Holy cow! Didn't realize that I still had this blog. Cool to see my thoughts at a younger age. Wow, time flies!

As you can see my last post was in 2012 when I was a wee medical student.

Since then, I've moved on to become a resident, now doing cardiology fellowship in the city that I was born and raised. Hard work and sacrifices have paid off.

Now, married and preparing for a family. Uncle to two cuties. No longer just work and career focussed. There's more to life than medicine.

Less time for written reflection, but more life experiences. Some good some bad.

Was medicine all work it in the end? I still think it is. What makes it more worth it is to have someone I can share the journey with.

Until next time. Will out.

Life Updates

It's 1:16 AM the morning before I start my family medicine core rotation. I should be in bed or reviewing a dermatological history, but I've had lots to think about over the past 2 weeks and have seriously questioned my future career choices, friends, and interests. I've finished my core rotations in surgery, medicine, and ER so far and my "second" semester is considered "lighter" with family medicine, obs/gyn, peds, and psych still to go. All I can think of is enjoying the upcoming summer as much as I can.

Many things have transpired over the past year. I can say that I'm happily in a long-term relationship with someone that I care about. When I am with her I am always happy and when I am away from her I always feel that something is missing. We are going to couple's match together for CARMs and I've firmly decided to place her above everything else. Surprisingly, this puts me somewhat at ease about deciding what type of doctor I want to be.

Fluffy issues aside, I am still stressed about what I am going to do about my future. I have many interests and I sometimes find myself spread too thin. At least I've narrowed my choices down to internal medicine, 5-year FRCP EM, and 2+1 in EM or hospitalist medicine yet the pressure to accommodate all these interests during electives is impossible. What electives, where to do them, how long will they last? Elective booking is still a work in progress. One thing I do know for sure is that I hate playing the CARMs game. It's superficial, unnatural, and creates unnecessary cognitive dissonance.

New things I've learned about myself during this busy clerkship year where my free time has never been limited to this extent before. I have ADHD, binge on videogames, despise sleep deprivation, love caring for patients that I get along with, love the outdoors, cherish my free time off to play sports, pick up new hobbies and catch up with old friends, love to travel, and will never be perfectly happy (or achieve a state of bliss).

Things I'd like to blog about from now until the start of my electives (fingers crossed that they will actually happen).

- Reflecting on patients that I cared for on internal medicine and abstracting life lessons and medical advice
- Frequent health policy updates: Drummond Report (when will I have time to read it?), CHC's vs. FHC's, patient safety (new interest!!!), MSc. (where oh where?), transition care reform, complex care centres and innovations, EMR's (a dark chapter in Canadian history)
- Prevention advice (inspired by family medicine rotation) - a daunting prospect or a realistic goal?
- Carving out research niche - will I be a clinician scientist/researcher? My supervisor recently said that I lacked the essence of curiosity.
- Still in search of mentors...
- Interests outside of medicine
- Where I see myself in 10 years
- Future travels

WC

Revived Interest in Health Policy

Why an interest in health policy?

Health policy has always captured my attention. My first exposure to the field was in 3rd year of undergrad with a course taught by John Lavis. All throughout my graduating year, I attended lectures on health care by Gordon Guyatt. Both made me wonder about macro level issues and gave me a taste of politics, economics, and social psychology. I even applied to graduate programs in public policy and health services research at UofT with the goal of informing the ongoing debate on a national pharmaceutical strategy. In med school, interest in health policy waned b/c of little curricular exposure. Generally speaking, anything related to the field was lumped together under the umbrella of a "Determinant of Community Health" course, which almost every UofT med student I know despises...unfortunately.

Why a revival?

A federal election is on the horizon and health care is a big topic. In order to comprehend the implications of health system changes, medical students may benefit from a basic understanding of health policy (re: physician/policy scientist). Most importantly, medical students should engage in dialogue to discuss about health care platforms and forums should be built into the curriculum to facilitate this (i.e. why not incorporate it in the "Determinants of Community Health" course that I alluded to before). Understanding how physicians and their patients fit into a larger system helps make sense of limitations in their every day practice.

