"How are you able to continue working after witnessing a death like that?"

I had a great question from a very insightful medical student after the first case of our day was to Code Blue that did not get any better. The code was on a young patient in my primary care. She was very unwell, and I'm sure nothing would that have changed the outcome. Tragic, true, circle of life type stuff. 

Initially, I felt really upset with myself. How could I just move on? I know this woman and her family quite well. Should not I be more upset with what just happened?

With every death, every code, I ask my team to do a quick debrief with me (longer if needed) to ensure that we did all that we could, and needed to do. I go over everything in my head as well. Where could I improve next time? Were we all wearing PPE? Did I speak with the family in a respectful, clear manner ?

This time around, the police were with us. We're a small town, so all tragedies involve them. It's great, because they call victim services if needed, get in contact with distant relatives, chase after teens who "can not take it" and run off. They are a really good bunch. They surrounded me and checked in on how I was doing. Asking if I would talk to someone if things went poorly. I am telling me I was a rock star in the trauma bay, That the family completely trusted me and was incredibly relieved to know that I would be the one working on their loved one. Basically making sure I do not get PTSD from the event - something I try to do for them all the time but was not used to having it in return. 

I was a bit upset, but felt like I was not upset enough. That I was a big faker pretending to care. 

It was not until yesterday that I was able to figure out why it is that I can just pick up and go on. This was the third patient that description fit that died in front of me this year that I was able to continue working after their pronouncement. 

I have a therapist. Everyone should. She helps me figure out things like this that niggle in the back of my head but that I do not take the time to work through. She helps me figure out when the culture of medicine is nutso and I'm right to ignore the culture and do what is right. 

Here is the answer, finally, med student of mine. I have an incredible resilience built around patient deaths. 

When I first got into med school, I knew that someone like me with a soft hear t might have a hard time with death so I sought out situations where I would be challenged. I thought about each deat h as an unavoidable event and looked for the way that I could make it the MOST comfortable for the patient and their family and (even when the patient is a baby). I learned that I could cry with family in a respectful manner. 

Each of those links is a blog post I've done during my training and practice to reflect on death and my part in it. I see myself as separate from the patient and their family. I love them in a way that is not family or friend, but caregiver. My role in their life is just a step in their journey through this world. They hold the same role in mine. While our lives intersect, my goal is to make our lives both better for the experience. I learn my lesson, then a go to intersect with another life. The lessons I've learned stay with me forever, but they are not necessarily emotional. 

Sometimes they are. A patient died of malnutrition at a young age, and you bet your ass I got angry and looked to make change. But, because I want the rest of my patients to be healthy, because i was not dwelling on his passing. 

So, my thought process goes like this; reflect on the death changeable and my role in it, reflect on the interaction with family and colleagues, move on to the next patient who needs to see me. This might happen many times during the day following that death. I still wonder if I could have done more for my patient before she died, but that use as a way to be a better doctor, not to dwell on the past. 

Death is part of life. My job is to keep moving forward. I see my getting back to work and helping other people as a way of respecting my patients' lessons to me. 

Pregnancy in Medical School

"Remember people, well except medical students, typically reproduce before the age of 30."

MD, cardiologist

(via coffeemuggermd)

I’ve had this in my drafts for a while. It still pisses me off a bit. Not that it necessarily should, the cardiologist isn’t saying that no med students have kids before 30 but it’s atypical. 

What pisses me off, is that those who recognize that their life starts NOW, not after residency, or fellowship, or any other magical time, and want to have children are treated as wackos by most of our community. I know I rail on about medical culture and why it is not reflective of reality, but I’m going to do it again. This is another example of thinking that we need to change. 

There is research on just about everything that med students do. You’re the easiest population for medical researchers to bug, so they do.

However, I can’t find much research on being a parent in medical school.  This focuses on mothers (wall free article). It’s the only paper I could find (lots for residents by the way, probably because they are also leading a lot of the research). A lot of the young women I’ve spoken with felt they were treated poorly by the fellow students because they were getting “so many” allowances for time. The new dads in my class felt like they were expected to carry on as if there wasn’t a new sprog at home.  

