Thursday, December 22, 2005

Preventative Medicine

Today I went out for breakfast. I had just fasted for 14 hours before my cholesterol test, so I thought little reward was in order. And besides which I was fading fast between a whippet like metabolism and no reserves I need an infusion of protein, lipids, and carbohydrates stat. Anyway as I was waiting to be seated I heard some older gentlemen complain about work, that they could be fired next year if they didn't quit smoking, that they no longer had junk food and candy bars in the snack machines, no more fried food in the cafeteria, and how similar things were happening at their kids' school. Actually complain was too nice a word, whining was more like it. According to them this was an insurance incentive for their companies and that was the reason that they had to be be healthy whether they liked it or not.
It is true that insurance companies and hence the companies purchasing the insurance are trying to save money, healthier employees is one way of doing this. However the truth is much grimmer than this, the healthcare system in this country is broken, it's like a battered bomber with the last engine failing, limping along but gradually losing altitude over a great big ocean. Manpower and financially healthcare is strapped, yes doctors make great salaries but the conditions they work in are demeaning, demanding, and difficult. People don't go into medicine for the money, emotionally wrestling with life and death is never adequately reimbursed. The load needs to be lightened and it isn't, there is an increasingly less healthy younger population and a rapidly growing elderly population with fewer health care dollars and doctors going around.
Thus we try to solve the problem before it happens. The only universally effective medicine is preventative medicine, once you have the problem we treat the symptoms rarely is there a cure. We can decrease heart attacks, diabetes, strokes, cancer, and many other killer diseases by controlling high blood pressure, obesity, and high cholesterol by prophylactically dealing with problems years before they manifest by exercise, diet, not smoking, not drinking, and other lifestyle modifications. Once you have any of these diseases we treat the symptoms, we can control your blood pressure, blood sugar, cholesterol, and whatever other damage by giving medication that have to be taken daily. It treats the symptoms, it doesn't solve the problem. The damage is done, we will need to keep regulating medications, keep admitting to the hospital because people don't take their medications, and continually balance side effects against benefits. You are not your car, there is no warranty, replacement parts, or trade in value. Long term physiological damage that is high blood pressure, obesity, high blood sugar, and high cholesterol will not kill you quickly, but destroy you slowly.
By no means do I wish to blame the patient. Go see your doctor for your check up, this too is preventative medicine. If lifestyle alterations fail, take the medication, thats OK. If you want to try alternative therapies, that's cool, but take your medication and see your regular doctor, too. I just want us all to take responsibility on the front end. If everyone exercised (and kept exercising) a half hour per day we would see dramatic decrease in heart attacks and strokes, if that increased to 90 minutes per day with a good diet ("The South Beach Diet : The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss" (Arthur Agatston)) doctors would be largely out of business. The new year is upon us:
  1. Take a 30 min walk everyday (if you can't go see your doctor) the easy way. No more elevators always take the stairs, park you car in the furthest lot and walk (less scratches on the car, too).
  2. Change your diet ("The South Beach Diet : The Delicious, Doctor-Designed, Foolproof Plan for Fast and Healthy Weight Loss" (Arthur Agatston) is an excellent reference).
  3. Increase your fiber intake.
  4. Reduce or even stop drinking pop/soda.
  5. Reduce your caffeine intake, 1 cup of coffer per day.
  6. Reduce your alcohol intake, 1-2 per day (if you can't, you're an alcoholic, seek out help).
  7. Stop smoking (between the patches and welbutrin this is the best time to quit, see your doctor).
  8. Brush your teeth twice daily and floss.

Wednesday, December 21, 2005

The XX/XY Excremental Hypothesis

All men are $h!t.
Before dating
Except for this guy, all men are $h!t.
Dating (honeymoon period, less than 6 months)
He's hot $h!t.
Dating (remainder)
Men are $h!t, except when $h!t hits the fan, then my man is THE $h!t.
I can work with this $h!t.
Trying to turn this $h!t into the man of my dreams.

I'm THE $h!t.
Before dating
Hey there, I'm still THE $h!t.
Dating (honeymoon period, less than 6 months)
Alright she says I'm THE $h!t, too.
Dating (remainder)
What? I'm not THE $h!t?
Oh $h!t.
Where'd my $h!t go?

