Thursday, January 11, 2007

Rank and Guile

For many of you medical students out there, January 15th marks the birth of a new stage in your career. One that will lead you to hours and hours (and hours) of gratifying time spent in a specialty of your choice. It will signal the beginning of the end of kissing residents’ misshapely asses, scutting for good evaluations, and the education-comes-first mentality. Less than half a year from now, you will actually receive a paycheck, call yourself “Doctor” and you may even live in a different state - all contingent on that RANK LIST. The Rank is a curious creature and many medical students have made crucial mistakes that put them in specialties and/or states that were not for them. Thus, has selflessly created a list of 5 rules for you to remember when constructing your ultimate Rank.

1. More is better. NRMP says: Applicants are advised to rank all of the programs deemed acceptable, i.e., programs where they would be happy to undertake residency training. Get it? If you could picture yourself at a place, put it on your list. And when you are hemming and hawing about whether you really would be happy at County, make sure the alternative you are comparing it with is no-place and it will make your decision a lot easier.

2. More is better. NRMP also says: “Unmatched applicants have shorter lists on the average than matched applicants. Short lists increase the likelihood of being unmatched.” Have we hammered this point home enough? Just in case we haven’t, think of how you’ll feel on Match Day when all of your friends are hugging and kissing and you’re worried about scrambling because you couldn’t picture yourself with all of those residents at County. Get over it and put everywhere you interview on your list!

3. Rank in order of your preference.
This is also straight form The position of a program on your rank order list will not affect your position on the program's rank order list, and therefore will not affect the program's preference for matching with you as compared with any other applicants to the program. Translation: They don’t know where you put them so it cannot affect where they put you. That brings us to another interesting point: Tell every interviewer that they are your number one choice! Act happy to be there and convince them that this really is the place for you with some unique observation about wherever it is that you’re interviewing.

4. Don’t Believe the Hype. Choices should not be influenced by what an interviewer might say to you – positive or negative. One never knows who is interviewing after you and we don’t just mean that they might be smarter and have better USMLE scores. They might be the Chief’s nephew or the daughter of the program director’s secretary, or be high-rankingly hot. Interviewers are human and humans have feelings, wants, needs, likes, dislikes and issues. Thus, take all interviewers’ promises with a large grain of salt and refer to Rule #3.

5. Do your due diligence. First, go to and read how the match algorithm works. Now that you have included all of your possible programs and are stuck on the order of what you like best and least – it’s time to research your options. Find out who the program director and Chairman are; Google the hell out of your department; consider lifestyle aspects like where you’ll live (and for how much); do they publish; so they go on to fellowships; etc etc. You get it now – so get to it and best of luck Ranking your List.

Saturday, January 06, 2007

Appendiceal Surprise or Big Pack of Lies?

Appendiceal Surprise or Big Pack of Lies?

Our favorite VIP patient and frequent topic of this column, La Lohan, has been admitted again!

It’s really a shame that it happened during such a tender time for the 20-year-old party girl-turned-AA-member. She was just getting used to normal blood alcohol levels and then wham! – an acute abdomen.

The details of how and when she got admitted are hazy, as per usual, but piecing together various stories, the most likely scenario sounds like she saw a doctor sometime Wednesday who diagnosed her with a hot appendix and sent her to Century City Hospital in Los Angeles to have it snipped out, where she most likely stayed in one of their luxe VIP suites (seen in pic). Ooooh la Lohan.

We’re quite sure she’s a good judge of hospital VIP suites by now. Maybe she would consider doing a Top 5 Best Hospital VIP Suites for

Why is it that Lindsay keeps returning as an inpatient? Is it the young interns? The pain meds? The swing-arm TV?

Now, we would have given Blohan the benefit of the doubt had we not seen’s new video clip of her jaunting out of the hospital on post-op day #1 (POD#1).

There is no question that the party princess would have had her appy done by laparoscopic approach. This way, surgeons could easily hide the 1-2 cm scars below her ischial spines and inside her umbilicus (belly button). And yes, that is less painful and often results in quicker recovery – but 24 hours??? That is really pushing it from a pain tolerance and medical standpoint. It just seems silly that she would not give the trocar incision sites at least until the evening to heal up a little. Which brings up another interesting quandary: what type of pain meds did she get, being that sh is trying to clean up her act?

