It's been awhile, I know.
Since I last wrote, I've had problems with my web address medschoolcaribstyle.com. For whatever reason I couldn't renew my domain name and when I tried registering it on a third party site, the domain name is still locked. I emailed google a while back and received no response so I've pretty much given up. There was a time when i was averaging 400-500 pageviews a day and now I'm lucky to get 100 people, but ya know what? It's kind of refreshing. I feel like I can say whatever I like again and not worry if I'm crossing any lines or breaking any rules.
I've done Cardiology, OB/GYN, and GI since I last blogged. I'll get my thoughts out some point this month since I have a nice little vacation till Dec 30th.
Happy Thanksgiving, folks.
Best,
Andrea
Wednesday, November 27, 2013
Wednesday, September 11, 2013
Something Different
Is it coincidence I signed up for the Boston Marathon on this fateful day?
I want to run on behalf of Dana Farber Cancer Institute. For those of you who are unfamiliar, it's arguably the greatest cancer research and treatment facility in the country and every year for the Boston marathon, several hundred volunteers agree to raise money for the organization in exchange for a number on their chest. That's right, I'm agreeing to raise at least $4000 for cancer research so I can officially run 26.2 miles.
After learning what happened in last April's Boston Marathon, I first felt disbelief, then sadness and finally anger and defiance. There was no way in my mind that I would miss next year's race, whether it was me running it, or simply standing on the sidelines screaming my lungs out, all I knew was I would be there.
For awhile I wanted to write a post trying to even remotely describe what that day is like. Patriot's day. Marathon Monday. And I realized I'm not a good enough writer to do so and nothing I said would capture the spirit of the day; the purity of the day. It's a holiday only observed by the city of Boston. Almost everyone is off from school and work and it's a MONDAY. You have families lining the course from the rolling hills of Hopkinton to the towering buildings of Copley Square, the attention starved Wellesley girls kissing the runners as they run through the tunnel, the intoxicated and boisterous BC students doing everything they can to get the runners up that last heartbreaking hill, and then the last 5 miles running into the city of Boston encountering the tens of thousands of fans spilling out from the 11 a.m. Sox game. There's a reason why it's considered the "mother of all marathons" and it's from the immense outpouring of love and support from the people and city of Boston. They truly roll out the red carpet for all who come to run this historic route and so so soooo many people running it, run it for something other than themselves. It's a day that celebrates the goodness, charity, and strength of the human spirit. It's Boston's greatest day and for those who have lived there, been there, run it, seen it, you know what I'm talking about. For those of you who've never gone, that's something for the bucket list. Go at least once in your life.
That's why when the bombs went off on that day of all days, it was just so disgusting to me.
For awhile I wanted to write a post trying to even remotely describe what that day is like. Patriot's day. Marathon Monday. And I realized I'm not a good enough writer to do so and nothing I said would capture the spirit of the day; the purity of the day. It's a holiday only observed by the city of Boston. Almost everyone is off from school and work and it's a MONDAY. You have families lining the course from the rolling hills of Hopkinton to the towering buildings of Copley Square, the attention starved Wellesley girls kissing the runners as they run through the tunnel, the intoxicated and boisterous BC students doing everything they can to get the runners up that last heartbreaking hill, and then the last 5 miles running into the city of Boston encountering the tens of thousands of fans spilling out from the 11 a.m. Sox game. There's a reason why it's considered the "mother of all marathons" and it's from the immense outpouring of love and support from the people and city of Boston. They truly roll out the red carpet for all who come to run this historic route and so so soooo many people running it, run it for something other than themselves. It's a day that celebrates the goodness, charity, and strength of the human spirit. It's Boston's greatest day and for those who have lived there, been there, run it, seen it, you know what I'm talking about. For those of you who've never gone, that's something for the bucket list. Go at least once in your life.
That's why when the bombs went off on that day of all days, it was just so disgusting to me.
It wasn't until about two months ago when I decided to go the insane route and run it. For those who know me well, they know I run a good deal. I probably average 30-40 miles a week, running 8 miles at a time so what's another 14? And when I run it, I really do want to run it for Dana Farber because of their Partner Program. You are matched up with a child treated in Dana Farber's Jimmy Fund Clinic and over the course of the year you meet up together for planned events, dinners, sporting events and there's nothing I'd love more than running for a brave individual fighting everyday of their lives to beat cancer. Those are real heros. Really. I'm not running this one for myself. I want to run it for every brave child fighting everyday against cancer. I want to run it for every man and woman who runs TO an explosion with no thought for themselves. I want to run for the people of Boston. I want to run it for Welles Crowther (BC '99), the man in the red bandana, who went back up to the 78th floor in the South tower and sacrificed his own life to save 12 people. I want to run to prove that there is nothing any coward can do to change or break the American spirit. #FreedomFromFear #NeverForget9/11
I'll keep you guys posted as to whether or not Dana Farber accepts my application.
Monday, July 29, 2013
Family Medicine at Bronx-Lebanon
Green book elective
Woof.
I've been putting off this post for some time now. Family Medicine was my second rotation and I finished it back in May, but I'm just never that enthusiastic writing about subpar experiences. Not that the whole experience was bad, but finishing with inpatient didn't leave a happy lasting impression.
Here are the basics of Family at Bronx-Leb:
Six week long elective that's divided into 3 weeks of inpatient and 3 weeks outpatient.
I started off with outpatient and you are assigned to any of the 4-5 clinics that are part of the Bronx-Lebanon tree and I ended up at the Tiffany clinic. I'm sorry I can't speak of the other sites, I just know nothing about them. What's cool about Tiffany is that there's only room for one med student and you work side by side with the attending, who happens to be Dr. B, and who also happens to be my favorite attending of the last six months.
Let me paint you this little picture: I had just finished three months of internal medicine at Mount Vernon, which essentially means I know nothing apart from doing blood draws and ABGs. I gained ZERO confidence with my ability to communicate and examine patients, I had no clue how to write notes, freaked out with the idea of doing a physical, and didn't even know how to begin to diagnose somebody. Naturally when you tell your attending you've already done the three months of internal medicine, they ACTUALLY think you can do all these things already! Fancy that.