Back to the paper, “Medical School-Mothers” in the Rhode Island Medical Journal. I’ve never heard of this paper, or this journal and I’m pretty damn excited about all things undergrad medical education and feminism. That’s disappointing. (Have you heard of it and I was just under a rock?)

They don’t tell us how many medical students were interviewed. I want to know what several means - is it 4? Is it 34? Help a sister in research out.

They also don’t discuss fathers. I get that women in medicine is new and all, but I want my colleagues to be good dads. I don’t want any of my colleagues to be fondly remembered by their grandchildren because their own children never saw them. 

“As part of universal precautions, all female medical students who are sexually active with men should be mindful of potential pregnancy.” BARF. Shouldn’t our male medical colleagues also be mindful? This reminds me of the episode in 2014 where a female medical student was at risk of losing her funding to study in Cuba because she “fell pregnant”, while her XY partner was not reprimanded. BARF I say. IUSs, condoms, and access to family doctors for all med students who want them!!

This article is mostly focused on what Student Affairs type people need to know (which is fantastic). 

But. 

What I would like to see is something that talks to many more students to provide curious students with help making decisions, something that gets more into the pros and cons of an educated choice. No one knows when the time is right to have children. Everyone has an opinion on it though. 

I’d also like to see a nation wide mentorship program - to be paired with an attending, hopefully in your chosen field, who also was a parent in med school. Knowing you have someone who has been there and survived. 

I’d like a handbook for parents in med school. Tips tricks and downfalls to avoid. I’d like this to be an open topic of discussion that starts in Year one. I want the parental leave policy to be pointed out to all students during orientation week. 

I want to know how much post partum depression and anxiety are present in the learners having children. We are all pretty crappy at taking care of our mental health, and how many of us have med studentitis? (Pregnant med studentitis is like that on freaking crack - everything that could possibly go wrong, will and you will blame yourself, even though you would tell your patients to think better of themselves. My friend had 10/10 stress through the last 4 months of her pregnancy. Uncool.) 

I want there to be scheduled check ins with Student Affairs during pregnancy and post partum to ensure this isn’t an issue. My suspicion is that the numbers of sufferers in the medical community are high. 

I want to get rid of the shame associated with wanting to be a good parent when you are ready to be one. Seriously. If we don’t stop acting like families in medicine are bizarre while we’re in first year medical school, how can we expect attendings to respect their colleagues and learners’ choices?

One of my colleagues is pregnant. I’m over the moon for her and her MD husband. The amount of stress they underwent preparing to tell the rest of the team about the (wanted, expected) pregnancy was overwhelming to ME. I’m not having a baby. Jeepers. They felt they needed to make it very clear that they do not want to stop practicing for more than 2 months each (like it’s not bad enough that they don’t get parental leave from our governing body). They were shamed into divulging the information much sooner than they wanted due to morning sickness. Our colleagues (all XY but me), have children with stay at home moms and incredibly twisted senses of what parenthood should look like with a physician parent. 

This has got to stop guys. We need to treat each other better and watch each others’ backs. 

What would you add to my list to make it happen?

Sexism in Clerkship

I’m going to point out that frequently during your clerkship, you will experience sexism. Sometimes these moments will be not too bad, a patient thinking you’re a nurse (are you kidding? I wish I knew that much in clerkship!)

Most times, it will be subtle. It will be everyone ignoring the suggestions made by the female clerk. It will be judging her outfit or flirting with anyone. It will be interrupting her, presenting her ideas as their own. It happens. It becomes common. Everyone will act like this is just how it is. Your job, male or female, is to make sure this is no longer common. Your job is to make sure that clerk feels supported. This is your team, you all need to be strong.

Here’s how to do it without waving a flag and making everyone on the team afraid of you.

When she is interrupted or ignored, wait until the interrupter is finished speaking, then say “I think that Meredith was making a good point, did everyone get to hear it?” When derogatory comments are made, ignore them and change the topic to whichever patient was being discussed prior to the comment. If someone is presenting Meredith’s ideas as their own, be subtle, this one is tricky. Something along the lines of “It’s a great idea, I thought as much when Meredith said it this morning at rounds. Maybe you two should work on it together!”

