half-baked idea: improv classes

Going back to my breast exam running diary, the easiest part of learning  to give a breast exam was actually touching the breast. It's just skin and fat. The hardest part was talking about breast, and watching all the words you use. Don't use inspect, feel, sag, etc. Don't stutter. Don't be nervous talking about breasts. So my half-baked idea is that we should work on our talking skills by taking improv classes. 

that's all, folks

I don't know anything about improv other than the few articles I just read about Stephen Colbert and Tina Fey, but it sounds like a great way for us to become comfortable interacting with patients. 

Here's 3 pieces of advice I just looked up about how to be good at improv:

1) Make a connection to the other player.
2) Never expect a certain answer, just react to what was actually said.
3) It doesn't matter what you're doing on stage as long as you sell it.

You can probably make the connection from these three points to medicine, but I'm going to lay it out for you. 

#1 - Make a connection to the other player. 

This has obvious implications in medicine, where half the battle is gaining the trust of your patient. Getting sensitive information from your patients - whether you need a thorough sexual history from an elderly lady or you're trying to talk to a teenager about alcohol abuse - it can be tricky. Not every patient is going to be a fire hose of information like our standardized patients. Not to mention, if you're going to approach patients about making a serious change like quitting smoking, you need an established relationship. 

#2 - Never expect a certain answer, just react to what was actually said. 

The small group interviews are good practice but it's a pretty straightfoward process. OLDCARTS. You already know exactly what you're asking before you go in, so you're basically rehearsing from a script. The problem is that when you're actually seeing patients you have to do a lot of winging it. Patients aren't going to tell you exactly how pain radiates. Doctors need to practice talking to human patients instead of robot patients.

#3 - It doesn't matter what you're doing on stage as long as you sell it. 

Patients are scared to see their doctors. Waiting for a second opinion on a cancer diagnosis is going to be tense. They don't want to see you nervously fumbling and trying to find the words to explain the situation to them. Patients want doctors to be confident. 

--

How expensive would it be to hire twenty local comedians and have them teach an improv class for 2 hours? I can tell you how much it would cost. Here's a local improv class:

Students would totally think it was fun, which would make it unique among required med school activities. It'd be a good group bonding activity, watching everyone screw up and have a good time with it. 

Not to mention, it wouldn't hurt doctors to have a sense of humor. 

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

Relationships in med school pt 11: So you think you know Greg Franklin

An interview with the one and only, Greg Franklin.

Ken: My first question would be: Can you tell me 3 things about you? Can be anything.

Greg: Sure thing. Sorry if it sounds generic and orientation-ish.

1) I'm a 22-year old Black male, a recent Clemson University graduate, and I'm from Blythewood, SC.

2) My hobbies include sports, reading, music, movies, food, traveling, thinking, sleeping, the usual.

3) Similar to your story in a previous post, I too got in trouble in grade school for poor penmanship. In fact, that was the first time I ever earned a "B+" on my report card. SideNote: I wonder if that's a common experience amongst docs.

Ken: Haha, nice. It sounds great. So let's get right into it. I've been interested in this for a while, but never really knew how to approach it. How can non-black people support black history month?

Greg: Very interesting question. 

Black History is American History. Black History is Human History. Black History is World History. Everyone can support Black History Month. I'm glad you asked this. I think the first step to enlightenment is having the curiosity. The next step, more challenging: ask the questions, seek the knowledge, read the literature. Don't be offensive, but at the same time don't be afraid to ask difficult questions. That's what diversity is all about: growing from each other's experiences. 

The goal of Black History Month is to enlighten all people of the contributions of African-Americans throughout history. Black History is special because, it's an underdog story. Many racial backgrounds have had to endure struggle to achieve equality, but slavery was one of the worst injustices in human history. Black people were literally property. And even after the Emancipation Proclamation was signed, and after the Civil Rights Acts were passed, many would argue that Black people are still suffering some of the after-effects of slavery today. 

