Just a quick jaunt through my thoughts this morning:

Within the world of academic medicine and scientific research, I often find myself surrounded by individuals who have large egos.  They think a lot of themselves, and sometimes not much of anyone else.  And a lot of times, it could be argued, it’s justifiable.  They’ve done great things, and they’re great at what they do.  But just because you can have a big ego doesn’t mean you should.

So I wondered: do these people realize that most of their students and “underlings” only seek their approval to the extent that it serves their own personal interests?  People don’t like the big-headed people because they’re fun to be around; they pretend to like them because they have power to influence their futures.  This is the definition of kissing someone’s ass.  And I wonder if those whose asses are frequently kissed realize that a large proportion of the sucking up isn’t because they are truly that good at what they do, but because they have the power to influence others’ futures.  Seems to me like that could be an important concept to which someone in power should be fully aware: the concept of “yes-men”.





My life of limbo:

I’m a Mormon.  But I’m pretty liberal on most issues.  I don’t have many Mormon friends.  I absolutely don’t fit in with traditional Mormon culture.  But I also don’t fit in well with non-Mormons.  I don’t drink coffee.  I don’t drink alcohol.  I generally don’t fit in with most of my friends in social situations.  Therefore, I live a life in limbo between two worlds, not quite fitting in with either.

I’m an MD/PhD student.  Grad students think I get a “diet” PhD (which is not the case in my program).  Med students think I’m weird for liking basic science and research.  I don’t quite fit in with either group.  Hence, again, I live a life in limbo between two worlds, not quite fitting in with either.

These are only two examples.  Limbo can be a lonely place.  But at least its quiet, sometimes.


The most recent rephrasing of the term “burnout” is “compassion fatigue”.  At least that’s what they’re calling it among medical professionals.  But I don’t think that’s exactly what I’m feeling.  In fact, I’m certain that it’s not, because I haven’t interacted with very many patients yet.  No, I’m just fatigued.  Compassion has nothing to do with it.

I feel like I could, right now, quit school and be adequately satisfied.  I just finished my second year of medical school and now I’m off to PhD-land to work for the next 4 to 5 years. Before starting in the lab, though, I have the USMLE Step 1 exam.  This is likely one of the most important exams of my life and I should be preparing more than I am, but I feel kind of numb to the urgency.  It’s as if I’ve accepted that a small improvement in my test score isn’t worth the quantity and rigor of the effort required.

I’ve kind of checked out.  And my feelings are even further complicated by my final exam scores that I just received today.  I passed, which is all that matters in the end.  But my score was substantially lower than what I had expected.  This is more of an ego bruise than anything.  I felt like I had done reasonably well.  Getting a low score puts questions into my mind about whether I really know what I’m doing.  (But if you ask any seasoned physician they’d say that no second year really knows what she/he is doing yet.  Somehow that’s not comforting.)  It shook my confidence.  But despite the sting, this is probably good for me.  The last thing this world needs is more overconfident medical students.

Back to PhD-land…

I have a meeting this afternoon with my new mentor.  He’s a strong scientist, an MD/PhD grad, and a nice guy.  But I’m nervous that I have little to discuss with him.  I’ve set up email alerts for papers in certain subjects, but so far that’s as far as I’ve gone.  I haven’t really read any of the papers.  I have ideas, but they’re very broad.  None of them are appropriate thesis ideas.

Since I’m just venting, and this is terribly uninteresting to read, I’ll get to some point…

Bottom line:  I’m stuck in a difficult place right now.  The path of my classmates and friends is diverging from my path.  I’m uncomfortable with mediocrity (even when it’s adequate), but I lack the time, energy, and will to achieve anything more than the minimum required right now.  I guess that’s kind of what burnout is.  My passion for this stuff has faded from a bright flame to a tiny glowing ember.  I really need to find some gas to pour on and start up the fire again.  Tricky part is… if I throw too much on too fast it smothers the ember.  What I need is not too much, not too little, but juuuuuust enough.

That’s another phrase I’ve heard thrown around lately: the “Goldilocks effect”.  My, aren’t we clever.  (forgive the sarcasm)

what is a student?

