Survey Says: Patients Like Pink Hair
Kendra Campbell -- I was utterly amazed by the huge response to my last post about whether or not a med student can have pink hair. I wanted to thank everyone who left a comment. I read every single one, and rather than reply to each one individually, I thought I’d write a post to respond.
By and large it seemed that a good majority of people in the medical profession think that pink hair is simply unacceptable for a med student or doctor. The number one reason people gave is because it could potentially harm patients or threaten quality patient care.
Now if you read the comments closely, you’ll note something quite surprising. The vast majority of patients who commented actually said that they wouldn’t mind having a med student or doctor with pink hair. Some even said that it would be a refreshing change. Of course I can’t take this as fact. The response group is obviously self-selected, and this is in no way a valid study. However, I thought this finding was quite ironic.
Since so many people expressed interest in finding out how this story ends, I thought I’d share my solution to this problem. I decided to shave my hair into a pseudo-mohawk. I shaved the sides super short, and left a two-inch strip of hair down the middle. I then dyed the sides a dark brown color, and the “pseudo-mohawk” portion light blonde.
The result? I guess I have a new age mullet (as the saying goes, “business up front, party in the back). If I want to be more conservative, I simply press the hair down into a less obvious style. But if I want to be a little funkier, I simply spike up the mohawk portion. Voila! I stayed within the range of “human” colors, but still have a non-traditional cut and color combo.
Today was the first day of my psych rotation. I have a lot to say about how my day went, but I’ll save that for a later post. So, how was my hairstyle received? Actually, incredibly well. The doctor who runs the program didn’t even notice my hair, and my attending physician had absolutely no problem with it. None of the staff or patients gave me any strange looks, and in fact, a few of them complimented me on my hair.
If I had to do it all over again, I might have kept the pink. I really got the feeling that although I might have gotten some strange looks at first, I wouldn’t have been sent home, and many of the people would have actually enjoyed it.
Perhaps I will dye it pink sometime in the future. But for the time being, I have found a happy middle ground. I feel pleased and confident with my new style. I don’t feel like I’m trying to be someone I’m not. And honestly, because I felt so relaxed with my new style, I think it came through in my interactions with my colleagues and my patients. I felt like I could really be me. And maybe that’s the best way to treat my patients.
A Father's Example
Ben Bryner -- My dad has a problem. He accumulates books like nobody I've ever seen. I guess this is an occupational hazard (he's a professor), but it's still frankly out of control. When I was growing up I always liked going over to his office. It's always been full of books piled literally from the floor to the ceiling; shelves all the way up one side of the narrow office, file cabinets full of articles, and bookshelves above the cabinets on the other side. And always a couple of rows of books on the floor, lined up with their spines facing the ceiling, and cardboard boxes full of more books stacked up behind the door so it only opened about 45 degrees. I remember when I was a kid he would sometimes hire me to try to organize the books on a Saturday. I realize now that this must have been a ploy to humor me since I liked going there, because by the end of the next week he'd have more books and any system to organize them would be overwhelmed. That office was also where I first used this crazy thing called the Internet, and although my dad has embraced the digital age, he keeps amassing books.
Perri Klaas, the noted pediatrician, author and founder of the Reach Out and Read program that distributes free books to kids at their well-child exams, has said that she can always tell when a kid in her office has been raised in a home full of books. Needless to say, I was very much shaped by the many books I grew up with, not just by the ones I read but by the fact that my parents had so many books that were prominent in the house and they clearly valued them. You can tell something about the people in a house by what's most prominent on the walls, whether it's antique china, old photographs, or taxidermied moose heads. At my parents', besides art that's been made by people in my family, the dominant objects of decor are books, because my dad's book collection has spread from the office and invaded the house.
As my dad took on more and more different projects, folding what most people would consider a second career into his existing one, the book collection expanded. This photo shows my dad's home office when I went to visit a couple of weeks ago, but the "playroom" where my brothers and I used to build Lego castles and pretend to be ninjas is also now full of bookshelves and small book-piles as well. My mom seems to be OK with (or at least resigned to) what others might consider a biblical-scale plague of books. Once you consider the books part of the furniture you can sort of ignore them; if my brothers and I were still kids we'd probably just be playing Ninja Librarians around them ("Are you returning this book late? No, no fee... just a katana-battle to the death!!").
What does medicine have to do with all of this? Well, doctors are surrounded by piles of information, new evidence that piles up daily all around them and never gets any smaller. Much of it is useful, much of it can be summarized, but there's no getting around the fact that there is more information than anybody can ever hope to categorize and master. This lesson gets reinforced every time I undertake a literature search before starting another research project. All of us in medicine are surrounded by heaps of information, and while we can hopefully convert some of that into our own actual knowledge, there will always be another heap waiting.
