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I don't refuse the vaccine, but there are several reasons that one would. It is reported that the efficacy rate of this year's vaccine is only 10%. That is dismal. There are known risks to vaccination including Guilliane Barre, cellulitis, flu-like illness, anaphylaxis and Autism (just kidding on the last one). All this in a setting where Vaccine makers have secured immunity against lawsuit regardless of culpability.

"Cutting for Stone" by Abraham Verghese is probably my favorite so far.

I also enjoyed "The Real Doctor Will See You Now," because it was very funny and honest. And I just finished "When Breath Becomes Air" and full-on ugly cried at the last paragraph.

Reminds me a little of Frankl's Man's Search for Meaning. It's been a while since I read it, and there is certainly a lot of outdated psychobabble at the conclusion of an otherwise masterful and haunting work, but I recall a line about a therapist asking a patient why he didn't just kill himself. The patient answered that someone had to feed the dog. I've always remembered (or perhaps mis-remembered that passage) and taken it to mean that meaning in life doesn't always have to be grand, just has to be something.

From a historical perspective, birth in America was moved from home to hospital not as the result of evidence-based studies that proved it safer, but for social and economic reasons that are fascinating and too complex for me to take the time to write about here. Here's a great book on the subject. (BTW I am NOT advocating for homebirth, I'm just pointing out that the reason for the switch is really complex and interesting and had little to do with patient safety.)

It's interesting how much we want to cling onto the idea that the current status-quo of birth in America is the bees knees and how we give excuse after excuse why it can't be improved upon. When a woman's risk of cesarean is based significantly upon which hospital she chooses to birth, there's a systemic problem.

I'm fortunate to work with obstetricians, MFMs, and other CNMs who see the value in all specialties working as a team to achieve the best outcomes for our patients. My midwife partners and I provide care to all of the maternity patients in our practice, from the lowest to the highest risk, and in varying degrees of collaboration and co-management with our physician colleages. We're proud of our outcomes and I think the model can (and should) be expanded throughout the country.

People like to portray midwives as being completely anti-medicine/anti-doctor, and I agree there are some that are (usually not CNMs, though). I just implore the medical community to please consider that we can do better in the case of maternity care, and expanding the role of nurse-midwifery is part of that.

For those interested in this topic, you should also check out The Danger Within Us: America's Untested, Unregulated Medical Device Industry and One Man's Battle to Survive It

I think you're getting at two different phenomena here. The second, which you mention is the concept of medical reversal. This is when common medical practices, often performed because of pathophysiological reasons or because of inadequate trials, are overturned. So NICE-SUGAR, per your example. My personal favorite here is one of the earliest medical reversals, the CAST trial, which showed that the routine use of antiarrythmics post-MI actually increased mortality (this was literally the standard of care, and based on sound logic, but WAY before my time).

Your first example -- tobacco smoke enemas -- I think falls into another class of deprecated medical practices, and that's pre-scientific notions of disease. So the idea of a tobacco smoke enema was that it would warm the inside of the body, counteracting the coolness of near-drowning. This was well within the boundaries of medical understanding of the humors (the view was that cold water would form a excess of phlegm from the cold and wet water, and the warm and dry tobacco smoke in the body cavity would increase the production of yellow bile to counteract this). There are a ton of humoral therapies that, to modern doctors, seems just absurd. If I had to pick the biggest blunder, I'd go with bloodletting, one of the oldest, and also one that managed to stick around until the 20th century.

I agree but with the notable exception of When Breath Becomes Air by Paul Kalanithi. That was probably the saddest and most insightful book I've read in a long time. He's also very non-masturbatory when describing his experiences.

"In May of 2013, the Stanford University neurosurgical resident Paul Kalanithi was diagnosed with Stage IV metastatic lung cancer. He was thirty-six years old. In his two remaining years—he died in March of 2015—he continued his medical training, became the father to a baby girl, and wrote beautifully about his experience facing mortality as a doctor and a patient. In this excerpt from his posthumously published memoir, “When Breath Becomes Air,” which is out on January 12th, from Random House, Kalanithi writes about his last day practicing medicine."

Really looking forward to reading his book. Have read some great things about it.

The comments section over at KevinMD for this article is becoming interesting with a former friend of the author showing up to defend the quackery by using emotional appeals.

EDIT: Here is a much easier way to get there - https://disqus.com/home/discussion/kevinmd/i_have_seen_both_worlds_and_the_naturopathic_one_is_terrifying/

And not a very good investment expert either, at least according to the Amazon reviews of his ridiculously overpriced book, which claims he's a huckster pushing gold bullion.

Don't know if you're aware but there's research out there showing a significant decline in empathy in [drumroll] the 3rd year of medical school. You're not alone!

Edit

Here's the study: https://www.researchgate.net/profile/Mohammadreza_Hojat/publication/26767120_The_devil_is_in_the_third_year_a_longitudinal_study_of_erosion_of_empathy_in_medical_school/links/02bfe51190bcd2d663000000.pdf

Introduction to Diagnostic Radiology

Edit: This is a free website with great cases that I used as a med student.

