Rural Rounds

Last month I was on the hematology service at the University Hospital. It is a service primarily composed of patients with leukemias, lymphomas, or a disease called multiple myeloma (a rather unique cancer of the blood). Very busy service, routinely with 18-20 patients to see each day and manage outside of new admissions and coordination of discharges. It's easy to let yourself get automated in such an environment: are the labs normal? Ok. Any fevers? Yes? Draw blood cultures and start antibiotics, lets move to the next patient. Medicine is perhaps easiest when you know the problem and know the solution, and you see that the solution works. A great example would be a patient with an ear infection; I simply prescribe antibiotics in the clinic and they go home, 5 days later their ear is better. Medicine is far more difficult when death comes into play, or you have a therapy that doesn't work. Such is life on a cancer ward. I have seen a number of my or my colleages' patie

This past Thursday-Friday was the annual Internal Medicine Residency PGY-2 (means a second year resident) Leadership Retreat. At the retreat, we had several lectures, breakout discussion sessions, and role play practice in how to employ leadership skills that help foster a positive learning and working environment. The lecture and discussion series was led by facilitators who have been trained through the Stanford Faculty Development Center and utilizes their Clinical Teaching Program curriculum. The focus was for how we, as residents, can facilitate a positive learning environment for incoming interns and for medical students on the team. It also focused on how to set goals for an inpatient team, and how to best use your attending as a resource. Overall, it was a great retreat. Though many people think that some people are natural born leaders, I think many leadership qualities, if not most, can be learned and trained. Sometimes those who have had some kind of training or learning in

This week is a vacation week for me. A year ago I started my medical residency in internal medicine-pediatrics and since then it continues to be a whirlwind. In my program at Indiana University , we switch between working within the pediatrics department and internal medicine department every 4 months. This year I did 8 months of pediatrics, divided by a 4 month block of internal medicine. Since I am doing a program that actually combines two residencies, my "year" is 16 months long; I will complete 8 months on internal medicine and 8 months on pediatrics before I am officially an upper level resident. This recent article in the L.A. Times blog highlights the current problem facing the U.S. healthcare system: spending. In most circles, the problem is usually blamed upon doctors and specialists, in a private setting, pushing expensive, sometimes unnecessary tests and procedures upon patients where they are not needed. It's portrayed as a pharmaceutical industry that spen

In 1847, maternal mortality from childbirth in a Hungarian clinic was approximately 18%. A second clinic that offered maternity services had numbers much nearer to 2%. Women begged for admission to the second clinic in order to avoid puerperal fever, the name of the illness associated with such significant death rates. At the First Clinic, medical students and physicians routinely performed autopsies as well as patient services, including maternity services. At the Second Clinic, midwives did delivery and did not participate in any autopsies. Following the death of a colleague who became sick with puerperal fever after being stuck with an autopsy scalpel, a physician named Ignaz Semmelweis inferred that cadaveric particles must cause puerperal fever, and that students and physicians were transferring them to mothers after doing autopsies. After instituting the practice of handwashing in the First Clinic, the mortality dropped from 18.3% in April of 1847 to 1.9% in August that same year

It has been much too long since posting an update. Now I am graduated from med school (officially Dr. Peppers!) and I am 7 months into my intern year in med-peds at Indiana University. I spent my first four months on pediatrics, and now am finishing my 3rd month of a four month stint in internal medicine. Currently, I am finishing my ICU rotation. What I have learned about medicine in the ICU is that if you take care of a patient's basic physiology, that is their basic biological processes, they will either heal themselves or not. Those who get better tend to do so of their body's own accord. Medicine is simply a means of preventing the processes that are 'damaging' the body from continuing to spiral out of control to the point of causing death or further injury. It is incredible what the body can bounce back from after serious illness. It's also heartbreaking how impossible it is to reverse some irreversible damage, such as a massive stroke leading to a coma, or th

It was Wednesday night last week that I had my first night of trauma call. Instead of my normal quota of one pager going off no less than once per day (usually with breaking news on our lecture schedule, but often to find my team or receive tasks), I was carrying a second: the trauma pager. It's not so much a pager to answer as it is an alert to begin making your way to the ER to admit an incoming trauma patient. I paged the resident on call for trauma service, and gave him my own personal pager number as well in case he needed to reach me for anything else. That was at 5 pm. It was almost 6 pm when I was paged and informed there was an in-house patient headed to the OR with an upper GI bleed. The surgical team was informed I would be on my way to help out, and I was to head to suite 15. I hung up and left the lounge to head towards the OR. I scrubbed before I walked into the OR suite, hat and mask in place as well, and was greeted by the scrub nurse who asked for my glove size