Monday, March 24, 2008
Last block
The last block began today. I'm now studying pharmacology and pathology. We have pharm a whopping 6 times a week to the paltry twice-weekly path sessions. I'm hoping I'll enjoy pharm since I want to do anesthesia which is all pharm. My friends give me a hard time because I always remember the drugs they tell us to ignore in all our other modules. I just got my gargantual Robbins pathology book in the mail today. Hopefully it will be more than a $90 doorstop, though who can say. The second years in my ward say they use it pretty frequently, so it seems like a good investment. I can't believe how fast the time has flown by. So far, it really hasn't been as bad as I though it would be. This block looks to be pretty tough because we have class most of the day several days a week. I don't really like that because I would rather have that time to study.
Tuesday, March 18, 2008
It's spring break, I guess.
It's always saturday afternoon. Any time I have a few consecutive hours off, it must be Saturday afternoon, which means tomorrow is Sunday, and that means church. Naturally, today is tuesday, so no church tomorrow, but it's still saturday afternoon. I think that friday afternoon, I will realize that I've just had spring break, and that it's time to go back.
My genetics exam didn't go as well as I had hoped, which was frustrating. It's the one class I've come closest to honoring this year and getting a negative z-score isn't the best way to finish the block. I was surprised that genetics wasn't really very hard. My undergrad class was a lot more molecular biology and not as many diseases, which made it more challenging. Virology was just tons of rote memorizing. Which viruses have +RNA genomes? which ones have ssDNA? circular DNA? reverse transcriptase? what could possibly be causing these symptoms: fever, nausea, vomiting and malaise? that's right, ANYTHING!
Well that's done. Onward to pharmacology and pathology for 9 weeks, then I'm done with first year! It has literally flown by. School has definitely gotten easier. I don't know if it's because last block I had already had genetics so the material was easier or I'm just better at studying, or if I have gotten used to the idea that no matter how hard I try, I can do no better than pass my classes?
This summer's plans are somewhat nebulous at the moment. I wrote earlier that I'm going to be researching perfused rat hearts and lipids? well, I might be doing something slightly different. The fellowship program that I'm applying for is only granted on a one student per lab basis, for reasons that were poorly explained. Unfortunately, there is one other med student already in my lab, which means that I have to find another PI. My current PI is collaborating with an MD on a project, so what will likely happen is that PI #2 will be 'in charge' of me, while I work with PI #1 in his lab. I don't really know if I'll be working the perfused heart, or if I will in fact be studying the effects of a fast food diet on mice livers instead. Hopefully I can do the heart because that's what really is more interesting.
My genetics exam didn't go as well as I had hoped, which was frustrating. It's the one class I've come closest to honoring this year and getting a negative z-score isn't the best way to finish the block. I was surprised that genetics wasn't really very hard. My undergrad class was a lot more molecular biology and not as many diseases, which made it more challenging. Virology was just tons of rote memorizing. Which viruses have +RNA genomes? which ones have ssDNA? circular DNA? reverse transcriptase? what could possibly be causing these symptoms: fever, nausea, vomiting and malaise? that's right, ANYTHING!
Well that's done. Onward to pharmacology and pathology for 9 weeks, then I'm done with first year! It has literally flown by. School has definitely gotten easier. I don't know if it's because last block I had already had genetics so the material was easier or I'm just better at studying, or if I have gotten used to the idea that no matter how hard I try, I can do no better than pass my classes?
This summer's plans are somewhat nebulous at the moment. I wrote earlier that I'm going to be researching perfused rat hearts and lipids? well, I might be doing something slightly different. The fellowship program that I'm applying for is only granted on a one student per lab basis, for reasons that were poorly explained. Unfortunately, there is one other med student already in my lab, which means that I have to find another PI. My current PI is collaborating with an MD on a project, so what will likely happen is that PI #2 will be 'in charge' of me, while I work with PI #1 in his lab. I don't really know if I'll be working the perfused heart, or if I will in fact be studying the effects of a fast food diet on mice livers instead. Hopefully I can do the heart because that's what really is more interesting.
Friday, March 07, 2008
Wow. Just wow.
So we had a standardized patient interview group meeting this week in PPS (patient physican and society). What we do is sit in a group, one of us interviews an actor playing the patient, we discuss possible diagnoses together, then someone else talks to patient about the diagnosis and possible treatments. This week's subject was diarrhea. The following story was related to me by my friend in whose group the following events transpired.
Our protagonist elicits the following history:
The patient is a 2 year old boy. His hispanic father relates the following history: patient has had watery diarrhea for the last 12 hours. The family had eaten together at a church picnic where chicken, warm rice, and other potluck foods were served. 5 hours later, the patient, and some of his family members all reported having intermittent non-bloody, non prurlent diarrhea.
Even the most un-medical lay person would probably leap to the diagnosis of food poisoning, specifically, some toxin mediated form (B.cereus, S. Aureus, or some other form). The history fits, the signs and symptoms fit, and the diagnosis is, in fact, food poisoning. You might also consider some viral gastroenteritis, but since the whole family is simultaneously sick in such short order, the illness is more suggestive of food poisoning. Now is when our hero shines.
When queried by the moderator about possible illnesses to include in the differential, our hero says:
"well, I feel that, it's , you know, like maybe esophageal atresia. Maybe it's like, like, a fistula, you know? like a tracheal-esophageal fistula? Or maybe, you know, I can't remember what it's called (now he waves his hand vaguely over the right upper quadrant of his abdomen), you know, like some hypertrophy of something? the duodenum? "
"Pyloric stenosis?" asks the moderator, dumfounded.
"yeah" replies the champion.
"NO." says the moderator, floored at the ignorance of our protagonist.
Now, some vocabulary for you so you can understand the colossal mistake that our protagonist made.
I'm amazed at how wrong his diagnoses were. Come on! the conditions he described, for the most part, are obstructive and would not, could not, result in diarrhea!! Not to mention that common sense alone would tell you it's food poisoning (though you might have to have microbiology to tell which bug is the likely culprit.) This dude is one of the SLU medscholars, who were selected as college freshman for automatic entrance into medical school, as long as they kept their grades up in undergrad. Simply stunning.
Our protagonist elicits the following history:
The patient is a 2 year old boy. His hispanic father relates the following history: patient has had watery diarrhea for the last 12 hours. The family had eaten together at a church picnic where chicken, warm rice, and other potluck foods were served. 5 hours later, the patient, and some of his family members all reported having intermittent non-bloody, non prurlent diarrhea.
Even the most un-medical lay person would probably leap to the diagnosis of food poisoning, specifically, some toxin mediated form (B.cereus, S. Aureus, or some other form). The history fits, the signs and symptoms fit, and the diagnosis is, in fact, food poisoning. You might also consider some viral gastroenteritis, but since the whole family is simultaneously sick in such short order, the illness is more suggestive of food poisoning. Now is when our hero shines.