Lego sets, good way to spend time with your kid :

https://www.amazon.com/LEGO-Star-Captain-AT-TE-75157/dp/B01CIGN8WA/ref=pd_lpo_vtph_21_bs_tr_img_1?_encoding=UTF8&psc=1&refRID=Q77T1YJS1WT1BTED6MR2

https://www.amazon.com/LEGO-Technic-Mercedes-Benz-Arocs-Building/dp/B01FAPFFCC/ref=sr_1_8?s=toys-and-games&ie=UTF8&qid=1521850181&sr=1-8&keywords=lego+constructor

You may want to check out the non-fiction book, When The Spirit Catches You And You Fall Down (https://www.amazon.com/Spirit-Catches-You-Fall-Down/dp/0374533407)

Story of a Hmong family's interactions with the American healthcare system. (It's more compelling than that might sound...) I think it was a bestseller when it was published ~20 years ago.

God, yes, I loved 'When Breath Becomes Air' - that epilogue by his wife was just as beautiful. I ugly-cried too, yet also felt a weird sense of acceptance, all thanks to his marvellous prose! Looking forward to reading 'Cutting for Stone', heard a lot about it. Have you read 'My Own Country'? I had read a few pages long back, but moved on to more interesting books, and having a reader's block to getting back to it.

You should read "When Breath Becomes Air" by Paul Kalanithi. He's a neurosurgery resident who got cancer and writes from his perspective of being a doctor and patient. He talks a lot about being the educated one and how he coped with the emotions of it.

I used to. I've been an overachiever my whole life, but not anymore. So I used to hate Medicine and thought that I would kick ass in fields like Physics, Engineering, or IT if only I were there. Until the day I finished reading So Good They Can't Ignore You by Cal Newport.

It truly transformed my thinking. Now I know that a job is a job. "The passion hypothesis" (as Newport calls it) is bullshit. There are few people who have a predetermined passion and can pursue them. Good for them, but for the rest of us we need to know that any job can be satisfactory if we are good at it. So now I'm trying my best at med school and I know that a good future awaits if I keep this mindset and keep trying hard.

Let me point you to Edzard Ernst and his systemic review of cupping.

You'll find a ton of journal articles about the supposed benefits of cupping on PubMed, but many of them will come from alt-med journals - Journal of Integrative Medicine, Complimentary Therapies in Clinical Practice, Evidence-based Complimentary and Alternative Medicine, etc. All of the studies I read after a pub med search were the same, and I'll admit I stopped after 10 because they made my head hurt. They were small, most of them too small to generate any good data. And used this poor data to make some pretty big claims. And the larger reviews, like this one, basically come to the conclusion that the studies done were poor and more studies are needed.

Maybe I can help. I have my own struggles and found this thread through the bestof link. So I feel your pain very much.

I do, among other things, professional webhosting. It doesn't pay the bills because I'm not good at making sales; but the hosting is business-class quality.

Perhaps I can help you get started with making a website about something. The "what" would be the big question. I took a glance at your posting history, and I'm not sure what your interests are, but I can tell you that the site could be anything from informative to selling things - whatever we can come up with that you're interested in.

I'll provide hosting in perpetuity. And I have credentials at not being fly-by-night: I've hosted much of the Simutrans community since 2004, and although my business is to sell web design and hosting, for "charity" sites, I don't charge anything, nor do I advertise or anything. I treat all of them like real customers, with the exception of payment.

If you're interested in talking about the possibility, let me know. It might lead nowhere, but it might get something going for you.

The Vaccine-Friendly Plan by Paul Thomas and Jennifer Margulis

>...a slower, evidence-based vaccine schedule that calls for only one aluminum-containing shot at a time important questions to ask about your childs first few weeks, first years, and beyond advice about how to talk to health care providers when you have concerns the risks associated with opting out of vaccinations...

Wall of text and "childs" [sic] in the original. There are glowing testimonials from Jay Gordon and Lyn Redwood. This is only not anti-vaccination by dint of the time-honored paper-thin disguises of "just asking questions" and "offering alternatives."

My biggest suggestion is to know the infections first. You have endocarditis? Ok. Well what drugs do we use for that and what bugs are the cause? Then put the pieces together. It's much easier for me to work the antimicrobials in terms of infection site first then what we treat with and why.

Sanford guide is a must have. Their tables are great as an overview for empiric therapy including what organisms you are trying to cover.

I also recommend the book Antibiotics Simplified. It's got some pretty good info in it including some clinical pearls. Antibiotics Sinplified

I know it's a cliche answer, but Being Mortal by Athul Gawande was a fantastic read. I think I read it just before I started medical school and it was incredibly thought-provoking. It looks at the general attitude to death and palliation from the medical profession as a whole, and is also quite topical as assisted dying laws are proposed in different parts of the world. I've also heard great things about When Breath Becomes Air by Paul Kalanithi. :)

Maybe I'm the only one, but I'm not sure how I feel about Atul. I think his books are all interesting, but there's something formulaic and, this sounds much more harsh than I'd like, emotionless about his writing. I've heard his new book is better about this, but after reading Do No Harm and When Breath Becomes Air I think Atul Gawande's stuff is interesting but not very compelling.

Not a fast joke, but I wrote this a number of years ago when I was pissed off after a night shift in the ER.

I sent it off into the ether of CL rants and raves because that's not something that I could post on my facebook. I only realized it'd made CL because I saw it posted elsewhere.

