Faith & miracles

This is a lovely article to read in the spirit of the season. :)

As we take stock of what we've accomplished and where we've failed to measure up, I find my scowling mask of medical skepticism falling away. I have to admit that there is so much wonder and mystery that science and medicine still can't explain.

- Wonder Abides (NPR)

Tips for the residency interview trail

I'm not going to be bashful about this. I'm known to give pretty good advice. Maybe because I'm a slightly anxious person and a perfectionist so I'm always (over)thinking things? (But then again, one could be too anxious and indecisive making him/her a poor go-to person for advice.) I think it's simply because I do my research before and after an event, evaluating whether or not the advice I got was actually helpful and what advice I would give to my future self and to others. Anyway, I've been on the interview trail for 3 weeks now, and I'm almost half way through. I want to share some tips I've thought of along the way:

• Schedule interviews with ample time in between for travel and rest. Back to back interviews (one day after the other) are absolute no-no's in my book. You might think you're a superhero after going through core surgery and core medicine in MS3, but you don't want to risk it for something this important. And if you're thinking, "well I don't really care about one of the interviews," then you why are you going at all?

Just

Our program director pointed out during her orientation presentation that she's not "just" practicing general medicine, she is practicing medicine. Do you ever hear anyone saying, "I'm just going into orthopedic surgery?"

I'm going into internal medicine, planning to do just general medicine - either as a hospitalist or a PCP or both. :)

Taiwan tops the expat health care charts

Nearly seven in 10 expats in Taiwan say they spend less on health care than they used to before moving – compared with a global average of just three in 10.

The FCO [Foreign and Commonwealth Office] states in its guide to the country: “As is to be expected of a nation as developed as Taiwan, health care facilities and medical equipment are of outstanding quality. Since 1995, Taiwan has had a socialised health care plan, the National Health Insurance (NHI) which covers nearly all citizens.”

- The Telegraph

My thoughts: Of course the survey is biased, in particular a lot of selection bias. Its respondents are not randomized, so you don't get a good representation. Also, the more important question is do you get quality health care for your dollars spent, however much less you do have to spend? That was a major debate in the comments section... I wish I had more time to look into this more, but some anecdotal "evidence," I've heard from friends who've spent time in Taiwan that you do get decent healthcare in Taiwan. I don't think anyone can beat the technology and innovation of the U.S., but we already know that U.S. health care system is far from being a model one.

Also, this is another piece of real life evidence that a country can be non-socialist and still have a socialist health care finance structure and not combust into a complete socialist government. So surprising! (Not.)

Things making me happy this week

• Journaling: it’s so wonderful to indulge in your own mind. It’s like taking a walk after a long day of sitting at a desk. You forget you had such wonderful muscles/thoughts.
• Learning so much from my attendings (my old ICM preceptors…we go way back)…Dr. H and Dr. S have both taught me so much about not just diagnosis and management of specific disorders, but clinical thinking and management. Here are some examples -
• Be mindful of the labs & tests you order: Don’t order a set of labs just because some preceptor at some point taught you to do so, think about whether or not the results would actually change your treatment plan. For hyponatremia, if you have a clinical diagnosis of true hypovolemia causing a hypotonic hyponatremia, then just start a trial of IVF hydration, and see what happens…if they respond, then that confirms your diagnosis! If you actually got labs, and the results point more toward SIADH, then what are you going to do with that information? Give the patient a vaptan or demeclocycline when they’ve already responded to IVF hydration? No.
• Just because a patient’s outside PCP or previous physicians have decided that the patient is at her baseline but she’s clearly still hypertensive or hyperglycemic, don’t just assume this is just her normal. It’s not normal! Don’t give into clinical inertia!
• Anticipatory medicine: even though the bump in creatinine might not be technically acute renal failure (>0.3 increase in Cr, >50% increase in Cr, or UOP <0.5L/kg/hr over <48 hours), doesn’t mean it won’t be by the next AM labs.
• Look at everything in the patient’s clinical context! If the patient is floridly psychotic and/or unstable, you worry more about their mildly abnormal lab values and vitals than if they’re clinically normal and at baseline. You widen your differential to include more rare and scary diagnoses, and order more labs to rule them out.
• Even when I’m at my loneliest and most down-trodden moments, I’m so appreciative of the support and love I have from my friends. Remember that love. Remember all the moments we’ve shared together and will continue to have together and let that give you strength!
• Getting that 7-8 hours of sleep Wednesday night. It’s true. Your brain performs better on more rest than on more information.

New technologies fuel patient participation and data collection in research

The changing dynamic of health studies driven by “big data” research projects will empower patients to become active participants who provide real-time information such as symptoms, side effects and clinical outcomes, according to researchers. The analysis lays out a new paradigm for health research, particularly comparative effectiveness studies that are designed to assess which therapies work best in routine clinical practice.

"When linked to the rest of the available electronic data, patient-generated health data completes the big data picture of real people’s needs, life beyond the health care system, and how changes in health and health care lead to meaningful changes in people’s lives."

- sciencedaily.com (New technologies fuel patient participation and data collection in research)

My thoughts:
Interesting idea. But still some obvious flaws. Must be some self-reporting bias among other biases... not unlike that of patients rating doctors, clinics, and hospitals... -_-

Lessons Learned Circumnavigating the Globe

"This was the first time that I realized that my own country, where we lament bad health care and florid corruption, could be seen as privileged. No child here has to die from hydrocephalus. That day I realized that the people for whom I advocate are more than the people of South Africa, more even than the people of Africa. As I walked out of the orphanage, all I could think of was how to fix this – this country I had never before seen nor felt particularly drawn towards. In the global village, the disenfranchised of Vietnam – and of any other country – are our compatriots, too."

--Lessons Learned Circumnavigating the Globe

The most powerful thing you can do is to simply write about what you know.