When queried by the moderator about possible illnesses to include in the differential, our hero says:
"well, I feel that, it's , you know, like maybe esophageal atresia. Maybe it's like, like, a fistula, you know? like a tracheal-esophageal fistula? Or maybe, you know, I can't remember what it's called (now he waves his hand vaguely over the right upper quadrant of his abdomen), you know, like some hypertrophy of something? the duodenum? "
"Pyloric stenosis?" asks the moderator, dumfounded.
"yeah" replies the champion.
"NO." says the moderator, floored at the ignorance of our protagonist.
Now, some vocabulary for you so you can understand the colossal mistake that our protagonist made.
- Esophageal atresia: when the esophagus forms in the embryo, it initially forms as a solid structure which then hollows out. If the hollowing out is incomplete, you have esophageal atresia. In other words, the esophagus is a blind-end tube. The first meal that the baby attempts to take after birth would, of course, not reach the stomach. No way this would happen in a 2 year old. Most of all, this COULD NOT, by definition, cause diarrhea! (not to mention everyone in the family? simultaneously?)
- Tracheal-esophageal fistula: an aberrant connection between the trachea and the esophagus, again from an error during embryogenesis. Also, this would have been evident during the neonatal period. Again, not a cause of diarrhea.
- Pyloric stenosis: The scar on my abdomen attests to my experience with this. In this condition, the pylorus, which is the connection between stomach and the uppermost portion of the small intestine, closes due to overgrowth of the sphincter muscle found there. Typically, this presents in first born males in the first month or two of life. Characteristically, there is projectile vomiting. Since the GI is closed by the hypertrophied sphincter, of course no food is reaching the colon to become diarrhea.
I'm amazed at how wrong his diagnoses were. Come on! the conditions he described, for the most part, are obstructive and would not, could not, result in diarrhea!! Not to mention that common sense alone would tell you it's food poisoning (though you might have to have microbiology to tell which bug is the likely culprit.) This dude is one of the SLU medscholars, who were selected as college freshman for automatic entrance into medical school, as long as they kept their grades up in undergrad. Simply stunning.
Friday, February 29, 2008
Great Stuff
Here are two great products sure to improve our drab lives in the 21 century. The first one will revolutionize home safety, and the second will encourage you to include this item in your food storage plan.
Burger in a Can
Ethics
This week has been one of mixed productivity for studying. We had out ethics exam yesterday which was the first essay exam I've written in 4 years. There was a short answer section and two cases to analyze. The cases were as follows:
1. Elderly woman falls and breaks hip due to MI. Husband and daughter bring her in, she has respiratory failure (presumably put on a vent?). MD is discussing DNR order with family. Dad says no, daughter says sign DNR. Daughter says dad was diagnosed with dementia and that she is the decisional (a real word?) authority. What do you do? Sign DNR? What concerns need to be addressed?
2. Man cares for mom with Huntington's chorea. She dies a lingering death, and he proclaims to his friends that he doesn't want to go that way, he'd rather die. Man is married w/ children. He is depressed and an alcoholic, for which he sees a psychiatrist. He notices facial twitching and sees two neurologists, both of whom diagnose him with Huntington's. He visits his psychiatrist and asks for help committing suicide, which the psychiatrist refuses to do. The man goes home, ingests all of his anti-depressant medications, pins a note to his shirt saying he doesn't want to be rescusitated, then falls unconcious. His wife finds him, and drives him to the ER. You're the ER doc, what do you do?
1. Elderly woman falls and breaks hip due to MI. Husband and daughter bring her in, she has respiratory failure (presumably put on a vent?). MD is discussing DNR order with family. Dad says no, daughter says sign DNR. Daughter says dad was diagnosed with dementia and that she is the decisional (a real word?) authority. What do you do? Sign DNR? What concerns need to be addressed?
2. Man cares for mom with Huntington's chorea. She dies a lingering death, and he proclaims to his friends that he doesn't want to go that way, he'd rather die. Man is married w/ children. He is depressed and an alcoholic, for which he sees a psychiatrist. He notices facial twitching and sees two neurologists, both of whom diagnose him with Huntington's. He visits his psychiatrist and asks for help committing suicide, which the psychiatrist refuses to do. The man goes home, ingests all of his anti-depressant medications, pins a note to his shirt saying he doesn't want to be rescusitated, then falls unconcious. His wife finds him, and drives him to the ER. You're the ER doc, what do you do?
Thursday, February 21, 2008
Kosovo Independance
As we all know, Kosovo recently declared independance from Serbia earlier this week. In their haste to throw off their shackles, they neglected the most important part of any national self-determination movement: good music. Any good nation building time (or unifying) has great songs, from The Star Spangled Banner (yes, I know it's from the war of 1812), Yankee Doodle, the Marseilleise, British Grenadiers, Battle Hymn of the Republic and many others. I have taken the liberty of composing a new anthem for the Kosovars. With help from my fellow lyricisists Mindy and Emily, I present:
(Sung to the tune of "Kokomo" by the Beach Boys)
Kosovo
Slovenia, Croatia, OOH I wanna take you to Serbia and Bosnia
Come on Pretty Mama!
Vojvodina, Albania Baby why don't we go!
'Cross from Italee eee
There's a place called Kosovo
The folk's who're there, they want to get away from it all
Bodies in mass graves, Ethnic cleansing is part of this land
We'll be falling in love to the rythm of machine guns, man
Way Down in Kosovo
Slovenia, Croatia, OOH I wanna take you to Serbia and Bosnia
Come on Pretty Mama!
Vojvodina, Albania Baby why don't we go!
Down to Kosovo,
We'll get there fast and then we'll take it slow
That's where the UN goes, way down in Kosovo
Vukovar, that Kraljevo mystique
Adriatic Sea eee
Ethnic cleansing means purity
By and by we'll defy
Some UN sanctions don't you see
Secession feels right
Rockets and the missile's light
That Slavic look in your eye
give me a Balkan contact high
Way down in Kosovo
Slovenia, Croatia, OOH I wanna take you to Serbia and Bosnia
Come on Pretty Mama!
Vojvodina, Albania Baby why don't we go!
Down to Kosovo,
We'll get there fast and then we'll take it slow
That's where the UN goes, way down in Kosovo
Now the Serbs they know, a little place called Kosovo
Now if they want to be free and get away from it all,
Go down to Kosovo
Slovenia, Croatia, OOH I wanna take you to Serbia and Bosnia
Come on Pretty Mama!
Vojvodina, Albania Baby why don't we go!
Down to Kosovo,
We'll get there fast and then we'll take it slow
That's where the UN goes, way down in Kosovo
(Sung to the tune of "Kokomo" by the Beach Boys)
Kosovo
Slovenia, Croatia, OOH I wanna take you to Serbia and Bosnia
Come on Pretty Mama!
Vojvodina, Albania Baby why don't we go!
'Cross from Italee eee
There's a place called Kosovo
The folk's who're there, they want to get away from it all
Bodies in mass graves, Ethnic cleansing is part of this land
We'll be falling in love to the rythm of machine guns, man
Way Down in Kosovo
Slovenia, Croatia, OOH I wanna take you to Serbia and Bosnia
Come on Pretty Mama!
Vojvodina, Albania Baby why don't we go!
