Between Coffee and iPad

A Taiwan-born US expat studying medicine in Singapore. Currently an MS2. This is where he talks about his life. By that he means this is where he rants whenever he feels like sharing his progress to look like he's not procrastinating.

[doctorofwhut]

The American College of Pediatricians Is an LGBT Hate Group

A small but clever hate group created a legit-sounding name to attack LGBT kids.

Today I learned about the existence of the American College of Pediatricians, a fringe group that was founded around 2002 in reaction to the American Academy of Pediatricians’ statement that gay parents pose no threat to adopted children. 

I won’t deny that I was initially confused at the headline. These people have named themselves so that they are very easy to confuse with legitimate physician groups like the American Academy of Pediatricians or the American College of Physicians. They publish hateful, misleading, and harmful statements on topics like LGBT health and HPV vaccines. Don’t be fooled! 

[mymedlife]

The American College of Pediatricians is an awful hate group whose positions include 

Discouraging the adoption of children by same-sex couples or single parents

Parental choice as to when and whether a child receives the HPV vaccine

Support for parental use of spanking in child discipline

Opposition to abortion 

Opposition to gender reassignment, including the use of puberty blockers

Support for abstinence only sex education 

As a pediatrician who is heavily involved in advocacy I often see this awful group cited as a reference and passed on as if they they are official policies. (For a laugh here is the one page list of the American College of Pediatrician’s policy statements compared to the American Academy of Pediatrics multi page with references)

Remember kids it’s the  American Academy of Pediatricians. 

[hirarzt]

Reblogging because this is important

[dxmedstudent]

When your newspaper is so biased against healthcare staff, that a story about hospital food is framed not as a call to improve provisions for patient meals, but to imply doctors and nurses are eating too well.

I’ll tell you that our undeservedly enviable gourmet meals, wolfed down hours late (if at all) whilst filling in paperwork, usually consist of:

A) At best, passable canteen food you got tired of a week after starting at this hospital.

B) Whatever dry sandwiches the ‘Friends’ shop’ is selling because nothing else is open this time of night.

C) Whatever combination of fridge remnants you managed to scrape into a tupperware container, whilst you eye your colleague’s sloppy canteen food.

D) The dry remnants of the Doctors ’ Mess buscuit tin or the ward cake box washed down with weak tea or the worst coffee you’ve had in your life, with minimal milk because the bottle ran out and there won’t be another til Monday.

Doctors and nurses don’t eat lavishly at work, nor are they responsible for what patients eat. They don’t control the funding for that; the ultimate responsibility lies with the government to ensure the financial needs of the NHS are met.

Framing it as if workers at the frontline are responsible shows just where this paper’s loyalites lie.

(Screenshot from the Junior Doctor Contract Forum, Hat tip to Peter Stefanovic for pointing out the silliness of the headline).

[hirarzt]

Patients are actually being made sure to at least have their 3 meals a day in the ward.

Sometimes doctors and nurses don’t eat or go to the toilet for 10+ hours, wtf is this article even saying.

[thelostmedstudent-oldaccount]

Real Talk

When I got out of high school, deciding to go into medical school was an easy choice for me. I went to university, studied my ass off for 2 years and then got accepted into medical school.

I thought I was set for life. That I had a guarantee for a career as a doctor. Looking back, I can only see how naive I was…

Medical school has got to be the toughest thing I’ve ever been through. The breakdowns, the physical and mental exhaustion, failing an exam for the first time, etc etc… I have questioned if medicine was my true path so many times that I have lost count. In fact, yesterday I called my sister in yet another breakdown, and she told me : “With the amount of times you called me like this, I’m honestly surprised you’re still doing it.” Reality check, no?

