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Medical Education, Medical Schools

Does medical school debt cause students to choose more lucrative specialties?

Last week, we re-published a Wing of Zock post on medical school debt. Over on that same blog, Julie Fresne, director of student financial services for the Association of American Medical Colleges (AAMC), takes issue with one of the original writer’s points: that concern over medical school debt affects students’ decision about specialties. Fresne writes:

While many claim that debt leads medical students to choose more lucrative specialties, AAMC research indicates that debt does not play a determining role in specialty choice for most students. The report, “Physician Education Debt and the Cost to Attend Medical School,” includes a section outlining evidence on the “minor role of debt in specialty choice.” Studies show that specialty choice is a complex and personal decision involving many factors. Some students with high debt do in fact choose primary care and AAMC data suggests that there is no systematic bias away from primary care specialties by graduates with higher debt levels…

Previously: It’s time for innovation in how we pay for medical school, 8 reasons medical school debt won’t control my life and Will debt forgiveness program remedy doctor shortage?

Patient Care, Stanford News

Medical mystery solved: Stanford clinicians identify source of Navy pilot’s puzzling symptoms

Medical mystery solved: Stanford clinicians identify source of Navy pilot's puzzling symptoms

Navy pilotTalk about medical mysteries: For two years, Navy pilot Robert Buchanan was plagued with symptoms like an irregular heartbeat, a drooping eyelid, hypersensitive sinuses, jaw pain and neck swelling – and no one could figure out exactly what was wrong.

“I had never encountered anything quite like it before,” said Edward Damrose, MD, chief of the Division of Laryngology at Stanford, who has been seeing patients for nearly 20 years.

Damrose worked with a team of doctors from a variety of specialties to determine the source of the problems – ultimately identified as a kind of decompression injury following a 2006 flight accident – and treat Buchanan. An article in the current issue of Inside Stanford Medicine chronicles the long road to treatment and ends on a happy note:

This winter, eight years after his near-fatal flight and two years after he came to Stanford for help, after a slew of diagnostic tests and more than a dozen incremental surgeries to fix his injuries, Buchanan passed [the Navy's] tests and qualified to fly again. With that step, he can move toward commanding a squadron of fighter pilots. “That’s the pinnacle of an aviator’s career,” he said.

“This case taught me to never, never take it for granted that you know it all,” Damrose said. “The answers aren’t always in textbooks.” The literature search also revealed other patients suffering from similar symptoms, almost all related to decompression injury, he said. “And Cmdr. Buchanan spurred us to keep going.”

Previously: NIH network designed to diagnose, develop possible treatments for rare, unidentified diseases
Photo by Todd Holland

In the News, Science

Stanford researcher on elephants: “We should value animals that have the same level of sophistication that we do”

Stanford researcher on elephants: “We should value animals that have the same level of sophistication that we do"

elephantsThe July issue of Smithsonian Magazine has a lengthy feature on the crisis facing elephants in Africa, with writer Joshua Hammer explaining, “Of the 50,000 elephants that roamed Chad 50 years ago, barely 2 percent are left. In the neighboring Central African Republic and Cameroon, the population may be even lower. Poverty, bribery and insecurity are all contributing factors in a region where a single large tusk can sell on the black market for $6,000—ten times the annual salary of a typical worker.”

Quoted in the piece is Stanford’s Caitlin O’Connell-Rodwell, PhD, a consulting assistant professor of otolaryngology, who has done extensive field work with the animals. She describes the connection between elephants and humans and expresses deep concern about the animals’ risk of becoming extinct:

“What is special about elephants is just how similar they are to us—socially and developmentally,” says Caitlin O’Connell-Rodwell, a Stanford ecologist who has written four books based on her Namibian field research on elephants. “If you watch a family group reuniting, their behavior is exactly like ours—the little cousins darting off together, the elaborate greetings of adults. Elephants offer a way of looking into the mirror, for better or worse,” she adds. “If we value human rights, we should also value animals that have the same level of sophistication that we do. We should keep those beings with us here on earth.”