Down to Kosovo,
We'll get there fast and then we'll take it slow
That's where the UN goes, way down in Kosovo
Vukovar, that Kraljevo mystique
Adriatic Sea eee
Ethnic cleansing means purity
By and by we'll defy
Some UN sanctions don't you see
Secession feels right
Rockets and the missile's light
That Slavic look in your eye
give me a Balkan contact high
Way down in Kosovo
Slovenia, Croatia, OOH I wanna take you to Serbia and Bosnia
Come on Pretty Mama!
Vojvodina, Albania Baby why don't we go!
Down to Kosovo,
We'll get there fast and then we'll take it slow
That's where the UN goes, way down in Kosovo
Now the Serbs they know, a little place called Kosovo
Now if they want to be free and get away from it all,
Go down to Kosovo
Slovenia, Croatia, OOH I wanna take you to Serbia and Bosnia
Come on Pretty Mama!
Vojvodina, Albania Baby why don't we go!
Down to Kosovo,
We'll get there fast and then we'll take it slow
That's where the UN goes, way down in Kosovo
Wednesday, February 20, 2008
Great Medical Words:
I'm something of a word afficionado, and I particularly enjoy sonorous ones that just roll off the tongue. As I have studied, here are a few of the more interesting ones and their definitions:
Chancroid (Chang-kroid?) : STD caused by Hemophilus Ducreyi
Ataxia Telangectasia(just puzzle your way through it. the 'g' is a 'j' sound): Rare mutation in the TP53 (i think) protein that regulates the progression of the cell cycle in the presence of DNA damage. Rather than pausing, the cycle progresses even with damaged DNA, causing tumors. Patients with this mutation have NO tolerance for X-rays, or CT (since this is many sequential XR).
Pica: Basically you eat things that aren't food: clay, paint chips, hair from the barbershop floor, etc.
Schizont (sky-zont): The polynucleated (1000's) stage of life in a Protozoa, particularly the causative agents of malaria.
Gumma :A soft, non cancerous growth resulting from tertiary stage of syphillus
Chancroid (Chang-kroid?) : STD caused by Hemophilus Ducreyi
Ataxia Telangectasia(just puzzle your way through it. the 'g' is a 'j' sound): Rare mutation in the TP53 (i think) protein that regulates the progression of the cell cycle in the presence of DNA damage. Rather than pausing, the cycle progresses even with damaged DNA, causing tumors. Patients with this mutation have NO tolerance for X-rays, or CT (since this is many sequential XR).
Pica: Basically you eat things that aren't food: clay, paint chips, hair from the barbershop floor, etc.
Schizont (sky-zont): The polynucleated (1000's) stage of life in a Protozoa, particularly the causative agents of malaria.
Gumma :A soft, non cancerous growth resulting from tertiary stage of syphillus
Sunday, February 17, 2008
The cycle begins anew, and some other ramblings.
Exam: 1, Spiff : 0. The exam was extremely difficult. I didn't study all of the microbial toxins in detail, and, guess what was tested? Toxins. The next segment of micro will be viruses and parasites, while genetics will instruct me regarding cancer, lysosomal storage diseases ( Tay Sachs, Reffsums, Zellwegers, Gaucher's, etc). Genetics is shaping up to be much easier than my college genetics class. Before medical school, I thought that all of the classes would be much more difficult than in undergrad. The material itself is about at the 300-400 level, maybe a intro level grad course. In other words, it's not too complex. What makes it more challenging is the pace, which, while exhilirating, leaves no margin for error or illness. I would liken a medical school course to taking a 300 level course at 3x speed. We literally spent 1 week on information that it took me 4 weeks to cover in undergrad.
I recently read " Another day in the frontal lobe", by Dr. Katrina Firlink, a neurosurgeon. On the whole, the book is a little disorganized and the subtle traces of a hypercompetitive emotionally isolated author bleed through. Physicians (and nurses too) negotiate critical nexuses in the lives of their patients, which can make for poignant anecdotes. The author of "Another Day in the Fronal Lobe", however, relates these stories in a way that feels contrived, as though she is telling them to be seen as the tortured neurosurgeon, when she is in reality more callous or withdrawn. An amateur gestalt analysis of the author reveals her to be competitive, slightly coarse, and subtly overcompensating for some ancient flaw. Perhaps I judge her too harshly, though, as the practice of clinical medicine is still several years away for me, and I don't know how I will react to the daily grind of illness and pain.
I was particularly astonished at the contrast in my perception of futility versus that of the cowboy neurosurgeon. Why wheel an obtunded, terminal patient into the OR simply to prolong a ''life" by 2 weeks (note, this surgery was not about pain relief)? Especially if this was against the patients explicitly stated wishes? What are we treating here? the patient? or the doctor's own unwillingness to let go?
We have been discussing medical futility in my ethics course recently, and it seems remarkable that the class, as a whole, seems to be in general agreement on what constitutes a 'futile' intervention. Equally incredible is that most people seem to agree that maintaining someone in a PVS (persistent vegetative state: where the patient has no higher brain functions, but can breath and maintian heartbeat. The patient will have normal sleep/wake cycles, but is completely unresponsive to stimuli) indefinitely is ethically wrong. Perhaps it is our callous youth that enables us to judge the family members who choose this course as being wrong. Personally, I do think that such behavior is wasteful and unneccessary, though if it were my child on the bed, I would undoubtedly have a different, or at least more well informed, opinion. With such ticklish issues to discuss, what surprises me is the near unanimity of opinion regarding theses topics. The "right to die" discussion (FYI, there is no legally defined "right" to die. it doesn't exist in US law. ) was slightly more animated, but I think most of the people in my class, if practicing in Oregon, would never intentionally prescribe a lethal dose of medication. I'm not sure where I'm going with all this, but I hope to adress these topics again when I have more experience on the wards.
I recently read " Another day in the frontal lobe", by Dr. Katrina Firlink, a neurosurgeon. On the whole, the book is a little disorganized and the subtle traces of a hypercompetitive emotionally isolated author bleed through. Physicians (and nurses too) negotiate critical nexuses in the lives of their patients, which can make for poignant anecdotes. The author of "Another Day in the Fronal Lobe", however, relates these stories in a way that feels contrived, as though she is telling them to be seen as the tortured neurosurgeon, when she is in reality more callous or withdrawn. An amateur gestalt analysis of the author reveals her to be competitive, slightly coarse, and subtly overcompensating for some ancient flaw. Perhaps I judge her too harshly, though, as the practice of clinical medicine is still several years away for me, and I don't know how I will react to the daily grind of illness and pain.
I was particularly astonished at the contrast in my perception of futility versus that of the cowboy neurosurgeon. Why wheel an obtunded, terminal patient into the OR simply to prolong a ''life" by 2 weeks (note, this surgery was not about pain relief)? Especially if this was against the patients explicitly stated wishes? What are we treating here? the patient? or the doctor's own unwillingness to let go?
