Say Goodbye to Your Stethoscope: An Interview With Dr. J. Christian Fox

With Portable Ultrasound, Some Medical Students are Already Ahead of the Curve.

So you're on wards, doing your best to look smart, take care of your patients, and get that fine letter of recommendation. Suddenly, the attending thinks he hears an extra sound while doing a cardiac exam. Now, full of joy and self pride, he will take time to let you have a listen. The goal, of course, is so you can develop your powers of cardiac auscultation or look like an idiot, the latter being more likely. Either way, you eagerly place your stethoscope over the patient's chest wall with a very intelligent and contemplative look, all while trying your best not to seem studentish. Tuning in to listen, you even furrow your eyebrow a little, shake your head up and down and mutter, “Hummmm very interesting....yeah...that’s very interesting,” careful not to oversell it. Of course, you hear no murmur, nothing other than good ol’ S1 and S2 lub dubbing along. But, you cannot disappoint your attending who is looking down at you full of pride for catching this slight blip on the radar of the patient's cardiac cycle. He is just glad someone is here to appreciate the level of medical acumen that has just been demonstrated and imparted to a future doctor who will carry on the sacred art.

Learning to identify and diagnose patients based on every little slosh or swoosh heard by your stethoscope is a skill that we are all expected to master as a medical student. However, according to Dr. Eric Tropol, you may never need it as a physician. As I watched the TEDMED talk by Dr.Topol, I learned that we may not need the stethoscope for long. Medical wireless and portable ultrasound companies are developing new devices that make it possible for doctors to carry an Echocardiograph machine in their lab coat. So now I don’t feel so bad about my underdeveloped auscultation powers. If I cannot hear something, I’ll just get and echo or ultrasound; problem solved.

However, now we have another predicament. Have you ever been asked to explain what you see on an ultrasound or echo? I have, and I get the same feeling when looking at a Jackson Pollock painting. Usually, my face gets all wrinkled, I shrug my shoulders and shake my head, utterly clueless. I have also been known to take the 3D Magic Eye approach, pushing my nose to the screen and staring intensely, hoping that a 3D image will magically pop out at me making the diagnosis. Hasn’t happened yet, but I’m still optimistic. There are a few medical students in the nation who are probably reading this and thinking I’m a giant kook because they can read ultrasounds in their sleep. Dr. J Christian Fox is the director of University of California Irvine’s portable ultrasound program. Part of his passion is to give the medical students and residents training in ultrasound techniques. He sees that the use of ultrasound will continue to grow as a tool for diagnosing and treating disease. After the interview, I was left wondering why more institutions aren’t teaching ultrasound in their curriculum.

 To Learn More Visit:

• www.ultrasound.uci.edu
• Search Fox Ultrasound in iTunes for free Podcasts
• www.sonosim.com

Check out our conversation below

A Career in Wilderness Medicine: Dr. Jerri Mendelson

Dr. Jerri Mendelson is a Dermatologist practicing in the northwest United States.  She also is a former wildlife biologist and a recognized expert in Wilderness Medicine.  In this video, Dr. Mendelson talks about her career and how she made the transition from wildlife biologist to Dermatologist.

ABOUT: Dr. Jeri Kersten Mendelson is a board-certified dermatologist. She began her professional career as a wildlife biologist with a degree from the University of Wyoming. Her wildlife jobs took her to Wyoming, northern Thailand and eastern Oregon where she worked as a big game biologist for the Ochoco National Forest.

After leaving the Forest Service she attended the University of Oregon where she received a Masters degree studying bat echolocation. It was at the U of O where she met her husband and for the next several years followed him to Northwestern University, University of Pittsburgh and finally to the University of Arkansas for his post doctoral training in neurophysiology and physical therapy. Along this journey she taught anatomy and physiology and general biology. She attended the University of Arkansas medical school and dermatology residency program while her husband ran a medical research lab and practiced physical therapy. Together, they raised two active Razorback-loving boys.