Typically, surgical patients, even those as young as 20, are observed for at least 24 hours to watch for any signs of infection (fever, chills, nausea, vomiting) and to make sure their gut is active again. That’s the best part. Gut activity is determined by the resumption of bowel peristalsis, or muscle contraction, forcing stool and air down the gut towards the rectum. Thus, docs determine if the gut is active by asking patients about flatus, aka ass-wind. I can just imagine the doctors asking LaLo if she beefed yet? Lucky bastards.

But if it was not her vestigial appendix what could it be? There are too many possibilities for what really could have happened, but here’s a short list:
- More “fatigue/exhaustion/anxiety/cocaine hangover
- Elective abortion – It’s a same-day procedure that is often well-tolerated and quite safe
- Some minor plastic surgical procedure
- Gastroenteritis

Regardless of whether the Queen of Teen had an inflamed appendix or not, we would like to thank her for providing this column with so much fodder this past year. We wish Lohan the best of luck and health in the future and look forward to her returning several times in 2007.

Friday, January 05, 2007

Top 5 Reasons for the Short Coat

1. Target Practice – In the complicated hierarchy of academic medicine, attendings beat on residents, residents beat on interns, patients beat on interns, and nurses beat on interns (and anyone else that show signs of weakness). Since the interns are so grateful to have help, most do not transfer their abuse to the medical students who serve to a) scut, and b) deflect some of the nursial abuse. When nurses see a short coat, their eyes light up like it was free food day in the cafeteria and that lack of white fabric might as well be a bullseye or a sign that says: 'Yell at me for sitting in your chair.'

2. Limits Responsibility – Despite the lack of experience and knowledge connoted by the short coat, it brings with it a certain freedom, i.e. those who don the half-length jacket are not liable for any missed labs, failed blood draws or late discharges. Ah, the life of the blameless.

3. Still Works with the Chicks – When residents see the short coats, we secretly smirk at the awkward presentations, constant ass kissing and lack of hospital savvy that wear the mini-coat. We hearken back to times when a test at the end of the rotation was our greatest responsibility. They are the pledges of the medical hierarchy, the plankton of the medical food chain. But to non-medical people, they are future earners and the next potential Dr. 90210. The white coat equals doctor and to those who care about such things, that is the long and the short of it.

4. Bottoms Up – Myth has it that the long white coat was invented to cover up the expanding asses of residents and attendings unable to make it to the gym because of their hectic schedules. Still able to hit the treadmill regularly, med students can proudly display their backside, and help bring down their higher-ups just a notch. Fashion Sense – The sport coat is back, baby. Go to any club/lounge/bar in NYC and see for yourself. No longer reserved for the 35 and older crowd, the jacket and jeans look affords the wearer a unique sense of casual-formalness never seen before. Donning that short white coat with jeans and a loose tie could land you ahead of the fashion game. Or the victim of an ass kicking.

5. Fashion Sense – The sport coat is back, baby. Go to any club/lounge/bar in NYC and see for yourself. No longer reserved for the 35 and older crowd, the jacket and jeans look affords the wearer a unique sense of casual-formalness never seen before. Donning that short white coat with jeans and a loose tie could land you ahead of the fashion game. Or the victim of an ass kicking.

Wednesday, January 03, 2007

Why This Reality Show Might Save America

Say what you want about Dancing With the Stars or The Surreal Life. Go ahead and mock that Flavor Flav show and the inane lives of teenage rich kids as seen on MTV’s Laguna Beach. But don’t you dare include any of those shows in the same breath as The Biggest Loser, possibly the most important show to hit primetime in the past 50 years.

Reality programming has become TV’s version of crack. It’s easy to make and equally addictive. Put a bunch of camera hogs with personality disorders together in the same house and watch the entertainment ensue. Just imagine if you could use the dependency for good rather than evil - that’s right, healthy crack.

