This post has nothing to do with medicine, humor, or any other theme I may have accidentally developed on my blog. This is one of the occasional posts where I just talk about what I want to talk about. I promise, it will still be worthwhile and not mindless drivel that makes you regret coming to my site. Sports will be the theme of the near future. The Ryder Cup is this weekend, which is one of the most awesome events imaginable. More about that in future days. For now, we must talk about Tebow.
A few disclaimers to start out with. I'm biased towards Tebow. Big time. For me, he is the quintessential sports hero. Not only do I share his Christian beliefs, but I love the way he plays football. I am a ground and pound guy. The NFL is incredibly too pass happy in my opinion. It was amazing watching him run all over people while all the pundits said it couldn't be done in the league. I say all that just to be fair. Beyond his undervalued skills, the guy is just a flat out winner. If we are picking teams on the playground, I'd take him with my first pick all day long regardless of the sport being played. His intangibles are that far through the roof.
I'm still amazed at the negativity directed at Tebow. I'm pretty confident much has to do with his outspoken faith. No one in their right mind can say the man can't win ballgames. He already has. He works harder than anyone. He helps those that are hurting and tries to be an example for kids. He regards his mission outside of football as more important than the game. All of these are things that we try to teach our own kids, yet he gets bashed daily. Why? Besides show an amazing will to win, being a great example, and not apologizing for what he believes in, what can you criticize about the man? If you disagree with his beliefs, say so. Don't hide behind petty criticism of his game when you really just want to see him fail so that you can try to connect any on the field failure he has to his religious views.
Something else I haven't figured out it is how the Broncos willfully let Tebow leave the city. Did you see what that kid just did for your team? I realize that John Elway is a Hall of Famer who wants to have a prototypical quarterback. But you must realize the opportunity before you. How much more of an impact will you leave on the game if you build a team around Tebow and win? Everyone said that style of play wouldn't work, and you proved that it did. Your next move? Trade Tebow!!?? Incomprehensible to me. I happen to love Peyton Manning as well. Think he is a great guy and one of the best QB's of all time. But this opportunity is much bigger than getting a 36 year old QB with multiple neck surgeries.
So there are my thoughts. Tebow is the man, plain and simple. He is the sole reason that I tune into the NY Jets games every Sunday. Now let's get him some playing time!
Saturday, September 29, 2012
Saturday, September 22, 2012
Article Concerning the Rules for Organizing and kNowing how to Name Your clinical study Magically, or the ACRONYM article
Most scientific disciplines, at their very core, amount to a bunch of big five year olds getting together and seeing if they can make something fun happen. Trial and error is the name of the game, and medicine is no different. We call our grand experiments clinical trials. One group of patients gets the newest idea for treatment, and the other group gets either nothing or the old treatment. The race is on, and we see who wins (vast oversimplification, but the general idea is there). Those of you in the audience that are medical know much more than this of course. However, there is a little known secret to clinical trials that, in my estimation, is essential to the results of a clinical trial having a lasting impact on medicine...the name.
If you ever been involved in a medical argument, you will hear the names of clinical trials flying left and right like bullets in warfare. Conjecture and personal opinion will only get you so far. We treat based on facts, people, and we get our facts from trials. You might think that we physicians are too objective to be swayed by things like the name of the clinical trial...you'd be wrong. It's a lot easier to quote the FAME or COURAGE trial than some long sentence that actually says what the trial is investigating. Heck, even the lowly med student or resident can remember a one word name or catchy phrase. Just that much easier to whip out that latest trial during rounds and impress the attending. For those that don't know, spontaneously producing a clinical trial on the spot during rounds to either prove your point or prove someone else wrong is the holy grail of medical students. You pull this off, and you can write your ticket for that rotation. It's kind of like winning American Idol without the fuss of months of singing on national television and listening to judges make dumb comments.
You may wonder what kind of criteria there are for a "memorable" clinical trial name. Based on previous results, here are a few guidelines (not strict of course, as creativity is encouraged here):
1. Brevity is key. One word is better than two. Shorter is better...you get the picture.
2. References to mythology are not only acceptable, but encouraged. Remember your audience. We're nerds.
3. The more bold and glamorous, the better. Titles like AFFIRM, AWESOME, VICTORY are examples. Go big or go home. Picture how the title will be listed when you are accepting the Nobel...and then make it even more bold.
