Grand Rounds Call for Submissions
Just a friendly reminder that all submissions for next week's Grand Rounds should be sent to mdphdstudent AT gmail DOT com by Monday May 2 at 6 pm Eastern Time. (I have an 8:30 am test...)
I've got a few great posts already, but of course I could always use more (and yes, patient perspectives are more than welcome!)
Attention all Time Travelers!
The date and location for the one and only Time Traveler Convention
has been announced!
May 7, 2005, 10:00pm EDT (08 May 2005 02:00:00 UTC)
East Campus Courtyard, MIT
(42.360007,-071.087870 in decimal degrees)
Most important for the success of this convention will be spreading the word so that future time travelers know about the convention. Write a few words in a local newspaper, carve into a clay tablet, or bury a time capsule in your backyard!
If you happen to be in Boston...
There is a potentially interesting panel discussion at MIT tomorrow night.The Impending Healthcare Crisis: Can it be Averted?
Grand Rounds XXXI and call for submissions
Grand Rounds XXXi
is up! I've nothing witty to say quite this early (why anyone would schedule early morning classes is beyond me), but take a look, and tell me what you think!
Also, I will be the host for next week's Grand Rounds. Did you miss Dr. Tony's early deadline? Submissions can be sent to mdphdstudent AT gmail DOT com by Monday May 2 at 6 pm. Yes, I have an early deadline too, as I have a test at 8 am the next morning.... I will try to confirm all submissions by email, if you don't hear from me within 36 hours of your submission, feel free to send me another one.
I need to learn Spanish or Cantonese or...
The Nytimes has an article on the effects of language barriers in the ER.
While the city I live in is not exactly as multicultural as New York, I know that language barriers are a problem here as well.
If only there were time in the medical curriculum to at least learn some basic spanish. Yes, I'm sure that there are spanish interpreters in most local hospitals, but I know that having at least a basic understanding of other languages will greatly help me. I wonder if it might be worth it to require a college-level foreign language class for medical admission, although yet again, it is difficult to continue to add prerequisites for admissions, and requirements during medical school itself.
Home-based rehabilitation for patients with cognitive disorders
As part of my cognitive disorders course,
we have to create an "on call notebook" which contains rehabilitation activities that can be used for a variety of patient encounters. These activities are often subjective, as therapies that address "real world" activities such as going to the grocery store aren't often studied for efficacy in a systematic manner. In addition, rehabilitation is often most effective when the therapy activities can be continued at home (in small, focused sessions spread out throughout the day.) But, caregivers don't necessarily have access to advanced therapy materials that work on specific cognitive skills such as attention or memory.
The University of Alabama at Birmigham has developed a great set of exercises that can be done both in a rehabilitation setting, and at home with primary caregivers. The Home-Based Cognitive Stimulation Program
contains a list of 48 exercises that address many every day skills such as working with money and improving motor control. Each exercise has variations for different skill levels, and involves single or multiple cognitive domains. Everything can be done at home, with minimal or no rehabilitation training, and everyday materials. It's a great starting point for involving caregivers in treatment, and empowering both the patient and their caregivers (a very important consideration in rehabilitation.) For patients not in a structured rehabilitation program, this home-based program can be recommended by the treating physician.
In this era of reduced inpatient and outpatient coverage and services, home-based rehabilitation programs will be a valuable resource for patients with stroke, TBI or other neurological impairments. While the most significant gains in cognitive function occur in the "spontaneous recovery period," which is generally within 6 months post insult, improvements can occur any time. I hope that more of these home-based programs are created (and studied for efficacy), because home-based rehabilitation may be the only type of rehabilitation available to some patients.
A Case for Model Checking
Many statisticians would agree that, had it not been for cacheable
communication, the exploration of erasure coding might never have
occurred. After years of unproven research into symmetric encryption,
we disconfirm the synthesis of Smalltalk. we describe new classical
communication, which we call Tab.
Recent advances in introspective communication and relational
communication synchronize in order to accomplish local-area networks.
Without a doubt, we emphasize that we allow Boolean logic to prevent
optimal modalities without the investigation of symmetric encryption.