Saturday, December 17, 2005

Inverse Wingman, 1st Class

"Wingmaning" is a sacred and tough job. It takes guts, verve, and the willingness to socially sacrifice oneself for the greater good. Women travel in units with good reason, guys are horny jerks. Women out on the town are like Napoleonic infantry units tightly packed in defensive squares, a lone skirmisher has no chance at cracking such a formation. Hence, a brave cavalry unit, the wingman, must be summoned and thrown against this grim if very attractive female military formation. The wingman performs a deed of social bravery to break the human wall and let his buddy meet the girl he wants, usually at some desperate loss to the wingman's ego and a funny story at his expense.
Since I like to go out and just carry on, that is, going out is for drinking and carousing and I like to meet women in other less artificial and alcoholically influenced situations (although such situations make me a lot better looking and funnier), I make a decent if tactless, unsubtle, poorly dressed wingman. Usually I shower.
Due to my unfashionable manner of enjoying myself many a girl has used me to talk to the guy they want or better yet and more amusing flirting with me to make some other guy jealous. Examples (names obviously changed):

  • "Hi I'm Phyllis. What's your name? Why Joker it's nice to meet you. Who is this? Hi Hank. Say Joker could you fill this glass for me"
  • "Joker, why don't you come to the party" x 5 phone calls -- once at party ignores me
  • The girl who basically spit venom at me since the day I met her and who I knew was insane, she started purring my name and asking me to "adjust" her kickboxing form while hungrily eying my friend. That one just scared me, so I faked illness and tactically withdrew.

If something like this happens to you, well you've just been turned into HER wingman, she's going to stroke your ego and charm you until the guy she wants gets envious or jealous of the attention. That either means he'll make his move on her or get pissed at you. This confusing state of enjoying being wanted but ultimately being rejected can hurt. But with age comes wisdom and increased scar tissue, learning the tell tale signs of being set-up for inverse wingmanship can give an ordinarily dull evening an interesting turn. Completely shutting down erstwhile faux flirtations will make girl's heads explode. Imagine having a girl glare evilly at you while sultrily whispering, "comic books are hot" or "nerds are so sexy" as she desperately fails at arousing any romantic interest in her true target.

Wednesday, December 14, 2005

Those who can, do. Those who cannot write standardized tests.

Today I took my psychiatry NBME shelf exam after 8 weeks of psychiatry clerking, lectures, and reading ("Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Text Revision) (Diagnostic and Statistical Manual of Mental Disorders)" (American Psychiatric Association), "Essential Psychopharmacology : Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series)" (Stephen M. Stahl), "Psychiatric Mental Status Examination" (Paula T. Trzepacz, Robert W. Baker), and "Psychiatry" (A. Mezzacappa, Giulia Mancini-Mezzacappa, Pretest) plus a few papers of interest on electroconvulsive therapy and other topics). So needless to say, I felt like a good student, I had worked with my patients and prepared more than I should. I'm told I have excellent clinical acumen and will perform brilliantly as a clinician.

Boy was I wrong.

Psychiatry is a self-contained clerkship at my school without prerequisites. Fortunately, I've had internal medicine and surgery because somehow these came up extensively during my exam, not to mention pediatrics (whoops hadn't done that yet), intensive/extensive pharmacology (would of studied whole lists of non-psychiatric medications that cause delirium and their withdrawal effects), child development (covered one day in behavioral science TWO years ago), substance abuse/addiction (which is managed by internal medicine here and apparently not covered in either clerkship), and reading x-rays (never made a psychiatric diagnose based on x-rays in 8 weeks). My fellow clerks have had less experience than me and probably got hosed on more questions. The test developers seem completely out of touch with the clerkship goals. Psychiatry has a false reputation as being a "weak" or "easy" field of medicine. In patient psychiatry is brutal, approximately the same complexity, morbidity, and mortality as critical care medicine but without the fancy monitoring systems. But apparently, psychiatry's inferiority complex is in full swing at least as presented by the Exam (has to be capitalized as it is the benchmark for 1/3 of my grade). There was a good deal of poorly thought out internal medicine, that is, internal medicine questions written by people who don't practice that type of medicine. If the Exam cannot do justice to the field of psychiatry in only 100 questions, perhaps psychiatry then deserves its shoddy reputation, not because it is true but because of the way it measures its students and makes them remember their time as psych clerks.

And if the NBME thinks this to be a "violation of testing policy", I have two words: "Bring it".