As much as I make fun of my father for this seemingly uncontrollable propensity for collecting books, I love books as well. Another trait I inherited from him is that I'm only really satisfied with work when I have too many things to do. My dad thrives on the challenge posed by juggling several projects, researching and writing so much that it amazes me, while traveling around to dozens of conferences and meetings and still staying very involved in our lives. This year I've tried my hand at juggling more projects than before, and in doing that I've recognized that my dad must have truly amazing time-management skills. Time management is probably the most important skill you learn in medical school, because without it you don't have enough time to learn the other ones.
More importantly than a love for reading, though, was the emphasis my dad placed on the need to stand up for the disadvantaged and to be a responsible citizen. I've gone into a different line of work than he did, and while I never felt any pressure to go into any particular field, it was always clear that I should pick a career that allowed me to make a difference in people's lives. I certainly hope my career will do that -- my choice to be a doctor had something to do with him anyway, since it was on a trip to northern Mexico with one of his classes when I realized I wanted to be a doctor. I was 15 years old, and the trip both opened my eyes to the reality of poverty in other countries, and showed me the need for physicians who are passionate about global health. So hopefully, twenty years from now when I'm neck-deep in clinical duties, research projects, conferences, and work on global health issues and trying to balance those with family, I'll still be inspired by my dad’s example. By then the books will fill their entire house, so I’ll picture my dad looking up from his typing, searching up and down one of many imposing nine-foot pillars of books for the right volume, and then forging ahead with his work.
Obviously my dad's got a large backlog of reading to do, and he may not get a chance to read this for a while. Anyway, Dad, when you do get to this, Happy Father's Day 2015, and thanks for everything.
The Scariest Med Student of All
You know those med students I’m talking about.
The Gunners. Every med school class has them. Usually there are multiple Gunners to a class. Being a Gunner isn’t necessarily all bad, all the time. In fact, some people take it as a compliment, meaning they’ll go the “extra mile” to learn.
But it doesn’t stop there. There exists something much more evil and far more frightening. The evil med student archetype that you may not know about, though nearly every class has one, is The Gunner’s more extreme counterpart, The Sniper.
Being a Sniper is different. It’s all bad, all the time. The term itself is relatively new, occupying the extreme end of the med school overachievement spectrum. While a Gunner is aggressive, a Sniper is malicious. While a Gunner shows off, a Sniper puts you down. Next to the guy who coughs in your face every morning during Pediatrics, a Sniper is the last person you want to do a rotation with.
A few comparisons:
-GUNNER: Reads. A lot.
-SNIPER: Checks out all four library copies of the “suggested” textbook for your rotation.
-GUNNER: Puts his pager number at the top of the list on any given service.
-SNIPER: Creates the pager list on any given service, and accidentally mistypes the pager numbers for the other two medical students.
-GUNNER: Suggests during rounds that perhaps he could give a short presentation on Disease X, prompting you to follow with “And I can present Disease Y.”
-SNIPER: Approaches the attending after rounds to offer a similar presentation, and then surprises you by doing said presentation the next day, while you remain presentation-less and lazy-looking.
-GUNNER: Finds obscure online resources and/or notes from previous classes, posts 20 links to online forum under the heading “FYI”.
-SNIPER: Finds online resources and notes, denies having any study materials when asked by a classmate in need.
Unfortunately for them and for all the hard work they put into their craft, being a Gunner or a Sniper can backfire. (You get it? A Gunner/Sniper backfiring? Haha. Ok.) Residents and attendings often see right through the aggressive attitude, and some don’t like it.
I’ve had classes with many a Gunner, and rotations with a few, and been called one myself. I don’t think I’ve ever made direct contact with a Sniper (although part of their sneakiness lies in their non-identification). They can be hard to spot. Beware!
If anyone out there has had a run-in with a Sniper, or a particularly bad experience with a Gunner, do share!
Can a Med Student Have Pink Hair?
Kendra Campbell -- I mentioned my pink hair in my last post, and some of you very observant folks out there may have noticed that my hair in the picture was in fact light brown. So, I thought I’d give some explanation for that, and also pose a question to the world. If you’ve been reading my posts for a while, you’ll know that I have gone through many different permutations of hair colors in my life. My hair has been every shade of the rainbow, and I’ve also cut it in many interesting ways.