The real thing to take away from Black History Month is to acknowledge the pursuit of excellence, despite the odds. Truth, humanity, and reason prevailed over the injustice, prejudice and adversity. Black people still have a long way to go in the US and all over the world: there are racial disparities in health, life expectancy, education level and income. I can't turn a blind eye to that, but Black History Month for me, is just a reminder to never give up hope, regardless of how harsh the situation may seem. And also to never forget the struggles that Black people have had (still have) to overcome.

K: So the last thing you mention, "the struggles that Black people still have to overcome." Tell me more about that.

G: Racial Profiling is real. Chicago's Death Toll is real. Black on black violence is real (and doesn't get much media attention). The prison system is disproportionately filled with black and brown people. Poverty is disproportionately brown/black. Health(care) disparities are real. I can go on and on....

We're all human, and we judge people. Even in medical school, we're taught not to have preconceived notions about patients, but at the same time, certain assumptions may help you understand a patient's story and eventually help to make an accurate diagnosis. "Stereotypes don't exist if there's no validity to them." I don't 100% agree with that quote but many people subscribe to that ideology. It's just unfortunate that Black people are labeled with negative stereotypes: dangerous, unintelligent, loud, lazy, etc.. 

Most of the racism that we see today is institutionalized. I know that there are still KKKlansmen and people who throw around racial slurs. However, for the most part, people like black people... as long as we stay in our roles: everyone loves Jay-Z and LeBron, but some people are not OK with having a Black boss. White privilege still exists, but many people (of all races) don't realize it. 

Something that most people don't think about is how "hyper-vigilant," being conscious of all of these things can make Black people feel. In an academic/professional setting, a challenge that I personally deal with is proving myself. Of course, everyone's trying to perform at the highest level, but as a Black person sometimes you feel an added incentive to do well: 1) because just 50-60 years ago, it wasn't possible for people that look like me to be here, 2) because other people may assume that I earned a spot because of affirmative action and I want to prove them wrong and 3) because there is a "shortage" of URM's in certain positions and I want to be an inspiration to the next generation so that in the future, there is no shortage.

We all know the statistics. We all know that racism, slavery, and the struggle for civil rights can be the blame for the current situation of "Blacks in America," but those events cannot be undone. We can never forget these tragedies, but in the spirit of Black History Month, we as a human race must press forward for a better tomorrow.

K: Any final thoughts you want your class to know about you?

G: Yes, Black people have problems, but what group of humans doesn't? We're not as bad as people think we are. I'm not gonna say "Don't judge," but I will say "Don't condescend!" 

Thanks again for the opportunity Ken, and to the readers: continue to have this discourse about race, worldviews, sexual orientation, politics, law, socioeconmics, morals, healthcare, whatever. Of course, your closest friends are going to probably have similar views as your own, but continue to diversify yourself. Hate to get all FPC-ish, but having random discussions is important especially since hardly any of us will be regularly attending class next year & 3rd/4th year, we'll be on the wards, so now's a good time to have these conversations with your fellow classmates that you wouldn't normally interact with. It's a vital part of growing to be a better physician and a better human being.

Allow me to end this with with a cookie-cutter, Hallmark card quote: "What unites us is far greater than what divides us" -JFK

Alright, that's pretty much all I've got. Until next time... Shine your light on the world.

K: preach.

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

best proposal ever

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

everyday I'm shufflin #5: clinical breast exam

 #5

These past two weeks we've had to learn the breast exam. I'd say this is the first block we've started to encounter awkward clinical situations like taking a sexual history, saying the word orgasm in a patient interview, conducting clinical exam of the breasts. sidenote - I dare you to say orgasm ten times fast without laughing. Anyways, thought this might deserve a running diary. 

--

10:00 AM: I should probably learn how to do a breast exam before I have to do it on the standardized patient. 

lawnmowing

10:01 AM: Just googled breast exam.

10:02 AM: Regoogled clinical breast exam.

10:10 AM: Watched a breast exam on youtube. That was awkward. Is that appropriate for youtube?

Should it be awkward? Should it feel normal? No, I'm pretty sure it should feel awkward. Why is anything related to sex so uncomfortable to talk about? Think about it, when's the last time you talked about sex with anyone? Even with people you have sex with?

