Brand Loyalty

Luckily, I've gotten down to a more manageable number of patient - it was touch and go there for awhile. This has given me a little bit of time for extracurricular activities such as preparing for the shelf and paying attention to lectures.

Did I say 'extracurricular'? Well, maybe 'subcurricular'. Or 'paracurricular'?

Anyway, I heard in lecture the other day that generic thyroid hormone is not bioequivalent. The name brand is actually better if you need to control the dose really tightly.

I was not surprised. I've been to a grocery store. I know that Frosted Flakes are supposed to be sold by a tiger. As a child, and to this day, I have always been really uncomfortable with some 'Sugar Flake' knockoff sold by Sammy the Sugar Ssssnake. That is not how it is supposed to be. It's difficult to put into words, but obviously Tony the Tiger knows the market and his product. I trust him. This other guy is just some drawing done to fool kids who haven't seen enough commercials. The brand name cereal is just better - not in any objective way, it just is.


This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.

Risk / Benefit

Sometimes there is no single right way to do things, but there is sure as hell a wrong way to do it. Actually, it happens quite often. Yesterday, for example, there was some debate as to whether or not you should wash your hands before or after shaking hands with a patient. My personal thought is that the patient has touched themselves at least everywhere that you are going to during the exam, so it really doesn't matter to much if you touch their hands after washing yours. Your mileage may vary.

However, all can agree on wrong ways of going about hand hygiene: eg - just skipping it, spitting on your hands and wiping on your pants, or demanding that the patient sterilize their skin so that you don't contaminate your hands. All wrong positions.


This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.

Off Label Use

There is an iPhone application I have been playing with of late, seen here. It augments your reality, presumably with extra reality, in the form of the amount of calories are in your food. In short, you provide a picture of said food, and it comes up with an estimate of the caloric content.

Naturally, I set out to try to prove that a 99 cent app can't possibly predict the essence of food as well as I can. At first, I started out with food, then food hidden by other food (Big Mac under a layer of saltines), then things that aren't food, and finally pictures of people that most certainly are not food (as depicted above).

Frankly, I'm no so much bothered by any inaccuracy, but by the fact that it is perfectly willing to make guesses on anything you put in front of it. If this thing ever gets into my facebook photos (or becomes SkyNet)... well that's a grim future where we're all just tens of thousands of calories to our reality augmenting overlords.

Side note - I was just thinking that if you couldn't read the words, the above drawing might look like some bizarre ad for vegetarian or vegan eating. Which made me think, are vegan babies allowed to have breast milk? What about the adults? Who is the authority on this?


This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.

Epocrates Platinum

There are correctable and non-correctable deficiencies that turn up repeatedly over the course of medical education. A common theme over the past month or two is that my medicine superiors tend to like me to be able to do history & physical, and often present the patient. Actual management, though, does not seem to be the purview of the JMS. Usually, it's enough to say something to the effect of 'hang fluid' or 'give antibiotics', and it's generally accepted that we're on the right track.

Some attendings, on the other hand, are not privy to this tacit guideline. Sometimes, I'll look at a potassium of 3.5, and want it at four. The correct way to do this would be to give 50 mEq of potassium chloride preferably by mouth, else by iv. A problem with this plan is that there is no such 50 mEq pill - they come in 20s.

Also, I'm not exactly clear on what a 'mEq' is... I think I forgot this in 2005.

In any case, now and then we have had pharmacy people following along. They are really good at Epocrates (for the record, Micromedex is also great - and iPad sized), and occasionally save me the trouble of looking 'medication simple'. I appreciate any opportunity to not look dumb.

Orientation Realities

The baby M1s at my home institution finished their orientation this week. I fondly remember those good ol' days. Well, the one good day... the morning of it, anyway.

Every couple years from here on out, it seems like the try to kill us again with an orientation (pre-clerkship lectures being the most recent). Pretty much, it's just alternate really hard academic tasks, with the really hard task of sitting in a room and being orientated for days at a stretch.

For some reason, it makes me think of that trick where you get the dog to balance a treat on his nose and not eat it until you tell him to. But I don't know exactly why that is.

In any case, they've survived the lectures and the coatings, now it's time to read stuff and answer questions about it. And repeat that process. Like sixteen times.

Good luck, kiddos!


This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.

New URL

In case anyone has deigned to put me in their bookmarks (the proper place being between the link to your disused MySpace page and the homepage for that Thai place you never go to anymore) - the URL has now changed to prosconsult.blogspot.com

Some guys from JJ Mudjacking wanted to be the Pros of Sand Consult, so I ceded the space. Best $6 I ever made!

Thrifty Business

Junior Medical Students do not, as a rule, have a lot of money. My entire income, for the past three years, for example, must be paid back with interest. This has the effect of essentially making anything I pay for cost 1.5 to 2 times it's actual sticker price (when it finally gets paid for - years from now).

Luckily, I get a lot of great financial advice. This usually take the form of 'Don't Spend Money on [x]'. Eg, 'Don't spend money on Starbucks.'; 'Don't spend money in the cafeteria.'; 'Here, take this free iPad'.

In fairness, that iPad wasn't free - it's included with the tuition.

Recently though, I'm enjoying the more proactive advice. This takes the form of 'Instead of [x] do [y].' So instead of cafeteria lunch, we sponge off the interns free lunch. Instead of textbooks, I do questions. Instead of my own internet conduction, I'm sharing a Wifi connection. Judging from the strength, I'm guessing the hub is maintained by political dissidents in China to avoid the firewall.

For the medical trainee, a penny saved is 1.8 pennies earned.


This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.

No Judgment in Brainstorming

Didactics is the process of making me learn without material that is specifically targeted to help me learn. This sometimes takes the form of 'noon conferences' that are geared toward residents. Two assumptions come into play here:

1) These cases are for interns. The presenter is usually seeking verisimilitude, looking for things that we would do to manage a patient in real life, i.e. - correct answers.

2) JMS students, by virtue of being there, are also allowed to talk. Sometimes, when one of us ventures an answer (or is called on to do so, at the peril of the presenter) we all feel as though we need to say something so as to not look like 'the stupider JMS'.

So naturally, we have the conditions for a perfect storm of derailing a conversation about giving aspirin to a guy with an infarction into a conversation about, "maybe we could freeze the guy because my old attending told me on a different patient that one of the criteria for brain death is that they have to be normal temperature so if they're cold maybe that means they won't die."

Beware run-on ideas when they bubble to the surface.


This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.

Dis-Orientation

One month in, I've noticed some things about my transition to wards. Right at the beginning, I had a lot of things that ostensibly helped me adjust to my new academic life. I was given great tips about not being sexually harassed, not plagiarizing, and why it's not a good idea for me to just show up when I feel like.

But the practical information... density... left a little something to be desired. BMP stands for 'basic metabolic panel' and the criterion for ordering said test is that we always do. You can't write a note in the EMR unless you access the chart a certain way. Attendings rotate at twice the speed of ordinary students. Et cetera.

Maybe you can't teach that stuff; maybe they just don't. It's not too hard to pick up, I suppose.


This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.