Where does this leave me?

Desperate for conversation with someone who shares some interest in health policy. Where is Sartorius when I need him? My free time is spent reading posts on healthydebate.ca, an informative website I recently stumbled upon. I encourage all to take a look. Finally, I'm left thirsting for a mentor and thoughts of pursuing a MSc. in the field become more appealing. At this rate, I will never settle.

WC

Career Update - Clinician Scientist?

Out with Community Medicine, Surgery, and Psychiatry.

Deciding between Family Medicine (+ Emergency), Emergency Medicine, Neurology, or Internal Medicine. Very different careers, I know.

Positive research experience in CREMs program with an excellent mentor. No longer thinking about MPH, but rather MSc. in Clin Epi. Stanford?

Half-Marathon here I come!

What is the "secret ingredient" to a happy life?

Inspired by "Kung Fu Panda."

Career Pondering

• Community Medicine: 2 years of Family Medicine training, 1 year of academic training (get MPH at London School of Hygiene and Tropical Medicine, Harvard, or Johns Hopkins), and 2 years of rotations - gives you flexibility to be clinician, researcher, Medical Officer of Health, health policy consultant, etc.
  
• Family Medicine + Emergency
• Emergency
• Internal Medicine
• Neurology
• Pediatrics
• Psychiatry
  

Graduation Goal

Before 2013: Princess Margaret Hospital's Ride to Conquer Cancer!

PTSD

Took a well-deserved break from studying by watching a movie with some old friends. I don't want to spoil the plot of the movie, but essentially a soldier (who was thought to be dead) unexpectedly returns from his service in Afghanistan suffering from post-traumatic stress disorder (PTSD). While a captive in Afghanistan, he was forced to kill his comrade or risk being killed himself.

When the solider returned to his family, he had difficulty trusting his loved ones. He presented with unusual behaviours, such as compulsively organizing dishes in the kitchen according to shape, size, and height. His affect changed from before - it became incongruent. Finally, he lost his ability to show emotion.

It's hard to say whether the movie made me more or less interested in psychiatry. I've always found psychiatry fascinating for the reason that patients often present with complex and multi-layered problems. Piecing together a patient's situation is no easy task, but the exercise itself allows room for interpretation and analysis. Psychiatry may not be one of the more evidence-based branches of medicine, but it does finely capture the art of it. However, treatment is usually long and arduous (even if you suggest pill-popping), some patients may deny having any mental health disorders, and improvements are hard to measure. With limited techniques and strategies, how do you know you are helping your patients?

WC

Reflections on My 22nd Birthday

Loosing energy and easily fatigued from 9-5 classes. Falling behind in my lectures even though I'm studious. Not leaving enough time for my friends and family. Getting moody, doubting my abilities, and questioning career choices. Unhappy with my learning progress and intimidated by my peers. Cannot express my thoughts clearly to others. Finding emptiness in other people's advice and suggestions. Looking for a confidence boost.

Dx: burnout?

Rx:

Long-term care: re-sparking the debate

Staff at Joseph Brant Hospital in Burlington are asking their elderly patients to go home in order to free up hospital beds for those needing acute/emergency care. Critics of this action suggest that the hospital is really removing, rather than freeing up, these beds in order to reduce their $5.5-million deficit. What strikes me as surprising is that staff are wearing "Home First" buttons to promote this initiative. What impression does this give to patients who absolutely need hospital care? Unfortunately, in order to balance the reality of taking on more patients, especially those with acute care needs, others are left to draw the short end of the stick. This time its seniors, re-sparking debate about the need for extended home care coverage and investment in long-term care facilities. 

A few issues are at play.

There are both advantages and disadvantages to receiving care at home. At home, patients are most comfortable in a familiar setting, can move around more to improve rehabilitation, and are away from any threat posed by superbugs at hospitals. However, the sicker the patient, the more supervision they need. Supervision by health care professionals costs money and currently the province only covers 1-hour worth of services - the rest of the costs have to be shouldered by the patient and their family. Admittedly, the hospital is trying to get churches and community organizations to help out, but the absence of any suitable long-term care facilities makes alternatives difficult to consider. 

