http://clinical.amandaxi.com/

tastefullyoffensive: [artjcf] Sadly applicable to most of...

Sat, 07 Jun 2014 22:30:07 -0400

tastefullyoffensive:

[artjcf]

Sadly applicable to most of us…

vicemag: These Drugs Were Prescriptions Before They Hit the...

Sat, 31 May 2014 14:22:20 -0400

vicemag:

These Drugs Were Prescriptions Before They Hit the Streets

Interesting!

Being a doctor was once a job with great purpose. Now it's just a business

Tue, 25 Feb 2014 11:37:24 -0500

Being a doctor was once a job with great purpose. Now it's just a business:

aspiringdoctors:

compoundfractur:

Nirmal Joshi: The ‘free market’ approach to healthcare means seeing more patients in less time. We’ve lost the human connection in health reform.

This is a call to begin a spirited discussion centering on such real healthcare reform. I am not naive to the hard economic realities of healthcare delivery or how civil discussions on reforming healthcare payments need to continue. However, meaningful and lasting solutions will not be found in models that commoditize health and continue to be based on a foundation of reward and punishment alone. They will be found in models that bring back the joy of healthcare to professionals who deliver it – physicians such as me and countless others who seem to have lost the single most powerful driving force – purpose.

An outstanding piece on health care reform from the perspective of a doctor.

This verbalizes so many things I have felt!!! Please read!

I hope I don’t lose my intrinsic motivation as I move forward with my medical training.

The Traits of a Winner

Wed, 15 Jan 2014 22:46:20 -0500

The Traits of a Winner:

onlinecounsellingcollege:

1. They have a dream. Without a dream, our life lacks focus – and we’re in danger of drifting and going nowhere at all.

2. They prepare for whatever they need to do – and knowing they’re prepared breeds inner confidence.

3. They are totally focused on what’s happening now – and are not…

Yes. This.

HealthCare.gov: How political fear was pitted against technical needs

Thu, 21 Nov 2013 19:10:08 -0500

HealthCare.gov: How political fear was pitted against technical needs:

Fear of political blowback and lack of central oversight contributed to the failed rollout of Obama’s health plan.

Interesting look into the years leading up to the launch of healthcare.gov. We know things aren’t working the way they should be, so let’s just stop bickering and get a solution going.

hi amanda, I've been following your blog for the past couple of months and am a senior pre-med student right now. i'm planning on taking the MCAT next summer and applying to med school after that. i'm almost 100% sure that i don't want to go to a med school with a competitive environment and the collaborative style is probably the route i want to take. do you have suggestions on how to narrow down my choices?

Fri, 01 Nov 2013 14:43:18 -0400

Hey Anon:

Thanks for following my blog!

As for narrowing down options for a friendlier, collaborative environment, that’s a tough question. I’d say that one way schools try to minimize unhealthy competition is by removing the tiered grading system, but this doesn’t really help narrow things down a ton since numerous schools have switched to a P/F system. Another thing you could look for is how the school encourages team-based learning and collaboration between the student body - I do believe that by creating an environment where it’s the norm to work with your colleagues, schools setup a great learning environment for everyone involved. Finally, the best test for determining whether a school has a competitive environment is through the interview day. You really learn a lot about the students, faculty and staff when you visit the school for the interview. Usually there is a time for applicants to talk frankly with students (so whatever they say will have no impact on your final admissions decision), so use that time to straight up ask about the competitiveness of student body. Keep in mind that every school has “gunners” - that’s just the reality of any highly competitive professional degree. That being said, I do believe that there are schools out there that are set up to attract the collaborative-type of applicant (OUWB included!).

Please let me know if I can expand any further and good luck with your application cycle!

-Amanda

oupacademic: On 1 October 2013, the Affordable Care Act will...

Tue, 24 Sep 2013 03:32:11 -0400

oupacademic:

On 1 October 2013, the Affordable Care Act will open enrollment and become effective throughout the United States. Still don’t know what this means? Check out our reading list.

