There’re 15 more minutes left of my birthdayyyyyyy!!!! wheeeeeeeeee
I am an old sucker, poor me….all 29 years of me~~ At least I have a great girlfriend who likes me for who I am!!!!
/)_/)
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c( (“).(“)

New horizons in Medicine

Amazing, I’m watching a Natural Orifice Endoscopic surgery, basically laparoscopic surgery where they basically cut a hole in the stomach and stick an endoscope through and perform surgeries like hysterectomies, peritoneal debridement, liver biopsies etc.

Its amazing to watch medicine and surgery undergoing this major shift toward minimally invasive techniques (minimize scarring, infection, procedure time, anesthesia). I saw it in Neurosurgery with the advancement of ultrasound based spatial imaging with DBS placement and now in GI with basically supplanting laparoscopic surgery through the endoscope.

I think we are entering an age where the line between surgeons and non-surgeons is becoming blurred. Surgery is becoming less and less invasive, and medicine becoming more and more invasive.

Rich Rothstein here is even talking about breast implants through endoscopy! Imagine swallowing your breast implants!

Fashionable Health: How to make money helping the poor

It just occurred to me thinking again about my last few meetings with Prof Chu and the idea that instead of preaching behavioral changes for the sake of health, mental sanity, prolonging life or other seemingly far away risks with uncertain consequences, the goal of changing someones health maintenance behavior really ties in very well with culture, social image, fashion. Its amazing how willing we all are to change our behavior, even enduring pain (such as by putting on high heeled shoes) to look fashionable, attractive to the opposite sex etc. Well, why can’t we channel this insatiable urge to look “cool” in front of our peers or “fit in” toward a beneficial health consequence? In my own case, I think to the time I was trying to fit in during high school and ended up learning how to read Chinese characters by singing KTV. Every week, I would buy the latest CDs and bring them home to play them and memorize the characters and every weekend, when my friends and I would go singing, the boys would croon their newest tunes in front of the ladies. It was silly and in any other context, I would not be caught dead trying to sing nor did I have any desire to really learn how to read Chinese at the time, but somehow the incredible need to fit in and be cool and the unquenchable teenage sex drive I had really made “studying” Chinese an imperative part of my life.

So this is really the fundamental idea behind commercializable health interventions, the idea that people don’t change their health behavior for the sake of good health but they might really take to the idea that good health is not just healthy but can be fashionable, sexy or cool too.

Case in point: the explosion of this DMS alum founded website: http://www.grassrootsoccer.org/

Dartmouth to San Francisco? Sweet

Just heard from Dr. N that we might be setting up a deal with a hospital in San Fran to add more clerkship sites for 3rd year! Sweeeet

That is, IF I pass my boards in June

Ruling out neurosurgery? Ruling in Hospital Medicine?

So last week I finally shadowed a neurosurgeon. I went into it thinking that I would like to do neurosurg for the following reasons

1) The brain is my fav organ system
2) I like working with sick patients (neurology patients tend to be more chronic outpatient care which I don’t like so much)
3) Neuro is a wide open field with a lot of growth potential and where the potential for technology innovation is HUGE in the coming decades
4) The idea of doing something where you really have a chance to help people in a profound way (I saw a neurosurgery patient with a DBS device who literally demonstrated turning on and turning off a debilitating tremor)

However, my experience was somewhat less satisfying. Although Dr. R, the Chairman of Neurosurg here graciously offered to let me shadow him and is one of the most dynamic docs I’ve met so far here, I found myself being a bit appalled at the culture. For example the chief resident, upon learning that the intern was post-call (which means that he had been up for 30 hours already and was leaving that morning to go home) referred to the intern as part of the “new generation that has to go home”. As for the surgeries themselves (I got to watch a temporal lobectomy and a DBS placement), I found myself not enjoying standing (very) still in one place breathing through my mask and not looking forward to 2-3 years of doing suturing as an “assistant” in the early years of residency before actually performing surgeries. I also didn’t like that the surgeons are so bound in one place and one function by their patients and that the residents all seemed really hard core and uni-dimensional. Overall, I think its a fantastic field but the adrenaline rush of doing these very long and very precise and methodical procedures has to be such a high that you forget what time it is, forget your need to go outside, go home, and have a life outside the hospital for you to really be able to even survive the training for something like neurosurg or any surgery for that matter. Unfortunately, I think for me, its really not enough and I found myself missing the constant excitement and diversity of patients, managing expectations and communicating and leading the hospital team activities of my inpatient rounds with Dr. Perras in Hospital medicine.

One highlight from the day though was our second patient who coded (likely due to some error in anesthesia) during a routine procedure and the ensuing chaos of trying to resuscitate him, thinking at one point that he was gone and feeling an eery tingly feeling go from my head down to my spine through my arms and legs. It was like one part shock, one part excitement, one part helplessness and I think it made me want to go into ER or ICU medicine even more than neurosurg!

Finally starting to get this health prevention stuff

So I met with Prof Chu again, the HBS professor I have been meeting with who made a few very convincing points about health prevention and economic decision making. The interesting thing is that human beings can be both extremely rational yet also extremely irrational. Rational when for example, deciding between planting cassava and potatoes as a farmer in Burundi and irrational when making health prevention decisions. For instance, we are very irrational in changing our behavior when the doctor tells us that we shouldn’t eat that fifteenth donut because of pre-diabetes and hypertension. Yet we are also irrational when for example women decide to wear high heeled shoes which kill your feet but are “fashionable”. Is there a way that our irrationalities could actually cancel one another out in a productive, health improving way? Prof Chu’s belief is that it can in a sustainable way. His current project between HBS and Harvard School of Public Health is trying to figure out some projects that would do exactly this.