Germy

It was my third weekend working in the Rose Medical Center's Emergency Department in Denver when the call came in. It was a Sunday morning -- often the quietest (oh no! somebody said the "q" word! I actively rally against the silly superstitions that stop us actually enjoying a moment of peace between the storms of chaos. Let the comment on the temporary tranquil present be met with a smile and a nod instead of derision and threats of bodily harm, as they most often are) time in the ED and maybe 8:30 in the morning at the latest.  I was standing close to the phone, leaning on my "COW" (which we were told were to be referred to as WOW -- for Workstation On Wheels, versus Computer On Wheels, as Nancy in HR got offended that one time she was on a clinical floor and heard the doctor tell the scribe to "grab the cow") and immediately was alarmed by the nurse's reaction.  We were a level III trauma, if I remember correctly, with no dedicated pediat

Welcome to the forth edition of an ongoing series built to break down common medical conditions and emergencies so all of us can have a better understanding of just why doctors do what they do. Thankfully I've been overwhelmingly healthy and issue free for my entire life. Good genes and luck more than wisdom and disciplined living. There are some patient presentations that trigger powerful feelings of empathy -- gout flares and osteoarthritis flares, in particular. I've had a couple gout flares -- the worst manifesting in my knee during my first semester of medical school. I didn't know what was going on and the pain was extraordinary. A solid decade of avid skateboarding will teach one to tolerate pain, but that gouty knee was terrible. Gout is nothing more than an acute arthritis caused by purine crystal formation in the fluid of the joint, which look like barbed wire under the microscope. The sharp, powerful sensations of pain do not disappoint, in that barbed wire

In this, the third installment in  Doctor, Doctor, Give Me The News  we turn not to another common medical malady or emergent disease process. Imma gonna try'n decode and simplify the malignant beast that is the American Medical-Industrial Complex. I see it as the largest barrier to our long term health and wellness but, at the same time recognize the success in emergent, dramatic, life saving machinations that we depend on.  The forces that have shaped our healthcare system remind me of another dynamic I've watched play out in our society.   The "right to choosers" versus the "right to lifers."  This truly is not an indictment on either side of the debate -- neither the time nor the place, but just my observations and what it has meant for public policy and politics at large, in this country. Afterall, large swaths of voters vote on this item, and this item alone.  Not hard to imagine that the good ol' polly teeshans understand this an

I never gave much thought to the root of the term "stroke" but a recent lecture given by a neurologist enlightened me. It stems from the 1500's when "The stroke of God's hand" referred to what we now call just "stroke." I’ll also refer to it as a CVA, short for "CerebroVascular Accident,” in this article. With continued workup of a stroke, we will then diagnosis either a hemorrhage or infarction. Infarction refers to the process which begins when a blockage in blood flow occurs. The tissue that is fed by the blood will die, provided there are no other routes for the blood -- no other corollaries. Sometimes, like in the heart we can have new blood vessels grow over time in response to decreased rate of flow, due to the growing partial blockage. More specifics diagnosis are made based on the what the blockage is made of; we'll get into that, too. At most 18% of strokes are hemorrhagic. A blood vessel, often an artery in the Circle of

Welcome to the first edition of an ongoing series built to break down common medical conditions and emergencies so all of us can have a better understanding of just why doctors do what they do. One of the most enjoyable parts of my day to day is explaining physiology and pathology to my patients. I've made it a habit to go over every test sitting side-by-side with the patient. I tell them what every element means; very briefly if normal and with a little more in depth explanation if abnormal. I break down the fancy schmancy radiology jargon and explanations, telling them what the reading means in plain language and what it means for them. Most people appreciate it, I think. Diabetes. So prevalent. So destructive. Many times preventable. Once in a while patients present to the clinic with complaints related directly to a new onset diabetes. The ones that do are often type I, or in the olden days, juvenile diabetes. This is a very different process than type II. In brief, type

Had more OSCEs today. Thought that was over with, actually. What does OSCE stand for, you may wonder? OsteopragmatipathSomethingClinicalExamination. Sounds about right. Had these on a regular a basis in medical school. Standardized patients, who are trained to act in a certain way and function as if they were a living "Choose Your Own Adventure" book, in that what I do or don't ask them determines how the visit goes. We're videotaped. We're given feedback from the standardized patients about every little thing we did. Of course, the more dramatic the more tempting the scenario is to set-up. I had to deal with an actress sitting in front of me reacting to the news that her pregnancy was culminating in a baby who would have no brain -- anencephaly -- and she had no idea before I sat down. The SP is able to cry on demand; it was impressive and believable. Another young lady had a history of trauma, was seeing me for a sprained wrist and would not make eye contact and

Your first interview is coming up. Your mom said to 'just be yourself.'  This may be good advice.  Nevertheless. Take a moment and reflect on those you have been with along this academic journey. Perhaps some of them should not 'just be themselves' during the interview process.  Assuredly none of the readers of this particular corner of the internet would find themselves in the position to go against their own mother's advice, but if only for our own edification let us forge ahead and review the world renowned  Germy's Annual Guide to Answering Residency Interview Questions So You Match Good . This year's installment is provided in a convenient multiple choice format.  1. Which of the following is the most appropriate response to the following: "Why are you interested in coming to our program?" A. Best results when I place my location here on Tinder B. Best food delivery options C. Best overhead page voice D. High