David Gets Pimped

Our med school, like many others with a traditional curriculum, offers students a full three-month summer following the completion of their first year. This provides a valuable opportunity to gain more research or clinical exposure as well as a welcome reprieve from the constant flood of book larnin’ that demands almost all of the preceding nine months. I will be spending the time completing a research project in general surgery. One of the perks of my particular project is the chance to scrub in on a variety of cases with my PI, who is also a surgical attending. This is very cool. This also means I get pimped. This…not as cool.

For anyone familiar with medical school or residency training (or maybe even a medical TV show), the following will be no great revelation. Pimping occurs when junior trainees (med students, interns, residents) are asked questions of varying difficulty and/or obscurity by their superiors (typically more senior residents or the totem pole-topping attendings), often during rounds, patient presentations, or in the OR. As the pimpee, you’re put on the spot with a second or two to find the right answer and no other resources at your disposal. It is not unlike the common undergrad scenario in which the professor randomly calls on an often unsuspecting student to answer a question in front of the class.


Pimping comes in a variety of flavors. Older medical students have described its use as something of a punitive mechanism employed primarily against those who are unprepared, overconfident, or perhaps just annoying. For the most part, however, it functions as a valuable teaching tool; it takes a lot more study/review to be ready to answer a question you don’t know is coming. Further, the potential for shame is undeniably a major part of pimping’s effectiveness. Getting the answer right? Not particularly gratifying. Looking incompetent in front of an OR full of doctors and nurses? No thanks. After all, no one wants to look bad in front of his peers or, worse, the people who hand out the H’s. One’s only recourse is to prepare as thoroughly as possible for the case at hand and hope for a bit of good fortune in the question lottery.


So far, my experience as a medical working girl has been relatively painless. The attending isn’t grading me, so there’s no tangible punishment to be had for a series of incorrect answers. He’s also a cool guy, so he’s not interested in embarrassing me or fixating on minutiae. Basically, he or the senior resident assisting the procedure asks questions that someone with a year of med school – or at least a quarter of gross anatomy and some background prep – should be able to answer. Still, the exercise isn’t a walk in the park. Identifying real-life, bloody anatomy – especially if you’re looking inside-out from the view of a laparoscope – is a lot harder than picking out structures in Gray’s or Netter’s or the all-the-time-in-the-world-for-meticulous-dissection cadaver lab. And when the question is about anatomy, rather than the mechanism of some antibiotic/3 causes of X/common presentation of Y, it stings a bit more when you fail to hit the proverbial mark (“You don’t know what that is? It’s right there in front you…”).

All in all, getting pimped is sort of like med school in a nutshell – it’s not always fun, you periodically look stupid, and sometimes you have to walk the streets…er…

David and Kevin are awesome at How Bad Can You Be At Knowing Who People Are™

After a long break due to final exams and rugged mountain vacations, I am proud to announce that we have successfully completed the first year of medical school. I apologize for the intolerable aching that has surely penetrated your soul, loyal reader, as you have struggled to maintain the will to live during this blog’s extended hiatus.

To celebrate our triumphant return to the golden pedestal in your online lives, I present yet another random musing of arguable worth.

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Recently, during some downtime on a post-finals trip, Kevin and I played a popular game with a few med school buddies, Robby and John, that I will call How Bad Can You Be At Knowing Who People Are™. Kevin, Robby, and I are really, really good at this game. John is really, really old, so he gets to play the host to save his heart from the inevitable overexcitement that accompanies HBCYBAKWPA™. As host, John presented a picture of a classmate and asked if the three of us could pool our collective brainpower to identify him or her by name. Going through the class, the three of us, combined, could only pick out a first or last name for about two-thirds of the subjects. Keep in mind, this is after a year’s worth of classes.



I’m bad with names in general, and Kevin doesn’t speak the good English, so perhaps we lack the requisite skills to know who people are. However, a freak prosopagnosia outbreak notwithstanding, some responsibility belongs to the unique med school social dynamic. The shift from college to medical school is one of those lifestyle transitions that one is vaguely aware of during the admissions process, yet cannot truly be appreciate until being in the thick of the med school action. In many ways, at least for people coming straight from undergrad life, medical school is like College 2.0; we take more classes, sit for more exams, and waste a lot of time discussing what we’re going to be doing in a few years. We still have no money, and most of us are going further into the red. Yet people have far more independent lives and bring much more diverse backgrounds to each incoming class.

