuesday, May 25, 2010
the privacy police are watching
I thought that I had lost my patient list the other day.To do so means having to call everyone on the list and apologise for the breech of confidence. I was terrified until I found it in my back pack where I never keep the list. Lesson learned.
they changed the art in the Walls outside the OR
While changing the art from the kids in town is lovely, it's confusing me a bit when I get off the elevator.
Monday, May 24, 2010
Sunday, May 23, 2010
Arizona is right, pediatric surgery IS hardcore
This is the mural outside the pediatric ORs. Kids don't really pay much attention to it though, they are mostly freaking out about their surgery.
It makes me wonder how they learned to be afraid. I know that parents are concerned about the surgery, they should be, but they really need to help their children feel comfortable with what is about to happen. A stressed out kid doesn't make any of the induction easier.
The surgeries themselves can be "bread and butter" (hernia repairs) or completely different from anything in the adult world.
When a newborn needs surgery, it's often because they were born with a defect of some sort. These can be quite satisfying since by fixing the defect, baby can have normalish anatomy. But the pts are tiny. This and the worrying parents are what make surgery so hardcore.
I am loving every minute on this rotation!
Saturday, May 22, 2010
Point of Care References
This is a review I threw together to help our library decide which electronic resource should be available for the medical school.
UpToDate is my favourite. As far as I'm concerned, it's the gold standard. It is easy to search, has helpful tables and images, links to other useful articles, is updated often, has useful medication information.
I've compared the following resources to UpToDate based on the following 3 searches.
1. radiotherapy (a general skill)
2. paraneoplastic syndrome (a general medical condition with many causes)
3. bladder cancer (a specific disease)
Pretty obvious I put this together during my oncology rotation right?
DynaMed:
ease of finding material: I liked that it had an alphabetic browser
did it have what I wanted?: radiation therapy and paraneoplastic syndrome were marked 'work in progress'; bladder cancer was there
therapy: decent description, appreciated the links to medications
ddx?: no
description provided: brief
does it quote evidence?: yes
ease of use: 7/10
overall score: 5/10
Harrison's Online Textbook:
ease of finding material: all 3 were easily found with search and browse
therapy: yes
ddx: yes
description provided: lengthy
quoted evidence?: no
ease of use:9/10
overall score: 8/10
PCP Pier:
ease of finding material: good for specific diseases but bad for general conditions
did it have what I wanted: maybe, was difficult to find radiation therapy (general)
therapy: yes
ddx: yes
description: point form
quoted evidence?: yes
ease of finding use: 7/10
overall score: 7/10, I liked it for the specificity it gave with the disease but it was useless with general topics. Maybe this plus Harrison's would be a useful combination.
Essential Evidence Plus:
ease of finding material: liked the refining guidelines provided
did it have what I wanted?: yes, but not always available in one place
therapy: yes
ddx: not explicitly
description: point form
quoted evidence?: yes with the level of evidence (great!)
ease of use: 6/10
overall score: 7/10, I liked the way the evidence is presented but feel it would take a very long time to gather enough information to do a presentation on any given topic
Clinical Evidence (BMJ):
ease of finding material: good if you want something that the BMJ has published
did it have what I wanted?: no, but lots of other good stuff
therapy: yes
ddx:not obviously
description: charts and point form
quoted evidence?: yes
ease of use: 9/10 when browsing, 6/10 when looking for something specific
overall score: 7/10, not sure I'd actually use this resource
MD Consult
ease of finding material: OK to find material, difficult to find material at my level though; overview is not bad
did it have what I wanted?: yes, but not all in one place
therapy: yes
ddx: yes
description: lengthy and often summarized
quoted evidence?:some
ease of use: 7/10
overall score: 8/10, I like that the information is laid out by subtitle on the beginning page (overview vs. signs and symptoms)
UpToDate is my favourite. As far as I'm concerned, it's the gold standard. It is easy to search, has helpful tables and images, links to other useful articles, is updated often, has useful medication information.
I've compared the following resources to UpToDate based on the following 3 searches.
1. radiotherapy (a general skill)
2. paraneoplastic syndrome (a general medical condition with many causes)
3. bladder cancer (a specific disease)
Pretty obvious I put this together during my oncology rotation right?
