David and Kevin approach doctordom

After a year of 6-week journeys into the depths of numerous medical specialties, acquiring enough experience along the way to become indubitable experts capable of writing a series of specialty summaries, Kevin and I are now newly minted MS-IVs.

Farewell, penultimance. Greetings, ultimiosity.

Kevin learns amusing words

Rock
-noun
1. A currently admitted patient who no longer requires >$3000/day medical services but can not be discharged because of social/legal/financial reasons. He/she stays on service getting 3 hot meals a day and unnecessary daily CBC and chem7s.



Rock garden
-noun
1. A collection of rocks (see above) that demand increase your daily paperwork time for no educational gain.

"Hey, are you done with your daily notes yet?" "I've taken care of all the acute patients, just need to tend to my rock garden and I'll be done."

Kevin deals with the Cross-Eyed Gunner

Medicine, much like golf, is often filled with oddball behavior that, while not being detrimental to patient care, can often raise the eyebrows of colleagues and patients alike. Medical students stumbling around in their 3rd year clerkships certainly aren't immune to this. So as a small case series, David and I would like to present a few of these "that-guy/girl" stereotypes

I'm sure most of you have all heard of "the gunner." The guy/girl that prerounds on your patients, asks questions during rounds to make you look bad and generally being an annoying dbag. I havent met one myself, but I'm sure they're out there... waiting to make me look bad. However, fewer people know of, or at least speak of, the cross-eyed gunner. This person has all the eagerness and moxie of a regular gunner but none of the competence and medical knowledge to match. This leads to a sad-parade of self-destruction that is pretty intriguing for an innocent bystander like myself.




The CEG is eager, very eager, to answer questions. Whenever the attending proposes a question, even if it's rhetorical, he/she will shout an answer as fast as possible. Unfortunately, the answers are usually wrong and only met by uncomfortable stares from the rest of the team. Often times CEGs have some self-awareness and realizes they've just given the wrong answer(once again) so they might backpedal and try to justify their answers in a really convoluted fashion that clearly has nothing to do with the actual patient. But luckily, this helps make me look good since I can step in and give the correct answer (although ultimately adding nothing to the overall care of the patient). Ah, the simple joys of medicine.

Comic: Ideal vs. Reality - Dermatology

David doesn't believe in magic

As scientific, evidence-based fields go, medicine has to rank at or near the top. The best doctors make clinical decisions based on both years of experience and what the newest research has identified as the appropriate standard of care. Yet anyone who’s seen a medical TV show or spent any time on an inpatient ward has probably noticed the prominent role of superstition in what is otherwise a primarily logic-based endeavor.   

One of the more benign examples is the concept of “clouds.” For those unfamiliar, a white cloud is someone who brings good luck and light call nights along wherever he or she goes, while a black cloud puts Murphy’s Law to the test with regularity. These terms are often applied jokingly or even affectionately on the wards, yet it’s not uncommon hear them said with a completely straight face. I’ve also heard students and interns scolded for predicting easy call nights or forecasting uncomplicated patient stays based on all of the relevant admitting information.  

                                         I hope this isn't the MI cloud...                                                                  

Admittedly, a fair amount of this superstition is tongue-in-cheek inside joking. Yet I’ve been repeatedly surprised at how superstitious nurses, residents, and even attendings can be, particularly with regard to call nights and new patient admissions. As another example, during sign-out, when the daytime team gives a quick heads-up to the call team or night float about any pressing patient issues to be aware of overnight, I’ve had multiple permutations of the following exchange:

David: Ok, for Mr. X, I don’t anticipate any issues…

On-call Intern: Gah! Don’t say that! [Scrambles to knock on table]

David: …with him…wait, what?

On-call Intern: Never. Say. That. It’s bad luck.  [Knocks on wood again and prepares to sacrifice small bunny on a tiny altar made of old reflex hammers and adorned with four-leaf clovers]

David: Uh…Ok, sorry. I, uh, hope everything goes to pot and you get called all night about him…?

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After a few of these encounters on multiple rotations, I’ve come to take a slightly different tact, at least with those superstitious housestaff members with whom I’ve developed a friendly rapport:

David: Light call so far? No admissions?

On-call Intern: Shhhhh! Don’t jinx it!

David: Jinx what? The fact that tonight guarantees to be a complete admissions shut-out?

On-call Intern: Dude…

David: That this call will henceforth be the standard against which all other easy calls will forever be judged?

On-call Intern: I’m going to slap you…

David: The fact that the Deities of Patient Admissions – may they smite you if they exist – are clearly too impotent to put forward a worthy challenge on your call night?

On-call Intern: Forget the bunny, I’m going to sacrifice you instead.

David: That…

On-call Intern: You do realize I evaluate you, right?

David: Ruh-roh.

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Maybe this is why I’m a black cloud…

 

 

Kevin and David think you might be interested in some merchandise

Now that David and I have reached our goal of becoming internet hundredaires, the next goal is to be come gajillionaires. After some brainstorming, we decided selling various merchandise at a 10% commission rate is the obvious way to go. So I've gone ahead and started a Zazzle store using the comics on iddx. Feel free to buy one or ninety. This is a pretty preliminary start but theres some mousepads available and a calendar of the comics. If you guys have any specific requests, let me know and I'll make it available (iddx underwear perhaps?). All proceeds do not go to charity. Unless you consider sleep-deprived med students to be charity cases, in which case 100% of the proceeds will be going to charity.



