So I am currently 1/3 of the way through the ob/gyn rotation, and unfortunately (due to very stupid reasons) I'm not enjoying it as much as I had hoped. 40 days until Japan...
In other news, I just finished reading this book called "Unnatural Causes" by Dr. Richard Shepherd.
The author writes about his career as a forensic pathologist in Britain/the UK. He writes very honestly, and I was hooked on this book from the very beginning when I first read the introduction online later reading the physical copy in very short drips and drabs at night before bed.
As of now I'm not sure what kind of career in pathology I want to pursue.
I find that I enjoy looking at slides, but I have also become interested in topics in forensic pathology.
We had one lecture (and only one) given to us by a practicing forensic pathologist and this was outside the curriculum of medical school -- in fact, it was through the activities of the pathology interest group that I first became aware that this was even a career option. Later I had the opportunity to observe a few forensic post-mortems, but I am not completely sure it's what I want to do because I'm between that and being a hospital/clinical pathologist.
One book which I think is a good starting resource would be the textbook Forensic Pathology by David Dolinak who is both a neuropathologist and a forensic pathologist. I read the entire book over a few months time. It was a very fascinating book, though I was unable to read it at length, given the material/content. I had to read it very slowly in small portions at a time. There was something fascinating about it that pushed me to read it to the end, however, similar to Dr. Shepherd's book.
Shepherd talks about his experience having PTSD which he attributes to having worked in post-disaster/massacre/terrorist situations i.e. 9/11, Hungerford massacre, Bali, Marchioness tragedy
It's strange, before this, I thought I had all but decided I wanted to look at slides all day instead of doing autopsies. I'm not sure if I'm being influenced by the unsavory interactions I'm having with the clinicians that I'm working with right now. Is it a reaction that I'm having by wanting to distance myself entirely from the microcosm of the hospital, the egos and squabbles of the clinicians, and their politics (?)
The other reason why I'm considering this again (forensics) even though previously I thought I had ruled it out as a career [...thinking back, it may have been because of my role of relative non-involvement as a student who was there on a very limited basis, essentially observing and not having a very active role in the autopsies I observed] have to do with my own curiosity and interest and I suppose a natural affinity for the job I suppose. Being able to determine why a person died is not as simple as it appears...
Either way, I guess because of this book and for my own reasons, I'm thinking about this career path again.
Two additional resources I would recommend for people interested in forensic pathology specifically would be Knight's forensic pathology (found easily online), and Simpson's Forensic Medicine (I was able to find the 11th edition in the library and flipped through it, but I would like to check out the most recent edition which I'm sure has a lot more updates).
One thing that does bother me would be the occupational hazards inherent to the job in terms of infectious disease. I have heard here and there about pathologists contracting various diseases on the job. Perhaps, given the infectious risk, there needs to be more formalized protocols when carrying out an autopsy, similar to how surgery in the past used to be much less regulated in terms of protocol leading to mistakes and surgical site infections.
What are some ways you all think infection risk could be reduced when carrying out an autopsy?
Friday, March 29, 2019
Monday, March 18, 2019
The Match and Ob/Gyn
Hey everyone, this past week was quite momentous as (medical readers likely know) it was Match Day just last Friday (in addition to it being St. Patrick's Day Sunday).
Match Day is the day where all the fourth year medical students in the country find out the location of the residency program where they will be working in residency (a.k.a. first real job out of medical school). It marks the transition from being a 'medical student' to being a resident 'doctor' although still a trainee. For my close friends, some of them matched to their top choice program, while for others they matched further down the list (i.e. in more competitive specialties, for example).
The rules are that the applicant creates a 'rank list' which lists the programs where the person would like to go to, and the program creates their own list of applicants. A computer program takes this massive amount of data, crunches it, and matches person to program.
On the actual Match day ceremony (typically a Friday), students, their friends and family receive and open the letters containing information about the hospital and the location where they will be working for the next several years. It is similar to other ceremonies (weddings, funerals) that commemorate and mark an important transition in one's life.
Even so, there are imperfections.
The difficulty of the match system is that one has very little control over where one actually ends up, given that it is determined by a computer algorithm.
It is especially difficult when couples are separated by this system. Even the 'couples match' (two applicants declare themselves 'a couple' and tries match them to programs within the same general region) can result in applicants being separated by hours. So what is the solution to this problem?
From what I understand ... one has to have two things - faith, persistence, and strategy. Expressing interest in a certain program in a desired geographic region can raise an applicant's rank on a program's list. Applying to many programs in the region of interest also increase one's chances of matching in a geographic area. And finally, doing an away rotation at an institution one would like to be at. Other than the things applicants typically do which consists of doing well on exams and making a good impression on an interview. The converse of which is what people applying have told me is referred to as 'avoiding red flags' (i.e. failing an exam, making a bad impression on an interview).
