Doctors Being Dumb #2: 07-31-2010

Full article: "Dr. Jacquelyn Kotarac Dies in Chimney After Getting Stuck While Stalking Boyfriend"

Summary: First of all, it's good to be posting on this blog again. I had to take a bit of a break for health reasons, and it's been way too long since I've added anything here. Trust me though ... not posting hurt me more than it hurt you. So let's get started, shall we?

The article posted is itself a pretty humorous summary of what happened, but if you haven't heard the news, it's really not funny at all. Earlier this year (very late August to very early September), this was one of the stories that started making rounds throughout the internet. The basic story goes like this: the doctor involved, Dr. Jacquelyn Kotarac, had a pretty dramatic, on-again-off-again relationship with her boyfriend. I have no idea how things got to the point that they did on the night in question, but whatever it was, Dr. Kotarac decided that the best way to deal with the situation was to confront her ex-boyfriend-or-whatever at his house.

Ex-boyfriend-or-whatever was probably thinking that he didn't want to deal with Dr. Kotarac's bullshit that night, so he snuck out of his house and went over to a friend's to spend the night. (Apparently, he was going to Europe the next day, which will become relevant later on in this story.) In the meantime, Dr. Kotarac decided that the best next course of action would be to try to break into Ex-boyfriend-or-whatever's house ... with a freaking shovel. This leads me to two obvious questions:

1. Where the hell did she get the shovel? Did she just carry it with her at all times for these kinds of occasions?
2. How did she fail at getting into a house with a goddamned shovel? Was it made of fucking plastic?

In any case, somehow, the shovel idea didn't pan out. So naturally, she opted for the obvious Plan B: climbing up onto the roof by using a ladder, removing the chimney cap, and trying to slide down the chimney like a goddamn Mrs. Santa Claus.

And if you ever needed proof that Santa Claus doesn't exist, this is it, folks. Dr. Kotarac got stuck in the chimney and died of asphyxiation. In fact, the only way that that her body was discovered was that Ex-boyfriend-or-whatever had hired a house sitter to feed his fish while he was away in Europe, so, three days after the poor woman died, the stench of decomposing flesh is what lead the house sitter to discover her body.

It took firefighters five hours to take apart the chimney and get Dr. Kotarac's body out.

Now, I'm not saying that Dr. Kotarac was a stupid lady - I would actually argue the opposite. For example, if you do a vitals.com search for her, you'll find that she went to UCLA for medical school, and did her residency in Cedars-Sinai. Clearly, it takes a lot of intelligence, drive, and skill to be able to succeed at places like those. But, even though I'm not qualified at all to diagnose Dr. Kotarac, it's pretty clear to me that Dr. Kotarac had some sort of psychiatric condition going on. It's a given that med school can drive people to their breaking point - believe me, I've been there. And I have to wonder, did the stress of medical school contribute to whatever was going on with her? Or did she succeed in medical school because of whatever her psychiatric condition was - something that created her to be driven beyond what normal people ought to be?

And what the hell does that say about how healthy medical school is for our psyches, anyway?

Best quotation: Alas Kotarac, while plenty smart being a doctor and all, is not all that schooled in the art of home construction or Christmas myths. Santa, as it turns out, would have difficulty making it down a chimney due to modern construction techniques, which dictate that chimneys aren't big enough for a human to slide comfortably down.

P.S.: Sorry if this post wasn't as humorous as the previous ones have been. I'll do better next time.

Medicine in the News #1: 06-17-2008

Full Article: "Eyes bloodshot, doctors vent their discontent"

Summary: Lots of things are contributing to doctors in the United States being frustrated by medical practice, including workload, loss of professional autonomy, payment denials, "informed" patients, the threat of malpractice, and decreased reimbursement. Each one of these issues is a substantial burden by itself; add them together, and it makes one wonder why doctors are allowed to be treated this way. In most of these cases, it seems that people are attempting to make their own lives easier at the expense of the doctors' well-being, which ought to be a criminal offense. With these many problems, it's no wonder that some doctors are thinking of leaving the medical profession altogether. Unless some big changes happen, one can expect physician dissatisfaction to stay at the high level where it is.

