Thursday, July 04, 2013

Two weeks in.

Today marks two weeks of being an intern. I have never felt so busy in my whole life. Pressed for time, but filled with energy. No time for food, every moment is devoted to my patients, my teammates, my colleagues, and soaking up new information, skills.

Everyone told me I would be humbled, and they were right. Many told me I would be invigorated, and I am.

I live, breath, eat, drink, and sleep my profession. Although I will not always be this busy or fully immersed, I continue to relish in these formative moments. God, keep giving me strength.

Sunday, June 23, 2013

BOOM

Intern year is no joke. The thrills and chills of being a physician, plus all of the documentation, disposition, and other administrative work to move things along. Boom!

Thursday, May 16, 2013

Much to ponder...

As my MSTP training life comes to an end, in favor of a new chapter training in Ob/Gyn in Philadelphia, there remains unfinished business, unwritten reflections. Here's a list with brief abstracts. I hope to expand on each:

1. USMLE Step 1 - why is it so hard, so feared? In many ways, it's like an intense, fast-paced language immersion program, where you have to learn the language without the why or always the precise "how." It's a way to lay out the foundations needed to start learning medicine as it is practices. It requires one to learn the foundations and science of medicine without any of the art. How frustrating and challenging. Along these lines: how do we *define* the stages of training? Should the learning objectives, and the comparisons and contrasts between and among stages of training be better defined? e.g. should medical students not simply be told to, "understand the pathophysiology, treatment, and prognosis" of a disease, but also being given the caveat that, "you will not be able, nor should you be expected to, manage X disease clinically; in this phase you are to learn to recognize and understand the core principles of the disease."

2. Philadelphia abortion doctor found guilty of murder, having killed neonates after botched late-term abortions. Ugh.

3. Career decisions in medicine: how to separate the forest from the trees, and stop listening to advice from people who shouldn't be giving it.

4. Deeply understanding the role of healthcare providers -- why isn't this better emphasized in medical training?

5. Shout out to my Ph.D. mentor, newly-elected member of the National Academy of Sciences.

6. Deep gratitude for my teachers and mentors at the UCLA David Geffen School of Medicine and the MSTP.

7. Deep gratitude for my undergraduate education at Pomona College, and it's enduring lessons and skills taught.

8. Even while medical schools are emphasizing the success of humanities-majors-turned-physicians, should we be dismissing the value of a rigorous scientific education and how it can play a role in medicine? Has science become the "S" word in medical education? Part of the burden falls on scientists, who need to learn to be more art- and humanity-minded. It's on us, too.

Saturday, April 13, 2013

I'm so tired

Nearing the end of the MSTP, and intellectually, I'm exhausted. Love what I've been doing, what I am going to do, but right now, I feel weary.

Time to re-charge.

Sunday, April 07, 2013

UCLA pride


It's no secret that UCLA and UCSF have a degree of healthy competition when it comes to being "Best in the West" (although UCLA is BIW x 20+years). Here's an anecdote from this weekend I think to be particularly reflective of the trash talking supposedly going on between the two schools:

According to the David Geffen School of Medicine Dean, A. Eugene Washington, UCSF from time to time ridicules the warm weather loving UCLA people, making snide comments about bruin people. Some time into his tenure at UCLA, Dr. Washington was asked by a former UCSF colleague, "Well, what do the people at UCLA say about SF?" To which Dr. Washington quickly responded,

"Nothing."

#once a bruin, always a bruin.

Thursday, March 28, 2013

Middle school failure = Medical school success?

Some compelling insights (albeit completely qualitative and non-quantitative in nature) into how struggling when younger predict future success: http://www.theatlantic.com/national/archive/2013/03/how-middle-school-failures-lead-to-medical-school-success/274163/ 

I recently failed at doing a relatively straightforward procedure on a patient, and the resident said to me, "don't beat yourself up," after I apologized. And at that moment, I made a pretty important self-realization: I am probably better off not succeeding at a given procedure, because I get too forms of feedback in the process: 1) I didn't succeed, but I figured out what some of the challenges of the procedure are, and 2) I got to see how the resident successfully performed the procedure thereafter. What if I had been lucky and succeeded right off the bat? Would I have the insight I (think I) have for the next time, had it just been totally easy for me? I think not. That's the beauty of the "failing" and getting feedback. And so, realizing that, I could earnestly say, "Yeah, no, if there's one thing I've learned in med school, it's that being unsuccessful at procedures and the like is all part of the job, and it's all an opportunity to LEARN!" Over-exuberance about failure aside, true that.