Here's one for $14 from Amazon that plugs into a USB port. But the whole situation is ridiculous. EHRs were supposed to be interoperable. We've invested decades and billions of dollars in an EHR infrastructure that is broken beyond repair, and will never be able to work as intended. ¯\_(ツ)_/¯

Once you know your state you can then work on this.

In Texas, we have to pass a test. There is a study guide on Amazon. Looks like the Kindle version is just a few bucks. Most people just cram the weekend before they take it. Nearly everyone passes - back in the old days when I took it (1996) there were 30 or 40 of us in a group and we all had to take it in person in Austin. We also had to haul our original diplomas (often framed) into the room for inspection. After the test, we waited around 20 minutes and then this old doc came in and said congrats, everyone passed.

Based on discussions with today's trainees, the test hasn't changed much, but the process has as now you just schedule it with a testing center.

Should you fail, you can have up to 3 total attempts.

Best of luck!

No, the legal exception from discovery only extends to the discussion in the room, nobody would ever open it up like that, but you might enjoy some of the written M&M type presentations. This is a popular site: http://www.medmalreviewer.com/

Also there is a book called "Bouncebacks" that is similar. https://www.amazon.com/Bouncebacks-Emergency-Department-Cases-Returns/dp/1890018619

Reminds me of the preface to Man's Search for Meaning.

"There is a scene in Arthur Miller’s (1964 one-act) play Incident at Vichy in which an upper-middle-class professional man appears before the Nazi authority that has occupied his town and shows his credentials: his university degrees, his letters of reference from prominent citizens, and so on. The Nazi asks him, “Is that everything you have?” The man nods. The Nazi then throws it all in the wastebasket and tells him, “Good, now you have nothing.” The man, whose self-esteem had always depended on the respect of others, is emotionally destroyed. Frankl would have argued that we are never left with nothing as long as we retain the freedom to choose how we will respond."

The reason I went into journalism and have a strong interest in health journalism is because of reporter John Stossel and his great work covering the issue of consumer scams in the late 1990s and 2000's. His book Myths, Lies, and Downright Stupidity spends a chapter on the issue of chiropractors and basically lays out that with his research and under-cover work that as far as he could tell then: its mostly a scam.

​

The book is a little dated (published 2006) but it really impacted me on how good journalism can break through to hard truths and point out bonkers things in society.

​

Its a quick read and I recommend it to you guys!

Those prices are for any drug that an NHS doctor prescribes. If they prescribe 30 days it's $11.23, if they prescribe 90 days it's $11.23.

If you pay $37.14 you get every drug that your doctor prescribes for three months.

$132.72 gets you a years supply of everything.

Whether they're generic or a $5,000 brand new drug.

The British National Formulary guide does say the cost to the NHS along with all of the warnings, adverse drug interactions etc.

The epidemiology of simply how neonatal/infant/perinatal mortality is calculated is really interesting and complex. It it because our moms are more unhealthy than moms in every other country? Or is it because we have a woefully broken system compared to our foreign counterparts?

Great book on American prenatal care, written by a practicing perinatlogist.

Informative article on some of the statistical inferences that can be made between European and American perinatal mortality.

I am reading the book How We Die by Sherland B. Nuland--recommended by Paul Kalanithi in When Breath Becomes Air.

This piece of artwork is mentioned in the first chapter, and I thought it a valuable piece of artwork for physicians and students alike to see.

-- I am a medical student, /u/Chayoss.

The patent argument aside, isomers can be drastically different in their activities from one another (see Thalidomide). Capsaicin has some interesting stimulatory effects that somebody thought could be avoided, and so the isomer was synthesized and patented. According to the grand total of one article I read just now, it has some potential benefits over capsaicin. The article is old, and there are some potential conflicts of interest in the funding source, but the science seemed sound at a cursory glance.

I bought this. Elgato Stream Deck – Custom A 15 Pack of LCD Key with Live Content Create Controller (Authorized Distributor, 1 Year Manufacturer Warranty) https://www.amazon.com/dp/B06W2KLM3S/ref=cm_sw_r_cp_api_glt_fabc_521Q96CGQGHE4GJ8B5ET

It’s super easy to have a button do dot phrases for you. There are more complicated processes that I’m working on such as executing lab or blood draw orders, but being able to just click a button to have phrases put in rather than type dot phrases has helped me.

Here’s a piece from the publisher’s description of the book the author of the piece just wrote that may provide more insight. https://www.amazon.com/Everything-Below-Waist-Feminist-Revolution/dp/125011005X/ref=nodl_ I have not read the content if the book go see if this description is accurate. “Why is the life expectancy of women today declining relative to women in other high income level countries, and even relative to the generation before them? Block examines several staples of women’s health care...”

This implies it’s the health care of women causing the reduced life expectancy, as opposed to other well documented factors as well as an overall decline in mortality throughout the U.S. population. Furthermore, it makes it sound as if health care was more women-focused in the past, (hence the decrease in mortality) something my guess is she herself would deny.

While I don't doubt that within the book she makes some valid points about certain medical techniques, the book seems to have an agenda attacking modern medicine, something which could be seen in the Sci Am piece. One could also cynically wonder if the recent publication of the book motivated the blog post.