Everyone on your clerkship team deserves to feel supported. Everyone deserves to be able to show what they know and learn. When your colleagues thrive they bring you with them.

Be the colleague you want to have.

Can I possibly improve my blog? Maybe.

For kicks, I decided to look on PubMed to see if there was any research done on blogging. There is. Actual research done on how docs blog. Cool. But it's Saturday, so I'm only going to look at 2 of them.

First of all, did you know about Web 2.0?? I sure didn't but I've been using it like a mad person for years. Web 2.0 describes web sites that use technology beyond the static pages of earlier web sites.

This article makes a point I've been considering for a while - making my blog searchable in a way that will make it easier to match experiences I've had with my progress in my training and any applicable social aspects. They propose that bloggers use the usual tags they use (my favourite seems to be 'note to self''), they call these folksonomy - plus a diagnostic code from the ICD-11. The blogs that the researchers suggest these tags be used include WebMD, Kevin MD, and CasesBlog. My blog has little to do with these blogs - it's just me, I'm trying to learn more about myself as a physician not necessarily educate others (though I hope that's a happy bonus), and, for the most part, I hide my patients' true diagnosis. If I choose to follow the proposed system in this paper, which frankly isn't terrible, it makes it more difficult to hide my patients' identity. Unless, I use the ICD codes only for my rants on specific topics like suicide and HIV, and ignore the diagnoses of the cases I dissect. Which certainly is something worth looking at.  While I won't follow their algorithm to the letter, I will try to remember to tag liberally.

Another set of researchers looked specifically at learners' blogs. It's like they were looking over my shoulder. They found that learners used their blogs to reflect on their experiences. Their table 2 looks at the analysis of the blogs and what is covered and offers a few suggestions. My absolute favourite is the suggestion to share coping strategies with peers. Personally, I would have put it under "emotional distress" not "interaction with peers". I think that many learners are looking for other learners' blogs to find out how they deal with the big stuff in their lives - exams, residency matching, patient death... Having a fairly anonymous way of talking about things we are afraid of telling each other face to face would be helpful. There are many conversations taking place on twitter and in medical journals about burnout. It seems to me that using each other via the anonymity of Web 2.0 is one way to seek help without worrying about repercussions.

They also found that blogging learners were likely to preach the benefits both of collaborative learning and having a solid support system. Of course they do. Blogging learners rock.

Pinilla et al also makes some suggestions about how medical educators can use their students' blogs to enhance their learning. One suggestions is that the educators look for where their learners are having problems with exams, etc. This creeps me out. If I had any inkling that my teachers were looking at my blog I would have stopped writing. Or at least edited my posts to the point of ruining the point I was trying to make. Random, unknown educators would have been welcome to peruse, but not my own teachers. Looking at broad themes and concerns of the bloggers in general is a great idea. That it might even be an option makes me happy that I've stayed the Imposter.

So, to recap what I've learned:
1. Tag my blog liberally so that finding information in the future will be easy, both for me and for my readers.
2. Encourage the use of blogs as a way to share coping strategies.
3. Blogging learners rock.
4. Educators should not follow their own learners' blogs. It's creepy. But I'm all for qualitative research. Especially when it's done by someone else.

My online appearance is more important than my physical appearance

I had a great time today reading posts and comments on Twitter about physicians' appearances.

Things I've learned:
1. Some docs really like this article from 2005 (!!!!) on the importance of dressing well for your patients. Remember it can take up to 3 years to publish an article so this data is from 2003 at the latest. Think track suits and Queer Eye for the Straight Guy.

2. The BBC would really like doctors to generally judge everything about their outward selves. This article looks at "scruffy doctors", overweight doctors, and doctors who smoke. They also acknowledge that many patients are expecting the white coated doctor to be male. 

Which brings me to...

