Tag Archives: Ideas

The Hardest Day

Second year has started off with a bang. If you are paying attention, you’ll see some crazy stuff in any medical school. Whether it’s an official lesson, or people watching, or patient encounters, or something you learn on accident while researching something else, there will surely be something to learn. Recently we had a deep lesson that I wanted to share, but first I need to set the stage.

All of the MS2 students are packed into our lecture hall. This isn’t the nice, new lecture with comfortable chairs that we used last year. This is the older lecture hall that doesn’t have enough seats for the whole class, the one with the terrible chairs, and the one with not enough room for your laptop and anything else on the desk. There are students standing in the back, and everyone looks sharp because we all are wearing our white coats and professional clothes.

On stage are six people. Standing at the podium is a Pediatric Hematologist who is running the event. She has a very serene demeanor, but seems to radiate strength from her small stature. Sitting at the table on stage are 5 others. There is a couple in their 40’s. He is lean and tan, with the muscle tone and hands of a construction worker. She sits next to him, well dressed and confident, if somewhat anxious. Another lady sits next to them. She is African American, somewhat heavyset, with a joyful face, floral blouse, and somewhat excessive afro. Next to her is an elderly little lady with thin gray hair and a stooped posture, and she is in deep conversation with the woman beside her, who is wearing scrubs and has two phones and a pager.

This is a lecture panel on handling the death of patients, specifically children. The couple on the end lost twin boys, their 5th and 6th children. The first died before being born. The second lived for 10 months, but had a debilitating matrix of health problems and lacked any ability to develop. The lady next to them had a daughter who developed bone cancer at age 11, which metastasized to her brain and took her life when she was 13. The older was a chaplain, and the last lady was a NICU nurse. Everyone was there to talk to us about handling death.

Most learning in medical school is very clinical and sterile. We learn about our bodies from distinguished looking old professors who wear white coats and use technical language to describe anatomy and physiology of organs and diseases, of which they are experts. That approach is obviously not practical when talking about handling death, so we learned from “experts” in their own way, people who had gone through this and were willing to talk to us about their experience.

I don’t like thinking about death, and I don’t think many of my fellow students do either. We are all young and vigorous, filled with the energy and optimism of youth. In my mind, death is something far off. It’s not that I’m scared of it, I just prefer not to think about it. I have been very fortunate to have made it this far in my life with living parents and grandparents.

This forum was not the first time that I had focused my heart and mind on this idea of death, and current events will tell you why. On Saturday evening the violence in Ferguson, MO erupted after a young man was shot and killed by police. Even as I write this tensions remain high, with protests and heavy police presence keeping the conflict in the national spotlight. It was only a few days ago that the world was shocked to discover that Robin Williams had ended his own life. Violence in Iraq and the Middle East have created a summer that will go down in history as a violent, restless summer.

I don’t want to talk specifically about any of those subjects listed above, at least not in this post. Instead, I want to talk about dying. The way someone reacts to death will tell me a lot about the way they view the world.

Death is a part of life, just like birth. Everyone is born, and everyone will die. What we do in between is what makes the difference. Death is also a great equalizer. I learned this lesson at a young age helping my dad clean our boat after a day on the lake. He always said that the boat ramp was the great equalizer. At the end of the day, everyone comes back to the ramp and goes home after a fun day of boating. It doesn’t matter how big your boat was, how big the truck you used to tow it, or how many fun inflatable things you could pull behind your boat. At the end of the day everyone comes back to the ramp sunburned and tired, and everybody had fun.

So when we die, as we know we will, we are all equalized again. Your influence, your money, and your responsibilities are all lost and left behind. What happens to you after you die? What or where do you think you will be after you die? Some believe that death causes you to cease to exist, but I find that hard to accept and impossible to believe.

The hardest part of the last few weeks has been actually organizing my thoughts on this matter. It’s not easy to do, when my cell phone keeps ringing, emails keep arriving, and the world flies by on my laptop screen. It’s easy to ride the wave of now, caught up in an endless progression of thinking about what happens next. Thankfully, I found the time to take my dog to a local state park and hike. So it was there that I hiked miles from any road, on trails not commonly traveled, and sat down for a water break. The sun was high in the sky, coming through the trees to turn the world green. Except for my trampling feet, the world was perfectly still. So I sat there for a long while, and I’m glad I did, because that’s how I was finally able to write this.

Lastly, I wanted to leave with the words to a poem. It was written in the 1600’s, but people then died at the same rate as they do now, and the words speak to people today just like they did 400 years ago.

