I don’t think computers will ever substitute a physician’s ability to “heal” the patient, nor do I believe primary care doctors are in jeopardy of being replaced (although I do feel nurse practitioners will take on a greater role in the initial workup of patients). But what I do know is that primary care will be foolish not to incorporate a computer’s suggestions in the future.

Is this shortage secondary to a lack of raw materials? Or perhaps pharmaceutical companies have little incentive to manufacture drugs with minuscule profit margins? Maybe politics is playing into it? Whatever the reason(s), our patients are ultimately paying the price.

• Has this been mentioned earlier in the PS? If so, consider removing it.
• Has this been outlined in any part of the application (namely the activity list)? Reiterating a very short portion of an activity to set the scene is one thing but duplicating the details is completely unnecessary.
• Is any part presumptuous? Is the writer making claims he or she has no way of knowing. Appealing to your humility by acknowledging your ignorance will serve you well early on.
• Flowery language is overrated and doesn’t show your command of language. Focus on masterfully unraveling your story rather than writing a laundry list with big words.
• Does this contribute to the the overall theme? I’ve read personal statements reiterating several disjoint activities which somehow magically lead the writer towards medicine. Have a theme in mind and focus on how each sentence relates to said theme.

I’ve found that shorter personal statements which focus on avoiding redundancy and are rooted in showing one’s path to medicine (rather than merely telling) is more effective, and consequently, more memorable. In adhering to just the important details, applicants don’t have to worry about going beyond the allotted word limits either.

When it comes to personal statements, Shakespeare said it best – “Brevity is the soul of wit.”

I’d like to be very straightforward – most med students who utilize social media are amenable to suggestions and thankful whenever our colleagues, professors, mentors, or even the general public questions our postings. As a group of aspiring physicians, we share the same intention – to educate others while in turn educating ourselves – but we find ourselves challenging accords of professionalism from time to time.

“A 47 y/o Caucasian male with MRN # 123-456-789 presents with the only documented case of Condition X known to mankind” is obviously going overboard and a prototypic HIPAA violation.

But what if I write about seeing a patient with hypertension in clinic today? Given how prevalent hypertension is, would that constitute “identifiable information?” If hypertension were replaced with something less common ( take priapism, for example), am I more likely to offend someone? Where do we draw the line?

Extremely conservative individuals would argue that students shouldn’t write anything on public domains. Facebook, Twitter, personal blogs, and the like should be terminated at the risk of sacrificing one’s professionalism or image. My view is precisely the opposite. By stifling our adoption of social media into medicine, we’re inevitably working against the grain of where society is heading.

Over the last decade, social media has become a cornerstone for business, advertising, communication and it continues to permeate other fields. We need to embrace social media and utilize it to exercise our creativity, but at the same time, it’s important that we are each other’s whistle-blowers. If you’re a physician. Or a dental student. Or a nurse, PA, or tech. Even if you’re outside of healthcare – it doesn’t hurt to contact the writer (myself included) directly, voice your concern, and help mold our virtues of professionalism.

It’s remarkable how often as a healthcare professional, “one mistake” is all it takes – a slip of the hand in the operating room, an improperly dosed medication, and in this case, a single blog post or Tweet which can be inappropriately extrapolated to represent one’s entire career. I say we continue using social media as a learning opportunity to impart our knowledge and enthusiasm in a way that is both professional and efficacious, but it can only be done with appropriate guidance along the way.

I got accepted to TCOM [a D.O. school in Texas] and Ross [an M.D. school] in the Caribbean. Which one do you think is a better option? Do you think I should reapply to MD schools again? I am very confused and don’t know what to do. Please give me some advice.

In all honesty, this isn’t a fair question. In a way, it’s questioning one’s definition of what it means to be a physician. Is it the M.D. after one’s name… or the actual calling? Is it the fact that you’re attending a mainland school… or just a prestige issue?

First of all, if you’re doing this for a particular degree, you should have some knowledge regarding the fundamental differences between allopathic (“M.D.”) and osteopathic (“D.O”) medicine. These days, to say that, “I’ve always dreamed of being a doctor” is very different than saying, “I’ve always dreamed of being an M.D.” What does osteopathic medicine offer in training that allopathic medicine misses? And vice versa?

