The Mid Level Practitioner: Physician Assistant edition

                                  Mid-level practitioners are an example of having the best of both worlds in the medical community. It provides a balance between work and having a life that physician training does not. With mid-levels you can still get the patient contact that makes medicine alluring without a decade long training. For some people this can be a perfect compromise between providing quality care and having an actual life outside of medicine. It provides a sense of balance that might be a better choice than medical school. I am glad that mid-level providers are the wave of the future.

                                   I am not  in PA school but i do know a couple. I  used to talk to them a good amount. PA  school is still very intense. They take many classes alongside the medical students. The good part is that they don’t have to be in school for 10 years. They can do it in about 2.3 yrs. A decade is a long time. A decade is a long time to be in debt. A decade is a prison sentence for first degree murder in some states. PA’s can start working after that 2 yr mark and start making a decent salary. Medical school is awesome but it may not be so awesome if you can’t find time to balance your personal life. You may end up as an unmarried 30 something and get bitter ( some female medical residents i know).

                                  I am glad that some people are willing to go the medical school route and commit their whole life to this one thing. We need people that want to be consumed by learning about medicine. But it is an extreme. Most people don’t do well with extremes. You can compromise. I am  glad that people are starting to spread the word that you can compromise. The mid-level practitioner is the compromise. I realize that as a PA you don’t know as much medicine as the physician. For some people this is alright. You still know a lot about medicine. You know enough to work autonomously on most things. Yes, you don’t get the same ego trip that you may get from calling yourself an MD but fuck your ego. Your ego is an insecure little wimp. Prestige is your egos shield. Ego and prestige have probably caused more misery in human existence than anything else.

                                  The chick in this video does a perfect job explaining why she left medical school and found PA school to be a better work/ life balance. She is everything i espouse in this blog. I wish people would look at things as rationally as she did. We as a society need to stop deifying the job of a physician. Pre-meds should know that it is ok not to go to medical school. They will see that there are other routes available  They will not get shuttled into the medical school trap by overzealous parents, college counselors and ridiculously glamorous tv shows (Grey’s anatomy).   Check out the videos.

Cluster Headaches and Faith

“The most terrifying fact about the universe is not that it is hostile but that it is indifferent, but if we can come to terms with this indifference, then our existence as a species can have genuine meaning. However vast the darkness, we must supply our own light.”……..Stanley Kubrick

Cluster Headache Video 1

Cluster Headache Video 2

                           I was reviewing the headache section in First Aid when I encountered cluster headaches. I decided to look it up. I came across these videos. Both videos are very interesting. I sincerely hope medicine can find a treatment for these headaches. As much grant money as possible should be put into researching this ailment.  The pain that these people experience must be the definition of hell.

                          It is interesting that the religious guy in the second video is still clinging to his faith. He has one of the most painful disorders known to man yet he is still deeply religious. This man is an amazing person. He views his disorder as a test given to him by a benevolent creator. I view it is as an example of the indifference of the universe. The universe does not care about your pleasure or your suffering. The planets still orbit around the sun whether you suffer or not. The universe simply is. It is up to us humans to transcend nature. By curing suffering we can be rise above nature. We can be more moral than the universe that we find ourselves in.

Hedonic Treadmill

This 2nd link has the concept of prestige mixed in with it:

Hedonic Treadmill and the no name cola test :https://www.youtube.com/watch?v=Mc5oj1_asc8

                        I don’t know if the Hedonic Treadmill is real. I do know that happiness is certainly fleeting. Its ephemeral. Its that moment when you realize “hey, this feels nice”. Its that really good laugh you get when your best friend tells you a ridiculous story. Or when you are hanging out with that girl you had a crush on since freshman year. I have learned to treasure the neurological high i get from these moments because they don’t last. What goes up must come down.

                        It’s probably better that the high subsides. A permanent high would be horrible. Pleasure in excess ceases to be pleasurable. I guess this is what our brain is trying to protect against. Maybe the chemical rush of getting that new job or buying that awesome blazer has to subside. This is why heaven would suck. I don’t know if i want to be eternally happy. How would that even work? Sex works on the same principle. No matter how hot the person is they will eventually get mundane. There are many theories on why our brain developed this tendency to go back to a baseline happiness. No one knows for sure.