Previously: Listening to elephants, communicating science, and inspiring the next generation of researchers, Elephants chat a bit before departing water hole, new Stanford research shows and Researcher dishes on African elephant soap opera
Photo by Caitlin O’Connell-Rodwell and Timothy Rodwell

Chronic Disease, NIH, Patient Care, Research

NIH network designed to diagnose, develop possible treatments for rare, unidentified diseases

doctors' tools - smallVertigo, nausea, headache, fatigue, confusion. For years someone close to me has experienced severe and periodic bouts of these symptoms. It’s clear something is wrong and yet, despite countless tests and visits with specialists in cardiology, neurology, ophthalmology, pulmonology, otolaryngology, and immunology, no one has been able to figure out what that something is. At one of his last appointments – to the great disappointment of this patient and (perhaps even more so) his worried and frustrated wife – my loved one was gently told that he may have to face the very real possibility that he’ll never get a definitive diagnosis.

Unfortunately, this patient is far from alone: Plenty of people are living with mysterious symptoms that affect their quality of life (or worse), and it’s not uncommon for patients with rare diseases to have waited years for their diagnosis. With this in mind, the National Institutes of Health launched in 2008 its Undiagnosed Diseases Program, a pilot program designed to “provide answers to patients with mysterious conditions that have long eluded diagnosis” and “advance medical knowledge about rare and common diseases.” (Since that time, 600 children and adults have been evaluated, and approximately 100 patients were given a diagnosis.)

Now, the program is being expanded into the Undiagnosed Diseases Network, with the NIH announcing last week that six medical centers – including Stanford – will be joining and contributing local medical expertise. The NIH will work with experts from these centers (including Euan Ashley, MD, PhD, Stanford’s principal investigator) to, as described in a release, “select from the most difficult-to-solve medical cases and together develop effective approaches to diagnose them.” The physicians will “collect and share high-quality clinical and laboratory data, including genomic information, clinical observations and documentation of environmental exposures,” and they’ll “benefit from common protocols designed to improve the level of diagnosis and care for patients with undiagnosed diseases.”

In our online story on the network and the $7.2 million grant that Stanford received, Matthew Wheeler, MD, medical director for the grant, notes that “Stanford was chosen for our informatics expertise, our experience with clinical interpretation of whole-exome and whole-genome data, and our scientific potential to follow up any lead.” As my colleague Erin Digitale further explained:

The team will use cutting-edge genomics and medical phenotyping techniques to diagnose patients, and will also aim to understand the underlying biology of patients’ conditions so they can generate targets for new therapies, Wheeler said. “We aim to make a deep dive into each patient’s biology,” he added.

By the summer of 2017, each new clinical site is expected to see 50 or more patients per year. Referring clinicians can submit applications on behalf of undiagnosed patients on the program website.

Previously: Using crowdsourcing to diagnose medical mysteries, New search engine designed to help physicians and the public in diagnosing rare diseases and The road to diagnosis: How to be insistent, persistent and consistent
Photo by Adrian Clark

Scope Announcements

Scope honored as among the best in digital health resources

Scope honored as among the best in digital health resources

I’m happy to announce that Scope has again received a Web Health Award. Now in its 16th year, the awards were designed “to recognize high-quality digital health resources for consumers and health professionals.” Scope received a bronze medal in the Winter/Spring 2014 contest, and we’re in good company (.pdf).

Previously: Scope honored by the Association of American Medical Colleges, Five thousand blog entries – and counting, Scope receives AAMC Award for Excellence, Scope wins a Web Health Award and Scope named “Best New Medical Weblog” in the Medgadget Medical Weblog Awards

Applied Biotechnology, Bioengineering, Science, Stanford News, Technology

Dr. Prakash goes to Washington

Dr. Prakash goes to Washington

Prakash at White House

It’s not every day that a researcher gets to hang out at the White House – so Wednesday was rather unusual for Stanford bioengineer Manu Prakash, PhD. Prakash, inventor of the 50-cent microscope, called the Foldscope, and a $5 chemistry kit, participated in the White House’s first-ever Maker Faire that day. He called it an “inspiring event” and tweeted the above photo from his time there.

And for those interested in learning more, a paper on the Foldscope was published online this week in PLOS One.

Previously: Stanford microscope inventor invited to first White House Maker Faire, The pied piper of cool science tools, Music box inspires a chemistry set for kids and scientists in developing countries, Free DIY microscope kits to citizen scientists with inspiring project ideas and Stanford bioengineer develops a 50-cent paper microscope
Photo by Manu Prakash

Medical Education, Stanford News

Stanford Medicine honors its newest graduates

Congratulations to our latest batch of graduates! The commencement ceremony for the school’s Class of 2014 was held on Saturday; the above photos provide a taste of the sunny, happy day, during which physician-author Abraham Verghese, MD, served as speaker.