Edit: Please note that I am a librarian and not a health professional!

For those doing a surgery residency or EM - I just release Trauma Guide - great resource for taking care of adult pediatric and critical ill trauma patients.

https://apps.apple.com/us/app/trauma-guide/id1462123331

https://play.google.com/store/apps/details?id=com.stanfordtrauma.guide

Yep, the erotic side of Cushing's Syndrome/Disease.

Could also be paired with the nightmare-inducing 1980s McDonald's mascot Mac Tonight for maximal efficacy (mask available here).

Also reminds me of When Breath Becomes Air by Paul Kalanithi. He was a neurosurgery resident when he was diagnosed with stage IV lung cancer. His goal during treatment was not to beat cancer, but just to feel well enough to operate again.

This free online Coursera course seems to run on a rolling basis (a new session starts soon after the prior session ends). A new session just began this week. You can easily complete the course in an evening. I did.

It's aimed at psychiatric triage and basic initial comfort/support -- no diagnosis or therapy. The course cites scientific literature that shows that kind of initial response has better outcomes than diagnosis/therapy, because it is all most "victims" need, and tells how to identify the few who need to be passed to more formal assistance/therapy.

You need a budget. It's budgeting software that's really simple to start using. https://www.youneedabudget.com/

This alone won't cut it for financial planning as an attending, but it's perfect for a resident.

If you're looking for a great memoir about what it is like to become the patient I would recommend reading When Breath Becomes Air. The book is written in the first person and catalogs a neurosurgeon resident's decline after being diagnosed with cancer. The book provides great perspective into what it is like to be a patient.

If you really have a lot of free time, The first edition of the United States National Formulary was published in 1888 and contains a list (with recipes!) of the majority of medicines available at that time.

If you need a shorter answer, the main method of making medicinal preparations in that time was the tincture, a solution of substances dissolved in alcohol. The wiki page has a neat little list of some popular ones you could start with. Laudanum (tincture of opium), as /u/pfpants and /u/fancypants3000 alluded to, is probably the quintessential "medicine" of the day. Note: if you have an alcoholic in your party, tinctures might disappear at a rapid rate.

If you go back to the earliest snapshot of the front page available It doesn't look all that different than it does today. Maybe a little bit more fluff today, but certainly tolerable levels, and I quite enjoy some of the humorous pieces that get posted here.

Regarding link posts I don't really think there is anything wrong with them. People can use their votes to determine the legitimacy of an individual link post.

> ...and questions from lay public asking us to explain medical facts to them.

I have mixed feelings about that. Seems like there is enough misinformation out there that if a lay person comes seeking clarification on some concept they shouldn't necessarily be scorned for it.

But at the same time I understand why not to allow it.

As others have mentioned, verified flair might be good, though at the same time you run the risk of alienating people who either don't want to verify, or for allied health which already receive a degree of derision in this sub.

I was wondering whether any of your patients have made the same experience because the original study only looked at 25 patients.

Patients at risk just went on sale this week Written by the President of PPP – Rebekah Bernard and Niran Al-Agba They also have a Podcast

Here's Apple's own Press Release about ResearchKit:

https://www.apple.com/pr/library/2015/03/09Apple-Introduces-ResearchKit-Giving-Medical-Researchers-the-Tools-to-Revolutionize-Medical-Studies.html

I can't even begin to understand the reach and impact this might have on medical research and data collection. Being able to collect more objective data about activity and even more reliable information about certain subjective data might just be the beginning.

Can confirm cost for aHUS treatment is $1mil/month, not sure if 100% of that is driven by Soliris (although it certainly doesn't help lol). Dialysis, plasmaphoresis treatments, endless doctors visits, medications ect. are also contributing factors. Looking forward to that kidney transplant :)

As of 2017, Soliris is the 7th most expensive drug in the world (https://www.fool.com/investing/2017/04/18/the-7-most-expensive-prescription-drugs-in-the-wor.aspx).

Check out Nearpod or Kahoot for presentation systems. These allow you to import a PowerPoint, but put in activities like polls, quizes, draw-to-identify, and more. Then during the lecture, everyone gets an access code, and can follow along, vote, and participate on thier own devices (smartphones, computers).

On these platforms, people can pick their screen names. It's a great opportunity to have some fun, as long as no one picks something extremely inappropriate.

Also, trying to keep lectures case-based can help, as it ties in learning in a way that feels more applicable. I personally like setting up the case, and then going through the mechanisms of the disease/medication. Then every time I talk about a feature, I refer back to what it was causing in the patient's presentation. I try to focus on why the disease is affecting the patient, as it can take the dry pathophysiology and turn it into a key element of the patient's story.

I loved loved LOVED Do No Harm by neurosurgeon Henry Marsh - it’s a must read! It really focuses on medicine and less on some aspect of medicine. For example House of God is about the shitty part of medicine, When Breath Becomes Air is about the philosophical and moral calling to medicine, Better and Complications by Gawande are about the performance and liability aspects of medicine respectively. I’ve found it difficult to find a book that really focuses in on the practice of medicine itself and what it’s like. Do No Harm does a great job of that.

