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.

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.

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.