Over a year ago, I wrote a post about whether or not it’s appropriate for a doctor to have a pink mohawk. I received a very big response, and it seems that everyone had varying views. At the time, I had just finished my first semester of basic science courses and wasn’t involved in patient contact, so I could sport my pink mohawk without anyone really caring. Eventually, my third and fourth semesters rolled around, and since I was involved in patient care and was required to dress “professionally,” I dyed my hair brown and had it cut as “professionally” as I could muster.
However, as soon as my break between classes would arrive, I’d either shave my head bald or into a mohawk and dye it a fun color. At the end of my fifth semester, which involved rotating at a hospital, I dyed my hair bright pink, and it’s been like that ever since. Because I have been studying for the USLME Step 1, I haven’t seen any patients or had to participate in any “professional” activities, so I could pretty much do whatever I pleased with my hair.
Now comes the hard part. I’ll be starting a psychiatric rotation in less than two weeks. I pretty much had planned on dyeing my hair brown or some other natural color, until a few days ago. I started thinking about it, and wondered what would happen if I didn’t. I’m not sure of the hospital’s policy, but I have a feeling that they wouldn’t necessarily send me home if I showed up on my first day with pink hair.
Some of you might be thinking that I’m crazy for even considering doing this. I understand. Why start problems if you don’t have to, right? Yes, I get that. But my hair is as much a part of me as anything. Why should I have to change it just to blend in? Anyone who knows me will tell you that my bright hair simply matches my personality. If no one is going to be harmed by my hair, what’s the big deal?
My other option would be to show up with “normal” hair on my first day, and maybe for the first week, until everyone gets to know me. Then, I could think about dyeing it to something more fun. But that just seems kind of fake to me. And maybe I’d get a worse reaction if I did it that way.
The other thing to consider is that this is in fact a psychiatric rotation. I’ve worked in psych before, and I know that anything that draws attention to you can be both good and bad. Sometimes it might help to break the ice with a patient, but other times it might be the focus of some psychotic delusion. You have to be very careful.
So, that’s my hair dilemma. Yes, I know there are more important things to worry about other than the color of my hair. But this just happens to be on my mind today, so I thought I’d pose the question to all of you out there to get your feedback. Can a medical student have pink hair?
Chicago on $1000 a Day
Ben Bryner -- Of the many hoops through which one must jump to finish medical school or obtain a residency in the U.S., the United States Medical Licensing Exam Step 2 – Clinical Skills Examination is perhaps the most awkwardly named. It’s also one of the most expensive, at just over a thousand dollars. Besides tuition, it’s hard to think of a larger single expense associated with medical school. It’s expensive because it involves several standardized patients in a series of exam rooms, around which test-takers rotate in rapid succession. These patients are trained to offer a complaint and a history and cooperate with a physical exam consistent with a disease from almost any area of medicine. Good news for those deathly afraid of children, though -– no kids are among the patients. Instead, in one exam room you may find a telephone with a parent on the other end of the line, describing his or her child’s complaint.
Once the history and exam are completed, the test-takers step outside to draft a note describing the encounter and list potential diagnoses and necessary tests. These can be typed or handwritten, depending on your preference. Since my hospital’s medical records are electronic, I’m more used to typing and I went with that, but it seemed like most of the people around me were writing with pencils. It probably doesn’t matter much, although I ran out of space in some of the typing fields.
The American Medical Student Association recently ran an article on the test. Key quote, from Dr. Ann Jobe of the National Board of Medical Examiners’ (NBME) Clinical Skills Collaboration Evaluation: “Most students spend $2,000 or less for everything, including travel and lodging. Students spend more going to residency interviews than taking this test.” Medical students are probably the only group of people who anyone would try to pacify by telling them that a test costs less than $2,000. And interviews allow you to meet and evaluate your potential teachers and workplace, while the exam allows you to hang out with strangers in an office building for a day.
The test seems like an unnecessary burden on students, who must travel to one of only five testing centers in the country, and adds one more expense to an already long list. Although I’m not too far from the site in Chicago, some students have to trek pretty far. I have my doubts as to its ability to weed out those with inferior skills, and the assessments of the test will not be available for years. For me the test was certainly anticlimactic –- like many, our med school already has a similar (but more difficult and comprehensive) clinical skills exam at the end of the first clinical year.
On the other hand, the pass rate is very high and no numbered scores are reported, as they are for other USMLE exam steps. Not having the scores takes a lot of the element of stress out of the CS exam. It also beats board exams for dental school, in which patients must find their own patients (sometimes paying quite a bit to find them) on which to perform certain procedures. Also, since it takes up most of a day to do Step 2 CS’s paperwork, see the standardized patients and write notes, at the lunch break they give you a sandwich and a can of soda. It’s not much, but for a standardized test it’s unorthodox in its generosity -– when I took the SAT and the MCAT I certainly had to bring my own sandwiches.
