April 27, 2009

Psychiatry in a Page Pocketmod

Since my Psych shelf is this Wednesday, I thought it would be appropriate to share my PocketMod.

It skims the basic H&P for Psychiatry with a bunch of mnemonics I acquired along the way.  It then goes through the diagnostic criteria for the major mood/psychotic/anxiety/personality/substance use/substance abuse/eating disorders.  It might seem a bit obscure at first because I abbreviated everything, but the shorthand makes it easier (in my mind) to read it quickly and recite it mentally.


Pocketmod PDF: Psych in a page


Wondering how to fold this document? See my previous post on the subject of PocketMods on the Wards.

April 21, 2009

National Library of Medicine Feature: Native Hawaiian Health

Whoa! Dr. Lindberg, the Director of the National Library of Medicine, talks about Native Hawaiian Health and Hansen's Disease (aka Leprosy) in Kalaupapa in his weekly podcast for MedlinePlus. MedlinePlus is an excellent resource for health education funded by the U.S. government with cool things like surgery videos, basic health topics and interactive tutorials.

Here are some excerpts from this week's podcast:
The health status of Native Hawaiians and Pacific Islanders is a major challenge for the physicians and traditional healers who serve the indigenous peoples of Hawaii, Guam, Samoa, and other Pacific Islands. However, the efforts to improve health care are fostering some imaginative, culturally appropriate approaches in Hawaii, including a network of clinics that combine western medicine with native healing, plus an interest in community outreach within the state's medical school and other health care organizations.

Kalaupapa is a reminder of ignorance, medical research dissemination and challenges, the ancient stigma attached to Hansen's disease, as well as human courage -- all nestled within one of nature's majestic settings.

Kalaupapa is a remote peninsula on the Hawaiian island of Molokai where from 1866-1969 about 8,000 persons with Hansen's disease (also known as leprosy) were exiled and quarantined. Dr. Lindberg led an NLM team (including me) that recently visited some of the remaining patients and providers.

Hansen's disease is treated today by a multi-drug combination that succeeded sulfone medications, which provided the original breakthrough management of the infectious disease starting in the 1940s. The drugs brought a quick reduction of symptoms, significant improvements in a Hansen's disease patient's quality of life, and removed the possibility that a patient in treatment was contagious.

Dr. Lindberg provides a great synopsis of issues in Hawaiian health that I must admit, I've taken for granted having grown up in here. So it's refreshing to hear a distinguished official from the Mainland take an interest in our little corner of the world.

Transcripts and Audio:
Native Hawaiian Health (audio podcast)
Kalaupapa & Hansen's Disease (audio podcast)

April 20, 2009

Vaccine Schedule Mnemonic

What is a good way to remember the vaccine schedule for children? This can be a pesky task, but I've come up with a pretty succinct way to help you remember!

Don't Be DR. HIP, who flu in an MVA , the DIMVit! and Hit My Teen
@ birth: Be

@ months 2,4,6: (DR HHIP)
DTaP, Rota, Hib, HepA, IPV, PCV

@ 12 mo-> flu

@ 12mo (MVA)
MMR, VZV, Hep A (w/ booster at least 6 mo later)

@ 4-6 y/o (DIMVit "dimwit")
DTap, IPV, MMR, VZV boosters

Hit My Teen (for teens)
HPV, MCV, Tdap

For adults, just remember a flu vaccine every year, update Td every 10 years (or 5 w/ dirty wounds), PPV @ 65 (or younger with risk factors... PPV, not PCV), and Zostavax (Herpes Zoster vaccine) @ 60 also.

April 19, 2009

Clinical Scenarios for Immunizations

In Pediatrics, I saw a mother who had a 2 year old daughter who was unimmunized.

"Now that she's two and out of the danger zone for autism... I'd like to start some vaccines," she said.

My preceptor and I spent the next ten minutes negotiating with her -- a major worry being "overwhelming" the child with dangerous chemicals. We settled on the DTaP and VZV vaccine after she made a few requests to "split up the components."

I did not understand some of her worries... and I'm not entirely convinced that she understood either. She was just worried. We emphasized that she avoid ALL travel and exposure to anyone who did travel around her child to avoid any avoidable illnesses.

So it's fitting that I found this series of Clinical Scenarios for vaccination at Immunizationed.org, featuring the following topics:
Adolescent Immunization
Chronic Liver Disease
Health Care Workers
Human Papilloma Virus
- Pre-adolescent female vaccination
- 23 year old female with abnormal pap
Pneumococcal Pneumonia
Shingles and Post Herpetic Neuralgia
It's a shame that they do not provide a script for addressing the "anti-vaccine" crowd, with ready statistics and concerns for public health and preserving herd immunity. It will be one of my goals to be capable of solidly addressing this topic in a manner satisfying to my hypervigilant mothers and autism-wary parents in pediatrics.

April 18, 2009

"For the Life of Me" and "Depression Too is a Type of Fire" by Taylor Mali

Love and loss.

Taylor Mali is a poet and a teacher and a true inspiration of the Word. He is best known for "What Teachers Make."

I wish that I could speak with the eloquence and gravitas that Mali has at his command. These two poems hit a particular chord in me that continues to hum. There is so much of me that I wish I could share with the world, but my idle thoughts lie unpolished and forgotten in some unexpressed corner of my mind. I find myself wishing that I had more time to compose myself in a manner worthwhile, yet when I do have time, I spend it appreciating only the works of others. I feel a sense of love and loss, but it is more of a manner of withdrawing into my own little safe world of medical facts to protect myself from the real world's imagined(?) horrors and disappointments.

Every once and a while, I find moments. I live moments of love. The smile of a patient at the end of a visit -- "you'll make a great doctor someday." "good luck to you." "it was a pleasure meeting you." "thank you, doctor." "Student doctor," I respond. A warmth creeps into my body, a smile uncurls naturally onto my face. Small moments in which the connections I find myself wondering if I could ever make with another person -- are precisely the things I do every day. I know there is a division between professional and personal life. I wonder if these friendships are worth the lonely nights and weekends spent studying dry facts and memorizing the latest evidence-based guidelines. Am I merely an algorithmic medical computer?


The satisfaction I feel at the end of the day does not stem from the recognition of a particular diagnosis or a particularly clever question I ask. It comes from the bond I forge with my patients. Is it worth the sacrifice of a more social life? For now, yes. However, I don't think it is selfish to want something more.

April 03, 2009

Critically Appraised Topic Powerpoint Template

Feel free to disseminate this Powerpoint presentation template for Critically Appraised Topics -- use it to spice up your journal clubs!

April 02, 2009

My First Practice-Changing CAT

Here's a presentation I prepared for today's Internal Medicine Journal club. The subject matter: Atenolol "causes" Diabetes. The idea was so preposterous when my IM preceptor brought it up that I HAD to look it up. Now I've found the first journal article I've come across that's so striking I want to change my practice and I'm not even in practice yet!

I enjoyed preparing this. I will continue to post practice-altering CATs as they come up.