4. The acronym doesn't have to fit perfectly, or at all. The original idea was the one word allows you to remember the entire name of the trial. Now that the fad has taken off, investigators no longer feel the need to confined by things like the definition of the word acronym. Just name it what you want and figure out the rest later.
5. A catchy name with a medical play on words is just flat awesome. My favorite example would have to be PROVE IT-TIMI 22. The number at the end aside, this title is genius. For the non medical folk, TIMI stands for Thrombolysis in Myocardial Infarction. The name can be found everywhere now. There is a TIMI risk score, TIMI study group, etc. Other clinical trials from the same study group have the TIMI acronym, but none achieved what this one did. A good title that plays directly off the name of your study group? Please. Stop it. We're not worthy.
So there you go folks. I've given you the keys to the academic kingdom. Go forth, publish, and change the world. For you laypeople, this should give you reassurance that medicine follows fads just like normal culture does. We ain't any better; we just dress it up enough to make it sound good.
If you ever been involved in a medical argument, you will hear the names of clinical trials flying left and right like bullets in warfare. Conjecture and personal opinion will only get you so far. We treat based on facts, people, and we get our facts from trials. You might think that we physicians are too objective to be swayed by things like the name of the clinical trial...you'd be wrong. It's a lot easier to quote the FAME or COURAGE trial than some long sentence that actually says what the trial is investigating. Heck, even the lowly med student or resident can remember a one word name or catchy phrase. Just that much easier to whip out that latest trial during rounds and impress the attending. For those that don't know, spontaneously producing a clinical trial on the spot during rounds to either prove your point or prove someone else wrong is the holy grail of medical students. You pull this off, and you can write your ticket for that rotation. It's kind of like winning American Idol without the fuss of months of singing on national television and listening to judges make dumb comments.
You may wonder what kind of criteria there are for a "memorable" clinical trial name. Based on previous results, here are a few guidelines (not strict of course, as creativity is encouraged here):
1. Brevity is key. One word is better than two. Shorter is better...you get the picture.
2. References to mythology are not only acceptable, but encouraged. Remember your audience. We're nerds.
3. The more bold and glamorous, the better. Titles like AFFIRM, AWESOME, VICTORY are examples. Go big or go home. Picture how the title will be listed when you are accepting the Nobel...and then make it even more bold.
4. The acronym doesn't have to fit perfectly, or at all. The original idea was the one word allows you to remember the entire name of the trial. Now that the fad has taken off, investigators no longer feel the need to confined by things like the definition of the word acronym. Just name it what you want and figure out the rest later.
5. A catchy name with a medical play on words is just flat awesome. My favorite example would have to be PROVE IT-TIMI 22. The number at the end aside, this title is genius. For the non medical folk, TIMI stands for Thrombolysis in Myocardial Infarction. The name can be found everywhere now. There is a TIMI risk score, TIMI study group, etc. Other clinical trials from the same study group have the TIMI acronym, but none achieved what this one did. A good title that plays directly off the name of your study group? Please. Stop it. We're not worthy.
So there you go folks. I've given you the keys to the academic kingdom. Go forth, publish, and change the world. For you laypeople, this should give you reassurance that medicine follows fads just like normal culture does. We ain't any better; we just dress it up enough to make it sound good.
Thursday, September 20, 2012
The Doctor Becomes the Patient
Like many doctors, part of what inspired me to go into medicine was spending a considerable amount of time on the wrong side of the doctor-patient relationship (that being the patient of course). Before medical school, that would make me a normal patient. Once you get some medical training, the term normal patient never applies to you. Ask anyone in the medical field. Doctors are the worst patients. Very few can handle such a drastic role change. One day you are making life or death decisions (OK, slightly exaggerated) on sick patients and the next you're asking the nurse if you can "use the potty." Quite the role reversal there. I've seen physicians-turned-patient argue with nursing staff about how they gave daily stool softeners 15 minutes too early. We really are a crazy bunch.