I’ve also read some of the others mentioned here and here are my thoughts:

• House of God: recommended as a “do you really want to go into medicine” test. It really focuses on the bleaker side of medicine and it’s pretty raunchy with almost a cartoonish depiction of sex between the interns and nurses. There’s an orgy scene at one point. But it does a good job dealing head on with the worst aspects of medicine- desperation, a colleague’s suicide, a psychotic break, and “loss of innocence” so to speak. I think everyone should read this to know the worst of what they’re getting into, but it portrays medicine in an overwhelmingly negative light.

• When Breath Becomes Air: should be read by everyone, this is the kind of book that gives you a new outlook on life. Definitely recommended but not as medicine-focused as some others.

Enjoy! Also I love reading so if anyone recommends more books then please do.

Lookingbill has a great primer, it was the first book I was assigned by my supervising board certified derm. It goes into just enough pathophysiology and covers a lot of common diseases without seeming overwhelming. Unless you're in derm, you're likely going to be referring out the majority of the esoteric diseases, and even this book goes into some of those oddities.

Lookingbill and Marks' Principles of Dermatology

https://www.amazon.com/Lookingbill-Marks-Principles-Dermatology-James-dp-0323430406/dp/0323430406/ref=dp_ob_title_bk

>d are quite good. I was also told as a crit care fellow that Stupor and Coma is one of the that all crit care docs should read, as it

tbh, it's been a while since covered derm. My favourite cardio book was on ECGs by Dubin. Apart from some infamous claims about the author, its a fairly short book (around 370 pages, big text), lots of pictures and very conceptual. hope this helps

1. Don't apologize for your tastes. But do learn to articulate your tastes, because this will help you find other "nicer" alcohols you like without wasting money. Why do you like Apothic Merlot. Is it the fruit flavors? Swish it around in your mouth? Do you taste fruit, herbs or spices? Which fruit? cherries or berries Berries? Do you taste spicy spices or warm spices? If you can pinpoint what you like you can go to a wine store and say something like "I'm looking for a fruit-forward, off dry red wine" Repeat process with fancier wine
2. Connect what you like about alcohol to the process of how it was made and the place it was made from. Blue moon is Belgian style beer. Unlike those German sticklers, these crazy Belgian monks started put all kinds of wacky stuff in their beer, like coriander and citrus peel so Belgian beers are really diverse and sometimes surprising ! The trivia is fun, and deepens appreciation of the beverage. Merlot grows a lot of places. Merlot from a hot, dry place (Argentina) will taste more robust and intense than a Merlot from a rainy place (Oregon) which might taste more mellow. This is why wines from different years can taste so different.
3. https://www.amazon.com/Wine-Tasting-Course-Every-Class/dp/1465405887 This book rocks, I've give like three copies as gifts
4. Done be afraid to drink hard alcohol the way you like it. Skip what you think is nasty (for all you know that tequila sat open next to a radiator for 18 months) . If it costs less than $40 a bottle, I'll add as many ice cubes in it as I damn well please.

Please note that pterodactyls and pterosaurs in general are flying reptiles and not closely related to dinosaurs. This clinically vital topic is likely to be covered in depth on the next board exam. I will note that your favorite flying reptile is the overhyped pterodactyl but recommend that you reconsider the noble Quetzalcoatlus.

(Also, see the excellent Dinosaur Empire! for high yield dinosaur, flying reptile, and marine reptile info sure to impress any 3-10 year olds in your immediate vicinity).

My experience is that e-readers and tablets are getting to be less and less distinguishable from laptop computers. Turn up the ambient light and turn down the backlight on your device and I'd say you're 90% there. That being said I do know Android devices do have a good interface for PubMed I don't know about much else though. I'm sure Apple has one just like it. https://play.google.com/store/apps/details?id=com.bim.pubmed

There is a book called "The Power of Habit" that tells the story of the Rhode Island Hospital where this was exactly the situation and people died as a result.

There was a HUGE deal and they totally turned around their system since.

>And if the studies have shown homeopathy to be ineffective, why is it still allowed to be practiced?

Unless something is outright harmful, and sometimes even then, it's difficult to make it illegal.

>And why do people claim it helped them? Are they lying? Mere coincidence?

People claim a lot of things that don't make sense. We never landed on the moon. Obama wasn't born in the US. You can run your car for free by using the battery to split water into hydrogen and then burning the hydrogen. Magnets can be a perpetual source of free energy. Just look around Snopes for more examples.

My personal opinion is that it's a combination of:

1. Most diseases and afflictions have a tendency to resolve themselves, regardless of whether an effective treatment is given or not.
2. People tend to easily assume that if you did something while you were sick, and some time afterwards you got better, that that automatically means whatever you did was what "healed" you.
3. People have an innate desire to feel in control of a situation, and if they can't control a sickness through actual means, then they turn to "supernatural means" (homeopathy, prayer, etc.). It at least makes them feel like they are doing something, and thus makes them feel better and helps them cope better psychologically.
4. Plain-old placebo effect.
5. Plain-old greed, from the part of people who want to separate others from their money. In the old days they were snake-oil salesmen. Nowadays they're homeopaths.

