I'm in the self-imposed jet lag that is the day before a night shift after time off. I stayed awake late last night, slept late this morning to the consternation of the household, and I plan to nap this PM. I work from 10 PM to 8 AM for the next 2 nights, then 1 AM to 8 AM for the next two nights. Repeat out for 7 night shifts in a row. Then 4 day shifts and off to South Africa.
The 6 first-year on-call interns admit from 1 PM to 1 AM, then there are three 2nd or 3rd year "float" residents (2 night and 1 day floats -- called NATO and DATO by our program) who cover the admissions from 1 AM to 1 PM. This can be a very, very busy shift and people generally hate it. Where you may take 5 fresh admits in 12 hours as an intern, you may take 5 fresh admits in 6 hours as NATO. One night float gets there early (10 PM) to serve as a modicum of backup for interns who are there alone and may need help with procedures or other stuff. The night floats admit to 7 AM and then signs out their patients to the interns; day float admits from 7 AM to 1 PM.
I'm not looking forward to it. First, there is the issue with switching my schedule around, which I am kind of used to. Second, it absolutely wreaks havoc with me helping out around the house at all. The kids wake up 6-7 AM, and need to get ready for school at 9 AM. They will be leaving the house a few minutes before the earliest possible time I can get home. I'll sleep sometime in mid-day, and I never sleep effectively so I end up sleeping too much during the day. Say 11 AM to 5 to 7 PM. Kids get picked up between 3 and 5 PM so I'm useless for helping with pickup duties as well. Then they are home right as I am getting up, so I'm all groggy and useless with making dinner or cleaning or playing with them.
The third reason it stinks is it is can be extremely busy, with no good time to do good workups, you just hope to admit and to stabilize patients as fast as humanly possible. You then dump them off as fast as possible to the post-post-call interns who hate NATO admissions. It's a great way to ruin your reputation as a thoughtful and complete senior supervisor to these interns. As a senior resident, you carefully supervise and critique their admissions. You review the presentation yourself, spend lots of time carefully examining and questioning the patient yourself, reviewing the literature, and then discussing it carefully with the attending and consultants. It's easy to accept the intern's adoring gazes on you as the Role Model Doctor. That all goes to hell as NATO, when you shovel a hastily thrown together pile of crap right on their head, worse than any admission that they ever would dare to bring to your god-like visage when you were running the team last month...
Showing posts with label medical rant. Show all posts
Showing posts with label medical rant. Show all posts
Saturday, February 28, 2009
Wednesday, February 25, 2009
Medical licensure
They make it surprisingly difficult to get a license to practice medicine. I wonder why.
In my residency program, I am protected by an institutional license to practice medicine. When I move to California, I think I can still use the institutional license but they encourage you to get your own. This also allows you to moonlight.
Last week, I started looking into the process. It became immediately apparent that This Was No Joke. "Allow up to 6 months to get a license." California gives a 10 year window for first applying for a license from the date of your first USMLE (licensing) exam. Mine was....August 1999. Extra documentation and possibly an extra exam may be required if it is longer.
Well, I guess I better get started.
Web application then fill-in PDF application took a few hours to do.
$1330 paid online. You know that is going towards the salaries of the best bureaucracy money can buy, finely trained in the art of rifling through a stack of documents and finding incorrectly filled out spaces and missing forms. Then, printing, collation, pasting (not taping) a photograph (not scanned or otherwise modified and Polaroids not acceptable), then notarization of said forms. Web form and $50 for USMLE transcripts. Forms submitted to the medical school for official diploma and transcript. Forms submitted to the hospital for certification of training, along with hospital seal and notarization. Forms submitted to fellowship to attest to enrollment in training program. Cover letters for all of the above. And everything got mailed off at the beginning of the week.
One last thing to take care of. California requires background checks from the FBI and the state. So I contacted the webmaster to send me fingerprint forms, which I got three days ago. Two days ago, I romped around Baltimore to figure out who could roll some prints. Eventually, I found out that not 3 miles from my house there exists a specific Baltimore City office to do just that.
Unsurprisingly, there are a lot of people in Baltimore who require background checks and fingerprinting. The first time I went to the office, there was a line of an interesting pie-slice of humanity out of the door of the office. That line was just a line to the clerk. After waiting in that line, one had to wait to get fingerprinted. I'd estimate about 100 people waiting, so seeing I had to get the kids in an hour, I left. I went back this morning. I got there nice and early to beat the crowds, only had to wait 1.5 hours (I was 9th in line), paid my $20, and got my fingerprints rolled. Mailed them off this afternoon.
It is a good thing because pretty much starting Saturday, I have solid work until June save the 2 weeks of vacation for the Big Trip. Let's see what parts have to be repeated after the world-class bureaucracy gets their mitts on my application.
In my residency program, I am protected by an institutional license to practice medicine. When I move to California, I think I can still use the institutional license but they encourage you to get your own. This also allows you to moonlight.
Last week, I started looking into the process. It became immediately apparent that This Was No Joke. "Allow up to 6 months to get a license." California gives a 10 year window for first applying for a license from the date of your first USMLE (licensing) exam. Mine was....August 1999. Extra documentation and possibly an extra exam may be required if it is longer.
Well, I guess I better get started.
Web application then fill-in PDF application took a few hours to do.
$1330 paid online. You know that is going towards the salaries of the best bureaucracy money can buy, finely trained in the art of rifling through a stack of documents and finding incorrectly filled out spaces and missing forms. Then, printing, collation, pasting (not taping) a photograph (not scanned or otherwise modified and Polaroids not acceptable), then notarization of said forms. Web form and $50 for USMLE transcripts. Forms submitted to the medical school for official diploma and transcript. Forms submitted to the hospital for certification of training, along with hospital seal and notarization. Forms submitted to fellowship to attest to enrollment in training program. Cover letters for all of the above. And everything got mailed off at the beginning of the week.
