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By assuming medicine and Christianity are pursuing the same things - which, coincidentally, happen to be things we want, such as health, the power to choose, and an able-bodied, painless death- Christians transfer even more authority from their religious community to medicine, reinforcing one of the least appreciated phenomena in Christianity since the Reformation- the growing amnesia that Christians can and should think, speak, and act differently than the rest of the world.

-Joel Shuman and Brian Volck

Reclaiming the Body: Christians and the Faitful Use of Modern Medicine

(via brojamin)

Apropos for this to come up in FB memories just after the Pathways reunion and admist residency interviews

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“I had a patient who, before I took care of her, was in the hospital every two months,” Taavoni said. “She has congestive heart failure and labile blood pressure. Her daughter emails me saying ‘her breathing is abnormal’ or ‘her blood pressure is up, or down.’ I go over within 24 hours, adjust her medicines a little, and we manage to take care of it. Since I started taking care of her 10 years ago, she hasn’t gone to the hospital at all.” Old School is becoming new school again

#medicine

He is unfit for the presidency and cannot be endorsed.

“In fact, what makes Mr. Trump so unusual is his combination of extreme neediness and unbridled arrogance. He is desperate for affirmation but contemptuous of other views. He also is contemptuous of fact. Throughout the campaign, he has unspooled one lie after another — that Muslims in New Jersey celebrated after 9/11, that his tax-cut plan would not worsen the deficit, that he opposed the Iraq War before it started — and when confronted with contrary evidence, he simply repeats the lie. It is impossible to know whether he convinces himself of his own untruths or knows that he is wrong and does not care. It is also difficult to know which trait would be more frightening in a commander in chief.“ This is from the Washington Post. Need we say more?

#donald trump #wapo

#julien baker #music #thefeels

Awareness of these issues, and the skills to deal with them, will help to narrow the chasm between June 30 and July 1.

“At the 12 month mark, 26.6 percent of the new interns still met the criteria for depression. Are we upfront about telling our medical students that in their first year after graduation, they have better than a one in four chance of being clinically depressed? Should we be starting a conversation, before residency starts, to mitigate that number?”

#residency #medicine

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doctorkintsugi

Well.

I 80-hour week of inpatient nights now complete. My awesome R3 gave me a congratulatory can of beer after our last signout.

Didn’t kill anybody (though caught myself making a couple of rx errors; MUST SLOW DOWN even when being hammer-paged), participated in a couple of codes. Quickly learned some important shit about being on days by being the person on nights who has to clean up messes. It was good.

It was also really exhausting. Even though I slept surprisingly well during the day, I felt sickeningly tired by 2am every morning, and I’m sure I was cranky by signout. I tried to hide it.

Nurses. Nights are all about nurses. Most nurses were wonderful, super on top of their shit, totally understanding about my inexperience, helpful, and appreciative of my attempts at high-quality doctoring. Other nurses yelled at me, hung up on me, manipulated me, and generally made life hard. I tried to ask for their input, say ‘yes’ as much as possible, be physically present whenever that was helpful (eg. agitated delirium)…I tried to be a good colleague. I’d say that was reciprocated 80% of the time. Thank you, awesome nurses. I will get better at this, I promise.

But, those other 20% of nurses, working at teaching hospitals in July? Please believe me when I tell you that we are trying. That being a brand-new doctor is very, very hard. And that being mean to us does not help, and is also really unprofessional and ultimately bad for patients.

cranquis

Always respect the nurses.

But nurses… do try to return the favor to the doclings, plz?

brojamin

BABY DOCLINGS

#gonnabemeinayear #ohgod #butmuchmorezombietiredandlesscute

We all watch the same videos. But some insist the camera doesn’t tell the full story.

“At birth, you are given a pair of binoculars that see black life from a distance, never with the texture of intimacy. Those binoculars are privilege; they are status, regardless of your class. In fact the greatest privilege that exists is for white folk to get stopped by a cop and not end up dead when the encounter is over.

