The Armor of a Medical Student

As in most professions, medicine calls for a certain standard of attire. But a medical student's panoply is more involved than just a tie and a white coat. If one wants to make it through the fray, one must be completely prepared for the challenges that lie ahead.


We begin the morning, bright-eyed and bushy-tailed, ready to take on the world
1. Stethescope - no medical professional can get by without it. Needed to listen to heart, lungs, internal organs, blood vessels, and more or less anything you can think of. Not to mention it gives you street cred (particularly when worn around the neck as displayed).
2. Clipboard - You cannot imagine the amount of paper that moves through the hands of a student through the day. This becomes the only means of organization
3. Cell Phone - The electronic leash. Usually over 40 text messages sent and received throughout the day telling you to go to radiology, come down to lecture, oh lecture's been canceled don't come down, have you gone to radiology yet?, etc.
Also the source of medical software. Because the human brain can't hold 40,000,000,000 drug names. Much less generic AND brand names for each.
4. Quick Reference Texts - Don't leave home without these. Great quick refresher while your resident is being pimped* during rounds.
5. Misc. Medical Equpment - Including reflex hammer, pen light, eye chart, tuning fork... because you never know when you'll need to serenade a patient on key.
6. Coffee Mug - The lifeblood of your humble observer. Because 5 am comes oh so early.



As the morning progresses, the student is charged with putting all that wonderful equipment to good use. Examining patients, writing notes, checking labs and all between the hours of 8-8:30.



Being on the floor is all about quick reference (as above). Here we display the three that your humble observer chooses to employ.
1. ePocrates software on cell phone - mostly useful for drug information
2. Massachusetts General Pocket Medicine - all of medicine in a cute little red binder
3. Maxwell's Quick Medical Reference - Lab values, key points to an H&P, and dermatomes. Often saves you from looking stupid in front of a patient.


In addition to what we carry on us at all times, there is the small issue of books. There are at minimum 5 authorities as far as texts are concerned, and they don't always agree (see putting reflex hammer to good use). At the end of the day, diffusion by osmosis might be the best use of Pocket Medicine.

And the most important part of the armor:


Like Gawain's Shield, makes you invincible to the blows of nurses, residents, fellow students, and anyone else who dares hurl less than encouraging words at you. Allows you to let it all just slide off. The medical student's infinite knot.


*Pimping - In medicine, used to describe scenarios in which the higher ups (attendings, senior residents) question those lower on the ladder (students, interns, etc.) More on this later.

Thanksgiving

Thanksgiving at the Kalamkarian residence usually involves about 38 people, a 400 lb turkey, and almost 30 side dishes. So what if I told you that this year, Thanksgiving at the Kalamkarian household was a nice quiet affair with only a handful of people (but 30 side dishes nonetheless)? You might look at me cross-eyed. It's true. Here are the pictures to prove it.

Here is the young star of the show, ready for his moment in the spotlight

The Before and After Thanksgiving shopping on my fridge

.Here we go. The provisions are out and ready to be turned into a delicious meal

Head Chef Marina Ravich is working on the perfect turkey.


Smile ladies!


Performing my duties as an American: watching football.


The bird's ready. The feast is on the table. Let's eat!



Such pretty faces to grace my apartment for turkey day!

Hope you all had as much fun as I did on this day. Happy Thanksgiving to you all!

Medical Code: The Shotgun Approach

November 25, 2008

The Shotgun Approach:
Praise the Lord & Pass the Ammunition

As mentioned in my "Mission Statement" doctors must have a valid justifiable reason for making the choices that they make. The absurd, to illustrate a point:

If you come to a doctor with a stubbed toe and she/he orders a chest x-ray, I think we can safely assume that is not good practice.

It is a generally held belief that a doctor should be able to make 60-80% of diagnoses based on a careful and thorough history of present illness and physical exam. It's amazing how often a patient actually spits the diagnosis out right at you and may be quite unaware that they are doing it. Unfortunately, too many practitioners have become utterly reliant on laboratory (e.g. blood work) and imaging (e.g. x-ray) tests to make the diagnosis for them. This is absurd considering the limits of such tests.

Now, I start by examining the practitioner but, to be absolutely fair, I have to look at the other side: the patient. Patients come to a doctor hoping for answers, hoping for help. They perceive tests as the ultimate in a doctor working for them, and the more the better.