After years of extensive research into the Internet, we demonstrate the
emulation of link-level acknowledgements . On the other hand, the lookaside buffer alone can fulfill the
need for the Ethernet.
Our focus in our research is not on whether wide-area networks and the
location-identity split can collaborate to address this
problem, but rather on describing a methodology for the refinement of
multi-processors (Tab). Existing atomic and wireless systems use
RAID to locate decentralized models. The disadvantage of this type of
method, however, is that the partition table and
Smalltalk can collude to fulfill this intent. On a similar note, the
basic tenet of this approach is the deployment of evolutionary
programming. Therefore, our algorithm studies the lookaside buffer.
Our contributions are as follows. We discover how local-area networks
can be applied to the analysis of A* search. Along these same lines, we
use read-write technology to disconfirm that replication and expert
systems are often incompatible. We propose a novel
methodology for the refinement of Internet QoS (Tab), disconfirming
that the producer-consumer problem and reinforcement learning are
The rest of the paper proceeds as follows. Primarily, we motivate the
need for journaling file systems. Further, to accomplish this
objective, we motivate an analysis of the Ethernet (Tab), proving
that Internet QoS and spreadsheets are entirely incompatible. We
place our work in context with the existing work in this area. Finally,
we conclude....Generate your own CS paperThe CNN article
A tip for working with stroke patients.
Another tip from my cognitive disorders class (for speech language pathologists and occupational therapists):
Try to approach a new patient on their "good" side. Many patients will be unable to express that they cannot see you or are having trouble understanding you (especially in the case of left hemisphere stroke), while those with right hemisphere stroke may be completely unaware of your presence, or may be unconcerned by the fact that they can't really see you.
Also, be aware of the patient's premorbid interests. Someone who hated reading the paper before the insult probably won't be excited about practicing reading, so that they can "read the paper again."
This week's Grand Rounds
is up at Gruntdoc
There are a lot of great posts this week, but I must recommend that when you sit down to read them, you avoid cutting sancho peppers beforehand (or at least, wash your hands better than I did!)
Stigmas in Medicine
I had a very insightful talk with a physician on friday. Among other things, we discussed how best to approach the fact that someone has an illness when applying to residencies and even when trying to get a license. As someone who is on the admissions committee for one of the residency programs here, he advocated honesty about any chronic illness, no matter how small. (This is actually in contrast to what many of my peers said, which was "just lie.")
His rational is that while disclosing an illness could put you at a slight disadvantage when applying to residency, the process is so subjective and full of prejudice that almost everyone will have some sort of "mark" against them, being personality or illness. However, disclosing an illness actually protects the resident. Think of the diabetic surgical resident. If his blood sugar drops during a long surgery, he needs to be able to take care of himself, and if his residency program is aware of his illness, he will probably already have mechanisms in place for such situations.
Although he was quick to point out that the analogy was not exact, he likened having an illness to being a foreign medical graduate. When reviewing residency applications, inevitably a new member of the committee will tsk tsk an applicant (no matter how qualified) for being a FMG. Of course, the doctor whom I was talking to was an FMG, and I must admit that I never would have known that, unless he had told me himself (he speaks better English than I do!). Even though all of his training other than medical school was done in the US (and he also got a PhD here in the states), the fact that he went to school in India still follows him around his career, though he's reached a point where his accomplishments should more than speak for themselves, and his colleagues are not questioned about their choices of medical school.
Unfortunately, biases still exist; someone with a mental illness will be more likely to be stigmatized than my diabetic surgeon. This is unfortunate given the high rate of mental illness and substance abuse in physicians, as one would think that reducing the stigma of having a mental illness as a physician would encourage more to seek treatment, which can only help the field of medicine.
My first suggestion for reducing this stigma? Reduce the potential career consequences for disclosing the fact that you experienced depression at some point in your life. When physicians in training feel comfortable disclosing the fact that they had a rough time in their first year in medical school, and don't worry that this disclosure will adversely affect their ability to get into a residency program, we will have made a major step.
You'll be back to normal in no time!
