Gene's Joint

Don’t shoot the messenger!

I inserted myself (as I have a tendency to do) in the middle of a two folks who had a disagreement with each other. Note to self: Don’t do this in the future, people tend to shoot the messenger!
In this case, though I think both appreciated this and actually welcomed my interjection. In the process, I learned something about both people’s reputations. More importantly, I learned how important reputation is, how fast rumors travel and how as you develop a history, you travel with that history wherever you go. Success in life is often about pleasing the herd. One mishap in your past can easily spook the herd and lead a stampede away from you.

Texture of the day

I recently had a nice conversation with Krishna, a fellow MD/MBA who had a wonderful saying which I thought worthy of writing down. He said that far more important than specific goals or accomplishments was the “texture of the day”. Similarly I have found the most fulfilling days have been ones where I have been able to learn something new, feel a part of building something exciting, feel helped or helpful to someone else, and most importantly feel connected with people and loved.

Wine!

Randall Grahm from Bonny Doon vineyards came to talk and taste today. Awesome! Will have to follow up on Edmund St John, Renaissance wineries.

Learned the following

– Terroir means from the place and minimalist wines that allow for nature to influence the wine rather than ‘effort based’ wine which winemaker controls everything

-I love Albarino wine, gotta get to Galicia some day

-invest in good glasses

Pay attention to what is right in front of you

I have ADHD, Attention Deficit Hyperactivity Disorder. I am certain of it. According to the DSMIV aka the bible of psychiatric diagnoses, I have 5 cardinal features of the inattentive type of adult ADHD and 5 features of the hyperactive type of adult ADHD. Although technically one needs to have at least 6 cardinal symptoms in each category type, I am pretty convinced that I am on the spectrum and pretty durn close to meeting the clinical criteria for a diagnosis.

Unfortunately, the choices for treatment leaves the subclinical ADHDer much to be desired. One the one hand there is pharmacologic treatment which consists of drugs like addicting amphetamines and atomoxetine which is a non amphetamine but have a few side effects of its own like suicidal ideation (whoo hoo). On the other hand there are behavioral changes such as getting more regular sleep and exercise which if I could change on my own, I probably wouldn’t be writing/complaining about having ADHD.

Finally there is an interesting treatment I came across called Neurofeedback which is a form of biofeedback where one looks at an EEG while doing a series of attention and hyperactivity tests to literally adjust one’s responses in real time. The literature on it at first rub also seems to be quite positive including several studies that look out 3-5-10 years at children treated for ADD who on follow up actually sustain the benefits of treatment. I wonder why the lack of adoption? The great ADHDer that I am though, I bet I will forget about it eventually and move onto the next thing like I always do :)

http://www.neurofeedback-scotland.com/support-files/efficacyneurofeedback-kaiser.pdf

Good Residency Interview Questions

I am going to start keeping a log of good interview questions I think of along the residency interview trail, feel free to post yours!

-To Chair: How does this program balance education, research and clinical care among its faculty? For example, how much non clinical time do the core faculty have?

– To Program Directors: Please explain why you received a ____ year instead of a five year ACGME accreditation and whether you had any citations

– Tell me about a time you mentored an resident and what lesson you taught them
– If you were me, what opportunities for would you take advantage of in your CA-3 year?
– To resident: On average, how many hours of sleep do you get per night, how many hours of reading per night? Off the top of your head, who do you dread being in a room with?

-To senior resident: What frequency % decisions do you get to make? Tell me about someone who has mentored you here. What was the last change they made in the program as a result of resident feedback? How politically involved, how much research, extramural activities do the residents get involved with?

What really matters? A spoonful of water in a hot bath

After staying with Ariel, Dan and Jenny and their kids for a couple of days in SF, I feel like I have a deeper appreciation for what really matters. Its not the glitz or dollars. What really matters at the end of the day is having a warm comfortable place to come home to. Put another way, its the family, stupid.

I watched Amber, Ariel’s daughter have a baby bath today with her mom and grandma taking turns pouring cupfuls of water on her as she squealed in delight. Now that’s happiness . . .