Store link: http://www.zazzle.com/iddxblog





make custom gifts at Zazzle

David and Kevin become internet hundredaires

When Kevin and I first started this blog, we wanted to provoke meaningful thought and discussion about medical education and chronicle the early steps towards physician-hood from the basic sciences to graduation and everything along the baby-saving, Jess-antagonizing, sleep-not-having way. All this, of course, only if the blog failed in its primary purpose of making us wealthy internet blogopreneurs who could quit med school and live a life of leisure for rest of our days.  

Well, friends, that day has finally arrived. Buoyed by a 100% legitimate string of ad-clicks, Kevin and I have reached the rarified status of making $100 in advertising revenue over the course of only two years. Averaged over all of the time spent writing and brainstorming, we’re in the oft-discussed yet rarely realized realm of multiple cents per-hour earnings. 

 

While we contemplate which Cayman isle to retire to now that this gravy train is going full-bore, we're planning a celebration in the interim, funded entirely by this massive windfall. Expect a spread truly befitting our recent successes; every attendee will get at least 1-2 pretzels, maybe more.

See you there!

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What?: IDDx Earnings Extravaganza

When?: Saturday, March 27^th, 8PM - ???!?!?

Where?: TBD

Who?: Kevin, David, Julia, you, maybe Jess

                                                           Kevin is Fat Joe...

 

Kevin might want to know watcha thinkin' about.

Time is winding down on my psych rotation and it’s given me plenty of time to reflect on the experience. I think it’s safe to say most students do not go into medical school with a yearning desire to enter psychiatry, quite a shame really. This little odd niche of medicine has quite a lot to offer.

3 Reasons to enter psychiatry

1) The sweet life
It’s no secret that the work hours in psych are awesome. As a medical student I got into the hospital at around 8:30, rounded with the attending and resident (no prerounding) until 11:30, wrote my notes and done by 2pm at the latest. Hey, they don’t call it psychation for nothing. This sweet life style extends to the residents as well. They all come in at around 8 and are done by 4 or 5pm. And EVERYONE is happy. I think in all my other rotations, people are always bitching about something related to their work hours (and I haven’t had surgery yet). It’s really no wonder our friend Jess is seriously considering psych as his future career as a way to maximize the amount of time for his video games.

2) Helping the underserved

Everyone says this during their medical school interview, but if residency match is any indication, most don’t follow through. The patients seen on psych truly are the most in need. These are patients who are so sick that they do not even know they’re sick. Combined with inevitable social and financial losses, these are the neediest group of patients any clinician will see. If you truly believe in the schpiel you gave to the admissions committee, you should take a good hard look at psych.

3) Hilariously bizarre
Mental illness is weird, I mean really weird. When schizophrenics develop bizarre delusions, they can be so bizarre it boggles the mind. I had one patient explain to me that she can see people’s sin by staring into their eyes and that’s how she knows her stepfather was a murderer. Hilarious. Although it became significantly less hilarious when she ran into their house with a knife…

3 reasons not to go into psychiatry

1) You’ll forget everything you learned in medical school

I feel bad for saying this but psychiatrists really don’t know that much about medicine. When you become so specialized in psychological illness, you end up forgetting a lot about physiological illness. At my hospital, we had to consult medicine/derm/neuro/etc for every minor medical issue. Morning blood sugar 180? Stat med consult. Odd looking rash on hand? Holy shit we need to page derm. Maybe this isn’t such a big deal for the future psychiatrists but I would feel like I wasted 4 years of medical school learnin’ by going into psych. Going along those same lines, there are only about 15-20 drugs that are ever used in psychiatry. What’s more interesting is that they all seem to be able to treat everything. I got the feeling that regardless of what your patient has, you can just shout out a random psych drug and there’s a greater than 50% chance you’re right.

2) Holy ambiguity

Mental illness is ambiguous. After all, what separates someone who is truly sick from someone that’s just a bit of an oddball? Psychiatrists tend to refer to the DSM-IV as their holy grail of diagnosis but even then, there are a lot of patients who are right on the edge who end up getting treated anyways. What’s more hilarious is that they are allowed to write things like “Possible Axis II features.” For those who don’t know, Axis II refers to the range of personality disorders people can have that can be maladaptive. But when you just say “possible Axis II features” it’s so ambiguous that you’re essentially saying the person is a bit of a douchebag but you’re not sure why.

3) Nonmedical BS

Treating acute mental illness is only half the battle in most patients. I would say a huge majority of the time and effort spent on patients is in finding appropriate living situations for them after discharge. This involves a herculean effort between social work, PT, OT etc etc to find the right place to live and the necessary financial support. This ties directly into point #3 in the other section. If you love that stuff, psych is perfect for you. If you want to enter tertiary or perhaps quaternary care, worrying this stuff will make you want to end it all, and ironically maybe bring you right back to the psych ward.

Comic: Ideal vs. Reality - Psychiatry