Here I am in my last year, about to go through the interview stages. I am now completely torn for what I want to do as a specialty : go in the surgical field, which I have always adored? Or go into family medicine, where the specialty itself doesn’t excite me as much, but I would have a better quality of life to do the personal things I love? And then there’s always the little voice inside my head that tells me to find another passion that’s outside of medicine…

The thing that drives me crazy with medicine is that there’s still that old school belief that if you want to be a doctor, you have to let everything else go. You can’t take a year off to do some soul searching, because that’s career suicide. I think it’s time to do some re-evaluating of how medical school is taught, the lifestyle of residents and doctors, and start modernizing the medical life. If we don’t, we will simply find ourselves with more unfit doctors that are trying to take care of others instead of themselves, and that I believe is simply unhealthy…

[chipsprites]

[dxmedstudent]

Anime med student problems… trying to stop a kid from crying so you can examine them.

[hirarzt]

Actually, crying kid is the perfect opportunity to made a couple of conclusions:

1.  If they’re crying, then they are definitely alert and arousable. That’s usually a good start.

2. You can shine the light into their mouths to check for oropharynx inflammation, ulcer, or other stuff going on in there

2. If they’re crying, they’ll be taking deep breaths in between. It’s hard, but you can auscultate their lungs

[hirarzt]

16/01/2017

It’s your first day at neurology posting. You only had 2 hours of sleep before this because your cold kept you up.

You met your new teammates, awfully nice group. You still have that cold.

You are wearing a face mask. Your sinus seems to be clearing up from your own warm breath, that’s a good sign. At least until you start to want to pass out, either from the lack of sleep, or from reinhaling your own CO2 and not enough O2 from wearing that same face mask for hours.

You never really get a chance to sit down except to send some emails during lunch break. You already ate your lunch on the way to the lunch table to be with your friends. It was sandwich.

The afternoon, you are following the attending who is taking you all to see patients for bedside case tutorials. You got asked to do the cranial nerve examination for a patient who has difficulty swallowing, and finds himself leaning to the left whenever he walks. You need batteries for /both/ of your pen lights.

Also, you have no idea what you are doing because when was the last time you did cranial nerve exam?

You realized that you can save yourself from passing out if you stop wearing the face mask because the air feels so crisp in your nostrils when you are mask free. Until your sinus starts acting up again under cold air, and you have to put the face mask back on.

It’s 6:30 PM, and you can finally go back and crash. Except you can’t. You have things to read up on. You look at your cat who decides to hog your bed, and you sometimes wish you aren’t a medical student.

Also, you’re pretty sure your 128-Hz tuning fork has left your pocket from 12 hours of walking in the hospital.

Also, your boyfriend lives 18000 miles away from you, and you are physically and sexually frustrated to no end. And, from talking to him just earlier, so is he.

[jewsee-medicalstudent]

Mesentery is now classified as an organ.

Researchers have classified a brand-new organ inside our bodies, one that’s been hiding in plain sight in our digestive system this whole time. Although we now know about the structure of this new organ, its function is still poorly understood, and studying it could be the key to better understanding and treatment of abdominal and digestive disease.

Known as the mesentery, the new organ is found in our digestive systems, and was long thought to be made up of fragmented, separate structures. But recent research has shown that it’s actually one, continuous organ.

The evidence for the organ’s reclassification is now published in The Lancet Gastroenterology & Hepatology. “In the paper, which has been peer reviewed and assessed, we are now saying we have an organ in the body which hasn’t been acknowledged as such to date,” said J Calvin Coffey, a researcher from the University Hospital Limerick in Ireland, who first discovered that the mesentery was an organ.

So what is the mesentery? It’s a double fold of peritoneum - the lining of the abdominal cavity - that attaches our intestine to the wall of our abdomen, and keeps everything locked in place. One of the earliest descriptions of the mesentery was made by Leonardo da Vinci, and for centuries it was generally ignored as a type of insignificant attachment. Over the past century, doctors who studied the mesentery assumed it was a fragmented structure made of separate sections, which made it pretty unimportant.

But in 2012, Coffey and his colleagues showed through detailed microscopic examinations that the mesentery is actually a continuous structure. And while that doesn’t change the structure that’s been inside our bodies all along, with the reclassification comes a whole new field of medical science that could improve our health outcomes.

“When we approach it like every other organ… we can categorise abdominal disease in terms of this organ,” said Coffey. “Now we have established anatomy and the structure. The next step is the function. If you understand the function you can identify abnormal function, and then you have disease. Put them all together and you have the field of mesenteric science … the basis for a whole new area of science.”