DynaMed:
ease of finding material: I liked that it had an alphabetic browser
did it have what I wanted?: radiation therapy and paraneoplastic syndrome were marked 'work in progress'; bladder cancer was there
therapy: decent description, appreciated the links to medications
ddx?: no
description provided: brief
does it quote evidence?: yes
ease of use: 7/10
overall score: 5/10
Harrison's Online Textbook:
ease of finding material: all 3 were easily found with search and browse
therapy: yes
ddx: yes
description provided: lengthy
quoted evidence?: no
ease of use:9/10
overall score: 8/10
PCP Pier:
ease of finding material: good for specific diseases but bad for general conditions
did it have what I wanted: maybe, was difficult to find radiation therapy (general)
therapy: yes
ddx: yes
description: point form
quoted evidence?: yes
ease of finding use: 7/10
overall score: 7/10, I liked it for the specificity it gave with the disease but it was useless with general topics. Maybe this plus Harrison's would be a useful combination.
Essential Evidence Plus:
ease of finding material: liked the refining guidelines provided
did it have what I wanted?: yes, but not always available in one place
therapy: yes
ddx: not explicitly
description: point form
quoted evidence?: yes with the level of evidence (great!)
ease of use: 6/10
overall score: 7/10, I liked the way the evidence is presented but feel it would take a very long time to gather enough information to do a presentation on any given topic
Clinical Evidence (BMJ):
ease of finding material: good if you want something that the BMJ has published
did it have what I wanted?: no, but lots of other good stuff
therapy: yes
ddx:not obviously
description: charts and point form
quoted evidence?: yes
ease of use: 9/10 when browsing, 6/10 when looking for something specific
overall score: 7/10, not sure I'd actually use this resource
MD Consult
ease of finding material: OK to find material, difficult to find material at my level though; overview is not bad
did it have what I wanted?: yes, but not all in one place
therapy: yes
ddx: yes
description: lengthy and often summarized
quoted evidence?:some
ease of use: 7/10
overall score: 8/10, I like that the information is laid out by subtitle on the beginning page (overview vs. signs and symptoms)
Friday, May 21, 2010
this is my laundry machine
I put dirty scrubs in on the right and take the clean ones from the left. It's great, and so much easier than cleaning my own clothes.
Thursday, May 20, 2010
back home
I realised this morning in my way into the hospital that I feel very comfortable here. It's like going back to my old high school after being on an adventure somewhere else.
Tuesday, May 18, 2010
one exam down, one more to go
The NBME exam wasn't as bad as I thought it would be. Either I killed it or it killed me but I didn't realize it.
Tomorrow is the oral exam. It's like a monster pimping session.
Speaking of, Surgical Pimpapalooza is a new app and really kicks butt. Check it out!
Monday, May 17, 2010
at the risk if sounding like a silly school girl or a cast member on Gray's....
I love that Hot ENT Surgeon always smiles and says hi to me. Swoon.
Sunday, May 16, 2010
Saturday, May 15, 2010
*just* family medicine
I grow weary of telling people that family docs are no longer GPs, that family medicine is a specialty.
But this article makes me feel excited to get to my residency and show them that a family doc is not just a real doctor but a well rounded one.
Betty White on SNL
What a freakin' riot. I can't believe she brought up micropenis.
And the skit about muffins is fantastic. I've always been a fan of promoting sexuality in the elderly and she really is the perfect spokeswoman.
The whole MacGruber marrying his grandmother thing....too soon?
That was well worth the study break.
Friday, May 14, 2010
Thursday, May 13, 2010
Wednesday, May 12, 2010
Funniest surgery moment ever
Today our consultant took a break mid case to demonstrate the shopping cart dance move. Easily the whitest guy dance I've ever seen.
my morbid sense of humour
An above knee amputation with a fish mouth revision looks just like the giant plant puppet in Little Shop Of Horrors. Seriously.
some words should never have been coined
Referring to our patients edematous genitals, my resident said 'scrotatoes'. Oh dear.
Monday, May 10, 2010
Well, she thought she did
I have a PGY1 friend in obstetrics who was required to do a geriatric rotation to fulfil her medicine requirement. We commented that little old ladies have gynecological problems too.
"Ya, I had a woman who had a pessary. Well, no, she just thought she did. She was a bit demented."
Sunday, May 9, 2010
more apps I'm using in clerkship
2009 EMRA Antibiotic Guide: This is an app designed by emergency physicians. It's not entirely complete but it's a fast way to get an idea of the direction to take when Antibiotics are needed.
You can start with an organ (pulmonary, skin, etc.), or by diagnosis, organism or topic. Common organisms and dosing are suggested for each. There's only a few steps to get to the dosing recommendations which is a real bonus.
This is cheaper than the Johns Hopkins version of an antibiotics guide and has fewer features. Your call.
P: C$15.99
Johns Hopkins ABX Guide: Organized by diagnosis, antibiotics, pathogens, management, vaccines and CME. This guide has more information than EMRA on vaccinations and tropical illnesses. The information is posted in a similar matter to how they post the 5MCC info. This can be a bit cumbersome to find info quickly but does give you significantly more data and suggestions than you get in EMRA.
