the a team

Med school gets a bad wrap for causing depression and physician burnout. To address that concern, here's some data I gathered in an anthropological study of med students on twitter.

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First, clinical requirements for depression: 

One of the symptoms MUST be: 

- depressed mood
- loss of interest or pleasure

At least 4 of these symptoms:

- sleep difficulties
- loss of interest
- guilt
- lack of energy
- concentration problems
- appetite
- psychomotor retardation
- suicidal thoughts

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Now the data: anonymous tweets from real life med students:

"I'm not even studying. I'm just that mentally exhausted I can't even watch tv." (lack of energy, loss of interest)

9:31 AM - "and with that...im crawling back to bed..." (sleep difficulties, lack of energy)

12:41 AM - "guess I should stay up all night..." (sleep difficulties)

"Somebody save me from this week. Straight burnt out" (depressed mood)

"need a study week shirt that says 'talk to me and I'll fucking kill you' ASAP #getmeitnow" (loss of interest)

"Today may be the first time I try RedBull ever. I'm THAT desperate and coffee just ain't cutting it. #studyweek #letitbeoveralready" (sleep difficulties, concentration problems, lac of energy)

"To allow myself a night away from the library, I have to answer online practice questions all night wherever I am. #medschoolproblems" (guilt)

"True Life: I just ate over half a bag over of Sweet and Spicy Chili Doritos and I could have kept going." (appetite)

"Just checked my loan interest. Always a fun time." (depressed mood)

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I'll let you draw the conclusions. On second thought, I do have one conclusion: more of our class needs to get on twitter. sidenote - I've been thinking of another segment for sidenote called tweet of the week. Basically, I'd just post the best student tweet of the week. Any interest in this? 

see you on the other side,

from ken

enjoy sidenote in 140 characters or less @kensidenotelife.

Physician Drug Abuse - where is the grey line?

We had a great lecture yesterday about impaired physicians that abuse recreational drugs like alcohol, prescription painkillers, cocaine, etc. It was a pretty black and white conversation - doctors shouldn't be under the influence while practicing medicine. But the gray area grows when we get to other forms of drug abuse - what about people who use drugs as a supplement? Is it wrong for a med student to Adderall to study late into the night?

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Let me go on a 3 part sports sidenote - 

1) Lance Armstrong recently came out on Oprah to admit his doping status. What he did might have been cheating, but was it wrong?  Everyone else in the Tour was doing it. (New Yorker article about what Lance did wrong)

guilty until proven innocent

2) Baseball Hall of Fame voting came out this past week and ZERO people were enshrined this year because of steroid accusations.  This included players like Mike Piazza who were great home run hitters during the steroid era, but never tested positive for steroids.  First of all, is it fair to assume these guys are guilty by association? Second of all, is it our place to stop these guys from their pursuit of greatness?  If they understand the consequences of steroids, should we stop them from bulking up, getting big time contracts, and trying to become the best baseball player that they can be?

3) Take endurance running.  One form of training is running in the mountains where there's less oxygen.  By training at altitude you train your body to produce more red blood cells, which carry more oxygen, and make your running more efficient. You have to work harder at altitude - but you get more result out of it.  Nobody would call this extra advantage cheating.

Technology has figured out how to mimic this effect with altitude tents where you can sleep in a low oxygen environment.  Whether you sleep in a low oxygen tent or you train up in Wyoming, the way your body makes more red blood cells is by producing more of a molecule called EPO.  Should sleeping in these tents be allowed?

Endurance athletes have also learned that you can inject yourself with a synthetic EPO solution to induce this RBC producing effect. Injecting EPO isn't allowed, but altitude tents are, even though neither of them require any extra work.

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Anyways, back to medicine: On an average day I have green tea in the morning. In the afternoon I have coffee around 12 or 1 PM to avoid the post-lunch coma. If I go past 2 PM without that delicious coffee, I'm hitting a wall and getting pissed off. Once I get that caffeine influx, I'm in a great mood and it's easily the most productive hour of my day.  

So if I can drink coffee to help me study, is it wrong to use ADD medication as a studying crutch?  Nobody has ever offered me Ritalin or Adderall, but if someone offered it to me.. what would I say?  Honestly.. I might consider it.  I could study more in less time. I could have more time and energy left to be a good husband. Not to mention I would be learning medicine better, and I would become a better doctor, so I would be saving lives, right?  

What if I thought I could get diagnosed with ADD and pick up some prescription fully legal Adderall?  

What if a surgeon decided to self-medicate to be especially focused for a tough case at the end of a long night?  What if he was doing heart surgery on your kid? 

..where do we draw the grey line?

See you on the other side,

from ken

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.