Medliorate

Improving medical students

Archive for August, 2008

Take Notes Anywhere – Evernote

Posted by medliorator on August 31, 2008

Evernote

Why You Should Be Using Evernote
A universal capture application is only as good as its ability to catch information no matter where you are and what you’re doing. With support for accessing and adding notes from your cellphone, through any web browser, or through the desktop version, the most popular note-taking application Evernote is perhaps the closest option to a true universal capture tool available next to plain old pen and paper.

Expand Your Brain with Evernote [Lifehacker]

Posted in Software, Tools | 1 Comment »

Know the Expectations

Posted by medliorator on August 30, 2008

In many ways, this is what we’ve come to in medicine. The expectations are almost insurmountable. Infallibility is the performance standard.  The delivery of healthcare has been relegated to the category of “commodity”, like automobiles and hair care products and soybeans.  Where’s my warranty, my guarantee? Why did I get an infection? Why didn’t you realize I had breast cancer when it was 0.5mm instead of 2mm? Did you wash your hands well enough before you came into my room?

But there will be more cases to come. More patients who expect nothing but a smooth, uneventful experience. Once again, I will have to gather my tools and perform…

The Burden of Reproducible Excellence [Buckeye Surgeon]

Posted in Professionalism, Tips & Advice | Comments Off on Know the Expectations

How to Make Clinical Decisions and Avoid Defensive Medicine

Posted by medliorator on August 29, 2008

I was asked to examine a patient who was scheduled for an emergency amputation of her leg because of gangrene. I went over her chart and discovered that one of the junior residents had seen her the night before and had requested two consults… I cancelled the consults because they were unnecessary.

The next day, I ran into the resident who requested the consults… I asked him why he asked for the consults. His reply made me see red. It is the reply of the imbecile, of the doctor who is afraid to think and make decisions, and it drives me to distraction: “To spread around the responsibility”. To be fair, it is not all his fault, he learned this “defensive medicine” posture from [the chief of anesthesiology].

I told him that even if he really believes in that philosophy, he should never actually say it out loud, it’s just plain embarrassing. I proceeded to impart two pearls of wisdom that I believe are universal:

  1. If you ask the consultant a stupid question, you will, invariably, get a stupid answer. Don’t just ask for a “cardiology consult”. One must ask the consult a specific (and hopefully intelligent) question. For example, “Does this patient need further workup and/or intervention for her chest pain?”
  2. You better have a damn good justification for delaying surgery if the delay endangers the patient. In this case, delaying the amputation exposed the patient to another day of infection that could have developed into full blown sepsis with septic shock… Had such a complication occurred, the first question the judge will ask is: “What did you gain from the consults that justified delaying surgery and endangering the patient”.

I believe in this guiding principle: Any investigation, whether a consultation or a blood test should be done only if the results will affect patient management. Not only is an unnecessary test a waste of money, it may even endanger the patient.

Unnecessary Tests [The Sandman]

Posted in Clinical Rotations, How-To, Medical Ethics, Professionalism, Residency | Comments Off on How to Make Clinical Decisions and Avoid Defensive Medicine

Electives vs Rotations

Posted by medliorator on August 28, 2008

Either, the student chooses an elective purely so they can travel, with medicine as the excuse, or the student has an area of interest that their elective hospital specializes in. The student may or may not be job seeking for the future. I should point out that the Elective rotation may also be taken domestically – it’s not compulsory travel.

Comparatively, the clinical rotation primarily educates the student… Simply put, a clinical rotation is all about how to do what you’re gonna do.

Heading Home… Overseas? [Degranulated]

Correlate: Perks of Away Rotations

Posted in Clinical Rotations | 1 Comment »

Advantages of Extracurricular Research

Posted by medliorator on August 27, 2008

Since I have been working on my PhD,

  • I have learnt how to plan an experiment, and finish it
  • I know how to draft, write, and submit a scientific journal article
  • I have had good quality research articles published, that add to scientific endeavour (Ever seen a dodgy registrar paper in a second-rate journal? Not for me.)
  • I have had the opportunity and experience of presenting my work at national conferences.
  • I have learnt how to do Medline and PubMed searches properly.

Better reasons to do medical research [Scalpel’s Edge]

Posted in Research | 1 Comment »

Cooking Once a Month

Posted by medliorator on August 26, 2008

1.   Make a menu

  • Choose recipes… that you’ve cooked successfully before.
  • Soups, stews and casseroles are the easiest to cook ahead of time…  Make a pot of tomato sauce with meat in it (or pesto), cook some pasta, and freeze both (stored separately).

2.    Avoid foods that don’t freeze well

  • Sour Cream (becomes thin/watery)
  • Mayonnaise (separates, but is fine if mixed into a recipe)
  • Cream Cheese (becomes watery and texture changes)
  • Cheese (crumbles, but is fine for shredding or in recipes)
  • Fried Foods (lose crispness or become soggy)
  • Egg Whites- cooked (become tough & rubbery)
  • Cream Pies (become watery or lumpy)
  • Cream Fillings (texture changes)
  • Frostings (texture changes)
  • Icings made with egg whites (become foamy)
  • Potatoes don’t taste good after being frozen, whether in soup, stew, or casserole.