Today I’ve been thinking a lot about this question.  Here are my thoughts:

A student’s job is to learn.  To try.  To make mistakes.  We are going to mess up.  And that’s the point.  A student needs to be given the space to think, to try, and to get it wrong.  That’s how we learn.

However, of course, this isn’t an all-or-nothing game.  Rather, there is a spectrum between perfection and failure on which each student can be found.  Realize, though, that I’m not referring to grading or performance here.  I’m talking about expectations.  How often is the student expected to reach perfection, or near perfection?  How often is the student allowed to miss the mark?

There is a balance to be sought in this.  The student must be permitted to make mistakes, just not excessively.  If the student is given too much latitude, they will miss out on needed correction and learning.  But if the student is given too little freedom, and is too severely corrected for every error, then the only lesson learned is that of fear — the fear of trying.

The student will learn that the best way to avoid failure is to make no attempt in the first place.  To prevent this, the student must be allowed to make an occasional mistake without the fear of failing an entire class, being held back, or expelled from school.  Only an accumulation of mistakes, or the repetition of prior errors, justifies such drastic punishments.

To use a sports analogy, what would baseball be without three strikes?  Who would (or could) play the game if one swing-and-a-miss was all it took to strike out?  And what would the game be like if one strike was sufficient to eject you from the remainder of the game?  That is why the game has three strikes: to accommodate less than perfection.

I feel like I’m rambling, but this is my point: students are students, and we will mess up.  We’re supposed to.  We need to be held accountable for our mistakes, but not to the same degree as the masters.  Because we’re not masters.  Not yet.  And if we’re not provided an environment in which we can safely attempt to become masters, then we might as well not even try.

At least that’s the lesson we’ll learn.

(Maybe another day I’ll rant about my philosophies on what a teacher is.  I’ll give you a clue: it’s not a simple holder or disseminator of information.  That’s a book’s job.)

HPV = human papillomavirus

Today the CDC expanded its recommendation for the HPV vaccine to boys and young men aged 11-21 years.

Here is my position:

  • HPV can cause cancer; HPV does not cause sex to happen. (If it did, it would be marketed very differently.)
  • Cancer can cause death, sex cannot. True, people can get diseases from sex (including HPV), and those diseases can cause death.  But transmission of those diseases can be minimized and prevented… by things like an HPV vaccine.
  • Therefore, If HPV can cause cancer, and if this can be prevented by a vaccine, then those at risk should get the vaccine if they want to avoid getting cancer.  Either that or guarantee that teenagers won’t have sex.  Good luck with that one.
Now, here are some details about HPV, what it is, and what it does.  This way I can count this as studying, kinda.
  • HPV = human papillomavirus
  • HPV refers to a group of over 100 non-enveloped DNA viruses that use skin and mucosal surfaces for replication
  • only some types (16, 18, 31, 33, 35) can cause cancer (i.e., have oncogenic potential)
  • there are two HPV vaccines: Gardasil protects against four types of virus (16, 18, 6, 11).  Cervarix protects against types 16 & 18 only.  16 & 18 cause about 70% of cervical cancers; 6 and 11 cause about 90% of genital warts.
  • more information can be found here:

who fits who?

You should know, this post has nothing to do with Uncle Sam.

Today at school we started a new “block”.  (Our curriculum is split up into segments of 8-9 weeks called blocks.  The last one was “Brain & Behavior, and we just started “Circulation, Respiration, and Regulation”.)  Each block is led by different physicians and scientists who specialize in the subject matter being taught, so inevitably there are changes in how things are taught each time we begin a new block.  The great thing about starting a new block, then, is watching a room of about 100 med students become very uncomfortable with the changes.  There are the vocal complaints and audible groans, then the pointed questions from high-strung “type A” personalities asking things like “Why are you moving away from a Board-prep style of teaching,” and “Why are you making it like that other block from last year that we hated so much?”

This got me to thinking:  Is the medical school supposed to alter their teaching style to fit the students, or should the medical students try to adapt to a changing situation?  Who should fit who?  Should the school bend to the student’s demands, or should the students accept it as a challenge and move forward?