Imagine my horror with the very first patient we see together Dr. B orders me to do a physical. Ummm... what? I stood there in all my idiotic glory and said, "maybe you should do this first one so I can see how you like to do them." He just kind of smirked at me, clearly saw that I was a bundle of nerves and did the physical. When in doubt the three things all doctors do (as far as I can tell in my limited experience) during a physical regardless of field are: 1. listen to the heart 2. listen to the lungs, 3. palpate the abdomen. Turns out Dr. B also likes looking in everyones' ears and mouths. Fair enough.
After the patient left he asked me exactly how much did I learn in internal medicine. When he discovered it was next to nothing, he just said "fine, you are going to learn everything you should have learned right here these next three weeks". And that I did. Within one week at Tiffany, I was interviewing patients alone, doing physicals, EKGs, Strep tests, pregnancy tests, pap smears, vaginal cultures. I came in everyday around 8:45, started by 9 and kept going till 4. We would see around 20 patients a day from prenatal visits to adults. During the down times we just chatted about all sorts of things and he would teach as well. I discovered he was a pretty awesome guy and I couldn't have been luckier to end up with an attending as chill, patient, and friendly.
After leaving Tiffany the most valuable asset I gained was confidence. I didn't realize how nervous and borderline awkward I was with patients. I am not a socially awkward person by any means, but for some reason in the hospital/office setting, I was so nervous and jittery. Patients could sense it. And I felt that way because not only did I not know what I was doing, I had no experience. Everyone's gotta start somewhere and for me it started at Tiffany. In those three weeks, I became confident and comfortable with what I was doing, asking, saying, and that's something I've been able to bring to all my other rotations and for that I'm forever indebted to Dr. B.
As positive as my experience was in outpatient, it was that negative in inpatient.
Family Medicine is on the 16th floor of the main hospital. They divide the 15 or so students into two different schedules for inpatient. The lucky folks (those with a last name beginning with M-Z) get the three day schedule during the week. These people work Tuesday, Wednesday, Thursday from 7 am to 9 pm. The unlucky people work the same ridiculous nonsensical hours but on Friday, Saturday, Sunday, and Monday. That's right... 4 days AND they must work the weekend! And just to add insult to injury every Thursday at 4 p.m. are the family medicine ground rounds and everyone in both inpatient and outpatient must attend (they take attendance for godsakes! Yes, we are children) The people working the weekend shift, are forced to come in on their day-off to the Bronx just to attend this one hour, useless lecture. And it would be all well and good if we all just lived in the Bronx, but there are students living out in Brooklyn or Queens who literally spend hours everyday commuting to and from the hospital. It's just plain mean to ask these people to show up.
You'd think with my above rant, I was one of the unlucky SOBs (not shortness of breath) with the terrible schedule. Hahaha nope, not the case. But still, I feel for my other classmates. It's in no way fair.
What I didn't like about inpatient was that it was mostly scut work. I spent my mornings filling out billing sheets oddly enough. Exactly why am I responsible for how much the hospital is supposed to be making on these admissions? I would run blood or urine down to the lab. Sometimes I would spend 20 minutes on the phone making appointments. My resident was usually pretty self-sufficient, but I do remember this one instance where he was on hold on the phone and I was next to him typing a note. He got tired of waiting and just handed me the phone and asked if I could just let him know when a human came on....? Hm. I wanted to say,"why don't you just put it on speaker so neither of us have to waste our time holding the phone," but I didn't. I sat there, 6 inches from him waiting for a human voice. Finally when someone spoke I handed it back to him and said nothing.
Mornings went by fast enough on the 16th floor. Myself and one other AUC student shared one resident so we split the 10 patients our resident was responsible for. After doing the billing sheets, we would write down the vitals and all new test results that were in for our patients. Our resident would round on the patients before the real rounds with the attending just to see how everyone's doing. Sometimes he would even let us know he was doing it (sarcasm noted). This was another thing I was getting frustrated with, while my colleague and I were getting all the new blood work, imaging results, new admission information, our resident would see all the patients without telling us anything. We would finish getting our information, walk over to our wing only to find our resident in the last room, finishing up. Then he would tell us we could go ourselves to the rooms if we wanted. Maybe I'm thinking too much on behalf of the patient here but I can't find anything more tiresome than having a resident come in asking you questions, doing a physical, then two med students asking the same questions and doing the same physical, and then the attending plus chief resident plus all of us all over again to do the same thing AGAIN all in the space of two hours. By the second week we worked quick and just stalked our resident before he went rounding.
After that the attending would come in and then we would round with him. He'd ask us students for the vitals and other pertinent lab results. Then the pimping... oh boy this guy loved to pimp and be so incredibly mean about it. If you didn't know or if you made an educated guess, he would just look at you or shake his head with a look of such utter disbelief you would feel like the stupidest person on the planet. Fortunately, I heard about the antics beforehand, so I was prepared. I had the thick skin on and let everything roll off. I'm wrong roughly 50% of the time and when he would make comments I just didn't care. I would just continue talking, guessing, answering, as if nothing happened. And over time I came to discover that's what he wanted all along. Show no fear. Continue to be engaged and vocal. If you don't know, say you don't know. If you get something wrong, go look it up and never forget it. I did all these things and it paid off. If I got something wrong the first week, he would ask me the same question the following week and I would nail it.
If you happen to have the same attending as me, know these two things (Seriously... everything, since he asks EVERYONE repeatedly and if you get stuff right, he likes to go to the nitty gritty):
1. There are FOUR ways to diagnose diabetes mellitus.
- Random glucose over 200 mg/dL WITH SYMPTOMS
- Fasting glucose over 126 mg/dL on at least two different occasion
- BONUS: "fasting" is when you haven't had anything for 8 hours
- glucose tolerance test over 200 mg/dL
- BONUS: wait 2 hours after taking 75 grams of grams of glucose
- HbA1c over 6.5%
2. Criteria for DKA
- Dehydration
- Blood glucose over 250 mg/dL
- Urinary ketones 3+ or serum ketones positive
- Bicarb <18 nbsp="" p="">less than 18
<18 nbsp="" p="">- pH 7.3 and below
After rounds with the attending, we usually just wrote progress notes. We did about one or two a day. I guess this is the one skill I was happy to gain during this three week stint. Learning to write notes is always a good thing, practice is a good thing. After notes were done, afternoons were boring. The evenings were boring. The hours just slugged on. I hated it. If given the choice I would rather work the 5 day 9-4 schedule of outpatient.