One hopes that the hospital is only releasing elderly patients when they are deemed fit to leave. This cannot be guaranteed in constrained circumstances where new patient arrivals dictate the frequency of freeing up hospital beds. Acute care needs trump chronic care needs, but a chronic care patient left unsupervised in their home can easily wind up with an acute care problem. Are they ways in which adequate home care services can prevent this from happening?

My housemate Gabe believes that technology offers a solution. Specialized monitoring systems could be set up at home to provide 24/7 visual access on the patient's whereabouts. In addition, gadgets could be attached to their bodies to provide feedback on vitals and any unusual physical movements. All this information could then be fed into a data processor where people would work around the clock to monitor the health and safety conditions of hundreds, if not thousands, of patients living at home. Could this work as a short-term solution? 

WC 

Teaching Evaluation

Period 1 Ratings   4 3 2 1 Total  Overall Evaluation of Orgo Instructor?  2  8  2  0  3.00   Was the instructor prepared for class?  3  7  2  0  3.08   Did the instructor make the class interesting?  3  7  2  0  3.08   Was the instructor on time?  11  1  0  0  3.92   Did the instructor move the class at the right pace?  5  6  1  0  3.33   Student 28, Evaluators: 13 Average 3.28   4 = Excellent; 3 = Good; 2 = Satisfactory; 1 = Poor; 0 = Unacceptable

Not bad. Wish there was qualitative feedback. 

WC

Crying Babies

Imagine this. You've been asked to supervise a male infant in one of the pediatric wards. Upon entering his room, you are relieved by the fact that he is sleeping peacefully. It's almost the end of your shift and you welcome some tranquility at last. 

As you take a seat at a nearby chair, you can't help but notice the rhythmic rising and falling of the infant's chest. You remind yourself to look out for any abnormal patterns of breathing. The boy is resting on his stomach and you wonder why he hasn't fallen asleep on his back. You remember from your developmental psychology class that it is generally safer for infants to sleep on their backs with their face to the ceiling. He seems comfortable in his resting position so you don't bother to move him. At least his head is tilted sideways so that you can watch his face while he sleeps. 

After the fascination of scrutinizing the baby subsides, your mind starts to wander. You start to think about your plans for the afternoon, for the rest of the week, and ultimately for the rest of the summer. A TV is right beside you, but you know better than to turn it on. If a parent walked in, you wouldn't want to be caught doing anything other than supervising their precious child.   

Suddenly, the infant blinks. Is he waking up or just teasing you in his sleep? He blinks again and his eyes widen. He's awake! You haven't played with an infant in a while, but you are ready to at a moment's notice. 

He starts crying. Not surprising. He probably misses his mom or dad and feels threatened by this random stranger in the room. Predictable attachment response for an infant at this age. You try to use soothing words to calm the baby, but to no avail. 

Next, you try rolling him over on his back to facilitate more open communication. Your maneuvers are clumsy and sloppy. His crying gets worse. 

You try to give him a soother. It works temporarily, but he wants none of it after a few seconds. He redoubles his crying efforts.

Out of desperation, you try to distract him with some toys. He hardly pays attention to them. By now, his wailing hurts your ears and you are emotionally crushed by the tears rolling down his cheeks. Must be a pain response to something medical in nature. 

You attempt the last trick in your books - a cuddle. You haven't done one of these in a while so you're naturally hesitant to take him out of his bed. You note several cords and lines attached to his body, which complicates getting a firm hold on his limbs and torso. Forgetting to swathe him in blankets, lowering the guard on the bed, and giving him enough neck support are only a few mistakes you make while performing this intricate move. He cries more intensely to signify your failure to attend to his needs. Frustrated, you put him back down on the bed. 

Despite years working with children and being a regular volunteer on the pediatric ward, you feel a strong uneasiness about what to do next. Besides being unable to calm the baby, you are not even certain about why he is crying. 

Feeling helpless, you're about to give up when a nurse suddenly arrives. Remarkably calm, she provides words of encouragement, explains why the baby is crying, and thanks you for supervising the child. It's her turn to take over now. You feel undeserving of her appreciation. 