On a completely unrelated note, I finished my surgery rotation last week.
Today I just had my first day of conferences for my Ob/Gyn rotation. I realized that it is a completely different language! Obstetrician-gynecologists communicate using unique terminology which you do not hear in any other field of medicine! It was kind of a shocker how much I realized I didn't know about the female body and pregnancy. I have a lot to learn the next 6 weeks.
An interesting conversation between two ob/gyn's which I overheard today was regarding the sufficiency of cytology specimens. One remarked that sometimes his samples resulted as insufficient for evaluation, and a few tricks/tips to avoid this. A suggestion was : because blood cells an obscure a sample, do not over-instrumentate while taking a sample. The other talked about how she improved by avoiding getting lubricant in the sample by ensuring that it was on the outer blades of the speculum (while doing a pelvic exam). It got me thinking about how to improve the yield of cytology specimens. She did discuss some laboratory factors such as compatibility of the media with machines used to process specimens etc. Due to variability in these factors, I would assume the yield varies between laboratories and it is interesting to think about how to potentially increase yield and specimen quality given the quantity given. This is a frustrating point for obstetrician-gynecologists because it means that the patient must come back for another visit, taking a chunk out of her day, and ultimately leading to decreased rapport and patient satisfaction, due to factors out of their control.
Hearing the clinician perspective about this made me realize how important it is for laboratory professionals to handle specimens with care, but also troubleshoot and make improvements in our own processes so that patients do not undergo extra procedures unnecessarily.
As much as people might say (as one surgery resident did to me just the other day in the OR), in pathology, "all your patients are dead", this illustration begs to differ. The information we relay to clinicians has an enormous impact on medical decision making, and we should consider carefully the message and potential impact/consequences. A very important way of framing this, I think, is by considering the range of actions a clinician might make based on the information contained in the report, as a thought exercise. For example, I was told by a surgery resident that even though a diagnosis may not be certain, a surgeon may choose to bring a patient to the OR simply based on a 'highly suspicious' diagnosis, in some cases. Of course this is on a case-by-case basis and clinical judgement, but it is always important to consider.
This brings up a few questions, such as: What happens when an interpretation gets out of hand? For example, a pathologist has made an equivocal diagnosis favoring two possibilities and it is interpreted as being 'entity X' (error of omission) in the patient's medical chart/clinician's notes. Is the role of the pathologist to point out this discrepancy and effectively impose oneself by correcting the people involved in the patient's medical care? This is an interesting ethical dilemma for pathologists as some might argue it is overstepping our bounds. Another sticky situation involves a pathologic diagnosis that is failed to be followed up on, effectively being missed by clinicians in review of the patient's charts. Should a pathologist be more proactive in alerting busy clinicians of the findings? Which would be the best way to do this (by letter, phone call)? Should we as pathologists take a more proactive role in improving our communication to the healthcare providers ultimately responsible for keeping track of the patient's medical course (?)
This weekend, I also went to donate blood again, seeing that it had been about 3 months, and I had some free time, and this very nice lady from the Red Cross phoned me and asked whether I would be available. I figured, hey, I have the weekend off after my surgery shelf exam, so why not? I had about 2 weeks to prepare in advance (whereas previously I just did it on a whim). So I went, having hydrated myself nightly the week in advance (was sipping on clears at home). To my surprise, I was able to complete the donation. Fun fact: Did you know there is about a pint or just under 500 ml (half a liter) in a pack of whole blood? I give credit to the incredible staff at the Red Cross who were able to place the needle even though I have small veins, and watched me carefully after the donation. The people who work there really do care.
The hours on this rotation are 5-6AM to 6PM, typically. With 2 weeks of L&D, Gynecologic surgery, and clinic. I think after this rotation, I will have more time to post again. =)
Match Day is the day where all the fourth year medical students in the country find out the location of the residency program where they will be working in residency (a.k.a. first real job out of medical school). It marks the transition from being a 'medical student' to being a resident 'doctor' although still a trainee. For my close friends, some of them matched to their top choice program, while for others they matched further down the list (i.e. in more competitive specialties, for example).
The rules are that the applicant creates a 'rank list' which lists the programs where the person would like to go to, and the program creates their own list of applicants. A computer program takes this massive amount of data, crunches it, and matches person to program.
On the actual Match day ceremony (typically a Friday), students, their friends and family receive and open the letters containing information about the hospital and the location where they will be working for the next several years. It is similar to other ceremonies (weddings, funerals) that commemorate and mark an important transition in one's life.
