Friday, February 19, 2010

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

Monday, February 15, 2010

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!

--------------------------------------------

What?: IDDx Earnings Extravaganza

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

Where?: TBD

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


                                                           Kevin is Fat Joe...

 

Saturday, January 30, 2010

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.

Wednesday, December 9, 2009

David and Kevin present some old favorites



Almost 2 years ago, David and I started IDDx with the humble hope of turning this site into a blogging powerhouse that could be our one-way ticket out of the obvious career dead-end that is medicine. Clearly that has not happened. But we have still managed to build (and re-build) a loyal following of readers that have somehow found our inane drivel to be entertaining (or at least interesting in a car crash-y kind of way). We thought this would be an appropriate time to revisit some of our old posts as a kind of year-end-review and maybe serve as a best-of (or worst-of, as the case may be with Jess) list for the newer readers. (Re)Enjoy.

-Kevin and David


Medical student life: A few insights into the fast-paced world of call-taking, baby-saving, and retractor-holding.

David, Robby, Dan, Beth, and the Johns save lives while on vacation.

Kevin wishes these classes were real.

Kevin falls, David watches.


Pre-medical advice: Words from the arguably wise about facing the application gauntlet.  

David tells you what to do (in an admissions interview).

Kevin debunks 2 myths about med school.

David presents the 15-15-1 theory.


Comics: Only stick figures can provide a true window into the inner med student soul.

MCAT - Then and Now

OB exams are tricky

Ideal vs. Reality - Emergency Medicine


Guest authorsWho's better - Julia, Jess, Julia, or Julia? You decide.

Julia knows exactly the kind of doctor she will become.

Jess tries to reach the keeds.

Julia presents a landmark case of PMS.


Random thoughts, pet peeves, and theories about life: A potpourri of IDDx musings.

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

David has difficulty with doors.

Kevin contemplates the diet of the Little Mermaid


Friday, December 4, 2009

David treats a wise child

During a recent shift at a pediatric urgent care center, a young boy came in with a scald burn to his arm. As I debrided his wound, we discussed some of the pressing issues of youth, including how awesome dinosaurs are and whether or not mall Santas are real (consensus: of course they are). All of 5 years old, he was a total fighter and didn't complain one bit throughout the procedure. 

After a heated debate about how fast Spot runs - we both said some things we didn't mean - the following exchange occurred:

-----

David: This must've been pretty scary, but you've been doing great.

Kid: Hey, I'm not scared of anything. 

David: Nothing? Really (unsure whether or not to entrust him with my fear of clowns)? That's pretty impressive.

Kid: Nope, nothing...

        ...except bush babies.

-----

Mildly confused about what he was taking about, I allowed the conversation to shift, and soon he was all fixed up and on his way home. Later, a quick Google search provided the images that will give me night terrors for the rest of my natural life.


Wise choice, kid...


Tuesday, December 1, 2009

Kevin might save babies like it's his job

The next installment of our career choice series.


3 reasons to do pediatrics
1. Congenital disease is fascinating
The magical journey from fish-like zygote to full blown baby is fraught with wrong turns and side streets to the bad part of town. Sometimes what comes out of the oven isn't what you expect. While most adult medicine follows some kind of logical pathology and things often dont stray too far from the norm, the presentation of congenital disease can be so bizarre it boggles the mind. Situs inversus (your insides are backwards), lissencephaly (your brain is flat), Transposition of the Great Vessels (your aorta and pulmonary artery are plugged into the wrong ends of the heart) are just a taste of some of the things you see as a pediatric specialist. A lot more interesting than COPD or diabeetus.

2. Plenty of subspecialties to suit your fancy
This is likely personal to me but during the first two years of medical school I always pictured pediatrics as a primary care residency with no subspecialty tracks. “Well where do pediatrics cardiologists come from?” you might ask. For some reason I thought you got there through internal medicine, cardiology then a fellowship in pediatric cardiology. Clearly I’m an idiot (but hopefully someone out there on the interweb is with me). In reality pediatrics is just like internal medicine, except you treat little people. This also means there’s a huge range of subspecialties to choose from, and as I mentioned in point #1, you get to focus on a lot of congenital malformations rather than the end result of a lifetime of self-neglect.

3. Saving lives (no seriously)
Adult medicine often revolves around management of chronic disease. Patients undergoing slow, methodical heart failure/COPD/diabetes/lupus(sometimes it is lupus), are never fully cured. The best you can do is manage their symptoms in order to extend/improve their quality of life. On the other hand, pediatrics is full of one-off illnesses that you can definitively treat and they can be on their merry way. Back when medical school was only 1-semester long and involved memorizing the 4-humors, congenital malformations was often a death sentence. Fortunately, we've come a long ways from then and there's a myriad of treatments for what ails children. You have a giant septal heart defect? No problem. Bowels outside the abdomen rather than inside? Just shove that right back in there. As a pediatrician you're really making a huge impact in the "total # of years saved" category. If there was a MD fantasy league, you'd want at least 1 pediatrician to pad those stats.




3 reasons to avoid pediatrics
1. Bad logistics
Unlike what your career counselor might have told you, you should never choose a career just because you like the subject matter. Every field has pros and cons in terms of call structure, location constraints, average salary etc etc that are all vital in making an informed career decision. For example, if you love cardiology but are on the fence on whether to treat big hearts or little hearts, here are some things to consider before you devote yourself to baby saving. Despite all my talk about congenital disease, kids are actually pretty healthy. And being healthy is bad for business. Because of the low demand, you will also make less money than your adult-caring counterparts. So do you really love congenital disease so much that you're willing to take a $100,000/yr pay cut? Furthermore, there are significantly less pediatric specialists than there are adult specialists. Because there simply isnt as many you, your group will be small, which is synonymous with lots and lots of call. What this also means is that there isnt a need for a pediatric neurologist in every town. If you want to subspecialize in pediatrics, you're almost guaranteed to be forced into a large-ish city in order to field the necessary amount of patients to stay afloat. Sorry, no country livin' for you.

2. Noncompliant patientsparents.
When I asked a lot of pediatricians why they decided to do pediatrics and not internal medicine, they often cited that they were frustrated by noncompliant patients such as COPD'ers that kept smoking or CAD'ers that kept eating McDonalds. For some reason, I have no problem with that. As long as the check clears, I dont care what you do. My job is to give you the knowledge, services and tools to allow you to live a healthy productive life. If you refuse, so be it. In pediatrics, the kids barely know what's going on so the work falls on the parents to follow through with the care plan. In this case, noncompliance by the parents means the kid is getting hurt. This I have a problem with. Even though CPS can step in during extreme cases, theres a huge gamut of noncompliance where you really can't do anything even though you really want to punch them in the head.

3. Child abuse
During my peds rotation I had the displeasure of seeing 3 child abuse patients. One of was severely overfed, one was severely underfed and the 3rd was an infant that had a broken femur and two broken clavicles. Obviously by ferreting out child abuse you're saving the child, but it's still a terrible thing to be a part of. Seeing that on a regular basis can be a real drain on the mental psyche.