Thursday, March 21, 2013

Gynecologic Oncologists

For the win, according to a new study out of UCI.

Also, when financial considerations come into play, private practitioners don't always do what's best for the patient (intraperitoneal chemotherapy is used less, in part, because it takes longer to administer without reimbursing any better than intravenous; although it's more complicated than that -- it's much more toxic and ridden with side effects).

If you or anyone you know is diagnosed with, or has signs/symptoms strongly suggestive of Ovarian CA, please please please go to a gynecologic oncologist, and preferably one at an academic center. Survival may depend on it.

And if it happens in seven years from now, please come see me.

Monday, March 04, 2013

On Age-Related Fecundity, Modernity, and "First World Problems" behind infertility

UPenn Medical Student Anna Jesus shares her story of realizing she had hypo/hypo infertility, got medical treatment to facilitate pregnancy before her eggs expired, while in med school.

But her amusing story brings up the First World Problem that is infertility in older women. Our society discourages and makes difficult child bearing in a woman's most fecund years (although 30% of causes of infertility are idiopathic -- completely unknown, meaning that as women become infertile regardless of age and as a result we don't know why and can't easily "cure" the "problem in these cases). For most infertile women, we've created the "problem." Anna Jesus's story suggests that we might need to "allow" women to become pregnant at a younger age.

In any event, here's an account of how I spend my days on Reproductive Endocrinology and Infertility:

Each day, I run into 10-15 friends or acquaintances in the Hospital in which I work. They ask what I'm on. I say, "Repro. Endocrinology and Infertility...a.k.a. First World problems!" Ha. Ha.

But it's kind of true. 100% true: REI is a medical specialty where, work on mullerian anomalies or legitimate structural (like uterus, tubes, ovaries, cervix, pelvis) or biochemical (various hypogonadisms, endocrinopathies, etc) issues relating to the speciality aside, a majority of the work is devoted to getting people who can't get pregnant, pregnant. And it turns out that, in many countries of the world, e.g. most places in the continent of Africa, there's no such thing as a doctor who actually addresses advanced maternal age, poor ovarian reserve, recurrent pregnancy loss, male factor infertility; nobody freezes and thaws eggs. No one does a Semen analysis or considers poor hypothalamic function.

Here in the First world, on the other hand, all of the above mentioned issues can be worked up, solutions crafted, and far more successful plans implemented. You can inseminate a uterus, you can induce ovulation, you can harvest eggs, artificially inseminate them (even inject sperm straight into cells), grow embryos, and then implant them in a uterus which thinks its already pregnant. You can freeze your eggs when you're 30, thaw and inseminate them at a later date. And on, and on.

But the major first world problem is this: women who either have major medical issues (prototypical younger infertility patient), or older women who have very low (1-5%) chances of getting pregnant as a function of their age, these women are those of First World REI. It's because we don't let people climb the corporate latter while raising kids; it's because people can't get enough help taking care of their kids because the government isn't very generous toward child-rearing, people just stay single longer and don't necessarily get into serious and long-term relationships until they are older (and then they are maybe in the middle of climbing the corporate latter), and then they finally have everything going for them: they are happy, well-off, well-adjusted, spiritually settled, and with someone else who has that, and then, right when you're FINALLY ready, you can't get pregnant. You can't.

So this is a first world problem, but it also reflects issues our society has created, which it exacerbates the problem for "driven" women who get old but want kids. REI gives them a chance they deserve, perhaps a chance they deserved when they were younger and more fertile. 

In third world country, women who don't have inherent problems with fertility, they give birth during their most fertile years. They don't use IVF because mostly they don't need it. and in the rare instances they need it, they either get charity, or usually nothing.

Wednesday, January 23, 2013

Chronic Traumatic Encephalopathy

Like a broken record, I continue to post on CTE and its prevalence in former NFL players. Now, UCLA researchers, several of whom are former colleagues and co-authors of mine (Drs. Barrio and Keppe) in research, tackle the problem. Check out this (http://www.espn.go.com/pdf/2013/0122/espn_otl_CTELiving.pdf) pilot study. I look forward to seeing what the impact of it is going forward.

Saturday, January 05, 2013

Jared Diamond strikes again

This time, he compares and contrasts primitive hunter-gatherer and modern societies' child-rearing practices in his forthcoming book, The World Until Yesterday, an excerpt of which can be found here. The excerpt is definitely worth a read, and the book is next on my list.