I'm taking a class outside regular medical school on cognitive interventions (focusing on improving outcomes for stroke and TBI for students in the speech pathology and occupational therapy programs here.) One reason I wanted to take this class is to get a perspective on how other health professionals are involved in the types of patients I might encounter as a doctor. This week, we had a moderate TBI survivor come in and talk a little about her experiences.
She highlighted one of the effects of improved emergency medical care that I hadn't really thought much of. Because people are surviving injuries and illnesses that once would have been fatal, there are more people walking around with brain injuries. The firefighters who pulled her from her car never thought she would make it out of the hospital. But, three years later, she was talking to a classroom full of students, with no apparent physical problems about how she learned to function in day to day life again. She likened herself to "that crazy old aunt everyone has, who is just a little bit off." She had developed such effective coping mechanisms that if she hadn't been talking about her brain injury, I may not have even noticed that anything was wrong.
A few things struck me. After her accident, she was told by her doctors that she'd be "back to her normal self" after 6 months or so of a rehab program. But of course, most TBI patients never really return to the same person they were before the accident. She had a hard time believing her therapists that she may not be able to go back to everything she did before the accident (including being a nurse who also taught in the college of nursing.) Three years after the accident, she still attends occupational therapy sessions, still attends the support group, and still has to adjusts her coping mechanisms to fit in with society. She was lucky in that her family has the resources to pay for extended rehab, and that she was very quickly identified as a brain injury patient in the hospital. But because a doctor told her once that she'd be "back to her old self" it took her a long time to accept that it was ok to try a new activity rather than spending all her energy trying to develop her skills to a level where she could go back to the type of volunteer work she did before the accident.
After she left, we had a great discussion on what the goals of speech and occupational therapy should be. Obviously, one goal is to get the patient to a point where they are relatively independent and functional in their environment. But even for those with more mild injuries, trying to get the patient back to the level of functioning that they had before the insult is a double edged sword. Every patient and family will have different goals for themselves that we need to work with when assessing function and developing a rehab program. As doctors, we need to be careful about our wording when dealing with brain injuries. While being able to walk, dress and feed oneself again is a great accomplishment for many patients, simply being able to do these things does not make them "normal" again.
Tangled Bank and Grand Rounds
This week's edition of the Tangled Bank
is up at Orac Knows
Click for the best science blogging on the web, and maybe a few tips on how to submit your next article for publication!
And, because I missed it yesterday, Grand Rounds
is up at Polite Dissent.
A friend from high school stopped by to chat and see the new house. He had just come back from a month in Honduras, and had a totally new outlook on his future. In his words, "It's hard to see that much poverty, and not be affected."
And I have to say, I'm proud of him. He had a few years where he couldn't quite find his place in the world, but now he has a mission. He's registered for a few science classes, to get the prereqs he needs to matriculate into a local nursing program. Eventually, he wants to finish up his four year degree, and become a nurse practitioner, and even wants go to medical school. A masters in public health would not be out of the question. Eventually, he wants to open a clinic in a rural area, and maybe even work in a clinic in latin america.
He just gets it. He has a drive, a passion, to really make a difference. I hope that he can sustain that drive. Though I know that in whatever he ends up doing, whether it is becoming a nurse, a doctor, or whatever else, he will change the world around him. I hope that if he does go to medical school, that this drive isn't beaten out of him. I know that many of my classmates have great expectations of how they will contribute to the world, but these expectations tend to get lost in the biochemical pathways that we beat into our brains. And I know that I can only hope that when I get out of school, all my pre-school idealism will return, but it is hard when looking forward means looking towards the next block of exams, rather than looking to the years after school and residency. Then, there are questions of debt, of politics, and of lifestyle. After years of working and studying for 100 hours a week, how attractive does being an overworked family doctor in Appalachia, look compared to becoming a dermatologist?
But I must say, my friend has inspired me. I needed a boost of idealism and hope. I needed to talk to someone who wasn't already involved and frustrated with the world of medical education and the uncertainty of the future. He has a plan. And I know, even if he never makes it to medical school, he will find a niche where he is happy. He doesn't have the resources or background to achieve his dreams right away, but I wouldn't be surprised if he enters medical school at 40, ready to take on the world. And I will continue to be inspired by him, and proud.