Residency

Oops: A glitch in the USMLE Step 2 Clinical Skills exam erroneously fails some medical students

“Dr. Scoles said that he was personally calling those who the problem affected. The error is ‘something that the organization deeply regrets, but it [uncovering the error] shows the kind of process that we’re committed to, to keep checking and rechecking,’ he said.

Of the 38 students affected, 14 were from U.S. medical …

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News flash: Dermatologists are better than non-dermatologists in diagnosing skin lesions

“Dermatologists correctly diagnosed nearly twice as many neoplastic and cystic skin lesions as nondermatologist physicians, according to research presented at the annual meeting of the American Academy of Dermatology.

Dermatologists were right 75% of the time when diagnosing neoplastic and cystic skin lesions, compared with nondermatologist physicians, who were right about 40% of the time.”

I guess …

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Bard-Parker asks: “Can the availability of fellowships leading to high-paying specialist postitions explain how IM and Pediatrics outperform FP?”
The answer is yes. Consider the following rant from an unhappy FP:

Finished FP Residency in 1992. The worst decision I ever made in my life was Family Practice! For the last 16 years or so I have have watched it continually decline in every single way. My …

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A resident anesthesiologist loses a malpractice case after misrepresenting himself as an attending

A patient suffered chronic leg pain and nerve damage after an epidural during childbirth. The resident was “only his fourth day of his rotation on the labor-delivery floor, and who had done only a handful of combined spinal-epidurals.”

One cardinal rule during residency – it’s always ok to ask for help.

Fast-track cardiology fellowships

To become a cardiologist, one has to complete 3 years of internal medicine followed by 3 years of cardiology. To avert a shortage of cardiologists, the American College of Cardiology is proposing a “fast-track” – skipping the last year of the internal medicine residency. The obvious losers would be the internal medicine training programs which will potentially lose senior residents to the cardiology fellowship.

Sleepy docs and the risk of car accidents

Interesting study from today’s NEJM, correlating the odds for reporting a motor vehicle accident and an extended (>24 hrs) work shift:

According to a study in this week’s New England Journal of Medicine, medical interns who worked shifts lasting 24 hours or more were twice as likely to be involved in serious crashes after work than doctors who put in fewer …

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Amazing stories of doctors who practice with disabilities

Practicing medicine can be hard enough. I can’t even imagine going through medical school and residency being blind or deaf.

A resident tells us what he really thinks

As someone who went through a city hospital residency, I can understand that sometimes things look pretty bleak. Complaining about insurance companies, lawyers, or the government is fine – however, blaming the patients isn’t really the answer.

Downtime and a word on cases

Apologies for the extended downtime today. If it happens too often, I may be shopping for a new server to host the blog.

I have had a great response to the recent case discussions. However, there has been some concern regarding patient privacy. A couple of points to clarify. First, all identifying information has been removed, and the presentation changed. For instance, a “65-year old man shoveling …

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MRI backlash: Crackdown on costs of imaging

“Harvard Pilgrim Health Care, based in Wellesley, Mass., started a preauthorization program in July. Practices are required to submit information to National Imaging Associates, a radiology utilization management firm based in New Jersey, before ordering a test. About 10% of the time, doctors end up having to discuss the case with a National Imaging Associates representative, who may suggest a different course …

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The DTC Debate

Trent responds to my articles on DTC marketing yesterday. I’ve read and appreciated his prior articles detailing the economic impact of DTC marketing. He writes:

Anyway, the other point that needs to be made is this: even if you think that direct-to-consumer advertising of pharmaceuticals needs to be restricted, it is extremely disingenuous for physicians to make these claims. For they are direct beneficiaries of …

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A Precarious Exchange

What an interesting article in bringing up a salient point.

To a physician, this scenario is all too familiar “” we call it “sign-out” “” but in a way, the anthropologist would be right: it is a peculiar ritual, this daily transfer of patients from one medical team to another. As I write this, at the end of a frantic afternoon, 18 residents are simultaneously handing …

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Does surfing for health information do you more harm than good?

“. . . people who use their computer to find out more about their condition end up in worse health than those who do not.”

I certainly support increased information flow and patient empowerment. However, there is a reason why physicians endure 7 or more years of medical school and residency. It is how the information …

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Music and medicine

It is thought that a connection between music and medicine exists – as evidenced by the prevalence of medical community orchestras. AMNews highlights the VA-National Medical Musical Group, while during residency, I used to play in the Longwood Symphony Orchestra.

Saturday reading

Lots of interesting stories to start your long weekend.

Advice for patients who want to buy medications online and limiting physicians’ liability:

Limit your involvement when it comes to Internet pharmaceutical purchases. Serve only as an information resource for your patients. Give them information from the FDA about the risks of getting drugs through the Internet, then let them make informed decisions.

Lessons in residency that don’t always apply …

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The future of primary care

The New England Journal published a sounding board piece on the future of primary care in the United States. The authors suggest that one paradoxical reason is the increased exposure to primary care in residency training:

But an additional possibility, albeit an apparently paradoxical one, is that the decline is due in part to the successful efforts by medical schools to increase students’ exposure to primary care practice. …

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More on good business vs good medicine

Here’s a cynical letter from an internal medicine physician found on Internal Medicine News:

The headline, “Internal Medicine Seen as Unmanageable Career Choice,” hit home.  One of the last sentences, however, demonstrated that someone missed the boat:

“The initial results suggest that students respond to a structured curriculum, which gives them the sense that internal medicine is a manageable career.”

 

Ouch.

 

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The medical world that awaits this resident

Our first winning entry is a story from a grizzled resident:

A lot is on my mind these days. I am thirty years old, I have a one year girl who is turning into an Olsen Twin with melodrama substituted for’acting’. I just had a new baby boy 7 days ago who has decided to make me relive my intern year all over again; sleepless nights and …

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Should psychologists be able to prescribe?

From today’s Boston Globe comes a story detailing the controversy about allowing psychologists (non-MD’s) to presribe medication. The state of Louisiana recently passed a law allowing this to happen. Here are some excerpts detailing the arguments on both sides:

. . . [the] president of the American Psychiatric Association, calls the Louisiana law ”really scary,” saying undertrained nonphysicians will harm, and perhaps kill, patients. ”Without a …

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A doctor is sued for following the USPSTF guidelines on prostate cancer screening

I came across this case from JAMA in January, 2004. Here are the basics:

1) A third-year resident, Dr. Merenstein, saw an educated 53-yo man for the first time at his resident clinic. A PSA level had never been done before.

2) A documented discussion about the risks and benefits of screening was done, and the patient was enouraged to consider the information. He was never …

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