20-Somethings

This piece about "20 somethings" and the movement toward recognizing one's 20s as a period unique - not adolescence, not true adulthood - is worth a read, especially if you're a 20-something.

In a way, doing extended post-college schooling may provide exactly what 20-somethings need: a transitional phase, gradually introducing more responsibility, life choices, and adult activities.

Who knows? As for me, I feel as though I identify much more with a "20-something" than a "young adult."

I know what I would want...

Early palliative care with usual treatment.  As the piece by Atul Gawande (linked to in Anthony's earlier post) suggested, early palliative care (hospice) reduced the costs of care, without negatively affecting patient outcomes.  Now this NEJM-published study on metastatic lung cancer shows that it even extends the lives of terminally ill patients.

WTF is up with...

1. Counseling on a patients' goals of care/end of life wishes/advance directives = "Death Panels" ?

2. Building a Islamic community center (which includes a prayer center; by a subdivision of Islam which has NEVER been supportive of or involved in terrorism) two blocks from the former WTC site in lower Manhatten = "Ground Zero 9/11 Victory Mosque" ?




People babble over issues of which they have no understanding.  And worse, they don't even try to understand.  They just babble.


::sigh::

As you know end-of-life care is a big deal...

... that can improve quality of life for dying patients and save the government a lot of money. Chuck C has written about the so-called “death panels”; the NYTimes and other news outlets have expanded the dialogue; now Atul Gawande has written an essay for the New Yorker.

I’d like to focus on one particular part of Gawande’s essay, where he refers to Stephen Jay Gould’s remarkable recovery from abdominal mesothelioma, which inspired Gould’s essay “The Median Isn’t the Message.”

Gould beat a normally lethal cancer. He is the exemplar patient that all physicians would like to have and treat. Gawande admits this sentiment himself:

I think of Gould and his essay every time I have a patient with a terminal illness. There is almost always a long tail of possibility, however thin. What’s wrong with looking for it? Nothing, it seems to me, unless it means we have failed to prepare for the outcome that’s vastly more probable. The trouble is that we’ve built our medical system and culture around the long tail. We’ve created a multitrillion-dollar edifice for dispensing the medical equivalent of lottery tickets—and have only the rudiments of a system to prepare patients for the near-certainty that those tickets will not win. Hope is not a plan, but hope is our plan.

The reality, as Gawande alludes to, is grim: optimistic hope in sexy, new treatments against diseases that we don’t completely understand. The grim reality, though, funds our futures as physician-scientists. A lot of basic research in a lot of different fields is needed to know which patients will benefit from which treatments. And some times the treatments will be palliative.

Gould studied patient-survival curves. He saw “himself surviving far out in that long tail.” But what does it mean to be in the “long tail”? People are hard at working doing this, particularly with breast and prostate cancer.

First day for first years

Welcome, first years.  On the first day of orientation, we at mstpla.blogspot.com welcome you to the UCLA MSTP.  This is a great city, school, and program.  Here's to productive MD/PhD training!