Dr. Mendelson is a certified Dermatologist, MD FAAD and currently practices in Medford. As a clinical associate professor at Oregon Health and Science University (OHSU), Dr. Mendelson also teaches dermatology to family practice residents during their rotations in the clinic. She has continued her educational interests by working with school groups and community organizations in sun/skin awareness programs. Jeri is a part time speaker and faculty member for the Wilderness Medicine Society.

Student Doctors: How To Get Rich In Medicine

Take a lesson from Trinidad Colorado. Sell the shovels, don't be the miner.

By Arlen Meyers MD MBA

Trinidad ,Colorado, located in the Southern part of the state on the Colorado side of Raton Pass, was, until recently, the "sex change capital of the world". More sex reassignment surgeries were done there than any other city, until recently when the surgeon left to take a job in San Francisco.

Trinidad , pop 7300, has a long, illustrious history. It grew up as a trading post along the Santa Fe Trail, one of the 3 primary "trails" in early 1800 America, that connected Independence, Missouri with Sante Fe, then part of Mexico and was a major trade route. The Trail provided entrepreneurs with two ways to make money. The first was by providing a way for people to do business or mine coal. The second was to sell things to the people who were doing the business or mining coal.

For example, the growth in traffic along the trail attracted Jewish merchants from the East Coast and Europe who saw a business opportunity providing goods, tools and supplies to Sante Fe Trail users. In 1883, they built Temple Aaron, now the oldest synagogue in continuous use in the state ( http://www.smallsynagogues.com/trinidad_co.htm ) The geneological connection to prominent Denverites exists to this day.

If you are looking for an opportunity, consider selling the tools to make the product, not the product itself. For example, there is tremendous interest in companies producing high speed automated DNA sequencers that will be able to deliver the $1 genome and provide an important tool to drive the personalized medicine revolution. Another company, Sharklet  (http://www.sharklet.com) is using a shark-skin like material that is bacterial resistent to coat medical devices, and, interestingly, the bottom of US Navy ships to prevent the accumulation of barnacles and other organisms that create drag on the hull.

Wars create fortunes. Be the guy who sells the bullets, not the soldier.

About: Arlen Meyers MD MBA is the cofounder, and Chief Medical Officer of MedVoy, a medical tourism company. He is also a Professor of Otolaryngology, Dentistry and Engineering at the University of Colorado at Denver and CEO and President of the Society of Physician Entrepreneurs.  Read more of Dr. Arlen Meyers posts on Freelance MD. 

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Taking Advantage Of Opportunites: Lessons From Dr. King

“If you can choose between opportunity and security, always choose opportunity.”

A couple of months ago, a wise friend gave me that sage advice; but sometimes I wonder, "What type of opportunity should I pursue?" Opportunities come in all shape and sizes. Which ones are important? Which ones will make a difference?

This incredible excerpt from a sermon given by Martin Luther King Jr. shows how he thought opportunities ought to be pursued. It is inspirational, humbling, and poignant.

I’ve also included the original audio below, thanks to archive.org. I think it's better coming from the man himself, definitely worth a listen.

And I say to you this morning, that if you have never found something so dear and so precious to you that you will die for it, then you aren't fit to live. You may be 38 years old as I happen to be, and one day some great opportunity stands before you and calls upon you to stand up for some great principle, some great issue, some great cause--and you refuse to do it because you are afraid; you refuse to do it because you want to live longer; you're afraid that you will lose your job, or you're afraid that you will be criticized or that you will lose your popularity or you're afraid that somebody will stab you or shoot at you or bomb your house, and so you refuse to take the stand. Well you may go on and live until you are 90, but you're just as dead at 38 as you would be at 90! And the cessation of breathing in your life is but the belated announcement of an earlier death of the spirit. You died when you refused to stand up for right, you died when you refused to stand up for truth, you died when you refused to stand up for justice.

-Dr. Martin Luther King, Jr. from the sermon “But, If Not” delivered at Ebenezer Baptist Church on November 5, 1967.