Death, be not proud, though some have called thee
Mighty and dreadful, for thou art not so;
For those whom thou think’st thou dost overthrow
Die not, poor Death, nor yet canst thou kill me.
From rest and sleep, which but thy pictures be,
Much pleasure; then from thee much more must flow,
And soonest our best men with thee do go,
Rest of their bones, and soul’s delivery.
Thou art slave to fate, chance, kings, and desperate men,
And dost with poison, war, and sickness dwell,
And poppy or charms can make us sleep as well
And better than thy stroke; why swell’st thou then?
One short sleep past, we wake eternally
And death shall be no more; Death, thou shalt die.
Thanks for reading!

How To Be My Favorite Teacher

I wrote this post several years ago for a different blog. In talking to some friends tonight, I was inspired to dig it up, re-polish it, and publish it again. I still think the idea is great, and I hope to teach at some point in my future. I think this idea works, and it’s fun to talk about. So here we go. Gamification. 

Gamification is not a word I just invented. While it is a newer word (first coined in 2002), it is a real thing.

If you try to gamify something (ok…I may have made that one up), you apply gaming principles to something that is not a game in order to create a better experience, enhance participation, or make something more enjoyable for others.

You may be familiar with many of the modern applications of gamification. Achievement badges, leaderboards, challenges, and progress bars are all common examples. Many iPhone apps have these features to keep you playing (talking to you, Farmville). Every xBox game comes with a list of achievements to unlock, intended to encourage players to continue playing the game even after they have beaten it once or twice.

Turning chores into a game certainly makes them more entertaining. Why not teach classes in the same way? Please don’t tell me that college courses currently place an emphasis on attendance and participation. As a system, the college lecture format is dated and often amazingly inefficient (especially considering the price many students pay to attend college).

So here is my idea. I am going to pretend that I am a Chemistry professor, teaching a class called “Introduction to Chemistry” for incoming freshman science majors. I have 400 students in my class. The class teaches basic chemistry, and most of my students will continue to take harder chemistry classes later in their academic careers, so I can assume they are at least reasonably motivated to do well in this course

I will format my class somewhat traditionally:
5 Tests x 100 pts each
5 Quizzes x 10pts each
5 Pop Quizzes x 10pts each
5 HW Assignments x 40pts each
1 Final @ 200pts.

=1000 points total. In my experience as a science major, this is a fairly common syllabus. Here’s where I change it up. I will also distribute a “Game Card” to each student. I would probably create a point system called “moles” or something dorky like that. You could achieve up to 100 mole points in the semester, perhaps. Some you can get automatically, others would require direct effort. At the end of the semester, your mole points are converted to extra credit points. For the math wizards, that’s 10% extra credit available for free. A whole letter grade.

How do you get mole points? Stuff like this..

Attend Office Hours and Ask Questions- 5 Mole Points
Most students will never attend office hours and ask for help, but will instead futilely struggle, search the internet, and ask friends. I’m no expert, but I bet that getting individual help from a professor will improve classroom performance.

Achieve 90% or Greater on an Exam- 10 Mole Points
This rewards students who perform well. It offers a clear motivation to excel on exams. You could argue that students who receive this achievement don’t need it, as they are already smarter than the average bear. I argue that a C student could conceivably study hard, get a 90%, and would deserve a 10pt bonus for his effort. Also, see next achievement.

Improve Your Test Score by 10% or More -10 Mole Points
This one is not for the smart kids. If you scored a 94% on my first exam, you got the previous achievement and don’t really have hope for this one. For the C student above, who maybe got a 75% on the first exam, this doubles the incentive to buckle down and perform better on the next test.

Other incentives could include activities like writing a short report on a current research topic that you find interesting, exposing the student to some practical applications of their studies while forcing them to take some initiative and break new ground. Scheduling an appointment with a tutoring service (if the school supports one-mine does) during the week before a test will help their test score and increase retention. Other “achievements” would reward class attendance, for example, or perhaps encourage participation. I thought about including one that would reward students for finding an error that I would purposefully include on the slides each week, so that they are encouraged to ask questions and think critically about what I write instead of blindly memorizing it.

The weather is awful, can't go to class The weather is beautiful, can't waste it in class  Lazy College Senior

There is a valid argument against my little game I created. Students would need to have a level of motivation and achievement to do more than just immediately lose the “game board” I gave them on my first day of class. Also, the teachers likely to implement this game would be good teachers already. They would teach dynamically, interact with students, and have their own ways to implement all of the same things I am attempting to do with my game. 

I think that’s fantastic. Maybe they use part of my games, maybe they use their own system. Whatever. I think that a system like this (or similar to it) would improve the classroom experience for teachers and students alike.

