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Medicine often finds itself in a quandary as a profession.  Like any profession, it offers an important service.  In a sense, patients are customers and consumers.  Physicians do compete to some extent with naturopaths, homeopaths, nutritionists, acupuncturists and all who hawk their latest miracle cure or millennia old natural remedy on late night television infomercials.  We try to separate ourselves out from these with science, evidence base, and therefore increased credibility.  While this credibility is very important to patients, the truth is they just want to feel better.   The conflict is this, as a scientists, doctors are trained to be skeptical of all medical claims so they can be rigorously evaluated.  Yet, as healers, it is critically important to believe that what you are doing is, in fact, best for the patient, as the patient needs to believe in the treatment for it to have any effect as well.  In a very important sense, we have to sell what our recommendation is to the patient.  

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It’s here again and back on schedule.  This week I’ve got emotion, fear and stigmatization on the mind, parables, heaven and hell and success for the soul and whoopee cushions, spleens and lots and lots of protein for the body, to name just a few.  So without further delay I present especially for you, the reader, the creme de la creme of the internet I happened to have stumbled across surfing the internets- Read the rest of this entry »

Choosing on a medical specialty involves learning your own answers to a series of questions?

-Do I enjoy patient interaction or not?

If no, consider Pathology or Radiology

-Do I like surgery and procedures more, or medicine and clinical reasoning, or both?

note- Anesthesia is a procedure and OR specialty, sort of surgery-lite.

Both- Ophthalmology, Orthopedic Surgery (well peds ortho anyway), ENT, Ob-Gyn, and Emergency medicine for procedures

-Do I prefer general, broad knowledge or limiting to one area or system, Primary care or specialist?

This is often a question of knowing a little about a lot, or a lot about a little.  However, It also involves whether you prefer relatively healthy patients or relatively sick.

-Do I do I prefer to see kids, adults, or both? (remember you can do almost anything for kids that you can for adults.)

The last question was easy for me.  From my point of view, pediatric care is superior to adult medicine in so many ways. Read the rest of this entry »

In Child neurology we are required to do a year of adult neurology. This is a year of complete culture shock. Children’s hospitals and adult hospitals are two completely different worlds. It is interesting to see the adult neurology residents complain about how chipper and upbeat the pediatrics people are. This is an odd complaint, until you realize adult neurology residents feel completely out of their comfort zone in knowing how to manage the patient. fear and discomfort are only augmented by sleep deprivation and being pulled in several directions at once, as you tend to be on call, Perhaps they can be forgiven when they really find it difficult to draw enthusiasm when awoken at 3am to hear about some “kiddo.” For me, being out of my element with adult patients is an even greater culture shock. Going from chipper to somewhat cynical and demanding is worse than the other way around.

The culture shock is particularly profound the Neuro ICU. For one thing, it is a prime site for so many spectacularly horrific things. While children with neurlogic problems can be heartbreaking, somehow I manage to deal with it. There is something about dealing with severe traumatic brain injury, brain tumors, stroke and brain hemorrhage all day that is particularly soul killing. The place is just saturated with death and loss. It was here I came to understand the phenomenon in medicine that is gallows humor.

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     Thanks to the Frontal Cortex, I recently stumbled across an article on the online journal n+1 that describes firsthand a new and disturbing trend in higher education, Adderall abuse.   Adderall is a mixture of long and short acting amphetamines that keep the mind revved up and the body energized for hours.  It appears overachievers at Ivy League Universities are sorely tempted by this as it improves test taking skills, focus, recall, enables all-nighters to work, etc.  The one group of students my mind immediately went to was the classic overachiever, the medical student.  Read the rest of this entry »

  As I recovered from depression, I discovered a whole new ailment, anxiety.  One of the first side effects the medication gave me was panic attacks.   I had a lot on my plate, really.  I had to toe the line, with no relapses.  I worried incessantly about the future.  I worried about my patients.  I worried about the rumor mill surrounding me.  I worried about the impressions, fair or otherwise, that others had of me. I worried about stigma. Read the rest of this entry »

  The events surrounding my transition from medical student to MD and resident were a tidal wave.  My education, training, mindset, social phobia, personal life, health all combined into what I can only refer to as the perfect storm.  Read the rest of this entry »

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