If you have not seen Loser, the basic premise is to get 14 morbidly obese people to lose as much weight as humanly possible in 100 days. They are divided into two teams and each team is given a personal trainer that works them like they have never been worked – and many of them really have never worked out. They are also taught important lessons about diet e.g. what is healthy and what is fat-inducing. They are taught how to order at a restaurant, how to prepare healthy family meals, how to count calories and so much more. Sure, there are blatant product placements and shameless ads for everything from low-fat turkey to exercise bikes but it’s all in good fat, er, fun. And the best part about all these life lessons that the losers get is that they are televised and even charted for the millions of obese watchers at home.

America is the fattest country in the world with more than ¼ of our population classified as obese. Our BMI’s are only matched by our insatiable hunger for TV, and reality TV in specific goes together with couch potatoes like special sauce on a Whopper. Who better to make you feel OK about yourself than 15 semi-retarded women literally fighting to marry a 5’3” ex-rapper with gold teeth and a giant clock around his neck?

The Biggest Loser is more effective than any institution or individual physician in combating the growing obesity epidemic. Not even the best of academia can affect as many lives over the course of a month as Loser does in one night. What doctor do you know talks to millions of households every week and shows demonstrable evidence that simple diet and exercise does indeed bare out results?

Week after week, the losers drop weight and improve physically and emotionally. There is a minimum of 10 crying scenes, 12-14 shots of massively sweaty tank tops and 6-8 mentions of how they are “doing it for their children”. As with any good reality show, there is bickering, badgering, complaining and just enough scheming to remind you that someone has to be sent home. But the proof is in the fat-free pudding for this bunch, as most often the person who lost the least weight is sent home to combat their eating issues alone.

Perhaps we like reality shows too much and are stretching to find the good in an otherwise crappy genre of TV. But if just one person at home learns that eating a short stack with two eggs on the side with bacon is not a typical breakfast then this show has succeeded in making people better. And isn’t that what we all want to do?

Check out this website to see some great before and after action

Monday, January 01, 2007

Drug Rep: I'm Suing

A six-figure salary, free dinners, company car and a paid cell phone is not enough for some. Namely, Susan Schaefer LaRose, a former sales rep for drug giant Eli Lilly is the lead plaintiff in a class-action lawsuit seeking compensation for 18 years worth of unpaid overtime.

She was never promised overtime and it was clearly spelled out that because of the unique style of pharamaceutical sales tactics. overtime would not be compensated.

The lawsuits, filed in New York, California, New Jersey and Connecticut, are the latest in a series of mass tort claims seeking overtime pay from U.S. businesses in recent years.The pharmaceutical company lawsuits seek overtime wages dating back two to six years, under federal and state statutes of limitations. Other companies affected are Boehringer Ingelheim Pharmaceuticals Inc., AstraZeneca PLC, Pfizer Inc., Johnson & Johnson, Amgen Inc., Hoffmann-La Roche Inc., GlaxoSmithKline PLC and Bayer AG.Schaefer LaRose said her 45-hour work weeks began lengthening as cell phones and e-mail became more prevalent."Those things were supposed to simplify our lives. They didn't," Schaefer LaRose said.

Anthony DeMeis, a co-founder of the Pharmaceutical Representative Society of New York, said it was unfortunate that some people are looking for ways to get more money from their employers. He said he doesn't know of many other jobs that offer college grads $60,000 to $80,000 a year with a free car and free cell phone.

"Everyone I know who does their job well works 60 or more hours a week," DeMeis said. "The harder you work, the more work you make for yourself. I think they're getting paid for overtime, through the bonuses they're getting."

Wow, we're not sure what to say about this. How many times did LaRose use her cell phone for personal calls? How about her corporate card and her generous bonuses? At a time when drug companies are criticized by the public the pharmaceuticalreps are being shunned by the docs, this disgruntled employee has a lot of moxie to think a jury will have a sympathetic ear to her pseudo-plight. Wining and dining a bunch of doctors is not like working in the mines or even toiling over hours of code (a similar lawsuit was won by IBM IT staff). It is known to be a social occupation in which employees tend to work hard and play hard. It is no secret that these reps are as much social event planners as they are purveyors of medication knowledge. The qualifications for the job are not steep and the most social of the bunch inevitably surpass their colleagues who would rather spend time at home. If this was a problem for her, why did she continue her job for 18 years? Regardless of the merit of the case, it is nice to be writing about a drug company being sued, rather than doctor.