I’ve been reading a lot lately, and I have noticed a few things on the web that reek of revolution in medicine. Technology and policy always are being developed to better the healthcare industry, and right now there some excellent movements that inspire hope for our field.
Top Five stories of the last few weeks, in no specific order
- 10 Healthcare Industry takes on the iPad - see what top docs think of the iPad’s utility in a medical setting, from MobiHealth News
- “Checklist Manifesto”: Healthcare reform rock star - Interview with Atul Gawande, New Yorker contributer and medical revolutionary, on Salon.com
- Docs Talk – a blog about the environmental impact of healthcare (and the health impact of environment) at the David Suzuki Foundation
- Psychotherapy reduces repeat ER trips – an explanation of how a Halifax hospital helps patients understand the emotional-physical connect, reducing the number of repeat visits they make to the Emergency Department for things like panic attacks; this could reduce overall wait times, and make visits for the aforementioned patients much more satisfying.
- Presumed Consent for Organ Donation coming soon to India - a brief article in Indian Express explaining the potential for opt-out organ donation to alter the face of transplant medicine in a country with a sordid history of illegal organ harvesting and trade; the issue of framing organ donation in such a way is very exciting for me, and I’ll pursue it further in another blog post.
N.B. I received a free copy of this software in order to review it.
Software: Rohen’s Photographic AnatomyManufacturer: Lippincott Williams & Wilkins /Modality Inc. (modality.com)
Cost: $24.99 USD Availability: iTunes App Store
Basic Connectivity: no subscription or internet required
Best for: medical students studying gross anatomy; old-timer doctors who have forgotten it all
You can almost smell the formaldehyde! Lippincott Williams & Wilkins and Modality Inc. have put together, exclusively for iPhone, a collection of cadaver dissection anatomy flash cards. Included in the app are 211 full-colour photos, based on the printed atlas by Joel Vilensky, Rohen’s Color Atlas of Anatomy: A Photographic Study of the Human Body, Sixth Edition.
Just like in a real anatomy lab, you can add pins and labels to demarcate key structures; this feature is best used in conjuction with another atlas for reference. On each flash card, if you click on a labeled structure, you can view the “Structure Detail” information, which lists some pertinent features (eg. function or a nerve or attachments of a muscle). There are also direct links to Wikipedia and Google should you seek more detail. Finally, the app indicates other Flash Cards in which the same structure appears so that you can see all views possible.
Total for Multiple Sclerosis Society of Canada: $1170 from my pledgers, $13k from whole event
THANK YOU!!!
$1170 raised!
The minimum to participate was $125 and I think it’s fair to say that we blew that right out of the water. I kept having to raise my goal, as people contributed more and more to the Multiple Sclerosis Society of Canada. Most of the money will go to research and some may stay on the Northern part of Vancouver Island to fund programming for those carrying the diagnosis in the area.
Way to go – I was totally floored by your support. Friends (even long-lost ones), colleagues, hockey pals, family, mentors, local doctors, and even one doc I’ve not met, you are outstanding! Mondo thank you to the ‘other half’ of Jess and Jess (two residents in a program of eight, we share the same name). I thank her for joining, fundraising, and making it an awesome weekend. Thanks also to Daniela, my friend with MS, for letting me exploit her story for fundraising purposes 
She was quite excited to hear how much we had raised and I hope she feels that was a sufficient kick in the knees of this disease. MS is BS.
Maybe next year I can get a proper team together with my fellow Residents. Many of us love to ski and snowboard, and we are all OCD overachievers, by trade. That could make for some genius fundraising. There is also an “MS Climb” in which people must raise far greater sums, eg. $20 000 for a 14day hike part way up Everest – maybe that’s something to do 10 years from now.
That was one hard-earned BBQ lunch!
It was quite snowy! (other Jess tries to get a photo)
Me with a gold medal for being one of the top fundraisers
You’ll notice there are no pictures of the obstacle course. That’s because it was suggested that it was meant more for kids… oops! But we made our own challenge 0f trying not to break our knees on the hard pack snow – and we succeeded.
