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Short White Coat

Prostate cancer screening: too early to say goodbye

Link|Comments () Posted by Ishani Ganguli May 30, 2012 05:45 PM

First they try to take away our mammograms, and now this? Last week, the US Preventive Services Task Force (USPSTF) followed up their October 2011 draft guidelines to recommend, definitively, that doctors not offer routine Prostate-Specific Antigen (PSA) screening for prostate cancer. They concluded from recent trials that the harms from over-diagnosis (biopsies and surgeries complicated by infection, bleeding, and incontinence) outweighed the benefits of early detection and treatment. Not surprisingly, the move was not universally welcomed, in part because the notion of not doing everything in our power to hunt down cancer feels horribly wrong.

But one key detail of the guidelines has been largely overlooked, the part that takes into account what individual patients want. “Physicians should not offer or order PSA screening unless they are prepared to engage in shared decision making that enables an informed choice by the patients,” the authors write. “Similarly, patients requesting PSA screening should be provided with the opportunity to make informed choices to be screened that reflect their values about specific benefits and harms.”

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tags cancer screening, prostate cancer, Prostate-specific antigen, PSA screening, screening guidelines

Short White Coat

An ounce of prevention against bullying doctors

Link|Comments () Posted by Ishani Ganguli May 10, 2011 04:09 PM

Short White Coat is a blog about learning to be a doctor. Posts appear here as part of White Coat Notes. Ishani Ganguli is a fifth-year Harvard medical student. E-mail her at shortwhitecoat@gmail.com.

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Theresa Brown’s recent posting in the New York Times Well blog about doctors who bully nurses generated a stir, especially among doctors defending their honor. As a medical student, I’ve witnessed and experienced my share of bullying by a handful of doctors (though to be fair, by nurses as well). In one instance, I watched a surgeon mock a new nurse in the operating room, teaching her with absurd faux-patience how to properly hand him his instruments.

As Brown notes, even subtle condescension and rare altercations impact patient safety. She suggests top-down attitude adjustments and civility training for physician offenders.

But doctors’ attitudes are formed, and so should be influenced, before hierarchies are fully ingrained -- in medical school.

Medical students have little exposure to other health professionals in the first two “pre-clinical” years of school. When we begin our third year, struggling to find our place in the bewildering jungle of the hospital ecosystem, it is all too easy to parrot and thus perpetuate any bad behavior by our superiors. Medical educators blame this on the “hidden curriculum” -- observing real-life practices that can override our textbook learning.

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tags medical education, Medical errors, medical school, medical teams, nurses

Short White Coat

Social media for the medical trainee

Link|Comments () Posted by Ishani Ganguli April 21, 2011 10:00 AM

Oh My Bieber. I can't believe @Mr.Doe in Room 237, County Hospital vomited AGAIN today. ROFL #ilovemedschool

There's using social media, and then there's abusing social media.

We reported yesterday about the Rhode Island emergency room doctor who was fined and fired for inappropriately posting about a patient on Facebook. No-one is quite clear on how to regulate this issue, or perhaps more importantly, how to incorporate the growing presence of Twitter and the like into our education as doctors.

The bookish medical student is not your prototypical early adopter (As our dean of students once told me, she couldn't find a single one who used Twitter or even knew what it was back in 2007). But social media has hit the mainstream. The cohort of tweeting and posting medical trainees has expanded in kind, prompting conversation among educators about what this means for professionalism, that nebulously defined yet critical requirement to be an upstanding physician.

Used well, social media are great for self-reflection and can help educate physicians and patients alike. But abuse is clearly a problem. In a 2009 survey, 60% of 78 responding medical schools reported incidents of students posting "unprofessional content" online. Some of these got the students expelled. So what should medical educators do?

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tags Facebook, medical education, medical school, social media, Twitter

Short White Coat

What patients hear

Link|Comments () Posted by Ishani Ganguli April 12, 2011 08:00 AM

Last week, I had elective oral surgery. I knew the basics of the procedure before going into it -- the resident periodontist would harvest (slice out) tissue from the roof of my mouth to bolster my too-thin gums (ew). I had fancied myself brave, but I felt anything but.

At the start of the procedure, my eyes clenched shut, I perked up my ears in case I could learn something useful. I felt enormous relief each time a supervising dentist came by and complimented the resident’s handiwork (nice graft!). But then I cringed at every oops, mention of a surgical instrument (you’re putting a blade where?), and indication that my mouth anatomy was less than ideal. This was personal.

I soon found myself wishing I were wearing headphones blasting Ke$ha, or any other white noise, to drown out comments from the resident or the assisting dental student that my medical training allowed me to understand just well enough to get nervous. But then, I wouldn’t be able to turn my head to the right on cue, or to pose for before, after, and during photos. So instead, I willed my brain to take me anywhere else: to my new apartment, to the beach, to a recovery period brightened by milkshakes and episodes of Curb Your Enthusiasm.

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tags medical education, oral surgery, patient-doctor communication, residency

Short White Coat

Harvard’s Match Day stats bear out national trends -- in a good way

Link|Comments () Posted by Ishani Ganguli March 28, 2011 09:36 AM

The results of Harvard Medical School’s Match Day, mirroring national trends, bode well for the future of American health care.

That is to say: Primary care was nicely represented among the 167 of us soon-to-be-graduates who matched at a residency program. By my count we have eight going into family medicine and 11 into dedicated internal medicine/primary care programs. Including the future residents in pediatrics (13), internal medicine (35), and combined medicine-pediatrics (3), which are generally considered primary care specialties, we are 42 percent strong. Last year, it was 36 percent. Not too shabby, class of 2011.

Nationwide, reports the National Residency Match Program, more US students chose family medicine (up 11 percent from last year), internal medicine (up 8 percent), and pediatrics (up 3 percent) in the largest match in history.