Best Quotation: "This whole week I haven't slept more than about six hours a night." I asked when his work usually got done. "It is never done," he replied, shaking his head.

#27: Wilford Brimley

Wilford Brimley is a genuine American hero. A former Marine turned actor, Brimley has always been on the backburner of the American public stage, and his reputation has only ripened as he has aged. You see, Brimley has never let things like irrelevance or a lack of expertise stop him from achieving his American dream. And Wilford Brimley's American dream is to sell you diabetic testing supplies.

If you are thinking of entering medical school, it's important that you become acquainted with the greatness that is Wilford Brimley. Brimley was born in 1934 in Salt Lake City, which makes him a septuagenarian and a Mormon. He gained prominence as an actor for his work in such films as the made-for-TV movie Ewoks: The Battle for Endor. After deciding that it was important for him to use his acting talents for evil rather than for good, he decided to get into the business of making commercials. After making commercials for a number of no-name companies (e.g., Quaker Oats), he eventually landed the role for which he will forever be known: the spokesperson for the diabetic testing supply company, Liberty Mutual.

In this capacity, Brimley has gained mass appeal within two very distinct groups of people: senior citizens and med students. Senior citizens resonate with Brimley's portrayal as the shining knight who has come to guide them to good health in these confusing and ever-changing times. On the other hand, med students know him as that old guy who can't pronounce the word "diabetes" for the life of him.

You see, when Brimley was made spokesperson for Liberty Mutual, nobody in the company worried that he might not be qualified to talk about diabetes, seeing as he had no medical training whatsoever. However, he did have diabetes and he was folksy enough to relate to their target demographic. In their minds, these two qualities made him the perfect salesperson. But as is so often the case, one group's salesperson is another group's buffoon.

It takes something special to grab the attention of the younger generations, like LOLcats or the Star Wars Kid. Wilford Brimley had that special something. Every time he tried to say the word "diabetes," it would always come out sounding like "diabeetus," and the kids couldn't get enough of it. The halls of medical schools everywhere rang for months with the sounds of "beetus-beetus," and comparisons of Brimley's appearance to that of cats were made (I particularly like comparison #4).

It could have stopped there. If it had been one commercial, the med students would have had a good chuckle for a few days and then went back to memorizing anomalies of the reproductive system. But no, like the Little Train that Could, many more videos with Brimley saying "diabeetus" were released. Wilford Brimley and Liberty Mutual were either unaware of his mispronunciation of this fundamental word, or actively encouraged it (perhaps to make him seem more folksy) ... and so his legend grew. With every new commercial that Brimley made, the narrative of "beetus-beetus" was renewed and retold. Remixes of his videos were produced. Fake motivational posters were created. Videos of him were shown in small group sessions. Wilford Brimley became part of our vocation's heritage.

The lessons that can be learned from the story of Wilford Brimley's diabeetus are many, but the one most relevant to the medical student is that diabeetus is a laughing matter; use this to your advantage. Medical students seem like a homogenous bunch from the outside, but spend a few months with them and you will realize that there are few things that all med students agree on. The hilarity of "beetus-beetus" is one of these things! If you find yourself in a situation where you want to talk to one of your classmates but can't think of a suitable topic, feel free to use "beetus-beetus" as a conversation starter. It can make the difference between an everyday acquaintance and a new best friend.

Doctors Being Dumb #1: 06-14-2009

Full Article: "Oxford graduate dies after being injected by experimental drug by sister"

Summary: I like to complain a lot about the different hoops that medical schools put their students through, mostly because the entirety of the process to get trained as a physician (both medical school and residency) is so long and painful. No other time in my life have I been so completely surrounded by people who have such little regard for actually doing an adequate job of teaching their pupils, and are instead entirely focused on protecting their own fragile egos. However, I'll be the first to admit that these hoops that they make us jump through do contain a few worthwhile lessons that can serve to make us better doctors than we'd be otherwise. "Don't inject your sister with an experimental serum that hasn't been properly tested or evaluated by it's manufacturers for fear of causing a life-threatening adverse drug reaction" is one such lesson, and is usually imparted to medical students during their first 24 hours of their medical school careers.

