medical education
sb admin | June 4, 2008I am often the bearer of bad news. I don't think I've ever been formally taught how to deliver bad news, but I've developed a style over the years, and I'm pretty good at it.
I work with medical residents every day in their outpatient clinics. Most of them have never had to deliver bad news. Some people are natural communicators, and some aren't. Often, one of my residents just "gets it"---they have a great deal of empathy, can "read" the patient from moment to moment, and without any help from me, they can successfully give the news.
What does it mean to give bad news "successfully"?…
sb admin | May 5, 2008I can't tell you the number of people who complain to me about having their hope taken away. Exactly what this means, though, isn't always clear.
Sometimes an oncologist will tell them (so they say) that they have a month to live. Sometimes their cardiologist tells them (so they say) not to travel to their grandson's Bar Mitzvah. Sometimes the spine surgeon tells them their back will always hurt, no matter what. So they say.
Patients tell me a lot of things. I'm not always sure what other doctors really told them, but what is important is what the patient heard. The oncologist might have…
terrasig | April 25, 2008Okay, some people are smoking some bad dope.
Whilst helping the PharmKid get down to the car for school this morning, I came upon PharmGirl, MD, in a rage while sitting in front of her laptop. The object of her vitriol was a 17 April article in BusinessWeek entitled, "Are There Too Many Women Doctors?: As an MD shortage looms, female physicians and their flexible hours are taking some of the blame." The article derives from a point/counterpoint pair of essays in the 5 April issue of BMJ (British Medical Journal) entitled, "Are there too many female medical graduates?" ("Yes" position, "No"…
terrasig | April 25, 2008MD/PhD student Jake Young at Pure Pedantry came up with a great idea and is collecting recipes for cheap, grad student/med student meals. (We of Eastern European heritage love a kid who suggests an inventive application of kielbasa.).
The submissions in the comment thread remind me that our food supply system is so screwed up that the most nutritious foods are the most expensive. When one is living on a student stipend, paying your own way, or , more seriously, if you are one of millions of US citizens living in abject poverty, one usually purchases the most calories per dollar. In our…
sb admin | April 23, 2008One of my duties involves teaching nurse practitioner students. Nursing is quite different from medicine, and many of the linguistic markers of nursing differ significantly from medicine. As more physicians' assistants and nurse practitioners enter the primary care world there will be a bit of a culture clash. For instance, my NP students often refer to a physical exam as an "assessment", a misnomer which I do not allow them to use with me. Assessments come after you have spoken to and examined a patient. Another difference is in the common use of "client" in referring to patients. This…
sb admin | April 13, 2008Think about your own experiences---you're at a party or a restaurant, and someone you're with says something obviously racist. You cringe, but given the setting, you can't decide how to react; after a pause, you probably decide to say something. Now imagine you're at meeting for work, and a senior partner says something racist. You want to say something, and you even know that under some circumstances there are laws behind you, but you don't want to get branded a trouble maker and risk subtle (or not-so-subtle) discrimination.
Now imagine you are sitting in the doctors' lounge, and a…
terrasig | February 13, 2008
We comply with the HONcode standard for trustworthy healthinformation:verify here.
Regular readers may note that I have been diddling with the content of my left sidebar and posting a new disclaimer tab to indicate the accuracy and objectivity of the health information presented herein.
I added these details as part of my application for accreditation by the Swiss-based Health on the Net (HON) Foundation, a non-profit organization formed in 1996 to deal with the then-new issue of how a reader can determine the quality and objectivity of medical information on a website. You can…
terrasig | December 14, 2007I learned via Kevin, MD, of a great new BlogTalkRadio show by Ohio physician, Doctor Anonymous. BlogTalkRadio is pretty neat in that you get video of the host, audio of the interview, and a chat window on which listeners can post a running commentary and discussion of the show. I got to "meet" Sid Schwab and Dr. Val, two frequent commenters as well as those whose blogs I read.