Those binoculars are also stories, bad stories, biased stories, harmful stories, about how black people are lazy, or dumb, or slick, or immoral, people who can’t be helped by the best schools or even God himself. These beliefs don’t make it into contemporary books, or into most classrooms. But they are passed down, informally, from one white mind to the next.”

#castile #philando (1983-2016)#racial justice

humansofnewyork

“All doctors have those patients who sit on our shoulder. Their image is always with you. One kid will pop into your head every time you hit a wall– when you encounter a disease that is so unrelenting that you’ve exhausted all therapies and you’re still not even close. One memory will keep you going. It’s a different kid for every doctor. It’s hard to know why they stick with us. I remember one patient that had red hair just like my son. And I remember one five-year-old girl who made me laugh, because when I asked her how she was doing, she told me: ‘I don’t know. You’re the doctor.’ And then there was the boy early in my career who was born without an immune system. He’d already lost two older siblings to the same disease. He lived the first two years of his life in an isolation room with no windows, and his entire exposure to the world was through a black-and-white TV. We gave him a bone marrow transplant, and suddenly his immune system came online. And we took him for a walk in the garden. This boy who had spent his entire life in a windowless room. And a sparrow landed on a bush, and he pointed at it, and said: ‘Bird.’ That moment will always be with me.”

wayfaringmd

Yaaaaasssssss. I like the picture of patients sitting on your shoulder. Some look like angels and some look like demons. And the demons tend to yell at you so you don’t screw up and the angels whisper to remind you when you did something good.

haveyoutriednotbeingsick

The right kind of doctoring.

ravenfirethief

I wish there were doctors like this in the real world.

wayfaringmd

There are doctors like this in the real world. That’s the point. Pretty much every doctor I know has stories like this.

brojamin

^Yup. One of the pediatricians who spoke at my school’s convocation recently urged the graduates to “develop their personal storylines with patients, some will be sad, but most will be joyful.”

There is no scientific basis to support undergoing juice detoxification or colon cleanses, as trendy as they may be.

““What does that even mean?” she said. Exasperated, she stopped reading.”

#medicine #medicalschool #pseudohealth

wayfaringmd

I swear

if I gotta ‘splain

ONE

‘GAIN

about these &%#&$@%# “new” (y’all, they’re like 5 years old) pap smear guidelines and fight with an 80 year old lady who had a hysterectomy in 1962 for “female problems” about why she doesn’t need a pap smear anymore

I’m gonna lose it.

I take it back. I don’t mind explaining. That’s my job, to educate my patients. It’s the battle that ensues afterwards because heaven forbid I suggest that guidelines and medical knowledge changes or gets updated or that a study of 400,000 people has more scientific validity than your anecdote about your neighbor’s cousin’s wife. I am tired of fighting that battle. I fight the same battle ten times a day.

Y’all, at least the AFP understands my struggle. What is this week’s title article? Cancer Screening in Older Patients. With editorials about how we’re over-screening and over-treating people for cervical, breast, and prostate cancer. These are my daily struggles, y’all. I spend an inordinate amount of time every single day going over the same. dang. spiel. Yes, I’ve made handouts. Do they get handed out? Do they get read? Negative. Why? Because even my OFFICE STAFF doesn’t believe me. Because every other doctor in this area is still following screening guidelines from 1986. I got people getting colonoscopies every 2 years for no go reason whatsoever; 80 year old ladies getting annual paps and they haven’t had an abnormal since 1953; 40 year old women asking for CA-125 testing and CT scans because their neighbor’s cousin got ovarian cancer and now they’re scared they caught it from them. I got 38 year olds getting Pneumovax because they had a cold once. I got 92 year olds with end stage dementia whose families insist they get mammograms. WHY?! Does nobody educate their patients anymore? Does nobody talk about shared decision making?

And Lord help me with the Zpaks. I’m sick of seeing eyes roll when I explain to the same patient for the 4th time in 6 months why the Zpak won’t treat their allergic rhinitis and if they’d just taken the dadgum Flonase they would have been better 3 months ago.