I would take long lunch breaks around 1pm. I would try to seem busy till we had teaching at 4. Teaching was a nice change of pace in the middle of the day, so I never minded it. It was something to do, something to be engaged in. Once teaching ended at 5, we would wait around for new admissions. I think I did 3 admissions during my time there. You do a full blown interview and physical of the patient and write it all up on the computer. Problem was, however, admissions would come in around 6:30 (just about that time when people are preparing themselves to leave). Then you would get an admission and since the whole process takes at least an hour, you just end up staying a lot later than you anticipated. Well at least this is how it went for me.
Conclusions:
Outpatient awesome (Tiffany clinic in particular)
Inpatient made me want to die, but mostly because of the unreasonable hours.
I think I would have rather done family med elsewhere.
Woof.
I've been putting off this post for some time now. Family Medicine was my second rotation and I finished it back in May, but I'm just never that enthusiastic writing about subpar experiences. Not that the whole experience was bad, but finishing with inpatient didn't leave a happy lasting impression.
Here are the basics of Family at Bronx-Leb:
Six week long elective that's divided into 3 weeks of inpatient and 3 weeks outpatient.
I started off with outpatient and you are assigned to any of the 4-5 clinics that are part of the Bronx-Lebanon tree and I ended up at the Tiffany clinic. I'm sorry I can't speak of the other sites, I just know nothing about them. What's cool about Tiffany is that there's only room for one med student and you work side by side with the attending, who happens to be Dr. B, and who also happens to be my favorite attending of the last six months.
Let me paint you this little picture: I had just finished three months of internal medicine at Mount Vernon, which essentially means I know nothing apart from doing blood draws and ABGs. I gained ZERO confidence with my ability to communicate and examine patients, I had no clue how to write notes, freaked out with the idea of doing a physical, and didn't even know how to begin to diagnose somebody. Naturally when you tell your attending you've already done the three months of internal medicine, they ACTUALLY think you can do all these things already! Fancy that.
Imagine my horror with the very first patient we see together Dr. B orders me to do a physical. Ummm... what? I stood there in all my idiotic glory and said, "maybe you should do this first one so I can see how you like to do them." He just kind of smirked at me, clearly saw that I was a bundle of nerves and did the physical. When in doubt the three things all doctors do (as far as I can tell in my limited experience) during a physical regardless of field are: 1. listen to the heart 2. listen to the lungs, 3. palpate the abdomen. Turns out Dr. B also likes looking in everyones' ears and mouths. Fair enough.
After the patient left he asked me exactly how much did I learn in internal medicine. When he discovered it was next to nothing, he just said "fine, you are going to learn everything you should have learned right here these next three weeks". And that I did. Within one week at Tiffany, I was interviewing patients alone, doing physicals, EKGs, Strep tests, pregnancy tests, pap smears, vaginal cultures. I came in everyday around 8:45, started by 9 and kept going till 4. We would see around 20 patients a day from prenatal visits to adults. During the down times we just chatted about all sorts of things and he would teach as well. I discovered he was a pretty awesome guy and I couldn't have been luckier to end up with an attending as chill, patient, and friendly.
After leaving Tiffany the most valuable asset I gained was confidence. I didn't realize how nervous and borderline awkward I was with patients. I am not a socially awkward person by any means, but for some reason in the hospital/office setting, I was so nervous and jittery. Patients could sense it. And I felt that way because not only did I not know what I was doing, I had no experience. Everyone's gotta start somewhere and for me it started at Tiffany. In those three weeks, I became confident and comfortable with what I was doing, asking, saying, and that's something I've been able to bring to all my other rotations and for that I'm forever indebted to Dr. B.
As positive as my experience was in outpatient, it was that negative in inpatient.
Family Medicine is on the 16th floor of the main hospital. They divide the 15 or so students into two different schedules for inpatient. The lucky folks (those with a last name beginning with M-Z) get the three day schedule during the week. These people work Tuesday, Wednesday, Thursday from 7 am to 9 pm. The unlucky people work the same ridiculous nonsensical hours but on Friday, Saturday, Sunday, and Monday. That's right... 4 days AND they must work the weekend! And just to add insult to injury every Thursday at 4 p.m. are the family medicine ground rounds and everyone in both inpatient and outpatient must attend (they take attendance for godsakes! Yes, we are children) The people working the weekend shift, are forced to come in on their day-off to the Bronx just to attend this one hour, useless lecture. And it would be all well and good if we all just lived in the Bronx, but there are students living out in Brooklyn or Queens who literally spend hours everyday commuting to and from the hospital. It's just plain mean to ask these people to show up.
You'd think with my above rant, I was one of the unlucky SOBs (not shortness of breath) with the terrible schedule. Hahaha nope, not the case. But still, I feel for my other classmates. It's in no way fair.
What I didn't like about inpatient was that it was mostly scut work. I spent my mornings filling out billing sheets oddly enough. Exactly why am I responsible for how much the hospital is supposed to be making on these admissions? I would run blood or urine down to the lab. Sometimes I would spend 20 minutes on the phone making appointments. My resident was usually pretty self-sufficient, but I do remember this one instance where he was on hold on the phone and I was next to him typing a note. He got tired of waiting and just handed me the phone and asked if I could just let him know when a human came on....? Hm. I wanted to say,"why don't you just put it on speaker so neither of us have to waste our time holding the phone," but I didn't. I sat there, 6 inches from him waiting for a human voice. Finally when someone spoke I handed it back to him and said nothing.