Thanks to all donors and organizers for making this fun and worthwhile event happen.
Thanks to family, friends, colleagues, and one tweeting doctor! You have all contributed to the Multiple Sclerosis (MS) Society of Canada’s vast fundraising efforts. To date, $775 comes from you, and travels via me, onto the ski slopes, and into research and support for people with MS. Incredible! Even for those of you who couldn’t donate, your words of encouragement, sympathy, empathy, mutual frustration and hope have been welcomed.
My friend Daniela, who carries the diagnosis, is delighted at this show of support. Another friend has joined the cause, and pledged her minimum amount all on her own!
I am incredibly shocked that such a generous outpouring came from all of you, in a time of great tragedy and need all around the world. I’m not a ‘loddy dah oooh that was sooooo inspiring’ kind of person, but holey schmoley, this really reminds me of what amazing and compassionate creatures you all are! I aspire to expressing even a fraction of that kindness in my coming years.
If you would still like to contribute – even $5 – find my pledge page here, or help out my friend with her pledges here. (yes, we both have the same first name).
The event is this Sunday, so lock your dial to this station for photos. There might even be a cape…
So… someone told someone told someone about my blog. After that, the Canadian Association of Internes and Residents (CAIR) decided to put me in its Resident Spotlight. For those of you who don’t know, CAIR represents about 7,500 Resident Physicians in the country. Actually, all of them, excluding those in Quebec.
They do lobbying and advocacy on a federal level, all in effort to support resident wellness which equates with good patient care. They also provide guidance and facilitate communication between the different provincial organizations, such as mine (ours, for those BC residents readin
g this!), PAR-BC.
On to the vanity part, because frankly I need to hurry up with this post so I can go admire my navel. CAIR did a short interview in which I might have accidentally revealed my not-so-secret-backburner-never-gonna-happen-but-wish-it-magically-would ambition to head into outer-space. It’s mainly the kind of questions you’d expect at a residency matching interview – only this time I didn’t have to fit the box.
Here’s an excerpt:
Why did you choose your specialty?
It was down to the wire with CaRMS, and I knew that I wanted my life to be full of variety. The only specialty that could allow me to constantly grow and change, and even alter my career path drastically as I saw fit, was Family Practice. Needing to connect with patients is a fundamental part of the job, and the appeal of that privilege was undeniable.
Read the brief interview here, CAIR Resident Spotlight, and find out my favourite on call food, because I’m sure you are just aching to know! I really hope there aren’t as many stalkers in real life as there are on TV*.
* I’ve been watching a lot of Criminal Minds lately. I’m not actually worried. But I do really like popcorn.
My best friend has MS, diagnosed in 2005.
Multiple Sclerosis is a disease in which myelin sheaths around axons (nerve conduits) of the brain and spinal cord are damaged. Picture an electrical wire with damaged insulation – the electrical pulse can short circuit or otherwise malfunction, causing a broad range of symptoms. Read more about it on wikipedia.
M.S. is B.S. There is no cure and much of the treatment is experimental, expensive, and can have some scary side effects. It is a debilitating illness, striking unpredictably, but we can fight.
I’m trying to do my (small) part by raising money – and I’ll be risking life and limb (I’m not a good skiier!) to ski an obstacle course and do a scavenger hunt with fellow participants. Fun for us, good for MS.
We can do better in our fight against MS. Please donate to help make that possible.
More about my experiences:
Lots of bizarre things started happening to my friend’s body before it was figured out. I remember her telling me about the numbness and weakness in her hand (that she thought was just due to writing too much) or when she called me with severe vertigo and couldn’t get out of bed. We went out for dinner and she had trouble crossing the street because her eyes would vibrate (“nystagmus”) when she tried to look to the right to see the coming traffic. Neurologists, ophthalmologists, radiologists, and many others were involved in the diagnosis. We were hoping for a curable brain tumour.