Beyond varied expertise in both baby-saving and non-baby-saving endeavors, students come from a broader spectrum of ages and life experiences than those one meets at earlier rungs of the academic ladder. During undergrad, if you live in a dorm, you see the same people daily; you share meals, do fun stuff together, and see the same friends before you go to sleep and as soon as you get up in the morning. In med school, many classmates have spouses and children and live far away. Classes last most of the day and studying demands much of the evening, so there’s a significant reduction in leisure time. Thus, despite having a class size of only 100-200 students, it’s often difficult to get to know each one of the people you see every day. Or, apparently, to even remember their names…

On the plus side, we now have our first elderly friend (Hi John!) and know what prosopagnosia means. On the down side, I have to live in fear of the moment when I ask a fellow classmate what year he or she is during a med school mixer next fall…

Kevin warns you about cranio-rectal impaction

Disease:
Cranio-rectal impaction (Having your head up your ass)

Symptoms:
Commonly misdiagnosed among the general population, a patient with cranio-rectal impaction will present with gross ignorance of current events or sociopolitical issues yet remain very outspoken. Unlike someone who is simply misinformed, people with CAI will claim to be experts in all fields of knowledge and refuse to acknowledge any information contrary to their own point of view (from inside the rectum). CAI patients are often combative, obstinate and generally annoying to be around.

Etiology and Epidemiology:
The direct cause of cranio-rectal impaction is, unfortunately, unknown but there are several correlative factors. Having a substandard IQ, illiteracy, and being Republican have all been traditionally correlated with CAI. However, recent epidemiological data has indicated a heavy correlation with extreme liberalism as well, thus suggesting a link between CAI and polarizing political views.

Treatment:
Standard treatment for CAI is difficult due to poor patient compliance. Symptomatic treatments via well-supported, cogent, arguments are usually useless, especially in cases of severe impaction. Family and friends of CAI patients are encouraged to take a hands-off approach and simply ignore the symptoms. Anecdotal evidence has suggested that unsuccessful attempts at treatment may exacerbate the symptoms, causing the patient’s head to be firmly impacted within the rectum.

Comic: Med Student Syndrome

Jess Judges People Who Take The Internet Too Seriously

Note: Jess, a frequent comedic muse for all of us here at IDDx, has chosen to grace us with his vitriolic brillance in this, the blog's inaugural guest post. Enjoy.
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In an effort to break the previously nigh-impenetrable color barrier of YM/IDDX, I have decided to end my months-long silence. Perhaps you’ve seen the way I seem to dominate the subconscious of our two gracious hosts and co-authors and wondered: “who is this mysterious and much-maligned ‘Jess’ about whom David and Kevin cannot stop thinking?” I know I have.

If you’re looking for a break from the pet peeves, the snap judgments, the arrogance, and general holier-than-thou attitude demonstrated by the Ubiquitous Duo, I’m afraid I’ll have to disappoint. In the spirit of this interblog, I’ve decided to contribute my own pet peeve, inspired by a recent firestorm of controversy surrounding David’s latest post. That’s right, Takes The Internet Far Too Seriously Guy, this post is about you. Your self-righteous but, ultimately, cowardly anonymous soapbox rant has found semi-permanent purchase in the electronic archives of Indifferential Diagnosis. Congratulations – if there’s one thing I love more than a good rant, it’s irony.

TTIFTSG, or TISG, for short, is an odd and unfortunate beast. Cursed with a chronic case of Perineal Silicosis, and a close relative of Self-Righteous About Obvious Or Long-Ago Resolved Causes Guy, he spends his evenings perusing and, usually, enjoying the assortment of witty banter that can be found on the internet. Usually benign, TISG has a proclivity for sudden bouts of ineffectual whining and self-righteousness which manifest, usually, in anonymous posts on blogs which have, intentionally or otherwise, touched him in a sensitive place. An ironic animal, TISG often vents his own insecurities by assuming the moral high ground over complete strangers, often engaging in copious amounts of projection in order to make himself feel like a sensitive, intelligent, and worthwhile human being. What places TISG an evolutionary stratum below his cousin SRAOOLARCG is that TISG often, by definition, hides behind the veil of internet anonymity to foist his presumed ethical superiority on others, thereby preventing any potential retaliation.

There are a number of logical fallacies inherent in our local variant of TISG’s behavior. In no particular order, they are:

1) TISG admits to having read at least ’10 other posts’ with ‘shit like this.’ Presumably, if it offended him in this post, ‘this shit’ offended him in these other posts – and yet, he visits this site frequently. Many times a day, in fact. That’s right, TISG – we can see you. In fact, I counter your rhetorical query with one of my own: who goes out of their way to read a blog, created by individuals he does not know, if it offends him so?

2) TISG has judged David and Kevin to be insecure, judgmental people based on their harmless, stream-of-consciousness rants in a blog predominantly intended for friends and classmates. His assertion is based on the UD’s habit of ‘going out of their way’ to judge others. By going out of your way to pass judgment on D and K, TISG, are you not every bit as insecure and judgmental as you accuse them of being?

