Thursday, September 08, 2005

Nice Little Chat

Bravomedic Blogger wrote:


I was reading the “Grand Rounds” at your blog. I’m currently 17 years old and want to go to medical school. I’m also a volunteer at a local rescue squad. Do you have any suggestions/tips for getting into medical school? My blog at http://bravomedic.blogspot.com explains the rest in case I’m forgetting something. The important stuff is toward the bottom.

Thanks in advance, 


On 9/6/05, Joseph j7uy5 <joseph.j7uy5@gmail.com> wrote:

First, since there probably many out there with this on their minds, I’d like you permission to post your email, and my response, on my blog. If that’s OK, please email me back. Having said that, here goes:

1. After reading your blog, I would say you are off to a good start, however:
2. It is not necessary, nor even desirable, to have every aspect of your life revolve around medicine.  Volunteering in a medically-related field is great, but just about any kind of volunteer work will make an impression on the admissions committee.  What they want to see is that you are a self-starter, that you don’t just waste /all/ your time, and that you have some inclination to help others.
3. It is important to show some degree of /balance/ of interests.  If everything you do relates to medicine, that just shows that you really really want to get in to medical school.  But being a physician requires a /sustainable/ lifestyle.  Involvement in art, music, sports, debate, chess club, whatever, shows that you have at least some ability to keep a rational balance in your life.  As a physician, you’ll need that.  It also shows some versatility and adaptability; both are very important traits in any of the helping professions.
4. Keep abreast of current social issues in medicine.  I remember that a med school interviewer asked me what changes I foresaw in the practice of medicine, over the next decade.  I was able to say that there would be a big change in reimbursement (HMO’s were just getting off the ground, then), and that the average age of the population is going up, so there will be a greater demand for geriatric specialists.  (I guess that was the kind of thing they were looking for, since they admitted me.)  It shows that you are beginning to understand that, /as a physician, you play an important role in your community, and in society as a whole./  It is not sufficient to know a lot of jargon and have good technical skills.
5. Speaking of jargon, it is important to be able to communicate clearly.  I am much more impressed by a medical student who can explain to a patient that taking too much Tylenol is bad for the kidneys, than one who tries to explain to a patient what interstitial nephritis is. In my opinion, the best way to learn communication skills is to read a lot, from a variety of topics; socialize a lot, with a variety of people; and write a lot, about a variety of topics and in a variety of styles.  That, in fact, is one of the reasons that I blog about all different topics, not just medicine.  When you write in your blog, think of it as a craft.  When you read something that strikes you as being well-written, take a moment to figure out why that is.
6.  Learn to take maximum advantage of whatever opportunities you have. In your volunteer work, ask yourself /first/ how it can help you become a better person, /before/ you ask yourself how it can help you get into medical school.  If you find yourself having to take a class in Shakespeare, ask yourself how that class can help you become a well-rounded, well-educated citizen.
7.  College: study what you are interested in.  Follow your instincts when you choose some of your electives.  Pick classes that you have heard have great professors, even if those classes don’t relate directly to medicine.  Spend time at your professor’s office hours.  You don’t have to be having trouble in the class to take advantage of that. College is your one and only chance to get a good Liberal Arts education.  They’ll teach you the medicine that you need to know in medical school, as long as you have the prerequisites from college.  The one thing I might add is that it is a good idea to take statistics, even if the medical school does not list that as a prerequisite.  Also, it is a good idea to participate in a summer research program, if you can.
8.  Learn how to learn from role models.  Despite the media emphasis on high-tech advances in medicine, medical education is still pretty much an apprenticeship.  You learn as much from watching how your professors act, as /people/, as you do from memorizing everything in a textbook chapter.  Watch how your elders deal with others.  Watch how they deal with stress.  /Ask/ them how they do these things.  Some people will be better mentors for you than others.  Learn to sense this, and spend more time with the ones who are good mentors for you.  Notice that some people are good listeners.  Pay attention to how they do it.  Watch two people conversing.  See how conversation works...or how it fails.
9. MCAT: MCATs have changed, and will change again, so I’m not sure I can give specific advice.  For example, when I took it, calculators were not allowed.  Therefore, when I studied for it, I did all the calculations by hand.  (I think that has changed, though.)  If there is an essay portion, practice writing essays by hand, if that is how you have to do it on the test.  Be sure to learn what you can about the test  before you take it.  There are some general pointers, that apply to any test.  The two factors that are the best predictors of success on any standardized test are: vocabulary, and algebra.  You have to be really  good at algebra.  Why?  Because if you are not, then many of the chemistry and physics problems are actually two problems in one: the math problem, and the science problem.  If you are so good at algebra that the math part of the problem is utterly transparent for you, then  you can focus just on the science part of the problem.
10.  Of course, #10 is the most important.  Do not go to medical school if you are not absolutely certain that it is the right thing to do.  That is as big of a mistake as marrying someone, when you are not sure  if you should.  At age 17, there is no way you could understand how big of a mistake that is.  Take my word for it.  Or ask your parents why it is such a big mistake.  Or ask any adult whom you respect.  They will  all tell you the same thing, assuming you have good instincts for deciding whom to respect.