3. A separate discussion has been playing out today on Twitter about how young female physicians are perceived spurred by this blog entry. Female docs are often (VERY often) mistaken for nurses. Even after introducing themselves as Doctor SoandSo. I know I've blogged on this before but I can't find it. We are also assumed to be the assistant, the secretary. As an older than average resident, I was usually mistaken for the social worker or my pediatric patients' mother DESPITE wearing an ID badge and my stethoscope. One intelligent staff member asked me 6 times during my 2 month pediatric rotation to fill out the insurance forms for "my child". She was shocked every time that I was *still* a physician. I was once blocked from a code by the nurse who called me to it because she thought I was a family member (again, with stethoscope and badge). 

While I was on rotations in other hospitals, I would carry a small bag with my "pocket" stuff. Pens, a Drug Pocket, my phone. Most "professional" women's clothing prohibits actually using pockets if they do exist. This teeny satchel was usually the scape goat in my mis-identification. 

This is one of those issues that makes me a bit cranky. Have I told you yet about the preceptor who told me that it was perfectly reasonable to be mistaken for the social worker since "doctors don't have long curly hair, you can't expect to be taken seriously"? It makes me see red. 

If, in real life, I'm mistaken for another profession or not a professional at all, based on my hair and my satchel, what must the medical world think of me based on my online profile? 

Some argue that our online presence allows others to see our "true selves" (it's the basis for many relationships that start online). Social media (SoMe), plays a big part in my life. I'm in a tiny rural town, most of my friends are in different provinces. Without my online presence, I would be entirely isolated. My professional online presence is split between The Imposter and Dr. SoandSo. Maintaining my anonymity on this blog is important to my being able to use it as a sandbox for trying out ideas and ways of dealing with patients in a safe environment. As Dr. SoandSo, I have opinions on family medicine and its role among the specialties. As just me, I am on Facebook with my friends and family so I can watch my family grow up from a distance. 

I'm seeing guidelines and suggestions about how docs (and everyone else) should behave online. It's true, many docs are illiterate in the ways of SoMe, but I think that they are aware of how to behave in a crowded mall. The same rules we learned in kindergarten apply. 

1. Share everything. Post your references so others can also be as smart as you.
2. Play fair. Don't overload your online profile so that your friends aren't also visible. 
3. Don't hit people. Don't call them names. Maybe they have had a really bad day.
4. Clean up your own mess.  Untag any photos that you wouldn't want your mother to put into the family Christmas card. 
5. Don't take things that aren't yours. Credit any source that you use. You wouldn't want someone else prancing around in the sweater you took 3 years to make claiming they knitted it themselves. Our intellectual property is just as important. 
6. Say you're sorry when you hurt somebody. Apologise when you make a mistake and correct those mistakes.
7. Wash your hands before you eat. MRSA y'all. 
8. Live a balanced life - learn some and think some and draw and paint and sing and dance and play and work every day some. Your online friends are interested in the new bottle of wine you found just as much as they are the new journal article that you found so fascinating. Share. But please don't overshare. 

Truthfully, first impressions are just that. The patients who mistook me for a social worker trusted my ability to care for their medical needs. First impressions don't matter nearly as much as who we as health professionals truly are. How many times have you heard from your patients the story about the surgeon in his million dollar suit with no bedside manner? Could you possibly sleep well at night knowing that you had treated your patients in a way that would have put you in the corner during kindergarten? My online presence is as close as it comes to knowing the real Imposter and how she speaks with her patients. 

Dress respectfully for your patients but act respectfully (online and face to face) for yourself as much as them. 

Learning radiology on your own

Check out the radiology channel on you tube. It includes such BRILLIANT gems as the ossification centres of the paediatric elbow. Awesome.

And don't forget the Wheeless Orthopadics text book. It gives advice on doing the physical exam and management.


- Posted using BlogPress from my iPad

Another open letter to clinical clerks

If your preceptor asks if you want to stay and see patients, the answer is always yes. Especially if it's not even noon yet.

Residency has tough moments

Telling a medical student what they need to do to pass. Encourage them to do what needs to be done, but let them make the decision to not fulfill any real objectives. Watching someone choose to fail at medicine is very hard to do.


- Posted using BlogPress from my iPhone

Studying while doing the dishes

Wrapping up 4 years of medicine is busy. Every time I turn around, there's something else that needs to be done, someone that requires a document that I had in first year, somewhere I need to be.