Apparently, Dr. Yvonne Pambakian was asleep when that lesson was being taught, as she injected an experimental drug into herself, her sister, their mother, and just for kicks, a random terminally ill woman. Researchers were developing the drug to treat diabetes and cancer, but were also hoping that the drug would have anti-aging properties as well. Both Dr. Pambakian and her sister (Mrs. Yolanda Cox) worked for the pharmaceutical company that was developing the drug, which had been set up by the only person stupid enough to think that these women were qualified to have access to experimental medications - their mother, one of the abovementioned women who allowed herself to be injected with the serum.

While Dr. Pambakian, her mother, and the random terminally ill woman did not have any adverse reactions from the medication, Mrs. Cox was not so lucky. She went into some kind of cardiopulmonary arrest after receiving the injection, and was taken by ambulance to a local hospital where she was put on mechanical ventilation. However, neurological testing showed that her brain was irreversibly damaged, and her family elected to have her life support machine turned off.

Now, I might be able to understand your willingness to inject your sister with such a drug if she was 75 and had a whole host of age-related health issues. Heck, I might even understand if your sister was 50 and a few age-related health issues. But, I'm going to have to question your sanity when you decide that it's a good idea to give such a drug to your 24 year old sister - which is exactly how old Mrs. Cox was. I'm not sure what age Mrs. Cox was hoping to achieve, but I'd have to guess that it falls somewhere squarely in the prepubescent range, since clearly that's the level of maturity that she reached in her 24 years on earth.

Hopefully, the negative press from this event will cause the company to self-implode and bankrupt this family, so that they can't breed any more children to further bring down the fitness of the human race.

Best Quotation: "Both sisters worked for a pharmaceutical company, Amro Biotech, set up by their mother, Dr Arpi Matossian-Rogers."

#26: Intra-class relationships

One word that is used with alarming frequency to describe medical school students is the word "incestuous." In fact, if and when you do matriculate at a medical school, you'll rarely hear the word used more often than in this context. The notable exception to this rule is, of course, West Virginia, but that's just more proof of just how incest-filled med school truly is. However, you'll quickly find out why this word is so frequently used once you get there: like moths to a flame, med students cannot keep their hands off of one another. You will find that medical students pair off quickly and, often, indiscriminately, so it's important to know how to take advantage of this situation (if you desire to do so).

The reasons that medical students fall into the same patterns time and time again are quite simple to understand, when viewed in the proper context. First and foremost, medical students simply don't have many opportunities to go out and socialize with non-med students. This is mostly a consequence of the extreme amount of work they're faced with; time that used to be spent meeting other people now gets taken up studying neural pathways, memorizing cardiac arrhythmias, and learning the mechanisms of action of various neurotransmitters. Simply put, medical students need an outlet. Most of them are young and hormonal, and if they don't have access to people of their choosing, then they will make do with whatever they're given.

However, while much of this behavior can be described as natural, just as much of it is a consequence of sheer stupidity. You'll find that medical students are so desperate to be with someone that they will date people who are completely wrong for them. For example, the following scenario is not uncommon:

You're out one night with a bunch of your friends from medical school who you haven't seen in a while, possibly at a dinner for one of their birthdays. You're making casual talk with them when suddenly you notice that two of your friends are acting more than a little friendly towards one another. At first, you try to remember if the two of them were dating, and you realize that this is a new development. You start recalling your experiences with each of them individually, and you come to the conclusion that these two people are not in any way, shape, or form complimentary to each other. Your mind will struggle to reconcile that knowledge with the information that they are, in fact, dating, and eventually you'll just stop thinking about it because it was never that important in the first place.

