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From the Scope archives: My parents don’t think I’m smart enough for family medicine

Tomorrow, medical students across the country, including those at Stanford, will find out where they’ll be doing their residency. In anticipation of the exciting event, known as Match Day, we’re re-publishing an entry penned last year by then-medical student Raymond Tsai. His candid and moving post was one of our most popular of 2013 and garnered comments from across the world. For the record, Tsai matched in family medicine at UCLA Medical Center (.pdf).

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Raymond Tsai and Danica Lomeli hug after finding out that both will be attend UCLA March Day at Stanford on Friday, March 15, 2013. ( Norbert von der Groeben/ Stanford School of Medicine )I’m not sure why my parents were surprised when I told them that I was applying to go into family medicine. It seemed like a logical transition after spending six years working in public health and primary care before medical school, but from the perspective of Taiwanese immigrant parents, I couldn’t have made a more absurd career choice. I was confronted with comments such as, “Most people choose careers to make money – why aren’t you?” Even more jolting was when they asked, “Why are you throwing away years of hard work and accomplishments?” I was flabbergasted by the line of questioning, but they’re my parents, so I had to answer the fundamental question – why family medicine?

For me, the answer is simple: I went into medicine to improve the health of my community and our society, and when I think about the most pressing health issues facing our nation, it’s preventable lifestyle disease. According to the Centers for Disease Control and Prevention, more than 75 percent of our health-care costs and 7/10 of deaths stem from chronic diseases that are largely preventable.

As a medical profession, we’ve largely been unsuccessful at getting people to engage in healthy behaviors. Luckily that’s where family medicine doctors are uniquely positioned to succeed. For one, the family physician has the breadth of training to serve everyone in a community, and in doing so, can influence community behavior as a whole. This approach is vitally important since lifestyle choices are never made in the clinic; they’re made in communities based on social norms set by families and peers.

Second, as I’ve learned through my own journey of overcoming obesity by losing 40 pounds in the past year, so much of one’s ability to implement healthy lifestyles hinges on one’s sense of self-efficacy. Again, that’s where the family physician comes in. A family physician has the benefit of deep interpersonal relationships developed through continuity of care to more effectively cheerlead and coach a patient to success. If executed correctly, family medicine has the potential to succeed in promoting healthy lifestyles, improving community health, and actually preventing disease in ways we haven’t been able to before.

The potential for primary care to fix our society’s biggest health-care problem and to have a real impact on overall population health is why I’m choosing to go into this field. Increasingly, policy makers are turning towards primary care to fix a health-care system that’s becoming more expensive than we as a society can afford. As that happens, I want to be at the front lines leading the charge and developing impactful solutions.

When I told my parents this, their response was, “There are already a lot of smart people who trying to fix this problem and unable to find an answer – so what makes you think you can?” In essence, they don’t think I’m smart enough for family medicine. The problem that primary care has been charged to solve is so big that my parents don’t think I can do it.

Maybe my parents are right, but that won’t stop me from trying. Ignoring the issue doesn’t make it any less urgent. To communicate this to my parents, I responded with a Chinese proverb they taught me long ago, “Plugging up your ears so you don’t hear the fire alarm doesn’t mean there isn’t a fire.”

Previously: Matching into family medicine

In the News, Sleep, Technology

Exploring the benefit of sleep apps

Exploring the benefit of sleep apps

man sleeping in bedCan sleep-related apps be of benefit to the bleary-eyed masses? That’s the question explored today by the New York Times’ Molly Young, who sought the advice of one of our sleep experts for her story:

Browse the iTunes store or Google Play and you’ll find them by the dozen: offerings with names like SleepBot and eSleep, represented by icons of placid sheep or glowing moons. The offerings fall into two basic categories. One tracks sleep patterns through the smartphone’s accelerometer (the doodad that recognizes when your phone is upside-down), giving users a blueprint of their time in bed. The second promises to lull users to sleep with music, hypnosis or guided meditation.