Unfortunately, using a shotgun approach (ordering every test known to man for screening*) is not only unhelpful but may also work against you. The more tests you order the more you put yourself at risk for lab error. This isn't just anecdote, this is fact. In fact, the odds of a false test result increase literally exponentially with the number of tests ordered.

So please, I implore my future colleagues to rely on their skills rather than some test. Be prudent and judicious in their use. Challenge yourself as a physician, think things through. And I beg my future patients, abandon the "more is better" attitude. Don't ask for unnecessary tests and work-ups. If a doctor says that you don't need them, don't feel abandoned. He/she is actually helping you more than you know.

*More on screening tests in the future

Mind Boggling Phenomena: He Wore An Itsy-Bitsy, Teeny-Weeny...

Ya, you know where the title is going.

Let's get real here folks. What possible reason could there be for a 60+ year old man to ever, EVER, EVER wear pink... bikini... underwear? Much less, to be walking around in that - AND ONLY THAT - for a good 5 minutes in the locker room of the gym?

Is there no more decency in the world? Is there no more shame? Is there NO LAW BANNING THIS BEHAVIOR?!

And don't even get me started on the ones who insist on standing naked in front of the mirror to comb their hair. *PUKE* Cover yourself up! Sheesh!

Medical Code: A Mission Statement

November 24, 2008

A Mission Statement

One of the first things you learn in medicine (or at least should learn in medicine) is that you cannot do things just because; you must have a VALID reason. Here I will preface all future posts under the "Medical Code" by laying out my intents and, more importantly, what I don't intend.

Medical care in the United States is, beyond a shadow of a doubt, still superior than most, if not all, of the rest of the world. We are blessed to have the resources available to constantly research, review, and improve our healthcare. As we all know there is no such thing as perfect...ever. Our healthcare system is no exception. There are aspects of the system that are bad, some that are inexcusable, and yet others that are intolerable.

My goal is to discuss issues in healthcare, both what's right and what's plaguing it, in the only way I know how: based on my experiences as a medical student, a patient, and an American.

My goal is NOT to point fingers, play the blame game, or accuse any one particular individual or institution of malfeasance or wrong-doing (barring extreme circumstances).

What I hope is that you'll come away from these posts with a new perspective. You may agree with me or you may not. Either way, I hope that I can solidify or modify your own beliefs on what is right or wrong for medicine.

As always, I encourage comments. Because if we're not talking about it, then nothing's being done about it.

Coming Soon...
- Laboratory Testing

Retrospective #2

September 29, 2006

Life, Whitecoat, and the Pursuit of a Car

Well folks, It's over! Our first exams have come and gone and I'm that much closer to my MD. No, I'm sorry, I don't know why your knee hurts and I can't tell you what kind of medication to take for your aching back! But I can tell all about the Brachial Plexus and the anastamoses of the arteries of the upper limb...

But that's for another time and place. Right now, I want to bring you up to speed on life here has been like lately.

I'm sure it's become clear to most of you that things have been really busy here. Classes run daily and require about 6 hrs of studying on a light day just to keep up. The first weeks were filled with a lot of activities for us First Semesters. Club barbecues, workshops, pledge meetings (more on this in a second), in between long stretches in the library make the days go by way too fast. It's now been a month that I've been living here, and it seems like yesterday that I was stepping off the plane.

The highlight of the second week was a ceremony called "White Coat." This is something of an initiation into medical school and the medical profession in general. Technically, it's supposed to be the first time that you wear the white labcoat as a student. Basically, Friday evening, we all gathered in one of the lecture halls, listened to speakers, then read our "Honor Code" (something about not cheating or whatever) then filed up to the stage, single file like good little kindergartners, and the professors put the white coats on us for the "first time" (forget the fact that we'd been wearing them around dead people for 2 weeks at that point). Afterwards they threw us a huge party at a club called "Bamboo Bernie's" (you can't make this stuff up) where, to the best of my recollection, the evening went swell! (insert smile with two thumbs up) Pictures are attached.