Money Management + Medical Students

If you've been in medicine for even a little while, you know there are a number of taboo subjects that just aren't discussed.

One of the most important discussions that medical students do not have while in training is the subject of money and overall financial management.

It's been very exciting for me to watch this very cool website, Uncommon Student MD, so quickly develop into the premiere source for honest, practical information for medical students. Over on Freelance MD, we've written a number of articles about investing and money management for physicians and medical students.  Here are some of our prior posts:

• Physicians and The Richest Man in Babylon
• Keep It Simple
• Physician Wealth Protection
• First Things First: Handle Your Finances as a Physician
• Physician: What Are Your Assets?

I also would like to recommend to you all Dr. Robert Doroghazi's book entitled The Physician's Guide to Investing.  I wrote a brief review of the book here on Freelance MD, and while I would differ from the author on a few of the finer points, I think the gist of the book is excellent.

Last, at our most recent Medical Fusion Conference I was able to sit down with Dr. Setu Mazumdar, an Emergency Medicine physician turned financial manager.  Setu gives his perspective of "financial independence" in this interview.  Check it out...it's worth watching.  Hopefully, by learning a bit about finances while in training you'll avoid some of the common pitfalls of physicians and money.

Click to read more ...

Interview: Preparing for Physician-Entrepreneurship

Troy Heidesch, Founder of Smart HouseCalls, speaks to students about starting a business.

Remember the blog post in December about Dr. Toby Bond? Well as it turns out, Troy Heidesch consults as a part-time Nurse Practitioner in his office and is equally as innovative. Troy is founder of Smart HouseCalls, a new start-up which connects patients to their physicians more effectively using webcam technology. His system is HIPAA compliant, high definition, stable, secure and most importantly, billable. Using this technology, quick follow-ups and educational meetings can be arranged over the internet face-to-face with the provider rather than over the phone with the office staff. This has the potential to make an enormous impact in rural areas where access to healthcare is a serious issue as well as add convenience to patients who might not otherwise follow-up due to a busy schedule. I was able to sit down with Troy to discuss his work during the start-up process--hopefully you'll find his insights helpful.

Q: Tell me what you're up to.

A: I am the founder and CEO of a Biotech startup called Smart House Calls. We have built a telemedicine platform that allow physicians to communicate with patients from anywhere to anywhere with an internet connection and then charge  either the patient or the insurance company for that interaction. This improves patient access to timely and convenient care, decreases emergency room visits, and is an income accelerator for primary care providers.

Q: What has been the most challenging part about starting a business?

A: Patience and getting over self-doubt. You expect that a great idea will sell itself. After a few months you realize that success is in the execution rather than in the idea and execution takes time. I believe that self-doubt is common to most entrepreneurs. You think, “Who am I to build a potentially very large enterprise?” Then, as you immerse yourself into trying to succeed, you start seeing that you are really no different than other successful entrepreneurs. You read voraciously, talk with anyone who will listen, and suddenly you find that you are executing and doing a respectable job.

Q: How have you changed your clinical practice to allow time for your business?

A: I work as a consultant for primary care practices seeing patients and then installing our system. This is now giving way to full time within the company as sales begin to ramp up. I get up at 5 AM, do a little work for Smart House Calls, go see patients, and then work until about 7 or 8pm before spending some time with my family. On the days when I do not see patients, the hours remain about the same (and that includes weekends!).

Q: What should students who have entrepreneurial interests be doing to prepare for a different career when they graduate?

A: Read. Great book to start with is “The E-Myth Physician” by Michael Gerber. Decide whether you want to be an employee in your own business or be a CEO at the beginning. They are VERY different from each other. A physician as an employee will spend the day seeing patients and spending time every week to make sure the staff is paid and will pay attention to billing. The CEO will build systems that will work regardless of personnel and will be able to scale. They will spend most of their time thinking five years ahead and implementing strategies to push the business in the direction they envision.