There’s a lot more I could say, but one rule of good communication is:
keep it short.

Comments, anyone?  I’ve never actually served on an admissions  committee, so I actually am not the best person to ask.  Try asking the same question at some med student blogs.  There are a few in my sidebar.  If you get some good advice, let me know what they say.

Good luck,

Bravomedic Blogger wrote:

Thank you. Sure, you can post it.

I’m not totally “shaped” around medicine. I’m on my school’s tennis team, I’m the salutatorian of my class, and like to think that I’m pretty pretty good at math and science (took AP Calculus and AP Physics and got a 5 and 4 respectively). The reason I only got a 4 on the physics is because my class didn’t cover thermodynamics or nuclear physics (about 20% of the test), so I must’ve done well on the other parts.

I already have some research involvement. I have a mentor for biomedical engineering who I work for. As for vocabulary, I’m in my 5th year of Latin.

Thanks again,


Good.  You are off to a great start.  Biomedical engineering is a great field.  In fact, I almost enrolled in the program here at University of Michigan, but decided to go to medical school instead. 


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Monday, September 05, 2005

A National Health Insurance Program for the United States

I am going to try to write this objectively, i.e., without using the <rant> tag.  

Just as 2002-2004 was the "post-9/11 world", we now live in the post-Katrina world.  Everything is different now.  The national political debate will shift.  It will be difficult for citizens to keep in mind the fact that we can't and shouldn't make national policy on the basis of a single topic.

Prior to the last Presidential election, potential voters listed health care, education, and the environment as major concerns.  But in the post-9/11 world, none of that mattered.  As a result, those issues got drowned out; they played no discernible role in the outcome of the election.

This was terribly ironic, since national security actually depends upon those issues.  National security, thought of broadly, is the security of our people and our land.  What difference does it make if we prevent some terrorist from launching a chemical attack, yet we allow our own corporations to poison us with lead and mercury?  How are we going to defend ourselves, if we don't education our children;  All of our children?  And what good does it do to spend hundreds of billions of dollars fighting terrorism, when the lack of universal health coverage leads to 18,000 excess deaths per year?

Most readers of Grand Rounds are educated people, people in a position to make a difference.  One way we can make a difference is to insist that our leaders give us the national debate that we want, that we need, to keep our Nation great.  We cannot afford to let them -- Democrat, Republican, Green, whatever -- shape the national debate.  
We must shape the debate for them, not the other way around.  

I am aware of the fact that many physicians oppose the concept of universal health coverage.  I also am aware that many support it.  My casual observations indicate that it is mostly the younger ones who support it; but of course, they are not the ones in positions of influence.  Yet.  

It would be difficult to outline the rationale for universal health coverage in a brief essay.  Fortunately, anyone reading this has access to the Internet, and there already are several excellent sources available.  Probably the best summary can be found in the online, open-access medical journal, PLoS Medicine.  

If you are not familiar with it, PLoS-M has an excellent Policy Forum section.  One of the earliest articles in that section was this one:
A National Health Insurance Program for the United States
The country must abandon its fragmented system

Don R. McCanne

The total projected spending on health care in the United States for 2004 is $1.79 trillion—15.5% of its gross domestic product [1]. That amounts to $6,167 per person, almost twice what most nations with comprehensive systems spend on care. Most policy analysts agree that this level of spending should be more than enough to provide all Americans with high quality, comprehensive health care. Yet the United States falls far short of these goals. What are the flaws in the United States health system that prevent Americans from receiving value from this huge health care investment? And what are the options for improvement? [...]
Dr. McCanne points out a few essential facts, such as this:
In 2000, the World Health Organization rated the United States first in its health expenditures per capita, but 37th in its overall health system performance, below most industrialized nations [9]. The United States is clearly not receiving adequate value for its health care investment.
In other words, we spend more but get less.  One reason for that, is the inefficiency that is inherent in the current, highly fragmented, highly redundant health care financing system.  Private insurance eats up 15 to 25% of our health care dollars.  (Although some of that is offset by savings introduced by rule-based care, sometimes known as "managed" care.)  In contrast, Medicare has an overhead of just 3%.  