My opinion:  the student should accept the challenge from the teachers.  Classically, that’s what education is.  The student has always been challenged by the teacher.  (That’s Socrates to the right — I admit that I don’t know much about him or his methods.)  Rather than complaining that the new way of doing things somehow makes it harder to succeed, the student should say, “Okay, so you’re making it more difficult — I’m going to do well anyway!”  Instead of taking that anxious energy and whining about the status quo, focus that energy and blow every test out of the water.  Look at it as a chance to prove that you can do well regardless of the circumstances; an opportunity to show your true mettle.  Prove that you are so destined to become a physician that you’re going to learn the stuff no matter what tries to get in your way!

I think of this kind of response as the “high road”.  Take whatever hand your dealt and make the most of it.  Take a less-than-ideal situation and do extraordinary things.  The “low road”, on the other hand, is just complaining about how it’s somebody else’s fault that things are hard for you.  Nobody likes a whiner.  And nobody is impressed by somebody who does well when everything is stacked in their favor.  But when somebody does well when it’s not easy, that’s impressive.

So what kind of “somebody” do you want to be?  Personally, I want to be the doer, not the complainer.

patron saint of headaches

If only medicine were this simple.

Have a headache?  Say a little prayer and a saint will bring a magical aged rabbit, place it on your head (which will feel extra nice because of its soft rabbit fur), and your headache will get better… probably.

Instead, nowadays, we spend several years and millions of dollars to figure out what causes headache and then even more time and money developing some kind of therapy.

But, to some people, modern medicine is just as mystical as the anti-headache rabbit idea:

Have a headache? Make a little phone call and a doctor will give you a magical pill, that you place in your mouth (which will feel extra nice because of its sweet coating), and your headache will get better… probably.

Just like magic.

the limerick of syphilis

There was a young man of Black Bay,
Who thought syphilis just went away,
And felt that a chancre,
Was merely a canker,
Acquired in lascivious play.

Now first he got acne vulgaris,
The kind that is rampant in Paris,
It covered his skin,
From forehead to shin,
And now people ask where his hair is.

With symptoms increasing in number,
His aorta’s in need of a plumber,
His heart is cavorting,
His wife is aborting,
And now he’s acquired a gumma.

Consider his terrible plight,
His eyes won’t react to the light,
His hands are apraxic
His gait is ataxic,
He’s developing gun-barrell sight.

His passions are strong, as before,
But his penis is flaccid, and sore,
His wife now has tabes
And sabre-shinned babies,
She’s really worse off than a whore.

There are pains in his belly and knees,
His sphincters have gone by degrees,
Paroxysmal incontinence,
With all its concomitants,
Brings on quite unpredictable pees.

Though treated in every known way,
His spirochetes grow day by day,
He’s developed paresis,
Converses with Jesus,
And thinks he’s the Queen of the May.

research ethics a la facebook

I’m taking a research ethics class right now.  It’s required for certain grants, and it actually teaches some very valuable information about how to properly go about research.  It’s still boring, but good nonetheless.  It’s a small class of about 20 people — mostly residents and researchers.

I typically sit towards the back row, and yesterday I noticed something funny.  Of all the people using laptops, at least 4 of them were looking at facebook during the lecture and everybody else was using email or google.  I thought that this was a phenomenon of people my age and younger, not older people who have real jobs.  I was wrong.

I’m guilty of it too, though.  I’ve been known to take a peek into the book of faces during lulls in lectures, but not in this class.  I don’t feel that using a computer is justified in this class as I take scanty notes.  I usually just sit there with a notebook and write one or two sentences per two-hour session.

The interesting thing was that facebook didn’t seem to distract from class participation or discussion.  We still held a lively discussion about what constituted human-subject research, yada yada yada.

So maybe facebook doesn’t get in the way of learning as some people have suggested.  Well, actually, it probably does.  In either case I suppose it’s disrespectful to the instructors, and you shouldn’t do it — very much.

But at least the younger students aren’t putting thumb tacs on teachers’ chairs and pulling other stupid pranks like they used to.  Nowadays a lot of them are just listless, obese, and apathetic.

Not sure which is better.