Damnit, there goes my afternoon…

A classmate posted this on facebook today.

It’s got all the makings of a perfect viral challenge – the taunt about preschoolers (CITATION NEEDED) alerts you that you should easily be able to solve it, and then the bit about it taking longer if you’re highly educated ([SOURCE]) really just needles you in the most annoying manner possible.

So naturally I ignored the fact that it’s just a made-up code with no research behind it and happily wasted 30 minutes on it.  Some people just want to watch the world burn.

Anyway, having succeeded in this experiment, I can resolutely confirm to you all that I suck at riddles.

… I have always sucked at riddles, and I’m honestly not entirely sure why I thought this would be any different.  Hope springs eternal, or something.

How about you?  How long did it take?  (Spoilers in the comments).

Tales From the Department of Backhanded Compliments

Preceptor:  I don’t know what to make of your lab values  … none of this is within my specialty, I’m sorry.  *turns to me*  Action Potential, what should we order?

Me:  Erm.  The leukopenia may still be an issue, so we should get another CBC with diff, right?  Then for the symptoms, how about an insulin level, a B12 level, a peripheral blood smear, and a creatinine kinase?

Preceptor:  AWESOME.  Sounds good.  *enters tests into computer*  Wait.. hmm. How about a metabolic panel?

Me:  Well, I’m tempted, but since the hyperkalemia resolved once, I don’t think a second high result would change our management.  So.. no?

Patient: You’re really smart for a student!

Preceptor:  She is!  You know, Action Potential – I used to have a really cute dog – a terrier mix that I brought into work every day.  And my patients loved it!  They started requesting that their next appointment be on a day when I’d have my dog!

Patient:  Haha.

Preceptor:  Eventually, I realized I could probably just drop the dog off at the office and go home without any change in patient care.  The dog was probably doing all the work anyway.  You’re just like that dog, AP!

Me: … thank you.

5 hours later

“Hey, AP, how’s it going?”

“My preceptor compared me to a dog.  Repeatedly.  And I’m pretty sure it was the nicest compliment ever.”

“… oookay, we need to get you a beer.”

EMRs: Pre-clinical vs. Clinical Med Student Opinions

My Pre-clinical Med Student Perspective:

Why is this a debate?  Why is it even an issue?  Why wouldn’t all medical records be electronic already?  Are you telling me we live in an age where I can do all my banking online, even depositing checks without leaving my bed – and yet there are still hospitals where orders are written manually, in handwriting so terrible it causes thousands of deaths each year?

The only logical explanations for this I can dream up are 1) healthcare bureaucracy is about as efficient and timely as an asthmatic snail, and 2) there’s a lot of attendings who feel that EMRs are “too confusing” or “easily hacked”.

Since I can’t do a damned thing about #1, I’m going to argue point #2.

First, the danger of “computer hacking” is vastly overplayed.  We’ve got to at least try to keep it in perspective: I can don my short white coat and stethoscope and stroll into any teaching hospital in America and simply open a paper chart.  I can read it completely without anyone questioning my presence in the slightest – they’re used to random med students they don’t recognize.

So “hacking” into completely non-electronic, 100% paper charts is – like 90% of success in life – simply a matter of walking confidently and wearing nice clothes.  And as xkcd reminds us, you can just buy lab coats.

Very relevant scene: http://www.youtube.com/watch?v=i5j1wWY-qus

At least hacking into EMRs will require some relative work.

As far as EMRs being “too confusing”, though – I have to admit, I have some sympathy for these guys.  They’re usually the same attendings you see concentrating like hawks on their keyboard as they type each e-mail letter. by. single. letter.

But as frustrating as that is to watch, I just have to remind myself that touch-typing wasn’t required for their generation.  It was a new, fancy thing after their time that was no doubt both really popular and really annoying.

It’d be like if I became an attending and the standard of care turned into… I don’t know… rapidly texting HPIs (12 year olds would fall over laughing at my texting speed), or…  other popular things I don’t understand.  (Skrillex.  Twilight.  Drop-crotch pants.)

Unfortunately, EMRs have to be implemented sometime, and there’s always going to be an older generation who isn’t used to working with them.  And they’re always going to complain – I mean, I sure as hell would – so it’s not a valid argument.

In short:  EMRs are logically the next step in healthcare and will benefit practically everyone once they get used to using them.  Forever and ever, amen.

My 3rd Year Medical Student Perspective:

GOD HELP ME, IF I GET ONE MORE ALERT OUT OF THIS COMPUTER I’M GONNA RIP OUT EVERY USB CORD IN ITS BODY AND USE THEM TO STRANGLE ITS SMUG-LOOKING SCREEN TO DEATH.

The 5 Dumbest Things I’ve Said This Month

The best part of being a 3rd year med student is that you know all the arcane trivial diseases the residents have forgotten.  So I’ve been able to make 2 really cool diagnoses, answer a handful of obscure mechanism-of-action questions correctly, and look like a complete idiot the rest of the time.

