Medliorate

Improving medical students

Archive for June, 2007

Communicate Better: Tune into Details

Posted by medliorator on June 28, 2007

Taking a good history and being a good doctor requires paying attention to even the most seemingly insignificant details. Many doctors might be very adept at scrutinizing their patients in every way, yet they forget to turn their astute powers of observation on themselves.

 

Communicating effectively with patients is not just about the questions you ask, but rather how you ask them. The tone of your voice and the reaction on your face can frequently communicate more to your patient than their lab results or their diagnosis.

 

I once observed a fellow student interview a patient who had a very long list of complaints. After the patient finished describing each complaint, the student said, “okay, and that’s it?” The student was obviously hoping that the patient had no more problems that they’d have to explore. It was quite apparent that the patient quickly caught on to the student’s annoyance, as she eventually gave less and less information about each complaint.

 

We’ve probably all seen at least one med student get so wrapped up in taking a history or performing an exam that they walk into the examining room without introducing themselves or asking the patient’s name. This “lack” of communication with the patient certainly does communicate a lot!

The Doctor is in the Details [The Differential]

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Remove Gall Bladder through Mouth

Posted by medliorator on June 26, 2007

The Oregon Clinic announced that Dr. Lee Swanstrom has recently performed the first transgastric endoscopic cholecystectomy in the US

Dr Swanstrom and his surgical team have subsequently completed two additional procedures as part of an IRB (Institutional Research Board) approved research study. The procedure involves removing the gall bladder without making traditional incisions on the surface of the skin, which is expected to result in less pain, lower risk of infection and a reduced recovery time as compared to traditional surgery.

Much of the discomfort and recovery time after conventional surgery — and even laparoscopic surgery — is due to the incisions made in the abdominal wall, particularly the larger incision needed to remove the gallbladder.

Natural Orifice Transluminal Endoscopic Surgery (NOTES), as this procedure has become known, involves passing flexible surgical tools and a camera through the patient’s mouth to reach the abdominal cavity by an incision made in the stomach. Once the operation is over, the surgeon draws any removed tissue back through the patient’s mouth and closes the hole in the stomach.

First Transgastric NOTES Gall Bladder Surgery in the US [USGI Medical]

Posted in News, Surgery | 1 Comment »

How to be a Parent & a Doctor

Posted by medliorator on June 21, 2007

New Intern says that the conflicting emotions he sometimes experienced were a bit challenging. “I’d spend so much time away from my family and get upset when I felt I couldn’t keep up with either them or school. School and family were in direct competition for my time and attention.”

Foughtfyr… says that the only way to make having a family and a challenging health career work is to have a support network. “We had a GREAT daycare set-up. Our next door neighbor had a licensed daycare in her home. My wife worked a 9-5 job and took care of the baby after that,” he said.

SDN member Oldbearprofessor, dad to two teenagers, says he and his wife, not living near family, formed their own support network. “My wife, who has a doctoral degree, works from home primarily and our parents are not in town, so mostly we’ve relied on others for the usual things like house-cleaning and babysitting.”

Farmercyst said the hardest times were immediately after the birth of both children, and now finds himself wondering just how much pharmacy school will impact his family life. “My suggestion is, if you’re planning to have kids, planning the timing is very important.”

For Farmercyst, it has been beneficial during times of illness in the family. “I’ve been able to explain to my wife the different medical conditions that our family has had to deal with as well as why the doctors have suggested different methods to diagnose and treat the different problems.”

Oldbearprofessor, who has established himself as a neonatologist, is able to share some of the perks of working in medicine with his kids, along with a little perspective. “I do a significant amount of traveling relating to international medical work and usually am able to bring at least one child along, especially now that they are teenagers. For me, medicine has been a way of showing my children the world, including some very poor parts of it.”

And Oldbearprofessor, who now is raising teenagers, has reassuring words for all parents in the medical profession. “Absolutely nothing I’ve seen or done suggests that the balance between good parenting and a medical career is not doable if you are committed to this balance.”

Doctor Dad: Balancing Medicine and Family [Student Doctor Network]

Posted in Tips & Advice | 1 Comment »

Greet Patients Better

Posted by medliorator on June 21, 2007

Handshakes preferred

“With the initial greeting, you can tell whether your doctor is genuinely interested,” Bari says. “You notice that first impression.”

Bari may not be the only one who prefers a more personal approach from a physician, a new study suggests. The research is published in the latest issue of the journal Archives of Internal Medicine.

Gregory Makoul and his colleagues at Northwestern University Feinberg School of Medicine surveyed more than 400 patients in 48 states… The authors reviewed 123 videotaped patient visits to see what the 19 doctors at two study sites actually did during an initial visit.