I've been listening to pod casts of med review while doing household tasks and driving. So much easier than that pesky reading.

Pedcases and Surgery 101 are through U of A in Edmonton. MedPod is fun as well, if rather racist at times. They were helpful in clerkship and I'm enjoying them now. I remember bits of the dialogue when I'm trying to remember facts.

All the podcasts have material on their sites that can be useful for studying. Pedcases in particular has quite a few cases to learn from.

Worth checking out. And makes it possible to study while doing housework. Because that's fun.

The Learner's Perspective

During my obs/gyne rotation in clerkship, I was given essentially no responsibilities and nothing to do. There were PGY1 - 5s before me in the OR and in L&D. I was as close to being useless as a person can be.

Whenever a patient came into the ER for assessment, I jumped at the opportunity. It was rare I could go since the PGY1 wanted the experience, but every now and then I was lucky and a call came while they were in teaching or scrubbed in and I would *have* to go.

I met a woman who came in from the periphery with abnormal bleeding. So abnormal, her hemoglobin (normally low for her) was half of what it was the week before. She was weak, pale, tachycardic and hooked up to a cardiac monitor. Kind of a big deal.

I did the usual med student thing - history and physical, wrote an admission note and orders - after I paged my consultant to ask if we could bolus her fluids then transfuse her since she was hypovolemic and headed to shock. This was a direct transfer so we were responsible for her care and the ER docs are supposed to be hands off - stupid politics. This made sense to my consultant so he agreed then left me to finish the paper work.

This was my patient! I finally had a Gyne patitent!

*ahem*

She was eventually moved upstairs and started on some of the miracle drugs we try when attempted to make the bleeding stop. It slowed down, but not enough as she was still requiring multiple transfusions to avoid complications of her anemia.

The consultant asked me to set up angioplasty for her fibroids with the interventional radiologist. Easy.

The day she was going for the procedure she was terrified - she’d never had surgery before - and her husband wasn’t allowed in the room. I was bored. There was another 4 vaginal hysterectomies on the board which meant that I would not be able to get close enough to the patient to determine gender let alone do anything. So I asked if I could accompany the patient into the IR suite, better to feel like I was doing something by holding her hand than gossiping with the OR nurses.

The patient was happy to have me there and the IR doc loved teaching me what he was doing. I got to show off my mad “switch out the empty IV bag” skills and generally kept the patient fairly calm. She was given a large amount of valium and some morphine because the procedure was painful but it didn’t seem to be enough. She was, to say the least, dopey. And adorable (not a professional thing to say, don’t care, you would have said the same thing if you saw her). She kept going on and on about how cute the doc was “do you think he can hear me?” “Yes, he’s standing right beside you.” “Oh, don’t tell my husband *giggle*.”

When the procedure was done and our patient moved back upstairs, she was in an enormous amount of pain. She was given a pain pump but it was difficult to control the amount of pain. Lesson one, when a part of your body is dying from ischemia, it hurts like hell. The bleeding was slowing down but not as quickly as she and her family expected which was really disappointing for them.

Things did eventually get better, both pain and bleeding, and the patient’s mother started asking again about getting pregnant and if we thought the procedure had saved her fertility. At this point, it was still impossible to know, but we did save her uterus and stopped the bleeding so we had been feeling pretty good. Lesson two, our patients often have different goals of care than we do, even if it felt like we were headed the same way at the beginning. Patients can hear what they want to (so can we). Neither us nor the patient likes having uncertain outcomes, but unfortunately, there they are, everywhere in medicine.

Chatting with my residents the next week in the lounge, I mentioned how funny our patient had been. They all jumped on me. Not for being unprofessional, but because they were jealous of getting to see the embolisation. They had never seen one and weren’t entirely sure how the procedure was done. I was able to see how the arteries of the uterus are laid out in real time and how they differ when a fibroid is involved. Lesson three, everything is a learning opportunity. Pay attention to everything going on or you may miss it. Your busy work project may be another learner’s gold mine so don’t take any of your opportunities for granted.

Yes - those kids in the photo are playing on a pile of manure - likely looking for the pony.