                     In physiology even receptors decrease in concentration when a stimuli is present for too long. It is called desensitization ( http://en.wikipedia.org/wiki/Homologous_desensitization).  I am not sure how to apply this theory of the Hedonic Treadmill to my life. I guess the first place to start is to know that material purchases of luxury items will not permanently make me happy. I guess the second lesson is that our brain does not necessarily want us to be happy. It wants us to survive. From an evolutionary stand point this Hedonic Treadmill must have given a survival advantage to those that possessed it. The people that didn’t have it did not pass on their genetic code. I imagine they must have been too happy to care about having sex. Or they were so happy they forgot  how to survive and died. Maybe struggle and unhappiness helped our survival.

                      After learning about this theory i have more questions than answers. What if happiness is just a simple neurological trick that our brain does in order to keep us alive? Our brain tricks us all the time. Many scientist believe that consciousness is simply an illusion that our brain preforms in order to help us humans survive http://en.wikipedia.org/wiki/Consciousness_Explained. Others believe that love is a trick to keep us pair bonded for long enough to have offspring. Maybe happiness is another trick. It probably wasn’t meant to last indefinitely.

                     Contentment is a better goal. It lasts for a much longer time than the quick chemical high of happiness. Contentment is irrespective of happiness. It’s that feeling of acceptance. Its the feeling of things being “good enough”. It is more an intellectual acknowledgement of things being ok. So instead of chasing happiness, maybe we should chase contentment?? I wish I had the answers. Why does our brain have to be so complicated?

Record Everything

 “The only real treasure is in your head. Memories are better than diamonds and nobody can steal them from you”
― Rodman Philbrick

                       At the end of the day all you have is memories. If I could tape a video camera to my shoulder i would. I would record every moment of my life. Why not? Memories are just recordings that the brain takes. Video cameras just do it better. One day all you will have left are the memories of the past. Half of the conversations with friends is just remembering some funny moment in the past. Memories are vital. I envy celebrities. Not because of the fame. I envy them because their life is recorded on camera. It is permanent. They are immortalized.

                  I admit that i take the technology of film for granted. It is so under appreciated. We have the ability to capture a moment forever at the press of a button. Humans in the past could not even imagine having such a privilege. We do.  One of the worst regrets is saying ” i wish i would have recorded it”.

                Its pretty cool to look at old recordings of friends and family. They are hilarious. They always make you laugh. They should invent a small camera that you can put under the skin on your forehead. The camera will record your whole life from birth to death. When you are old you can relive your life when ever you watch the film. That would be cool. Scientist, I give you 3 years. Get it done.

Conformity is Suicide

            

 

I have a high state of resentment for the conformity in this country. If you’re not married and having children, it’s like your life is empty or you’re a communist meanie.

Bill Maher 

 

Whenever you find yourself on the side of the majority, it is time to pause and reflect.

Mark Twain 

 

                            If you go with the herd you will get slaughtered. The masses are lemmings that will follow each other into a river and drown. Life is not a “one size fits all” scenario. The people that are most successful are the people that defy mainstream culture and create their own path. Cultural currents are usually misinformed and easily manipulated. There are 4 recent examples that illustrate this point. They are the housing bubble, college, marriage, and the stock market.

  Housing Bubble:            

                               Houses never lose value was the often repeated lie of the decade. This lie was so pervasive that people took it as an economic law. I just turned 28 but i can still remember when people in the United States went house crazy. It was complete pandemonium. Flipping houses was an epidemic. I remember my parents buying real estate under this false dogma. I vividly remember my mother explaining to me that houses are a great investment because they always appreciate in value. Never did i hear any adult question this statement. The economist that did question this statement were laughed at and ostracized. Fast forward 6 years later and the non conformist were correct and the conformist were wrong. It was a very expensive lesson learned. Especially for my mother. 

 

College:

                                  In my high school you were considered a loser if you didn’t go to college. Going to college was perceived as the essential step to having a comfortable life. Not going to college was equal to heresy. The cult of college was reinforced by every high school counselor in the country at that time. They would implicitly communicate to you that if you don’t go to college you will be doomed for life. Upper middle class parents would disown their children if their kids decided that they didn’t want to go to college.  We laughed at the few kids that decided to hold off on college and to try their hand at a trade school. Fast forward 10 years later. We now have a looming trillion dollar college debt crisis. Many college graduates now understand that college was not necessarily a good idea. Again, we see that the non conformist were correct and the conformist were wrong.