Last night, Dr. A interviewed Mexico Med Student, Enrico, who is currently a 3rd year med student at the Universidad Autónoma de Guadalajara (UAG) School of Medicine in Guadalajara, Mexico. (Dr. Val was supposed to be…
terrasig | November 25, 2007As I sat to write a post this morning, I became more engaged in a story in the New York Times magazine by Dr Daniel Carlat entitled, "Dr. Drug Rep." Joseph of Corpus Callosum recently commented here about being solicited to recommend fellow physicians in the local area and nationally who he perceived as "thought leaders" in his specialty.
Carlat was such a physician who was cultivated by Wyeth to discuss their antidepressant, Effexor XR, to fellow physicians at conferences and in doctors' offices. His piece in the NYT magazine chronicles his development by Wyeth as a drug spokesperson and…
terrasig | October 7, 2007Via Clinical Cases and Images, I just learned that Mark Rabnett at the University of Manitoba has just compiled a comprehensive list of medical student bloggers.
No one source is complete, so I hope this list will be of help to the fevered mind that cannot rest until every blogging student in the health sciences has been tracked down. I see a permanent job for a few people who are willing to work for no salary while exposing themselves to resident evil, anger, fear, and cadaver fumes. As for me, if I don't wake up screaming I just may have to go back to renegotiating Nietzsche in the…
terrasig | May 16, 2007Time is short today so here are two quick picks of blog posts well worth reading on topics related to our normal discussions:
Joseph at The Corpus Callosum discusses a paper and a news report on putting drug safety risks in objective perspective relative to other risk behaviors we encounter daily, like driving a car. Depending on one's aversion to risk, some drugs can be considered relatively safe or dangerous, but Joseph points out that one must also consider the benefits of drugs in these risk assessment. But safety is not absolute: all beneficial activities and behaviors carry some risk…
terrasig | April 12, 2007I wish I could claim responsibility for this essay but the mega-props go to Roy M Poses, MD, of the team blog, Health Care Renewal (blog mission statement: "Addressing threats to health care's core values, especially those stemming from concentration and abuse of power.").
Last week, Roy wrote, "Med Schools to Faculty: Show Me The Money," based on an interview with Dr Lee Goldman, the Dean of the Faculties of Health Sciences and Medicine, and Executive Vice-President for Health and Biomedical Sciences at Columbia University.
From Goldman's "cold hard facts about academic medicine" are:…
terrasig | February 27, 2007As if everyone doesn't have enough deadlines right now, 1 March is the deadline for submission of medical education manuscripts to the Journal of the American Medical Association (JAMA). The call for papers was issued in December and accepted manuscripts will appear in the 5 September 2007 issue:
Practicing physicians aspire to be good, whether this attribute is defined with respect to intellectual skills, manual skills, or professional standards. In medicine, it may indeed be nobler to teach others to be good (in any of these senses). However, doing so is arguably far more difficult. Those…
terrasig | November 16, 2006Over the last several days, Dr. RW, Orac, and Joseph (Corpus Callosum) have been discussing the virtues, or lack thereof, of a national medical student association espousing the coverage of integrative, complementary and alternative medicine (ICAM) modalities in the medical curriculum.
Our SciBling, Joseph, raised the interesting point that CAM education might improve the one aspect of medicine that administrators and health insurance companies are trying to drive from medicine: the doctor-patient relationship. I would say that none of the MD bloggers disagree that time constraints in the…
terrasig | November 13, 2006Both Dr. RW and Orac have great posts this week on the dichotomy of critical thinking skills espoused by the American Medical Students Association (AMSA), a US national medical student association. Most interesting is their support this week of a PharmFree Day on 16 November whose nobel goal is to minimize the influence of the pharmaceutical industry on medical students, residents, and fellows.
However, Dr. RW points out the hypocrisy of one segment of the organization that states; "we [The AMSA Humanistic Medicine Action Committee] advocate for Complementary and Alternative Medicine…