Facets of gamification are already working. The Khan Academy incorporates these ideas into their online lessons. At the end of the day, doing your chemistry homework will never be as fun as playing real games, pursuing hobbies, or spending time with friends. If these ideas will give people extra motivation, and if that extra motivation translates to academic success, then I think they are worth pursuing. It may not be incredibly fun, but there are much worse games to play.

P.S. I first published this in 2011, so the Hunger Games reference was less dated. Also, I think I am a better writer now, but I’ll let you decide.

4 Kinds of People Who Must Love/Hate the Internet

We all live in a new age. Since the Internet has connected all of us in ways previously thought impossible, our very culture has changed in so many ways. Some companies have profited greatly from the rise new technology (Google), while others have been ruined (Blockbuster). Some people, however, have a mixed bag. These people include

1. Photographers

Despite my own complete artistic ignorance, I am aware of the fact that there is a group of highly skilled artists who take pictures. They understand concepts like lighting, focus, mood, color, and other artsy words to create pictures that are dramatic and inspiring. I think about guys like Robert Capa, who covered five wars. He was quoted as saying “If your pictures aren’t good enough, you aren’t close enough”. To put that in perspective, this is the same man who covered relatively dangerous situations like…oh, D-Day.

Doesn’t get much closer than this.

These kinds of people still exist today, I am sure of it. The problem is that they are completely overwhelmed by millions of teenagers with Instagram. Having an iPhone and access to the internet virtually guarantees pictures with sepia filters will be posted #nofilter to Facebook at some point in time.

The upside to being a photographer nowadays is also the internet. Building a portfolio, maintaining a website, and social networking give easy access to potential employers and give an aspiring photographer more exposure than was possible years ago. It’s also possible to edit all of your pictures with photo shop, but that’s an entirely different story. In college I had a roommate who was a photographer. He would shoot weddings and senior pictures, and actually rented out a studio in his hometown (which was ~2 hours away). He was very talented, and would upload his pictures directly to an iPad so his clients could see them immediately after he took them. Keep in mind he was about 20 at this point. He made thousands of dollars in cash every weekend (which he unwisely decided to keep in his desk drawer for a long time), and he now works for ESPN, shooting college sports and parts of their annual swimsuit edition. He relied absolutely on the internet and 4 different computers to keep all of his projects straight, but he was very successful.

2. Cable Companies

Cable companies want you to buy their big cable packages. That’s where they make their money, and it’s also why I get ads in the mail every week to upgrade to cable and phone. It is becoming increasingly common for people (like me) to skip out on the cable part and just pay for monthly internet. Cable costs about triple the price, and I know we won’t watch it, so we don’t pay for it. From their perspective, they just lost a significant part of their “income” from me, their customer, while still having to maintain the infrastructure necessary for me to have that service. Netflix, YouTube, and medical school suck up huge amounts of data, and the race is on to keep up with society’s insatiable need for bandwidth (upgrading to fiber optic cables, for example). This is expensive for them, but it might also save them in the future as more people ditch the traditional cable packages but remain customers for the internet access.

3. Actors

Admittedly, celebrities have always had many people paying close attention to them. In fact, there are other people paid to follow them around and report on what they are doing, which is ridiculous, but whatever. This applies mostly to people who are already rich and famous, so it isn’t the worst thing that could happen, but it must certainly be annoying. They used to run the constant risk of having unattractive pictures taken and then finding those pictures on magazine and newspaper covers everywhere.

Now things are much worse. Paparazzi still follow celebrities around, like those little fish that attach themselves to sharks, but now they can post things to the internet. Once things hit the web, they will never ever go away, just like when you eat a single piece of pizza for lunch and you can still taste it two days later. Instead of having yourself on a magazine cover at the grocery store checkout for a week or two, you now have thousands of copies of that picture or news story circulating on the internet. Forever. Awesome. Paparazzi are also assisted by people who attempt to hack cell phones, Facebook accounts, and laptops to produce scandals and generate publicity for themselves, and they do it for free.

Most celebrities are also benefiting from their ability to use the internet to generate positive publicity. They can maintain an online presence and still generate attention, even if they aren’t in any upcoming movies or TV shows. I follow a few celebrities on Twitter just because they are funny (I have absolutely no idea if they are in any recent movies).

4. Musicians

Becoming a professional musician that makes a gazillion dollars is a lot like becoming a professional athlete. At one point, most boys in this country played baseball. Only a fraction of a percent of them ever sign an MLB contract. Tons of kids learn to play the piano, guitar, or drums. Very few of them ever play for Maroon 5 and make tons of money. Becoming a successful musician isn’t always about talent. Certain Disney stars have turned into “musicians” and continue to make money and sell songs despite their (sometimes) questionable musical ability.