When you get to medical school, you will undoubtedly be attracted to someone in your medical class, and will be inclined to date them. It would be unbecoming of me to tell you what to do, but just remember: don't do it. The pros and cons of dating within your class include:

Pros:

• Easy access: It's very easy to meet and spend time with people in your medical class. There are always things going on - house parties, tailgates, holiday parties, etc.
• Quick-forming, intense relationships: One consequence of medical school being so compact and intense is that the students become incredibly close as a result. This same closeness that is found in friendships will also be found in romantic relationships (which, if handled properly, can be a very, very good thing, wink wink nudge nudge).

Cons:

• Too much access: You literally cannot get away from the person. For at least the first two years, you and the person you'll be dating will have almost the exact same schedule, which is suffocating for even the most dependent of individuals.
• Too little privacy: Because medical school class sizes are so small, news travels fast. If something happens in your relationship, you can be sure that most everyone will know about it before you do.
• Messy breakups: It is well known that medical school is like high school - people form cliques, and if you and your significant other break up, people will take sides. The best thing to do in this situation is to get everyone on your side, quickly.
  
  

#25: Parents

If you're considering entering medical school, it's important for you to determine a strategy for dealing with your parents. Simply put, parents seem to have missed the memo letting everyone know that medical school is "challenging"; there is no other way to explain why they are so consistently unsympathetic to their children's needs and struggles. ("Challenging" is the euphemism of choice these days; initially, medical school administrations wanted to use more accurate language, but exhaustive research determined that using words like "pathologically depressing," "psychosis-inducing," and "hell" would not be the most profitable marketing strategy.)

Most people would agree that since medical school prepares you for an occupation in which you will be dealing with life and death on a daily basis, it's important that you take it seriously and approach it with your full, undivided attention. However, this kind of logic is lost on parents. Parents are fragile, emotional creatures who have their own human neuroses and agendas through which they will aggravate you.

Perhaps your parents desperately want you to get your medical degree so they can tell all your relatives about how smart their branch of the family is. Or maybe they've recently developed an anxiety disorder, and can no longer go more than 15 minutes without calling to guilt trip you into making plans to come home. Or, perhaps your parents are partially supporting your way through school, and have become obsessed with making sure their money is being spent wisely.

Those of you with one or both parents as medical doctors may be under the impression that your parents will be more supportive of you than a non-doctor parent would be, seeing as how they once had to go through the same "challenging" educational process as you. However, science has shown that parents who are doctors are actually less likely to be sympathetic to their children's issues once they enter medical school. The reasons for this are not completely understood, although research is continually being done on the subject. Some studies have shown that doctors have been so completely beat down by the medical establishment that they spend most of their free time feeling sorry for themselves; they have no empathy left to expend on their children. Other studies indicate that perhaps there is a correlation between succeeding in medical school and having terrible parenting skills. Nevertheless, the fact remains that children of doctors who are thinking of entering medical school need to be prepared for especially callous behavior on the part of their parents.

Regardless of what your situation is, you need to have a game plan for relieving your parents' tension. Otherwise, you could be looking at four years of near-constant arguments and drama, which is fun on Gossip Girl but frustrating in real life. A few strategies that have proven effective in the past include:

• Ignoring them and dealing exclusively with your more wealthy and understanding relatives: while there are many benefits to this course of action, the most overlooked one is that it enables you to surreptitiously keep tabs on your parents to know what they're up to.
• Complaining about your siblings in order to distract them: this can be a useful maneuver if you find yourself dangerously close to an impending argument.
• Appeasing them through ritual animal sacrifice: note that this may not work if your parents adhere to a monotheistic religion.
• Moving away and changing your name without telling them: the disadvantage to this is that you won't see your parents for at least four years, but the advantage is that you won't see your parents for at least four years.
  
  

#24: The cost of tuition

While most pre-med students can tell you that getting a medical education will be "expensive," they have no real understanding of the magnitude that the word "expensive" actually implies. However, they can tell you that medical school will be expensive because "everyone says that it is." In this sense, they are slightly more evolved than parrots, able to regurgitate key phrases to their superiors in exchange for a few month-old saltines and a bit of yarn (a skill that will be most useful in medical school).