In the meantime, Hovig and I had been trying to get settled in as much as possible, which meant, acquiring a car. Now let me preface the next story like this. Opening a regular run of the mill bank savings account in this country requires a previous appointment, 2 forms of ID, including a U.S. Passport, proof of residence, acceptance letter from the university, your first born and a kidney... not to mention 2 hours to get everything set up.
Now I told you that story to tell you this one. During the car search we were able to get in touch with Junior (you can't make this stuff up) at the Nissan dealership, who called us a day later to inform us that he had a car for us to lease. We walked up to the dealership, he handed us the keys, we got in the car and drove off. Terms of the lease? EHH, we'll talk about that later.
So to recap...
Savings Account: 2 Hours, Passport, Kidney
Car Lease: 2 minutes, a smile, a thankful wave as you drive off...
You can't make this stuff up.

This is getting lengthy, so I'll try to answer all you questions bullet point style:

- Nope, still no hurricanes or tropical storms so keep lighting those candles in Church for us!
- STILL Humid. I've given up on doing anything with my hair. This is about as fro-ed out as I've ever been
- We now find ourselves saying things like "Nah, don't go to Simpson Bay for that, French side is much better!" and "Damn tourists need to get off the road."
- No, I don't study on the beach. Studying anatomy alone requires 3 books, a booklet of possible test questions, a lab guide, and my laptop with lecture notes. Sound like I can do that on the beach?
- The words "YAH-MON!" are rarely uttered here, although I did hear it the other day. Must have been Jamaican tourists.
- Yes, I'm rushing a medical fraternity. It's never too early to start networking or acting like a frat guy.

OK, I think that's everything for now.

If anyone can find a way to package In & Out and cheekoufteh and send it to me, I'd love you forever.

Love,

Nareg

Absence Makes The Heart Grow Fonder

Dear Readership,

I recognize that there has been a serious delay in the posts on this outlet. For this, your humble observer accepts full responsibility and apologizes.

However, this time apart has given some great insight into the fact that there are those of you who actually read the blog. I always figured my site got more hits from me than anyone else, but apparently, I'm doing something right, because there have been numerous requests for new posts.

Recognizing that with this great power comes great responsibility, I have begun diligently working on some new material. Please be patient with me, as I refuse to inflict sub-par work on the readership. As such, I promise that the forth-coming works will be material of the highest quality.

Here are some ideas I've been throwing around for regular features:

1. Mind-Boggling Phenomena: Revisit events in the life of your humble observer that make him shake his head and question whether he is really alive and witnessing said event.

2. Just Putting It Out There: Bold statements from your humble observer about the state of the world (perhaps too bold to ever be retracted)

3. Medical Code: An in-depth analysis of the ins & outs of medicine, the state of healthcare, and the good, the bad, and the ugly as seen from the eyes of a medical student, your humble observer.

These will be, of course, in addition to my standard posting. Thank you again for your patience.

Running Everywhere At Such A Speed

I was surprised to find that The New York City Marathon route literally runs right next to my building on 4th Ave. Here are some pictures.

I've Been Had

"I've said the same thing to four different people today, and you're the first person to tell me, 'I understand', and I appreciate it. Because I don't like being talked down to, and I don't like being appeased. I like being understood."

These words from my patient's lips was greater than any of the pats on the head offered by any intern, resident, chief, or attending. It meant I was doing my job. I'm not talking about the 'job' of running around like a chicken with its head cut off, writing notes, getting Radiology to read films, or updating patient lists. I mean attending to people's needs and concerns. After all, what is a doctor if not someone who is concerned with your well-being, be it physical or emotional? I realize that for the most part, I don't do much to help them with their physical ailments. At the end of the day, however, when I've left my last patient's room, I feel confident that I've devoted the proper attention to them and done my best as their advocate.

So how do I shake this sheepish feeling of being 2 inches tall that came about when I realized a different patient was simply using me for their own selfish reasons. For reasons of confidentiality, I cannot divulge any particular information. Suffice it to say someone is abusing the system, and I fell for it hook, line, and sinker. When the amused nurse brought it to my attention, I felt more than stupid for having fought for this patient all day, and actually been quite annoyed at the apathetic response I received.

I knew these situations existed in medicine, and I had vowed that I wouldn't let them get me down. But when you've put all you've got into being there for a patient, it's hard to swallow the disappointment. So how does one walk away from the hospital, go home, sleep for 5 hours, and get up the next morning to do it all again?

You move on and treat all patients with the same compassion regardless of their intentions. Because that's what you're there for. As one of my classmates who once was in the military put it: "You live to fight another day." which to me means, there are worse tragedies in life, so shake it off and get yourself back in the fray.