As you exit the room with a hanging sense of defeat, you wonder what you would do if the nurse didn't show up.

Am I ready to respond to an emergency?

Last weekend, I did a course on Standard First Aid and CPR. If there is one thing I took away from the experience, it would be the following: saving a person's life in any emergency situation is of utmost importance. Those with adequate training have a responsibility to intervene in dire situations that call for their expertise. 

All of this seems noble and Good-Samaritan like, but I'm still left with an unsettling feeling. After a weekend of training, I hardly consider myself qualified to handle an emergency situation on my own. If I make a mistake in any step of the life-saving protocol, am I not guilty of doing more harm than good on the patient even though I act out of good faith? Despite sufficient training, making a mistake is a real possibility in the heat of the moment as you race against time to save a life. 

For example, using an automated external defibrillator (AED) can help bring a patient back to life from cardiac arrest by delivering an electrical shock. Although the AED is a reliable, user-friendly, and generally worry-free device, things can still go wrong if metallic objects are not removed from the patient's body before administering the shock. These details are all too easy to miss in the spur of the moment. If death results from this negligence, you may not be held liable due to Good Samaritan laws, but can you truly escape the blame put on yourself? Can you erase the thought that, had you not intervened, the patient would probably still be alive? In this case, fear of adverse consequences and doubt about one's competency are legitimate excuses for inaction. Wouldn't it be better if someone else assumed responsibility? 

I'm at the cusp of understanding not when and how, but if, I can provide care. 

Methadone not good enough?

One of two Calgary methadone treatment centres that services about 500 patients is scheduled to close at the end of this month. The reasons include not meeting city standards for zoning and not adequately consulting with community associations before it opened in late 2008. 

How it managed to open despite these claims is anyone's guess, but is it justifiable that the community associations are legitimately worried? On one hand, they can be blamed for adopting a "not in my backyard" policy and fueling the stigma of those living with substance addictions. But if you put yourself in the shoes of a community resident, having addicts freely and frequently roam your streets may be a good enough reason to complain. 

Let's take a step back and look at the big picture for a second. Closing the treatment centre will leave a few hundred of people without the appropriate care and support needed to wean off their drug addictions. This will be particularly devastating to those who are already committed to their regimens, but that need convenience and habituation to carry themselves through. The risk of relapse will be high, potentially undoing years of hard work on the part of both patients and health care workers. 

Although immediate closure seems like a worst-case scenario, relocation is not that much better. As mentioned, treatment for substance abuse can be long and arduous. If people with addictions rely on routines to maintain compliance, any disruption in this pattern can be detrimental. How big of an impact will moving a clinic cause? I guess it depends on how far away it will be from the greatest locus of clients, how many health care personnel will continue to work in it, and if the services will be delivered at the same level of efficiency. It doesn't help that a 3-month wait time exists at the other methadone clinic, which cannot realistically take on more patients. 

What bothers me is this. Even though science (and perhaps some heart-warming testimonies) can show compelling evidence of the effectiveness of methadone treatment, the needs of substance abusers often come second to none. Are they less deserving of treatment because of who they are or what they do? You would be surprised if I told you that those with drug addictions come from all walks of life. 

Even then, a doctor would say no to this question because dealing with health and health care issues is what unifies all human beings. As Perri Klass puts it nicely, "doctors are engaged with individual humans at the level that makes everyone human." 

On the other hand, a policy-maker (as this is a career path I'm still considering) has to weigh several other opinions, ranging from those of city counsellors to community members to anyone else with a public interest on this matter. Policy-makers sorting through this dilemma would be hard-pressed to take sides between those that are healthy versus those that are unhealthy. Doctors, as advocates for their patients, have a clear position. 

How can someone reconcile being both a doctor and a policy-maker?

WC

Big'ups

Big'ups to the movie Up!

I finally had the chance to see it, and after much anticipation, it still managed to exceed my expectations. Just based on the preview alone, one would think that the lead character, Carl, is just a grumpy old man with nothing better to do than concoct wild ideas of flying a house. Who would have thought that he lived a life that many people only wish they had, of growing old with the person you love the most?

