Monthly Archives: March 2009

Early in medical school I felt assured of the notion that all physicians are unified by a common code, a shared spirit for betterment and healing. Now that I am three-quarters of the way through my third year of medical school, I am quite certain that there can be many noticeable differences between specialties and the roles physicians assume. I was reminded of this when I was guiding two second year medical students through a differential based on their joint interview and exam of a patient: the two students, one planning to pursue a career centered on patient care and the other planning to pursue a field more distanced from patient interaction, displayed very different approaches to tackling the “simple” objective of diagnosing a patient in the clinic and determining a treatment. During the clinic session, the first student took all of the vital signs, conducted the majority of the interviews, and performed all of the physical exams. However, this student tended to hesitate when asked for an assessment of the patient’s condition. The second student interjected a few questions here and there and jumped to conclusions much more quickly, sometimes correctly and sometimes incorrectly (such as suggesting an NSAID for a painful joint in a patient who had a history of a bleeding peptic ulcer).

It would seem that style of approach and attitude play a significant role in steering a medical student toward one field or another: we mold ourselves to the archetypes we see in each field. Those who want to operate in the surgical suite practice the impenetrable confidence and cocky, competitive sportsmanship of surgeons. Those who seek to practice hospitalist medicine don the red badge of courage of Internal Medicine and its unwritten mantra, “We are the real doctors.” Those who see the brain as the king of all organs and consciousness as the meaning of life learn to find fascination in life’s current perplexing mysteries of the mind, however insignificant to everyone else. Those who find the heart to care for the sick of mind learn to harden their hearts to the jests of their colleagues and the curses of their sickest patients. Those who find they care the most for children denounce the self-inflicted suffering of modern adult life and fully embrace and idolize the preservation of innocence. Those who enjoy the fast pace of the Emergency Room floor the gas pedal and don’t turn back. And those who find comfort and poise in the Radiology reading room start investing in a good set of golf clubs (just kidding. Sort of).

However, in the end, our differences are merely caricatures of a more nuanced reality. I recently had a discussion with two friends about medical curricula, and they both argued for the need for flexibility in a physician’s character and manner. In their case, they argued for flexibility in scientific knowledge; instead, I would argue more for the need for flexibility in the ways we approach our patients, our colleagues, and our profession. The best physicians, those who patients, students, and colleagues alike speak of with awe and admiration, are those who surpass the usual boundaries and the commonplace stereotypes with ease and purpose. As I take on new roles and add more letters before and after my name, I hope that I do not forget to stay true to myself.

A couple gems I recently discovered:

1. Pocket Medical Spanish (by Modality Inc.)

Having used another one of the Modality products previously, I was excited to try out Pocket Medical Spanish (I was invited to try it out by the company for free). I am very impressed by its organization, ease-of-use, and high production quality.

As with other resources, the app is sorted into a few general sections (Introduction, General Questions, etc.) and problem-specific sections (Pain, Chest Problems, Abdominal Problems, Nervous System Disorders, Ob/Gyn, etc.). Navigating through the app is easy and quick: the transition time is very short, and each sub-section has a concise title (in the Chest section, you find “1: Chest Pain. Vomiting. Nausea…, 2: Previous heart trouble. Palpitations…, 3. Recent cold…”). Some of the sections are also cross-referenced, so you can sometimes navigate between sections by clicking on links below each phrase (although I would like to see many more of these links in future versions).

One of the unique aspects of this app is that it facilitates patient-doctor dialogue in an additional manner: the app is designed such that the doctor can stand alongside the patient and ask questions with a visual prompt. Each Spanish phrase can be expanded to fit the screen so it is easy to read. Additionally, the program has a “tools” section with Spanish versions of a clock, pain scale, calendar, and more with items that can be selected by patients tapping the screen and easily translated for the doctor. For someone like me who has just begun learning Spanish (and will need to practice on my own time with respect to pronunciation), this is a very useful assisting device during an initial evaluation before a translator can be consulted.

Lastly, the audio quality of the spoken phrases is excellent; I hope to someday pronounce my Spanish phrases as well as the recordings! I sent the developers some suggestions for new content and some minor refinements, and I look forward to seeing updates to the app. Although this app is the most expensive of the medical spanish programs so far ($20), I think the quality and the reliability of updates from the developer makes it a worthwhile, lasting purchase.

2. Diagnosaurus DDx (by Unbound Medicine)

Having used Diagnosaurus DDX occasionally on AccessMedicine previously, I was excited to see this inexpensive app arrive on the scene. Notably, the DDx database is offline, so it is useful for someone like me with an iPod Touch practicing in clinics and hospitals without free wireless access. This app is a quick draw, useful adjunct to more detailed resources (on paper or on the iPhone): it helps to have resources that are concise and quick to access and other resources that have more detail when needed.

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