Musings of a Mind on Medicine

Although I said I wasn’t going to do this, I’ve decided to provide a list and brief review of the various medical apps I have on my iPod!  With the exception of epocrates Essentials, all of these applications were either cheap (a couple bucks) or free.  (If the pictures are too small, just click on them to see the full-size version.)

Let’s divide them into three general categories:

1. All-in-one – epocrates Essentials, Medscape, Skyscape, and PEPID
2. Tools – Diagnosaurus, MedCalc, MedRef, and WellAdult
3. Educational – Eponyms, Case Hx & Ex, MedicalRadio, ECG Guide, and iRadiology

In this post I’ll be discussing the All-in-One applications.

The first (and most expensive) of my applications was epocrates Essentials.  Like the free epocrates, it contains information on just about every drug under the sun, but Essentials also includes information on a plethora of diseases.

A fun feature is the pill ID.  This one comes in handy if a patient presents you with the “little white pills” he’s been taking but can’t identify.  You can input the information about the color, shape, imprints, etc on the pill and it will kick back some possible matches with images.  Unfortunately, the pill images and disease photographs are only available with an active internet connection.  All other content is available offline.

There is also a medical calculator and a medication interaction checker.  The Deluxe version includes a medical dictionary and ICD9/10 codes, but I didn’t opt for those.

I like epocrates a lot.  I referenced it often on my first couple rotations, but I’m not sure it’s worth the hefty price now that there are new and free competitors available such as…

Medscape.  Medscape is a relative newcomer to the field and they just upgraded their program to include over 3,200 clinical reference articles and a section on Clinical Procedures in addition to their outstanding drug information and interaction checker.  Other features are a News section and a way to complete CME credits from your iPhone/iPod.  Like epocrates, pictures and videos are not available offline.  It doesn’t include a pill ID or medical calcluator, but even still, if this had been available a year ago, I would have never paid for epocrates Essentials.

Because Medscape is so new, I haven’t had a chance to try it out in practice, but I’m excited by the design and content, and I think it will be a real benefit in my information arsenal.

Third in this class is Skyscape, another free all-in-one reference.  The only reason I might recommend against it is because it’s a little harder to navigate and its layout isn’t as pretty as the two aforementioned competitors… but for those who like a concise outline format, this may be the ideal program!  Skyscape features a medical calculator, an interaction checker, a drug reference, and OCM (Outlines in Clinical Medicine), which contains many useful and informative entries on a variety of disease states (no pictures though).  I think it’s more detailed than epocrates or Medscape when it comes to the pathophysiology of diseases.  It may not be as pretty, but it’s crammed with information.

Finally, we have PEPID.  I don’t know what that stands for, but this free program seems to be geared toward emergency medicine, as its focus is primarily on overdoses and antidotes.  It also includes a drug interaction checker, and a limited medical calculator.  A paid version will give you an expanded medical calculator and use of a Differential Diagnosis tool.

Honestly, I haven’t used PEPID much yet, but it might come in handy on my ER rotation when I’ll more likely be facing overdoses on various substance.

Conclusion:

It may seem a bit excessive to have so many similar programs (and perhaps it is), but I find that each has its gaps.  Often where one is weak, another is strong, so I personally think that it’s good to have more than one resource at hand, especially if they are free like Skyscape and Mesdcape.  It never hurts to have extra information at your fingertips, right?

Next time: Part 2: Tools

As always, please feel free to leave a comment or contact me using the “Contact” link above. 

I never used to mark in my books, but lately I’ve taken a liking to highlighting things.  Like, everything.  Maybe it’s because I feel like it helps me internalize what I’m reading.  Maybe it’s because it looks impressive.  Who knows.  I know I can’t sell these books back, so what’s the harm in marking them up?

Well, yesterday two highlighters met their fate at my hand while I was working on this:

From My PANCE Review Book

Hey, if I’m gonna go through them at that rate, I might as well buy them in bulk, right?

And so, arriving Wednesday from amazon.com, I’ll have 12 shiny new zebra zazzle highlighters to mark up my books to my heart’s content.  Yeah, I could have bought these (or a cheaper kind) in a store, but I know I like this kind, they were a little cheaper on amazon, and I have free two-day shipping for a while.

Yes, I have a highlighting problem, but there’s no harm in that, right?  Hey, at least I’m studying! 

