Dr. H. Gilbert Welch has written a new book Over-diagnosed: Making People Sick in the Pursuit of Health, with co-authors Lisa Schwartz and Steven Woloshin…

From this blogger’s review of the book:

We are healthier, but we are increasingly being told we are sick. We are labeled with diagnoses that may not mean anything to our health. People used to go to the doctor when they were sick, and diagnoses were based on symptoms. Today diagnoses are increasingly made on the basis of detected abnormalities in people who have no symptoms and might never have developed them. Overdiagnosis constitutes one of the biggest problems in modern medicine. Welch explains why and calls for a new paradigm to correct the problem.

The “risk/benefit ratio” for tests/interventions is a very important topic in modern medicine. And IMO, med students are taught very well how to know/emphasize the potential benefits of various medications and screening tests, but NOT enough about the subtle risks of “over-treatment” in situations where the patient has no symptoms.

(Thanks to long-time Cranquistador doctom666 for the link!)


P - How are you feeling?
me - I don’t know.
P - are you depressed?
me - i don’t know anymore, it all feels the same.
P - What feels the same?
me - everything.
P - By everything, do you mean life?
me - obviously, hence the word everything (sweeping arm gesture)
P - You seem agitated Mr Turnage. 
me - you’re very perceptive Doc.
P - Are you angry at me? 
me - obviously.
P - Tell me why, please be specific.
me - ok, it’s because i get pressured into coming here to see you, to get help, and mostly all you do is tell me shit that i already know. plus you come off as an arrogant elitist asshat… hows that for specific? 
P - Ok, I hear what you are saying… so,  Everything. 
me - yup.

Oh My Lord

The end of October/early November is going to be a busy busy time.

Oct. 27th - Start a new block in med school.
Oct. 29th - Fly to the Bay Area. Catch up on things I missed.
Oct. 30th - Deliver a talk at Stanford School of Medicine on medical education, technology, and culture shift. (If that kind of stuff interests you, register for this FREE Stanford course. You’ll see me talk!)
Oct. 31st - Fly back to Portland and catch up on school work.
Nov. 1st - Go to University of Oregon v. Stanford football game.
Nov. 2nd - Drive back to Portland. Catch up on school work. Study butt off.
Nov. 3rd - Resume studying butt off.
Nov. 4th - Take a test on things I studied my butt off on (officially the most awkward sentence I’ve ever written).
Nov. 5th - Continue studying butt off.
Nov. 10th - Pretend like I’m a doctor at an OSCE.
Nov. 11th - Furiously study butt off.
Nov. 12th - Take another test on things I studied by butt off on. Immediately collapse after turning in test and proceed to nap on lecture hall floor while sobbing tears of sweet joy.

It’s a miracle I’m surviving medical school without coffee.

bright sunshiny day

On peds, I’m working with residents and with other med students for the first time. So far I think they’re all awesome. 

One of the residents asked about my last rotation. I told her a little about it, and she was like, “wait… I did that same OB rotation. Were you with that GUY? Gawd, I haaaaated that guy. That rotation was terrible.” Ha. NOT JUST ME.

Speaking of Dr. OBnoxious, I filled out an evaluation on him this morning. It was, by far, the harshest eval that I have ever given anybody. It honest and fair, but still a little hard for me to write. I’d so much rather give positive feedback, but the man was a terrible teacher. 

My new set of attendings seems great. I’m excited about them. And the patients are very cute so far. 

anonymous said:

my dysphoria is getting so horrible, I can barely get out of bed. I'm on antidepressants but they're not helping. I've missed days of college, and I can't figure out how to approach my professors (I can't come out to them yet) and let them know why I haven't been showing up and why my grades are so bad. I need help

Ren says:

Who’s prescribed you the antidepressants? You need to talk to them and explain that they aren’t helping, or that you need further help - intervention on your dysphoria, especially, if that is possible.

Emailing your professors would be…the best plan…but if you can’t come out to them I’m not sure what to tell you. You can at least explain to them that it’s depression/mental health preventing you from performing at your fullest - you wouldn’t exactly be lying.

I’m glad you’ve recognized that something needs to change, though. You need to see someone who can help you figure out strategies for your dysphoria, ways you can start transitioning if that would help, and medication that will work better for you. (If your meds aren’t helping, you should be on different meds, yeah?)

I’m sorry you’re in this situation, but know that we’re all here for you, okay? Stay strong. You are valid and your struggle is valid - you will get through this and we are behind you the whole way. <3

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