Mornings went by fast enough on the 16th floor. Myself and one other AUC student shared one resident so we split the 10 patients our resident was responsible for. After doing the billing sheets, we would write down the vitals and all new test results that were in for our patients. Our resident would round on the patients before the real rounds with the attending just to see how everyone's doing. Sometimes he would even let us know he was doing it (sarcasm noted). This was another thing I was getting frustrated with, while my colleague and I were getting all the new blood work, imaging results, new admission information, our resident would see all the patients without telling us anything. We would finish getting our information, walk over to our wing only to find our resident in the last room, finishing up. Then he would tell us we could go ourselves to the rooms if we wanted. Maybe I'm thinking too much on behalf of the patient here but I can't find anything more tiresome than having a resident come in asking you questions, doing a physical, then two med students asking the same questions and doing the same physical, and then the attending plus chief resident plus all of us all over again to do the same thing AGAIN all in the space of two hours. By the second week we worked quick and just stalked our resident before he went rounding.
After that the attending would come in and then we would round with him. He'd ask us students for the vitals and other pertinent lab results. Then the pimping... oh boy this guy loved to pimp and be so incredibly mean about it. If you didn't know or if you made an educated guess, he would just look at you or shake his head with a look of such utter disbelief you would feel like the stupidest person on the planet. Fortunately, I heard about the antics beforehand, so I was prepared. I had the thick skin on and let everything roll off. I'm wrong roughly 50% of the time and when he would make comments I just didn't care. I would just continue talking, guessing, answering, as if nothing happened. And over time I came to discover that's what he wanted all along. Show no fear. Continue to be engaged and vocal. If you don't know, say you don't know. If you get something wrong, go look it up and never forget it. I did all these things and it paid off. If I got something wrong the first week, he would ask me the same question the following week and I would nail it.
If you happen to have the same attending as me, know these two things (Seriously... everything, since he asks EVERYONE repeatedly and if you get stuff right, he likes to go to the nitty gritty):
1. There are FOUR ways to diagnose diabetes mellitus.
- Random glucose over 200 mg/dL WITH SYMPTOMS
- Fasting glucose over 126 mg/dL on at least two different occasion
- BONUS: "fasting" is when you haven't had anything for 8 hours
- glucose tolerance test over 200 mg/dL
- BONUS: wait 2 hours after taking 75 grams of grams of glucose
- HbA1c over 6.5%
2. Criteria for DKA
- Dehydration
- Blood glucose over 250 mg/dL
- Urinary ketones 3+ or serum ketones positive
- Bicarb <18 nbsp="" p="">less than 18
<18 nbsp="" p="">- pH 7.3 and below
After rounds with the attending, we usually just wrote progress notes. We did about one or two a day. I guess this is the one skill I was happy to gain during this three week stint. Learning to write notes is always a good thing, practice is a good thing. After notes were done, afternoons were boring. The evenings were boring. The hours just slugged on. I hated it. If given the choice I would rather work the 5 day 9-4 schedule of outpatient.
I would take long lunch breaks around 1pm. I would try to seem busy till we had teaching at 4. Teaching was a nice change of pace in the middle of the day, so I never minded it. It was something to do, something to be engaged in. Once teaching ended at 5, we would wait around for new admissions. I think I did 3 admissions during my time there. You do a full blown interview and physical of the patient and write it all up on the computer. Problem was, however, admissions would come in around 6:30 (just about that time when people are preparing themselves to leave). Then you would get an admission and since the whole process takes at least an hour, you just end up staying a lot later than you anticipated. Well at least this is how it went for me.
Conclusions:
Outpatient awesome (Tiffany clinic in particular)
Inpatient made me want to die, but mostly because of the unreasonable hours.
I think I would have rather done family med elsewhere.
Tuesday, June 18, 2013
Endocrinology at Bronx-Lebanon
Blue book elective
Hands down, my favorite rotation yet.
Usually third year medical students don't do electives since third year is reserved for the 5 cores but hey, this is AUC, I'm a January class, everything gets shuffled up. I actually don't start another core rotation till September (OB/gyn) but that's besides the point. Endocrine is a 4 week rotation, and you work closely with one resident and the attending. I'm the only medical student, which I actually prefer. Working with a bunch of other students sucks sometimes, especially if you are working with the "gunner" types who basically throw themselves at every resident being absolutely obnoxious as possible constantly asking if they can do this or that, trying to go above and beyond for no other reason than to seem like they care more than everyone else around them. Ah but I digress, that's a discussion for another day.
Working alone is fun! Having real responsibility for a change is fun. Coming to work actually means something for this rotation and I can't recommend it enough for those of you searching for an elective. I come into work everyday around 9 am and find the resident I'm working with for the day. Usually there's one or two residents on for the month, but since this is the end of the year and everyone is graduating, things have been chaotic in this respect. I go to the 8th floor residents' lounge and ask who's on for today. At this point everyone knows me as the endocrine girl so they've been good about informing me who I'll be working with. More often then not, the resident I am supposed to be working with is in clinic in the mornings (i.e. not in the hospital) so when a consult comes in, I get to do it.
What does that even mean, you ask? Well in a hospital, when patients are sick with something, they may have something else going on with them that might be outside the ability of the internal medicine docs who are caring for them.... that's where the consults come in. They call in the specialists for that particular field of medicine and since I'm doing endocrine these cases involve the hormones. Right now I'd say 80% of the consults are for uncontrolled or newly diagnosed diabetes. I've also had quite a few hyperthyroidism cases, one Hashimoto's, a few hypercalcemias, a couple panhypopituitarism, and a Cushing's disease case.
My resident will usually call me up and say "hey An-dreee-a [that's not how you pronounce it btw] we've got a consult. This is the patients name, MR number, and reason for consult. Go." I write this all down, take a look on the computer about what they're doing in the hospital and then I go interview and do a quick physical on the patient. That's another added bonus for consults- I just run up and down the floors during the day, see some of my friends in the process and yea, just the change of scenery does me wonders. Things get boring quick when you're relegated to the same 5 rooms for an entire day.