When I first decided to become a physician, I hadn’t even heard of osteopathic medicine. I was under the naïve notion that “doctor = M.D.” myself, and unfortunately, a lot of cultures around the world are still firm proponents of that sentiment. Times have changed, D.O. physicians are permeating every residency, and in the majority of cases, patients couldn’t tell you if their physician has an M.D. or D.O. The lines are indeed blurring.

In my short time on the wards, I’ve come across several D.O. residents who, from my eager-to-learn medical student perspective, are better teachers and more friendly to patients compared to their M.D. counterparts. This isn’t to downplay the M.D.s who have taken the time to show me the art of medicine, but I’m trying to make the point that one’s degree (whether M.D. or D.O.) does not, by any means, reflect the quality of a physician. Judge them by the collective package, not just a degree.

In my opinion, when deciding between a Caribbean M.D. school and mainland D.O school, it’s more prudent to assess things which actually matter – the school’s board exam pass rate, cost of tuition/living, and the clinical training you’ll receive. Had I been in this position, I would have chosen TCOM (the only D.O. school in Texas) over any Caribbean M.D. school simply because of the in-state tuition, proximity to my home in Houston, and clinical opportunities in the Dallas/Fort Worth metropolis. Others may have chosen to go to the Caribbean because of the environment and fact that the M.D. degree is more globally recognized (useful if someone wants to practice international medicine).

So in closing, try picking the school based on parameters which can contribute to your success as a physician and future plans in practice.

Yet in the course of medical education, it seems that we’re still forgetting to instill a very fundamental principle – the art of “learning how to learn.” Medicine is ever changing and the general fund of knowledge is doubling at an astronomical rate. In fact, I have to accept that much of what I learned in the basic sciences a year ago is either flat out wrong or obsolete information. That’s pretty scary. How can one possibly manage to stay up to date?

Simple – med students need more concepts and less content. By learning how to learn… actually knowing which resources to consult to get our evidence-based answers and sifting through extraneous information to find relevant information… the pursuit of new knowledge becomes far simpler.

In my limited experience, clinicians are much better at emphasizing this form of learning compared to their doctorate counterparts. While both are undoubtedly important components to the healthcare system, clinicians and researchers focus on very different details. These inconsistencies make it difficult for medical students to ascertain what information is “high yield” for diagnosing and treating patients versus impressing their research mentors.

How do we best ask new medical students to learn an inconceivable amount of human biology in 1-2 years? You teach them how to learn!

Oral vancomycin and metronidazole have routinely been used to treat this form of colitis, the former being better for more severe cases; however, as of May 27th, the FDA has approved a new antibiotic – Dificid (fidaxomicin). Dificid’s true beauty is in the fact that it, more or less, is selective for C. difficile thereby leaving healthy intestinal flora minimally disturbed. While Optimer Pharmaceuticals ascertains the “cure rate” of Dificid to be similar to that of vancomycin, it’s the recurrence rate they should rightfully herald as an achievement.

The following table shows the recurrence rate of C. diff in patients treated with fidaxomicin versus Vancocin© (vancomycin):

Source: Optimer Pharmaceuticals, Inc.

Cost will likely be an obstacle in the beginning, but it’s good to see a more efficacious drug being approved by the FDA for a relatively common and potentially fatal disease – Clostridium difficile colitis.

The primary issue these measures are trying to address is medical error caused by interns who are simply burned out from being overworked. By mandating things like uninterrupted five hour naps and capping shifts at sixteen hours, the intention is to drastically reduce preventable mistakes. This is great and all, but I can see it crippling the training of surgeons.

Surgical residency programs are geared towards one thing – case exposure. By essentially limiting the amount of hours interns work, are we not simultaneously limiting the number of unique cases residents encounter on the wards? As an intern, you should be looking to work as much as possible while there are senior residents and attending physicians supervising your work. Once you’re a fully licensed, board-certified surgeon, you’ll rely on your experience to guide your practice – an experience that can only be appropriately tailored with a ridiculous amount of patient encounters and practice.

Next, I would hate to be a senior resident when these guidelines (having to supervise junior residents at all times) go into effect this summer.