There was an obvious climax to the movie. This was when Carl finally reached Paradise Falls and looked over his sentimental "Adventure Book" for the last time. Up until then, Carl had been living on a unfulfilled promise to his late wife, Ellie. When he flipped through the book, little did he realize that Ellie's adventure began when they got married. It was a heartfelt reminder of cherishing the past and moving on. 

Sometimes we need a wake-up call to remind us of appreciating, rather than, regretting life's journey. Sometimes it takes the most unlikely of characters, such as a chubby Wilderness Explorer, a talking dog, and even an overgrown pelican, to change our frame of mind. Sometimes, embarking on a new adventure happens when we least expect it.

WC

Dental Discoveries #2

My tooth aches. It's the same tooth that had a cavity and then a filling. I'm seeing the dentist this Wednesday to get it checked up. I suspect that either the filling came loose or the cavity wasn't completely removed. Either way, the dentist should fix it up without charging extra on top of a regular appointment. I will be quite surprised if I have to pay additional costs for what very well may have been her mistake. 

During my last appointment, the dentist recommended a wisdom teeth extraction. She stressed the importance of preventative action: taking out your wisdom teeth at a younger age will lower your risk of getting infections in the future. In her opinion, removing the teeth before their roots fully mature would be a less invasive and less painful procedure (no bone drilling required!). Although she presented these reasons convincingly, I was suspicious about her vested interest in doing the extraction. I asked her about the fee for removing one wisdom tooth - a whopping $300! For three teeth, my dental insurance would not only max out, but over 2/3s of the funds would have to come from my pocket. Tooth be told, I needed to talk to other people and do my own research before making a final decision. 

So far, I have shared my concerns with three of my colleagues at UofT dentistry. They have all provided me with some sound advice, despite the controversy surrounding wisdom teeth removal. One friend encouraged me to consider whether my teeth will induce pain and discomfort by putting pressure on adjacent ones. When I reviewed my X-ray images with the dentist, she pointed out that one of my teeth was growing in sideways. I admit that I was worried about this at the time and almost bought in to the procedure right away. 

My other friend told me, in more detail, about how impacted wisdom teeth can cause many problems down the road. There are several ways. If they grow sideways, they can crowd the rest of your teeth and mess up your beautiful row of pearly whites. Although this may be true, tooth alignment does depend to some degree on the size of your jaw. 

He also discussed the possibility of having the wisdom teeth erupt into the oral cavity, allowing bacteria to accumulate and cause decay on adjacent teeth. Although infrequent, these infections can spread to the head and neck regions, potentially damaging surrounding nerves. In a worst case scenario, the brain and heart can be infected through fascial spaces. 

On the other hand, he mentioned about the cons of going forward with wisdom teeth extraction. With any medical procedure, risk is involved and mouth surgery is no different. For example, the lingual nerve, which is fairly close to the third molars, can be damaged if the surgeon is not careful. I wonder how often this happens as I have yet to look at studies that investigate dental errors. 

My last friend talked about the risk of having caries on partially erupted and fully impacted wisdom teeth. This can potentially lead to damage to the surrounding bone structure if decay progresses toward the root of the tooth. When he mentioned this, I couldn't help but wonder whether good oral hygiene would save any of this from happening. He did say that brushing wisdom teeth is more difficult than brushing regular teeth. In addition, there is no accessibility to those that are impacted.

He did leave me with some positive considerations for keeping the "wise" ones. First, they can be used to treat damaged teeth - I guess in a similar way as grafting skin for burned areas on the body. Apparently, they can also prevent bone resorption of the jaw during old age. As to how this happens, I have no clue. I'm sure the dental literature holds the answer. All these considerations come with keeping immaculate oral hygiene. 

At the moment, I am leaning towards having my wisdom teeth removed, but only when my dental insurance coverage gets renewed in the fall. I have three impacted wisdom teeth with one growing sideways into an adjacent tooth. Although none of them bother me at the moment, they are in a prime position for extraction because their roots are not fully grown. This means that the surgery will be less intense and post-operative recovery will be smoother if I do not delay.

