best of sidenote 2012

watch your back, Dwight Howard
Top 5 things I did during break:

5) Shot 100 free throws, made 41.  Extremely proud of myself. 

4) Tried my hardest to grow facial hair.  I plucked one out and measured it using the lab microscope - achieved a few millimeters.  

3) Saw my first 3D IMAX movie (The Hobbit) and got motion sickness.  Still loved it.  

2) Started researching possible jobs after getting an MD/PhD from MUSC.  Top 2 options: match in orthopedic surgery and become the medical consultant for Grantland, or follow Rembert Browne's career trajectory - graduate from a small liberal arts college in '09, write a funny blog for a while, get picked up by Grantland as a full-time writer. 

sidenote - here's how my career idols have evolved over the past five years:



1) Went to Anthropologie in a hoodie and sweatpants.  Probably the #1 time I felt like an outsider.  I'm sure they thought I was trying to shoplift $80 tanktops.  


--

Anyways, here are the most popular posts of the year 2012:

MUSC Orientation running diary


The Decision: I'm going to take my talents to South Carolina

2012, the year of the palm tree

What do you want to do with your life?

Relationships in med school pt 3: Marriage Review yr 1

Insane in the Sarcolemma: test week #2

Why Kenyon College Kicks Ass


Why MD/PhD?


Metzger/Keyserling wedding in review

Thank you for a great 2012!  Expect more bullshitting in 2013.

See you on the other side,


from ken


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

Math > Mayans: a Nate Silver Book Review


The Mayans came out with the bold prediction that the world would end two days ago.  For better or for worse, the Mayans were full of it, and we're all still here. But according to the hottest thing since sliced bread - Nate Silver - we shouldn't be surprised.  

If you've never heard of Silver - he hit it big for using math to predict the election.  Before that he developed one of the top major league baseball forecasting systems - PECOTA.  And before that he was a professional online poker hustler.  Silver's recent book The Signal and the Noise: Why Most Predictions Fail - But Some Don't is all about his specialty - predicting.  The thesis: predicting is hard, but some things are easier to predict.  For instance, Silver analyzes earthquake predictions and weather forecasts - while the computing industry has allowed weather forecasters to take leaps, earthquake hunters still have miles to go  

While Nate Silver is definitely a bonafied genius.. he's not quite an original, more like the remix. He's the same genius as Bill James and the Moneyball crew that first applied mathematical analysis to baseball.  He's the same genius as the guys who decided to infuse bioinformatic analysis to biomedical research.  Silver was simply the latest to add a splash of math to a field in desperate need of it.  

So my question is: how can we apply the same genius to medicine?

to be fair, it's not like airplanes
have advanced much either
Here's one of the main reasons I think med school education is outdated.  We need a clearer definition of a good doctor.  Since our current definition is utterly vague, med students are left with the same training program that educated doctors in the era of kitty hawk.  

In track - you have the goal of running as fast as possible.  In order to do this, you don't just run around in circles randomly.  You run according to a rigorous schedule, each day with a set purpose.  One day might be optimizing VO2 max, another increasing lactic acid tolerance, and yet others to train neuromuscular junctions to fire optimally.  It's a real science.  

We need to get med school education to that same point.  Once we have a scientific defintion of "a good doctor" it'll become a lot easier to figure out how to educate "a good doctor."
I bet you thought we were just
running around in circles

So this is where it gets hard - quantitatively defining a good doctor.  What sort of stats should we be keeping on doctors?  I don't have any good ideas, so instead here's a list of half-baked ideas Kevin Wildes-style.

1- (%age) times washed hands per opportunity
2- # of times yelled at a nurse per shift 
3- total amount of shit other doctors talk about you (respect of co-workers)
4- triathalon time (endurance is important)
5- miles walked per shift (shows commitment and effort..?)

Anyways, please send your half baked ideas my way.  I need to incubate some more ideas.  

See you on the other side,

from ken


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

Fundamentally Insane: test week #3

shout out to Tripp Mostertz
This week is test week #3 - cardiopulmonary block.  The first two blocks were lots of biochemistry and anatomy that we had to learn to lay the foundation.  This is the first block that it felt more clinical.  Now we're learning about the heart and the lungs, and how the body really works.  Which is good.. except for everyone's burned out and ready for break.  

Sidenote to fellow students - we are a mere 50 hours away from winter vacation, a glorious two weeks away from the syllabus.

Everyone's been complaining about how we're all sick of school, talking dreamily about all the plans (or lack of plans) we have for the next two weeks, and how we can't wait to talk about things other than pulmonary vein pressure gradients.  

And just like we asked for - enter the real world.  In case you haven't been on facebook in the past two days - there was a shooting at an elementary school in Connecticut where a 20 year old man murdered 20 children, a high school principal, the school psychologist, and his own mother. There were immediate calls left and right about gun control.  

But what I want to know is - what's the fundamental problem underlying gun-related murders?  
comics speak louder than words

Sidenote - In Portland, OR, methamphetamine used to run rampant, so the state government made a push to cut out the meth problem.  At the same time, the heroin trend rapidly increased and took over as the drug of choice in Portland.  Was the meth ban a success?  If you look at the meth numbers the state government was definitely successful, but if you think about the underlying problem.. maybe cracking down on meth didn't get it done.

So, what if the best way to prevent murders wasn't to eliminate guns?  