I would hate to be a professional musician. It’s one of those fields where, no matter how good you are, there is always someone better than you. Nowadays, thanks to the internet, those people can be anywhere on Earth. Even when popular mainstream bands create good songs, it won’t be long before some talented teenagers with good equipment make a cover that is better than the original song.

One more thing. Remember when we bought actual CDs? From music stores? From the perspective of the band, that’s actually a good thing. How many times did you really like 4 (or less) of the songs on the CD, but you ended up buying the whole CD for those 4 songs? That created a good margin for groups, who got a whole CD of sales, even if they only had a single good song. Now nobody buys CDs. Instead, we buy music on iTunes, if we buy it at all. I haven’t bought music in years, I just listen to Pandora, YouTube, and the radio and I’m fine. Even if there was a song I absolutely had to buy, I’d get it on iTunes for $1.29. That doesn’t work out nearly as well for the band, since I am no longer paying $12 for the CD.

I could add to this list, and you probably could too. Authors lose money from illegally downloaded PDF copies of their hard work, but the Fifty Shades of Grey series started out as a PDF and that lady made a gazillion dollars. Many doctors who lecture at medical school complain about patients who are convinced they have cancer (thanks, WebMD), but huge advances in electronic health records have changed the way we do medicine. I’m convinced that an internet outage at my medical school would cause some students to have serious anxiety attacks. I am on the internet for hours and hours every single day, and many of my hobbies (like writing this blog) rely on the internet. I love it, but I hate it.

Thanks for reading! Thanks to a recent guest post featured on Student Doctor Network, I have had a huge influx of new readers from more than 15 countries, which is awesome. Thanks for the emails and comments, it’s been a lot of fun.

sortadrwordpress@gmail.com

Standardize Me

I didn’t post at all last weekend, even though I really wanted to do so. There are a few good reasons why. Besides unsuccessfully fighting off a cold and studying for three exams this week, I am also incredibly lazy and didn’t have the time or motivation to sit down and write the post that has been on my mind for several weeks. It’s only fitting that I find this motivation shortly before my pathology final, most likely using a blog post as another reason to avoid studying  for this test. As one classmate posted on Facebook so accurately: “I find that I Netflix better with study going on in the background”.

I don’t even have to study all that hard for this exam. Because of our grading system (pass/fail) and the assignments and tests I have already completed give me all but six points I need to pass the class. To put in another way, I need to get just 6/100 questions correct to pass this class. I could do that in my sleep. Don’t worry, I will study hard and do fine. (Edit: I actually did pretty well on it).

Our Pathology overlords are doing us a bit of a favor, they tell us. All of their exam questions are “board style”, similar to the format we can expect when we take Step 1 next year. This means that we take the exams on our computers through secure browsers, and that some of the multiple choice questions have options a-h instead of a-e.

Our questions are slightly harder than this, by the way.

Another way we are being prepared for Step 1 is that we are doing everything way faster than previous classes have ever done anything. As I write this in the first week of March, we have already completed all of the Year 1 curriculum. Next week we will begin Year 2 curriculum. The benefits to us include more time to study for Step 1, and more time in rotations before having to make important residency decisions. This all seems like a good idea to me, but we are the guinea pigs in this little experiment, so only time (and our board scores) will tell how it worked out.

This got me thinking about all of the standardization we are receiving. The main goal of the first two years of medical education is to perform well on Step 1. My understanding is that this test makes sure new medical students have an appropriate amount of basic medical knowledge before entering the wards and practicing on real patients. This actually works out very well for me, as I have a long history of crushing standardized tests (including NBME pathology most recently).

Recently my brother-in-law graduated from the police academy. Police officers have a very important and challenging job not unlike a doctor. They have a huge body of knowledge to learn, including the geography of their city, procedures of their department, legality issues, physical ability to drive, arrest, restrain, and I know many cops that have a highly developed “sixth sense” that gets them out of dangerous situations. Even my limited EMS experience has shown me the value of this sixth sense, but I doubt it could be taught.

Now if the police academy worked like medical school, they would spend 2 years in a classroom watching powerpoint presentations on street layouts, with the dangerous areas highlighted. They would take multiple choice exams on how to handle interactions with dangerous suspects, maybe watch videos on driving skills. Thankfully, my brother’s academy didn’t work like this at all. He rode with cops, listened to their advice, and saw firsthand dangerous areas of town. He went to an abandoned runway and spent an afternoon learning defensive driving techniques.