I'm anxious to see what the literature has to say about my colleagues' advice. 

WC

Losing Momentum...

Teaching is something I used to enjoy. Now, it feels like a chore that I just don't want to do. 

When I'm giving a lecture, I often wonder what my students are thinking about me. Are they confused about my explanations? Do they think my jokes are too corny? Am I a boring lecturer? I can sometimes read their minds through their facial expressions and body movements. Not everyone is going to be wide awake and interested about what I have to say, yet I am quick to assume fault for this. Irrational, no? 

Today, I got the sense that my students were getting fed up with my teaching style. I covered a particularly unexciting section of organic chemistry, which involved writing out reaction upon reaction on the board. I admit that I wasn't fully prepared for this class - my boardwork was sloppy, my explanations unclear, and I made mistakes. As the class carried on, I felt that I was losing the confidence of my students, leading to doubts about my ability to teach. I was quickly reminded of my struggles during the training session for this job. 

Why am I having these reservations? Maybe there are things that I don't like about this teaching position. Firstly, organic chemistry is not my passion. I don't get excited about electrons moving around, but I'm sure that there are some people who do. Secondly, teaching that requires intense board work for 2.5 hours is physically laborious. I feel like I have to bring a change of clothes, a towel, and a water bottle even though I'm not headed to the gym. Finally, my learning philosophy is fundamentally different from what the Princeton Review practices. Being in the shoes of a student, I know that there is limited value to lecture-based learning. It takes a lot of skill and practice to be an excellent lecturer, but if I could have it any other way, I wouldn't be teaching the material in this style. 

Teaching does have its perks. It's always nice to interact with the students and help them reach the "Aha!" moment when they finally understand a concept. Questions that are asked during class encourage me to be quick on my feet. Finally, teaching is an opportunity to develop communication skills - you have to be clear and concise when conveying your knowledge to other people. 

I suppose that I just had a bad day and things will pick up in the next class. I wish there was an opportunity to get more consistent feedback from my students so I could see where to make improvements. I'm not satisfied with being just an average teacher...I want to be a good one. 

WC

What a patient can teach a doctor?

Dressed in a gown and wearing only shorts, I felt cold in the doctor's room. This was going to be a long night, I reminded myself, and popped a piece of cinnamon-flavoured gum in my mouth to freshen my breath. I quickly reviewed my clinical case so that I knew all the facts of my "fake" condition. The OSCE examination was supposed to commence 15 minutes ago, and I had no idea why things were starting so late. Oh well, I thought to myself, time for me to sneak in a power nap. Afterall, I needed all the rest I could get before blitzing for 6 hours straight.

As I was just about to close my eyes, the clinical evaluator for my station came in. She looked a bit flustered, and I gathered that she too was unhappy about the lack of punctuality. We had a quick introduction before she started shuffling through her papers and getting organized. When she was finished preparing, we discussed about possible reasons why the examination was running behind schedule - could it be that some preceptors or standardized patients didn't show up, was there a mix-up in the organization, did some first-year medical students loose their way? We did not know, but clearly she was becoming more impatient with each passing moment. 

Alas, we heard shuffling noises behind the door - the students were lining up and reading the triggers! A gentle knock on the door soon followed. The first medical student was ready to enter the room and perform their required duties. I was nervous for them. 

A young man in his late twenties walked in. Upon entering the room, he washed his hands right away, introduced himself, asked me how I should be addressed, and asked permission to examine me - all standard procedures of a short clinical exchange. Did he forget the confidentiality spiel? I made a mental note of it. I could tell that he was anxious - it showed in his trembling hands and stuttering voice. He asked me to describe my symptoms and I gingerly recalled the information relevant to my clinical case. For some responses, I deliberately spoke in vague terms so as to prompt him to follow up with more focussed questions. There was nothing interesting or outstanding about my clinical presentation, but I noticed that the medical student was trying hard to study every response I made. Simultaneously, he was trying to work through a standard set of history-taking questions - past medical history, family history, taking any medications, drinking/smoking/recreational drug use, diet, etc. There were moments where he paused to recall a series of questions. This impacted the flow of the conversation. Who would have thought that communication could be so challenging in a clinical setting? 

