Journal Club

This morning, I will be leading a journal club discussion for the Yale-New Haven Hospital emergency medicine residency. The topic is "Fight or Flight in the Face of Epidemics: Making a Case for Codes of Ethics." We will be looking at some of the ways codes of ethics succeed in shaping physician behavior and where they might break down.

As an icebreaker, I am asking my colleagues to put themselves in the context of various disasters to think about how they might respond. Since all three questions are New Haven-themed, I thought I would pose them here, as well!

1. A SARS-like illnes broke out in NYC two weeks ago. There are 76 fatalities, including five physicians and 7 nurses. Boston just reported its first death, and there are 5 patients in YNHH with the disease. Will you:

A. Volunteer for MICU coverage
B. Come to work as usual
C. Call in for backup
D. Head for the hills

2. The Indian Point (north of NYC) nuclear reactor's cooling system was sabotaged by an environmental terrorist group, resulting in a meltdown that was not properly contained. New Haven is in the predicted fallout area, but the extent is still unknown. Will you:

A. Sign up for surge (ED surge that is) duty
B. Work for the first few days, then leave town
C. Avoid the chaos entirely

3. Hurricane Zelda slams Long Island Sound in a late season perfect storm situation. Manhattan experienced a storm surge of 15 feet, incapacitating the health care system in NYC. New Haven has flooding, but the hospitals still function. FEMA and the military are looking for docs to staff tent hospitals. Would you:

A. Stick around to treat the victims of this disaster
B. Get out of harm's way but stay close enough to help radiation-contaminated victims
C. Take an extended holiday yo the West Coast

... and now, your answers please!

Gene Patents

If you didn't know, about 20% of all human genes are currently patented by companies or universities. This is important to people wanting genetic tests. Myriad Genetics is probably the most profitable of these organizations, having secured rights to the BRCA1 and BRCA2 genes. You are at increased risk for breast, uterine and possibly colon cancer if you have mutations in these genes. If you have a family history of one of these cancers, knowledge of the mutation can help decide treatment. But the price of the test is around $3000, which can be argued is the price for innovation or conversely, the effect of a monopoly.

Yesterday, the financial security of gene patent-owning companies fell into question when a District Court judge invalidated gene patents on BRCA1 and BRCA2. This could open the floodgates to more affordable genetic tests or stifle R&D, depending on who you ask. But the upshot for this New Haven Resident is that the Laboratory Medicine Resident I'm married to may have a different way of doing things in the near future. (Lab medicine physicians are the docs who do and send off tests in hospitals.)

Indeed, the NYTimes article about this case cites a leader of the Lab Medicine professional society as calling the decision “a big deal.”

“It’s good for patients and patient care, it’s good for science and scientists,” he said. “It really opens up things.”

I'm sure the folks at ScienceBlogs will be picking this story up. Indeed, check out what Genetic Future and The Questionable Authority have written. We will see how the appeals process works with this one.

The Exams That Never End...

Yes they go on and on, my friend...
Someone started writing them not knowing what they're for
And now we'll keep on taking them forever, asking them for more...

Exams that never end...

I'm taking my in-service exam this Wednesday. It's in the neighborhood of four hours long, and is all about emergency medicine. The best part is that it happens to be in the midst of the New Haven portion of my vacation! Thankfully, the number of exams has diminished to the frequency that makes them useful for self-improvement. I expect that there will be plenty of room for improvement between this year's and next year's installments.

And you thought exams ended with graduation. Medical residents in all specialties take in-service exams once yearly, and generally in the same week.

But wait! There's more!

We also must take the third installment of the licensing board exam at some point. It is a general topic exam that covers all specialties. Fortunately for ER doctors, there is not a lot that we don't see walking through the door.

When it comes time to be board certified in emergency medicine, however, there is a whole new round of EM boards, which include oral exams in a hotel in Chicago!

When I think about it, though - keeping myself sharp enough to pass these difficult exams is just another way to do justice by my patients. Who wants a doctor who forgets (insert important medical fact here) when said patient experiences (insert relevant medical condition here) in the middle of the night?

For any of my EM colleagues who happen their way to these parts, good luck this week!

And for other New Haven residents (i. e. my neighbors), we know that the tests that we sometimes complain about actually make us better docs!

Color Career Test

Working nights for five weeks does a number on the circadian rhythm!!! What do you do when you wake up at 2:30 AM and cannot get back to sleep? Tonight, I studied a bit, watched part three of the excellent Masterpiece Classic presentation of "Emma", and surfed the web. I'm more prone to take online tests in the middle of the night! Anyway, have you read about the non-verbal personality test using colors?

It's called the Dewey Color Test. If you take it, answer the question asked. Don't pick your favorite color, pick the one you most prefer to look at...

