Eating Chocolate and other lessons from the ABIM Forum

Every year, the ABIM Foundation convenes a set of thought leaders on American health care to answer the tough questions.   At first glance, this year’s meeting  had the same standard agenda –  talks and discussions followed by networking and informal activities. However, for some reason, this Forum was more exhausting. Perhaps trying to solve the nation’s vexing problems facing health care is fatiguing! So, what were some of the themes that we came away with? • Intrinsic motivation is powerful, so can we create it? We heard about the potential dangers of extrinsic motivation through financial reward. Pay-for-performance, after all, is a tool that is only as good as the system is designed, and many designs have not been very effective. I was reminded of an unusual medical education experiment when they started paying residents in pediatrics on a fee-for-service model (yes, residents). The residents saw more patients, and their outcomes even improved with fewer ER visits! But, closer inspection yielded that these residents stacked their clinics with well child visits, who were healthier and did not need to visit the ER. So fee-for-service residency was abandoned. While everyone agreed it was time to move away from fee-for-service medicine, do we really think a change in the payment system creates intrinsic motivation? One health system offered their solution: recruit those that are intrinsically motivated. But, that still leaves us with how does one become intrinsically motivated? The...

Just Call Me Doctor

Every once in a while, a nurse or patient mistakenly calls me doctor and I giggle. Me? A doctor?  Did I really look authoritative or seem to know what I was doing? You mean those poised people in long white coats, who have the ability to reassure with a few sentences, and have seemingly boundless, wiki-level knowledge in their brains? Surely it’s obvious that I’m just a bottom of the totem pole, work 60 hours a week for free med student. Recently, though, it’s beginning to sink in that in less than a year, I really will be a doctor I remember the first few weeks of MS1, mainly just shadowing my preceptor in the continuity clinic. Then, I was figuring out how to address patients or how to drape them properly, and thinking to myself, man I’ll never know as much as Dr. R.  She had only been out of residency for about half a decade, but I couldn’t imagine a time when she was any less composed or knowledgeable than the physician I knew. She was able to relate to patients so well, immediately knew the answers to questions they asked her, and even when she didn’t, was able to reply confidently and in such a manner that they were satisfied with anything she said. I understood that I was still a little baby stem cell in the infancy...

Gut Microbe Gene Sequencing May Provide Future Therapies

Larry Smarr, Founding Director, CALIT2, examines the 90% of cells in the body that aren’t human, most of which reside in the large intestine. A recent study used metagenomic sequencing of DNA from stool samples to identify the myriad species of microbes in the gut. He advises doctors to view gut microbes not as an enemy, but as an ecological garden. Read more about Larry Smarr. Filmed at FutureMed, in February 2013, at Singularity...

The 5 Stages of Med School Interview Grief

1. Denial No. No, that did not just happen. Did I really just say my biggest inspiration in life was Carly Rae Jepsen? No; and I also couldn’t possibly have said that my biggest career goal was to “get rich or die tryin’.” No one in their right mind would say these horrible things during a med school interview. He couldn’t have noticed how much I was sweating, could he? Oh god, but he shook my hand… he must have felt how disgustingly sweaty my palms were. Christ, that must have been like shaking hands with an armpit. When he asked what my biggest flaw was, I’m pretty sure I said, “Booze… jk!” I actually said “jk” out loud, didn’t I? Did I fart? I think I farted. I think I blacked out in there. No, no. There was no med school interview. What interview? 2. Anger Then again, it might have gone a little better if the interviewer hadn’t been such an jerk. “Oh, look at me. I interview and my shirts sleeves aren’t too short for my arms, like this stupid beady-eyed guy I’m interviewing! I’m so cool!” Well, excuse me! Sorry I couldn’t think of a time where I worked as part of a team to solve a problem like you wanted me to. I guess I’m not even good enough for an entry-level job licking...

This Short Video Will Change the Way You Look at Healthcare… and Low Budget Commercials

ZDoggMD wanted to make a commercial for Turntable Health. But then, he looked at his budget. Turntable Health is a a membership-based primary care and wellness ecosystem focused on everything that keeps patients healthy. It’s a really terrific idea, springboarded by the efforts of ZDoggMD in downtown Las Vegas and definitely worth checking...

How I’ve Handled Life as an MD/PhD Candidate

As Voltaire said, “Uncertainty is an uncomfortable position,” and the transition to medical school or grad school (or both!) often comes with much uncertainty. For many of us, we move away from home, leaving loved ones and everything that we’ve known. If you’re like me, you went to college close to home so the transition wasn’t too bad. So this is really the first time on your own and this is the first time you’ve felt such a massive shift in your life. At the same time that we move away and start our new adventure, our undergrad friends get real jobs and start to figure out their lives in our absence. While we struggled to get into school before they started their job search, now they are the ones trying to figure things out while we are set for the next 4+ years or 8+ years for MD/PhD students – I like to call it “putting off getting a real job.” As we go in different directions with our lives, it can be hard to handle. But this is not our first rodeo. The same thing happened when we began college as we left our high school friends behind. We made new awesome friends who perhaps shared a major, career interest, extracurricular interest (for me, most of my friends were made through the marching band), or love of alcohol and...

FOAM: It’s Not Just the Frothy Stuff at the Top of Your Beer

As a medical student in the 21st century, it’s highly unlikely you go to the library for anything other than the peace and quiet the environment affords you and to be surrounded by your studious cohort in an effort to motivate histology studying. We live in the age of the internet. We’re mobile, on the go. Why peruse the articles on the dusty shelves when you can download a PDF from Pubmed, sipping on an Americano from Hipster Coffee Co.? Why attend lectures in business casual garb at 7:00 am when you can podcast, eating cheerios in bed in your sweatpants in the afternoon? Plus, with the information age and the rapid turnover of data, what you read in a book can become outdated almost as soon as you pick it up. Enter FOAM – Free Open Access Medical education. So, what is FOAM? Legend has it, the founder of the acronym and editor of Life In the Fast Lane, Dr. Mike Cadogan, was at a pub in Dublin when the inspiration came to him in the form of an almost empty glass of Guinness. FOAM is a constantly-updated, ever-expanding online repository of free, electronic resources for medical education. It’s a Facebook page, piquing your interest in updated diagnostic guidelines for subarachoid hemorrhage, as you idly scroll through your feed and gaze at pictures of toddlers at piano recitals....

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