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Monthly Archives: July 2009

A fair proportion of the people who arrive at my weblog are searching for information on the viability of the iPod Touch as a medical PDA. During the third year of medical school, the iPod Touch has been an excellent companion for me: having the Epocrates medication database at my fingertips has been invaluable, and having various medical texts and medical calculators on hand on the wards has been very handy. However, for various reasons, I finally decided to upgrade… to the iPhone 3GS!

So far, I have found the new device (and having Internet access at all times, in all locations) to be a brilliant piece of technology that is revolutionizing my life. In addition to the previous apps I have found indispensable, having Internet access has given me rapid access to obscure pieces of medical knowledge: How else would I be able to quickly look up information on Global Transient Amnesia or Weber’s Syndrome when all of the ward computers are already being used?

On another note, my fellow sub-intern has clued me in to the broadening availability of medical texts provided by Skyscape for one-time fees (without automatic updates, although the books are not updated yearly anyways): in particular, he showed me Sabatine’s Pocket Medicine and The Massachusetts General Hospital Handbook of Neurology, two books I have in paper form. The digital versions are searchable, and it would be nice not to have to carry as many textbooks in my white coat pockets. The speed of the iPhone 3GS makes Epocrates (which was sluggish on the original iPhone and the iPod Touch) and these other resources much more accessible.

Pushed tPA for the first time for an acute ischemic stroke patient yesterday, just under the 3 hour mark (although current evidence and AHA/ASA recommendations allow administration up to 4.5 hours after the onset of symptoms).

The patient’s symptoms are predominantly aphasia, one of the more frightening consequences of stroke. Although some people with less exposure to stroke patients may think that hemiparalysis (paralysis on one side of the body) or hemiparesis (severe weakness on one side of the body) would be more frightening, aphasia almost instantly changes the way others unfamiliar with the patient view him: Why does he only say a few words or nothing at all? Why is he answering questions with the wrong words? Why does he look so confused when I’m talking to him? (Is he mentally retarded? Is he stupid?) In every moment of our social lives we take for granted the ability to communicate effectively: to follow commands, to convey humor, to express opinions and feelings. How do you connect with the world without this?

Good luck. We’re here to help.

I am finding myself standing in the shoes of my past residents and attendings, reliving moments where I saw them shine in patient care or grit their teeth and get down to the business of accomplishing a difficult task. For example, I recently sat down with one of my disgruntled patients to explain why we needed to subject her to a variety of tests despite her discomfort and desire to shorten her hospital stay. I saw myself following the example of my Surgery chief resident, a charismatic physician who took the time to clearly and deliberately lay out the options for each patient despite the constant time pressures. As the day to day tasks of medical management in the hospital pile up, I find myself resorting to the methods my Medicine residents used to keep track of patients and their many needs; it’s amazing how much information can fit on an index card with the help of a fine point pen and a little micrographia.

Furthermore, as I delve deeper into my responsibilities as an acting first year resident, I find myself staying at the hospital longer, past required hours, to see my patients and make sure they are well. After all, they are my patients.

Now that I am one week into my senior year of medical school, I can say with some confidence that feels quite different from my experiences as a (lowly) third year medical student. It is a great pleasure to work with third year students: not only is it enjoyable to teach and feel like one is helping someone else, but it is also gratifying to see how far we have come in developing clinical skills and a nascent ability to survive Medicine. The emphasis changes from surviving the wards (and the requisite clerkship exams for each specialty) to thriving as a young doctor. I am currently spending four weeks on a sub-internship, a trial where the fourth year medical student takes on the role of a first year resident with matching responsibilities, in my field of choice: Neurology. Clinical instructors often use the acronym “RIME” to represent the four stages of a medical student’s evolution: reporter, interpreter, manager, and educator. Most of a third year medical student’s responsibilities and expectations involve accurate reporting of history, physical examination findings, and laboratory and imaging findings as well as the development of clinical diagnosis skills (interpretation). Now, as a fourth year and a sub-I, I’m taking on more responsibilities as a manager (making treatment decisions and requesting studies) and an educator (teaching students, and occasionally residents, with less experience in a particular area).

On a personal note, I’m enjoying revisiting my field of interest after a one year absence and solidifying my fund of knowledge. I’m more confident now in my examination skills, assessments, and gut feeling. I’m also developing confidence and comfort in the notion that sometimes I know more than an intern and sometimes second-year residents: they’re not necessarily far from my present state of knowledge. Maybe next time I’ll even be confident enough when I hear someone with more experience than me ask “Which side?” when discussing an anterior communicating artery aneurysm to respond, “What do you mean? There’s only one.”

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