It's a tough call. As someone who knows jack about antibiotics, this guide is a bit overwhelming. I'll use EMRA most often.
P: C$ 24.99
epocrates: I only use this for pill ID and the interaction tool. I get my dosing, adverse events, and other drug info from Dr. Drugs. The pill ID is most useful with an internet connection so you can actually compare the pills a patient has in their hand with the ones we know about. The interaction tool is great for comparing meds that patients are taking to rule out causes of weird symptoms.
Meds are discussed by dosing, black box warnings, contraindications, adverse reactions, drug intereactions, pharmacology...
P: free!
Eye Chart Light: An easy to use app. Not perfect by any stretch of the imagination, but in a pinch, it helps with visual acuity.
You can start with an organ (pulmonary, skin, etc.), or by diagnosis, organism or topic. Common organisms and dosing are suggested for each. There's only a few steps to get to the dosing recommendations which is a real bonus.
This is cheaper than the Johns Hopkins version of an antibiotics guide and has fewer features. Your call.
P: C$15.99
Johns Hopkins ABX Guide: Organized by diagnosis, antibiotics, pathogens, management, vaccines and CME. This guide has more information than EMRA on vaccinations and tropical illnesses. The information is posted in a similar matter to how they post the 5MCC info. This can be a bit cumbersome to find info quickly but does give you significantly more data and suggestions than you get in EMRA.
It's a tough call. As someone who knows jack about antibiotics, this guide is a bit overwhelming. I'll use EMRA most often.
P: C$ 24.99
epocrates: I only use this for pill ID and the interaction tool. I get my dosing, adverse events, and other drug info from Dr. Drugs. The pill ID is most useful with an internet connection so you can actually compare the pills a patient has in their hand with the ones we know about. The interaction tool is great for comparing meds that patients are taking to rule out causes of weird symptoms.
Meds are discussed by dosing, black box warnings, contraindications, adverse reactions, drug intereactions, pharmacology...
P: free!
Eye Chart Light: An easy to use app. Not perfect by any stretch of the imagination, but in a pinch, it helps with visual acuity.
P: free!
Eponyms: Something that I've found in clerkship is that our consultants use eponyms more than they use the names that make sense. We're taught logical names of conditions and structures but they were taught goofy names based on some dead guy. This app is quick to use and easy.
The eponyms are categorized by specialty, anatomy, tests and procedures. A short definition is provided for each eponym. Useful when your orthopod said "something that began with c" but you're not sure what.
Well worth having.
P: C$1.99, there's a free version too but I don't know how inclusive it is
and yet, still more to come
Saturday, May 8, 2010
I will study antibiotics
I will stop watching Angel and learn. It could happen, though not likely today.
OHIP Decision
This article in the Globe and Mail indicates an interesting change in how OHIP may be delivered and how it's payment may be considered.
"More broadly, the case suggests Canadians should be savvier before going under the knife, asking doctors how many of a given operation they have performed, and their death and complication rates. It also raises a delicate debate: How many operations does a surgeon have to perform to be considered proficient?"
When you consider several factors, including Malcolm Gladwell's Ten Thousand Hour Theory it's hard to imagine how medical students and physicians ever see enough of a specific pathology to master it. (In case you are unfamiliar with this theory, it essentially states that to truly be the master of *something*, you need to have practiced it for 10, 000 hours. Essentially four hours a day for ten years.)
Medications and imaging reduce the severity of many pathologies we may normally see. Speaking with residents and consultants, it seems that 10 years ago putting in chest tubes and draining abdominal ascites were procedures often done.
Now though I can honestly say I've seen 2 abdominal ascites drained and 2 chest tubes placed (both on the same patient). I would not be able to perform one myself if the need arises, but now that I've finished the rotations in clerkship where I might see one, I have to hope that when residency rolls around I'll have another chance.
Something as uncommonly seen as this cavernous brain stem tumour would be difficult to master based on number of cases alone, though interesting that the American surgeon managed to amass 200 cases. Would virtual cases or those practiced on animal models count to one's mastery?
What is most concerning about the principle behind this ruling in favour of Brad's family is that if everyone decides to only be treated by the very best, those of us training to do our best are unable to learn. When the specialists retire, the patients will have set up a situation with no one to care for them.
Clearly this is taking it to the extreme, but I think the point is still valid. Medical trainees need to learn on real patients. Patients deserve the best care. These two factors do not need to be mutually exclusive and we see that in academic hospitals.