Rapid Interpretation of EKGs by Dale Dubin, MD. It has nice little cheat sheets too. http://www.barnesandnoble.com/mobile/p/rapid-interpretation-of-ekgs-dale-dubin/1101426459/2673841211744?st=PLA&sid=BNB_DRS_Marketplace+Shopping+Textbooks_00000000&2sid=Google_&sourceId=PLGoP20420&k_clickid=3x20420

And the whole point of the article is that the physicians feel they can spend more time with their patients. If you're spending more time per patient, you must also make more money per patient.

>sliding scale fees are also not uncommon.

And you have lots of office staff to manage that for you, which you would be getting rid of to avoid overhead under this model. Or are you keeping your office staff and the same overhead?

Edit: An example quick and dirty calculation: If you're going to spend an hour with each patient including travel and other time associated with home visits, and you're charging $100, working 8 hour days with 5 weeks for time off, illness, and random stuff, assuming you're 100% booked all the time, your annual revenues are less than $190k, out of which you have to pay all your expenses. That doesn't sound like a reasonable business model for a physician.

According to consumer reports, the fees are generally $100-150 per month for concierge medicine in addition to the claims they recover from medicare for the service. TL;DR The market is currently pricing this significantly higher than $100 per visit.

The study itself. Here's the link:

https://www.researchgate.net/publication/303711260_Cortical_functional_correlates_of_responsiveness_to_short-lasting_preventive_intervention_with_ketogenic_diet_in_migraine_A_multimodal_evoked_potentials_study

It's a single blinded study (evaluators) with a baseline metric of two months, with N=18. Pt were put on the ketogenic diet (KD) and then the same format for detecting migraines as the baseline was followed.

Results: >The [results table] also shows that there was a significant reduction in attack frequency (from 4.4 ± 2.7 to 1.3 ± 1.1 attacks/month, t= 4.70, p< 0.001) and attack duration(from 50.7 ± 26.9 to 15.8 ± 20.1 hours, t= 5.43, p< 0.001)after 1-month duration [of the] KD

Note the overlap in CI for frequency is 1.7 vs 2.4 (so maybe not significant?) and duration is 23.8 vs 35.9. The high variance from low N likely added to the low power here.

Fairly straightforward, and to be honest while it's not a very deep study, for what it is I think is fairly well done - and it's great to see something come out positively as this is a Dx which has little to offer other than palliative assistance (and O2, little that does).

Interestingly, this Italian study came from their own report of two obese twins who suffered migraines, went on the ketogenic diet, and then saw reductions of their events. Hopefully more trials to follow soon.

Isn't there a law requiring insurance companies to have a certain percentage of money go towards providing care?

Edit: Yes there is.

"The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in on premiums on your health care and quality improvement activities instead of administrative, overhead, and marketing costs.

The 80/20 rule is sometimes known as Medical Loss Ratio, or MLR. If an insurance company uses 80 cents out of every premium dollar to pay for your medical claims and activities that improve the quality of care, the company has a Medical Loss Ratio of 80%.

Insurance companies selling to large groups (usually more than 50 employees) must spend at least 85% of premiums on care and quality improvement.

If your insurance company doesn’t meet these requirements, you’ll get a rebate from your premiums."

This book is great:

https://www.amazon.co.uk/Accident-Emergency-Radiology-Survival-Guide/dp/0702042323/ref=sr_1_1?dchild=1&amp;keywords=emergency+radiology+survival&amp;qid=1624822280&amp;sr=8-1

There's this book. I have the third ed, it's quite good (and seems like it will be a good reference for at least a decade or so until I'd either buy an updated one or not buy again due to not using.)

Mullvad is a bit better then PIA and possibly the best VPN out there. Checks off all the green marks on uses group IP addresses, and offers a complete set of VPN features with in depth tutorials on it's site on how to use them all. It barely even affects my internet speed and I use in the US for I think €5 a month

PIA is good too, but it doesn't offer full features and it's located in the US

I highly recommend reading When Breath Becomes Air... when you have the time and energy for it ;) other than that, don't forget to treat yourself to all the little things (coffee break, dinner delivery, a new lego set, power naps, etc.) they add up and make all the difference imo. Also. YOU CAN DO IT!

I definitely agree with that; I'm in the process of reading his memoir. Have you read "When Breath Becomes Air" by Dr. Paul Kalanithi? I just finished it, and really enjoyed both his writing style and his discussion of the philosophy/metaphysics involved with being a physician and a patient.

You're uneducated on this topic and think a quick Google will sort you out!

Here is a published version of these blogs you're so dismissive of

There are basically a billion book / internet article / discussions about this issue in relationships. This is one of the most recent ones that presents a possible strategy, of course it assumes that both parties are willing to cooperate

Fair Play https://www.amazon.com/dp/B07NTX84PY/ref=cm_sw_r_cp_apa_glt_9JHK0YGJWV15283C94FF

I will say that it sounds like you're talking about two different issues... One is the burden of being the Household CEO, The other is the the actual execution of the tasks. Messing up the cooking with just 3 tries (it can be improved!)! is ok but the household CEO thing is a different issue.

I do agree that no matter how this all plays out, it's going to be Worth it to your household to hire a once-weekly professional cleaner. BTW, In addition to the entire internet being available to teach someone about household chores and cooking, if your H a written book about how to maintain household chores and cleanliness, there's "home comforts" and "Martha Stewart's Homekeeping Handbook:" both of which are very gendered but do contain instructions about how to do stuff like sorting laundry and how full to make the washing machine.

