Monday, May 11, 2009

Medicine Sub-Internship

Currently a sub-I at SFGH, please don't get sick in the next month or you might see me.

Recently registered for step 2 USMLE.
Warning: CS costs $1,055 alone to register and CK costs $495. That doesn't include the mandatory travel to LA or lodging.

Recently bought an i-pod touch to enjoy first apple product. Got absorbed in installing apps and was reading through Yelp, found out that there are many patient reviews of UCSF Medical Center. It's so interesting read those reviews, which are either 1 star or 5 star (max)...which makes sense since you only make the effort to type something if you are extremely satisfied or ridiculously angry.

Some observations of Yelp feedback: Interestingly, the polarized reviews had many themes in common. The 1-star patients usually are in general good health with minimal contact with healthcare, coming in with a musculoskeletal complaint (eg xray for foot/hand, sprain or acute flu with SOB) to Urgent Care (oohh, lots of ire). The main complaint is waiting time (up to 8 hrs) in the ED, brusque staff, lack of parking, billing, hospital food, etc. There were very few complaints about doctors' care (except for one woman who was turned away by an ED physician for SOB), and no complaints about residents or trainees (except one patient cited the lack of continuity with residents in clinic).

Patients who write 5-star reviews generally have serious/chronic/rare ongoing medical conditions. Some families will write on behalf of patients. One reviewer wrote on behalf of a friend who had heart surgery, another patient was grateful for the teaching program regarding kidney transplants, etc. One patient noted that the lab reports for rare diseases will be processed faster at UCSF than at other hospitals. Some patients who had life-threatening conditions praised the ED.

Reading that uncensored feedback might be a good exercise for our hospital administration to see what can be improved. We can score big points with patients if we make the logistics of getting healtcare more convenient -- making appointments online and keeping clinic wait times within 1-2 hrs (or the pizza is free!).

Sunday, May 10, 2009

Friendly PSA

Call your mother today!

Remember that the US postal service raises prices on stamps to 44 cents tomorrow!

Thursday, May 07, 2009

Reflections on Third Year

"So what should I know for third year?" someone asked me recently.

Whoa. Wow. Um. Where to begin?

Undoubtedly, the third year of medical school has been the most memorable experience thus far in my life, and even now when I reflect on all the crazy and outrageous and wonderful and awful things that I've seen, I can't even believe that it happened to me and not some 2D person on "Grey's Anatomy." In psychiatry, they might call that derealization.

Being a third year medical student is like being a guppy in the hospital ocean. You wander around helplessly, trying to learn how to coexist in a complex environment under some very talented and harried residents. It can be totally confusing and bewildering, but it also opens the door to levels of opportunity and privileged intimacy with strangers previously unheard of. Sometimes, third year feels like an apprenticeship where you learn things using your hands and watching others. Other times, it can feel like boot camp or pledging a fraternity. In many ways, you learn things about yourself and other people during your first year on the wards...and none of these lessons can be easily transmitted's almost like everyone has to undergo a second awkward adolescent period as a rite of passage. Also, being a third year medical student was like regressing back into being a 4-year-old child, because the medical world is often alien to the newcomer and learning how to be a doctor is like learning how to be an adult all over to speak medical jargon in surgery vs. psychiatry, how to be polite (pager etiquette), how to follow rules, how to learn what might be important (lab values, complaints) and what is unimportant when listening to a story -- simple things that seem obvious to the indoctrinated.

What also amazed me was how simply being a third year student opened doors in the hospital... From being a mere college graduate with an interest in medicine to someone invited to scrub in on surgeries, write notes, interview patients, perform IV insertions and intubations, and witness the miracle of birth...I learned halfway through third year that simply saying, "I'm a medical student, can I watch?" led me to opportunities beyond imagination.

Third year is hard, I definitely feel slightly burned out, but surprisingly my cynicism has not worsened. If anything, I've shed a little bit of my "beat around the bush" mentality. It was more difficult to blog about third year than anticipated, mostly because of time constraints but also because of privacy issues (HIPAA etc). If I had more time, I would write out paragraphs of my ten most memorable experiences this past year, but instead will list them in no particular order:

1) participating in a liver donor run to New Mexico over Thanksgiving
2) scrubbing in on liver transplants
3) befriending a boy with a giant retroperitoneal tumor in rad onc and crying outside the OR after hearing that it was wrapped around his aorta
4) taking care of little kids in peds urgent care
5) watching babies being born in fresno
6) inserting a 14-gauge IV into the dorsal hand vein of a patient under the curtain on anesthesia
7) chasing after a psychotic HIV+ transgendered patient at SF General on psychiatry
8) participating in my first code while scrubbed in on a vascular surgery in which the patient had an MI on the table...he was placed on ECMO
9) learning from medicine to "always do what's right for the patient" and to talk to unconscious patients as though they were awake, even though it seems strange, it's a sign of respect.
10) watching the work-up of a patient who turned out to have Q fever endocarditis