1:30 PM: Staring at pictures of placenta. I hate the placenta. I wish I knew what a chorion was. Every day I study embryo I move farther from a potential career in the NICU. 

3:15 PM: Pelvic exam training at the simulation center. Shove fingers into rubber vagina. This seems brutal. I can't imagine doing this on an actual woman. "Howdy ma'am, let me just cram my gloved fingers up your vagina."

4:40 PM: Dean's reception. Tons of free food. Tons of med students flocking there. Best food - chicken fingers and artichoke dip. Observing some flirting going on. sidenote - I wonder how many intermedschool couples we'll have?

4:55 PM: Only rumors I've heard about the breast exam. Not as long as scheduled. Not that bad. 

5:10 PM: Arrive for breast exam. Hope I get a dude.

5:15 PM: Everyone is super chatty before we split up to go to the exam rooms. Overcompensating for being nervous?

shoutout

5:25 PM: Break into individual groups and walk over to rooms. 

5:26 PM: Our preceptor is sick and not happy about it. She does not want to be there. Our standardized patient is in good spirits though, and she's joking around with us. Apparently, she's the infamous standardized patient who was told her breasts are "not remarkable" by a student last year. Not pleased. 

5:30 PM: After the preceptor runs us through the breast exam she asks who's going first. Greeted with silence. 

5:32 PM: First student goes. To no one's surprise, it's a woman. Guys are too nervous. 

5:43 PM: Guess I'll go next.. Ken: I'm just going to inspect your breasts.

Patient: Don't use the word inspect, it sounds too sharp.

Ken: Yeah sure, sorry about that.

sharp

5:45 PM: Ken to patient: Can I ask you to move your gown so I can inspect your breasts? 

Ken to self: every damn time..  

5:47 PM: [touches breast] That wasn't so bad. Pretty much like touching any other tissue. Talking about breasts is by far the most awkward part.

5:53 PM: Next student goes. He'd actually seen this standardized patient last week in small group when we took sexual histories, which lead to this conversation:

Patient: Oh I remember you you're the student who helped me with my sex problems.

Student: Oh right, hope you're orgasming well.

Patient: Yep, it was fixed in a week. Thanks for your help.

Student: I do what I can. 

Doctor patient relationship, violated. 

6:07 PM: Student: So what words should we not use?

Patient: When you're observing the breasts, don't say "sag" or "droop." Especially with older women. "Feel" is also awkward. Just use examine. 

must have been epic

Talking about breasts is awkward. I feel like there's a half-baked idea here. We should be trained in talking better. Especially good for introverts. 

6:18 PM: Guys in peanut gallery whispering inappropriate breast jokes. Woman student not laughing. 

6:32 PM: Last guy finishes up his exam: "Ok, I'm going to go over and tell your doctor that nothing looks remarkable here." 

6:40 PM: Leaving. Not as bad as everyone thought.  

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

NBA Wednesdays: An Open Letter to Jeff Green

that ain't safe

Dear @unclejeffgreen,

Thank you for being you:

First of all, thank you for being a Celtic.

You are only 26 years old, yet two years ago you underwent major surgery to fix an Aortic Aneurysm. While recovering you went back to school at Georgetown, a top 25 university, to finish up your degree in English and theology. Thank you for repping education. I wish I could discuss philosophy with you. 

On the court, some nights I watch you and you're unstoppable. Channeling your inner LeBron James and driving hard to the basket. Spotting up for corner 3's like Ray Allen. Big enough to post up small forwards, and way too explosive for power forwards to slow down. Playing the kind of D that could slow down LeBron James. Thank you for being a fun player to watch. 

jeff green doing jeff green things

Some nights you aren't quite at the high expectations I peg you at. There's many a game I wish you could rebound more. There's other nights when I wonder where those ballsy drives to the basket went. But KG said it best, "He's so good that sometimes we just forget he just went through major heart surgery. That's what you forget." 

And it's true. I forget that all the time. When I really think about it, it's crazy that you're playing basketball at all, let alone at an NBA level. 

And since Rondo went down you've upped your game to another level. I watched you drop 31 on the Suns and loved every minute of it. 

You are such a baller that Kevin Durant once dedicated his season to you. 