In the modern eat-or-be-eaten world I'm not that surprised that people turn to murdering innocent people.  That seems like the next logical step in a dominance-obsessed culture.  Take sports - the closest thing to a modern day religion - some sports have basically devolved to exerting physical superiority over each other.  

let us come together and worship
Take med school - a subculture obsessed with academic dominance.  We all worship at the church of AOA, eating up any advice from the prophets that score 270 on boards and match in plastics or CT surgery.  Think about it - it's well established that no doctor remembers half the fun facts they learned during M1/M2.  I believe there's a point to learning some of it, but some is probably about 70%.  Is there a point to killing ourselves to get to that 90 - 95% level?  The only point I can think of: to establish ourselves as the 1%ers of med school and assert our academic dominance.  

In a world that's all about dominance - should we be surprised that people turn to murdering the innocent?

See you on the other side,

from ken


test week #1: foundations
test week #2: anatomy

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

Why I love WY pt 4: what waiting tables taught me about choosing a medical specialty

living in the woods for a summer = legit
Part 4 of a 5 part series - Why I love Wyoming.

Pt 1: An intro

I spent the summer of 2007 in Flagg Ranch of Moran, Wyoming - smack dab inbetween Yellowstone and Grand Teton National Park.  

When I landed in Jackson Hole, Wyoming I had no idea what I was doing there.  In my joke of an online job application I listed three preferred jobs.  My #1 job was housekeeping because it had the least hours.

I ended up with the most time consuming job possible - the restaurant.  It opened up at 6:30 AM to please the early morning crowd, but also stayed open until 11 PM for the late-night drinkers.  Everyone in the restaurant had to work 50-60 hour weeks, and it was hard work - I've never done so much standing or speed walking in my life. Much respect to any waiters out there - your life is hard. 

the Flagg Ranch team
My favorite part of Flagg Ranch: My coworkers cared about life. There's a lot of boring people in this world, and I never wanted to be one of them.  I have a theory that society forces people into square pegs with words like "mature" and "important" which really just means "boring."  If there's anything that's bad for your soul, it's being bored.  I'd bet that boredom leads to more alcoholism and sexual infidelity than any other emotion.  So what's the cure to boredom? Adventure!

Enter my awesome coworkers.  Several of my coworkers at Flagg were kindred spirits - young college kids in a finding yourself mold.  There were also college students from Turkey, Jordan, Russia - wanting a taste of the American experience.  And then there were the older folks - including our fearless leader - the bartender that doubled as a youth gymnast, hardcore solo mountain climber, ladies man, entrepreneur extraordinaire.. the whole 9 yards.  

the backyard
Whether we were from the Midwest or the Middle East - we all made the conscious decision to leave our comfort zones and move to a place where we didn't know anyone.  We slaved away at tough day jobs, and all the while climbed some monstrous mountains, and met some fellow brave spirits.  These were people who were throwing up a middle finger to the square peg of society.  

--

great book
I'm the kind of med student that's going to change my mind every six weeks about what sort of doctor I want to be, but whenever I think about match day 2,286 days from now, sidenote - WOW that is long. Anyways, whenever I think about the match - I remember those days waiting tables at Flagg Ranch.  

I want to be with people who give a shit.   

The life of a physiatrist sounds sweet - but I want a medical specialty where my co workers and I aren't chasing lifestyle. I want to live in a world where my friends and coworkers are after greatness.  Token NBA analogy - I'd rather be Kobe Bryant than Shaq.  I see my future filled with long nights in the hospital fixing babies hearts, drinking coffee at 3 AM, and talking shit about how the medical system is broken.  Peds CT surgery, see you in seven years.

See you on the other side,

from ken

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

The Curse of the Overachiever: RIP - Jovan Belcher

my prayers go out to the Chiefs
One of my friends recently sent me a request for a blog post, which made me realize - I need to start taking requests!  I'm happy to write about most things, especially if they're controversial.  Please email or comment if you have any ideas because on sidenote - we give the people what they want.

Sidenote - When keeping it real goes wrong.  I recently posted a "senior mentor essay" on sidenote, which I submitted for my Fundamentals of Patient Care class.  The objective of the assignment was to, "Write an essay expressing the student's attitudes and opinions about caring for elderly patients."  I figured this meant I should tell them my honest feelings of struggling to overcome my self-centerdness so I could authentically serve other people.  Fast forward a few weeks to my class evaluation - my instructors considered "putting me through remediation (code word for fail) for my writing skills and sending me to the writing center."  I thought this was funny.  

So anyways, back to my friend's request.  She sent me an article debunking the trendy positive thinking movement.  Here's my understanding of positive thinking - overpower any negative thoughts with buzz words like "stay positive."  

Here's my problem with positive thinking.  Serenity now - insanity later (see clip).  Bottling up all your problems and covering it up with warm and fuzzy mantras is only a temporary solution.  

Soceity is too afraid to deal with serious shit like suicide.  It's even too afraid to talk about anything resembling a negative emotion - we have to cover everything up with positive thinking movements.  But when negative emotions are neglected, it doesn't end there.  

As I've talked about before on sidenote - physician burnout and physician suicide is a big problem.  The stats say that ~400 physicians commit suicide every year, giving medicine the highest rate of suicide for any job.  And the hidden curriculum starts early - up to 30% of medical students screen positive for depressive symptoms.  

Young doctors have a lot in common with star athletes - at every stage of life they've been praised for being talented, hard working, and having their life together.  Yet, people like Belcher happen all the time, and everyone screams out - but he had such a good life! 


eat or be eaten
Doctors and athletes are a lot of things - but they are not invincible. I've never been a professional football player - but I imagine it's like medicine.  A world of talented individuals where weakness is looked down upon.

Rugged individualism might work for med school when you need time to cram in fun facts for Step 1, but what about residency - when you're facing the human side of medicine, and patient die for no apparent reason on the operating table?  Is it really right to tell those surgeons to just stay positive? 

Shouldn't we encourage them to keep it real and seek help when life is hard?

See you on the other side,

from ken

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