This is a short test, but I think worked pretty well for me. As expected, the top two options have a bit of built-in conflict...

Best Occupational Category

You're a RESEARCHER

Keywords

Independent, Self-Motivated, Reserved, Introspective, Analytical, and Curious

e investigative types gather information, analyze and interpret data, and inquire to uncover new facts. They have a strong scientific orientation, enjoy academic or research environments and prefer self-reliant jobs. Dislikes are group projects, selling, and repetitive activities.

RESEARCHER OCCUPATIONS
Suggested careers are College Professor, Physician, Psychologist, Pharmacist, Chemist, Marketing Research, Inventor, Sales Forecasting, Project Engineer, Dentist, Identifying Consumer Demand, Chiropractor, Dentist, Medical Technician, Optometrist, Research & Development Manager, Respiratory Therapist, Real Estate Appraiser, Chiropractor, Veterinarian, Geologist, Physicist, Science Teacher, Medical Technologist, and Author of Technical Books.

RESEARCHER WORKPLACES
Task-oriented careers where you can become absorbed in the job, be original and creative, and not conform to rigid company rules will work best for you. Unstructured organizations, for example, that allow you to sail your own ship are vital.

Suggested Researcher workplaces are universities and colleges, home office positions, medical facilities, computer-related industries, scientific foundations and think tanks, research firms, and design laboratories.

2nd Best Occupational Category

You're a CREATOR

Keywords:

Nonconforming, Impulsive, Expressive, Romantic, Intuitive, Sensitive, and Emotional

These original types place a high value on aesthetic qualities and have a great need for self-expression. They enjoy working independently, being creative, using their imagination, and constantly learning something new. Fields of interest are art, drama, music, and writing or whether they can express, assemble, or implement creative ideas.

I am a physician first and then a writer, and will probably end up in academics... go figure.

The better to see you with...

One of the great things about emergency medicine is the ability to incorporate ultrasound as an extension of the physical exam. Ultrasound is not just for babies folks! We can use it to see clearly through the skin to diagnose numerous conditions.


After getting this image, the patient went back for emergency laser surgery. Any guesses about what this person's problem was?

Link All About It!

Right-O!

There's lots of stuff I'd like to blog about, but, well... I have not enough time for it. So if you are dying to read things I've written or are thinking about in the world of medical or New Haven residency, here are some links:

My performance evaluations so far agree that I'm always working on improving my own medical case presentations, so I guess I'm an expert worth asking how you should present cases on rounds.

I continue to try and stir up some controversy in the ethics conversation board over at MedStudent Connect, but still thus far, I've not had any takers...

If ever I have the time, I'm thinking of joining the Elm City Cycling advocacy group because of the excellent ideas they put forward in their recent recommendation to leaders in New Haven's City Hall. Biking in New Haven has kept me from putting on the pounds that interns typically gain.

Like my sister, we are gearing up for a small seedling farm to stock our backyard garden. Until I get a chance to write about our activities, read what she is up to.

At the end of December I attended and spoke at an aldermanic committee meeting about red light camera legislation. It was actually a meeting to recommend support for a resolution to be voted on by the full city council to indicate that New Haven supports proposed state legislation permitting municipalities to install red light cameras should their citizens approve them. Were there enough condionals in that sentence? I learned a little bit more about how municipal government works and spoke for a policy I support. We shall see if anything comes of it!

And I know everyone is out there waiting with bated breath for the June 2010 issue of Virtual Mentor because it will focus on ethical dilemmas in emergency medicine. Until then, you'll just have to read other excellent issues about different topics in medical ethics.

Finally, I am pleased to announce that our kitchen remodel is nearly complete. For your viewing pleasure, here are before and after photos.



























The low image quality is because I used the iPhone. But methinks the shots are good enough for you to get the idea. I'm going to go install the dishwasher right now!

Back from the MICU

The medical intensive care unit is a very difficult place for interns to work. I'm glad my month is finished.

I'm back to being a regular New Haven Resident, which includes time for writing, for studying and for kitchen renovation in the midst of learning how to intubate patients and how to look at just about everything you can imagine using ultrasound.

Here are some other things I've been working on recently:

A little article about couple's matching for residency over at Medscape. The couple's match is how medical school graduates can be guaranteed placement in a city where their partner (who must also be a soon-to-be intern) will also match.

I'm also helping kick-start some conversations over at a discussion board within Medscape, called Med Student Connect. Check out my morning report posts if you want to work through some clinical brain-teasers. #1, #2, and #3. I'm trying to kick up some controversy in the ethics section, but haven't any takers yet.

You'll need a free log-in for Medscape to read each of these. Sorry.

So not very much news from me other than these. For now...