We have been discussing medical futility in my ethics course recently, and it seems remarkable that the class, as a whole, seems to be in general agreement on what constitutes a 'futile' intervention. Equally incredible is that most people seem to agree that maintaining someone in a PVS (persistent vegetative state: where the patient has no higher brain functions, but can breath and maintian heartbeat. The patient will have normal sleep/wake cycles, but is completely unresponsive to stimuli) indefinitely is ethically wrong. Perhaps it is our callous youth that enables us to judge the family members who choose this course as being wrong. Personally, I do think that such behavior is wasteful and unneccessary, though if it were my child on the bed, I would undoubtedly have a different, or at least more well informed, opinion. With such ticklish issues to discuss, what surprises me is the near unanimity of opinion regarding theses topics. The "right to die" discussion (FYI, there is no legally defined "right" to die. it doesn't exist in US law. ) was slightly more animated, but I think most of the people in my class, if practicing in Oregon, would never intentionally prescribe a lethal dose of medication. I'm not sure where I'm going with all this, but I hope to adress these topics again when I have more experience on the wards.
Thursday, February 14, 2008
The Answers:
H. Influenza, Bordetella Pertussis, and Legionella all cause respiratory infections. Respectively they are: eppiglottitis and meningitis, whooping cough, and pneumonia.
Answers to 3 disgusting questions:
Kliebsiella
Psuedomonas Aerugenosa (BAD NEWS. you don't want this.)
Vibrio Cholera (not so common in north america.)
Answers to 3 disgusting questions:
Kliebsiella
Psuedomonas Aerugenosa (BAD NEWS. you don't want this.)
Vibrio Cholera (not so common in north america.)
Monday, February 11, 2008
Critical Crud part the Seconde
I recieved a nasty surprise two weeks ago when I realized that "Critical Issues in Health Care", the course I detested fall term was scheduled to continue after Christmas. Fortunately last week, we had to make up our snow day so we cancelled CIHC. This week is an exam week, so, in my opinion, a poor week to have a 2 hour loss in study time. My classmates, judging from their actions, agree. As I have already related, CIHC is composed of medical students, social work students, and nursing students. Since there were assigned seats, I had to sit in the third row where I normally would sit in any class save this one. Looking down the rows in front of me and next to me, every medical student was studying micro on the sly. Without exaggeration, every single one was studying. The social work and nursing students were far more attentive, hopefully providing much needed camouflage while we tried to cram.
CIHC is not a class that provides a lot of useful information. Given that we're expected to memorize over 400 slides for micro, let alone master genetics, how can we be expected to pay rapt attention to a 2 hour presentation on "Using the Inter-disciplinary Team Effectively"? I think that as 3rd years, we'll learn pretty fast that: nurses see the patients more than we do and can provide useful information, that social work is helpful, so is PT, and the pharmacy can help as well. I doubt very much that anything more substantial than that will stick in my mind, at least from this lecture. I realize that there is more to medicine than science and data. In the first two years however, trying to drink from the fire hydrant is pretty pre-occupying . My feeling is that if you're already a jerk or someone who can't communicate effectively, then a 2 hour lecture once a week as an MSI is not going to make a great deal of difference. Well, my friends Hemophilus, Bordetella and Legionella are calling. (bonus points to the reader who can tell me what organ system these guys infect.)
Questions for the readers who thought the first question was too easy:
1.Pt coughs up "red currant" sputum. After being disgusted, you make the presumptive diagnosis of ______?
2. Your burn patient has fruity smelling blue pus coming from his wound. Immediately you suspect _______?
3. Your Sri Lankan patient has loose, "rice-water" stools. Fasting has no effect on the flow, which is nearly constant. After resourcefully cutting a hole into the mattress to facilitate drainage, you tell the patient he has _______?
OK, so those were gross. I only realized this after I wrote the questions, which I guess proves how far i've fallen. Answers will be posted on the next post.
-Spiff
CIHC is not a class that provides a lot of useful information. Given that we're expected to memorize over 400 slides for micro, let alone master genetics, how can we be expected to pay rapt attention to a 2 hour presentation on "Using the Inter-disciplinary Team Effectively"? I think that as 3rd years, we'll learn pretty fast that: nurses see the patients more than we do and can provide useful information, that social work is helpful, so is PT, and the pharmacy can help as well. I doubt very much that anything more substantial than that will stick in my mind, at least from this lecture. I realize that there is more to medicine than science and data. In the first two years however, trying to drink from the fire hydrant is pretty pre-occupying . My feeling is that if you're already a jerk or someone who can't communicate effectively, then a 2 hour lecture once a week as an MSI is not going to make a great deal of difference. Well, my friends Hemophilus, Bordetella and Legionella are calling. (bonus points to the reader who can tell me what organ system these guys infect.)
Questions for the readers who thought the first question was too easy:
1.Pt coughs up "red currant" sputum. After being disgusted, you make the presumptive diagnosis of ______?
2. Your burn patient has fruity smelling blue pus coming from his wound. Immediately you suspect _______?
3. Your Sri Lankan patient has loose, "rice-water" stools. Fasting has no effect on the flow, which is nearly constant. After resourcefully cutting a hole into the mattress to facilitate drainage, you tell the patient he has _______?
OK, so those were gross. I only realized this after I wrote the questions, which I guess proves how far i've fallen. Answers will be posted on the next post.
-Spiff
Friday, February 08, 2008
Kodos For President
So, one day Kodos and Kang ran for president on opposing tickets, one Republican and one Democrat. When they confronted the skeptical public, they reminded them that:Kodos: " you can't win! It's a two party system, one us will be president"
Lenny: "What if we vote for a third party candidate?"
Kang: Go Ahead! Throw your vote away!
And this neatly summarizes the race for the white house as I see it. I don't often wax political, but since this is an election year, this blog is my forum to rant. Currently there is no candidate that I want in the white house. Romney is now out, though I thought he had integrity and economic know-how. Hillary is not my choice, thank you, I don't think that her brand of American socialism is a sustainable model for "universal" health care. Barack? I don't know. Again, the ugly spectre of "universal" care is present.
Who is going to pay for it? Health care costs are rising geometrically, which means that a corresponding portion of the governement budget allocated to pay for it (either now with Medicare and Medicaid or through some future single payer plan) will rise commensurately. Easy! you say. We'll just pay more taxes, or more elegantly, we'll re-allocate current tax dollars. Hmm. possibly. Say we do raise taxes to match the increase. My high school econ (which, I admit, is rusty) says that taxation and revenue are related to the old Laffer curve. Theoretically, in the limit of infinite (100%) taxation, government revenue would paradoxically be $0. Why? because people won't work if they don't have some take home income. DUH you say. Of course they won't, and the government won't tax 100%. Yes, obviously. But the point is, as tax rates increase, government revenues decreases, above a certain point. So, if the cost of health care is increasing geometrically, theoretically there will be a point at which 100% of the federal budget will be allocated to health care. Dire? yes. Inevitable? I don't know.
All this brings us back to presidential canditates and why I am loathe to choose either Democrat candidate. So that leaves us with: McCain, the septugenarian war hero, Huckabee the Evangelical Yokel, Ron Paul, who wants to defund the government and return us to the American republic familiar to Andrew Jackson in the 1830's (from a political standpoint, not socially or technologically obviously). Since I am officially not registered with either party, I have no party lines to cross, and am free to vote as I please. What will happen in November? I don't think that the electoral process should involve voting for one candidate only to keep his/her opponent from attaining office. I did just that in 2004, and I regret it. I will probably write in a candidate, perhaps Colin Powell. He doesn't want the office, which means he's qualified to hold it. I don't care that he won't get elected (unless the readership of my blog consists of 55% of the US population and I convince them tool), at least I will have voted for the best candidate.
KODOS AND KANG '08
Tuesday, January 29, 2008
Z? I told you so!
So the grades for my exam on saturday just came out. I did very well in genetics, and pretty well in microbes. The genetics exam was actually my best exam thus far in medical school, which is surprising considering I have always found genetics to be a very difficult subject. When we get our grades, they also tell us the Z score we achieved, which is the number of standard deviations from the mean that you were. Both Z scores were pretty positive, which means that I did significantly better than a lot of my classmates. On the grade distribution plot, however, there are always a few hapless souls who's Z score is in the -2+ range. School policy is that if you have a Z score less than -2, you failed the exam. I don't know how you could study for weeks and get a Z score of -3.2, but according to the chart, it's possible. Perhaps there was a family emergency or something. Alternatively, the person subscribes to the p=MD philosophy, though evidently they missed the part about p= passing your exams....
Wednesday, January 23, 2008
Sisyphus Was a Medical Student
Hippocrates fathered many of the ideals that are still revered in medicine. Fourth year medical school students recite the Hippocratic oath as they graduate and move onward, pledging to first, do no harm. Hippocrates originally stipulated that his students also bequeath their worldly goods to their instructor, a tradition that medical schools have also maintained. Other, less popular traditions have fallen by the wayside, for instance the moratorium on surgery or the fact that physicians were supposed to be celibate.
Recently, I also learned that Hippocrates instructed Sisyphus. Sisyphus was the first medical student in fact. Unfortunately, he didn't do well in his studies, and so, was doomed to repeat them until he mastered them. Current interpretations of Greek history maintain that Sisyphus was doomed to push a rock up a hill, not eternal remediation of medical coursework. This revisionist viewpoint is, however, erroneous.
Modern medical schools have modelled their curriculum on Sisyphus' experience. As with all modernization comes variation and improvement. Rather than endlessly repeat the same material, as Sisyphus did, which would in fact reinforce the facts, current pedagogical theory maintains that his experience is best mimicked by constantly changing the material. Today's medical student, then, is force to memorize dozens of pages of material, regurgitate for the exam, and repeat the process endlessly. Like the revisionist Sisyphus, the current medical student reiterates this pattern every 4 weeks. Since the human memory is finite, the hard work put in by the medical student is for naught, ulitmately. Though he may kill himself trying to learn the material, by the end of the next block, the previous block's material is 80-90% forgotten. He can take grim comfort in knowing that ulitmately cramming immunology is fruitless because by the end of the term, it will be as though he hadn't learned it at all, and the minute amount of retained knowledge was the information that was already in place before the course. I love medical school.
Sunday, January 20, 2008
Cold
Well dear readers, I haven't much to say. It has been a cold week here in St Louis. Today the low was 9, yesterday the low was 8. Fortunately, our heat has been working so our little hut stays nice and warm. Mindy and I went ice skating at Forest Park at an outdoor rink there. It was quite a nice evening. We've resolved to do more dates this year and skating was a nice start. Several hundred other people must have had the same idea however, since the rink was quite crowded. Also in keeping with new year's, I have been running three times a week with Mindy in Tower Grove Park. It's really nice to get that sympathetic stimulation in the morning to jump start my day. I still study all day long, but at least I don't feel like I'm getting more and more sluggish as they weeks progress.
We had ward conference today, which was meant to be an abbreviated block so we could "have the final session in our homes." What that meant however, was that I was at church for 5 hours instead of the usual 3. We had trainings for the Elder's Quorum and a Ward Council to attend. Sacrament meeting was pretty good, with the exception of being 2 hours long. There were several people called up from the audience to speak, but some of the talks felt like they were just there to take up time.
School is school, by which I mean that it's still like drinking from a firehose. I feel like I finally have a handle on the stuff that was presented at the end of the first week, leaving me all of last week's material to master. Immuno is pretty interesting. Genetics is ok. THe one downside is PBL sessions which we are obligated to attend.
For the uninitated, PBL stands for Problem Based Learning, and is a curricular element that, while all the rage at medical schools, is mercifully absent from most of my curriculum. What is supposed to happen in PBL is that a group of 10 students with a faculty moderator review a case weekly. Between sessions the students do lit searches on various subjects and report back the next week. At the next session we all share our information and the next portion of the case is revealed. THe theory is that we are supposed to learn to present things, do lit searches, and of course learn about the material in question.
Some of these things actually happen in reality. We do in fact learn how to do lit searches, and we do present things to one another, supposedly mimicking case presentations that happen on the wards. What really happens, however, is that we wind up being "experts" on some trivial minutae and never really learn what our colleagues researched. Sometimes the lit searcehs are incredibly time consuming as well, sapping valuable time from studying genetics or immuno. The PBL sessions are 45% of my grade, which means it behooves me to do a good job, and relieves me of the burden of some exam studying, since each exam is only 18% of my grade then. Fortunately we don't spend as much time in PBL as a lot of the other groups, which means I can study T cell activation even more!
I hear you, though. YOu are thinking, why doesn't Spiff care about collaborating with his colleagues? Doesn't PBL provide the relevance factor that Spiff is always complaining is missing in lecture? Isn't it nice to learn in a different way every now and then? Wouldn't it be much better to have self directed learning all the time, since you're more likely to remember what you find yourself? Spiff will now field these questions.
-RE: collaboration: PBL isn't collaboration. It's lots of separate people contributing to a discontinuous and unorganized whole.
-RE: relevance: PBL doesn't introduce relevance necessarily. Instead we get bogged down in the minutae of say the mechanisms of isochromome 6p formation in retinoblastoma. The potential is there, but relevance is not necessarily associated with PBL
-RE: Different learning modality: See also -time wasting
RE: self directed learning: Yes, it is true that I tend to remember stuff that I research myself. BUT, on a per unit time, PBL is really inefficient. I talked to our moderator about this in private, and he said that PBL is not designed to be an efficient learning tool in terms of volume. It is more to practice the interpersonal skills. Great. I already know how to give talks and presentations.
It is some consolation that at least my group mates aren't total tools, which is the case in some groups. We have several ground rules which keep things moving briskly too.
-NO powerpoint
-NO presentaion over 3 minutes
-Yes treats every week
-1 page max on any handouts
AT least PBL is only weekly and fortunately it isn't too big of a waste of time.... though we'll see what I say as the term progresses.
-Spiff
We had ward conference today, which was meant to be an abbreviated block so we could "have the final session in our homes." What that meant however, was that I was at church for 5 hours instead of the usual 3. We had trainings for the Elder's Quorum and a Ward Council to attend. Sacrament meeting was pretty good, with the exception of being 2 hours long. There were several people called up from the audience to speak, but some of the talks felt like they were just there to take up time.