Losing a patient

Today was the White Coat Ceremony for the class of 2014. It's an enormously emotional event. The deans talk about the friendships that will be forged, the lessons that will be learned and the incredibly journey these first years are about to embark upon. They talk about the support of family and friends that have allowed us to reach our potential.

It's incredibly stirring. I teared up. My friend teared up. We have seen how important those friendships, lessons and family have been on our journey. We knew exactly what he meant when describing the patient that we would have to tell is suffering from a terminal illness. We remembered the hope and anxiety we felt as we waited to don our own white coats.

Several members of the new class also got a bit watery eyed. It's easy to become so happy, so anxious, so overwhelmed with the event that the only release is to cry. It's a tremendous day.

All of the new members attempted to hide their red eyes. They were embarrassed to be showing so much emotion in front of their now colleagues whom they had yet to meet. It's seen as being weak and unprofessional to cry, nothing like the wonderful physicians the deans had just described.

And this all reminded me of one of my favourite patients who died while I was on call.

He had a mixed bag of ailments despite being younger than me. We started every morning's rounds with playful flirting back and forth. He was everyone's favourite patient.

On his last morning, we knew something wasn't right. He'd had a bit of bleed during the night, but not enough to make him look so wrong. He was tachycardic, but no more than usual. He was also alternating between cold sweats and not - something he assured me was normal for him. He was scared though and that made us scared too.

My resident and I checked in on him several times during the day. We ordered and followed up on a slew of tests. We chatted with him and his family, checked in on what the nurses were thinking and tried to stay on top of an otherwise incredibly busy shift. Nothing seemed to be glaringly wrong.

Late that night, my resident and I ran into each other outside our patient's room. I hadn't been paged, just wanted to check in. The resident had been paged that our patient was unwell.

He had gotten up for a walk, become quite dizzy and unable to continue walking.

He was also a colour that let me know things were really wrong. His colour, stagger and perspiration look like the Netter's cartoons of patients in haemorrhagic shock. Seconds after I saw him, we had him on the ground and called the code. It felt like seconds later he was in the ICU and a row of intensive care nurses and PSAs were taking turn performing compressions while the residents called out the drugs to administer in sequence. They tried to keep him alive until his family was able to arrive. They worked like crazy for our patient they had never met.

TOD was called more than an hour before the family arrived. The new team of nurses took over and prepared our patient for his family to see him. They cleaned him and propped him up in bed. If it wasn't for the non-functioning endo-tracheal tube sticking out of his mouth, we might have been able to believe that he was still alive.

I went in to thank these nurses for helping and told them how important this patient was to our team and his family. And I cried. I couldn't stop. But I didn't want my team to know that I was crying. Heaven forbid they know that I care so much about this patient I had spent so many hours caring for and talking with. The nurses hid me in the room with them and told me it was perfectly acceptable to cry. They helped me pull myself together before going out to see my team again.

We met with the family and our senior for the shift (not a member of the original team) went over what had happened. I kept my head down and quietly cried, wiping my nose on the sleeve of my hoodie. Once the story was told, the family broke down and we left them alone. Grandpa grabbed my hand on the way out the door, didn't say anything, just held my hand and cried.

Our consultant came to the hospital as soon as she heard. Usually an incredibly stoic woman, she was silently crying while going over the last CT we had ordered. We went through all our actions of the past 24 hours for what felt like the 59th time while our consultant quietly nodded, asked some questions, then said "You did everything you were supposed to do. Thank you."

It was exactly what we all needed to hear.

While I get that it's no good to go to pieces when we have bad days like these, I don't think we need to entirely hide our emotions either. I worried during our family meeting that the family would think that I didn't deserve to grieve with them. This was in my head, I don't think they could have possibly noticed anything outside their own grief.

Crying is how I express so many of my emotions. Sadness, anger, frustration, happiness. I wish I didn't always feel the need to find a place to hide when I need to do it, especially since I'm not the only one. I hope I remember to tell my clerks that it's OK to cry, laugh, hiccup and do whatever we need to do during our day to be ourselves. It's so easy to get lost in the business of filling out forms, performing procedures then dictating them, desperately trying to discharge patients to make space for the ones clogging up the ED that we lose the feelings we had on our first day of med school.

