JAMA once again!

Another pleasant surprise at the Journal of the AMA. It turns out that each issue has had a podcast associated with it since early 2006. It's a 10-minute summary of each issue, and the more I study medicine, the more I find each issue valuable and pertinent.

My membership in the AMA not only entitles me to electronically archived back issues, but all the other digital accoutrements that go along with them. Like with the Ginsu knives, you can just hear "but wait, there is more!" Every month, there is also a 55-minute interview with the Author in the Room, a feature that is "designed to bring clinical evidence into practice by connecting clinicians and others to authors of JAMA articles."

So good stuff all around. And I've got my membership paid up front for another 3.5 years.

Occasional Irony

As it should be in the hierarchical reality of medicine, the first years look up to the upperclassmen as the veterans who've seen it all and know even more. But once in a while I'd hear something just the opposite in conversations with my classmates: older residents and doctors telling us that we know more. It was something both difficult to believe and quite obvious. After all, we just had anatomy, we just did biochemistry, so it should still be fresh. All of this was basically anecdotal for me, until, that is, a few days ago, when an intern (1st year of residency) asked me some relatively straightforward anatomy question. Before I was able to register surprise, she added that I'd have a better idea since I just took the subject. The way medical school rolls along, we will end up remembering the most important details, which obviously will be repeated several more times in our schooling, but many things will fall by the wayside. Such is life and such is education.

Unconscious

Fainting, or syncope in medspeak, is not quite what I had in mind, but like the previously mentioned JAMA journal, I'd like to have some classical painting, preferably with 18th-century powdered wig extravaganza on my blog as well. So here it is. But the topic of discussion is really OLD CARTS. Thanks to our school's insistence on clinical exposure from year one, we had a chance to memorize this tried-and-true mnemonic that doctors use each time when they ask about pain. O=onset; L=location; D=duration; C=character; A=aggravating factors; R=relieving factors; T=temporal aspects; S=scale of 1-10. By the time a clinician is practicing, this is old hat, so ingrained that it's happens almost unconsciously. If you pay attention to your doctor, you'll find most of these elements when s/he asks you about your symptoms. Some doctors have such an awesome conversational style combined with just the right dose of personality, that it's tough to spot. But oftentimes the scale of 1-10 is the dead giveaway that you've been had, so to speak. And you thought you were entertaining the doc with your tales of last month's trip to that Star Trek convention.

I have a long way to go (the Star Trek convention's in Denver ;), but today, I was relaxed enough to lapse into OLD CARTS, all in Polish by the way, during a conversation with my mom. Oddly enough, we're covering the GI system, and she called me out of the blue with a related question. So after this "writeup," I'll be researching some stuff for her. HIPAA rules prevent me from elaborating any further.

Where's my paranoia?

I'm waiting for the unhealthy sense of paranoia to set in, as we sample from the buffet of diseases on almost weekly basis. So many things can go wrong, in so many horrible ways. Abdominal pain, since we're doing the GI module, can be so many things, from indigestion to pancreatic cancer. So far, I haven't worried my head of about any aches and pains. Exams are the biggest thing to worry about right now. The other reason is probably that everything is still in a very theoretical stage for us--that's how the first two years are: bookwork and exams. Once we start seeing patients in hospital settings, manifesting the symptoms we learned about, things will become more real, so to speak.

So paranoia is on a back burner. Black Sabbath had theirs in 1970; I'll have mine in 2010, perhaps. Let's hope that RIAA doesn't get too upset about this image.

This year and beyond.

We're knee deep in the GI module. From here on, the coursework marches to the steady beat of systems-based modules, which makes things very interesting. We cover all the standard goodies in each module: physiology, anatomy, histology, pathology, and biochemistry. It's called an integrated approach, which seems to be the way of teaching medicine that many schools are opting for these days. The classic method was to teach function of the healthy body the first year, and follow it up by disease the second year. In any case, I'm growing to like the integrated approach, since it feels like seeing all the dishes on the table and having a chance to sample all of them.

Up next are the renal and musculoskeletal modules--one month apiece. Exams will pretty much be with us on weekly basis, except for the spring break which is coming up at the end of March. Things will cool off a bit during renal & muscoskeletal, but the pressure, as always, will be on. Classes end in the last week of May, which gives us the very last summer vacation. There will be a bit of time off during the summer of the second year, but that will be spent preparing for USMLE Part 1, the famous board exam. The first part of the boards makes or breaks the career. A high score opens the doors to the competitive residencies. I'm sure I don't have to explain what happens with the low score.