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.

Lessons in Global Health: What Every Student Should Know

• One of the first and most important lessons I learned was that earlier in your career, you will receive far more than you will be able to give.
• Nonetheless, they were still important because they taught me the complexity of navigating research design and protocol in other  countries, the uncertainty involved with international endeavors, and the persistence that differentiates those who remain in global health and those who come to visit for a short time.
• They [the patients] sacrificed, not necessarily because they believed it would make a difference in their lives, but rather because in poorer regions of the world, relationships and hospitality are valued sincerely.
• Another important insight I gained only by taking chances was that you are your only limitation.
• One last lesson I learned was that as a student in global health, your biggest contribution will be determined by the greatest need.

AMSRJ Spring 2014 Vol. 1, No. 1

The use of sterile maggots in wound management

Learned today that this is a thing. The joys of being on psych consult!

• It’s long been recognized that opportunistic infestations by maggots of wounds sustained in battle can prevent infections or even septicemia
• It was widely used until early 1940s when antibiotics were introduced
• How it works:
• Debridement due to maggots’ production of enzymes including collagenases, chymotrypsin-like & trypsin-like enzymes
• Disinfecting of the wound via their anti-microbial secretions
• Stimulates wound healing possibly by stimulating fibroblasts
• It’s like the super early version of wound vacs…with anti-microbial properties.

“I believe empathy is the most essential quality of civilization.”

 — Roger Ebert (RIP). A physician without empathy - that’s a scary human being.

You know you're supposed to be in medical school when

You stay after clinic is over for over an hour to dilate your friend’s eyes, play with the direct and indirect ophthalmoscopes trying to get a good view of her retina, describe your findings…be confused by them, but then have them confirmed by the attending with diagnoses of tilted disc and peripapillary atrophy 2/2 severe myopia. <3

Looked something like this: