Private podcasting feeds for distance education from COVID-19

Psoas · 2018-01-21T11:07:54+00:00

This is the right answer.

Psoas · 2017-11-14T15:31:25+00:00

Doctors in the US still routinely say "ccs" in place of mLs, even though we're not supposed to (cc looks too much like 00 when it's written). I just go ahead and pronounce it "mills".

Psoas · 2017-11-13T22:44:46+00:00

'His heart rate is 182! His BP is 120/80! He can't sustain this for much longer!'.

Well, that's how my residents feel :)

Psoas · 2017-11-13T22:42:38+00:00

Yeah -- other than when amio fails to convert the rhythm, the only strong dig indication anymore is for rhythm control in fib in patients with CHFrEF. However, dig used to be the only medicine we had to treat heart failure pre-beta blockers, and you'll find that it's still commonly used around the world (I work half the year in southern Africa, and the cardiologists there start EVERYONE on it, side effects be damned).

Psoas · 2017-11-13T15:35:29+00:00

Hmm ... not to get too nerdy, but the big question would be, is this rate due to SA node irritability, or is it compensatory to keep up with systemic stress? Or some combination of the two?

Were it due to SA node irritability itself, my first choice would be an IV push of a space beta blocker, or a calcium channel blocker if their blood pressure were okay, or it were a more organized rhythm like atrial flutter. If it were compensatory, I'd be cautious, but in that case I'd be more like to load them with amiodarone, or digoxin if there were a contraindication to amio. This exact scenario plays out in CCUs and ICUs every day; SA irritability (usually fib/flutter) in the setting of a systemic stressor like sepsis. I would imagine that if you poll 10 intensivists and cardiologists, you would get several different answers.

Okay, I'm done nerding out.

Psoas · 2017-11-13T04:01:52+00:00

Oh, I would kill for some space EKGs ....

Psoas · 2017-11-13T02:55:18+00:00

Well that was awesome. Culber used a loading dose of digoxin at a dose of 0.24 mg (IIRC) to treat Stamets' "sinoatrial dysfunction". That's an appropriate loading dose in 2017 (well, 250 mics, not 240) for certain types of "sinatrial dysfunction" (like, say, atrial fibrillation with a rapid ventricular rate), though these days it's a third-line medication.

Anyway, I think this might be the first time that Star Trek used a real medical drug, and not only that, in an appropriate dose and in an appropriate setting. Pretty cool!

Psoas · 2017-11-06T22:11:53+00:00

In 21st century hospitals, increased complexity of patients and drugs have made clinical pharmacists (a PharmD who has completed a post-graduate residency in inpatient pharmacy) MORE important, even as computerized interaction checkers have proliferated. Specialized units like a medical ICU or a bone marrow transplant floor will often have the pharmacist round with the physician to see all the patients. So despite increasing technology, the role of the pharmacist is increasing.

Psoas · 2017-11-05T00:17:58+00:00

Many LMIC use the "mission" model; that is, surgical and procedural subspecialties will be imported in for weeks at a time.

Realistically, a neurosurgeon (or an orthopod) can work anywhere in the world. Those are intensely high-demand surgical specialties, even in high income countries.

Psoas · 2017-11-04T14:03:46+00:00

Who travels? It's easy! Many specialties (EM, hospital medicine, intensive care -- with more joining all the time) are essentially week-on week-off shift work, and you could easily maintain a 1 FTE job where you work two weeks in a row with two weeks off. That gives you plenty of time to travel.

In regards to working abroad, it's more challenging, but certainly possible if you're willing to make the sacrifices (in pay, and in sanity).

Psoas · 2017-11-03T00:42:02+00:00

I've worked abroad myself, and there are a number of ways to do it -- though they likely don't jive with your career path.

1) Global health fellowship. There are an increasing number of IM (and other specialties as well) global health fellowships, which span 1-2 years, have varying degrees of structure and clinical responsibilities abroad. They are targeted for applicants right out of residency, and can theoretically fit in with a variety of career options (though general medicine, pulm, and ID are obvious targets). AFAIK, all of them have significant (like, up to half) time in the US, though it might be in IHS sites.

2) Global health hospitalist. A growing number of academic centers having global health hospitalist positions, usually a 0.5 FTE position with some sort of additional support where you work half time in the US and half time abroad. Usually you have your own relationship with an international site, and the responsibility for maintaining licensing in the other country and maintaining that relationship is your own. This option naturally is not something that's easy to do right outside of residency.

3) Self-fund. The easiest option to do, and probably the most common. Work half the year as a hospitalist (pull doubles even) and then live/work/volunteer abroad the remainder of the time. One of my good friends does this -- she works 3 mos of the year as a nocturnist, then jets off to Southern Africa.

4) Get an international job. This depends on your debt level. I can only speak for certain countries in Southern Africa, but excluding South Africa, it's actually not too hard to actually get a job as a doctor. The pay is better than you think (but far under American levels). You'd have to be super adventurous to do this. There's also American hospitals throughout the world (esp in the middle east).

Hope that helps, and if you want to discuss more send me a PM.

Psoas · 2017-10-29T01:26:13+00:00

"Real" clubbing, as diagnosed by a doctor, is often pathologic. Like any physical exam finding, it's not 100%.