One last thing to take care of. California requires background checks from the FBI and the state. So I contacted the webmaster to send me fingerprint forms, which I got three days ago. Two days ago, I romped around Baltimore to figure out who could roll some prints. Eventually, I found out that not 3 miles from my house there exists a specific Baltimore City office to do just that.
Unsurprisingly, there are a lot of people in Baltimore who require background checks and fingerprinting. The first time I went to the office, there was a line of an interesting pie-slice of humanity out of the door of the office. That line was just a line to the clerk. After waiting in that line, one had to wait to get fingerprinted. I'd estimate about 100 people waiting, so seeing I had to get the kids in an hour, I left. I went back this morning. I got there nice and early to beat the crowds, only had to wait 1.5 hours (I was 9th in line), paid my $20, and got my fingerprints rolled. Mailed them off this afternoon.
It is a good thing because pretty much starting Saturday, I have solid work until June save the 2 weeks of vacation for the Big Trip. Let's see what parts have to be repeated after the world-class bureaucracy gets their mitts on my application.
Sunday, February 22, 2009
Life insurance
Because I have 3 children (that I know about) and some time off, I figured there was no time like the present to take care of grown-up stuff that I've been avoiding to this time. So I called our car/rental insurance dude and asked him about life insurance.
After usual formalities, he had only one question for me -- "Do you have an exercise program?" Nothing about smoking, or family history, or smoke detectors in the house, or seat belts while driving, or my hobby of fighting bulls with chainsaws glued to their horns.
Of course with my (normally) 60-80 hr a week job, 3 kids, and aforementioned toreador duties, I don't have an exercise program. I barely have a seeing-the-kids program many months. I walk the stairs at work (I work on the 4th floor and we often have patients on the 8th), I am on my feet most of the day, and of course I try to at least roll around with the kids a little.
The question struck me as a little weird. Not because I completely doubt exercise -- it has proven benefit in preventing prediabetes turning into diabetes, also bunches of stuff on it improving COPD, heart disease, obesity, osteoporosis, yada yada yada. But it got me thinking about the science of exercise in someone like me -- mid 30s, no comorbidities, not overweight, last I checked not hyperlipidemic or hypertensive.
It proves there is not much out there. I spent a few hours flipping through the PubMed results for different searches in which I was specifically looking for outcomes. As you can imagine, most searches bring back several thousand articles, so I narrowed in to review articles. This absence of evidence is unsurprising, as a study to look for adverse outcomes on healthy adults would have to be enormous in order to show any sort of effect (because events are rare). As always, absence of evidence is not evidence of absence. The interesting thing, though, was a number of papers (for example here that I found that support really moderate physical activity (30 minutes of walking a day and it doesn't matter if it's at work, plus a bit of resistance training) in healthy people. More activity, in some studies, is associated with negative outcomes.
This makes physiologic sense. Among the only things that have prolonged lifespan in animal models are reduced caloric intake. The metabolic process itself generates bad things, like the over-hyped "free radicals", which contribute to disease and aging. It doesn't make sense to overeat and then to try to burn it off in the gym because you are just causing metabolism to go into overdrive.
In short, I think I'll have to incorporate some resistive exercise and increase my walking, probably to stave off hypertension, hyperlipidemia, and frailty. Also to keep myself from becoming overweight, which is expected as metabolism normally slows down with age. But it's far from clear that a regular exercise program beyond the very mild recommendations does anything to promote health or survival in a healthy age group, and I don't see why it's the first question from a life insurer.
After usual formalities, he had only one question for me -- "Do you have an exercise program?" Nothing about smoking, or family history, or smoke detectors in the house, or seat belts while driving, or my hobby of fighting bulls with chainsaws glued to their horns.
Of course with my (normally) 60-80 hr a week job, 3 kids, and aforementioned toreador duties, I don't have an exercise program. I barely have a seeing-the-kids program many months. I walk the stairs at work (I work on the 4th floor and we often have patients on the 8th), I am on my feet most of the day, and of course I try to at least roll around with the kids a little.
The question struck me as a little weird. Not because I completely doubt exercise -- it has proven benefit in preventing prediabetes turning into diabetes, also bunches of stuff on it improving COPD, heart disease, obesity, osteoporosis, yada yada yada. But it got me thinking about the science of exercise in someone like me -- mid 30s, no comorbidities, not overweight, last I checked not hyperlipidemic or hypertensive.
It proves there is not much out there. I spent a few hours flipping through the PubMed results for different searches in which I was specifically looking for outcomes. As you can imagine, most searches bring back several thousand articles, so I narrowed in to review articles. This absence of evidence is unsurprising, as a study to look for adverse outcomes on healthy adults would have to be enormous in order to show any sort of effect (because events are rare). As always, absence of evidence is not evidence of absence. The interesting thing, though, was a number of papers (for example here that I found that support really moderate physical activity (30 minutes of walking a day and it doesn't matter if it's at work, plus a bit of resistance training) in healthy people. More activity, in some studies, is associated with negative outcomes.
This makes physiologic sense. Among the only things that have prolonged lifespan in animal models are reduced caloric intake. The metabolic process itself generates bad things, like the over-hyped "free radicals", which contribute to disease and aging. It doesn't make sense to overeat and then to try to burn it off in the gym because you are just causing metabolism to go into overdrive.
In short, I think I'll have to incorporate some resistive exercise and increase my walking, probably to stave off hypertension, hyperlipidemia, and frailty. Also to keep myself from becoming overweight, which is expected as metabolism normally slows down with age. But it's far from clear that a regular exercise program beyond the very mild recommendations does anything to promote health or survival in a healthy age group, and I don't see why it's the first question from a life insurer.
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