A million times out of a million I would rather root for a scrappy team with bleed-green vets like KG and Pierce, than any team of collected superstars. I want the teams I root for to like playing with each other, to care about playing great basketball, and I'm glad the Celtics are that team. 

You are inked to the Celtics for the next 4 years, and I'm glad to have such an inspiring human being on my favorite basketball team. Please keep doing Jeff Green things.

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

half-baked idea: 3 yr MD

Just saw this article on an unnamed med school blog I follow. Sounds great, lots of relaxing and fun vacation activities. I'm sure it's nice after three years of working yourself into the ground. 

I have a handful of friends that are fourth years, and their life is indeed a glorified vacation. Everytime I go into the lounge to heat up my lunch and go straight back to eat at my desk, I see them hanging out and watching TV. I see them laughing at us while we're going for that second pot of coffee, obsessing over the vertebral level of the superior mesenteric artery. Is it L1? L2? L1/2? Somebody tell me. 

L1. It has to be L1. 

Except, there's one problem. You are paying money out the freaking window to take this vacation. Now that subsidized Stafford loans are a thing of the past, every year counts. The cost of med school has to be one of the biggest detractions to med school. It pushes away talented could-be doctors, and simultaneously pressures young MD's to chase high paying jobs so they can pay off their loans. One of the attendings at a bible study I attend has four kids, his oldest is 12, and he just finished paying off his loans. 

So here's my half-baked idea: what if we shortened med school by a year? 

There are already schools (Duke Emory, Baylor, University of Vermont, UPenn, UVA, Lerner, to mention a few) that shorten the 2 clinical years and the 2 basic science years by just enough to give you a free year to pursue an independent project ranging from bench research to community outreach. This idea if GENIUS. At Stanford they give you every Wednesday off so you can pursue an activity of your choice, which I've covered here. What a great chance to think about what you can do for the world. So I love the idea of having a free year, but what if we just cut out that year entirely?

It would work out logistically. Given how unimportant the pre-clinical years are, there should be no problem with cutting out some M1/M2 time. sidenote - If you don't believe me, look up NRMP residency match statistics. The only things that really matter - step 1 scores and third year clerkship grades. 

First - we'd cut out M1-M2 summer (3 months), a resume-padding waste of time. We'd limit biochemistry to only a few fundamental concepts, cut out 75% of it, and you'd learn the rest of the stuff as needed (1 month). We'd get rid of OB-GYN and peds as req'd clinical rotations (2 months). So you'd only be required to do the fundamentals - surgery, internal med, family, and psychiatry. Then you'd remove half of 4th yr (6 months), which we've established is a long vacation. 

The money you'd save by spending one less yr in school is huge, but the MD appears much more doable as a 3 yr degree. At that point it's just as long as law school, and they're flooded with applicants.

The only possible downside - you're a year younger, so you'd be slightly less mature and prepared for actual medicine. This is where I'd combine this idea with my half-baked idea of mandatory year off between undergrad and med school would come in, so you'd be the same age when you graduated. 

3 yr MD. Sounds great?

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

Relationships in med school pt 10 - So you think you know Tripp Mostertz

The lovely couple. 
Bryn is a first year peds resident at MUSC.

An interview with the one and only, Tripp Mostertz.

Ken: So let's start with where you've lived.

Tripp: Ok, so I was born here in SC and went to grade school here, but then my parents decided they wanted to move, so we went to Utah. Salt Lake City. 

Ken: How was that?

Tripp: It was ok, I think my parents weren't huge fans of it because they didn't like the mormon feel and it was hard to develop deep relationships because they weren't mormon. They eventually decided to move back, I lived here in Charleston for a year. I went to Wando HS, actually. Then I moved up to Clemson where I met Bryn.

K: Yeah, let's get to that. How did you guys meet?

T: Well, we were both band geeks. Bryn - she was really goot at flute. We met right away, but we didn't date until our senior year. I also loved marching band, and I kept doing that at Clemson. We played for the basketball games and all that. 

K: So what else did you do at Clemson?


T: I was an electrical engineering major. I didn't know what that was, but I really loved music and I think I just figured I'd start a recording studio or some crazy shit like that. 