Marriage: 

                                      Our society expects everyone to be married and have children. Not being married and being in your middle age is perceived as odd. People start wondering if you are socially dysfunctional. They start assuming that you are homosexual (nothing against gay people, i support gay marriage) if you are unmarried too long. Statistically speaking, American marriages are an abysmal failure. Half of all first time marriages end up in divorce and 60% of second marriages end up in divorce (http://www.divorcerate.org/). So the odds are that if you get married today, you will divorce your spouse within a decade. Why is this still an expected social convention? Because people are conformist. Again we see that the nonconformist may be correct. 

 

Stock Market:

                                    A rule of thumb in trading stocks is that once the masses hear of a great deal on a stock it is already too late. By the time a stock is mainstream you better have sold because its on its way down. This is why mainstream stock market shows never made sense to me. Why are you getting stock advice from a guy on television. Millions of other people are watching the same show and going to buy the same stock. People in groups lose their ability to critically think. They lose introspection and devolve into a primitive hive mind. Maybe this is an evolutionary relic that allowed our species to survive for thousands of years. I do not know. I do know that i will no longer ridicule the views of the counter culture. They may just be right. 

Are You A Doctor Yet

https://www.youtube.com/watch?v=M_pfzYD1dXY

                              Story of my life minus the Asian part. You know something is an epidemic when popular culture makes fun of it. I know some Indian kids who tried to rebel against the whole doctor thing. They got ostracized from their family for about a year until they gave in. I know some African kids that did not want to apply to medical school after college. Their parents hated them for about 3 years. Now they are kinda over it. Except every now and then they make little snide remarks at thanksgiving about not being a doctor.

                                  Doctor worship with immigrants is beyond insane. They are like the medical school mafia. I think its a conspiracy among the medical schools. They secretly pay Asian and African parents money in order to funnel their kids into their schools. Its a symbiotic relationship. Medical schools get an inflated amount of applicants and our parents get some kick back money. Im going look into that one. It sounds plausible. Im just sayin you never know.

                                                                        

Unemployment Diary: Want Ads

Reblogged from delicioustacos:

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Retirement is a buzzkill

                            The average life expectancy for a male in 1901 was 47.6 yrs.  For a female it was 50.6 yrs old. Retirement was not much of an issue in the early 1900′s. Now the average life expectancy for a male and female is 83 yrs and 85 yrs respectively. Most people can not work until their 80′s. It is just not feasible for the average person. We are forced to spend our working years saving for at least a decade of not being able to create an income. This is why retirement is a buzzkill.

                            Most of the jobs being created are low wage service sector jobs. Even in this horrible economic climate, these jobs are relatively easy to find. I have friends that work 2 minimum wage jobs and make ends meet. They are able to hold down an apartment and they have a small amount of disposable income. If they get fired from one low wage job they find another one within weeks. This seems like a workable solution to a horrible economy until you factor in one thing. RETIREMENT.

                             I told my “starving artist” friend that working two jobs is not too bad. He could do that forever and things could be ok. But then I realized that 20 somethings  can not do that forever. It takes a tremendous amount of money to save for the 15 to 20 years when you will not be physically able to work. The older you get the less able you are to work two minimum wage jobs. Even if you could, how would you save for retirement?  This increase in life expectancy in the last century has ushered in a new set of challenges. A large retirement savings is one of them.  When you are in your 20′s you don’t think about it. The starving artist lifestyle is cool when you are young. It is not so cool when you get older.  Why cant we just stay young until the day we die. Or just stop ageing at like 40 and then just die 30 yrs later. Fuck retirement.

                              I can partly understand why immigrant parents force their kids into medical school. They want to shield them from the harsh realities of the job market. They want their kids to have security in their old age.  Going the safe route just for economic security has its sacrifices. You never really get to venture out and take risks. What is that point of saving for retirement if you haven’t really lived.  I guess it’s a trade off . Hopefully I can be that elderly person that still works a job they love until they die.  That would be cool.