Her MRI showed extensive plaques, and she was diagnosed with relapsing remitting multiple sclerosis. Scary. It’s unpredictable – not knowing when you are going to have an ‘attack’ could be as awful as enduring the flare up. She’s had periods of blindness requiring IV steroids and unusual sensations and weakness in her extremities. Originally, she moved to the far North to take a job that had benefits that would cover her medications and had to travel by plane for her MS specialist appointments regularly.
While it saddens me to think about how this disease will take over her body, and how scary it must be not knowing when she’ll have an attack, her attitude and humour in all this inspires me. For her and for everyone touched by MS, we can do better.
When I was little, I loved to read, so I automatically participated in the MS-Read-a-thon, not knowing what the disease was at all. My grade 5 teacher had it. She worked half time, and it wasn’t surprising to have a substitute teacher regularly. All I knew about MS then, is that it meant she walked with a cane, was weak, and got frustrated a lot (in retrospect, probably because she couldn’t do all the things the other teachers could do). Now, as a physician and a friend to someone who has MS, I know a lot about it – and I don’t like it!
More Information:
- MS has been in the news lately with Dr. Zamboni’s controversial theory and surgery; much more information is needed before this treatment (or any other new one) is considered safe, efficacious, and is made widely available.
- MS is BS - a blog about a family and their fight with MS, mainly focused on their current fundraising efforts
- MS Society of Canada – Canada is a leader in research – partly because MS is prevalent in Northern Hemisphere countries; 55,000 to 75,000 Canadians live with the disease
- Serving people with Episodic Disabilities is a challenge; not knowing when an attack will happen makes it hard for people to maintain meaningful employment
Recently, Med Valley High asked about whether it was appropriate to insist on being called “Doctor” in a social setting or to introduce yourself as “Doctor Soandso.” I sometimes struggle with social convention, as I am in some ways a radical and in others, a conservative sheep hiding in the corner.
I’ve thought about some of the unwritten rules that I try to follow. They seem pretty safe to me, but some days I feel more doctorly than others, so I have an inextricable bias.
Introducing Others:
1. Wherever possible, use the most respectful title: “This is Dr. Soandso, Head of Surgery” and let them correct anyone else if they prefer to be called ‘Jim’ instead.
2. If you are about to introduce someone and you aren’t 100% on how to say their name even if you’ve known them for years, that’s a good time to figure it out finally. It goes something like “hey, how do you say your last name exactly? I don’t want to get it wrong!” and they are usually keen to help out. You then get to show off that you were listening when you help them make a grand entrance!
Introducing Yourself:
1. It always depends on the context, but generally you should say whatever it is you like to be called while performing the task you are performing. At hockey, I am “Jess” because it’s easier to yell
2. With patients, I usually say “Hi, I’m Dr. Otte but you can call me Jessica if you like” and secretly giggle if they say “yes, Doctor!” I also wear a nametag with my full name preceded by “Dr.” so they know my role because I don’t look as ‘doctory’ as I could. Also, I read a paper ages ago that said patients prefer doctors with white coats, handshakes, and nametags – and I hate white coats!
3. When I meet doctors/nurses/non-patients in the medical setting, I’ll say my first name and “I’m one of the Residents” or “I’m the Resident with X service” because they usually know what that means. Sometimes I’ll mention my last name because people don’t know how to say it, and I don’t want them to feel uncomfortable and need to ask me about it later on. I won’t correct them if they mangle my last name because as long as they spell it right in the chart, it doesn’t matter! The only time I would like a nurse to call me “doctor” is in front of the patient, if I’ve not yet met the patient. It just helps keep my role congruous in the patient’s mind.
4. When I’m on the phone to clinics or wards, I usually say “It’s Dr. Otte” so they know that it’s the doctor calling to speak to the nurse or another doctor. This can expedite things and few receptionists will put you on hold for an hour under this system. I also say “Dr. Otte” on the phone when calling patients or families so they immediately know what the call is about. I think it’s funny when they yell “oohhh, it’s the doctor!” to the family that happen to be in their house at the moment. It’s very sweet! (You can tell I’m not used to this MD thing yet, right?)