School is school, by which I mean that it's still like drinking from a firehose. I feel like I finally have a handle on the stuff that was presented at the end of the first week, leaving me all of last week's material to master. Immuno is pretty interesting. Genetics is ok. THe one downside is PBL sessions which we are obligated to attend.
For the uninitated, PBL stands for Problem Based Learning, and is a curricular element that, while all the rage at medical schools, is mercifully absent from most of my curriculum. What is supposed to happen in PBL is that a group of 10 students with a faculty moderator review a case weekly. Between sessions the students do lit searches on various subjects and report back the next week. At the next session we all share our information and the next portion of the case is revealed. THe theory is that we are supposed to learn to present things, do lit searches, and of course learn about the material in question.
Some of these things actually happen in reality. We do in fact learn how to do lit searches, and we do present things to one another, supposedly mimicking case presentations that happen on the wards. What really happens, however, is that we wind up being "experts" on some trivial minutae and never really learn what our colleagues researched. Sometimes the lit searcehs are incredibly time consuming as well, sapping valuable time from studying genetics or immuno. The PBL sessions are 45% of my grade, which means it behooves me to do a good job, and relieves me of the burden of some exam studying, since each exam is only 18% of my grade then. Fortunately we don't spend as much time in PBL as a lot of the other groups, which means I can study T cell activation even more!
I hear you, though. YOu are thinking, why doesn't Spiff care about collaborating with his colleagues? Doesn't PBL provide the relevance factor that Spiff is always complaining is missing in lecture? Isn't it nice to learn in a different way every now and then? Wouldn't it be much better to have self directed learning all the time, since you're more likely to remember what you find yourself? Spiff will now field these questions.
-RE: collaboration: PBL isn't collaboration. It's lots of separate people contributing to a discontinuous and unorganized whole.
-RE: relevance: PBL doesn't introduce relevance necessarily. Instead we get bogged down in the minutae of say the mechanisms of isochromome 6p formation in retinoblastoma. The potential is there, but relevance is not necessarily associated with PBL
-RE: Different learning modality: See also -time wasting
RE: self directed learning: Yes, it is true that I tend to remember stuff that I research myself. BUT, on a per unit time, PBL is really inefficient. I talked to our moderator about this in private, and he said that PBL is not designed to be an efficient learning tool in terms of volume. It is more to practice the interpersonal skills. Great. I already know how to give talks and presentations.
It is some consolation that at least my group mates aren't total tools, which is the case in some groups. We have several ground rules which keep things moving briskly too.
-NO powerpoint
-NO presentaion over 3 minutes
-Yes treats every week
-1 page max on any handouts
AT least PBL is only weekly and fortunately it isn't too big of a waste of time.... though we'll see what I say as the term progresses.
-Spiff
Wednesday, January 02, 2008
Evidence Based Medicine
BMJ 1999;319:1618
Seven Alternatives to Evidence Based Medicine
David Isaacs, Dominic Fitzgerald
Clinical decisions should, as far as possible, be evidence based. So runs the current clinical dogma.(1, 2) We are urged to lump all the relevant randomised controlled trials into one giant meta-analysis and come out with a combined odds ratio for all decisions. Physicians, surgeons, nurses are doing it(3–5); soon even the lawyers will be using evidence based practice.6 But what if there is no evidence on which to base a clinical decision?
Participants, methods, and results
We, two humble clinicians ever ready for advice and guidance, asked our colleagues what they would do if faced with a clinical problem for which there are no randomised controlled trials and no good evidence. We found ourselves faced with several personality based opinions, as would be expected in a teaching hospital. The personalities transcend the disciplines, with the exception of surgery, in which discipline transcends personality. We categorised their replies, on the
basis of no evidence whatsoever, as follows.
Eminence based medicine
The more senior the colleague, the less importance he or she placed on the need for anything as mundane as evidence. Experience, it seems, is worth any amount of evidence. These colleagues have a touching faith in clinical experience, which has been defined as "making the same mistakes with increasing confidence over an impressive number of years."(7) The eminent physician’s white hair and balding pate are called the “halo” effect.
Vehemence based medicine
The substitution of volume for evidence is an effective technique for brow beating your more timorous colleagues and for convincing relatives of your ability.
Eloquence based medicine
The year round suntan, carnation in the button hole, silk tie, Armani suit, and tongue should all be equally smooth. Sartorial elegance and verbal eloquence are powerful substitutes for evidence.
Providence based medicine
If the caring practitioner has no idea of what to do next, the decision may be best
left in the hands of the Almighty. Too many clinicians,unfortunately, are unable to resist giving God a hand with the decision making.
Diffidence based medicine
Some doctors see a problem and look for an answer. Others merely see a problem. The diffident doctor may do nothing from a sense of despair. This, of course, may be better than doing something merely because it hurts the doctor’s pride to
do nothing.
Nervousness based medicine
Fear of litigation is a powerful stimulus to overinvestigation and overtreatment. In an atmosphere of litigation phobia, the only bad test is the test you didn’t think of ordering.
Confidence based medicine—
This is restricted to surgeons.
Comment
There are plenty of alternatives for the practising physician in the absence of evidence. This is what makes medicine an art as well as a science.
Contributors: DI and DF each contributed half the jokes and will
both act as guarantors.
Funding: None.
Competing interests: None declared.
1 Evidence Based Medicine Working Group. Evidence-based medicine: a
new approach to teaching the practice of medicine . JAMA 1992;268:
2420-5.
2 Rosenberg W, Donald A. Evidence based medicine: an approach to
clinical problem solving. BMJ 1995;310:1122-6.
3 Sackett DL, Rosenberg WM, Gray JAM, Haynes RB, Richardson WS.
Evidence based medicine: what it is and what it isn’t . BMJ 1996;312:71-2.
4 Solomon MJ, McLeod RS. Surger y and the randomised controlled trial:
past, present and future. Med J Aust 1998;169:380-3.
5 McClarey M. Implementing clinical effectiveness. Nursing Management
1998;5:16-9.
6 EBM and the IMF. J Exponential Salar ies 1999;99:1-9.
7 O’Donnell M. A sceptic’s medical dictionar y. London: BMJ Books, 1997.
Short reports
Departments of Education and Medicine, New Children’s Hospital, Westmead, NSW 2145,
Australia
David Isaacs clinical professor, Dominic Fitzgerald staff physician
Correspondence to:
D Isaacs
davidi@nch.edu.au
BMJ 1999;319:1618
1618 BMJ VOLUME 319 18-25 DECEMBER 1999 www. bmj.com
Thank you British Medical Journal for a little levity!
-SS
Seven Alternatives to Evidence Based Medicine
David Isaacs, Dominic Fitzgerald
Clinical decisions should, as far as possible, be evidence based. So runs the current clinical dogma.(1, 2) We are urged to lump all the relevant randomised controlled trials into one giant meta-analysis and come out with a combined odds ratio for all decisions. Physicians, surgeons, nurses are doing it(3–5); soon even the lawyers will be using evidence based practice.6 But what if there is no evidence on which to base a clinical decision?
