One of my medical school instructors calls tanning beds “cancer beds.” I thought this cartoon was a great representation of that.When MJ and I were driving across the country, we were struck by the number of tanning salons that we spotted out in the middle of nowhere areas. In the states of Montana and Wyoming, they dotted the highways, sometimes as the only building off the road. It was strange to say the least.

Plus, sun tanning beds don’t even help you make Vitamin D (a vitamin normally made in our skin when exposed to sun). Tanning beds use UVB rays, rather than Vitamin D encouraging UVA rays from the real sun. And frankly, so much of our food (milk, cereal, etc.) contains Vitamin D, so you really shouldn’t use it as an excuse to get some rays.  A better option is getting a spray tan. I have my reservations about dying skin, but cancer prevention wise, it’s a much better choice.

Or just rock your alabaster skin like me. (I’m quite ghostly.)

Skin cancer is the most common for of cancer in the United States. According to the American Cancer Society, there are over 68,000 new cases of skin cancer per year and over 8,600 deaths per year. I have several friends who have had to have cancerous growths removed already. These mid-20s to early-30s friends are now paying for high school summers spent in the glorious sun…It’s not any fun.

Remember to:

• stay in the shade
• cover your skin with clothing
• wear a hat
• wear sun glasses – they protect the sensitive skin around the eyes and protect your eyes from corneal damage. This is extra important for light eyed people.
• wear your sunscreen (minimum 15 SPF)! Don’t forget to lather the tops of your ears, your forehead, back of your neck,  and your nose. I am so happy that so many cosmetics now contain sunscreen – it’s making it a lot easier to protect my skin these days.

There are only 5 days remaining in my third year of medical school. I don’t know where the time has gone. While preparing for my final exam in pediatrics, I’ve also been a bit overwhelmed by the responsibilities that lie ahead. My fourth year schedule is a bit up in the air right now as I shuffle various electives to try to solidify the “strategy” behind my schedule. I find that there are not enough months in the fourth year to do all of the electives that I want to do. Fourth year is generally seen as a fun and relatively relaxed year (especially the second half when residency applications are submitted and interviews are over). However, as I look ahead, I know that this upcoming year is the last year where I will not be responsible for patient care. I have been providing patient care all year, but not nearly as independently as I will during my intern year. It’s scary to think of that. Also, I continue to struggle with my residency choices. I am sure that I love surgery, but not sure that I am willing to give up the other components in my life to the degree that will likely to necessary. I don’t know where I belong. I want to look back on my choice and say that it was correct, that I would do it all over again. I want to lead a happy, fulfilling life. I don’t want my life to be my work. I want work to be a rewarding part of my life. This is an ongoing conflict in my head. I’m trying to work it out. I’m trying to become centered in myself and in the world around me. I’m doing yoga. I’ve made a serious decision to commit to daily meditation. I’m hoping that these efforts will help me find my path.

Recent Events:

On Friday, I presented my first academic poster. It was on a survey study that my friend and I conducted on healthcare worker decision-making styles (medical students, residents, fellows, attending doctors, nurses, social workers, and Ph.D.s). It went very well and we’re looking forward to writing our manuscript. I think that we have an excellent chance of getting published – which would be awesome. It is so rewarding when work pays off.

Upcoming:

Starting next Thursday, I will be taking my first guitar class at the Old Town School of Folk Music. I essentially taught myself guitar (with the help of a few friends), and I’ve stagnated in my progress. I’m hoping to pick up some new skills and meet some new people. I’m always looking to hang out with non-medical people.

In one week (during my medical school vacation), I have a three day long intensive ethics consultation course. The course actually lasts several weeks, but most of it is online. I’m really looking forward to practicing my consultation skills. I haven’t lead a consultation since before medical school. I’m also excited to hear how other people have been trained – what works for them, what has been troublesome, effective, etc. I think that there are so many ways to do it well and I’m happy to have the opportunity to see more than my limited viewpoint.

If you are looking for ways to access bioethics literature, here are several options that I have found to be useful.

1. Your university/institutional library:
If you are affiliated with a university or other institution that has access to online research tools, then your library will You can search for ethics resources in the same way that you would search for any other resources in Ovid. I usually search for a topic (such as “informed consent” or “access to medicine”) and then also search for “ethics” and map the two together. Most major journals include ethical topics in their scope of interest. Depending on the level of accessibility that your institution provides, you may have full text access to these articles.

Careers in Medicine is a website that my school encourages us to use. I took the Medical Specialty Preference Inventory which helps rank the 6 main specialties.

“Specialty preference scores indicate your overall level of preference for each of 6 medical specialties. Scores of 73 and higher indicate a preference for a specialty with higher scores indicating greater preference. Scores of 69 and lower indicate little preference for a specialty with lower scores indicating lesser preference.”

At least I feel like there is some consistency in terms of what I think I’m interested in and what these surveys indicate.

Surgery-General 74

Obstetrics and Gynecology 49

Internal Medicine 48

Pediatrics 48

Family Medicine 42

Psychiatry 36

This morning I took the Medical Specialty Aptitude Test from Virginia University Medical School. It’s a 130 question test that helps guide you in terms of which specialties might best fit you. It’s open to anyone, so if you are just curious what kind of a doctor you might be if you followed that path, give it a try.