These numbers don’t necessarily correlate with how many new primary care doctors will emerge from residency in three to four years. The vast majority of my classmates going into internal medicine, for example, will specialize in a field like cardiology or oncology.

We are still far from fixing our national shortage of primary care doctors.

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tags Match Day, medical education, medical school, primary care

Short White Coat

Matched!

Link|Comments () Posted by Ishani Ganguli March 18, 2011 03:44 PM

With the flip of an envelope lid, the next three years of my life flashed before me. I found out at noon yesterday, Match Day, that I’ll be in the 2014 class of Massachusetts General Hospital’s Internal Medicine/Primary Care residency program.

Thus ends a seven-month courtship that began with personal details -- photo, narrative, letters, and numbers -- sent through a centralized service to programs each of us had selected in our chosen specialty. Throughout the winter, we visited these sites, students feeling out program directors and vice versa. Sometimes, notes and phone calls were exchanged.

Last month, we told the service which residencies we liked, the residencies told the service which of us they liked, the matching algorithm did its thing, and voila, on the third Thursday in March, we received notice of our training program soul mate, printed in Times New Roman on a single folded sheet.

For medical students, Match Day can be exhilarating or deeply disappointing. Some schools create pageantry around the event, asking students to come up to the mike in front of an amphitheater of classmates to receive and read aloud their results. Others, like Harvard, simply pass out the envelopes and serve lunch. Either way, I felt a bit strange, even queasy, having my future handed to me like that, perhaps because I had no control, no undo button, at this stage of the process.

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tags Match Day, medical education, medical school, residency

Short White Coat

Better health care, from above and below

Link|Comments () Posted by Ishani Ganguli February 3, 2011 09:00 AM

To those in the quality improvement world, it was exciting but came as no big surprise: a study published this week shows that a safety checklist system reduced patient deaths by 10 percent and nearly eliminated bloodstream infections in the Michigan hospitals that adopted the approach.

To the average future doctor, these sorts of efforts, and the skills to engage in them, are probably unfamiliar.

A year ago, I wrote with a friend about the dearth of attention to quality improvement in medical training. Well, not a whole lot has changed at most schools. The real action is still confined to outside their walls and includes only the trainees who seek it out.

The other weekend, my co-author and I had the chance to sit in on some of that action, and it didn’t disappoint. At the third annual Patient Safety and Quality Leadership Institute, guest speakers championed the cause with ministerial fervor though, of course, they were preaching to the choir (participants submit applications and pay up to $250 to attend.). The idea is for these health care trainees, including pre-meds, medical and nursing students, and residents, to return to their institutions with data and examples of how to teach the topic and start quality improvement projects of their own.

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tags health care, health care reform, medical education, Medical errors, medical school, Patient safety, quality improvement

Short White Coat

Parting thoughts on Guatemala

Link|Comments () Posted by Ishani Ganguli January 6, 2011 11:35 AM

When I was filling out the final report for my rotation in rural Guatemala, the section on project category gave me pause. The “Service” box (which I ultimately checked) was the most fitting, but it was also presumptuous.

I wanted to take good care of my patients, who were underserved and incredibly deserving. At the same time, it would be disingenuous for me to claim purely altruistic motivation: I also went to learn about medicine in a rural setting, to practice my Spanish, and to experience living abroad.

Did I even do any good? I spent my mornings doling out diagnoses and prescriptions behind a rough wooden school desk, perhaps easing the workload of the Guatemalan med student responsible for the clinic. (With permission, I also posed for the requisite clinical action photos, such as Student in Scrubs with Stethoscope and Child).

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Short White Coat

Health Lit 101, in Spanish

Link|Comments () Posted by Ishani Ganguli November 1, 2010 09:30 AM

I've taken the five-year-old's history, listened to her lungs, and pressed on her belly. I know what she has (a cold and diarrhea, both viral) and what she needs: handwashing, plenty of fluids. Half a teaspoon of syrup three times a day for seven days, plus half a pill once a day for 10 days, plus a packet of powder dissolved in a liter of water -- one cup after every bowel movement.

Now to explain that so it sticks.

Effective communication is, of late, a popular topic in medical school. Poor health literacy has been linked to decreased treatment success and more medical errors, and as doctors, we need to work to minimize these effects. Prior to my two-month rotation in rural Guatemala, this need had never felt so pressing.

Because Spanish is not my first language, nor that of my patients (around San Juan Sacatepequez, the native tongue is Kaqchikel), I'm acutely aware of the words I choose, the way I use them, and of how they're received.

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tags Guatemala, medical education, Medical errors, medical school, Spanish

Short White Coat

A tale of two residency application systems

Link|Comments () Posted by Ishani Ganguli October 22, 2010 01:56 PM

On my weekend travels exploring Guatemala’s gorgeous natural offerings (Caves! Volcanoes! Giant lakes! Smaller pools!), I’ve gotten to meet a mix of international medical students on their own final-year electives.

Residency applications aren’t the first topic of conversation, but they come up eventually. Which is how I heard that this is a big two weeks for the Brits. On Monday Oct 11, students applying to foundation programmes (the British equivalent of residency) learned the questions they must answer for 60 percent of their ranking score. They had until today to submit their responses.

Later this year, they’ll be ranked within their medical school based solely on their graded 200-word answers to each of those five questions and class grades (40 percent). These ranks determine if they get their first, or 20th, choice of foundation programme.

The Brit students I’ve talked to bemoan the seemingly arbitrary quantification of their ability to wax eloquent and the paucity of data points on which they’re judged -- especially in a competitive year.

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tags medical education, residency

About white coat notes

White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at cconaboy@boston.com. Follow her on Twitter: @cconaboy.

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