This book is fantastic for that--extremely detailed.: https://www.amazon.ca/Evidence-Based-Physical-Diagnosis-Steven-McGee/dp/1437722075

There's also this: https://jamaevidence.mhmedical.com/Book.aspx?bookId=845

No Death, No Fear by Thich Nhat Hanh. All of his writings, in general, have helped me immensely. He is a Buddhist monk, however I remain agnostic and do not find his teachings “religious” seeming. Discusses peaceful ways to accept and appreciate life and death.

The U.S. edition has a different subtitle. Available in usual places, e.g. Amazon:

https://www.amazon.com/Shock-Journey-Death-Recovery-Redemptive/dp/1250119219

https://www.amazon.ca/Prestige-Medical-4350-TRO-Tourniquet-Tropical/dp/B0026K6KME/ref=sr_1_2?ie=UTF8&amp;qid=1542759508&amp;sr=8-2&amp;keywords=Prestige%2BMedical%2Btourniquet&amp;th=1

Found this on Amazon -- comes out to about the same after accounting for international shipping etc. So expensive!

Bad Pharma by Ben Goldacre is great. I also enjoyed Do No Harm by Henry Marsh. I wasn't as impressed by When Breath Becomes Air. Being Mortal by Atul Gawande was good. Stoned: a Doctor's Case for Medical Marijuana was really interesting. I liked Emperor of All Maladies as well.

Not really "tablet", but phone. If you're a resident, I doubt you'll use a tablet much. I've tried to incorporate my own laptop or tablet since the hospital ones are incredibly slow; I have yet to find a way to do it efficiently and without constant worry. I use my phone for 99% of things and the app I use is called the Hospitalist Handbook.

https://play.google.com/store/apps/details?id=com.agilemd.android.ucsf.hospitalisthandbook&amp;hl=en or https://itunes.apple.com/us/app/hospitalist-handbook/id1214415358?mt=8

It's an app made by UCSF medical center. I've posted about it many times and it has been a godsend. It's uptodate/the purple book) in outline format with only the clinically relevant information in quick, searchable, access. MDcalc or medcalc are great calculators. That's about it. During rounds, my attendings have not expected us to know labs unless it's relevant (you should know the sodium of a pt admitted for hyponatremia or the the vitals/WBC/lactic on a septic pt) and most will not since it's all EMR based and easier to view(especially trends). Notes are still best served by writing on your census. Nothing is worse than your system freezing/crashing just as you start to write down orders/the things attending has said. Just stick with paper and a check box/list system for that stuff.

With this being said, if you're an attending, I'd probably pick up an ultrabook over a tablet of the same size/weight (lenovo make a thinkpad carbon that weighs 2.5lbs, just picked one up) as many EMRs may not be compatible/functional(I believe cerner is view only from an ipad) with iOS/android.

Lowly med student here but one of my cards attendings loves using QxMD's Calculate.

It has simple stuff that everyone's heard of/knows/at one point had to memorize like CHAD VASc, CURB 65, PSI, Well's, 4T score of HIT to more complex formulas like APACHE II, risk of dialysis after cardiac surgery, PCI mortality, risk of recurrence of kidney stones.

It's organized by specialty, user friendly, has a clean GUI, and very easy to use.

All of Medical Joyworks' apps are quite fun, but I'm an even bigger fan of Resuscitation because of the relative freedom you have to treat the patient.

it seems to be this study

ImMucin: A novel therapeutic vaccine with promiscuous MHC binding for the treatment of MUC1-expressing tumors

> Must have taken a ton of work and time

You bet it did :) About the mitral valve, well I should say I didn't know that at the time of modelling, I am too tired to edit it now, but will definitely consider changing it whenever I can...

And about the future projects, I am in a dilemma, whether to add liquid inside these chambers using realflow or go to pathologies omitting the physiology... I still have a fear that adding blood could make the model clumsy, but I will give it a try once... If that fails, I'll go directly to various pathologies and upload them sketchfab soon....

And thank you very much for your kind comments.. :)

Google body was amazing and wonderful (and free)....unfortunately its been bought out and hasn't relaunched yet. Here is the future site. I'm hoping it is just as good. zygotebody

A lot of tongue in cheek answers here (and rightfully so, the system is a mess in the US) but this seems like a relevant read for you:

https://www.amazon.com/American-Health-Care-System-Practical/dp/3319675931/ref=nodl_

Not a textbook per se but it has a textbook version. I still reread this as a pulmonary critical care attending every now and then. Linda Constanzo's BRS Physiology. Guyton and Hall is good to pass exams but it's better to know than to memorize. By rereading a simple book, you'll know it. Still helps my decision making process on a daily basis.

BRS Physiology (Board Review Series) https://www.amazon.com/dp/1496367618/ref=cm_sw_r_cp_api_glt_fabc_PC251SRRQTNDY4FCQTZQ

<em>How the Immune System Works</em>

I'll take a stab at a serious answer. Bought this a few years ago.

https://www.amazon.com/dp/0323100457/ref=cm_sw_r_cp_apa_fabc_G55XX1ESJ3JANSZKMRJE?_encoding=UTF8&amp;psc=1

The info is good. Taking a paperback on a rafting trip with shoddy dry bags.... Not so much.