When trainees are in the OR with their consultants, the trainee does the majority of the surgery while the consultant assists. The consultant is there if the trainee needs help and to offer advice about unusual findings during the procedures. The patient gets the care of several surgeons, often two anesthesiologists and 2-3 nurses during their surgery. The trainees have read about the case and the pathology and are up on the latest findings (unless they are terrible trainees, but that's another story).
I'd feel safe in a training hospital.
But I'm still stuck on what it will take for me to be a great family doc. Our residency is only 2 years. I feel like I haven't been studying enough to be on top of everything I'm supposed to know for clerkship let alone residency. Getting my 10, 000 hours in is going to be a challenge.
Currently, I'm in the hospital on the weekend, taking an extra call shift in the hopes of seeing a new pathology I haven't seen before. I know that I learn by seeing and doing and that I can't do this from home.
"More broadly, the case suggests Canadians should be savvier before going under the knife, asking doctors how many of a given operation they have performed, and their death and complication rates. It also raises a delicate debate: How many operations does a surgeon have to perform to be considered proficient?"
When you consider several factors, including Malcolm Gladwell's Ten Thousand Hour Theory it's hard to imagine how medical students and physicians ever see enough of a specific pathology to master it. (In case you are unfamiliar with this theory, it essentially states that to truly be the master of *something*, you need to have practiced it for 10, 000 hours. Essentially four hours a day for ten years.)
Medications and imaging reduce the severity of many pathologies we may normally see. Speaking with residents and consultants, it seems that 10 years ago putting in chest tubes and draining abdominal ascites were procedures often done.
Now though I can honestly say I've seen 2 abdominal ascites drained and 2 chest tubes placed (both on the same patient). I would not be able to perform one myself if the need arises, but now that I've finished the rotations in clerkship where I might see one, I have to hope that when residency rolls around I'll have another chance.
Something as uncommonly seen as this cavernous brain stem tumour would be difficult to master based on number of cases alone, though interesting that the American surgeon managed to amass 200 cases. Would virtual cases or those practiced on animal models count to one's mastery?
What is most concerning about the principle behind this ruling in favour of Brad's family is that if everyone decides to only be treated by the very best, those of us training to do our best are unable to learn. When the specialists retire, the patients will have set up a situation with no one to care for them.
Clearly this is taking it to the extreme, but I think the point is still valid. Medical trainees need to learn on real patients. Patients deserve the best care. These two factors do not need to be mutually exclusive and we see that in academic hospitals.
When trainees are in the OR with their consultants, the trainee does the majority of the surgery while the consultant assists. The consultant is there if the trainee needs help and to offer advice about unusual findings during the procedures. The patient gets the care of several surgeons, often two anesthesiologists and 2-3 nurses during their surgery. The trainees have read about the case and the pathology and are up on the latest findings (unless they are terrible trainees, but that's another story).
I'd feel safe in a training hospital.
But I'm still stuck on what it will take for me to be a great family doc. Our residency is only 2 years. I feel like I haven't been studying enough to be on top of everything I'm supposed to know for clerkship let alone residency. Getting my 10, 000 hours in is going to be a challenge.
Currently, I'm in the hospital on the weekend, taking an extra call shift in the hopes of seeing a new pathology I haven't seen before. I know that I learn by seeing and doing and that I can't do this from home.
Friday, May 7, 2010
I stripped a varicose vein today!
That's the only exciting thing today though.
Yesterday, a pt went asystolic on the table for a minute. When we asked him about it today he responded 'oh, that happens sometimes'. As long as he's comfortable with it....
Yesterday, a pt went asystolic on the table for a minute. When we asked him about it today he responded 'oh, that happens sometimes'. As long as he's comfortable with it....
Wednesday, May 5, 2010
more iPhone/touch apps for clerkship
I started talking about the apps I had found useful in clerkship here. I still use Diagnosaurus, 5 Minute Clinical Consult and Dr. Drugs quite a bit. I also use a bunch more. I'll be the first to admit I have a ridiculous number of apps.
Wards: Patient Tracker: this is a program that lets you put the pts name, chief complaint, tests ordered and plans for discharge into your phone. It takes a bit of time to get everyone in which was a real deterrent from bothering to use it on surgery, but I did use it on medicine and found it helpful. I was walking around with lists of patient names with info scribbled under their names, updating from the previous day every day, trying not to lose a sheet and get attacked by the privacy police. (Speaking of the privacy police, there is a password requirement to enter and get the information.)
When the app first came out, you were restricted to the consults/tests in the bank. Now you can put your own in so that it becomes customized to the service.
It's great for following patients through their hospital stay and doing discharge summaries at the end since you've highlighted the big points while there were in hospital - if you take the time to enter the info. Really, time is the only drawback to this system.