80 percent of the patients surveyed want to shake their doctor’s hand — and about half prefer that their physician use their first name during that initial encounter. “Doctors are told to greet patients appropriately, but we rarely tell them exactly what to do,” says Makoul. “The point of this study was to provide evidence to help doctors know what to do.”

the handshake may be even more important at the end of the visit. “I very much feel that a handshake after going over what we have agreed upon as a plan is like ‘making a deal,'”

Paging Dr. Friendly [ABC News – Health]

Posted in Communication, Professionalism | Comments Off on Greet Patients Better

Tools for the Library Crowd

Posted by medliorator on June 19, 2007

Search your local library and online booksellers simultaneously with Book Burro

 

Build bibliographies fast with BibMe

 

Get free Clif Notes online with LitSum

 

Look up book prices on the go with ISBNSpy

13 book hacks for the library crowd [Lifehacker]

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How to Take a “Meditation Nap”

Posted by medliorator on June 11, 2007

You can benefit from this in as little as 5 minutes, but optimal time would be 10-20 minutes.

 

1. STRETCH your legs for 30 seconds.

2. SIT on a chair or couch. If you’re at work back away from your desk a bit.

3. CLOSE YOUR EYES.

4. STRETCH your arms above your head, slowly roll your head to stretch your neck.

5. DEEP BREATHING – take at least 3 deep breaths in and out. Do this slowly and hold in between the in and out breath.

6. REST and RELAX your face, jaw, eyes and whole body.

7. BE AWARE HOW YOU FEEL as you relax.

8. CALM THE MIND. Let go of all thoughts. As thoughts come into your mind, just repeat this gentle reminder to yourself “Empty The Mind.” You may want to switch over to a word of your choosing to focus on (mantra) that will help push out other thoughts. Examples of words are Peace, Calm, Rest, Empty, Power, Strength, Love. Any word is fine. In fact the word “OM” can be helpful because it is not attached to other meanings. Whatever works for you is what is best at that moment!

9. IGNORE NOISES in the same way that you ignore thoughts. Repeat your mantra or “Empty the Mind.” Don’t get mad at noises, just flow with them as if they are waves under your boat of meditation.

10. OPEN YOUR EYES slowly after about 10-20 minutes. Take a few more deep breaths and stretch again: arms, neck, legs.

How to Nap at Work – or Anyplace You Need a Rest [Life Learning today]

Posted in How-To, Wellness & Health | Comments Off on How to Take a “Meditation Nap”

Forum Filter: Top 3 PDA Programs

Posted by medliorator on June 8, 2007

BlondeCookie: What are the 3 most useful medical PDA programs for clinicals?

Spinosum:
1. iSilo (FREE iSilo texts can be obtained from www.memoware.com)
2. Skyscape 5MCC
3. Skyscape DrDrugs

DOctorJay:
1. epocrates free edition – but the pay for version is real nice with DDx
2. isilo
3. medcalc – for all your quick equation needs
and Stedman’s as a crutch when you just can’t remember that word

southerndoc:
1. ePocrates Essentials (the name says it all – the best pharm reference)
2. PEPID EM (specific to emergency medicine, but other specialties available)
3. MedCalc

wook:
1. UpToDate (which also includes a drug database)
2. Stedmans
3. Archimedes (helped me remember the equations or just plug in play if I wanted).

Adcadet:

1. Lexi Complete (includes drug info, 5mCC, tox, abbreviations, dictionary, etc)
2. iSilo
3. PIER – slow, and doesn’t have every disease in it, but it really does a great job of going in-depth into what it covers and backs up what it says with evidence.

loveumms:
1. Merck Manual – just like the book for your PDA (FREE) … plus has a great lab tool that helps decipher common labs
2. Epocrates – for meds but I have found that having the PDR also is a good tool
3. Even though I like 5mcc differential diagnosis calculator I think that diagnosaurus is pretty good (for being FREE)

medgator:
The Johns Hopkins Antibiotics guide is awesome….
http://hopkins-abxguide.org/

mackaikai:
1. outline of clinical medicine (OCM)
2. A2ZDrugs
3. 5MCC

Sheon:

1. UCSF Hospitalist Handbook (Couldn’t have expected more and it’s free)
2. Epocrates (Free, and it comes with the useful calculators if you choose to download them)
3. Hopkins ABx guide (very good for learning the alternative Abx and often allows you to play STUMP THE ATTENDING)

KentW:

Speaking of useful Palm OS software, I highly recommend Mike McCollister’s “McPhling” (http://mikemccollister.com/palm/). I also like snapCalc5, a freeware pop-up calculator applet. Very handy for on-the-fly calculations without leaving the program you’re in.

From Student Doctor Network forums

Posted in Software | Comments Off on Forum Filter: Top 3 PDA Programs

Diagnose Skin Cancer without Biopsy

Posted by medliorator on June 7, 2007

“The standard way physicians do a diagnosis now is to cut out a mole and look at a slice of it with a microscope,” said Warren Warren… “What we’re trying to do is find cancer signals they can get to without having to cut out the mole.”The distributions of hemoglobin… and melanin… serve as early warning signs for skin cancer growth. But because skin scatters light strongly, simple microscopes cannot be used to locate those molecules except right at the surface.