Medical school isn’t taught like that, and I’m not even sure it should be. All I know is that medical school has been taught the same way for a very long time, which is why it is so standardized. There is a well defined process to becoming a doctor, steeped in tradition and learning. If improving the quality of medical education came at the cost of leaving behind those traditions, would anyone attempt it? Will there be a series of huge sweeping changes in the coming years, or will innovation come in small steps, creeping along over the years?

I’ll have to think more about this, but it’s something that will be on my mind as I work my way through medical school.

This post is now very late, but thank you for reading!

 

Everything Wrong With College

It’s been another busy week of medical school for me. We are preparing for our comprehensive pharmacology exam, along with finishing up final exams in toxicology and microbes. There is plenty of studying to be doing, and I have also been busy working on a final presentation for my clinical elective. Yesterday, in fact, I spent my last day at the dermatology clinic. It just isn’t a Wednesday until I help the resident freeze genital warts. Too much info? That’s medical school for you 🙂 Thankfully, I gave an “superb” presentation (on a subject that isn’t even a tiny bit interesting, so I’ll leave that part out) so it’s safe to assume I earned at least a letter of recommendation from her. Sweet. I take the time tonight to write about education, specifically college, so that I can piece together a short narrative describing not only the problems with college education today, but also what it means to Americans as a whole.

Like most twenty somethings, I grew up with a pretty clear picture of what success in life looked like. It came from teachers, parents, school counselors, and other adults, but the message was the same: successful people went to college, got a degree, and then earned more money and were happier because they did. The not-so-subtle indication was that I, too, should go to college if I wanted to be happy in life. Smart people went to college, I was told, or at least college made people smart. I don’t know when this idea was perpetuated on Americans, but I suspect it was around my parents generation. My dad didn’t go to college, although the pressure to get a degree certainly existed when he graduated high school.

I played the game very successfully. After graduating top of my high school class, I took a full ride scholarship to a good state school. According to the “rules” I was taught when I was younger, I had won the game. I was virtually guaranteed four years of education and a degree of my choice (with no debt upon graduation). Of course, I started college in 2009. This was not a good time for the economy, and college graduates suffered for it. I spent my college years reading news stories about how hard it was for grads to find a job, and feeling secretly glad that I had a few years for the economy to turn around before I graduated. Despite this, my university set enrollment records for all eight semesters I attended. Of course, now I am in medical school and have nearly a decade of school still ahead of me, so take that with a grain of salt.

So now I wonder why people still rush to take out loans and attend school for degrees they may never use. I watched many friends amass huge debts and drop out after 3 years. I saw people waste huge amounts of time, money, and energy, and now they have nothing to show for it. I saw friends take a semester off and 4 years later wish they had stuck with it. So here are some of the things I wish people would really know about college.

1) Colleges Are Businesses

dollar for dollar

We are coming up on the time of year when high school seniors everywhere begin posting acceptance letters on Facebook, listing the college/university they plan to attend. That’s great for them, but it perpetuates a myth that sucks people in every year: that colleges are somehow exclusive. To put it another way, University of _______ actually wants you to attend their school. There are a small handful of uber elite schools that are competitive to gain admittance (MIT, Harvard, etc). The other 99% of schools want you to attend because they need your tuition to make money. It doesn’t stop there, either. They need your fees, parking passes, textbook purchases, and other expenses as well. I’m not saying that these schools aren’t trying to give you a stellar education. Just know that they want to give you a great education and also make money. But mostly the money.

2) College Is Not About You

This will be shocking to anyone who has seen any marketing materials for any school anywhere, been to college, or even heard anything about college, but I think it’s crazy that it goes unrecognized. Think about any university advertisement, and it’s usually some combination of the following ideas:

“Follow YOUR passion, pursue YOUR dreams”

“Create YOUR OWN major”

“Classes that fit YOUR schedule”

This was the third result after Googling “University Brochures”.

It’s like the whole school is expressly designed to help you along in life. False. The school wants you to pay money to them, or at least do something awesome later so they can get the publicity. Of course they’ll let you take a semester off. Of course they’ll let you do your degree in six years instead of four. Of course they offer online classes. They are a business and they’ll do what it takes to earn your tuition dollars.