I've taken care of many of these patients before, and the key is let them make decisions. I'm not talking about letting them treat themselves but giving options whenever possible. They will be much more likely to go along with you if they feel that they're participating in their own care. Being given multiple options for how and where to urinate may seem trivial, but it may be what holds together the psyche of some of the most neurotic people you will ever meet (I know, I'm one of them). The fun part is that the patient usually knows exactly what you are doing. They have likely treated other patients like this themselves. You can usually share a good laugh with them once you get their initial anxiety under control. Good physicians are fairly self aware. Part of what makes them good is the ability to perfect every detail of what they do. That includes being able to "poo poo in the potty."
In other news, life is busy at the HumorMD household. We have recently had a new addition, which we are very proud of. HumorMD Jr. and I had some quality time last night. We discussed diagnosing a STEMI (type of heart attack), and he's already an expert. Maybe we'll add world renowned physician to his previously mentioned athletic prowess. I just feel bad for the other kids getting compared to him...
I've taken care of many of these patients before, and the key is let them make decisions. I'm not talking about letting them treat themselves but giving options whenever possible. They will be much more likely to go along with you if they feel that they're participating in their own care. Being given multiple options for how and where to urinate may seem trivial, but it may be what holds together the psyche of some of the most neurotic people you will ever meet (I know, I'm one of them). The fun part is that the patient usually knows exactly what you are doing. They have likely treated other patients like this themselves. You can usually share a good laugh with them once you get their initial anxiety under control. Good physicians are fairly self aware. Part of what makes them good is the ability to perfect every detail of what they do. That includes being able to "poo poo in the potty."
In other news, life is busy at the HumorMD household. We have recently had a new addition, which we are very proud of. HumorMD Jr. and I had some quality time last night. We discussed diagnosing a STEMI (type of heart attack), and he's already an expert. Maybe we'll add world renowned physician to his previously mentioned athletic prowess. I just feel bad for the other kids getting compared to him...
Tuesday, September 18, 2012
4 AM
In light of my recent post outlining my thoughts on the "work above all else" culture of medicine, I thought I would take you through the stages of a typical call night. Given the new work hour rules, this could mean different things to different people. What I will describe is the traditional 30 hour call that has long been a part of medical training (now 28 hour call for 2nd and 3rd year residents).
The morning of your call day is spent just like every other day. You pre round and then round formally on all your team's patients. If you are the intern, you will likely actually pay attention during all of rounds that day. On the traditional medicine team, each intern is responsible for half the team with the upper level resident overseeing everyone. You can imagine that it is not uncommon as an intern to enter a transcendental state where your body remains still but your mind is 2 continents away when you arrive at a patient's room that is not yours. A call day changes this because after everyone leaves that evening, you will be managing the patient through the night. Best to actually have some idea of what is going on if the nurses are going to page you when a patient starts circling the drain.
Next phase is lunch and then getting work done in the afternoon. Again, this is not much different than ordinary except you are likely to start admitting new patients. If your team is high functioning and generally humane, the non call members of the team will take the first few admits since you have to stay all night. If you have made enemies amongst your team or work with people looking to make you their enemy, then its time to pony up and take your punishment. Trying to admit new patients while discharging others and getting all your other work done is not fun, but we have all done it. Having a really rough afternoon in this regard can mean one of two things. You have either already exhausted the sick population around your hospital, or it is the tip of the iceberg that is about to sink your ship.
This brings us to the night portion of your call. For new interns, this is the part known as "I'm so scared I crapped my pants." For the rest, this is "another night stuck in this stupid place." You will know if that precious commodity known as sleep will be enjoyed by midnight. Still working at midnight equals no sleep. Caught up by midnight equals possible to catch a few hours. This rule of midnight is based on my experience and is nearly flawless.
Next up on your schedule is the dreaded hour known as 4 AM. This is rock bottom if the rule of midnight has stated that you are still awake and working. Though tired at other portions of your 30 (so sorry, 28) hour call, this is where you will feel physically and mentally beat down to the max. Personally, 4 AM is usually associated with a wave of nausea, inability to sit more than one minute without my eyelids drooping, and deep desire to end anyone's life that stands between me and the closest bed. This is where the men are separated from the boys. Many a med student's career has crashed and burned at 4 AM as they have totally lost it and submitted to the weariness. I've had multiple med students downright refuse to do work at this hour. Some have even just gone home without even asking, never to show up again. There is nothing glamorous about making it through this phase of the guantlet. There is only survival.