Simply put, most pre-med students have no standard against which to realistically compare the cost of a medical education. On a day-to-day basis, they are concerned with the price of a can of Campbell's condensed tomato soup ($1.65), which isn't really comparable to the cost of four years of tuition at a private medical school ($139,000).

(For those of you playing along at home, the amount of money you would spend on tuition payments for four years of medical school would buy you 84,242 cans of Campbell's condensed soup.)

Making sense of tuition costs is irritating. Tuition costs vary greatly from school to school; there is no standard tuition that all medical schools adhere to. However, many medical schools with similar characteristics can be grouped together, so that general trends emerge. For example, a private medical school will charge around the same amount to all students (regardless of state residency), while a public medical school will charge in-state students massively less than non-residents for attending their school. For completion's sake, here are some figures:

• Average cost of a year of tuition at a public medical school (in-state student): $16,690
• Average cost of a year of tuition at a public medical school (non-resident): $34,900
• Average cost of a year of tuition at a private medical school: $34,749

Of course, these are just generalizations. Medical schools reserve the right to do what they want, so they can buck these trends as they see fit. For example, the University of Colorado (a no-name public medical school) charged non-residents $75,700 for a single year of tuition!

Please notice that these figures do not include anything outside of the base tuition cost. Books, school fees, living costs, prescription drugs, non-prescription drugs, illegal drugs, and health insurance all have associated costs that are entirely separate from the cost of tuition, so having enough money to cover all of those expenses is also important.

All of this has the added benefit of adding another layer of complication onto your decision about which medical school to attend.

However, there are a few things you can do to help lower the cost of tuition:

• Be a minority: Many medical schools have scholarships set aside specifically for minority students, so by fulfilling the criteria for these scholarships, you can make life much, much easier for yourself.
• Have a recently-deceased relative: Medical schools need a certain amount of bodies for dissections for the first year students, and every year, they scramble to meet the number that they need. Medical schools may be flexible in offering some sort of compensation for an anatomical donation. (Note: do not actually do this.)
• Have rich parents: This one is self-explanatory.

Most students, however, will need to take out loans in order to cover the cost of tuition for medical school. If this is you, remember that most doctors make very large sums of cash upon exiting medical school (not including those who go into family medicine), so this mortgaging of your present against your probable future income will generally work out in the end.

#23: Obstinacy

Medical students are one of the most brash and opinionated group of people you will ever meet, probably second only to full-fledged doctors. They love sharing their opinions on anything and everything, even if you don't want to hear them. Especially if you don't want to hear them. And especially if you don't care. If you ever watch a television show with a med student, prepare to have every plot, information, and wardrobe inconsistency identified and dissected at the level of a graduate-degree thesis (complete with bullshit theorizing). The importance of this obstinacy as a survival mechanism cannot be overstated, as it has served them well in their previous 20-plus years of life; pre-med classes are not easy, and this obstinacy is often the only thing driving these students to do well in their classes.

A common misconception is that the majority of medical students are obstinate, which is simply not the case. The reality is that the majority of successful medical students are obstinate (while the rest are cheaters). This is because the more obstinate medical students don't have silly things like guilt and morality nagging at them when they make a mistake or hurt a classmate's feelings, and without these psychological hindrances, they are free to to keep moving forward even when they royally screw things up.

There are a few things med students are especially obstinate about, including liberalism. If you are thinking of going into medical school and you hold any conservative viewpoints at all (e.g., that abortion is wrong), you should prepare to have these views mocked without mercy, especially if you go to a top ranked medical school.

Usually this obstinacy will not cause you too much of a problem, as you will quickly learn to avoid these people in your social circles. However, your classmates' obstinacy can become an issue in small group settings, as you will be forced to sit in the same room with other med students for two hours at a time, with everyone being "encouraged" to share their views on random different inane topics. In order to survive in this setting, always remember that there truly is no one "right" viewpoint, no matter what that annoying bitch says or how loudly she says it. The quieter you are and the more you let things slide, the easier it will be to pack up your things and walk out the door when the small group session is over.