So I tried to enjoy the sandwich, just as I tried to enjoy the test in general by making a weekend out of it. I had a good time hanging out in Chicago for a couple of days after the test. Including the testing fee it was the most expensive vacation I’ve taken in a while. But if I don’t have the time or money to take the vacations I want, at least I can enjoy the ones I’m forced to take.
What's That Smell?
Thomas Robey -- Is there another profession where one can expect to routinely encounter such a diverse array of odors as occur in medicine? Clinical aroma may not be the most pungent or revolting of smells –- crime scene cleaners are probably worse –- but in what other career is identifying foul fragrances actually an important skill? The differential diagnosis from one odor could easily include abscess vs. BO vs. foot fungus. Sure, some specialties and patient populations may have an increased preponderance of smelly patients, but it’s a given that medical students and residents encounter a fair share of smells before choosing their practice.
As for me, I hope to refine an olfactory prowess so it may add to my clinical armamentarium when I practice in an urban emergency room. As such, I’ve compiled a list of top twelve smells of medicine. Why twelve? So that this can be converted to a calendar, of course! I’ll leave it to the comments section for proposed images for these smells. Note that I took liberties with some of the Latin medical-sounding words. Some are diagnostic scents, others are odors you just need to learn to deal with.
1. Ketohalitosis (fruity breath)
2. Pungent Urine (usually dried into clothes)
3. Feculent Abdomen
4. Anaerobic Abscess
5. Operating Room Flatus
6. Bromodrosis (smelly feet)
7. Ichthiosmia (the fishy smell of bacterial vaginosis)
8. Post-Op Diarrhea
9. Halitosis (applies to some attendings)
10. Vomit (ideally, not on your scrubs)
11. Bromhidrosis (body odor)
12. The Smell of Labor
Please let me know if you’d like to go in together in marketing a “Smells of Medicine” calendar.
A Guide to Guidelines
Anna Burkhead -- Before medical school, and probably up until the beginning of third year, I had never even heard of “guidelines” in medical practice. I guess I just thought that docs prescribed what they wanted and ordered the tests that they wanted whenever they felt the need. Well, it turns out that there are entire organizations devoted to the creation of “guidelines”. Medical guidelines (also known as clinical protocol or clinical guidelines) are based on evidence and current data, and provide suggestions and criteria for prevention, diagnosis, prognosis, and therapy.
Guidelines have existed in some form or another since the advent of medicine. In much older times, they were based on traditional wisdom and authority, whereas today’s guidelines are evidence-based.
The purpose of guidelines is to provide the ideal (most effective and most cost-effective) care to patients and reduce risk for all parties involved in healthcare. Following guidelines also standardizes medical care and thus serves to diminish conscious or unconscious prejudice in doctors.
Doctors are not “required” to follow guidelines (no medical police will come after you if your patient with blood pressure 144/82 is not treated), but there may be questions for the doctor if that patient had a stroke or heart attack with untreated hypertension.
Many, many, many professional physician organizations produce guidelines. It can be overwhelming to sort through them. Here are a few good places to look for US medical guidelines.
* National Guideline Clearinghouse: http://www.guideline.gov/
(You can browse by organization or by disease)
* Agency for Healthcare Research and Quality: http://www.ahrq.gov/
(This is the parent organization to the NGC, above)
* American Heart Association guidelines: http://www.americanheart.org
(Click on "For Healthcare Professionals", then "Statements and Guidelines")
* American Academy of Family Physicians guidelines: http://www.aafp.org
(Click on "Clinical Care and Research", then "Clinical Recs")
* American Diabetes Association guidelines: http://www.diabetes.org
(Click on "For Health Professions", then "Clinical Practice Recommendations")
I have one last plug for clinical guidelines. Of course, knowing guidelines and adhering to them will protect your patients, yourself, and your future employer/organization. But, to all the medical students out there, nothing will make you look smarter, and impress your attending more, than to say (in the least snooty way possible! Make a mental note that constantly quoting guidelines will make enemies of your medical school peers, and will not impress attendings), “The recent updates to the AHA’s STEMI Guidelines give a Class I recommendation to early oral beta-blockers for STEMI patients without contraindications, whereas IV beta-blockers are a Class IIa recommendation due to the higher risk of cardiogenic shock.” Whew, that was a mouthful.