So hypothetically if I were on night call as a brand new ENT intern and a patient came in with his neck hanging open after being stabbed, I’d undoubtedly require the help of an upper-level resident or attending. Now let’s say another patient comes in with otitis externa during the same shift. There’s no need for an attending/upper-level resident to physically be present for me to a.) assess the severity of the otitis externa, b.) prescribe a course of Ciprodex and c.) say “Follow-up in the ENT clinic. Have a nice day.” This gives the intern a valuable learning opportunity to assess the patient, provide treatment/follow-up, and relay the info back to the team. Plus, in reality, if it’s 3 AM and a vanilla case of tonsillitis comes in, the upper-level resident will likely want to either split the work or take the case on entirely so everyone can just go home. Multiply this scenario throughout the entire intern year… and that’s a lot of missed learning. Remember, these same interns will be upper-level residents the following year too.

This case was on the GI service at St. Luke’s during my second month of internal medicine. I apologize in advance for the abbreviated history as I was not actually assigned to this patient.

A “well nourished” Hispanic man presented with several weeks of weight loss secondary to diminished intake because of excruciating abdominal pain. No nausea or vomiting, no blood in urine/stool, still passing flatus and having regular bowel movements (no diarrhea/constipation). Review of symptoms unremarkable aside from aforementioned weight loss. Past medical history, family history, and social history noncontributory. Upper endoscopy showed an antral mass which was subsequently biopsied and stained. Surgery ultimately resected the mass and part of the surrounding antrum. Patient recovered well.

The following are actual images from the upper endoscopy.

Unfortunately, I didn’t snap a picture of the pathologist’s report. The following is the histology of the mass… taken from Google Images.

1.) What, specifically, is the mass in question?
2.) What did the pathologist stain for in the biopsied specimen to confirm the diagnosis in question 1?

Obama’s administration enacted sweeping health care reforms last year, causing both unprecedented controversy and great waves of international acclaim. There has been a wealth of political jargon and inaccurate generalizations regarding the changes. Some call it socialized medicine, a step towards the left the debt-ridden United States can’t afford to take. Supporters, on the other hand, identify the overhaul as a solid step toward eliminating poverty. Both of these common generalizations go a bit too far. More importantly, does it even matter? The law stands to be overturned by the Supreme Court, as many states overwhelmingly file suits against the federal government. Governors and state officials of NINETEEN states claim the reforms overstep the authority of Congress. They want Supreme Court to step in to tell the current administration: It is unconstitutional to make all Americans buy health insurance by 2014. Do you think it is?

As a medical student, are you unsure what this means for your future? Should you be glad more people will get coverage under the umbrella of new reforms? After all, doesn’t the Hippocratic Oath bestow you with numerous obligations towards your fellow human beings? The bill does promote preventative care one of the most important components of the Hippocratic Oath. WAIT, how does this affect your salary? This is a PROFESSION, and you should be rewarded accordingly for all your work just like any other field.

If you’re a first or second year medical student, how can you be expected to sift through all that information? The bill and its addendums take up thousands of pages! The truth is: both parties are trying to address valid concerns. The reforms do try to provide affordable insurance coverage to all Americans, but at some cost to personal choice.  Your opinion on the reforms may be closely related to your views regarding the appropriate degree of government intervention in the lives of citizens. Should governments intervene to make health care accessible to more citizens? If something is beneficial for citizens, should governments force citizens to partake in that practice (in this case, buying health insurance)?  Here are some major changes that may affect your life as a future physician.

You’ll be treating more people who are terminally ill

The bill makes it illegal for insurance companies to deny coverage to patients with preexisting conditions. This may be costly for insurance companies, but many who can’t afford treatment (because they are denied coverage) may finally get the medical help they need.

Potentially Higher Overhead Costs

Medicare will be expanded to provide preventative check-ups WITHOUT co-pays. There are a number of changes that affect Medicare without appropriate funds. This may increase costs of operating for physicians which may be accounted for through higher physician fees.

Uniform Information Exchange

This could help you tremendously when you get new patients. New insurance plans make it mandatory to have uniform system to exchange health information. You won’t have to worry about different systems used by different companies.

Your Patients will Face Penalties for not Purchasing Health Insurance by 2014

This is probably the most controversial component of the health care bill. In 2014, if you don’t have insurance, you’ll be forced to pay a fine. This amount increases if you refuse to purchase insurance by 2016. You’ll have to pay an additional tax (a % of your income). The idea is to increase the pool of insurance plans to make health insurance affordable. Numerous competing plans are supposed to equal out the forces of supply and demand.