I am actually quite impressed with how close it is to specialties I am currently considering: general surgery and anesthesia (both of which came out in my top 7). Colorectal surgery is a fellowship after general surgery, so those really don’t sit independently. Nuclear medicine is a fellowship after Radiology. Urology is a surgical subspecialty. Dermatology is its own subspecialty, which precludes the need for a 3 year internal medicine residency.

Also impressive is that the bottom choices are also what I consider to be my bottom choices through personal reflection. Psychiatry, neurology, internal medicine and family medicine are all important fields, but I do not fit into them at all.

I am amused by the fact that aerospace medicine (whatever that is) lies so low on the list considering that I am married to an aerospace engineer.

Rank	Specialty	Score
1	colon & rectal surgery	47
2	nuclear med	46
3	urology	45
4	general surgery	45
5	dermatology	44
6	radiation oncology	44
7	anesthesiology	43
8	emergency med	43
9	nephrology	43
10	pathology	43
11	occupational med	42
12	radiology	41
13	thoracic surgery	41
14	obstetrics/gynecology	41
15	gastroenterology	41
16	hematology	40
17	ophthalmology	40
18	plastic surgery	40
19	otolaryngology	39
20	orthopaedic surgery	39
21	pulmonology	39
22	infectious disease	39
23	med oncology	38
24	neurosurgery	37
25	rheumatology	37
26	cardiology	37
27	allergy & immunology	36
28	endocrinology	36
29	preventive med	36
30	pediatrics	36
31	aerospace med	35
32	psychiatry	34
33	neurology	34
34	physical med & rehabilitation	30
35	general internal med	30
36	family practice	29

Current U.S. health care policy prohibits the “dumping” of patients. This means that a hospital cannot refuse to admit a patient based on factors such as insurance coverage so that the patient would need to seek care elsewhere. 

Here’s the quick and dirty:

In the initial article last week, the Chicago Tribune wrote about a child mauled by a pitbull patched up and turned away  by the University of Chicago ER staff. According to the report, his lip was nearly ripped off. He was given a tetanus shot, antibiotics, and told to follow up at Cook County Hospital a week later. The patient’s mom, who works in health care, didn’t buy it and took an hour long bus ride to Cook County that night, where her son was rushed to surgery. 

Response from U of C’s COO and Associate Dean, as well as the Section Chief of Plastic Surgery. They state that the decision to delay surgery was based on sound medical judgement, not based on insurance status. 

The plot thickened today as the nation’s leading group of emergency physicians, American College of Emergency Physicians, responds to the story. 

“Dr. Nick Jouriles, ACEP’S president, criticized the hospital’s Urban Health Initiative, which diverts patients to clinics and hospitals on the South Side. Jouriles said the hospital is trying to “cherry pick” wealthy patients over poor.

‘This is a dangerous precedent that could have catastrophic effects in poor neighborhoods across the country,’ Jouriles said in the ACEP statement, calling on Congress needs to hold hearings about hospital emergency care.”

I am oh so behind on my posts. I have so much to blog about, but have been pretty busy.

What will I be when I grow up? A surgeon? Something else? What cool stuff have I been encountering on the wards?

Hopefully I’ll tell you soon!

Today is the last day of my psychiatry clerkship, as well as my Justice Ethics class.

Due to the… ah hem… inclement weather, our exams were postponed by 2 hours. Fortunately, I only have to drive three miles to school, so I should be able to make it on time. I just want this exam to be over so I can check off the psychaitry box of life.

The rotation was a good experience for what it was. I am so glad that there are angels out there who are driven by that type of medicine. Mental health is a much bigger problem than many people acknowledge. Knowing all that, I know that it is not the field of medicine for me.

I’m so ready for vacation! I don’t go back to school until January 5! I can’t believe how much time we get off. We’re soooooo lucky!

Back in November, my cousin asked me to knit a Christmas stocking for her son [my godson].

I started knitting the day before Thanksgiving and was done by the following Wednesday. It knit up far faster than I thought it would (thank goodness!). I ended up designing it myself, including the tree motif (Ravelry link) from Handknit Holidays Evergreen Gift Bag. I knitted it top down with a short row heel. I think I included too many short rows though because the heel just seems too big. I have been considering sewing it up to be a bit smaller… Maybe that’s overkill.

All that’s left to do is sew the hanging loop to the top of the sock and a bell to the toe. I’m planning to send it off to Iowa on Monday!

[I'll post pictures soon!]

Want to test your STD IQ?  Get the STD Picture.

I was recently posed with a question about recognizing genital herpes. I found the above link on WebMD and found it interesting.  Having a good understanding of sexually transmitted diseases is especially important for anyone who is sexually active, since many STDs can be transmitted even when the partner doesn’t have any clear signs of infection.

For some good information specifically on genital herpes, check out the following links:

Centers for Disease Control Genital Herpes Fact Sheet

WebMD Genital Herpes Health Center