My interviews usually take 10-15 minutes where I'll ask about past medical history, social, family histories, a quick and very focused review of systems and then for physicals I just listen to the heart and lungs and press on the belly and ankles and my work is done. Of course if you are there for thyroid, you do have to do a thyroid exam. If you're there for diabetes it's good to look for acanthosis nigricans around the neck or axilla (Board question: acanthosis nigricans it most commonly seen in type 2 diabetics!!! Don't say stomach cancer) and asking about how long they've been diagnosed and what meds they are on to control it would be key.
After that I start my consult note and wait for the attending to arrive to the hospital so I can present the patients to her and then we round together and discuss what should be done with the patient. On average I'd say we've been getting three consults a day but I've had as much as six and as little as one.
The attending was absolutely fabulous. At Bronx they rotate attendings each month and I've been fortunate enough to meet both women who are each energetic, knowledgeable, and considerate. My attending was constantly teaching everyday during rounds which I loved and she seemed to enjoy it herself. Teaching attendings are far and few so don't waste the opportunity. You will learn a ton of endocrine during this rotation and if you couple this with some studying at home, you'll be great for boards. I can't recommend this rotation enough.
Hands down, my favorite rotation yet.
Usually third year medical students don't do electives since third year is reserved for the 5 cores but hey, this is AUC, I'm a January class, everything gets shuffled up. I actually don't start another core rotation till September (OB/gyn) but that's besides the point. Endocrine is a 4 week rotation, and you work closely with one resident and the attending. I'm the only medical student, which I actually prefer. Working with a bunch of other students sucks sometimes, especially if you are working with the "gunner" types who basically throw themselves at every resident being absolutely obnoxious as possible constantly asking if they can do this or that, trying to go above and beyond for no other reason than to seem like they care more than everyone else around them. Ah but I digress, that's a discussion for another day.
Working alone is fun! Having real responsibility for a change is fun. Coming to work actually means something for this rotation and I can't recommend it enough for those of you searching for an elective. I come into work everyday around 9 am and find the resident I'm working with for the day. Usually there's one or two residents on for the month, but since this is the end of the year and everyone is graduating, things have been chaotic in this respect. I go to the 8th floor residents' lounge and ask who's on for today. At this point everyone knows me as the endocrine girl so they've been good about informing me who I'll be working with. More often then not, the resident I am supposed to be working with is in clinic in the mornings (i.e. not in the hospital) so when a consult comes in, I get to do it.
What does that even mean, you ask? Well in a hospital, when patients are sick with something, they may have something else going on with them that might be outside the ability of the internal medicine docs who are caring for them.... that's where the consults come in. They call in the specialists for that particular field of medicine and since I'm doing endocrine these cases involve the hormones. Right now I'd say 80% of the consults are for uncontrolled or newly diagnosed diabetes. I've also had quite a few hyperthyroidism cases, one Hashimoto's, a few hypercalcemias, a couple panhypopituitarism, and a Cushing's disease case.
My resident will usually call me up and say "hey An-dreee-a [that's not how you pronounce it btw] we've got a consult. This is the patients name, MR number, and reason for consult. Go." I write this all down, take a look on the computer about what they're doing in the hospital and then I go interview and do a quick physical on the patient. That's another added bonus for consults- I just run up and down the floors during the day, see some of my friends in the process and yea, just the change of scenery does me wonders. Things get boring quick when you're relegated to the same 5 rooms for an entire day.
My interviews usually take 10-15 minutes where I'll ask about past medical history, social, family histories, a quick and very focused review of systems and then for physicals I just listen to the heart and lungs and press on the belly and ankles and my work is done. Of course if you are there for thyroid, you do have to do a thyroid exam. If you're there for diabetes it's good to look for acanthosis nigricans around the neck or axilla (Board question: acanthosis nigricans it most commonly seen in type 2 diabetics!!! Don't say stomach cancer) and asking about how long they've been diagnosed and what meds they are on to control it would be key.
After that I start my consult note and wait for the attending to arrive to the hospital so I can present the patients to her and then we round together and discuss what should be done with the patient. On average I'd say we've been getting three consults a day but I've had as much as six and as little as one.
The attending was absolutely fabulous. At Bronx they rotate attendings each month and I've been fortunate enough to meet both women who are each energetic, knowledgeable, and considerate. My attending was constantly teaching everyday during rounds which I loved and she seemed to enjoy it herself. Teaching attendings are far and few so don't waste the opportunity. You will learn a ton of endocrine during this rotation and if you couple this with some studying at home, you'll be great for boards. I can't recommend this rotation enough.
Wednesday, May 15, 2013
Finding an Apartment in New York City
I got the news I was moving to New York City 16 days before I had to start my internal medicine rotation at Mount Vernon. It was holiday time so you can say I was feeling a tad overwhelmed. I hopped online to hotpads.com and started looking for places in the Upper East Side. For those of you who don't know, there are TONS of AUC students living in the UES and I just wanted to be near them since I desperately missed their beautiful faces.
Here are a few tips I'm willing to impart on apartment hunting in NYC:
Rule #1 (the most important rule): GET A ROOMATE!!!! NYC is the most expensive city in the country and getting a one bedroom or studio is astronomical. Students living alone pay anywhere from $1750-$3000 a month in Manhattan. However for those who get a two or three bedroom apartment, each person ends up paying $1000-1200 at most. Had I more notice, I would have definitely tried finding a roommate.
Rule #2: Brokers are expensive and you most likely have to go through them to find a long term living situation, but they are not necessary in "doorman" buildings. If you have time, you literally can just walk around to every tall apartment building in the city with a front desk and doorman and ask about room availabilities. Again, if you are looking for a one bedroom it's going to be expensive, but if you've got one or two other people living with you, the price is much nicer for all. And what's even better is you don't have to pay a broker fee! Someone offered me this advice beforehand, but again since I was in a bind for time...
Rule #3: Craigslist is not always terrible. Yeah, there are some sketchy ads on there, but if you have a friend in the city to check out the place beforehand, then give it a shot. Craigslist is actually a very good option for those of you who only need to live in the city for a month here and there. Also you should check out sublet.com for that same reason.