If you’re the data-driven type, a sleep-tracking app surely appeals. By placing the phone next to you in bed and tapping a button, you record your movements and a sleep chart is created. But according to Dr. Clete Kushida, the medical director of the Stanford Sleep Medicine Center, these apps are hardly precise.

“Without EEG — brain wave activity — it’s very hard to tell different stages of sleep apart,” Dr. Kushida said. “People can stay still and the device will think the person’s asleep.” Still, “the advantage of these devices is that they can help individuals become more aware of a potential sleep problem,” Dr. Kushida said.

Previously: Why physicians should consider patients’ privacy before recommending health, fitness apps, A look at the “Wild West” of medical apps, Designing the next generation of sleep devices, Exploring the effect of sleep loss on health, Turning to an app to help your health and Stanford sleep expert offers evaluation of science behind one sleep device
Photo by dearoot

Parenting, Stanford News, Videos

Stanford patient celebrates son’s first birthday with help of her care team

Stanford patient celebrates son's first birthday with help of her care team

This touching video is a must-watch. The piece focuses on a young mom whose serious illness has kept her hospitalized for more than a month. When the patient’s care team learned of her son’s first birthday, they sprang into action and threw the little boy a party right then and there – ensuring that his mom wouldn’t miss this most important milestone.

“Some patients tug at your heart,” Hirut Truneh, the unit’s patient care manager, told Stanford Hospital’s Sara Wykes, who produced the video alongside Todd Holland. The video certainly tugged at mine.

Grand Roundup

Grand Roundup: Top posts for week of February 16

Grand Roundup: Top posts for week of February 16

The five most-read stories this week on Scope were:

Top 10 reasons I’m glad to be in medical school: As part of our SMS Unplugged series, first-year medical student Hamsika Chandrasekar highlights ten things she likes about being in medical school. Among them: discount coffee, sleeping in scrubs, and (on a more serious note) “finding meaning every day of my life.”

Stanford study finds Lyme disease among ticks in California parks: Ticks infected with the bacterium at the root of Lyme disease have been found roaming California parks, as described in a Stanford study to be published in Emerging Infectious Disease. The findings, Ana Thompson, executive director of the Bay Area Lyme Foundation, said in a Stanford Report piece, are “an important step toward dispelling the perception that you cannot acquire Lyme disease in California.”

New Stanford-developed method finds tumors in children without exposing them to radiation: Researchers here have developed a way to scan young cancer patients’ bodies for tumors without exposing them to radiation. The technique could reduce patients’ risk of developing secondary cancers later in life.

Sleep on it: The quest for rest in the modern hospital: In this SMS Unplugged entry, medical student Mihir Gupta writes about helping hospital patients rest and heal. “As students,” he writes, “we can at least identify role models who are the kind of physicians we want to be – physicians who notice when a patient is sleeping and decide, ‘I’ll come back later.’”

A physician shares his story of being diagnosed with amyloidosis: In a recent Stanford Hospital video, Kevin Anderson, MD, shares his story of working with Ron Witteles, MD, co-director of the Stanford Amyloid Center, to receive a heart transplant and get his health back on track after receiving a diagnosis of amyloidosis.

And still going strong – the most popular post from the past:

What are the consequences of sleep deprivation?: Brandon Peters, MD, an adjunct clinical faculty member at the Stanford Center for Sleep Sciences and Medicine, explains how lack of sleep can negatively affect a person’s well-being in this Huffington Post piece.

Scope Announcements

Scope will return tomorrow

George Washington

Our offices are closed for Presidents Day; Scope will resume its regular publication schedule tomorrow.

Photo (modified from original) by Phil Roeder

Grand Roundup

Grand Roundup: Top posts for week of February 9

The five most-read stories this week on Scope were:

Top 10 reasons I’m glad to be in medical school: In the latest installment of our SMS Unplugged series, first-year medical student Hamsika Chandrasekar highlights ten things she likes about being in medical school. Among them: discount coffee, sleeping in scrubs, and (on a more serious note) “finding meaning every day of my life.”