Someone remind me to install a jacuzzi in my mansion . . . make that two, one for the mansion and one for the stretch . . . :)

Anatomy of a great day

Today was a great day at the end of which I feel happy, excited and content. What were the elements?
Great nights sleep, feeling like I could take my time to catch up and put things in perspective after a long week of non stop interviews, a great lunch at a new eatery with good service and excellent service, finding a new bookstore and learning a little (read a few pages of Mike kryzewskis book about the gold medal bball team), feeling like my career is going somewhere(went to a good residency dinner), talking with someone I care about(Jane) and building something exciting (working on a Tuck healthcare club event) and receiving a compliment (from the editor in chief of the A&A journal whom I interviewed with in NYC)

Anatomy of a great day

Today was a great day at the end of which I feel happy, excited and content. What were the elements?
Great nights sleep, feeling like I could take my time to catch up and put things in perspective after a long week of non stop interviews, a great lunch at a new eatery with good service and excellent service, finding a new bookstore and learning a little (read a few pages of Mike kryzewskis book about the gold medal bball team), feeling like my career is going somewhere(went to a good residency dinner), talking with someone I care about(Jane) and building something exciting (working on a Tuck healthcare club event) and receiving a compliment (from the editor in chief of the A&A journal whom I interviewed with in NYC)

Something about Tejas

I’m in a Turkish cafe in the Rice Village in Houston (apparently Rice refers to the university not the food). Just had a tasty lamb kebab plate for 9 bucks and the waiter even threw in some extra bread and yoghurt for free. The service was good and fast and friendly. It’s interesting to compare this to the rest of the populous places in the country where people complain and the service and attitudes are horrible. My parents when they visited a couple of years ago made the comment that America was no longer the beacon of progress that it once was. Perhaps there really is something to be said for a laissez faire government that is proactive about attracting business and talent to the state with pro business income tax, tort reform and a low cost of living. Maybe life in Houston would not be bad after all as it would represent a real diverse setting, low cost of living and high salaries with a growing life sciences sector driven by institutions like Baylor, MD Anderson, Rice in the setting of a pro business and pro innovation government. Well we will see how my interview goes tomorrow with the Anesthesiology department here. If only I can get overthr whole perception about being in the “hick” south.

Residency Interview Update

So it occurs to me that I should probably start blogging about the residency interview trail as that is what I will be living and breathing over the next two months. First, Anesthesiology is a four year training program, first year is called the Clinical Base Year which can either be a surgery year where I play surgeon’s bitch and run around managing surgery patients so the real surgeons can be in the OR, medicine preliminary where I get to play medicine doc and do pretty much the same stuff as the residents or transitional year which is a mix of both with some obstetrics and pediatrics thrown in. Then there are actually 3 years of Anesthesiology training.

What this means for residency applications is that I will be interviewing for both programs. One track is the internship year interviews and the other is the resdiency interviews. So far I have had two interviews for Anesthesiology and one for preliminary medicine. What’s my goal program? Honestly for intern year I would love to do a preliminary medicine year in a place where I will learn something but not hate my life too much. For anesthesiology, I really have three criteria: work-life balance, high program reputation, mentorship and location. I am hoping to find a warm place with some good mentors and decent hours that will allow me a bit of time to read, enjoy life and who knows maybe even start a business after my training. I throw reputation of program in there for two reasons. First, I suppose I do want a program with a good reputation mostly because I want to feel like I can rely on my training years from now even if I do not do 100% clinical work. As a mentor at Stanford who works mostly in the ICU, does anesthesia a month out of the year in rural Africa and runs a basic science lab told me, you want to get the best training so when you go do something else, you can always have your training to fall back on.

So far, I have interviewed at 2 programs for anesthesiology, DHMC and NYU and one for preliminary medicine St. Luke’s Roosevelt in NYC. They were fun interviews. As my home program, DHMC rates pretty highly on mentorship and work-life balance, decently on reputation of program and low to medium on location. On a gut feel level, I know I will be happy here although I will feel a bit like I am never going to leave. NYU on the other hand rates medium on work-life balance although the chief residents did a pretty good job selling the place and I did see some smiling post-call residents on the way into the room. They rate high on location obviously, medium-low on reputation of program and medium-low on mentorship although I haven’t had a real conversation with any of the attendings yet. Overall gut feel was that it would be an all right place for 3 years but I could do better.

St Luke’s Roosevelt was interesting, I actually thought that the program was pretty well organized with a “drip admissions” system where you get 1 day off consistently every week, staggered blocks of electives throughout the year and never have overnight call. Overall, I think you have 3 really light months, 3 moderate months and 6 heavier months which ain’t bad. I would say its probably a medium-high on work-life, high on location, medium on mentorship, low on reputation. Overall gut feel is pretty moderate.

Next up, Columbia followed by UT Southwestern in Dallas, Baylor in Houston, UCI, UCLA Harbor for prelim then UC Davis and Kaiser Permanente in Oakland and then its off to Chicago for Loyola and Northwestern before a break for the holidays. Wish me luck!