K: And what happened to that track?

T: Well I had this internship my junior year, in this power plant. And it sucked. I didn't talk to anyone, we just worked on fixing obsolete parts. I was thinking my life is over, and that this was going to be the worst thing ever. I had never thought about an advanced degree, and I'd never even really thought about the future, but after that internship I had to think. 

I started taking some bio classes and ended up in this great bioE class where I studied lower limb fractures, and coming up with a quantitative way to interpret the recovery. I ended up turning that into graduate work at Clemson. 

K: And where was Bryn during all this?

T: We went to Clemson together, but when I stayed at Clemson, she moved to Durham to work in a cancer lab at Duke. 

K: So you dated long distance - how was that?

T: It was a challenge that we needed to know this was right. I'm not one to give advice or anything like that, but I think it's important. Like, maybe if you can't survive it, maybe it's not right. I'm not saying there aren't other marriages that don't work out, but at least for me it was good to see. 

K: And then at what point did you get married?

T: Well let's see. We got engaged the winter before she started school, so that must have been around '07. That was right before I defended my graduate work, then I moved over to Durham to work in a lab up there. Then, she started med school in fall of '08 and we got married on New Year's Eve 2008. 

K: That's fun, why New Year's?

T: No reason really, it was just convenient since Bryn had a break. And no one ever has real plans for New Year's so we figured we'd just give everyone a reason to come together and party. 

Actually there was a funny story with the party - I didn't care about much with the wedding. Except the music. I was a stickler for the music, and I subdivided the night into hours with different themes of music. One night Bryn was looking through it and she accidentally deleted the playlist. And I was like ok, I think I can remember what was in each section. And Bryn saw that as a big reassuring moment of us getting married. She was like - "You didn't get mad after I deleted all that music." It was funny but it was a big moment of commitment. 

K: Probably more funny in retrospect.

T: [laughs] Right, right. 

K: And why'd you decide that was the right time?

T: Well, we dated a long time. Like 2001 to 2007 or something like that. And we knew we'd be in the same place for the first time since college. I guess I proposed because I just knew. It's not like I had a checklist or anything like that, but I kind of had an internal one, and I eventually reached the point where I didn't think there were any more checks until I could be sure this was right. I was sure this was what I wanted. 

It's like from When Harry Met Sally, which is actually our favorite movie, but they say something like, "When you know you want to spend the rest of your life with someone, why not make it now?" Actually, and this is funny, but the pastor that did our wedding actually mentioned that movie, and we hadn't even talked about it, so it was like fate or something. 

throwback

K: And how about coordinating the simultaneous move of you to MUSC med school and her to MUSC peds residency?

T: Yeah, so that was hard. I felt like I could get in somewhere, and I really liked MUSC. My MCAT was in the range, and I was really strong in other things. I had good research experience, I did graduate work in bioE, volunteering, all of that. And she was supportive, but at the same time there's no couples matching at this point, so she had to know what I was going to be doing before she had to set up her match list. 

I remember it was a whole complicated process of figuring out when I had to move to South Carolina so I could get in-state tuition, and have a better chance of getting in. In the end it just ended up working out, I got in here, she set up her match list, and of course she had no trouble getting in. 

K: And here you are now. Any last things you want to say?

T: Man, what I don't enjoy is when people complain about studying. Because I fucking love studying. Yeah, some of the material's a drag, but still. I get up in the morning, make some coffee, and I can't imagine doing anything else that I would love more. I took a long route to get here, it was so hard. And this is just philosophical, but dude, this is not bad. All you do is work hard, and you come out with a cool job. This is not bad. 

K: preach.

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

youtube Fridays - Kanye/Jay-Z's 'No Church In The Wild'

Literally spent 2 hours analyzing this video and song. Expectedly, this came while I was doing a Bacro lecture. Came across this interesting article by a sociologist that studies religion and hip-hop. Anyone have any insight on it?


See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

Everyday I'm Shufflin #4: hospital visit running diary

 #4

aka hospital visit, aka shadowing a nurse

5:20 PM: Depart home for unnamed hospital. 