Just goes to show international differences! Fluclox is bae in the UK. Covers most of our relevant organisms for SSTI and GI upset is not a particularly frequent cause of discontinuation in my own experience of chucking it around. Also, our 1st line local choice for prophylaxis in cardiac transplant patients.

Buffered fluclox elastomerics if you need a continuous infusion that is, but most of the use cases for IV Fluclox usually mean the patient is going to be in hospital anyway.

Cefalexin in the UK is an essential part of UTI treatment strategy, so exposing all the GI/GU flora to it for a SSTI when a narrow spectrum agent exists seems unusual to me. We also use a lot less cephalosporins in general as a medical cultural habit.

> My "side hustle" is moonlighting at my regular job

I'm surprised that's not the most common answer. If you can make $150+ per/hr and easily pick up additional shifts then you're crazy if you think you can do better owning a restaurant or an alpaca farm.

> hey, owning this farm lowers my tax bill and it makes me happy dammit

Owning a farm because it makes you happy makes perfect sense. Losing money on it because it lowers your taxes is insane.

The Millionaire Next Door wasn't the greatest book, but it had an interesting chapter on why many doctors are terrible at accumulating wealth.

I'm not in medical school yet (applying right now!!) but I found Atul Gawande's "Being Mortal" and Paul Kalanithi's "When Breath Becomes Air" both to be big sources of inspiration when I decided to pursue a medical career.

When Breath Becomes Air by Paul Kalanithi is by far my favorite medical related book.

I don't want to spoil any of it for you (it is an emotional read,) but I just noticed that the New York Times article called it "as illuminating as Atul Gawande's 'Being Mortal.'"

Actually I made an interactive neuroanatomy app for android before, but that did not pan out as much I expected it to be, so I am trying to see if CVS could work out better in this field...

Journal articles:

Read by QxMD - lets you pick and choose journals or specialty topics that you want to subscribe to and organises them for you so that you can read them when you've got some free time. Similar to how Flipboard works. You can quickly go through the abstracts or if you've got an institution log-in and password, you can download the whole PDF from the app.

Great way to stay on top of new literature.

Technically yes...

But there are apreensive parents that don't want a tonsillectomy in the first consultation, there are waiting lists and there's crappy insurance... And there are nasal steroids + montelukaste [1] [2]...

Recently I attended a conference where Gozal talked a bit about this... It comes much to the clinical feeling and patient care setting...

So for most of my patients my common approach is to try anti-inflammatory treatment on the first consultation (as most haven't had a proper allergic evaluation or previous nasal treatment), and a brief reevaluation, when you can already see who is responding and who isn't, and for these, schedule surgery or subsidiary workup...

I feel you dood. Which is why I follow this little lady on Facebook! She often manages to say exactly what I'm thinking... and sadly, she's probably the kind of medical student we all wouldn't hate! :-(

Valid counterpoints - I think at a certain level you need to be there. I think the benefit of a BMV versus NIPPV is there's no peep, pressure is easier to control and augmented to each breath. Again at this level you really need to be there.

>>The device to connect oxygen to a needle doesn't exist.<<

Take the connector off a 3.0 ET tube and it will fit into the needle and attach to your BVM.

http://tinypic.com/view.php?pic=1z3b6kx&amp;s=6

Who cares? There's already a generic alternative. the authorized generic of Adrenaclick (epinephrine auto-injector), is a cheaper option—we found it for $142 at Walmart

There have actually been many trials and lots of data that show the benefits of melatonin for insomnia in all age groups. Just as an example, here is the first page of the google scholar search results: http://scholar.google.com/scholar?q=melatonin+insomnia&amp;btnG=&amp;hl=en&amp;as_sdt=0%2C31

It's mentioned in all of the recent treatment guidelines I've read for insomnia - like you said it's pretty safe, and works pretty well too!

videos by this guy helped me heaps

http://www.khanacademy.org/science/biology/v/types-of-immune-responses--innate-and-adaptive---humoral-vs--cell-mediated

This isn't even TED... it's a cheaper program called TEDx.

TED is a conference where people go and talk about something incredible. TEDx is where people go when their talks are not good quality enough to go to TED. It's more local.

If you want stuff that is actually intelligent and inspiring, go straight to www.ted.com (their website has more information) and don't bother with the TEDx videos.

That would be an extensive task to interpret multiple journals... uptodate does it, but they also charge a lot of money.

• Google scholar
• Pubmed

Two good places to search (at least look at journal titles and abstracts) for summaries of different papers.

• medscape or webmd

good for general knowledge topics that attempt to cover a disorder in it's entirety that most people would be able to sorta-kinda understand.

I wished the same, but it's "The Verge" and that's that.

This might cater to your interest

Edit: Follow up talk here.

They say it in the actual article. You can get it from Library Genesis. I didn't check ResearchGate.

Thank you Dr. Green for your short stories, I can't wait to read the novel!

For those outside the USA Book Depository (technically still Amazon) carries Trauma Room 2 with free shipping. It was a little cheaper than buying from Amazon.com + international shipping.

Check out BabyConnect as it has many similar features for babies, including med administration, temperatures, etc. Also has online sync, etc.