If the version of success I learned in school is to be believed, your degree should show that you are qualified, diligent, hardworking, ambitious, or some mixture of those. If your degree is four years long and you are going to “normal” college (not night school or a non-trad), get it done in four years. Chances are that a marketing degree is not your passion, so don’t pretend like it is. Work hard, get your degree, and spend your extra time pursuing your other hobbies and interests. Those are also qualities that define your character, and while they may not be on your CV they will certainly impact your chances at landing your job/achieving your goals after school. This leads me to…

3)  College Can Be a Huge Waste of Time

College is not hard. You may hate me for saying that, but I’m telling the truth here. My degree was in Molecular Biology and a little bit of Chemistry, and I know that my four years of college were significantly more difficult than any of my peers. How do I know that? Well, I lived with them, and I know I spent way more time in class and studying than they did. So how hard did I work during school? Not that hard. Each semester I attended class for 20 hours a week and studied about 10 hours, sometimes 15 hours. That adds up to less than a normal work week. Also take into account that I lived on campus, so I had no commute. I also ate dorm food from a cafeteria that was 30 seconds from my room. We also went to school for 32 weeks of the year. I spent lots of time exercising, playing video games, and doing lots of whatever I wanted. It was great.

Fact is, college classes should not keep you busy. My class schedule was about as bad as undergraduate schedules can get, and I still managed to work all eight semesters, get married, earn my EMT certification, and complete an Ironman triathlon. My most memorable moments from college have nothing to do with school.

In this sense, I think college is actually bad for many young adults. As a country and a society, we are taking our most energetic young people and forcing them into a 4-year holding pattern. The 18-24 age group is full of young, talented, motivated, technologically competent, people who are the future of our nation. We are bright enough to have terrific ideas, and naive enough to not know when something can’t be done. But we have to attend classes for just long enough each week to not actually get a real job, but not enough class that it’s truly “full time”. Those classes can range from being interesting (wine tasting) to being totally useless (most of my humanities courses), and after 4 (or more) years of sitting through classes, they will finally graduate into the real world, often with crippling debt.

This is the hardest part for me. I am (or at least I was) a perfect candidate for college. I’m naturally curious, enjoy learning, and am prone to obsessively mastering new hobbies and subjects. Yet after four years I had only one or two good professors who actually made the class worth attending, and honestly I was a little burned out. I have thought long and hard about what I could have done with those four years if I could have them back.

4) You won’t learn much during college

This might seem like a continuation of my last point, but it’s not. College classes are still largely taught in a lecture format, often in huge lecture halls. One of the few things I remember from Abnormal Psychology was that students typically remember only 5% of the material presented in lecture format (10% if multimedia graphics are used). This is a bad situation, even if you assume that the professor is awesome and the students care. Small wonder that employers are struggling to find qualified applicants among graduates that they interview. What happened? I thought that undergrad degree was the key to landing a good job? Now that everyone seems to get a degree, I guess not.

College has become like bonus high school. More and more people seem to be going to college, and it hasn’t been working out like we thought it would. Maybe this trend will reverse itself in the next few decades. I will certainly think long and hard before I help my future son finance a $80k degree. I get that college will always be required for some professions (hello medicine, law, etc), and that makes sense (sort of, I will someday write about that too).

It’s not that I’m too good for college, or that our generation is too good for college. It’s just that college isn’t good enough for what it costs. It’s not just the huge debt, it’s the years and time being lost as well.

If a college degree is the vehicle for success, it’s a taxi. It works great for getting you directly from one place to another, but if you just jump in and ride around for four years you’ll be broke and lost.

I need to stop writing now, and this seems like a good place to do it.

Thanks for reading!

As always, feel free to comment below or directly to my face at sortadrwordpress@gmail.com

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Let’s Talk About Drugs

Maybe the timing is coincidental. Maybe studying pharmacology so much lately is making me more attuned to notice stories and posts regarding drugs and disease. Or maybe there has legitimately been a lot of really terrible Facebook posts, links, and comments lately (at least on my Facebook page). When someone on Facebook posts a story and claims “this is why I will never get my kids vaccinated!” I sometimes die a little inside. I would love to dissect their claim, present some objective evidence, and state my own claim in a reasonable manner, but we all know how that goes. Instead, I have turned to my blog, where I will be presenting some of the more common statements I’ve seen and the reasons why they are ridiculous. We’ll start with….

1. Doctors overprescribe drugs. They need to stop throwing pills at problems. They put my friend on too many drugs and he developed all of these side effects. Etc.

As seen in:

Image

Yeah…I’m pretty good at MS Paint

:

First things first: it is very possible to be taking too many drugs. We had an entire lecture on this last week. It’s fine to be on a handful of drugs, but if you have a patient routinely take 10+ pills per day you are going to run into problems with side effects, compliance, and drug interactions. So why is it that patients accumulate so many medications? Why do doctors consistently prescribe drugs for patient complaints?