“This is relevant universally as it affects all of us.”

(Source).

[quilavastudy]

Doing a cardio exam when you have no idea what you’re listening for is like: ‘yep, I can hear the heart… the heart is pumping. Patient has a heart. Good.’

[theglowstickchronicles]

Me the first time I heard a rub: what the frickity frack is that? Patient: seriously???

[silverstars87]

I said to my preceptor, “The heart is squeaking. What the fuck?”

And she laughed.

[medical-gal]

Got a murmur once for which i didnt need a stetoscope

[chroniclesofachemist]

O_O What the shit is squeaking

[homotology]

What y'all listening too for Christ sakes??

[farceoflars-deactivated20210508]

My favorite was once going back and reading a dictation that said, “no murmurs appreciated,” and I actually laughed hugely for minutes because you could hear that blower across the room with no stethoscope…

[dxmedstudent]

I believe that’s why we use the term ‘appreciate’. A murmur may be there, but you can’t blame some poor soul for missing the obvious :)

[hirarzt]

I think it is more distressing to not be able to appreciate the Apex beat than the murmur, and it does happen with large patients

[play6irl]

[thug-gifs]

Reblog in 40 seconds and you will be put on the path to achieve your dreams and find your fortune

[hirarzt]

Happy new year! Going to start the day right with doing some practice questions in preparation for the next rotation (and the shelf exams that I have to retake...) Hope I pass those pesky tests this year!

[mypsychology]

For more posts like these, go to @mypsychology​

[hirakumblr]

Calling for U.S. Medblrs

A petition is now going around, started by medical students across the US who are starting new grassroots organizations to protect patients’ rights to healthcare, and protect the Affordable Care Act (aka. Obamacare). 

A number of schools that has started getting involved so far are:

Mount Sinai, U. Michigan, U. Maryland, Yale, Harvard, Johns Hopkins

First role will be to sign the petition below and present it to the Congress on January 8-9, 2017.

Please consider signing up below if you want to start getting involved!

Healthcare is a Basic Human Right! Protect healthcare rights!

https://docs.google.com/forms/d/e/1FAIpQLSfptqGHKRRgQpF66Fw1rXDey_ijO9TT4k1xjgbJ7WVnf52G1Q/viewform?c=0&w=1

[hirarzt]

Waiting for my SHELF result

The waiting game is awful.

My school just had to have a SHELF exam scheduled on December 23rd.

I know it can’t be helped because sometimes calendar just turn out that way.

But waiting for my score for days, I feel like I am molding inside because I can’t even properly enjoy Christmas when there is the SHELF at the back of my head as I am wondering if I have to resit the exam or not.

[whereismystethoscope]

The NHS and the Reality of the New Junior Doctors' Contract.

I am a junior doctor who works in the Accident and Emergency department of a Midlands’ hospital.

It’s a hard job, like many within the hospital. The pressures on the staff and the department itself are considerable.

Over the past months, with the evolving dispute surrounding the contract for junior doctors, I, like my colleagues, have watched with intrigue. Intrigue has made way for indignation, disappointment and anger.

We have tried to remain professional despite the thinly-veiled attacks on our integrity and sense of vocation, our outrage cemented in false statistics and sensationalist reporting designed purely to denigrate the NHS and every single person who works within it.

The furore has dimmed somewhat since the announcement of imposition of the new contract, in the media at least. This has at least given us all time to reflect on what has happened.

I have read as many articles and posts from as many different sources as I have been able to. Many are in support of the juniors and the NHS as a whole whilst some have demonised the BMA. Others have tried to simplify this action to a pay dispute.

I’d like to try to describe my last week to you and explain why this is a dispute about something else entirely.

This is about life.

It is about providing the opportunities for patients to have their lives cared for, adequately and professionally, so that they can leave the hospital in a better situation than when they arrived.

This is about fuller and happier lives for the families of those patients who can build new memories, enriched by the presence of a loved one.

And it is about life for the people providing that same care.