#22: Tests

The entire profession of medicine is obsessed with tests. This is unlike most other professions, which have the common sense of realizing that after an individual makes a certain amount of progress in the field, the job becomes less about bullshit basic knowledge and more about specialized knowledge and people skills. It is true that most professions have qualifying exams of some sort, such as the bar examination for lawyers. However, only medicine forces their practitioners to continually retake exams for the entire working life of a given person, even years after the person has received their medical degree. (As you might expect, masochists tend to do extremely well in this system.)

This process of continuous testing starts with the SAT in high school and continues with the MCAT in college. Many students freak out over these two exams, but in reality, these tests are jokes compared to what you'll have to deal with in medical school and beyond. During the first year of medical school, you can expect to have a quiz or exam every single week. (If you are in a systems-based teaching school, you can also expect to have anatomy lab practicals that coincide with the final exam for each sequence.) Thankfully, second year is a little less vicious in terms of exam frequency. At the end of the second year, all medical students are required to take a massive exam called the USMLE Step 1, which is a comprehensive test of the entirety of the previous two years. The USMLE Step 2 and Step 3 come later on, as well as national shelf exams all through the third and fourth years. However, don't think that the testing stops once you graduate from medical school; board recertification exams must be retaken every seven to ten years!

Ostensibly, this incessant testing occurs for the sake of patient safety. If you force people to refresh their knowledge base in order to pass a recertification exam, you might expect them take better care of their patients by drawing upon that knowledge base later on. The only problem with this sort of thinking is that seven to ten years is more than enough time in which to forget all the stupid minutia that you get tested on. The real test of whether or not a doctor is competent is whether or not they do a good job of managing their patients illnesses on a day-to-day basis, including taking it upon themselves to keep up with emerging trends in medicine. One would imagine that such a doctor would also be able to pass a board certification exam, but apparently it is too much to ask to have the exams be a replica of what doctors actually do on a daily basis. It makes much more sense to ask them to partake in an unnatural, non-intuitive process that tests them on knowledge that is marginally relevant to their ability as a clinician.

If you are considering going into medicine, you should come to terms with the fact that the best years of your life will be spent memorizing and regurgitating vast quantities of information (unless you decide to take some time off before going into medical school). You will basically be a glorified parrot, and your position could be better filled by any kind of PDA. The first point is even more true if you are female, as the longer you wait to have children, the more your uterus will shrink down to nothingness.

#21: Pass-fail grading

Many schools are moving towards a strict pass-fail grading for part or all of the lecture years of medical school, which means that your actual numerical percentage for each sequence is never seen by anyone, and can therefore never count for any kind of future job placement. This is the only criteria worth taking into account when deciding on which medical school to attend. The medical school curriculum is taught at a breakneck speed, and pass-fail grading is the only thing that will allow you to stop backstabbing your classmates and appreciate the material instead. That kid who can't shut up about the research he's doing, your annoying anatomy lab partner, and you (who stays in bed past 1 p.m. every day) are all on the same page for as long as pass-fail grading lasts. Go ahead, take that breather. For once, you're not falling behind.

While medical school will bombard your brain with a ridiculous amount of information, pass-fail grading will remind you that being able to guess 75% of the correct answers on the test is good enough to be a doctor. Since no one will ever see your scores, you might as well use the least amount of effort possible to get through the lecture years, and save that energy for improving your golf game or something.

The only downside to pass-fail grading is that medical schools are starting to use it as an excuse to not improve their curriculum. Why worry about how hard you're pushing your students, how badly classes and events are scheduled, and how poorly information is distributed, when instead you can just say that they should be able to deal with it because everything is pass-fail? Although the giving up of a competent administration for a pass-fail curriculum is more than a fair trade, it would be nice if such a trade never had to be made in the first place.