I’ve been away from school for nearly six months now, and it took me a long time to settle into any kind of study pattern.  For the heck of it, I’m going to share with you what’s in my Leave-of-Absence/2nd-Year arsenal:

My latest favorite is A Comprehensive Review for the Certification and Recertification Examinations for Physician Assistants. Although the title is cumbersome, this 358-page text has quickly become my favorite review book as I try to cover a broad knowledge base before returning to school.  It is presented in concise outline format and flows in a fairly logical systems-based manner.  There is also a 300-something question pretest that I’m saving until I get closer to graduation.  We’ll see how I do on my exams, but so far, I recommend it.

The other book I’m reading most is actually my pharmacology textbook, Pharmacology for Nursing Care.  Now, don’t get turned off by the title because I actually find the text interesting, understandable, thorough, and even pleasurable to read.  It also reviews some physiology and pathophysiology, so I don’t have to pull out my other books to remind myself how the drugs work.  I’ve already plowed through the first 250 pages of this book, which leaves me only a thousand or so to go!  Haha.  (PS – I taped a strip of paper over the words “Nursing Care” in the title so that my book now reads Pharmacology for Physician Assistants.  )

Netter’s Atlas of Human Anatomy will always be one of my favorite books.  The illustrations are gloriously clear and accurate enough that I did well in my practical anatomy exams without spending any extra time studying the dead dudes in the cadaver lab.  I LOVE my Netter’s and recommend it to all students in the health professions.  I’m thinking about purchasing the iPhone edition when I have a little money.  Maybe.

Those are the three books on which I’m focusing most of my time until I return to my clinical rotations.

For rotations themselves, there are a lot of pocket-size study aids, but I think the Boards and Wards series is my favorite.

This handy little book contains an overview of the pathophysiology and treatment for many of the conditions you’ll encounter most commonly on your clinical rotations.  It’s in outline format (which I personally favor) and has particularly key points in bold print.  I think it’s good reading for downtime on lunch breaks or between patients when you want to be productive but can’t think of what to do with yourself in those awkward little chunks of time.  It isn’t exactly a thorough review, but it has a lot of good information.

The Boards and Wards people have made other pocket books including their Pharmacology for the Boards and Wards, which I purchased a few months ago but have only briefly flipped through since.  It goes through the key features of the various classes of medications, highlighting the mechanism of action, side effects, and other critical information in a concise format.  Since my pharm knowledge is admittedly lacking, I think this little book will be good study material for me on the floors.

For clinical rotations, I also have some really handy medical references on my iPod, but I’ll discuss those in another post.

I have also spent some time listening to some medical podcatsts.  Unfortunately, I don’t know how to link to them in a blog post, but I’ll list off some of the better producers.  (All of these are free!)

• The University of Iowa Department of Emergency Medicine
• Podmedics
• HHMI’s Holiday Lectures on Science
• Revision for Medical Finals

I won’t claim to be studying non-stop, but at least a little time each day is devoted to the books or podcasts or whatever.  I REALLY wish my school recorded lectures and posted them online, but no such luck.  Oh well.  I think I’m doing pretty well with my powerpoints and the books I’ve referenced in this post.

Please feel free to offer any suggestions or ask me any questions!

HT to Happy Hospitalist for pointing out this cool and amusing picture:

I laughed aloud when I saw this… very clever!  (Now I want sour gummy worms!)

It was my first day.  Standing in front of the full-length mirror, I used my hands to smooth the folds out of my white coat.  Although rarely concerned much with my appearance, I couldn’t help but notice that it made me look a little washed out… or maybe I was just that nervous.  It fit nicely and otherwise looked good on me, but it felt so foreign, like a Halloween costume, or part of a long and detailed dream.

I would soon discover that the white coat is a powerful thing.

Although I hadn’t changed, my interactions with patients over the following days and weeks led me to realize that suddenly, people trusted me and believed what I said.  It didn’t matter to them that I was a brand new student with a shortage of both clinical knowledge and self-confidence.  As one of my first patients said, “You’re wearing a white coat and you work with the doctors.  What more do I need to know?”

Most patients and families opened up to me, entrusted me with their concerns, and asked me their questions.  I didn’t usually have the answers, but I could relay the question and do the research.  When I did have an answer, it seemed that they hung on my every word and valued it as the authoritative truth.