Rule #4: If you do use a broker, just go ahead and use mine. I can vouch for him. His name is Evgeni, he's a young, friendly, good looking Russian guy who specializes in the Upper East Side. He asked for my specifications, price range, and then proceeded to find me 8-10 places where I could easily have lived in any of them. His fee is 12%, be sure to arrange that with him beforehand (or any broker for that matter). Or if you want, you can ask to be shown places that have a broker's fee of one month's rent and he can do that as well. Evgani's number is 646 248 0320. Go ahead and say you know me, I really don't mind even if you don't.
After one day of exhaustive apartment hunting I ended up with a beautiful studio on 85th and York. It's one of the few walk-ups with an elevator, the laundry room is directly across from my door, and I'm a 10 minute walk from the subway. Please enjoy the pictures below.
 |
| This is NOT my place, but I did take this when I found out I was approved for my apartment. |
Rule #1 (the most important rule): GET A ROOMATE!!!! NYC is the most expensive city in the country and getting a one bedroom or studio is astronomical. Students living alone pay anywhere from $1750-$3000 a month in Manhattan. However for those who get a two or three bedroom apartment, each person ends up paying $1000-1200 at most. Had I more notice, I would have definitely tried finding a roommate.
Rule #2: Brokers are expensive and you most likely have to go through them to find a long term living situation, but they are not necessary in "doorman" buildings. If you have time, you literally can just walk around to every tall apartment building in the city with a front desk and doorman and ask about room availabilities. Again, if you are looking for a one bedroom it's going to be expensive, but if you've got one or two other people living with you, the price is much nicer for all. And what's even better is you don't have to pay a broker fee! Someone offered me this advice beforehand, but again since I was in a bind for time...
Rule #3: Craigslist is not always terrible. Yeah, there are some sketchy ads on there, but if you have a friend in the city to check out the place beforehand, then give it a shot. Craigslist is actually a very good option for those of you who only need to live in the city for a month here and there. Also you should check out sublet.com for that same reason.
Rule #4: If you do use a broker, just go ahead and use mine. I can vouch for him. His name is Evgeni, he's a young, friendly, good looking Russian guy who specializes in the Upper East Side. He asked for my specifications, price range, and then proceeded to find me 8-10 places where I could easily have lived in any of them. His fee is 12%, be sure to arrange that with him beforehand (or any broker for that matter). Or if you want, you can ask to be shown places that have a broker's fee of one month's rent and he can do that as well. Evgani's number is 646 248 0320. Go ahead and say you know me, I really don't mind even if you don't.
After one day of exhaustive apartment hunting I ended up with a beautiful studio on 85th and York. It's one of the few walk-ups with an elevator, the laundry room is directly across from my door, and I'm a 10 minute walk from the subway. Please enjoy the pictures below.
Friday, May 10, 2013
Internal Medicine at Mount Vernon
Green book core
I was warned by a peer of mine beforehand that I should expect to be disappointed. Go in with low expectations he said, and everything will be fine. He was right.
I was warned by a peer of mine beforehand that I should expect to be disappointed. Go in with low expectations he said, and everything will be fine. He was right.
When I first walked into Mount Vernon on that cold January morning all I saw was a run down hospital, with 30 beds. There are about 20+ internal medicine interns/residents and I had no idea how they could possibly split up so few patients between them. Turns out the first years (interns) are the ones who primarily care for those admitted in the hospital and the second and third years oversee and guide the interns in their management of the patients. As for medical school students... I spent a good many weeks trying to figure out what our role was in all this. This is what I walked away with:
Daily Schedule
Arrive by 7:30 a.m.- For those of you driving, med students get free parking in the garage. You have to ask the security guard at the front desk for a coin. For those taking the train, you've got to take the subway and then switch to the Metro North to get to the hospital.
7:30-8:00 a.m: Listen to the head nurse discuss discharges for the day and then listen to the residents who were on night float discuss the new admits over night (usually anywhere from 2-5 patients). On Mondays and Fridays there may be a resident/med student presentation on an interesting case with Dr. R.
8:00~8:45 a.m.: Chase down an intern before they all disappear and ask to follow them for their morning rounds. Stand and listen silently as each intern does a quick interview of each of their patients. Each intern will have anywhere between 5-10 patients on any given day. If you're lucky the intern will voluntarily discuss the case with you, if not, it's fine to ask them questions since they are all friendly anyway.
8:45-9:15/10:15: A number of things can happen during this time. If you know how to do blood draws and ABGs and the residents trust you, they will ask you to do the blood work for them. If you can't do either of those things then you probably just go back upstairs to the residents lounge on the 6 floor and hang out until cardio rounds.
9:15/10:15- an hour later: Depending on the day, cardio rounds with Dr. N will happen at either 9:15 or 10:15 on the 4th floor. This is the most useless hour of the day. Residents gather around Dr. N and they go through each patient in telemetry. As students you have to stand at the other side of the desk and you can neither hear nor understand what's going with each patient.This will take take 45 minutes and you just stand there silently. If time permits, Dr. N will pull up a couple of EKGs on a screen and teach the residents. You stand there still confused. You are never acknowledged. The session ends.
10:15/11:15-Noon: Hang out or go get an early lunch. I usually go the cafeteria or the nearby Subway. The only things worth eating at the cafe is the soup and the chicken cutlet sandwich. People like getting food during this time because there's usually a noon conference.
Noon-1:00 p.m.: Noon conference can be either a student presentation on a case/disease, an attending teaching the students/resident about something in their specific field, or a test prep/board review Q&A session with Dr. E.
1:00-Whenever: God knows what. You're probably safe to go home at this point, although officially we have to stay till 4 for no real reason. For the first few weeks I would go to clinic in the afternoons till about 3 and then head off. For some reason, I was the only one who would do this since there was an odd rumor going around that our malpractice insurance didn't cover the outpatient clinic, which literally makes no sense.