I made dinner tonight!

It's been so long. I love being able to put together a healthy yummy meal - feel so productive.

yesterday I also sent off a paper to the school journal

it's been ages since I've actually finished a project and I'm amazed by how much better I feel

I've been trying to write at least 15 minutes a day which according to my book "writing your journal article in 12 weeks" (cheesy title but a fantastic book). It's been great to get me moving forward on some of my kabillion projects I have on the go.

It saves me on days like this when I have residents who act in silly, petty ways.

no more clerkship exams

no more call until residency

campfire and friends

summer begins!

you can have ice chips

It always seems so strange that patients are so grateful when we let them eat ice chips, pee without a catheter walk with the freedom of no iv's. On my psych rotation we handed out smoke passes to patients who were well behaved.

If patients make enough urine, out goes the foley.

There is such a huge amount of power given to the docs over their patients' smallest and most basic bodily function. Things everyone takes for granted.

the morning after my last call shift of clerkship

what a crazy night

I can't wait to sleep

more apps I'm using in clerkship

As far as organizational apps I've added, my favourite are calengoo and toodledo, but not just for their fun names.

CalenGoo:
Made to sync with your google calendar. I use this instead of the native calendar because I love my google calendar. You can set it up to text you before appointments, colour coordinate different aspects of your life, set up repeating appointments. Information is stored so you can access it off line, sync when you have an internet connection. There is an option for including details of your events. I usually cut and paste the information from emails into this space, e.g. 'don't forget to bring your midterm evaluations to this teaching session'. There are many more features, these are the ones I like most. The designers update the app on a fairly regular basis with improvements.

Definitely worth the price tag.
C: $6.99

Toodledo: I love that I can type up my to do list on my computer, organize it into folders depending on what the tasks are and sync it to my iPhone. Then I can tick off everything as I get it done.

I love ticking off that things are done!

Some of the features include setting up a repeating task (e.g. laundry qweekly), entirely customizable folders, lists tasks according to when they are due or by folder, you can add notes to tasks. They've added a notebook feature for the folders but I haven't really taken advantage of that yet. I can see it being useful for putting in contact information for a research project though.

Tasks can be organized into high to low priorities, or even star the ones you simply can't miss doing. The Hotlist automatically fills up with your most important tasks based on how you have organized them.

You can set up reminders with a series of fun sounds.

C: $3.99

File App:
This is a great way to store pdfs and word documents onto your device to save for later. I've filled mine with the lecture slides for this block so I can refer to them during lectures or review during down time. It really is all about being able to keep learning during downtime.

I also have my own versions of 'complete history and physical' sheets in it for 03:00 when I know I'm forgetting something, but can't remember what.

It's easy to set up sharing with your home wifi network so that you have your documents native to the device.

Some documents are just too big (my pdf version of the First Aid series), but it can still hold some large documents (my pdf version of the Case File series). I wouldn't bother getting the pro version since the free is so useful just as it is.

Free!

iFlashcards study helper:
This is another app you sync with your online account to have information native to your device. You can even share your login with someone you study with to enhance your pack of 'flash cards'. It's easy enough to make up the questions you know you'll need to review. I use this app for things like drug doses and uses, hormones, structures in anatomy. You can also put photos in.

When studying, you can mark cards you want to go back to or shuffle the deck and go through the whole thing again. You can also reverse how the cards are presented (i.e. given an answer, what was the question).

C: $3.99

PubMed On Tap:

Exactly what it sounds like. You need an internet connection for this one. By typing in keywords to the search engine, the app gives you a list of abstracts to peruse - the entire abstract. You can save the abstracts you want to look up in a file. If you have a mac you can sync this list with your computer. If there is a free article available, it will connect you with the resource.

I love it.

Even with just the abstract, you can get information on the latest research in whatever question is being discussed. I've used it to find the current guidelines on dosing of meds not commonly used and why paediatricians don't know about Octaplex.