Health Care Reform and American Politics, Revised and Updated Edition by Lawrence R. Jacobs and Theda Skocpol

The Health Care Case: The Supreme Court’s Decision and Its Implications edited by Nathaniel Persily, Gillian E. Metzger, and Trevor W. Morrison

The Tough Luck Constitution and the Assault on Health Care Reform by Andrew Koppelman

Caring for America by Eileen Boris and Jennifer Klein

Food, Economics, and Health by Alok Bhargava

Insecurity, Inequality, and Obesity in Affluent Societies edited by Avner Offer, Rachel Pechey, and Stanley Ulijaszek

Health and Social Justice by Jennifer Prah Ruger

The Oxford Handbook of Health Economics edited by Sherry Glied and Peter C. Smith

The Oxford Handbook of the Economics of the Biopharmaceutical Industry Edited by Patricia M. Danzon and Sean Nicholson

The Oxford Handbook of the Social Science of Obesity edited by John Cawley

Looks like a good list.

NYT - Medicine's Search for Meaning

Sat, 21 Sep 2013 09:44:13 -0400

NYT - Medicine's Search for Meaning:

I heard Dr. Rachel Naomi Remen speak at an AMWA conference. Her voice was so soothing and her stories, powerful. I’m hoping for an opportunity to read her books soon!

This, my friends, is scary. More details from the CDC in their...

Tue, 17 Sep 2013 19:12:05 -0400

This, my friends, is scary. More details from the CDC in their comprehensive threat assessment.

The Gesture

Mon, 16 Sep 2013 11:51:00 -0400

It was a quarter past six in the evening. The day team had just completed their sign-out to us. As we sat quietly along the periphery of the trauma bay getting oriented to our list of patients, a small army of hospital personnel started trickling in. We were expecting company.

He was rolled into the first slot. From behind the desk, I tried assessing how serious the injuries were, but the crowd obstructed my view of the patient. Eager to help, I put on a pair of gloves and approached the stretcher. It was a mess of joints sprouting out of awkward angles and blood painting abstract images across his body. As the primary survey was conducted, I watched the organized chaos unfold from the sidelines.

When the team leader called for a secondary survey, I stepped up to help roll the patient. I had a front row view of at a mangled extremity and blood soaked sheets. After the spine and rectal tone was cleared, we gently laid him back down. Meanwhile, supplies were being gathered for intubation. In his confused state, he kept trying to sit up and move his dislocated upper extremity. I reflexively held his arm down in an attempt to stabilize the field for airway access.

His eyes turned toward me as he asked, “Can I get up now?”

I shook my head as I responded, “No sir, we’re trying to help you. You need to relax.” As his arm relaxed, his eyes remained transfixed on mine. I continued, “You’re doing great.” Suddenly, his head flexed up and his arm resisted mine. Blood spattered everywhere as we tried to control his movements.

I tried again, “Sir, you need to keep your head down. We’re trying to help.”

His eyes drifted toward my voice again as he replied, “Can I get up now?” I shook my head in response and felt the tension from his arm fade away. His eyelids drifted downward as the endotracheal tube was placed.

Hours later, we were called to his bedside. Although he had been primarily stable, his vitals dipped in and out of tumultuous waters. Our team was there to place additional invasive lines. As the area was prepped and draped, his hand kept grabbing at the resident. She motioned toward me and I grabbed his hand to keep it from distracting her. His fingers closed tightly around mine.

The area was prepped and my arm covered by a sterile drape. Underneath the blue barrier, his grip was strong, but frigid. I squeezed for reassurance. His eyes moved to meet mine; they looked confused and frightened. I checked the monitors for his vitals – stable. Suddenly, he started shivering in response to the hypovolemic state. I asked for warm blankets and bundled his exposed body. As more sedatives were pumped into his IV, his hold slowly loosened.

Since starting clerkships, I have often felt like a fly – curiously buzzing around and always in the way. Prior to this experience, I firmly believed that medical student rotations offer the illusion of contributing to the healthcare team and rare moments to truly assist. The reality is that in an effort to advance our medical knowledge, we can hinder or delay healthcare. But as I held this man’s icy hand, my paradigm shifted; in this moment, I was a buoy keeping him afloat.

