American medicine is the best in the world when it comes to providing high-tech care. If you have an esoteric disease, you want to be in the United States. God forbid you have Ebola, our academic medical centers are second to none. But if you have run-of-the-mill chronic diseases like congestive heart failure or diabetes, the system is not designed to find you the best possible care. And that’s what has to change.
— 

Dr. Sandeep Jauhar

Dr. Jauhar’s book is called Doctored: The Disillusionment of An American Physician

The first time it was an ear, nose and throat doctor. I had an emergency visit for an ear infection, which was causing a level of pain I hadn’t experienced since giving birth. He looked at the list of drugs I was taking for my bipolar disorder and closed my chart.

“I don’t feel comfortable prescribing anything,” he said. “Not with everything else you’re on.” He said it was probably safe to take Tylenol and politely but firmly indicated it was time for me to go. The next day my eardrum ruptured and I was left with minor but permanent hearing loss.

Another time I was lying on the examining table when a gastroenterologist I was seeing for the first time looked at my list of drugs and shook her finger in my face. “You better get yourself together psychologically,” she said, “or your stomach is never going to get any better.”

If you met me, you’d never know I was mentally ill. In fact, I’ve gone through most of my adult life without anyone ever knowing — except when I’ve had to reveal it to a doctor. And that revelation changes everything. It wipes clean the rest of my résumé, my education, my accomplishments, reduces me to a diagnosis.
A large part of becoming a doctor involves two skills: observing things about patients, and learning how to transform those observations into words that will make sense to other doctors. Both come with time and practice. You’ll get better at this, so don’t stress about it.
—  Me to a nervous pre-med student, after having the honor of listening to her first ever “history and physical” presentation.
10 Tips For You Newbie Doctors from Someone Who Was in Your Shoes Not Too Long Ago

Soooo black Wednesday has been and gone. For the unintiated this is the day when all the fresh doctors from medical school arrive to take up their first jobs.

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(no, we’ll be fine! I promise!)

I am a year senior so we get inducted and start around 2 days later than the newbie doctors. When I finally met the 2 doctors under my tutelage one of them burst into tears in a mixed state of happiness at my arriving and reflection of her struggles during the last couple of days and the other was clearly stressed out of her mind and putting on a brave face.

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Over the next week I gave them some advice and guidance and they started leaving on time and in fact became much more confident with their role. We even have bowling with the team to look forward to now that everyone has settled in.

I hope to share the advice I gave them with anyone else who is a new doctor and finding things daunting. This is advice from someone who has been in your shoes and needed this advice at that time. Hope it helps.

1. You should never be I’m a position where you are the last port of call for medical advice - you will always have seniors to ask advice from. Please seek their advice and don’t feel you are alone. We expect this of you in the first few weeks. This leads me onto…

2. If there is any doubt…ASK! - A junior that is not aware of their limited knowledge and of when they should call for advice is a dangerous doctor. If you have any doubt just run it by a senior. Do not think this makes you a worse doctor. It makes you a better one.

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3. The senior nurse is a font of knowledge - you can always ask their advice on things. They have been there for years and will know the ins and outs of the wards. Want to know what the usual discharge planning for a fractured neck of femur is? Ask the sister. Want to know what clinics you can refer your patient to? Ask the sister. Want to get someone to calm down a patient’s family since you are preoccupied….who you gonna call? Just hope you don’t have a matron/sister like this one…..

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4. Get to grips with the history of all your patients - when you are doing the ward round with the consultant and they say “oh, who was he again?” in reference to a patient you should be able to tell them everything they need to know. If you can do that then the senior doctors and all the nursing staff will have much more confidence in what you say. How can you do that? That leads me onto….

5. Make a patient list that you regularly update and contains the salient things you need to know - I typically make my list at the end of the day and update it very briefly with any new overnight patients the next morning. My list contains patient name, dob, hospital number, comorbidities, presentation and current management, salient blood tests or scan results and an empty box for note making. Read over this list before you start your ward round just to refresh your brain and go wow them with your knowledge!