The only real problem with it is a problem with me, my spelling. There is no autocorrect and it will only search for exactly what you put in.

The Lite version only gives you 20 (or 10?) abstracts at a time. I upgraded to this version within a day of using the Lite.

C: $2.99

Dragon Dictation:

This is an indulgent, not always useful app, good for when I'd rather talk out loud than type though. I'm impressed with how well it picks up my voice and converts it to written words.

The latest update adds to the keyboard that was available for editing. Now you can email, text, facebook, copy your dictation for use in another app or on your home computer.

Great for thinking out loud about research papers. It's a program I've seen for computers while at conferences and one that I plan on using in my own practice when I grow up.

Free!

Considering dipping my feet in chocolate

Or maybe enrolling in a social niceties class.

I spent yesterday with my foot in my mouth or realising that I am not ever going to be a standoffish doctor.

In the morning, in front of a consultant I went on and on about hating this rotation. In my defence I didn't see him right away because he was behind a nurse in the elevator. Still mortifying. I know him outside of the hospital as well which for some reason makes it even worse.

There was an emergency that didn't follow protocol in a rapid manner. The nurses had been harping on it being someone else's fault. Likely the family medicine resident but they wouldn't listen to me who saw the miscommunication take place. I told our chief resident that a miscommunication that took place was as much the nurse's fault as the resident as the nurse came around the corner.

d'oh

Later in the day, I accidently told a patient's family she'd had a boy when it was supposed to be a surprise. The same patient had an incredibly stressful day. During one of the most stressful moments, I was at her head, stroking her hair and trying to keep her calm. Without thinking, I bent over and kissed her on the forehead. She seemed to need a familiar action. Regretted it immediately. The patient however told me later that she was very happy for it. It made her feel happy and good in the moment.

phew

I am an emotional person. I have always been an emotional person. I speak my mind, I tell people I love them, I get excited when they're excited, I cry when they cry. It makes me get too involved, I worry when others don't.

I think it also makes a difference when people are having a really bad day. That makes the rest of it worth while.

CaRMS wackiness

When med students in Canada are entering their final year of study, they apply through CaRMS for their residency - the Canadian Residency Matching Service.

To put it mildly, it's a terrifying time for students in the 2011 classes across Canada. Some have been padding their resumes since they got their acceptance to med school oh so many moons ago. Others have just realized that they should have done research/picked a specialty/vaccinated a small country before now and are currently scrambling to fill their CV with astounding accomplishments. It's a bit goofy.

Back in the day, Canada had a brilliant way of doing things. Rather than being forced to choose our specialty right out of clerkship, medical students went into a year of internship. This was spent in a series of departments - like the clerkship year was for me - but with more responsibilities. Following this year, the students matched to their residencies where they focused their studies. Some docs went straight from this year to practice (general practitioner), while specialists specialized.

Problem was that eventually docs wanted to specialize early and did 'straight internships' that set them up for their specialty. Clerkship was developed to give medical trainees a way to see aspects of medicine they may not otherwise have access to. Unfortunately in the short amount of time allocated to students in clerkship per rotation, it is difficult to get a good idea of what the specialty is really all about. For example, my deliver room rotation is only 2 weeks long. We had 1 woman deliver a baby during business hours this week. I couldn't possibly decide I wanted to be an Obstetrician based on that.

This was a problem when the rotating internship year was in practice too, now it's moved forward a year or two.

While I accept that the one year of rotating internship is insufficient to train a modern physician to be able to practice anything, having just one year to choose our future is also insufficient.

At my school we have four months in our last year that is just for electives, a way to pad our CaRMS resume and discover more about the specialty we have chosen to pursue or rule out. My classmates started setting up these fall electives in January to ensure their application to residency would be shiny.

This is a great system for those students who are born knowing precisely what they want to do AND are correct. Some in my class however found out half way through (or later) in their clerkship year that they were not pursuing the path they should. They fell in love with a new specialty and are scrambling at the last minute to get electives and research set up in this new specialty.

I don't have a solution to this aside from starting our residency years split into two camps, medicine and surgery. Set up a rotating year based on this, then apply after our R1 year to the specialty of choice.