Previously: Congratulations to the Class of 2013!, Stanford medical school alum fulfills lifelong dream to participate in commencement ceremony and In commencement address, Atul Gawande calls for innovation around “entire packages of care”
Photos by Norbert von der Groeben

Medical Education, Patient Care

Tips from the trenches: Surviving being on call

Tips from the trenches: Surviving being on call

We’re big fans of lists here on Scope (see here, here and here), so I thought I would highlight one that offers “10 ways to survive (and maybe even enjoy) being on call.” Geared towards students and doctors who have the “emotionally and physically draining” experience of being on call in the hospital for 24 hours, Baylor College of Medicine physician Mary Brandt, MD, (no relation) suggests:

Eat well and eat often. Do not rely on fast food or the hospital cafeteria. By far the best plan is to bring really good food from home. You need to have “comfort” food on call. If you don’t cook, buy really good prepared food that you can look forward to. Make sure you have “plan B” ready if your call day gets completely out of control by having an energy bar (my favorite is Kind bars), peanut butter sandwich or other “quick” food in your white coat pocket.

Make your beeper a “Zen bell”. Use your pager or phone as a tool for mindfulness. When it goes off, take a deep breath, relax the muscles in your face and shoulders and be present.  This is a proven practice to decrease stress – try it, it works!

Learn. Take advantage of the unique educational opportunity of being on call. The fact that there are fewer people around at night and on the weekends has a real impact on how and what you learn on call.   If you are a student or junior resident, you are more likely to be the first person evaluating new consults and admissions. You are also more likely to have one on one time with your senior resident or faculty as you care for patients together.  If you are further along in your training,  the “down time” on call (if there is any!) is a great time to catch up on reading.

Previously: The OMG Factor: Curbing your enthusiasm during clinical rotations

Stanford News, Videos

Say Cheese: A photo shoot with Stanford Medicine’s seven Nobel laureates

What happens when you gather together seven Nobel laureates for a photo shoot? This may sound like the start of a good joke, but it’s actually just an introduction to the video above, shot at the medical school earlier this spring. In it, we get a quick, behind-the-scenes look at the school’s past winners – including our most recent Nobelists, Thomas Südhof, MD, and Michael Levitt, PhD – as they chat and wait patiently for their photo to be taken. (The resulting photograph appears on Stanford Medicine’s new website.)

Previously: Stanford winners Michael Levitt and Thomas Südhof celebrate Nobel Week, Stanford’s Michael Levitt wins 2013 Nobel Prize in Chemistry, Stanford’s Thomas Südhof wins 2013 Nobel Prize in Medicine and Stanford’s Brian Kobilka wins 2012 Nobel Prize in Chemistry

Chronic Disease, Parenting

“I’d rather bury my child than leave him behind”: Mother of developmentally disabled child on redefining parenthood

"I'd rather bury my child than leave him behind": Mother of developmentally disabled child on redefining parenthood

As a mom of two, I found myself doing a double-take when I came across a recent Huffington Post headline: “Bury My Son Before I Die.” In the moving, difficult-to-read (and, presumably difficult-to-write) piece, the mother of a boy with lissencephaly who is “developmentally… like an infant in a 15-year-old body” describes caring for him and worrying what might happen to him as he grows older. “It goes against everything we believe about motherhood, but I’d rather bury my child than leave him behind,” she writes, before going on to explain:

I used to worry about Benjamin dying, but now, 15 years in, I worry about him surviving beyond my husband and me. Only we have comforted Benjamin through daily seizures and seven surgeries. We are his one true voice. No one can understand Benjamin the way we do.

I have learned to embrace motherhood with brutal honesty. I don’t actually want to see my son take his last breath. I don’t want to know life without him. For as long as I live, I will do whatever I can to keep Benjamin healthy and give him the best possible quality of life. His happiness is my happiness. He is no less than anyone else, deserves every right and consideration. As Benjamin’s advocate I can guarantee a strong proactive force. When I’m gone, I can do no more.

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