This taught me two lessons: first, that the white coat commands a lot of respect (whether deserved or not), and second, that it is of the utmost importance that I have my facts straight before I talk to the patients because they seem to trust anything I say.

The combination of these realizations left me feeling about 20% empowered and 80% terrified.  I even tried to convince a patient or two to not trust me so much, but it was to no avail.  In retrospect, it was a selfish and unfair request.

My new perspective really drove home the importance of honesty, integrity, and humility in my chosen profession.  When you wear that coat, when you’re in the role of the provider, people will trust you.  (In my case, they trusted me more than I trust myself.)  When you are given that level of sincere trust, it is your solemn obligation to conduct yourself in a manner that honors it.

May I always remember the lesson I’ve learned from my short white coat.

~

PS – this is my 200th post on this site!  Can you believe it??

I’ve been cleaning out the bookshelf, and I’ve decided that I can probably part with some of the textbooks that I haven’t opened in a few years.  A quick search of amazon and half.com told me that they’re not even worth the cost of shipping, so I’ve decided that I want to donate them.  During my undergrad, people would come and collect textbooks to send to 3rd-world countries, and that’s what I want to have happen with these.

I’ve got a pathophysiology book, a biochemistry book, a genetics text, and a health psychology text (all from my undergrad) that I’m willing to part with.  I’m also thinking about letting go of the physiology and pathobiology texts I have, but those might be good for explaining conditions to patients in the future.  Maybe.

Anyway, do any of my readers know where or how I might be able to donate these textbooks?  They’re in nice shape and perfectly good.  I just don’t want them to go to waste.

Thanks.

Lookout world!  It’s only three more weeks until I don the short white coat again!

I got my clinical rotation placements on Wednesday evening… and I must say, I’m pretty pleased!

First, I’ll be doing orthopedics at my school’s hospital, 10 minutes from where I live.  I know one of the residents in orthopedics there, so I’m excited to work with him a little.

Second, I have psychiatry at a hospital in Queens.  I found out from some classmates that students at that rotation have a very defined role (which is always helpful), and that the hours there are about 8-4 every day.  My commute will probably be 2 hours each way with traffic, but If I had to pick a rotation to have to commute, psych is it!

Third, I have surgery back at my school’s hospital.  The first week of this rotation is night shifts (I think), but at least I won’t be driving all over the island.

When I sent a mass email to my classmates asking for information about these rotations, I got a handful of responses, most of which gave quite positive reviews. I trust them to be honest with me on things like this, and I’m grateful they’re willing to help me out.

My remaining rotations are still up in the air, but these are the ones I’ll have left:

• OB/GYN,
• emergency medicine
• outpatient internal medicine,
• outpatient pediatrics, and
• elective (probably family practice)

Goodness, I have such a long way to go…

I got the following email yesterday:

Hi Christine,

I am writing to let you know that you have been cleared by the university  to return.  You will receive some official documentation stating that this is the case, but I also wanted to let you know ahead of time of the formal letter.  [...] Good luck and take care,

BR

WAHOO!!

This has been a long time and a lot of work in coming, but now I know for sure that I’ll be resuming my clinical rotations in FOUR weeks.

It looks like I’ll be able to get a Wells Fargo MedCAP loan without a cosigner (which is a relief since I didn’t know if I could find one).  One of our awesome program staff members is going to register me for my rotations and get me signed up for the student health plan again.

I still don’t know where I’ve been placed so I’m hoping it’s not too brutal.  My first three rotations are orthopedics, psych, and surgery.  Ortho and surgery are notorious for being some of the more difficult rotations (schedule-wise), and psych bears its own baggage for me.  I just hope they didn’t put me back where I was placed before I was hospitalized in September.  That would be AWKWARD.

To make my life a little easier once I’m insanely busy with school again I’ve bought one of these totally spiffy devices —>

It’s a single machine that both washes and dries your clothes.  It’s the size of a dishwasher and doesn’t require any special hookups or vents so you can stick it anywhere as long as it’s near a water supply and a drain.

It was difficult for me to find time to go to the laundromat to wash my work clothes, so I’m hoping that this will alleviate that stress.  I think it will.

And in case you’re wondering, I got it used on craigslist for $650.  It’s still more than I could really afford, but I didn’t pay the $1300 that these things cost new.  I’m not quite that crazy (but I AM crazy enough to drive into Manhattan and hire movers to pick it up!  If you’re in the NYC area and want one, there’s another on craigslist that someone is selling for $700.)