They have some interesting clinics at Mt. Vernon that are worth going to. In addition to the regular outpatient clinic, I've been to the HIV clinic and Methadone clinic, each providing its own unique experience on a very different patient population.
Also during this time, some people pick up a side project during the rotation so they may spend an hour or two in the afternoon to catch up on their work.
If you aren't going to the clinic or doing project work, there's really not much else to do. Every so often there might be "bedside rounds" where a student is selected to do a full interview of a patient as 15 residents and students look on, but that only happened 4-5 times out of the three months.
Overall, Mount Vernon was not a good place for patient interaction, but you are able to gain a few skills if you are willing to work for it. I walked away learning how to perfect ABGS (drawing arterial blood) and I'm somewhat proficient in blood draws. It's also great if you enjoy studying. You get ample time to study if you so choose.
They have some interesting clinics at Mt. Vernon that are worth going to. In addition to the regular outpatient clinic, I've been to the HIV clinic and Methadone clinic, each providing its own unique experience on a very different patient population.
Also during this time, some people pick up a side project during the rotation so they may spend an hour or two in the afternoon to catch up on their work.
If you aren't going to the clinic or doing project work, there's really not much else to do. Every so often there might be "bedside rounds" where a student is selected to do a full interview of a patient as 15 residents and students look on, but that only happened 4-5 times out of the three months.
Overall, Mount Vernon was not a good place for patient interaction, but you are able to gain a few skills if you are willing to work for it. I walked away learning how to perfect ABGS (drawing arterial blood) and I'm somewhat proficient in blood draws. It's also great if you enjoy studying. You get ample time to study if you so choose.
Monday, May 6, 2013
Something I Learned Today
I never really considered this before, but this is as fundamental as you get when deciding how to manage your patient's health. When someone has uncontrolled diabetes, seizures, hypertension (or what have you) on the current drug they are on... what do you do?
a. Increase the dose of the current medication?
or
b. Add a second drug?
Today we had a couple pharmaceutical reps talking up ezetimibe, a drug that inhibits cholesterol absorption by the brush border of the small intestines, and how it's an excellent drug to add on to the first-line statins for those with hypercholesterolemia. They were questioning my attending if he ever used it as an add on or if he just increased the statin dose, to which he answered "add on".
There isn't a real correct answer to this question since doctors do both of of these things depending on the individual case, but my attending says he personally prefers to add a second drug if he's able to convince the patient. The problem with increasing doses is you increase the risk for side effects and many patients can't tolerate high doses because of this. So giving two low dose drugs not only synergistically combats whatever pathology you're dealing with, but you're also reducing the potential side effects that would be seen with upping a dose.
That being said, it is a hard sale convincing patients to take two pills when they can just take one, but with the proper communication and education, you can win them over because at the end of the day people want to live as unaltered a lifestyle as they've led up to that point. Nobody likes having to take a pill everyday (sometimes for the rest of their life) and it can be disconcerting to have to take something that causes daily discomfort. The patient is our number one priority and as physicians we want to make him/her as comfortable as possible and maintain a high quality of life. That includes limiting side effects.
a. Increase the dose of the current medication?
or
b. Add a second drug?
Today we had a couple pharmaceutical reps talking up ezetimibe, a drug that inhibits cholesterol absorption by the brush border of the small intestines, and how it's an excellent drug to add on to the first-line statins for those with hypercholesterolemia. They were questioning my attending if he ever used it as an add on or if he just increased the statin dose, to which he answered "add on".
There isn't a real correct answer to this question since doctors do both of of these things depending on the individual case, but my attending says he personally prefers to add a second drug if he's able to convince the patient. The problem with increasing doses is you increase the risk for side effects and many patients can't tolerate high doses because of this. So giving two low dose drugs not only synergistically combats whatever pathology you're dealing with, but you're also reducing the potential side effects that would be seen with upping a dose.
That being said, it is a hard sale convincing patients to take two pills when they can just take one, but with the proper communication and education, you can win them over because at the end of the day people want to live as unaltered a lifestyle as they've led up to that point. Nobody likes having to take a pill everyday (sometimes for the rest of their life) and it can be disconcerting to have to take something that causes daily discomfort. The patient is our number one priority and as physicians we want to make him/her as comfortable as possible and maintain a high quality of life. That includes limiting side effects.
Thursday, May 2, 2013
Books for Clinicals - Internal Medicine/Family Medicine
I've been very very bad. I know and I apologize. I do plan on having a full update soon on my three months of Internal Medicine @ Mount Vernon, my move to NYC, finding housing in NYC, and the differences between clinicals and basic sciences. I hope to roll out these posts in the following days, as well as answer all the questions you guys have been asking, but first I'll start with this fairly easy, yet informative post about books you may want for the start of medicine.
1. Mass General Pocket Medicine
You see this little green book on every single residents on the floor. I love it because it's so concise and clinically oriented. It focuses on how a patient will present with a disease, abnormal labs, diagnoses, and how to TREAT him/her. When I first started Internal, I had bought the Oxford Handbook of Clinical Medicine and was disappointed because of it's sparse treatment information, which I find is the most important thing to be learning at this stage in our education. Sure we've learned about many diseases, the pathogenesis, how it may present, what abnormal labs we may see, but what do we DO about it? That's what 3rd and 4th year is all about.
2. The Practitioner's Pocket Pal
This handy little book is about 90 pages and gives you the essentials on what you would need to know in the wards. It discusses lab values, what to ask for when taking a history, how to write SOAP notes, progress notes, differential diagnoses for common complaints, a rundown of the most commonly used drugs, ALCS emergency algorithms, and even gives you helpful Spanish-English medical words.... this book has a little bit of everything and I love it. You'll see most students with the Maxwell's Quick Medical Reference book, but I find this one more useful.
3. Download the Epocrates App for Android/iPhone
When it comes to knowing your drugs- mechanism of action, indications, contraindications, dosing, side effects, black box warnings, pregnancy class, pricing (which I find most interesting... no idea how expensive drugs are) this app has everything and you'll be using it fairly often. Another drug app that I've seen students use is the Micromedex... I still like epocrates better because for whatever reason it loads faster on my phone.