Other doctor name and role etiquette:
1. Regarding putting your title on credit cards, I haven’t done this one yet. I’ll admit that I’m tempted to see what happens – anecdotally, people say they get better service; I imagine that expectations for high tips and ‘coming to the rescue’ are also much higher. I look a lot more like a PhD than an MD (I’m young, have a piercing, and wear casual/funky clothes when I travel), so the airline staff would probably think I’m just a pretentious twit anyway.
2. Female doctors are regularly confused as being nurses, male nurses are often seen as the doctor. I am not a nurse. My dad is a nurse. He’s the moustache man in his hospital’s “Caring Spirit Brochure” for heck’s sake! I am not THAT caring! I will correct people if they say “Nurse, please, I need a bedpan.” I’ll tell them that I’m a doctor – and I’ll get them a bedpan if I know where one is, unless the nurse is nearby and not preoccupied. It just makes life for everyone easier.
3. Talking about the job is a challenge. I’m proud of what I do, and I believe I’ve worked hard to get here. Despite that, I ought not to rub it in people’s faces. It takes practice to get over the “dooood, I’m a doctor! oh my godddd! I’m a doctor” phase but I’m getting there. When people ask “oh, what do you do for work?” I try to say ‘healthcare.’ If they really don’t care, they’ll stop there. Most people dig deeper, so then I’ll tell ‘em straight up, but then promptly move on to ask about their profession.
That usually goes okay, however guilt or shame sometimes kills me when they say “I work at MacDonald’s” because I feel like a turd; this is mitigated if they actually really enjoy their job. Part of it is my latent condescension thinking ‘what non-teenager would want to work for MacDonald’s?’ but I’ve learned that there are people who like it and have some hilarious stories about their time there. Ask about the treads of their shoes! Actually, instead of profession, what I’d rather ask is what kind of music a person listens to – that is a way that is easy to relate to all people and it’s hard to find someone who doesn’t have any musical taste in common with whom I don’t have some favourite band in common.
4. It’s always fun to laugh at names of people who don’t exist (or aren’t within earshot!). Here are some funny names including lots of unfortunate doctors’ names for when you are bored – most of them are miserable. I like “Hugh Jorgan,” “Les Plack” (a dentist), and Dr. I. Ball (optometrist).
What do you think? Am I really a turd?
When you find yourself getting out an otoscope (that fancy light thing for looking in ears), preparing a child mentally for having the device stuck in their orifices by a stranger is an essential task. It’s nice to warm the kid up a little because it will also make the job easier. Today, I showed a very articulate 4 year boy old “my magic light” and pretended to look inside his shoe, at his knee, and finally at his fingers. I remembered that you can make fingers glow if you put the light directly against them. Greatly satisfied at recalling this, I said:
“Now we are going to make your finger like E.T.’s!”
*putting light against kid’s finger*
“You know E.T., don’t you?” I begged
and the poor little creature said “yes!“But he said “yes” to everything I asked.
So, just FYI, 4 year olds don’t know about E.T., and you are at least marginally ancient if you know that ugly brown alien.
People ALWAYS ask 
me how old I am. In some ways, I am old. Very old. I am a doctor, so in my social circle, which (like anyone else’s) includes some people who haven’t yet decided on a career path or who make a living doing awesome fun stuff that no one can believe is a real job (eg. video game testing!), being in a profession sometimes makes me seem a lot older than I am. So I’ve been told.
My face also betrays my fatigue, and I’m sure one can guess the extent to which brow-furrowing and eyebrow-raising are a part of the profession from the history these actions have etched on my face. I also have had the privilege to travel a lot and try to undertake as many adventures possible, so I might seem a little more ‘worldly’ than I really am. I think my parents did a good job, so (no thanks to my efforts) I am an oddly well-adjusted human which is often mistaken as maturity. I can even be crotchety at times – I’m already jaded and sarcastic, hoping to secure a place on the balcony next to Statler and Waldorf well before I retire from practice.