Many objections have been raised, regarding the prospect of universal health care.  Most of these are addressed in a short article on the Physicians for a National Health Plan (PNHP) site: Single-Payer Myths; Single-Payer Facts.  

It's not that politicians have ignored the issue.  The problem is that the citizens have allowed them to demote the issue to the point that it gets lost in all the fuss about the more obvious aspects of national security.  Also, persons with their own agendas have spread misinformation about the subject.  Worse, citizens have not taken the time to inform themselves about the details of the subject.  Instead, they draw conclusions based upon broad, but misguided, generalizations and assumptions.  

John Kerry had an idea, to have the federal government pay for catastrophic coverage.  Brad DeLong argued for this on his blog, here.  Dennis Kucinich also had a plan, one which I think was even better:  
The type of system I am proposing -- privately delivered health care, publicly financed -- has worked well in other countries, none of which spend as much per capita on health care as the United States. The cost-effectiveness of a single-payer system has been affirmed in many studies, including those conducted by the Congressional Budget Office and the General Accounting Office. The GAO has said: "If the US were to shift to a system of universal coverage and a single payer, as in Canada, the savings in administrative costs (10% to private insurers) would be more than enough to offset the expense of universal coverage."
As it happens, the crux of his plan is the same as that proposed by PNHP.

I am not foolish enough to think that that anyone is going to have a change of heart, or mind, as a result of this post.  However, I am optimistic enough to think that some people will take the take the time to become more informed about the subject.  Perhaps then, they will press for much-needed change, based upon their own informed positions.

Categories: science, medicine
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What we have seen and heard over these past few days has been horrible.  For the next twelve hours, I am going to focus on my sense of touch.  Nothing else.

The Mourning After

Sense of touch scintillates upward, the dorsal columns of my spine
Parietal lobes are soothed by the texture of twine
The data indicate baling twine is coarse, a bit prickly, but also smooth in spots
Twine holds the hay, which is needed, by those who depend upon me

Biceps and deltoids contract, I feel them opposing the weight
Cerebellum coordinates the yin and yang of muscle groups
It is pleasing that the muscles dance together, so perfectly, despite gravity
I know that, because of this dance, those who depend can be nourished

I decide to dare, to see what is before me
Rods and cones delight the occipital lobes
Layers of water vapor, fog, have settled between the hills
The water brings sustenance, which is needed, by the farmland around me

Rays of the sun, they dash slantwise over the horizon
Retinas dutifully report via the first cranial nerve
Stalks of wheat, amber, waving in the cool gentle breeze
The dew settles on them, also cooling, also sustaining them

I do not dare, to see what is beyond this horizon

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Sunday, September 04, 2005

From the Sea

There is a restaurant called Pelagos.  The name means "from the sea," in Greek.  It is underground, but has a patio open to the sky.  A staircase leads from the sidewalk to the subterranean patio.  The is a metal fence along the sidewalk.  On the patio, there are tables with umbrellas.  Large windows provide a view of the patio, from inside the restaurant.  Looking out, a person might be fascinated by the geometrical shapes formed by the window frames, the the tables, the steps, and the fence; that person might also be happy to glimpse a bit of sky.

Except now it starts to rain.  Unhappy patrons rush in from the patio.  But some people had read the weather report, and stayed inside for their dinner.  

Inconspicuous, along one wall of Pelagos, sit three men, of three generations.  As is always true in this Universe, the three men sit arranged in a triangle.  

All speak English as their native language.  But the oldest learned Japanese; the middle, German; the youngest, Russian and Latin.  

As it happens, the Latin form of Pelagos is Pelagius.

The oldest of the men enjoyed hunting and fishing, but no longer can do these things; he reads about history and the human mind, appreciates fine wine, listens to jazz.  Raised in poverty, he used his intellect to complete an advanced education; then went on to build security for his family, and a good reputation for himself.  This stands in stark contrast to the earlier generations of this particular lineage.  The oldest moved up in society by trying to improve himself, never by trying to take advantage of others.