Q: Any other comments?

A: If you have a great idea, talk about it to everyone person you meet. Do not worry about someone stealing your idea. Ideas are a dime a dozen, it’s the execution that is hard. By talking with everyone about your idea or plan, you will gain insight into the marketplace to help determine whether you really have something that people would want to pay to get. Finally, drop any ego or worry of losing control, hire people who are obviously much better than you. They will make you better and will pull your business to success much faster (success may not happen at all without this type of talent). A people should hire A people. If you hire B people they will hire C people and so on. Your idea will flounder and die if your first hires or partners are not exceptional.

So readers, what are your questions about starting a business? Leave comments and we'll get the discussion started.

A big thanks to Troy for his time and insight into these issues. For more information, see their website at SmartHouseCalls.com.

The Anatomy Of The Medical School Gunner

This is my dad, Dick Gunnerson III. He made me what I am today. A Gunner!So...you want to be a gunner?

Many people have been begging me to share the secrets of the exclusive brotherhood who's rich history goes back to the dawn of man. It’s members include James Bond, The Most Interesting Man In The World, Donald Trump, Chuck Norris, all Ninjas, and of course, Stephen T. Colbert. By now you know that I am talking about The Gunners. Of course they exist in every field of study and every walk of life. Each one has its own breed; however, there is none more notorious, none more revered than The Medical School Gunner.

In fact, I decided to become a doctor because I heard that medical school is a place where gunners are respected and honored by the teachers. I knew it would allow the true gunner in me to blossom and thrive. Personally, I believe gunners are born; they are not made. When I was young, I did not always know I wanted to be a doctor, but I always new I wanted to be a gunner. Medical school was just the best way to express my gunner within.

Some have said that your potential as a gunner is inversely proportional to the number of friends you had growing up as a child. This makes complete sense. When you spend your days crushing life, you really don’t have time left over for friends, or even family for that matter. I guess the unimportant things in life just fall to the side. Follow these tips, and soon you’ll be on your way to doing just that. If I forgot any gunner tips, post a comment and let me know.

If you are sleeping more than 4 hours per night..stop it!

This will just make you weak. True, most doctors and scientists who study sleep will tell you that a lack of sleep will wreck your immune system, may make you depressed, and can even kill you; but they probably don’t know about the Gunner Shake. The Gunner Shake includes 1 cup of ice, 4-6 shots of espresso, 6-10 pills of Adderall ground to a powder, 5 raw eggs, 1/2 cup cheyenne pepper, a bunch of wheat grass, and a tiny squirt of epinephrine (no too much, just enough to give it some kick). All blended together for a tasty midnight snack, it will have you charging through the night, and in some cases, to the Emergency Room. Don’t worry! The pay off is all worth it!

Asking questions is not for learning; this is your chance to show everyone in class how much you know.

Frame all questions in such a way that helps everyone else see that you clearly understand the information on a higher level. The question may be slightly off topic or completely disconnected from the subject at hand but remember your education is the most important. Just to be clear, when I say education I mean grades. Remember, grades take precedent over understanding the material, friends, pets, and even little ol’ grandma...just get used to it!

Always minimize your study time when you are conversing with other classmates.

Lead with phrases like “I just can’t seem to focus,” or “I haven’t touched those biochem lectures.” This will lull them into studying less and open the door for you to destroy them even worse when the test comes! This will be simple for you if you are taking full advantage of The Gunner Shake.

Always sit in the front row. If it happens to be full, pull a chair out in front of the front row!

This will put you in the prime position to chat with the professors after lecture. It is the prime time to extract clues that will lead you to the type of questions that will be on the test. A simple, “Carbamoly phosphate, right? That would make a great test question. Am I right?” Priceless hints like this will add yet another boost to your grades and cement your position as a Gunner!

These four simple principles should propel you through the first 2 years of medical school. It’s true the last two are a whole different ball game, but I will have more on that soon. If you can’t wait, you can check out my post on Crushing Wards for a start.