Two weeks later, I went up to his room. I had been following his recovery through his electronic medical record, but wanted the opportunity to speak with him. I peeked my head from behind the curtain and I saw a man deep in thought. He was sitting up in a chair covered with bandages. Healed lacerations peeked out from under his gown.

“Hello, sir,” I said as I walked toward him. “I’m Amanda, one of the medical students in the trauma bay when you were brought in.” His eyes lit up as they met mine. He then held out his hand. I reached out to be greeted by a grasp that was familiar and warm.

Perhaps I was hormonal when I saw this the first time, but tears...

Tue, 03 Sep 2013 04:55:12 -0400

Perhaps I was hormonal when I saw this the first time, but tears actually welled up in my eyes. Solid work, Cleveland Clinic.

"Scientists have given a new name to the deaths that occur in surgery after something goes..."

Tue, 20 Aug 2013 18:32:00 -0400

“"Scientists have given a new name to the deaths that occur in surgery after something goes wrong—whether it is an infection or some bizarre twist of the stomach. They call them a “failure to rescue.” More than anything, this is what distinguished the great from the mediocre. They didn’t fail less. They rescued more."”

- Dr. Atul Gawande, Commencement Address at Williams College

http://www.newyorker.com/online/blogs/newsdesk/2012/06/atul-gawande-failure-and-rescue.html

Nathan Henrie | Interview Season Tips for Fourth Year Med Students, Part 1

Mon, 19 Aug 2013 00:39:50 -0400

Nathan Henrie | Interview Season Tips for Fourth Year Med Students, Part 1:

numberneededtotreat:

I’m just starting down this road and these look like some great tips from Nathan Henrie. I’m looking forward to the rest of the series.

This will come in handy…

NYT - Beautiful Pathologies

Sun, 18 Aug 2013 17:35:00 -0400

NYT - Beautiful Pathologies:

Life is a balance - while organ transplantation often requires the loss of a life, it is also symbolic of new beginnings for the recipient. It is the greatest gift one can give to another human and an honor when medical students have the opportunity to be part of the procedure.

Hi will you continue to blog? Would like to keep reading. Thank you

Sat, 17 Aug 2013 23:49:49 -0400

Hey there!

Sorry about the radio silence on my part - clerkships really do take a lot out of you [especially since I’ve been on night float this past week!]. Keep in mind that I’m still contributing to The Differential and Med School Insight on a regular, weekly basis, so try checking those two places for some of my work. Otherwise, I’ll be a bit more frequent about posting again when I’ve completed my Surgery clerkship [this Thursday!].

Thanks for the ask!

-Amanda

A Quick Guide to Chest X-Ray Interpreting

Sat, 17 Aug 2013 17:47:42 -0400

A Quick Guide to Chest X-Ray Interpreting:

aspiringdoctors:

cranquis:

blue-lights-and-tea:

rjjaramillo:

A systematic approach to Chest X-Ray (CXR) interpretation is essential to avoid missing significant pathological changes. With time and practice, interpreting CXRs will become easier, but first you have to find an approach that works for you.

Useful!

Very useful. And this guide even includes the most-often-pimped question about interpreting xrays — "What’s the first thing you should check on an xray? Be sure it’s for the correct patient!"

Awesome!

COME AT ME BRO.

Just kidding! runs away and hides

Great resource!

Hi Amanda, I would like to start an AMWA branch at my school. I am aware of the logistics of starting one, but I'm not creative enough to come up with ideas for member participation! If you have any suggestions, they'd be much appreciated. Thank you!

Mon, 29 Jul 2013 18:54:54 -0400

Hey there!

I’m sure you’re plenty-creative but just need a little inspiration to get the gears turning. Either way, here are some ideas for getting going:

Begin with a strong team

Recruit a strong Executive Board to help with the process of recruitment and event planning. Once you have a couple of devoted individuals on-board, the rest is just fun and games [and sometimes a bit of stress…]. Listen to everyone’s ideas and try to come up with a skeleton or outline of how you want the year to run. Don’t try to convince yourself that this plan is set in stone, however, refer to it every once in a while for guidance.