If indeed you do have the mental fortitude to survive, then the hour of 5AM is when the glow of hope appears on the horizon. With only one hour until everyone else arrives, you can now begin to effortlessly push away work with the time old adage of "I think that decision is best made by the primary team." Nurses know this phrase well. They also know that all decisions except for those that are emergent will be pushed off until 6AM once that phrase appears and the hospital grinds to a screeching halt. For the resident, it is now time to grab whatever catnap possible, round on your patients, and get the heck out of there. One more 4 AM between you and freedom (aka the end of residency) is now gone.
The morning of your call day is spent just like every other day. You pre round and then round formally on all your team's patients. If you are the intern, you will likely actually pay attention during all of rounds that day. On the traditional medicine team, each intern is responsible for half the team with the upper level resident overseeing everyone. You can imagine that it is not uncommon as an intern to enter a transcendental state where your body remains still but your mind is 2 continents away when you arrive at a patient's room that is not yours. A call day changes this because after everyone leaves that evening, you will be managing the patient through the night. Best to actually have some idea of what is going on if the nurses are going to page you when a patient starts circling the drain.
Next phase is lunch and then getting work done in the afternoon. Again, this is not much different than ordinary except you are likely to start admitting new patients. If your team is high functioning and generally humane, the non call members of the team will take the first few admits since you have to stay all night. If you have made enemies amongst your team or work with people looking to make you their enemy, then its time to pony up and take your punishment. Trying to admit new patients while discharging others and getting all your other work done is not fun, but we have all done it. Having a really rough afternoon in this regard can mean one of two things. You have either already exhausted the sick population around your hospital, or it is the tip of the iceberg that is about to sink your ship.
This brings us to the night portion of your call. For new interns, this is the part known as "I'm so scared I crapped my pants." For the rest, this is "another night stuck in this stupid place." You will know if that precious commodity known as sleep will be enjoyed by midnight. Still working at midnight equals no sleep. Caught up by midnight equals possible to catch a few hours. This rule of midnight is based on my experience and is nearly flawless.
Next up on your schedule is the dreaded hour known as 4 AM. This is rock bottom if the rule of midnight has stated that you are still awake and working. Though tired at other portions of your 30 (so sorry, 28) hour call, this is where you will feel physically and mentally beat down to the max. Personally, 4 AM is usually associated with a wave of nausea, inability to sit more than one minute without my eyelids drooping, and deep desire to end anyone's life that stands between me and the closest bed. This is where the men are separated from the boys. Many a med student's career has crashed and burned at 4 AM as they have totally lost it and submitted to the weariness. I've had multiple med students downright refuse to do work at this hour. Some have even just gone home without even asking, never to show up again. There is nothing glamorous about making it through this phase of the guantlet. There is only survival.
If indeed you do have the mental fortitude to survive, then the hour of 5AM is when the glow of hope appears on the horizon. With only one hour until everyone else arrives, you can now begin to effortlessly push away work with the time old adage of "I think that decision is best made by the primary team." Nurses know this phrase well. They also know that all decisions except for those that are emergent will be pushed off until 6AM once that phrase appears and the hospital grinds to a screeching halt. For the resident, it is now time to grab whatever catnap possible, round on your patients, and get the heck out of there. One more 4 AM between you and freedom (aka the end of residency) is now gone.
Thursday, September 13, 2012
Baby Daddy
I'm going to be a father soon. This has given me a first hand look at the crazy way people react when they see a pregnant woman. The reactions range from shrieking in a voice that blows out your eardrum to recoiling as if my wife was growing a den of venomous snakes. There really is no in between. Some people can't stay away and others are gone before you get the sentence out. I will admit that it was strange the first time I felt my baby move in my wife's belly. I like to play a baby version of Whack-a-Mole where I find body parts sticking out and poke them until they are moved elsewhere (I'm not violent I promise). I don't really like to be poked and prodded myself, so I can't say I blame the kid when he occasionally gives a little shot back. My wife isn't a fan of this, as you can imagine. Already have big plans for him though. Any infant that can punch his dad through a uterus should have major athletic potential. At least that's what I'm going with.
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