3.    Keep in mind how some foods respond to freezing.

  • Raw Vegetables (lose crispness, but if prepared correctly can be used for cooking or stews & soups.
  • Pastas & Grains (softer after freezing/reheating- undercook before freezing to counter-balance)
  • Seasonings, onions, green peppers, herbs & flavorings (flavor may increase or diminish with freezing. Add afterwards when possible)
  • Soups. Freeze the components of soup separately (broth, chicken, blanched onions, celery, and carrots) rather than freezing the assembled soup.

9. Freeze the meals. Always seal, label and date the prepared meals. It’s no fun playing the guessing game when finding the mysterious freezer dinner.

  • Freezer bags – Remove as much air as possible. A vacuum sealer is highly recommended. Soups and stews can be poured into freezer bags, sealed, and stacked flat; once they freeze, you can store them vertically like books on a shelf.
  • Use aluminum pans or line cake pans or casserole dishes with heavy aluminum foil so they can be removed from them once they’re frozen; later, you can put it back inside that pan or dish for thawing and serving.

How to Do Once a Month Cooking [wikiHow]

Posted in Productivity | Comments Off on Cooking Once a Month

General Surgery Demographics

Posted by medliorator on August 25, 2008

From the November 14th edition of JAMA, an article penned by Dr. Josef Fischer titled The Impending Disappearance of the General Surgeon via A Chance to Cut is a Chance to Cure:

The population of general surgeons is decreasing. Fewer residents are choosing general surgery and existing general surgeons are aging, and as a result 32% of general surgeons are older than 55 years and 20% are younger than 35 years. Emergency department visits have increased 26% since 1993, and 75% of hospitals report inadequate on-call surgeon coverage. For the first time ever, the Medicare Payment Advisory Commission found that their beneficiaries have more trouble accessing specialists than do private-pay patients

While most attention of health policy experts has focused on the care of the chronically ill, changes have occurred in an important component of the workforce—general surgeons. Their numbers have been decreasing precipitously. Causes of this shortage include an unfavorable work environment, reimbursement issues, professional liability, and, probably most important, the change in the nature of the workforce of individuals who are entering medicine.

The Future of Surgery XII [A Chance to Cut is a Chance to Cure]

Correlate: Gender in Surgical Demographics

Posted in Health Policy, Surgery | Comments Off on General Surgery Demographics

How to Win Friends

Posted by medliorator on August 24, 2008

1. “If You Want to Gather Honey, Don’t Kick Over the Beehive”
don’t criticize, condemn or complain. People rarely blame themselves for anything, so if you criticize them not only are they unlikely to change, but also they may resent toward you.

2. The Big Secret of Dealing with People
People will go long way – sometimes even become insane – just to get the appreciation they need. So be a person who give honest and sincere appreciation to others.

The way to make a good first impression is so simple that we sometimes forget it: smile. When you smile, people will feel that you are glad to meet them. They will feel accepted and get a good first impression about you.

3. If You Don’t Do This, You Are Headed for Trouble
People put tremendous importance on their names. Therefore it will be much easier for you to win their hearts if you approach them by using their names.

4. An Easy Way to Become a Good Conversationalist
It may seem counterintuitive, but being a good conversationalist is about by how good you talk. It’s about how good you listen. Encourage others to talk about themselves and be a good listener.

Dale Carnegie: You can make more friends in two months by becoming interested in other people than you can in two years by trying to get other people interested in you.

Review: How to Win Friends and Influence People [Life Optimizer]

Posted in How-To, Wellness & Health | Comments Off on How to Win Friends

How to Get Along with Others

Posted by medliorator on August 23, 2008

2. Build up the other person’s sense of importance. When we make the other person seem less important, we frustrate one of his deepest urges. Allow him to feel equality or superiority, and we can easily get along with him.

4. Give sincere appreciation. If we think someone has done a thing well, we should never hesitate to let him know it. WARNING: This does not mean promiscuous use of obvious flattery. Flattery with most intelligent people gets exactly the reaction it deserves — contempt for the egotistical “phony” who stoops to it.

5. Eliminate the negative. Criticism seldom does what its user intends, for it invariably causes resentment. The tiniest bit of disapproval can sometimes cause a resentment which will rankle — to your disadvantage — for years.

6. Avoid openly trying to reform people. Every man knows he is imperfect, but he doesn’t want someone else trying to correct his faults. If you want to improve a person, help him to embrace a higher working goal — a standard, an ideal — and he will do his own “making over” far more effectively than you can do it for him.

Dave Packard’s 11 simple rules [Hewlett-Packard]

Posted in How-To, Tips & Advice | Comments Off on How to Get Along with Others

Organization on the Go – Pocket Mod

Posted by medliorator on August 22, 2008

Smart widget pages allow you to take information on the go!

The Pocket Mod

Posted in Productivity, Tools | Comments Off on Organization on the Go – Pocket Mod