I had a chance to “moonlight” in the internal medicine “drop-in” clinic at the Kaiser Medical Center in San Francisco while I was finishing my residency and endocrinology fellowship at UCSF.  I was superbly trained in in-patient care and there was no IV or PA line that I couldn’t put in with my eyes closed.  I was comfortable taking care of really sick people and thrived on complex, acute cases.  I knew ...

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How many students enter college and immediately proclaim that they are  “pre-med?”  Often this declaration is accompanied with an already well thought-out choice for his or her future specialty. This incredible ability to see into the future must be hereditary, as I have had 3 or 4 different parents tell me about how their kids are going to have to choose between medical school A and B, and/or how Johnny ...

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If you are a second-year medical student, there is one thing on your mind at this time of year: Step 1. Although scary, there are things that you can do to help calm your anxiety and get your best score. Set a goal In my opinion, before you start really preparing for Step 1, you should have two things clearly in mind: where you are with your score and where you want ...

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In my first week of the 3rd year surgery clerkship, I was introduced to some of the "Rules of Surgery." For example, "All bleeding stops eventually," or, "Everyone doesn't need to die with an incision," and even "The enemy of good is better." Boarded for this particular afternoon was a pancreaticoduodenectomy (the Whipple procedure), which for students is known to be a must-see operation if given the opportunity. However, the night ...

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If Dr. Ezekiel Emanuel gets his wish, tomorrow’s physicians won’t deserve to be paid as well as physicians today because they won’t be as well trained. Dr. Emanuel, a brother of Chicago Mayor Rahm Emanuel and a chief apologist for the Affordable Care Act, is the lead author of a startling opinion column in the March 21 Journal of the American Medical Association.  He argues that there is “substantial waste” in ...

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I eyed my chat screen with a good amount of suspicion. A friend of a friend who I had rarely spoken to had initiated a chat conversation with me with the opening line “How are medical school apps going?” The cursor blinked in anticipation. I began to think about possible ulterior motives that she, another pre-medical student, could have had. Perhaps she just wanted to use me as a comparison for ...

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I have worked in continuing medical education for 12 years and the argument over industry support of CME has grown tired and wearisome. Truth be told, I’m sick of it. I have always been a staunch defender of industry support of CME – and still am, for the most part – but listening to the same old arguments on both sides of the issue has become akin to the Elmo ...

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So this is what it feels like to have a rush of adrenaline in crisis—a potent mix of excitement and panic. I yelled out the patient’s name and shook him. No response. The only sounds were the shuffling of the sole nurse at the foot of the bed and the electronic hum of the myriad medical machines decorating the room. I slammed my fingers into the patient’s carotid arteries. No pulse. As ...

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Residency directors have a challenging job.  They are entrusted with selecting young doctors and training them over the course of several years.  Newly graduated medical students are thereby turned into internists, surgeons, radiologists, pathologists and the like.  Fellowship directors build upon this foundation with extra training, setting the stage for these graduates to become clinical experts in their respective fields. The Maintenance of Certification (MOC) process adds an additional and continued ...

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Doctor, do you know a lot about human nutrition? You said "yes?" Congratulations, if that is true. But I suspect that South Carolina Congressman Joe Wilson's infamous quote "you lie" is applicable. American medical schools traditionally have done a horrible job with their curricular treatment of clinical nutrition. University curricula are controlled by the faculty and, when the faculty don't know or care much about a topic, it often gets short shrift. I ...

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