I feel like I am constantly bucking against the medical establishment around here. I’m doing what my professional organization –and every other major organization in this country–recommend and people look at me like I’m this sketchy new doctor who doesn’t know what they’re talking about. How bout realize your doctors haven’t read a journal article in 15 years and they’re SUPER behind?! I’m not the radical one here. I’m the one following standard of care. But when the local standard is 20 years behind the national standard, how can I get my patients to catch up?

This has been a rant.

/endrant.

brojamin

Didn’t realize how all of the above is until I got away from the burgeoning academic center that most of our rotations center around. Direct quote from the older family med doc I rotated with during outpatient family medicine: “Some days are amoxicillin days, some days are azithromycin days, some days are no antibiotic days. It just helps the workflow around here that way.”

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Medical schools have programs to foster inclusivity and combat racism. They're not working.

“I always chose amicability over advocacy. I didn’t want to jeopardize my grades and evaluations by calling attention to intolerance, so I stayed silent instead of voicing the values I believed in.

During my internal medicine rotation a few months later, a patient called me a “colored girl” three times in front of the attending physician. The doctor did not correct the patient, nor did she address the incident with me privately.”

Great piece here. She addresses, or at least highlights, many of the questions that I was hoping Dr. Tweedy’s book would answer but was unfortunately lacking.

The importance of senior level team members stepping up to call out these moments, however, is imperative. Because of the power differential intrinsic to M3 and M4 years, it’s impossible to comfortably challenge a patient, resident, or attending on something as incendiary as racism without risking damage to your residency application.

#race #medicine #medical school

buttonpoetry

Was the slave this nation’s first antiperspirant? Just something you bought to make you sweat less?

FROM THE VAULT: Will Giles - “Deodorant” (NPS 2015)

Performing for Hawaii at the 2015 National Poetry Slam. Hawaii placed 2nd overall in the tournament. Subscribe to Button on YouTube!

(via buttonpoetry)

Damn. These are all real products btw.

#spoken word

Everyone who has spent significant time in the halls of a hospital knows this voice. It echoes monotonously through the halls, an Orwellian clarion demanding the attention of the busy inhabitants. For medical students on medicine or surgery call teams, ears perk up, pulses quicken, and steps hasten. A steady and clear loop, it cuts through the hustle and bustle of the floor: “Code STAT, West Tower, 4F, Code STAT, West Tower, 4F…."

My first publication! But not the valuable kind in the residency rat race. Still slogging through data analysis and journal submission guidelines for those coveted “peer-reviewed” pieces that count as golden tickets into the Match factory

#medicine #medical school #humanitiesinmedicine #englishmajorstillhangingon

medicalstudentrefuge-blog

First post

Original title, eh? Check out the “About” section for a little bit about why I’m writing in the first place.

I am starting this blog as a medical student just coming to the end of my third year. In fact, I have just one more rotation. Phew.

I am meeting with a couple friends who are a year below to talk about what to expect from third year, and for any advice I have on Step 1 studying. ***FEAR NOT: THIS POST IS NOT ABOUT THESE THINGS, THERE ARE PLENTY OF OTHER PLACES TO READ ABOUT THIS AD NAUSEAM***

So it’s made me think a lot about where I was a year ago, and how much I have learnt, but also how hardened even the most optimistic of us have become. When we started rotations, we were all so excited to finish the endless lectures and finally learn how to be doctors! I felt like finally I would be learning things that would have relevance to patient care. And I have. I have learned a lot of medical things, and I have learned a bit about how to talk to patients and how not to talk to patients.

But I have also learned some things about - for lack of a better word - survival. I have learned how to look up topics on my phone discretely before rounds so I have some idea what the heck the attending is talking about. I have learned how to start my notes the night before so that I can wake up at 4am instead of 3:45. I have learned all the moments in a day I can run and get something to eat from the caf and what items fit in my white coat/scrub pockets. I have learned to make coffee relatively cool so I can literally chug it as I am headed to the hospital. Over the year, I definitely feel like I have lost a lot of my curiosity and am just trying to get through the day. It wasn’t until I was talking to my fellow classmates about this, that I found that a lot of us feel this way.

SURPRISE, SURPRISE, there is a word for this! Burnout!

Every day, especially in the third year, is essentially an interview. You can never let your guard down completely. Expectations are high in medicine, for good reason. You are dealing with very serious things that have very serious consequences. So you’d better be prepared. But the culture of medicine does not practice positive feedback. Everyone is tired and burnt out, and teaching medical students can add to the workload. We know this. We feel in the way. We are sorry. We just want you to like us. It is amazing how someone acknowledging your presence makes the hugest difference in your day, not to mention someone saying, “good job today.”

I think what makes third year so hard is not necessarily the hours, but just the sheer exhaustion of performing 100% of the time. The system (grading policies, format of education) creates an atmosphere that makes it difficult to want to learn for the sake of learning.

How do you feel like 3rd year has changed you? Or medical school in general? Do you feel like people openly talk about their struggles at your institutions?

brojamin

Expectations are high in medicine, for good reason. You are dealing with very serious things that have very serious consequences. So you’d better be prepared. But the culture of medicine does not practice positive feedback. Everyone is tired and burnt out, and teaching medical students can add to the workload. We know this. We feel in the way. We are sorry. We just want you to like us. It is amazing how someone acknowledging your presence makes the hugest difference in your day, not to mention someone saying, “good job today.” ^This. So on point. I can’t count how many days, I’ve looked back at the end of the day and thought, “man, I really didn’t do much today (in terms of patient care) but I’m so tired.” Or reflected on the fact that I made it through the day without an attending or resident making eye contact with me the entire day. The biggest thing I’ve noticed is how easily skeptical/dismissive I’ve become of people’s pain. People either shrug in melancholic agreement or blink in horrified wonder depending on if I’m sharing with a fellow med student or someone outside the profession.

me when @wayfaringmd follows my tiny tumblr, because she is medblr famous and lives the real doctor life while I’m still on the M3 grind. also great to see a physician honestly grapple with questions of faith and medicine. All the while calmly fending off the insatiable tide of pre-meds seeking advice. #kudos

#Medblrs #fanboying

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Study shows that white medical students and residents often hold "fantastical" stereotypes about blacks that may explain why African Americans are less likely to receive pain medication.

"Researchers at the University of Virginia quizzed white medical students and residents to see how many believed inaccurate and at times "fantastical" differences about the two races -- for example, that blacks have less sensitive nerve endings than whites or that black people's blood coagulates more quickly. They found that fully half thought at least one of the false statements presented was possibly, probably or definitely true."

Yes, this is ‘social science’ and not an RTC, and the sample sizes aren’t thousands, and the methodology could’ve been explained better (http://m.pnas.org/content/early/2016/03/30/1516047113.abstract), etc etc. A friend pointed out this article to me (s/o to DJ Lee) and as I looked around social media the classic medical student/health professional classic quibbles and nitpicks are already sprouting like weeds (I know them all, I’ve used them). “We need more information” “The sample size wasn’t large enough” “The statistical analysis was under-powered.” While some of those points are certainly true (this is absolutely an area that demands more focused and rigorous scholarship), they aren’t paramount. At the end of the day, this is another unfortunate recording of a phenomenon extensively documented in the literature; Race (and gender, but that’s another post), affects physician’s perceptions and treatment of pain and illness. Discrimination is baked into the very epistemology of medicine, sometimes for good, here, and most often, for bad. I don’t have a solution, but the least we can do is admit the extent of the problem, especially within the cadre of physicians and medical students.

#medical school #medicine #race #pain management

dramoor

Lord Jesus Christ, Son of God, have mercy on me, a sinner.

(Art by Stephen B. Whatley)

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