5:43 PM: Arrive one hour before hospital visit starts. Open Net Anatomy to get a head start on studying. 

5:45 PM: Instead, research Chris Paul vs Kyrie Irving stats. 

6:28 PM: I should really do something... Back to Net Anatomy.

..what?

6:45 PM: Lost in the hospital, trying to find unnamed hospital unit. That's how often M1's are in the hospital. 

6:47 PM: Arrive at unit. Can't find charge nurse, stand around awkwardly hoping someone will ask me something. 

6:51 PM: A bunch of doctors converge around this one patient's room. Follow them around like a puppy dog. Hope they do something cool. Wait, I hope they don't ask me any questions..

6:58 PM: The doctors stick a tube down this guy's throat. I think that's called an intubation, but, not really sure. Everyone disperses. 

7:11 PM: Still waiting for charge nurse. 

7:16 PM: Watching one of the bitter residents skyping with his son. That must be fun.

7:23 PM: Charge nurse arrives: "I don't have any patients tonight so I can just show you around for a bit, then you're free to leave." 

Ken to self: "Don't screw this up."

7:25 PM: We see a patient that has some high tech catheter contraption running up from the back of his knee into his abdomen that bombards blood clots with radio waves to destroy them. 

modern medicine

7:28 PM: Ken: Do you like your job?

Nurse: Yeah, I used to be a chem major so this is a big change. When I was younger I never thought I'd be a nurse and taking orders, but I really like it here. In the ICU you get to do some thinking as a nurse. The doctors give you a little more autonomy, and it feels like they treat you more like a comrade than their slave.

7:32 PM: Ken: Any complaints about doctors for a med student?

Nurse: Your life is probably going to be hard, you have to listen to nurses bitch at you for the rest of your life. At the same time, you should listen to nurses. Also, don't be afraid to ask for help because you don't know everything. 

7:37 PM: Going around the unit to calibrate instruments while talking more bullshit about working in a hospital. 

7:41 PM: Walking out the door. So clutch.

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.

NBA Wednesdays: 5 bullet points about All-Star weekend

no he didn't

1) This was an embarrassing moment for Chris Bosh, but let's remember for a second that Chris Bosh is (right or wrong) an All-Star starter. It's not like he's some scrub, he's still Chris Bosh. This moment really speaks to Chris Paul's game. 

It counts for something that on All-Star night, when the best 10 players in the world are on the court at the same time, CP3 dealt out 15 assists, scored 20 pts on just 10 shots, and had the testes to nutmeg an All-Star. You know Chris Bosh will remember this in Game 7 of the NBA finals when he gets switched on a pick and roll. Obviously, CP3 was already at the 'guys I would go to war with' level, but nights like this definitely remind me: wow - this is a special player. 

The Clippers have to move Bledsoe for a big man. Whether or not CP3 stays in Clipper land, this might be the only shot for the Clippers to get to the Finals in a long time. Jamal Crawford isn't having miracle seasons like this on a regular basis. Otherwise, he wouldn't be Jamal Crawford.

dunking

Faried's shot chart

2) Kenneth Faried had his coming out party. 40 pts and MVP in the rook/soph game, had a 50 pointer in the dunk contest, early darkhorse All-Star for next year. He even made a corner 3. 

3) Kyrie Irving played crunch time in the All-Star game. There's no doubt everyone knows he's a star. His only downside: of all NBA superstars he gives the worst interviews. Every other answer I heard from him was a one word answer. He talks like a guy afraid to screw up. This is a man that wanted to bet $50,000 on a one-on-one game against Kobe Bryant. He has interesting things to say. Let's hear it.  

4) KG is staying in Boston. He believes the team has a shot, his no-trade clause remains firm, and I love him for it. The Heat are probably unstoppable, but all I know is I wouldn't bet on the Heat over. Most recently, the Celtics without Rondo showed up LeBron et al 100-98.

Arne Duncan vs Usain Bolt

5) In the celeb All-Star game you get to see the fastest man in the history of the world going up against the Secretary of Education. Only in the NBA. 

See you on the other side,

from ken

taking requests for future blog posts. please comment or email.