Great Books for the Medicine Shelf!!
At the end of each of the 5 cores- internal medicine, psychiatry, pediatrics, surgery, and OB/GYN, AUC students have to take a 2.5 hour, 100 question shelf exam at a nearby prometric center. I took my Medicine one last Friday and feel that I did pretty well on it. Here are the two books I heavily leaned on:
1. Conrad Fischer's Master the Boards for USMLE Step 2 CK
This book really distills the material to clinical presentation, best initial test/ most accurate test for diagnoses, and the step-wise approach for treatment. There is NO in-depth discussion of the pathophys and whatnot of certain diseases because this book basically assumes you know all that information already from basic sciences... so some people may not like this because it is so sparse on that particular material. If you want something to supplement this book, people absolutely love using Step-Up to Medicine, which I've thumbed through and it's actually pretty good. It reminds me a little bit of Goljan since it is in outline form but it does provide more information on diagnoses/treatment options.
2. MKSAP for Students 5
Everyone can agree that doing practice questions is a great way to study for any exam, so most students turn to UWorld. Of the possible 1400 internal questions on UWorld, I probably did around 400 questions and found them to be their usual u-worldy type selves. Then I went on to amazon and one of the "recommended books" on my page was this MKSAP question book. I figured why not buy it and give it a shot and oh my god, I am so glad I did! Not only does it give you amazing explanations and beautiful salient points on the clinical aspect of medicine, but these questions were a perfect match for the shelf. I probably had 5 or so questions that were almost identical. There are 11 sections divided by organ system and I did 5 of them before taking my exam. Had I gone through the whole book...
I should be getting my shelf score tomorrow so I'll let you guys know how I did.
FYI: You need a 53 to pass and a 77 to honor.
update: ended up with a 71... a bit short for honoring, but still pretty good for my first shelf
1. Mass General Pocket Medicine
You see this little green book on every single residents on the floor. I love it because it's so concise and clinically oriented. It focuses on how a patient will present with a disease, abnormal labs, diagnoses, and how to TREAT him/her. When I first started Internal, I had bought the Oxford Handbook of Clinical Medicine and was disappointed because of it's sparse treatment information, which I find is the most important thing to be learning at this stage in our education. Sure we've learned about many diseases, the pathogenesis, how it may present, what abnormal labs we may see, but what do we DO about it? That's what 3rd and 4th year is all about. 2. The Practitioner's Pocket Pal
This handy little book is about 90 pages and gives you the essentials on what you would need to know in the wards. It discusses lab values, what to ask for when taking a history, how to write SOAP notes, progress notes, differential diagnoses for common complaints, a rundown of the most commonly used drugs, ALCS emergency algorithms, and even gives you helpful Spanish-English medical words.... this book has a little bit of everything and I love it. You'll see most students with the Maxwell's Quick Medical Reference book, but I find this one more useful.3. Download the Epocrates App for Android/iPhone
When it comes to knowing your drugs- mechanism of action, indications, contraindications, dosing, side effects, black box warnings, pregnancy class, pricing (which I find most interesting... no idea how expensive drugs are) this app has everything and you'll be using it fairly often. Another drug app that I've seen students use is the Micromedex... I still like epocrates better because for whatever reason it loads faster on my phone.Great Books for the Medicine Shelf!!
At the end of each of the 5 cores- internal medicine, psychiatry, pediatrics, surgery, and OB/GYN, AUC students have to take a 2.5 hour, 100 question shelf exam at a nearby prometric center. I took my Medicine one last Friday and feel that I did pretty well on it. Here are the two books I heavily leaned on:
1. Conrad Fischer's Master the Boards for USMLE Step 2 CK
2. MKSAP for Students 5
Everyone can agree that doing practice questions is a great way to study for any exam, so most students turn to UWorld. Of the possible 1400 internal questions on UWorld, I probably did around 400 questions and found them to be their usual u-worldy type selves. Then I went on to amazon and one of the "recommended books" on my page was this MKSAP question book. I figured why not buy it and give it a shot and oh my god, I am so glad I did! Not only does it give you amazing explanations and beautiful salient points on the clinical aspect of medicine, but these questions were a perfect match for the shelf. I probably had 5 or so questions that were almost identical. There are 11 sections divided by organ system and I did 5 of them before taking my exam. Had I gone through the whole book...I should be getting my shelf score tomorrow so I'll let you guys know how I did.
FYI: You need a 53 to pass and a 77 to honor.
update: ended up with a 71... a bit short for honoring, but still pretty good for my first shelf
Friday, January 4, 2013
Rotations Schedule
I called my clinical advisor that very day. I'm sorry to say that she is terrible. AUC really ought to look into fixing its clinical department. Not only did I have to call 8-10 times to finally get a hold of her, but when she promised me she would send me a revised schedule on a specific day of the next week, she didn't do it. So the following week I called her 5 more times, left a message, and still didn't hear back from her. I called her the next day, got a hold of her and she said that I just needed to wait till she emailed me back my schedule. She never did and I'm supposed to start my first rotation next Monday.
People who took their Step exams a week or two after me got their schedules today and when I saw that some of them got the psychiatry rotation at Bronx that I wanted (and was told there was NONE AVAILABLE) I went absolutely insane. Enraged. Dear readers, I flipped out and I'm actually surprised at how angry I was, but there it is. The poor woman who picked up the phone got my bitchiness and aside from her exclaiming "EXCUSE ME!" after I demanded that she MUST fit me somewhere in the Bronx for psychiatry, she was actually very well composed and that settled me down. 10-15 minutes later, I got the schedule you see just above.
What does it all mean? In one 15 minute phone call, a capable young woman who isn't even my advisor fixed my qualms and gave me a schedule that I'm happy with. I don't understand why my own advisor couldn't do it for me. I'm not one to call for someone to be fired, but honestly something needs to be done to improve this whether it be more training or... I don't know. Anyway, I'm happy to be starting clinicals and can't wait to share my experiences (good and bad) with all of you!
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