We need the environment and the system in which to optimise the delivery of the care we are capable of giving in order to save lives, improve them and empower them. It’s what we strive for every day.

We also need the environment to balance our own working lives against our need for social interaction, rest, learning, adequate nutrition and maintenance of our physical and emotional health.

Without this, it is not possible to offer the best care that any of us can hope to provide.

And that is a travesty for patients.

From last Saturday (20th Feb) in seven days, I was Rota’d on for 72 hours. This comprised of:

Fri 19th: off Sat: 14-0200 Sun: 14-0200 Mon: 12-21 Tues 12-21 Wed: 2200-0800 Thurs: 2200-0800 Fri: 2200-0800.

In reality, I worked nearly 85 hours.

On Sunday evening I left work at 0340, got home at 415, went to bed at 0500 and was up at 0930 before another 10 hour shift that turned into twelve hours.

I had one proper break all week- that is, half an hour to sit and eat a sandwich and have a cup of tea. I had one proper meal.

I missed my scheduled teaching for the week because I was on nights. I had a meeting on Thursday morning after my night shift to discuss why I had missed so much teaching and the extra e-learning I would need to do in order to compensate for this, as well as that already required that I was yet to complete.

I crashed my car on the way home.

That night I led the care of a seven week old in cardiac arrest due to an undiagnosed narrowing of their aorta and a hole between the atria in their heart. We were successful.

The other patients I remember from the week were a gentleman who I told required further investigation because he had a brain tumour; a lady on chemotherapy who had an overwhelming infection; a 10 year old with a life-threatening asthma exacerbation; and a lady who had been hit with a hammer in the eye.

We were so busy one evening we had someone with a supraventricular tachycardia, another with a bowel obstruction and another with a diabetic ketoacidosis in the waiting room- we just had no space to put them into a room.

These people were critically unwell and there is an energy that comes with that. This is what we are trained for. This is what we do.

The patients that turn out to be more difficult when you are tired are those inbetween; blood results unremarkable, imaging without abnormality, but distinguished clinical signs.

Send home or admit? GP follow up or medical review? Non-specific abdominal pain or appendicitis?

When you are tired, the mistakes lie here. In the grey areas. And it is so easy to miss.

For example: A man comes in with a respiratory tract infection. You treat it. He is epileptic. You refer him, and he is to be transferred to a medical bed. You are not informed there is a delay in transferring him to the ward. He doesn’t receive his regular medication because you didn’t prescribe it in your rush to see the next patient. The nurse tells you and they prevent a fit. You feel awful; but until you see his face you can’t even remember him because you’ve seen 10 patients since and numerous relatives.

1g of paracetamol prescribed; but the patient is 45kg and you didn’t check. She should have had half that. My colleagues prevent me overdosing her.

I enter the department each day and look at the bed board and hope I don’t recognise any names of patients that I treated the day before.

I’m tired when I start.

We finish late on shifts because we can’t leave these patients. We aren’t clock-watching.

It is not straightforward to hand over the details of a case to a colleague and ask them to contact intensive care. It is better for the patient that we do it ourselves; so that is what we do.

Sometimes, there is nobody to hand over to. So we stay on. Because that is what we do. That is what is right.

We don’t take breaks so we can tell your relatives your blood tests results and the likely course of a new diagnosis or life event. That is normal.

We do this in an increasingly litigious society where our mistakes are magnified and we are punished, rightly, for our errors. Twice this week my consultations have been recorded by relatives, once without my knowledge at the time.

Is that right?

Is any of this right?

Is it right I am being pushed more and more by my seniors, by my health secretary, by my government?

Is it right that I am in increasingly difficult environments that make it more likely that a patient will come to harm? More likely that I will end up in court with the coroner? More likely that my career will stall? More likely that my health will be affected?

I go on holiday in my fixed annual leave and realise it is the first time I have had to process the cries of the woman I comforted after we lost her 5 month old daughter on Boxing Day. A week after she had lost her husband in a motorbike accident.

I remember the 11 year old who tried to resuscitate her 42 year old mother. We couldn’t save her. She wouldn’t let me go when I told her and I watched her grow up in front of my eyes as she comforted her father when he arrived and was so stricken with grief he couldn’t get up from the floor for an hour.