Warren’s group has now developed a technology for coaxing both hemoglobin and melanin inside questionable skin moles to emit light by exciting them with highly controlled laser pulses.

The innovation uses a delicate interplay between two laser beams, each emitting a different color of light. To keep the skin from overheating in the process, the lasers must also be able to pulse on for only femtoseconds…at a time.

“We have proposals pending for developing a compact laser system that could be sitting in a dermatologist’s office here at Duke within three years where we could actually have the first human demonstrations,” Warren said.

Diagnosing Skin Cancers with Light, Not Scalpels [Duke University]

Posted in Dermatology, News | Comments Off on Diagnose Skin Cancer without Biopsy

University Stem-Cell Funding

Posted by medliorator on June 6, 2007

The [California Institute of Regenerative Medicine] awarded money to 17 campuses around the state for the next three years, including $2.8 million at Stanford University, $2.7 million at the University of California-Santa Cruz, $2.6 million at UC-San Francisco and $1.7 at San Francisco’s Gladstone Institutes. Millions more were awarded to support instruction in stem-cell techniques for scientists throughout Northern California.

The funding will allow universities to build, renovate and expand their embryonic-stem-cell labs.

A boost for stem-cell studies [San Jose Mercury News]

Posted in News, Research | Comments Off on University Stem-Cell Funding

Understanding Car Insurance

Posted by medliorator on June 6, 2007

If you have the displeasure of owning a vehicle medical school, this former Progressive service rep may help you to save on insurance. It reads like a Progressive ad, but useful information has been extracted.

Progressive uses a point system to determine your rate.
Comprehensive Claims (0 points) – claims that are not accidents; like fires, thefts, vandalisms. Don’t be afraid to report these kinds of claims. I can virtually guarantee they have no effect on your rate at Progressive.
Not at Fault Accidents (0-1 points) – it is rare for a NAF to effect your rate, but it can.
DUI, DWI (0-2 points) – Most companies won’t insure a DUI. They are barely a rating factor at Progressive. If you have a DUI on your record, I can pretty much say you will never find a lower rate than Progressive.
Tickets (1-2 points) – All speeding, stop sign, defective equipment, traffic light, yield tickets go here. Usually 2 points a piece.
At Fault Accidents (3-4 points)
Jailable driving offenses (8 points)

 

Factors affecting your rate:
Age: Young drivers are much, much more expensive
Gender: According to studies, males are higher ‘risk’ than females.
Location: Urban areas pay more; Poor neighborhoods pay more; Even very nice neighborhoods pay slightly more. The best areas are middle to lower-middle class suburbs and rural areas.
Credit: This plays a very big role in your rate. The only state exempt from credit checks is California
Your Vehicle: [in order of increasing risk] 4-door sedans, 2-door coupes, convertibles, minivans, trucks, SUVs. The bigger your vehicle, the more damage it has the potential to cause. Foreign cars are slightly more to insure since replacement parts cost slightly more.
Your Driving History: Driving histories go back 36 months, except in New York (which is 40 months). Your history is composed from three reports; your MVR or Motor Vehicle Report, the state database of your ticketed driving history; your CLUE report, a collection of previous insurance companies reports stating the numbers of claims you’ve had, and YOU. If you say you got in an accident, were never sited [sic] for it and never claimed it on your insurance, but you still tell us, it’ll be put on your record with an approximate date.
Color of your car does NOT effect your rate.

 

Waiving Fees:
Late Fees: As long as you are not consistently late with payments, you can usually get [late fees] waived if you call with some excuse. Just pretend to be concerned about the late fee on your account ruining your credit or good standing with the company (even though it won’t). Technically, Progressive reps aren’t allowed to waive any fees without talking to their supervisor first. And if for strange some reason the rep says no, ask for a manager.
Non-sufficient fund (aka returned payment) fee: As long as you have a good payment history, just call and say your checkbook was stolen. Every once in a while, a supervisor will ask for proof from the bank. Although it probably won’t happen, just call after normal business hours when banks are closed, or anytime Sunday. Call centers are open 24/7. If they still press for proof (again, which they probably won’t), just keep pressing the fact that you shouldn’t have to wait until tomorrow to prove it and want to get this bill taken care of.
Cancellation Fees: If you ever want to cancel midterm, you can. Many states have done away with cancel fees, typically about $50. However, if yours still does, when they ask you the reason for canceling, just say you moved out of the state or the country. They may ask you if you tried a rate in your new state, say you did but you found a much better one. No cancel fee will be assessed.

10 Confessions of a Progressive Insurance Rep [The Consumerist]

Posted in Finance | 1 Comment »