I fully expect this to become a recurring feature.

5. Resident:  So, we could order a head CT, but we know she hasn’t had a stroke or a brain bleed, so what could we possibly see from that?
Me:  Parasites!
Resident: …

4. Resident:  Wait, why did the patient need a mitral valve replacement?
Me:  Because… the patient had…  *surreptitiously checks chart*  a St. Jude valve.

3. Me:  Wow, this is going to be a slow day, huh?

2.  Me:  On assessment, I’m most concerned with the patient’s morning blood pressure, which was  65 / 71.  … wait.  Hold on.  No.

1. Me: Just in case, shouldn’t we get a stool guiaiac test?.

Forbidden Medical Abbreviations

Med Student Law of Averages

Our OB/GYN shelf scores came back!  I saw my raw score and felt surprisingly relieved.  … But then I translated it into a percentile.

All I can say is “I did better than the national and local average?  I’M A CHAMPION.” feels a hell of a lot better than “... wait, but… gah.  How is that still “55th percentile.”?*

And sure, I get that 55th percentile is completely different from 55% – and I truly am happy with my score – but either way, I think it’s funny that I’m still falling victim to a personal Lake Woebegone effect.  It just won’t die.  There’ll this shockingly irrational part of me that can’t seem to reconcile “trying my absolute hardest” with “less than 90th percentile”.

You’d think my carefully curated collection of perfectly average M1 test scores would have knocked all of the 90th-percentile-ambition out of me by now, but no.  False.  

Welcome to med school: where superiority complexes go to die.

… and are then summarily resurrected after every test, living forever as intense zombified versions of their former selves.

BRAAIINS.

Not A Fashionable Med Student

Today I felt too lazy to put together a legitimate outfit or shave, so I just threw on a black dress and black stockings.  And a pendant necklace.  Also, my hair’s out of control, per usual.

Then I looked in the mirror and saw this:

At first I thought I’d have to spend a few minutes finding another dress, or a less Celtic-looking necklace, or maybe even washing my hair again.

But then I realized:  I’m on psychiatry right now.

NOT CHANGING A THING.

Overheard in Med School: OB/GYN edition

“You know why I’m glad the OB/GYN shelf is over?”

“Why?”

“Because I NEVER AGAIN have to look at that godawful woman on the cover of our OB/GYN book.”

“Wait, what’s so bad about the woman on the cover?”

“Everything’s wrong with her.”

“Like what?”

“Well, first, what’s she doing wearing that mask under her nose?  I mean, the thing has to actually cover your face – it doesn’t work by magic.  And the fact that she’s wearing a mask and cap at all - just to do an ultrasound – makes me think she’s an idiot, and the fact that she’s trying to use it without any gel just confirms it.  Hell, even if she was doing something else, when would you ever wear a mask and cap without gloves?  THAT NEVER HAPPENS.  Also, you can totally see that under that mask SHE HAS NO CHIN, and that weirds me out, man.

“…”

“It weirds me out.“

Study Music Sunday – No Vocals, No Problems

Because you deserve for a night full of flashcards to feel as epic as a night without any.

(Sometimes – in the non-stop action movie that is your life – you have to make your own training montage, damnit.)

Or – for those who aren’t sure you want the Dramatic Montage Sequence pumped all the way up to 11 while you study – here’s something for simply feeling relentlessly cheerful and lucky to be right where you are:

The Secret To Honoring Your Psych Rotation…

… is to have some personal experience solidly behind it.

Preceptor:  Oooh, this patient is on Celexa and Lexapro?

Me:  Well, that’s not good.

Classmate:  Why?

Me:  Because the active drug is the same – citalopram – so the effective dose is doubled.

Classmate:  But it’s not the same dose…

Me:  Right, but since Lexapro is escitalopram – the (S)-isomer only, whereas the same dose of Celexa contains both – it’s roughly twice as powerful, because the (R)-isomer isn’t metabolically active.  So if the patient’s on 40mg of Celexa and 20mg of Lexapro, that’s equivalent to 80 mg of Celexa – which is actually TWICE the maximum dose for any therapeutic benefit.

Classmate: … Huh.

Me:  That’s the theory, anyway.

Preceptor:  That’s.. wow, that’s almost right.

Me: Well, I guess I should add that, #1) the explanation is slightly more complex than just the isomer ratio, and #2) there’s some evidence that the (R)-isomer is actually somewhat active – just less predictable, which is what Forrest Pharmeceuticals is clinging to to convince psychiatrists to continue to prescribe Lexapro over Celexa, despite the fact that Celexa has several generics while Lexapro has none.

Preceptor/Classmate:  …

Alternatively, I guess you’d be more likely to honor your psych rotation by not being a smart-ass know-it-all.  Or at least by not keeping people guessing about why you just happen to be such a smart-ass know-it-all about psych meds specifically.

But I’ve gotta say, that sounds like less fun.

(My evaluation is going to be interesting!)