Second Look

Here is the video my amazing and talented classmates made for our Second Look Weekend (when all the accepted students visit to decide if they want to come)!

Happy Easter!

I may be studying for a psych exam on Easter, but I just read that a sunny mood helps in memorizing data and solving problems. I'm so glad it's a sunny spring day in Baltimore so that I can quickly memorize these facts about intelligence and IQ, anesthesia and consciousness, bipolar disorder, major depression, personality disorder, schizophrenia, and so on. Then I can go play sand volleyball and have a nice Easter dinner with the Bmore crew :)

Sleep

Here's the deal: you need 8 hours. The body's sleep "cycle" is controlled by two things

1) Homeostasis - your body wants to be sleeping 1/3 of the day (8 hours) (Theoretically, it doesn't matter when you get those 8 hours... you can sleep for an hour, be up for 2 hours, go to sleep for an hour, be up for 2, sleep for 1, etc. But that's not actually how it works because of the other control system

2) Circadian rhythms - your body had "alertness" impulses that are at their lowest during the hours of 10 pm - 9am. This is controlled mostly by input to the brain in the form of a hormone called melatonin and the external cue of light.

Basically, your eyes have rods and cones to see things, but they also have retinal gangion cells that receive light only for the purpose of telling your brain what time of day it is. Then your body and mind know when to be awake and when to sleep.

If you're like me and have trouble sleeping here's the take home message: get plenty of light during the daytime/productivity time of 7 or 8 am until about 9 or 10 pm (yes, hard to do while in a dark lecture hall for a good portion of the day). Then turn off the lights (and bright computer screens that your eyes mistake for daylight) and go to bed. Be consistent with this. Sweet dreams!

Spring Break!

After my hematology/oncology (blood/cancer) exam a few Fridays ago, Matt and I took off for South Carolina to visit my best friend Kristen and her boyfriend! The 9 hour drive was mostly uneventful, but it was nice to not have anything to think about for a week. (I did have a summer research project proposal, a case write up and a scholarship application to complete over spring break, but I fit those things in here and there. No big deal.)

Kristen bought all the ingredients to make a Lebanese feast! We made tabbouleh, kibbeh, and hummus, and bought delicious pita bread and grape leaves. Amazing. We also went mini-golfing, to a honky-tonk bar (mostly to listen to the band and people watch) and enjoyed the company of two great friends! (Kristen - we LOVE your boy! He has such a great sense of humor, he's thoughtful and fun, and he likes to play trivial pursuit. He's a keeper!)

On the way back to Baltimore we stopped for a night in Chapel Hill, NC to check out the real estate. Seriously. We went into realtors offices and had them highlight neighborhoods that we might like in Chapel Hill, Cary, Durham, and Raleigh. I really love driving around with Matt planning our next move in life - and it makes me so happy that we are on the same page about these kinds of things. :)

The final weekend of spring break was spent babysitting our niece, Jules, and carpooling with Bridget and Mike (and Jules and Tucker) to Olean for Mal's birthday. I love being back in Olean with the whole family just as much as my parent's love having us all back under one roof! What a relaxing and much needed break.

Neuroanatomy

This is step one in our lab for tomorrow. Click on the image to see it better.

What do you think?

Our clinical curriculum has focused on teaching us the skill of communicating with our patients, of making eye contact, reading body language and leaving space for the patient to talk. After practicing these things in the simulation center with standardized patients, I was feeling pretty comfortable stepping into my longitudinal clerkship placement with an ob/gyn. Then I realized that the real world doesn’t always work like the sim center – the real world requires using computers with electronic medical records. Of course this has MANY advantages... but one huge disadvantage is how computers change the way we communicate with patients.

Dr. R. is a great clinician. His patients trust him, confide in him, ask questions, raise concerns and talk to him honestly. Unfortunately, patients are talking to his back about 50% of the time while he reads ultrasound reports, updates the record, writes orders, electronically submits a prescription to the patient’s favorite pharmacy, or writes a note for the patient’s employer. Truthfully, I understand that it’s much more efficient to do the “paperwork” while sitting with the patient – but I’m frustrated that in exchange for saving time and being efficient, Dr. R. must compromise his communication and relationship building opportunities. There have been a few times when I have seen the patient’s body language or facial expression from where I stand and it has been clear that Dr. R. did not understand their question or did not recognize a patient’s hesitation or unease.

One of the main reasons for this situation is the set up of the exam rooms; the computer is on the counter and faces the wall. There has been talk about this problem being solved with tablet computers or iPads, and I hope this will be the case soon. The other factor is that Dr. R. likes to spend time with his patients in the exam room instead of splitting the patient’s scheduled time with time at his computer. One of Dr. R.’s colleagues doesn’t actually touch the computer while in the exam room with her patient. But she remains efficient by spending less time with her patients and stops at the workstation between patients to update the electronic medical record and sign orders.

It’s tough to say which option allows the most “face-time” with the patient. I would like my patient to know that I’m listening to them and to be able to talk face-to-face the entire time. I also want to be able to read my patient’s body language and observe their symptoms and signs of illness. This would likely inhibit me from using the computer to get the “paperwork” done efficiently and effectively, but would also require I leave the patient room before their appointment is over so that I can take care of the paperwork before seeing the next patient.

I'd really like to know what some readers think about this situation in their doctor's office. Does your doctor turn his or her back to you while typing on the computer? How does this make you feel? Would you rather your doctor use the computer while in the room with you so that you know the records are being updated with the correct information? What should I strive for as far as communicating with patients?

Match Day!

Thursday, March 17th was MATCH DAY! The balloon rainbow stretched two stories high and there were pots of gold coins with the secret to where the 4th years matched for residency at the end. At noon the class of 2011 opened their gold coins together and realized that they were finally going to be a surgeon, a pediatrician, or a radiation oncologist.

Even though I only know one 4th year student, it was honestly quite emotional seeing the happiness on the faces of the students, their spouses or parents, advisors, deans, lecturers and mentors. 3 years to go...