3) That you continue to read the blog is evidence that you enjoy it. Therefore, one can only presume that you are looking to assure yourself that you can read this blog and still be a good person by condemning others – the difference between you and our hosts is that you, TISG, meant it. Don’t get me wrong, D and K mean every word – especially in re: me – but their intention is not to make anyone feel bad (though they obviously have), but to amuse others who enjoy such humor. You, on the other hand, are serious – and your intention was simple: to attempt (unsuccessfully) to make them feel bad for their work. I leave it to the kangaroo court of classmates and friends to determine which one is, as they say in ‘the biz,’ douchebaggier.

4) The simple truth is that David and Kevin’s posts are predominantly inspired by, to use your eloquent colloquialism, ‘shit like this.’ Without people who acted ridiculously, how would they propagate their insensitive and judgmental wisdom throughout the internet? The self-righteous hilarity of your comment is precisely what makes them, and their fateful readership, tick. That they are meant light-heartedly and sarcastically has obviously been lost upon you. Ergo, you’ve prompted precisely the sort of behavior to which you are opposed.

Still, I must commend you – comments like yours, coming from outside of the intended audience (comedically-astute and thick-skinned individuals) make this all the more enjoyable for those of us. Simply put, TISG, your presence, while confounding and ultimately self-contradictory, is panacea for a pair of writers with nothing better to do than belittle others for their own amusement – immediate reward for minimal effort, borne entirely of your embarrassing misstep. And make no mistake – this is embarrassing for you.

For those of you who want a one-sentence summation of this rant, here it is: the blog is called Indifferential Diagnosis for a reason. Thank you for coming, but check your soapbox at the door.

Unless you’re David or Kevin, of course. That’s just one of the many unfair societal double-standards to which we’re subjected.

I feel so much better about myself, now.

David Presents His #2 Pet Peeve: Considers It Tomorrow At Midnight Guy

It should be painfully (delightfully?) obvious that 1) Kevin and I enjoy ranting about random things; and 2) these rants are so inane and unproductive that each person who reads them finds himself or herself a bit dumber as a result. This bodes particularly poorly for Julia, whose previously ludicrous 200 IQ is probably at -5 now.

Nonetheless, in an effort to continue the general dumbing down of all those with whom I anonymously associate on the intertubes, I present my second greatest pet peeve of all: Considers It 'Tomorrow' At Midnight Guy (MG, because I'll definitely get tired of writing 'CITAMG' 20x in the next three paragraphs).

On the surface, MG probably doesn't seem like he'd be that annoying. After all, the next day does officially start at 12:00AM and, perhaps more importantly, you might find distinctions about when 'tomorrow' truly begins completely insignificant in the grand scheme of things.

Well, then, you'd be wrong. Sure, considering it to be tomorrow at the stroke of midnight doesn't necessarily hurt anyone, but MG goes far beyond this simple interpretation and uses it for pure evil. Most frequently, MG derails a random late-night social situation by being an unnecessary time-stickler:

Hero: Man, it's really late, I can't believe I have to get up so early tomorrow.
MG: You mean today.
Hero: What?
MG: You have to get up TODAY. It's past midnight, so it's actually the next day.
Hero: Gawd, why are you like this?

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Or, MG can make typical scheduling excessively difficult:

Hero (at 2AM): OK, so we're meeting tomorrow to discuss the project?
MG: You are correct, sir.
Hero: OK, later.
MG: See you Wednesday.
Hero: Wait, what? I thought we were meeting tomorrow...isn't that Tuesday?
MG: Today's Tuesday, tomorrow's Wednesday. Check your watch.
Hero: OK, you obviously knew, based on the context, that I was talking about Tuesday. You know on Wednesdays I teach that Being Awesome class and on Thursdays and Fridays I save babies.
MG: Yeah, but tomorrow's Wednesday.
Hero: Seriously...why?

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Thus, MG creates a significant hassle where there is absolutely no need for one. Everyone who knows him has to adjust their expectations purely because of his outlandish anal-retentiveness. No one really benefits, people are routinely confused, everyone dies a little bit inside, and sometimes people show up to meetings when no one else is there.

OK, end rant. It's way past midnight and I need to wake up early today...

Introducing: Indifferential Diagnosis

Greetings,

To the millions of loyal readers out there, we just wanted to give a quick heads-up that we decided to change the name of the site to Indifferential Diagnosis. We wanted to go with a more medically relevant name, but don't worry, everything else will continue as is. Same great taste with only half the calories.

The new website is http://iddxblog.blogspot.com, and going to the old site will just auto-link you here.

We managed to move all the old posts over so all the amazing content is still intact.  Unfortunately, the switch-over to the new site means we lost all of the comments on the older posts, so feel free to make it rain in that department.

Well, see you later!

Kevin and David