Even so, there are imperfections.
The difficulty of the match system is that one has very little control over where one actually ends up, given that it is determined by a computer algorithm.
It is especially difficult when couples are separated by this system. Even the 'couples match' (two applicants declare themselves 'a couple' and tries match them to programs within the same general region) can result in applicants being separated by hours. So what is the solution to this problem?
From what I understand ... one has to have two things - faith, persistence, and strategy. Expressing interest in a certain program in a desired geographic region can raise an applicant's rank on a program's list. Applying to many programs in the region of interest also increase one's chances of matching in a geographic area. And finally, doing an away rotation at an institution one would like to be at. Other than the things applicants typically do which consists of doing well on exams and making a good impression on an interview. The converse of which is what people applying have told me is referred to as 'avoiding red flags' (i.e. failing an exam, making a bad impression on an interview).
On a completely unrelated note, I finished my surgery rotation last week.
Today I just had my first day of conferences for my Ob/Gyn rotation. I realized that it is a completely different language! Obstetrician-gynecologists communicate using unique terminology which you do not hear in any other field of medicine! It was kind of a shocker how much I realized I didn't know about the female body and pregnancy. I have a lot to learn the next 6 weeks.
An interesting conversation between two ob/gyn's which I overheard today was regarding the sufficiency of cytology specimens. One remarked that sometimes his samples resulted as insufficient for evaluation, and a few tricks/tips to avoid this. A suggestion was : because blood cells an obscure a sample, do not over-instrumentate while taking a sample. The other talked about how she improved by avoiding getting lubricant in the sample by ensuring that it was on the outer blades of the speculum (while doing a pelvic exam). It got me thinking about how to improve the yield of cytology specimens. She did discuss some laboratory factors such as compatibility of the media with machines used to process specimens etc. Due to variability in these factors, I would assume the yield varies between laboratories and it is interesting to think about how to potentially increase yield and specimen quality given the quantity given. This is a frustrating point for obstetrician-gynecologists because it means that the patient must come back for another visit, taking a chunk out of her day, and ultimately leading to decreased rapport and patient satisfaction, due to factors out of their control.
Hearing the clinician perspective about this made me realize how important it is for laboratory professionals to handle specimens with care, but also troubleshoot and make improvements in our own processes so that patients do not undergo extra procedures unnecessarily.
As much as people might say (as one surgery resident did to me just the other day in the OR), in pathology, "all your patients are dead", this illustration begs to differ. The information we relay to clinicians has an enormous impact on medical decision making, and we should consider carefully the message and potential impact/consequences. A very important way of framing this, I think, is by considering the range of actions a clinician might make based on the information contained in the report, as a thought exercise. For example, I was told by a surgery resident that even though a diagnosis may not be certain, a surgeon may choose to bring a patient to the OR simply based on a 'highly suspicious' diagnosis, in some cases. Of course this is on a case-by-case basis and clinical judgement, but it is always important to consider.
This brings up a few questions, such as: What happens when an interpretation gets out of hand? For example, a pathologist has made an equivocal diagnosis favoring two possibilities and it is interpreted as being 'entity X' (error of omission) in the patient's medical chart/clinician's notes. Is the role of the pathologist to point out this discrepancy and effectively impose oneself by correcting the people involved in the patient's medical care? This is an interesting ethical dilemma for pathologists as some might argue it is overstepping our bounds. Another sticky situation involves a pathologic diagnosis that is failed to be followed up on, effectively being missed by clinicians in review of the patient's charts. Should a pathologist be more proactive in alerting busy clinicians of the findings? Which would be the best way to do this (by letter, phone call)? Should we as pathologists take a more proactive role in improving our communication to the healthcare providers ultimately responsible for keeping track of the patient's medical course (?)
This weekend, I also went to donate blood again, seeing that it had been about 3 months, and I had some free time, and this very nice lady from the Red Cross phoned me and asked whether I would be available. I figured, hey, I have the weekend off after my surgery shelf exam, so why not? I had about 2 weeks to prepare in advance (whereas previously I just did it on a whim). So I went, having hydrated myself nightly the week in advance (was sipping on clears at home). To my surprise, I was able to complete the donation. Fun fact: Did you know there is about a pint or just under 500 ml (half a liter) in a pack of whole blood? I give credit to the incredible staff at the Red Cross who were able to place the needle even though I have small veins, and watched me carefully after the donation. The people who work there really do care.
The hours on this rotation are 5-6AM to 6PM, typically. With 2 weeks of L&D, Gynecologic surgery, and clinic. I think after this rotation, I will have more time to post again. =)
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