A rare cancer survivor’s journey to thriving and advocating: Here, an Inspire contributor shares her experience being diagnosed with a rare type of tumor and discusses why she became involved in patient advocacy. “I couldn’t live with the fact that no one knew much about this insidious disease and that research dedicated to pancreatic cancer lagged so far behind other major cancers,” she writes.

New Stanford-developed sweat test may aid in development of cystic fibrosis treatments: This blog entry discusses a development that could someday lead to more targeted treatment for cystic fibrosis, a recessive genetic disorder that affects the lungs and digestive system.

A physician shares his story of being diagnosed with amyloidosis: In a recent video, Kevin Anderson, MD, shares his story of working with Ron Witteles, MD, co-director of the Stanford Amyloid Center, to receive a heart transplant and get his health back on track after receiving a diagnosis of amyloidosis.

Stanford-developed device shown to reduce the size of existing scars in clinical trial: A device invented by School of Medicine researchers has demonstrated in a small clinical trial that it can help decrease the size of existing scars when used after scar-revision surgery.

And still going strong – the most popular post from the past:

What are the consequences of sleep deprivation?: Brandon Peters, MD, an adjunct clinical faculty member at the Stanford Center for Sleep Sciences and Medicine, explains how lack of sleep can negatively affect a person’s well-being in this Huffington Post piece.

Technology

Twitter 101 for patients

I quite like this blog entry, from the Society for Participatory Medicine, on how patients are using Twitter to “seek and speak out.” Along with outlining how she used it during her bout with cancer (“I found information on just about every possible concern from ongoing clinical trials, to the latest medications, what foods to eat and why yoga was good for breast cancer patients”), the writer provides statistics, definitions, and guidance for the newbie Twitter user. A Twitter 101, if you will.

Previously: How using Twitter can benefit researchers, How, exactly, can Twitter benefit physicians?, What to think about when using social media for health information and How patients use social media to foster support systems, connect with physicians

Addiction, In the News, Public Health

A focus on addiction, the country’s leading cause of accidental death

A focus on addiction, the country's leading cause of accidental death

Over on Wonkblog, there’s a lengthy discussion between Stanford addiction expert Keith Humphreys, PhD, and Harold Pollack, PhD, on drug overdoses, the recent death of actor Philip Seymour Hoffman, and ways to prevent others from dying. The entire piece is worth a read, but a few parts jumped out at me:

HP: Many people don’t realize that overdose is the leading cause of accidental death in the U.S. I gave a talk about five years ago in Chicago, and I mentioned that we had more overdose deaths than traffic fatalities. My audience literally did not believe me. People were absolutely convinced that I had mis-transcribed the numbers. Every year, America loses a little over 32,000 people in auto crashes, and something like 38,000 from overdose deaths annually.

KH: Yeah, it’s remarkable if you compare overdoses to AIDS, which at its peak was taking about the same number of lives. The difference in reaction is really startling. We appropriately became galvanized about HIV/AIDS, and implemented much better public policy to prevent HIV-related deaths. It’s much harder to get traction on the overdose issue, or even to get people to believe how prevalent the problem actually is.

HP: Just to note the numbers, in 1999 there were about 4,000 prescription opiate overdoses. In 2010, there were about 16,000. By comparison, there are about 10,000 gun homicides in the United States.

KH: It is pretty amazing. Many people are focusing on the return of heroin and saying, “It’s all the fault of criminals.” You’ve got to remember, 4 in 5 of people today who start using heroin began their opioid addiction on  prescription opioids. The responsibility doesn’t start today with the stereotypical criminal street dealer. We basically created this problem with legally manufactured drugs that were legally prescribed. This really flies in the face of the argument that  if we just had a flow of legal drugs, the harms would be minimal.