The middle-generation man never particularly enjoyed hunting or fishing; indeed, is not terribly fond of any sort of killing.  At times, he has been known to read about history, and the human brain.  He raises horses and builds computers.  Although proficient at photography, he never cared so much about music or other forms of art.  He drinks beer, but never more than 16 fluid ounces (about 500 milliliters). sometimes he pretends to like wine, but generally does not pretend much.  One of the reasons that he does not drink much alcohol is that he hopes, someday, to live up to the reputation that his father established for the family.  If you ask him, he'll say he does not care about his reputation.  That is not really true, but the reason he cares about his reputation, is that he wants a better life for subsequent generations.

It annoys him that the restaurant brings a 12-ounce bottle of beer, with a 10-ounce glass to put it in, but that is a minor point.  It annoys him more, that some people don't think for themselves.

The youngest, like his father, is proficient at photography; unlike his father, he prefers digital -- like most young people these days.  One summer, he rode a bicycle in China, after which his father posted the pictures on the Internet.  The youngest uses computers, can upgrade them, but mostly sees them as tools to be used for specific purposes; unlike his father, he is not terribly fond of the hardware side of things.  At a very young age, he wanted to be an ichthyologist, or maybe a limnologist; later, he got interested in history and political science.  In his honors calculus class, he wrote a term paper about public-key cryptography.  Folk music is one thing he cares about, although he has chosen to not develop his innate musical talent.  He'll be off to college soon.  After thoughtful consideration of his many interests, he now thinks he will study virology and immunology.  

The older and middle of the men have devoted a great deal of effort to alleviating the suffering of individuals.  The youngest has grander plans, as a young person should.  He would like to prevent the suffering of many; not limit himself to saving people one at a time.

They sit and enjoy their dinner.  They talk about things.  It is an ordinary time.  Perhaps none of the three will, individually, make a lasting impression on the course of human events.  However, geometry has a lesson for us: the triangle, expanded to three dimensions, can form an icosahedron.  Perhaps the lineage of the three men will, over time, manage to build something just as elegant.

But instead of looking forward, we now look back.  As we sift through history, we see that there have been many who would have changed the course of events for the better.  Sometimes, the geometry of the Universe permits this; sometimes, it impedes it.

History has a lesson for us.  As the Roman empire was crumbling, and the Dark Ages began, there was a great struggle among theologians.  They cast aside Plato, and with him, his beloved tetrahedron, cube, octahedron, and dodecahedron.  Worst of all, even the supremely elegant icosahedron was tossed back into the sea.  

They thought the cross would solve everything.  Alas, they could only think in two dimensions.

One of them dared to dissent.  He carried the peculiar name Pelagius.  He promoted the idea that humans are basically good, and that it is through their free choice of actions that they keep themselves good.

In contrast, the predominant view at the time was that of St. Augustine, who believed that humans were fundamentally tainted by the original sin, and any good they had, came from the grace of god. 

The geometry of the Universe was not kind to Pelagius, although ultimately he managed to avoid the worst of fates.  From Wikipedia:
When Alaric sacked Rome in 410, Pelagius fled to Carthage, where he came into further conflict with Augustine. His follower Coelestius was condemned by a church council there. Pelagius then fled to Jerusalem, but Augustine's followers were soon on his trail; Orosius went to Jerusalem to warn St Jerome against him. Pelagius succeeded in clearing himself at a diocesan synod in Jerusalem and a provincial one in Diospolis (Lydda ), though Augustine said that his being cleared at those councils must have been the result of Pelagius lying about his teachings.

Augustine's version of Pelagius's teachings about sin and atonement were condemned as heresy at the local Council of Carthage in 417.

Those are the people who told us to put away childish things.  Those are the people who cast aside the icosahedron as a mere trinket.  But it so doing, they brought us the Dark Ages.

The online Catholic Encyclopedia contains the following commentary about Pelagius:

Meanwhile the Pelagian ideas had infected a wide area, especially around Carthage, so that Augustine and other bishops were compelled to take a resolute stand against them in sermons and private conversations.
Imagine that, being infected with the notion that humans are fundamentally good.  Is it some kind of virus?

Outside Pelagos, it rained.  Those who had not familiarized themselves with local meteorology got soaked.  The three generations of men, well-acquainted with the Sciences, stayed dry.   One of them wants to study viruses.  Perhaps there is hope.

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