Participants, methods, and results
We, two humble clinicians ever ready for advice and guidance, asked our colleagues what they would do if faced with a clinical problem for which there are no randomised controlled trials and no good evidence. We found ourselves faced with several personality based opinions, as would be expected in a teaching hospital. The personalities transcend the disciplines, with the exception of surgery, in which discipline transcends personality. We categorised their replies, on the
basis of no evidence whatsoever, as follows.
Eminence based medicine
The more senior the colleague, the less importance he or she placed on the need for anything as mundane as evidence. Experience, it seems, is worth any amount of evidence. These colleagues have a touching faith in clinical experience, which has been defined as "making the same mistakes with increasing confidence over an impressive number of years."(7) The eminent physician’s white hair and balding pate are called the “halo” effect.
Vehemence based medicine
The substitution of volume for evidence is an effective technique for brow beating your more timorous colleagues and for convincing relatives of your ability.
Eloquence based medicine
The year round suntan, carnation in the button hole, silk tie, Armani suit, and tongue should all be equally smooth. Sartorial elegance and verbal eloquence are powerful substitutes for evidence.
Providence based medicine
If the caring practitioner has no idea of what to do next, the decision may be best
left in the hands of the Almighty. Too many clinicians,unfortunately, are unable to resist giving God a hand with the decision making.
Diffidence based medicine
Some doctors see a problem and look for an answer. Others merely see a problem. The diffident doctor may do nothing from a sense of despair. This, of course, may be better than doing something merely because it hurts the doctor’s pride to
do nothing.
Nervousness based medicine
Fear of litigation is a powerful stimulus to overinvestigation and overtreatment. In an atmosphere of litigation phobia, the only bad test is the test you didn’t think of ordering.
Confidence based medicine—
This is restricted to surgeons.
Comment
There are plenty of alternatives for the practising physician in the absence of evidence. This is what makes medicine an art as well as a science.
Contributors: DI and DF each contributed half the jokes and will
both act as guarantors.
Funding: None.
Competing interests: None declared.
1 Evidence Based Medicine Working Group. Evidence-based medicine: a
new approach to teaching the practice of medicine . JAMA 1992;268:
2420-5.
2 Rosenberg W, Donald A. Evidence based medicine: an approach to
clinical problem solving. BMJ 1995;310:1122-6.
3 Sackett DL, Rosenberg WM, Gray JAM, Haynes RB, Richardson WS.
Evidence based medicine: what it is and what it isn’t . BMJ 1996;312:71-2.
4 Solomon MJ, McLeod RS. Surger y and the randomised controlled trial:
past, present and future. Med J Aust 1998;169:380-3.
5 McClarey M. Implementing clinical effectiveness. Nursing Management
1998;5:16-9.
6 EBM and the IMF. J Exponential Salar ies 1999;99:1-9.
7 O’Donnell M. A sceptic’s medical dictionar y. London: BMJ Books, 1997.
Short reports
Departments of Education and Medicine, New Children’s Hospital, Westmead, NSW 2145,
Australia
David Isaacs clinical professor, Dominic Fitzgerald staff physician
Correspondence to:
D Isaacs
davidi@nch.edu.au
BMJ 1999;319:1618
1618 BMJ VOLUME 319 18-25 DECEMBER 1999 www. bmj.com
Thank you British Medical Journal for a little levity!
-SS
Thursday, December 27, 2007
Research
So I am planning on doing my spring elective in a research lab, as well as spending the summer there. The school offers 35 or so research fellowships for summer research projects done by MS1s, and hopefully I can get one. After several years of being anti-research, I have decided to reverse my position in the interest of optimizing my chances of matching in a residency.
The PI (principal investigator) I'm going to work with does research on phospholipids and cardiac reperfusion injury. Phospholipids are the primary component of cell membranes. Those found in cardiac muscle cells are suscepible to oxidative damage from halogens like those found in white blood cells. What we'll be studying is the role that the products from these reactions play in atherosclerosis and in reperfusion injury. When the heart or any other tissue is ischemic for a period of time and oxygen flow is finally restored, the incoming oxygen damages the tissues more than the original ischemic insult. Oxygen alone is not responible for the additional damage, but other reactive chemical species as well. It is these other reactive species that we'll be studying, particularly halogenated aldehydes. The image at the top is of a plasmalogen, a phospholipid susceptible to chemical alteration by reactive halogens
Sunday, December 09, 2007
Memory
As studying is my only pastime, I have given a lot of thought to the aquisition and retention of knowledge. As I have written before, the pace at which facts are fed to me is quite rapid, and the length of time permitted to learn them is correspondingly brief. Sadly, as I have also written, the length of retention is also rather brief.
The process of learning in many ways resembles an old-fashioned water driven mill. The sluice of water cascading over the wheel is like the knowledge my professors attempt to teach me. Unlike a mill, however, the flow rate is subjective. Though the actual pace remains more or less constant, previous exposure to similar material makes the flow seem more or less rapid. As the water hits the buckets the wheel begins to turn, slowly at first, but eventually at a rate that closely matches that of the water. Similarly, I learn slowly at first, but eventually similar information becomes easier to aquire, until at some point, I hardly need to study I'm so familiar with the concepts being presented. I have not reached this point by any means.
Retaining knowledge also fits the analogy, though now the wheel is running in reverse, like a pump. The buckets dip into a pond are carried up until the apex of the rotation, where they dump their contents into a drainage sluice. Some of the buckets in this case, are extremely leaky. So much so that at times they reach the apex of the arc nearly empty. Others, have hardly any cracks and are able to dump nearly all their contents into the sluice. Most of the buckets on the wheel are fairly leaky, however, requiring many revolutions of the wheel to fill the cistern. The cistern can fill more quickly if the wheel turns more rapidly, but as the wheel spins, some of the water slops out because of the speed. In order to fill the cistern most efficiently, the greatest number of buckets possible should be intact. I don't know how to fix the mental buckets, however, in such a way that learning either takes less time or with fewer repetitions.
The process of learning in many ways resembles an old-fashioned water driven mill. The sluice of water cascading over the wheel is like the knowledge my professors attempt to teach me. Unlike a mill, however, the flow rate is subjective. Though the actual pace remains more or less constant, previous exposure to similar material makes the flow seem more or less rapid. As the water hits the buckets the wheel begins to turn, slowly at first, but eventually at a rate that closely matches that of the water. Similarly, I learn slowly at first, but eventually similar information becomes easier to aquire, until at some point, I hardly need to study I'm so familiar with the concepts being presented. I have not reached this point by any means.
Retaining knowledge also fits the analogy, though now the wheel is running in reverse, like a pump. The buckets dip into a pond are carried up until the apex of the rotation, where they dump their contents into a drainage sluice. Some of the buckets in this case, are extremely leaky. So much so that at times they reach the apex of the arc nearly empty. Others, have hardly any cracks and are able to dump nearly all their contents into the sluice. Most of the buckets on the wheel are fairly leaky, however, requiring many revolutions of the wheel to fill the cistern. The cistern can fill more quickly if the wheel turns more rapidly, but as the wheel spins, some of the water slops out because of the speed. In order to fill the cistern most efficiently, the greatest number of buckets possible should be intact. I don't know how to fix the mental buckets, however, in such a way that learning either takes less time or with fewer repetitions.