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6. Blood tests should be checked religiously and don’t forget to book then in advance - most hospitals have a phlebotomy service, do take advantage of them. Book blood tests you want the day before and on Friday for the weekend (let the on call doctors know to check the blood tests during the weekend) and for Monday. When a patient has had blood taken you will typically get results back by around lunch time. Try and specifically allocate yourself a time to review blood tests and don’t leave it to the last minute of the day….discovering a potassium of 7 several hours after the fact is not good practice and will leave you staining your pants at the end of the day…

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8. If you have a portfolio that you need signatures for to show you have competency in skills….Get it filled early. Do not ever wait till the last minute because you will be stressed and may not even get exposure to things you need to get signed off last minute.

9. After work, chill out. Relax. Don’t stress about the day. It’s someone else’s problem now. I strongly recommended going to the gym or doing some sport to keep you fit and get rid of work stress. But do whatever you find helps.

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10. Plan out your career as far as you can. If you want to be a surgeon. Let your team know and ask to help on procedures and get in on research papers and audits. These things are easier to do the earlier you start them!

And finally, have fun. Get to know your team. Have some banter. Crack some jokes. Make lifelong friends. You will have a great year. Till next time dear readers.

DoctorPhantom

7

"Dash Shaw, it’s fair to say, is something of a genius." –Chris Ware

Praise for Shaw’s previous book

New School is about art, about the art that’s in the book itself…There’s stuff going on at other levels, the intuitive, the level of the unconscious, the subconscious I guess you could say…This book is just fascinating…[A] masterful, gorgeous and defiantly odd work that demands close attention—and richly rewards it.” –NPR’s “Best Books of 2013”

Doctors
by Dash Shaw

96-page full color 6” x 8” softcover • $16.99
ISBN: 978-1-60699-803-8

Due to arrive in about 2-4 weeks. Click the thumbnails for larger versions; get more info, see more previews and pre-order your copy here:

http://www.fantagraphics.com/doctors

3

The Woman Who Gave Birth to Rabbits —- The Mary Toft Hoax

In 1726 a bit of odd news swept Britain, apparently in Surrey a woman named Mary Toft was giving birth to rabbits.  According to Toft, one day when working in a field she was startled by a rabbit.  Since then she had been continuously giving birth to still born rabbits and rabbit parts.  News of such an anomaly became sensational, attracting the attention of some of the most popular and learned physicians of the day.  

Under observation by a number of physicians for several weeks, it was noted that Mary Toft gave birth to nine whole baby rabbits (all of which were dead at birth) as well as various assorted bunny parts.  Over time Toft’s case became even more sensational as she gave birth to parts of other animals such as cats and eels.  Incredibly, a number of physicians examined her, all of whom declared the phenomenon to be genuine and natural.  Many traveled hundreds of miles from other countries, and were considered to be the most learned and educated men in all of Europe.

In December of 1726, Thomas Onslow, the Earl of Onslow investigated the matter and discovered that Toft’s husband, Joshua Toft, had been purchasing rabbits for the past several months.  On December 3rd he caught Joshua in the act of smuggling the rabbits into Mary’s room.  Mary Toft was threatened with a painful exploratory surgery to uncover the truth of the matter, at which point she confessed to the hoax.

As it turns out, over the past several months Toft had been appearing to give birth to rabbits by inserting small rabbits and rabbit parts into her nether regions up where the sun don’t shine.  While weird and disgusting, the hoax created a continent wide scandal that rocked the medical community.  People all over Britain and Europe were shocked that supposedly the best physicians and scientists in the world could be so foolishly misled.  Those who had been duped by the hoax saw their reputation and careers instantly ruined, among them the noted physician Dr. Nathaniel St. Adre, personal surgeon to King George I.  

As for Mary Toft, the rabbit birthing woman was charged with fraud, but acquitted upon intervention of the medical community, who didn’t want the trial to continue leading to further embarrassment.  Toft was later arrested and imprisoned for receiving stolen goods.  She died in 1763.

Many people have been submitting pictures and stories to improvingbirth.org.

These stories are heartbreaking and terrifying. The people who would do this shouldn’t be medical professionals and certainly shouldn’t be in obstetrics. 

These stories can be incredibly triggering, so be careful.

4

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