Self Examination aka Introspection

“Whole problem with the world is that fools and fanatics are always so sure of themselves, and wiser people are full of doubts”

― George Bernard Shaw

                     One of the most important traits in life is self examination. Self examination takes objectivity and humility. The ability to stop and to ask your self why you believe a certain thing is critical. The ability to ask yourself why you behave a certain way is even more critical. Humans have core beliefs. These core beliefs become entrenched in our psyche from birth. Challenging them is a very scary proposition.

                    Honest self examination takes objectivity. Humans are notoriously bad at being unbiased. It is in our very nature to be biased. Consciousness is biased by definition. Philosophers still argue about whether true objectivity is even possible  http://forums.intpcentral.com/showthread.php?2620-Is-objectivity-possible. I do not think it is possible.  Everything from our political views to our view of our own abilities is biased. Humans are  great at lying to ourselves. We are most biased when we automatically presume ourselves to be objective. Not many people are willing to admit to themselves that their religious, political beliefs, and views on life are greatly influenced by their environment.

                   Self examination takes humility. It is very humbling to admit to yourself that you are wrong. I have had to admit that I was wrong many times. But the more I do it, the easier it becomes. I accept the fact that i am still trying to figure out this blue marble in the middle of space  called earth. Examining the reasons for my insecurities is very humbling. Examining my physical and mental limitations is also humbling. This is why humility is necessary for honest self examination. I find myself greatly modifying my views on politics, life and love every 9 months or so.  It is alright to not have it all figured out. It is always humbling to realize that didn’t know anything about life when i was 18 yrs old( but i thought i did). I still don’t know shit 10 years later. The more I learn the less i know.

                  Life is extremely complex. Anyone who says that they have the definitive answer on anything is lying. I have learned that listening to those that disagree with you is a sure path to gaining wisdom. One can find truth in every argument. Taking honest criticism is another path to wisdom. A true friend is invaluable because they offer that unbiased examination of me. This unbiased self examination by my true friends has changed my life for the better even though it hurts at the time. The more something hurts, the more truth it holds. It is like exercise. You start feeling the burn because it is working. The most self destructive people are the people that have no one to give them honest criticism.

                 I often wonder would atrocities be committed if people had an honest self examination of their motives? Would the tutsi’s and hutu fought if they had stopped and objectively examined their motivations for violence? Would bigotry still exist? Would Nazi supporters during WW2 have still supported the regime if they took time to objectively analyze their motivations? Would there be any evil in the world if people where objective in their self examination? Maybe self examination is too scary. It might uncover too many hard truths about ourselves that we would rather leave hidden.

Step 1 and the FMG

                                 This test is a paradox. It has become the bane of my existence. I don’t understand it. I know “dumb” people that pass and “smart” people that fail. To be honest I have to give credit to my American graduate friends that take 2 weeks to study for this test and pass. That’s wild to me. Doing that seems the equivalent of shooting a basketball from the stands and it going in the hoop every time.  I understand that they had better instructors and are better science students. Even though they are better medical students it is still impressive that they are that well prepared. I tip my hat.

                                To my fellow FMG’s. We are the red headed step child that has bad body odor  and braces of the medical community. Going the foreign medical route is like taking the back door. No, its like breaking into the house through the chimney and potentially getting stuck. We are at a severe disadvantage to begin with. This test is pretty much the most important test we could ever take. It sucks. Some FMG’s do really well on the test after studying for just a month. But other FMGs including myself, take a lot longer. To be honest I take it as even more of an indication that I should not be a physician. At this point i just want to pass to prove a point to myself. I have about 8 weeks left to encounter this beast. Then i am definitely out of this medical thing pass or fail. New career here i come! No more memorizing 50 billion medical factoids a day! No more First Aid! No more faking a passion for medicine!

                               To my FMG’s that really really want to be physicians I say hang in there. Even if this test if giving you a hard time. You are a case of passion without the raw talent. It is going to be a very difficult road but it can be done. I know of people that made it even though they did not have the raw talent. I personally know one guy who didn’t give up and it took him years to pass the test ( Rudy syndrome). I don’t know why he choose to keep pushing ( i do know but who am i to judge) but to each his own. The funny thing is that this test has no correlation with the MCAT score. You can get 30+ on the MCAT and still struggle with this test. Anyway, enough of my rant. I’m gonna get some sleep.