Probably because that’s what they are trained to do. And because it works. I am not attending medical school to learn how NOT to prescribe drugs. I’m learning how to harness the incredible therapeutic potential available to me and every modern physician. There are so many drugs that work so well at fixing common problems I would be remiss as a physician if I didn’t prescribe.

Example: If a 48 year old man comes into my practice for a check up, and I notice he has high blood pressure, I have two options. I can tell him he needs to eat healthier, exercise, and drink less alcohol. Over time, this would make him healthier and lower his blood pressure. Of course, very few patients will actually do this. He is most likely to walk back into my clinic a year later and tell me that he was busy at work, tried walking but hurt his foot, and otherwise didn’t get any healthier. And he was exposed to an extra year of uncontrolled high blood pressure, increasing his risk for serious problems later on in life.

I could also give him a prescription for Lisinopril. He could take a pill every morning, his blood pressure will go down, whether or not he improves his lifestyle, and I improved his chances of living a longer, healthier, happier life.

The trap of this example is when a patient comes in with an upset stomach, so I give a script for that. They take it and their stomach is better but they feel dizzy and sick, so I give another script for that. That’s usually when people start experiencing really bad symptoms from taking too many drugs. Do people think that the doctors were intentionally trying to hurt people with these medications? There’s nothing nefarious here. The intention was always to treat.

2. If I vaccinate my kids they will get autism. It’s unnatural. I don’t want to expose them to those terrible things. It’ll do them more harm than good.

As seen in:

This has come up a few times lately, especially after we watched Jenna Mccarthy on the Rockin New Years Eve a few weeks ago. I’d like to start by saying that if you are taking healthcare advice from a Playboy model, please re-evaluate your life and see an actual physician immediately. Vaccinations do not cause autism. I’ve looked at the evidence for it, and its pretty slim. For the rest of this article, however, I’ll assume it could (I’m feeling generous). People who don’t vaccinate their children are susceptible to two fallacies. First, that by avoiding vaccination they are somehow protecting their kids from exposure to the pathogens that cause disease. Second, that vaccination is primarily intended to protect their child specifically.

Ever heard of a kid with polio? Rotavirus? Smallpox? Probably not in recent memory. How about whooping cough? Few Americans (or none, in some of those cases) ever develop these diseases. The reason isn’t that the disease doesn’t exist anymore, but instead that vaccination has prevented the pathogen from causing disease. Viruses and bacteria are everywhere. Always watching. Always waiting. Just kidding, but there are way more of them than us, and our immune system clears them very efficiently ever day. If you don’t vaccinate a child against a disease, that doesn’t guarantee that they will never see that pathogen. It just handicaps their immune system if they should ever come across it.

Second, vaccinations aren’t exclusively intended for your child specifically. The key here is a concept called herd immunity. If you prefer to think of the human race as something different than a herd, call it population immunity. When the herd is vaccinated (say 95%) against a disease, only 5 out of 100 members will be susceptible to developing a disease. Should one of them acquire the disease, their chance of spreading it is low, because only 4 of the remaining 99 members can acquire it. If the herd is unvaccinated against that disease, however, one member acquiring it will cause a rapid spread through the herd. There will be a few members who are naturally resistant (there is always a small percentage of people with natural resistance to some disease), but the rest of the herd will be devastated. Getting your child vaccinated is less about their protection than it is for the rest of your kids class. Some vaccines don’t matter for kids, but for adults. Children don’t develop symptoms when infected with Hep A, but they can spread it to adults, where it causes serious illness.

This is what comes to mind when I think of “herd immunity”

3. I’m so worried that I have the swine/avian/llama flu! Everyone is going to die!

Actually probably so. If there is a total disaster to worry about, it would be a mutated influenza virus. We all remember the H1N1 outbreak a few years ago, and ever more recently new mutations like last years H7N9 virus caused concern. Should a strain of influenza develop easy transmission between humans as well as the ability to easily cause disease or death, it will be scary. Influenza changes and evolves quickly enough already, which is why there is a new flu shot every year. Millions of people died in 1918 during an influenza outbreak, where massive global troop and refugee movements allowed it to ravage the world. Despite the present lack of a world war, we have a constant state of travel and mobility, both internationally and regionally. Scary scary.