After the history-taking, he performed an abdominal examination on me. I had to lie across the bed in the room with my gown rolled up to my chest and drapes across my lower extremities. I felt vulnerable, self-conscious, and not surprisingly afraid. This random stranger was about to put his hands on my stomach and perform tests that would induce discomfort and pain. I could tell his hands were cold and I cringed at the prospect of having sweaty hands kneading at my skin. I was not prepared for this kind of up-front and physical interaction with a person entrusted to care for me. I had a rare glimpse of what it feels like to be a patient.

During this one-night stint, what did I learn about being a doctor? Sure, it is important to know how to take a proper history and physical examination. As you build a differential diagnosis about what the patient has, you have to be quick on your feet to process new information. It is important to ask the right questions that will guide your clinical judgment but not restrict the flow of the conversation. For example, when you ask a patient if they have experienced "fevers, chills, or nightsweats", you might get a response along the lines of "no." Does that mean that the patient is experiencing none of these symptoms or just a few of them? It doesn't hurt to clarify, summarize, or paraphrase in these circumstances. But these competencies alone do not separate average doctors from good ones. 

Of all the medical students that I met that evening, who did I prefer to be my doctor? Those that showed empathy immediately caught my attention. One of my rehearsed opening statements consisted of telling the students that I was worried about my condition. Only a handful of students picked up on the opportunity to say, "I could imagine that going through this must be hard for you." A seemingly insignificant statement made a significant difference in my mood. Realistically, it's difficult to remember to be empathetic when your mind is juggling what you're trying to say, what you are seeing and hearing, and how everything fits together to paint a clinical picture. But showing empathy is crucial because it demonstrates that you genuinely care about the patient's plight and take interest in understanding their situation more deeply. 

Of course, there are other things that a physician can do to show concern for the patient. For example, asking permission to perform certain procedures, explaining in lay terms what they are doing during an examination, warming their hands before touching the patient, and reassuring them that they made the right decision of coming in. These are all small actions that demonstrate respect and professionalism, the sum of which can have a huge impact on the patient's disposition. If we know that these displays of politeness and dignity are effective in building patient rapport, why do I still suspect that they are not emphasized enough in real life situations? No doubt there are competing objectives. In a brief 10 minute appointment, how do you know that you are showing enough empathy while balancing your duties of taking a thorough history and physical examination? Ten minutes is arguably not enough time to perform all these tasks, yet there is a point to be made about being efficient in the way you communicate. Of greater concern, how do you show that you are genuinely empathetic about your patient's plight when you have nothing in your past experiences to relate to what they're going through? For example, if a young pregnant female comes to see me about aborting her fetus, am I really in a position to understand what she is enduring? And finally, when does being genuine cross the emotional threshold in a way that biases your clinical judgment and renders your thought process irrational? 

In that brief encounter between the physician and the patient, I almost find the weight of the physician's responsibilities overbearing. 

WC

New Hairstyle...

Let me begin by saying that I think my head is awkwardly shaped. It is round yet asymmetrical, with the misfortune of having hair grow longer at the sides than on the top. In addition, my hair is dry and coarse in texture - two qualities that would make you cry if you were my personal stylist. Did I also mention that in bright, reflective light you might mistake my black hair for being gray? 

When I was young, I used to hate going to the barbershop because I almost always expected to be disappointed. My barber would ask me what I want, to which I would reply, "go crazy." I was never impressed by a single design. 

Recently, I've grown accustomed to my current hairstyle - the quasi fo-hawk. Its a clean cut, a bit funky, and has encouraged me to care more about personal grooming. However, maintaining this bad boy requires me to drop a bill almost every two weeks. Frankly, its time for a change. 

I know that my new hairstyle will be longer than the current one, with proportionally more length than width. I might push for a messy or a clean look, the former requiring less styling product and the latter requiring more. I'll also give the hair stylists a second chance. When I grow my hair, at least they'll have more confidence working with something long enough to hide their mistakes...

Here are some photos of old hairstyles. Should I return to them or try something new?