HP: Can I ask you an embarrassingly basic question? If someone like Philip Seymour Hoffman presumably had access to all sorts of prescription opioids, why does he end up injecting heroin?

KH: That’s actually a good question. Cost drives many people to heroin. It’s more expensive to buy oxycodone than it is to buy heroin. Presumably that was a less pressing concern for Mr. Hoffman. Perhaps the intensity of the rush of injected heroin was more reinforcing to him than opioid medications were. The prescription medications have a longer, slower cycle of action in the body. His heroin use could also be the result of habit. He had experienced a heroin problem before, many years ago. It could be that that was the drug that he knew best or was available in the networks of dealers he used. I’m speculating about somebody I don’t know, but those are some possible reasons.

For most people it’s cost. Add one other thing; when people lose their health insurance, they may need the opioids to manage their pain. People sometimes end up buying street drugs including heroin to manage their pain because they have lost the insurance that used to cover their pain medication.

Previously: A reminder that addiction is a chronic disease, Is it damaging to refer to addicts as drug “abusers?”, Breaking Good: How to wipe out meth labs, How police officers are tackling drug overdose, Do opium and opioids increase mortality risk? and How to combat prescription-drug abuse

Grand Roundup

Grand Roundup: Top posts for week of February 2

Grand Roundup: Top posts for week of February 2

The five most-read stories this week on Scope were:

Hawkeye Pierce (i.e. Alan Alda) teaches scientists how to better communicate about their work: During a recent workshop with Stony Brook University’s Alan Alda Center for Communicating Science, Stanford scientists practiced speaking and writing effectively about their work and learned which theater skills could be useful in building public interest in research.

Humble anti-fungal pill appears to have a noble side-effect: treating skin cancer: A new study led by Stanford dermatologist Jean Tang, MD, PhD, shows that a common anti-fungal treatment called itraconazole may be useful in treating basal cell carcinoma – the most common form of skin cancer.

The remarkable impact of yoga breathing for trauma: In this piece, Emma Seppala, PhD, associate director of Stanford’s Center for Compassion and Altruism Research and Education, discusses the effectiveness of yoga breathing for veterans with post-traumatic stress disorder.

You are what you read: The academic diet of the 21st-century medical student: Here, third-year medical student Mihir Gupta discusses the recent explosion of printed and digital medical resources that offer students alternatives to the classic texts that previous generations swore by. Gupta’s piece is the third installment in Scope’s weekly SMS Unplugged series.

Another piece of the pulmonary-hypertension puzzle gets plugged into place: A new study led by Marlene Rabinovitch, MD, and her colleagues at Stanford’s Vera Moulton Wall Center provides more insight on pulmonary hypertension, a dangerous increase in the pressure of blood vessels in the lung.

And still going strong – the most popular post from the past:

What are the consequences of sleep deprivation?: Brandon Peters, MD, an adjunct clinical faculty member at the Stanford Center for Sleep Sciences and Medicine, explains how lack of sleep can negatively affect a person’s well-being in this Huffington Post piece.

Scope Announcements

Scope honored by the Association of American Medical Colleges

Some more good news about the blog: Scope received accolades in the GIA Awards for Excellence. We were given honorable mention in the social media category, with one of the judges commenting, “A great effort with impressive traffic. A consistently excellent blog, with interesting and informative mix of content.”

The Awards for Excellence, a competition of the Association of American Medical Colleges, are designed to “acknowledge the most creative and effective approaches used to promote academic medicine in the United States through alumni, communications, development, marketing, and public affairs programs, and products.”

A big thank you to the AAMC, our contributors, and – of course – our readers!

Previously: Five thousand blog entries – and counting, Scope receives AAMC Award for Excellence, Scope wins a Web Health Award, Scope wins a 2010 Excellence in New Communications Award, Scope wins 2010 Health and Life Medical Blog Award and Scope named “Best New Medical Weblog” in the Medgadget Medical Weblog Awards

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