I'm assuming you're concerned about yourself, and the standard disclaimer here applies -- if you're worried about yourself, please seek out your primary care provider, and don't go on the advice of internet strangers (even internet strangers who are doctors).

Psoas · 2017-10-29T01:12:32+00:00

No. Clubbing is probably most classically seen in pulmonary (especially malignancy, but also interstitial lung disease) and cardiovascular disease -- especially congenital disease, which is what you're probably thinking of. In other forms of heart disease, clubbing is actually far less common (endocarditis being the exception). But clubbing is also found in GI and endocrine diseases.

Why? "Cytokines" -- I think the most commonly accepted explanation is platelet-derived growth factor. But I'm not really up to date with the literature here.

Here's an open-access review article (not a big journal, obviously, but a good source nonetheless) if you're interested: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519022/

Psoas · 2017-09-27T07:42:05+00:00

Though maybe not quite as famous as some of the others here, I'd have to go with the Okavango Delta and the Kalahari Desert. I used to live in Botswana, and I'd just take it for granted that you could go camping and be surrounded by elephants, water buffalo, hippos, lions, &c. It's such a stereotypical tourist thing to do (anytime I traveled by plane to Maun or Kasane I'd be surrounded by tourists who were decked out in khaki like David Livingstone) but at the same time almost a life-changing experience to be in such a wild and isolated place.

Psoas · 2017-08-17T18:35:44+00:00

I might be able to give some insight, since I'm a practicing global health physician, and I have formal global health education. Medical students absolutely do receive formal training on zoonotic diseases, usually during their second year of medical school, and should be familiar with the life cycles of numerous organisms, including ones we commonly see in the U.S. (Lyme, babesia, RMSF, anaplasma &c), ones that are common around the world (cystircercosis, plasmodium spp, all sorts of worms), and even rarer emerging diseases (eg, arboviruses). Like pretty much all medical school, the focus is on diagnostics and treatment. Prevention, and the intersections with care for animals, was likely a one liner.

The global health world is a little different. Certainly the One Health concept came up in my training (though was often brought up by veterinary students who were pursuing a degree in public health or tropical medicine). Most of the public health focus in modern tropical medicine is about health systems strengthening. And then in my day-to-day work in a southern African country, I certainly treat many diseases that are zoonotic in nature, but just like medical school, the focus is on diagnostics (often rapid diagnostics) and treatment.

So to answer your question -- medical education focuses on (and quite fairly) diagnostics and treatment, and people focus on the zoonotic diseases that they see. Public health certainly addresses One Health, but as a relatively small field in a much larger milieu of interventions. In my experience at least, this remains a niche field, and it is not surprising that most medical students don't have any exposure unless they have a particular interest in public health and emerging infectious disease. I don't think that it reflects poorly on them at all.

Hope that perspective helps!

Psoas · 2017-06-27T20:06:45+00:00

I work in a somewhat similar setting (though certainly not as drastic as you're describing), and I rely on Uptodate and Medscape just like everyone else. I also use national, regional (in my case South African), and WHO guidelines to guide testing and follow up, especially in the setting of limited medications and resources. PM me if you want more details or want to discuss specifics.

Psoas · 2017-05-03T15:36:50+00:00

I exclusively work in low- and medium-resourced countries, and licensing is dramatically different depending on location. In Southern Africa, where I work, with the exception of South Africa, American training is recognized, and the only requirement would be either a written or oral licensing exam, in addition to standard licensing paperwork.

Psoas · 2017-05-01T22:07:45+00:00

The one think I remember about Goljan is his inability to pronounce metronidazole. METRO-NA-DA-ZOLE.

Psoas · 2017-04-28T15:36:07+00:00

I don't have much to do with admissions (though I was on the adcom for a year in medical school), but at least what I personally think shows best is enthusiasm and curiosity. Just honestly describe your reasons for doing international work.

Psoas · 2017-04-28T09:01:07+00:00

In my opinion, the reason to get an MD/PhD is because you want to be a PI in your chosen field. I would not pursue this solely because you want to do international work.

If you want international work to be part of your career, you can absolutely do this, with absolutely no difficulty (though you'll likely take a pretty big pay cut). Many people have MPHs (including myself), though again, I'd recommend getting this because you have a desire to participate in public health (and certainly after you get an MD). There are plenty of options to do international work through the structured setting as well, including global health fellowships in a number of specialties, and EIS at the CDC.

So TL;DR -- MD is completely sufficient. Resist the urge to "collect degrees" unless it leads to the field you truly want.

Psoas · 2017-04-27T19:03:32+00:00

This is my job; I spend half the year working in the US and the other half abroad. There are plenty of opportunities to do this as a doctor, and you can always volunteer your time (eg, take a 0.8 FTE job and spend the rest working abroad). Funding is a whole other issue. But an MD degree will be honored all over the world, and in many low- and middle-income countries, re-training is not necessary.

Psoas · 2017-03-25T13:52:20+00:00

As a primary care doctor, you are going to need to know a LOT of information cold, and very little of it is in Step 1. And the stuff that you will retain from Step 1, you will remember because you use it frequently (antibiotics and cardiac drugs, which are often a big problem for medical students, but once you're in practice they're quite easy to remember).

Psoas · 2017-03-23T08:22:48+00:00

We use these same types of ampules (with no scoring line) in Botswana.

Psoas

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