I need to be alert, well-rested and healthy. For these patients and these relatives, they deserve for me to be at my best.

And I need to be at my best for me too.

I do this job so families and friends can share more precious moments together. My chosen career doesn’t afford me the same opportunity.

If the new contract is, as planned, imposed in August, this week will be more normal for my colleagues.

Being at my best will be impossible.

And despite not agreeing that the care I provided last week deserved the £6.54 per hour (£5.40 if calculated under the terms of the new contract) I received, that is not what our profession is concerned with.

For patients and all healthcare staff, this contract is morally, ethically and fundamentally wrong.

[hirarzt]

You know what is sick about all this? Where people (And I heard this from the higher-ups), who'd say that if you really are doing this for the noble pursuit that is medicine, you would not mind working late for your patients. But, amidst all this, doctors are humans, too, and, in time, they're gonna have worse health than their own patients at the rate things are going. And then I had classmates and faculty who kept emphasizing "self-care" and "community" and "support", but I never really felt that any of these really properly addressed the real issue at hand.

[thingstolovefor]

I’m not even trying to be a nurse and this was hella encouraging! #Love it!

[futureblackwakandan-deactivated]

My motivation

[hirarzt]

Holy crap this is hella encouraging

[hirarzt]

chocolaterebelconformor

Hang in there darling^^ Iam sure everything will work out :D

Thanks! I hope so, too! Really, though, it’s the SHELF exam that’s gonna be a beast. Trying to juggle between time for SHELF exam and time for ward has been a long, hard fight for me.

[hirarzt]

Mid-clinical posting changeover

Today my current attending caught me dozing off during ward round and got told that if I am just going to be sleeping, I might as well just leave.

Yeah that was a /good feeling/.

Anyways, I got my new roster for December.

My new attending physician starting tomorrow also happens to be my bedside tutor.

This could be a good and a bad thing: Good because he is very academic and nice and would talk to you about all the interesting cases he has seen.

On the other hand, instead of once a week, he’ll grill me like filet mignon on a daily basis.

Also, I should note that both for November and December, my attending physicians happen to be Cardiologists. I never thought I’d be having this much exposure to cardiology for my internal medicine rotation, but here I am.

Here’s to surviving the wards up through passing my SHELF exam for internal medicine.

[wheresonichedgehogwnt]

You know what bugs me about discussions of physician burnout and resiliency?

They seem to be based on the idea that people who completed four years of medical school and however many years of residency and worked hard and sacrificed and were constantly pushed out of their comfort zone and didn’t see their family or friends as often as they wanted and made new friends and communities wherever they found themselves, and did this their entire young adulthood, aren’t actually resilient and that the issues they’re facing can be fixed by meditating for five minutes a day and taking a walk at lunchtime.

First of all, since when did physicians get lunchtime?

Second of all, since when did becoming a doctor in the first place not take a lot of resiliency, so why do people assume physicians, who have already demonstrated themselves to be resilient, are the ones who need fixing?

[md-admissions]

Couldn’t agree more. Say it louder. Physicians are being blamed for being human in an inhuman system. It’s up to EVERYONE to realize this is a serious issue driving physicians to suicide and abandonment of a passion they once loved. And it’s on all of us to say this is not how we want healthcare delivered.

[telep0rt]

Yes. Yes. Yes.

I get really mad when I sit through those burnout discussions because I feel very blamed.

It is not the fault of someone who works 80-100 hours a week, never sees their family, and puts 100% of their emotional energy into a job that takes and takes from them that they feel burned out. So DON’T tell me to “practice mindfulness” or “do more yoga” or “make time for my family” – like I could somehow fix myself.

I am strong. As physicians and trainees we are incredible to fight through what we do every day. So let’s change the conversation – we’re not burned out. We’re taken advantage of. Our humanity and our love of our jobs is taken advantage of.

Don’t tell me to take a walk. Tell the system to allow me time for one.

[hirarzt]

Even as a medical student in clinical rotations, I've been not having lunch until, like... 5 pm?!