My youth has been lost to textbooks and answering pagers, stewing over what dose of dilaudid to order rather than where to party for Spring Break.
I cling to the fact that sometimes I am young! It’s usually at work that I am seen this way. “You look 19!” is a common expression from patients and nurses. Well, I like loud music and counter-culture; I am a Resident Physician, not a fully certified doctor, so of course I’m younger than some of the doctors they are used to working with. I don’t need glasses, don’t have distinguishing grey hair, and sometimes dress a bit cheeky with a three-piece women’s suit (and tie) or brightly coloured shoes. My eyebrow piercing is telling of my youth; people often ask me if it is a problem, but usually if I get to the point with a patient where I can open my mouth, they see that I am competent, approachable, and have their best interests at heart. At least, I think that’s what happens!
I’m the first to admit to my lack of experience and not afraid to ask for help from preceptors if I’m out on a limb, and this fluctuating confidence means I’m never the authority on a subject. Childishly, I seek naps in the on-call room whenever possible and can sometimes be caught eating the same thing day after day after day. Being young and looking young means it is easier for me to talk to suicidal teenagers feigning mutism (yep, it’s happened) and to get away with acting pretty goofy with pediatric patients. I haven’t done a lot of medical student teaching, but the fact that I can easily recall exactly what it’s like to be in those shoes will help make my efforts relevant and more gentle than they would otherwise be.
Overall, I hope I strike a balance between youthful curiousity and calm maturity, but that’s probably just my naive and demented perspective.
Oh Boy! I haven’t written any decent posts recently, and I’m not sure how it’s looking for the near future.
Despite all the curriculum meetings and workshops I’ve attended regarding initiatives in resident wellness, I find it a struggle sometimes. I left work slightly early (5:30PM, all of my work was complete) and went to the grocery store. Sure enough, my pager went off in the car while I was stocking up on veggies. So, I called back, informed them I wasn’t “on call” and, silly me, dealt with the reason for the call. Kind of.
I had left early because I have a hockey game tonight that’s a little earlier than it usually is. I also wanted to eat right. I ate so poorly during my Obstetrics rotation out of convenience and self-pity (woe is me!) that it’s time to shape up again. I find cooking enjoyable and when I cook, it looks good, tastes good, and is at least marginally healthy.
Things feel like a juggling act even though my hours are reasonable and my first call of the month isn’t until Wednesday. I can’t go to rounds tomorrow because they overlap with my Family Practice clinic day, which I booked a month ago, before I had heard that Palliative Rounds are on Tuesdays; last week I made the rounds, but I missed out on seeing some pre-natal patients that are specifically booked on Tuesday mornings to see me. Not ideal.
My Saturday was spent in Vancouver speaking at the CaRMS (Canadian Residency Matching Service) Open House at UBC. We were sharing the nitty gritty on the Nanaimo program; I found myself beaming and thinking “wow, we are pretty lucky!” And we certainly are – this program is the most flexible on the planet, I’m sure. But silly me, I didn’t use the rest of my Saturday productively. Somehow, I also volunteered myself for the first Journal Club (happening in 2-3 weeks), have a giant (though interesting) book to review for this blog, and am *slightly* overdue for an oil change on my car. And so on.
No toodledo list can save me.
p.s. why doesn’t the iPhone have a built in task list? why doesn’t their calender show items that are scheduled as “all day” ?
rain, car, work, death, stairs, elevator, passenger seat, coffee, boat, walk, golf cart, potholes, pirates, beautiful, music, love, croissant, mud, red shoes;
golf cart, passenger seat, rain, charts, stairs, pager, stairs, stairs, stairs, phone, elevator, lunch?, ink, nausea, lunch?, scribble, 5:30!, condolances, lunch?, scribble, car, mail, Trail!, food, phone, powerpoint, seaplane
and that’s how it goes.