P: C$4.99
Shozu: Lets you keep up with your blog between cases/in moments of serenity so your family and friends know you are alive. Easy enough to use. Doesn't let you type in landscape mode though which is a huge drawback.
P: C$4.99
Calculate (Medical Calculator) by QxMD: This really is the only calculator you'll need. And it's free. Just get it.
If you want more convincing, you can customize it to the rotation you're on or keep it at the general practitioner mode to have all calculations quickly available. It's not just fun with numbers like figuring out the anion gap, there's also check lists like the Ottawa Ankle Rules, Pediatric Glasgow Coma Scale and risk of relapse into heavy drinking.
It takes a little while to get used to all the options available to you and remembering to access them when you need them.
P: FREE!
Cardio, Heme, GI, Neph Calculators: These are all done by the MedQx guys. Just get the calculator above to have everything in one app, no redundancies.
Hospital Codebook/Phonebook: Your contacts list is a better way to handle this information. Not a useful app.
P: C$.99
A2Z of Dermatology: I'm on the fence about this app. If you already know the name of the dermatological feature you're looking for, you're away to the races. If not, it can be a bit of a long haul trying to figure out what the rash is that you're looking at. I'd prefer to see this as an algorhythm type app - like a derm calculator "what colour is the lesion" "is it elevated"...you have melanoma! Ah, maybe that's why, too much like diagnosing your own illness. But I digress.
The app lists the lesions in alphabetical order by their commonly known name. It gives you a photo and a description of what the lesion is, what may have caused it and often a treatment. There is usually a link through to Google images for other examples of the lesion, which is helpful.
But, not really worth the dough. Use google yourself for this.
P: C$3.99
more soon...
Wards: Patient Tracker: this is a program that lets you put the pts name, chief complaint, tests ordered and plans for discharge into your phone. It takes a bit of time to get everyone in which was a real deterrent from bothering to use it on surgery, but I did use it on medicine and found it helpful. I was walking around with lists of patient names with info scribbled under their names, updating from the previous day every day, trying not to lose a sheet and get attacked by the privacy police. (Speaking of the privacy police, there is a password requirement to enter and get the information.)
When the app first came out, you were restricted to the consults/tests in the bank. Now you can put your own in so that it becomes customized to the service.
It's great for following patients through their hospital stay and doing discharge summaries at the end since you've highlighted the big points while there were in hospital - if you take the time to enter the info. Really, time is the only drawback to this system.
P: C$4.99
Shozu: Lets you keep up with your blog between cases/in moments of serenity so your family and friends know you are alive. Easy enough to use. Doesn't let you type in landscape mode though which is a huge drawback.
P: C$4.99
Calculate (Medical Calculator) by QxMD: This really is the only calculator you'll need. And it's free. Just get it.
If you want more convincing, you can customize it to the rotation you're on or keep it at the general practitioner mode to have all calculations quickly available. It's not just fun with numbers like figuring out the anion gap, there's also check lists like the Ottawa Ankle Rules, Pediatric Glasgow Coma Scale and risk of relapse into heavy drinking.
It takes a little while to get used to all the options available to you and remembering to access them when you need them.
P: FREE!
Cardio, Heme, GI, Neph Calculators: These are all done by the MedQx guys. Just get the calculator above to have everything in one app, no redundancies.
Hospital Codebook/Phonebook: Your contacts list is a better way to handle this information. Not a useful app.
P: C$.99
A2Z of Dermatology: I'm on the fence about this app. If you already know the name of the dermatological feature you're looking for, you're away to the races. If not, it can be a bit of a long haul trying to figure out what the rash is that you're looking at. I'd prefer to see this as an algorhythm type app - like a derm calculator "what colour is the lesion" "is it elevated"...you have melanoma! Ah, maybe that's why, too much like diagnosing your own illness. But I digress.
The app lists the lesions in alphabetical order by their commonly known name. It gives you a photo and a description of what the lesion is, what may have caused it and often a treatment. There is usually a link through to Google images for other examples of the lesion, which is helpful.
But, not really worth the dough. Use google yourself for this.
P: C$3.99
more soon...
Monday, May 3, 2010
recharging my battery
Despite being incredibly sick during this conference I feel so excited. Being around this many people who want to improve medical education has opened my eyes to options in my future career. I've met and networked with some wonderful people. I'm now aware that a masters of medical education. I'd planned on doing a M. Ed but now that I know this exists I'm wacky excited.
I've also been made aware of several potential research projects that I'd be excited to initiate.
I also made it to a talk on how to write a better paper for admission to a medical journal.
bliss
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