Quality attracts quantity

The most important aspect of starting a successful organization is quality. If you offer something that your peers cannot get elsewhere, they will eventually join. It’s the same in business and any other market. So before throwing together something haphazardly, consider if this is something you’d take time out of your busy day to attend. If not, then you might want to rethink your strategy. One example of this for the AMWA Branch at OUWB was the “Dinner with a Doctor” series that I started. Each month, a female physician would host an intimate dinner at their home. Not only did it offer the opportunity to network with successful women in medicine from the community, but it also provided a comfortable environment for frank discussion and everyone left in a blissful food coma.

Constantly reassess

Perhaps your first event that you were expecting a huge turnout for didn’t go exactly as planned. Can you solicit feedback from attendees? Can you identify a particular reason why it didn’t go as planned? Perhaps something as simple as the event being too close to an exam or overlapping with another one could make a huge difference. Constantly look back upon what you’ve done and see how you can improve.

Use available resources

The AMWA National website has numerous resources for getting started. Consider applying for a Branch Grant (we’ve been awarded one of these and it makes a difference!) and advertise the student scholarships available. Also, the 99th Annual Meeting (essentially our annual conference) will be in Washington DC the weekend of March 14-16… this is a huge opportunity to expand your medical knowledge, present a poster, get involved on a National level, find a mentor and have a phenomenal time with some of the most inspiring women in medicine. (Oh, and I’m one of the Co-Chairs planning it so this is my plug, haha).

Don’t reinvent the wheel (if you don’t have to)

Check out the AMWA at OUWB branch website and Facebook Page for ideas on what we’ve done.

I hope this helps and feel free to follow-up with additional questions!

-Amanda

When Doctors Tell Patients What They Don't Want to Hear

Mon, 29 Jul 2013 03:41:12 -0400

When Doctors Tell Patients What They Don't Want to Hear:

Can we really expect that a nation of more satisfied patients will be a healthier nation over all?

smcgaughey: Clueless: I had often heard that being an intern...

Sun, 28 Jul 2013 06:29:00 -0400

smcgaughey:

Clueless:

I had often heard that being an intern was a far more enjoyable experience than being a med student. Hearing stories of long hours, stressful decisions, and overworked interns, I found that hard to believe. Granted, as a pediatric intern, my experience is different than a surgical or even internal medicine intern— yet I now understand the benefits of transitioning to a resident.

Our rapidly digitized and regulated medical system has the unfortunate side effect of cutting medical students out of patient care. My former med school used a robust EMR system. It disallowed easy entry of student orders. Furthermore radiology prelim reads went directly to interns, and daily lectures usually cut into crucial patient care. However med students are, in my opinion, unfairly tasked with following and presenting a patient’s hospital course. They round, gather numbers, read results, and review radiology studies. Unfortunately this is a practice, more of reading of the day’s events, than a recap of an experience they were involved in. The system is designed to handicap their ability to truly assume an autonomous role in a patient’s care.

In theory residents should keep their students updated in the latest events and involve them in the decision making process. This is a practice easier said then done. Despite these hurdles, I had wonderfully talented and caring residents during med school. Many of them overcame barriers in the system to actively engage me in patient care. They recapped their orders, filled me in on radiology studies, and “ran the list” with me to make sure I was up to date. Certainly having these residents in the past has pushed me to pay back this educational debt. While medical students may face logistical hurdles– they are bright, eager, and resourceful. It is worth the extra time and energy to involve them in every facet of medical care. I as find the balance between efficient patient care and medical student teaching, I hope that the many hurdles our system fade.

Trying to balance getting orders into the EMR system and involving us medical students is no easy feat. I, too, have been lucky thus far - my residents have made sure we had patients to keep up with and orders to put in for them. Although there are definitely hurdles that have not yet been scaled, I’m sure with time they will come down.

ICU-induced PTSD

Wed, 24 Jul 2013 04:48:00 -0400

ICU-induced PTSD:

The Intensive Care Unit can be frightening for a new medical student - imagine how it feels to be the patient or their family.