4. Have you heard about all of these new resistant bacteria? MRSA, VRE, CRE? It’s going to be the end of medicine!

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Surely you have heard of these new “super bacteria”. Are they scary as well? Yup. Are they the end of modern medicine? Nope. That link above was shared by a friend but written by a lawyer. Antibiotic resistance is certainly a problem, but it’s one that we will solve. I have had antibiotic resistance pounded into my head for the last six weeks. When to use antibiotics, when to hold them, how to identify resistant strains, combination drug therapies, etc etc. I can remember a high school teacher from years ago talking about MRSA, how terrible it was, and how that would be the end of modern medicine. Multiple resistant bacteria have developed since then, nastier than MRSA, even. Why am I not worried as much about CRE? First, because its nosocomial (acquired while in a hospital). These super bugs don’t exist everywhere around the world. They usually only infect people with extended hospital stays and invasive therapies (like catheters). Second, they will be beaten as well. People far smarter than me are always working on drugs to combat these resistant strains that develop. A resistant infection is never a good thing, but in order to find yourself developing one of these you would probably already have had something pretty serious going on.

What do you think? Let me know in the comments below or at sortadrwordpress@gmail.com

Thanks for reading

So You Still Have a Blog?

Do you have a Facebook? Of course you do. How about a blog? Even if you don’t have a blog, you are reading one right now, so I guess you’re familiar with the concept. How often do you see people post links to other blogs on your Facebook? I’m guessing it happens quite often. Here’s an example of the type of post I see often:

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That’s from a blog written by James Michael Sama. I don’t know all that much about him, except that his posts appear on my Facebook about twice a week. Even a quick look at his blog shows that he has slightly less than ten million hits on his blog. I can also tell by his archives that he started blogging in June 2013. Take a look at my archives over to the right. When did I start blogging? June 2013. How many views do I have on my blog? Not ten million. Not even close!

I suppose I need to give him the credit for that. He has been in feature films and mainstream media far more than I have (which is never, by the way). He also posts far more frequently than I do, and often on topics that are easily readable. Let’s face it, more people want to read about dating, relationships, and current events than they want to read about science, medicine, religion, or whatever else I’m thinking about. His posts are also well written and creative. So I’m not trying to compare authors or blogs here, I’m just telling you about this guy to set up a point I want to make about blogging.

The strangest thing about blogging is how lopsided our interactions are. I get to write things, post them on the internet, and let them stand for all time and eternity. I covered that briefly here. To write a blog, one must believe at a certain level that “I can write something that others will want to read”. This is the opposite of Twitter, where people just assume that everyone wants to hear about what they had for lunch. To write a blog, you have to be able to string together a line of reasoning, assembling your thoughts and shaping it into a post that is interesting enough that people want to click on it and read it. The best (and worst) part of blogging is that anyone can do it.

I have this theory that 42% of all blogs have one post called “I have a blog”. Because starting a blog requires an internet connection and two thumbs, nearly anyone can jump online and make a blog. Historically, this is unprecedented. I can sit in my office and write a post in about an hour. Let’s say a few people put it on their Facebook pages, and it goes viral. Suddenly hundreds of thousands of people have read my post and I get tons of traffic. 100 years ago, there was no way to reach hundreds of thousands of people that easily. Radio, perhaps, but that was harder to access. Newspapers, maybe, but only certain groups of people could actually write in a paper. Anyone can write a blog, and who knows if that post is the next one to go viral?

The downside to the accessibility of blogging, of course, is that anyone can do it. I’ve read some blogs and wondered whether they had ever graduated high school, or even attended one. I followed a blogger for a while who posted once every three weeks, and his/her only content was “I’m sorry I haven’t been posting lately….I’ve been like super busy”.

Blogging is great, especially when authors like Sama go out and reach a huge audience, but I don’t see it lasting. I understand that my little post here is just one tab on your browser, and I have to compete with everything on the internet for your attention. Blog posts take time to read, and require much more effort from you than, say, a YouTube video. It can be difficult to find your way to a blog you really enjoy consistently, while YouTube gives you a recommended playlist based off your preferences, so after you watch a cat video there are 12 more cat videos to watch. My favorite blogs have been those that people referred to me. When I search for blogs, on Google I have much worse success.

I’m not upset that I don’t have ten million views on this blog, since that was never my goal. My goal is to write, and enjoy writing, and talk about what I learn and see during medical school and life. That’s not a good recipe for generating ten million views in six months (unless somehow I was already famous). At the same time, I like it when people enjoy what I write. That’s the whole point of blogging, right? If no one reads your blog, that’s just a diary. While I enjoy Sama, Matt Walsh, and Fat Cyclist, I know that I will never be that kind of blogger. Why? Probably due to my sporadic writing schedule and “no proofreading ever” policy, among other things (like medical school, for instance). If I wanted a million views in the next six months, I am confident I could get them. I just know I wouldn’t have as much fun as I am now, and I’m having lots of fun 🙂

Thanks for reading!

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