Anyway, the real news is that I’ve gotten the okay to go back to school!  I have my work cut out for me, that’s for sure, but I’m excited to get back into my studies!

Due to the impending blizzard, work was canceled today.  I’d be really excited, but it means I’m losing a day’s pay and it’s hard to be too thrilled about that.  So here I am, sitting on my couch, relaxing, studying, and becoming BORED OUT OF MY MIND.

It was only a month or so ago when I left this very lifestyle and started my temp job.  However, I wasn’t bored before.  Somehow, I was able to sit around all day without feeling any real drive to get up and do something.  Although lame as all get-out, it was, perhaps, convenient for my jobless, school-less situation.  At the very least, it made my circumstances more bearable.

Now though, I’m raring to go.  I need to do something.  I want to get out and create something or engage in something purposeful, and being stuck at home and not allowed to spend any money is making me feel trapped.  I’m in the mood to move… not that I’m going to… but I have this burning need for “bigger and better.”

At my interview with the BAC (behavioral advisory committee) liason, she asked what the difference is.  It’s hard to specify… I could only tell her that “I’m just doing better.”  And I am.  “And why do you think that is?” she asked.  “It’s hard to say,” I replied, “it could be thanks to some medication changes, or just due to the natural ebb and flow of time, or perhaps a little of both.  There’s no way of knowing.”

Her other questions raised a valid point: what happens if I start to get depressed again?  Having learned from the past, I proposed the following options:

• Pay attention to signs of struggle and act sooner (no more hoping it will just go away)
• Ask friends for help if I’m having trouble keeping up with things like dishes and laundry.
• Maintain a relationship with a therapist who can help me recognize when I’m struggling and help me through tough times
• Accept that I AM going to struggle, perhaps more than my classmates, and that it is unreasonable for me to expect perfection from myself.  The best I can do is the best I can do, and I think that will be enough.
• Allow another leave of absence to be an option, if necessary.

The last point would, of course, be a last resort in a doomed rotation, but for the sake of sanity and having an escape, it needs to be an option.  Few things are worse than feeling trapped in a hopeless and overwhelming situation.

I know that I’m going to have to work my butt off if I’m going to make it through the rest of PA school.  Yes, that scares me a bit, but I also have faith enough in myself to think that I can be smarter about it this time, and that things will be okay.  It may be rocky, but I can do it because I have a plan this time, and that’s what matters.

~

PS – Someone finally bought that fish tank from me today.  I’m seriously relieved because I was starting to fantasize about setting it up again.  Now I’m saved from myself! 

I should be studying… but as enticing as diseased feet are (yech), I’m somehow struggling to stay focused.

I’m waiting to hear back from the behavioral advisory committee – the psychologists and other people determining whether I’m ready to go back to school – but it will probably be a few more days before I get a final answer.  I’m optimistic though.  Things are going well right now (mood-wise), and I can’t see any reason for them to tell me no this time.

I need them to remove the hold from my student account so I can register for classes and get my financial aid taken care of.  I also need to discuss my clinical rotation schedule with the faculty member who arranges these things, because the way things are now, I’ll have no breaks at all between April and November, and that’s a long time to go without a week off.  Maybe we can move my rotations around a bit to space it out a little better.

Wait… did I already mention that in my last post?  Oh well.

Completely unrelated is the fact that my fish is finally actually swallowing his food instead of spitting it back out like he had been doing for the past few days.  This makes me happy.  I am also happy that he has not taken any real interest in the cherry shrimp co-populating the tank.  Many bettas would see the shrimp as a tasty snack, so I’m glad they’re getting along fairly peaceably.

Oh, and if anyone wants to buy a 5.5 gallon fish tank, I have one I’m trying to get rid of.  I’ve had about four craigslist people flake out on me so far, and I’m getting kind of annoyed.  Someone just buy the dang thing already!

In other news, I don’t have to go to work tomorrow because we’re expecting 10-16 inches of snow tonight through tomorrow night.  I’m excited because I like snow, but I’m not too thrilled to lose a day’s pay.  That’s one sucky thing about being a temp – no PTO.  My plans?  Exercise (on my mini stepper!), shower, and lounge about in my pajamas.  Oh, I guess I could study too… that might be a good use of my time. 

Speaking of studying, that would probably be the wiser use of my evening, so I guess I’ll be going now.  Bye!