Monday, December 03, 2007
You're in medschool when...
You read about a friend of a friend on facebook who hurt himself skiing and are more curious about the exploratory surgery than the patient's status. My comp described it thusly: they life-flighted him out and when they got to UofU hospital, they cut open his stomach to see where the bleeding was. After removing his gall bladder and a damaged spleen, he's doing ok. I immediately thought "what artery were they looking for when they cut open the stomach? shouldn't they be looking around it at the pancreaticoduodenal , proper hepatic or splenic arteries? I then realized that my comp probably didn't mean they literally cut open his stomach, but that they cut open the abdomen. Silly insensitive spaceman spiff.
Sunday, December 02, 2007
Philosophical Wax
Sunday school provided me with an interesting insight today. One of my non-medical school friends here is a SLU history grad student. He specialized in classics as an undergrad and usually brings his Greek Bible to church to supplement his english quad. He sometimes gives great insights into the meaning of scriptural verses based on the etymology of their phrasing.
We were reading in 1 Peter a verse that is often quoted in Latter-Day Saint circles. 1 Peter 2: 9 "But ye are a chosen generation, a royal priesthood, an holy nation, a peculiar people; that ye should shew forth the praises of him who hath called you out of darkness into his marvelous light: " Three of these phrases "chosen generation, a royal priesthood, an holy nation" refer most definitely to the status of ancient Israel as God's people, handpicked from the inhabitants of the earth. Latter-day Saints include themselves in this description as well, being the modern day continuation of the House of Israel. What is curious, however, is that the term "peculiar people" is usually interpreted with the modern definition of peculiar meaning unique, strange, perhaps eccentric, odd, or different. What my friend pointed out was that in his Greek bible, the word used in place of peculiar did not have any connotation of uniqueness or idiosyncrasy. Instead, it shared a root -pecu , with the english word pecuniary, having to do with property, ownership , or money. According to an etymological dictionary, the root specifically pertains to private property, i.e. ownership by one individual, and in particular property defined in terms of cattle. In this context then, it is evident that the word "peculiar" in this sense is descriptive of God 'owning' the House of Israel, rather than any bizarreness on their part. Use of "peculiar" in the sense of oddity was actually first evinced only in 1608, three years prior to the publication of the King James Version of the Bible. The current usage, while apt, is not strictly the most accurate from a doctrinal point of view then.
We were reading in 1 Peter a verse that is often quoted in Latter-Day Saint circles. 1 Peter 2: 9 "But ye are a chosen generation, a royal priesthood, an holy nation, a peculiar people; that ye should shew forth the praises of him who hath called you out of darkness into his marvelous light: " Three of these phrases "chosen generation, a royal priesthood, an holy nation" refer most definitely to the status of ancient Israel as God's people, handpicked from the inhabitants of the earth. Latter-day Saints include themselves in this description as well, being the modern day continuation of the House of Israel. What is curious, however, is that the term "peculiar people" is usually interpreted with the modern definition of peculiar meaning unique, strange, perhaps eccentric, odd, or different. What my friend pointed out was that in his Greek bible, the word used in place of peculiar did not have any connotation of uniqueness or idiosyncrasy. Instead, it shared a root -pecu , with the english word pecuniary, having to do with property, ownership , or money. According to an etymological dictionary, the root specifically pertains to private property, i.e. ownership by one individual, and in particular property defined in terms of cattle. In this context then, it is evident that the word "peculiar" in this sense is descriptive of God 'owning' the House of Israel, rather than any bizarreness on their part. Use of "peculiar" in the sense of oddity was actually first evinced only in 1608, three years prior to the publication of the King James Version of the Bible. The current usage, while apt, is not strictly the most accurate from a doctrinal point of view then.
More on the money
So, rather than letting me be 5K richer, the Financial Aid department decided I would be better if they just took the scholarship and applied it to the G.R.A.D Plus loan (GRAD PLUS stands for Government Rape And Defrauding of Professional, Law, and Uther Students since the loan is at an astronomical 8% interest, which is not deferred to graduation). This is both good and bad. Good because I don't have 5K of a high interest loan, but bad because it doesn't increase the net amount of money at my disposal. I wish they had let me keep some of the loan money because the amount budgeted to each student is only barely enough for even a small family such as mine. Oddly the health insurance is one of the most costly expenses we have. You would think that a medical school would understand the need for affordable insurance more than anyone else, but no. Everyone who has more than just themselves living on the financial aid disbursement has to take out more loans to pay the insurance. The coverage is phenomenal, but expensive. All of my friends are on WIC, food stamps, and those with several children are on Medicaid. Yet, for all this, some people claim that medical students are entitled and don't understand poverty.
One of the guest lecturers in our interdisciplinary health issues class made that very claim. She was a guest lecturer from Washington DC. She also said that few, if any of us, had worked to get into our seats, nor did we really deserve them. Are there a few entitled jerks in my class for whom daddy is paying their way? maybe a few, but I don't know any. I don't know how she had the gall to make her claim, since something like 65% of medical school applicants don't get in. If we got in, isn't it implicit that the admissions committee thought we deserved it? I was also enraged by her claim that we didn't understand poverty. The single students live at 161% of federal poverty, married but no kids 120%, 1 kid at about 100%, two kids at 79%, and the one guy in our class with 4 teenagers lives at 61%. These numbers are based on our maximum financial aid disbursement as a fraction of the federal poverty line for a family of the described size as indicated by the Department of Health and Human Services. Yup, that guy whose family survived medical school for 4 years on Medicaid sure doesn't know what it's like. I hope that we don't forget the years that we spent eking out a living when it comes time to treat Medicaid patients or the uninsured. Who knows what the "system" we have in place will be like in 7-10 years when we all start practicing.
One of the guest lecturers in our interdisciplinary health issues class made that very claim. She was a guest lecturer from Washington DC. She also said that few, if any of us, had worked to get into our seats, nor did we really deserve them. Are there a few entitled jerks in my class for whom daddy is paying their way? maybe a few, but I don't know any. I don't know how she had the gall to make her claim, since something like 65% of medical school applicants don't get in. If we got in, isn't it implicit that the admissions committee thought we deserved it? I was also enraged by her claim that we didn't understand poverty. The single students live at 161% of federal poverty, married but no kids 120%, 1 kid at about 100%, two kids at 79%, and the one guy in our class with 4 teenagers lives at 61%. These numbers are based on our maximum financial aid disbursement as a fraction of the federal poverty line for a family of the described size as indicated by the Department of Health and Human Services. Yup, that guy whose family survived medical school for 4 years on Medicaid sure doesn't know what it's like. I hope that we don't forget the years that we spent eking out a living when it comes time to treat Medicaid patients or the uninsured. Who knows what the "system" we have in place will be like in 7-10 years when we all start practicing.
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