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

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.

The Top 10 Reasons Why You Should Not Go To Medical School... And The Single Reason You Should

There used to be a different post here.

There used to be an entire list on why you should not go to medical school; the top 10 reasons you should not go to medical school and one reason that you should. If you want to reason the other side of the story go to this article, "The Top Ten Reasons You Should Go To Medical School And The Single Best Reason Not To."

The post talked about reasons for not going to medschool; of losing friends, spending the best years of your life as an underpaid, overworked, and sleep deprived slave, and then found the one reason — and only one — to go to medical school.

But, after a number of emails with the author and revisions that included removing parts of the posts, and an update at the bottom of the post asking for all comments to be added to the authors site, the author has had a change of heart and asked for the entire post to be removed and so we've complied with that request.

Now we are not generally in the business of trying to step on people's toes, and we try to be respectful of everyone's wishes and we certainly want to provide as much value as we can to all of the sites that we link to. However in this case it seems a little onerous (and somewhat unethical) to delete everyone's thoughtful comments along with the original post. So, we decided to just remove the post in its entirety and change the discussion slightly.

Of course what are the things we noticed was that most peoples thoughts did not agree with the basic tenets of the original post; that there are at least 10 reasons why you shouldn't go to medical school or become a physician and only one reason that you should.

In fact, while there are a couple of people that agree that medical school and becoming a physician is a challenging career path, many of the comments voice the opinion that medicine had a lot to offer in exchange for the shortcomings of the current health care system.

Here is an example:

There are very few professions that meet people from all walks of life that confide in you very personal issues and want to know your opinion just because you "are a doctor". A job where you get to be on your feet rather than stuck behind a desk all day staring at a computer or on the phone and for the most part get to have educated, intelligent, and interesting people as your co-workers. As a doctor let me assure you - none of us are starving. – Gut Girl

Of course, opinions all vary and there are any number of physicians I know that would gladly hang up their stethoscope if they could replace their income, but so would a lot of people with other jobs.

This site's only real purpose is the uncover the ways that medical schools students (and physicians) can leverage their skills, training, and degree and help them to craft a lifestyle that is both rewarding and fulfilling. If that's clinical practice while you start a business on the side, or forgoing clinical practice altogether, fine. There's a puzzle-piece that everyone needs, and it's usually NOT just doing what everyone else does.

You can read the opinions of others below. Some of them are leaning towards the combative side. Let's keep it civil.

The Most Practical Illustrative Guide to Medical Student Conduct Ever Created

If you want to have half the medical school skills that I possess... You will take these lessons to heart.

It's the holiday season and while many of you medical students and me wannabees out there are sitting on your fat keisters and losing your competitive edge. I have been doing research on how to be even more awesome at medical school (it may not be possible for me because I've already reached the pinnacle of greatness... twice). My search was turning up very little in the way of advice that is actually superior to something my giant brain has already conceived, but then I ran across this little gem. It's nothing I don't already do, but the drawings are great for memorization purposes.

It is such a perfectly distilled set of practical medical student skills that I might have cried while reading it if I was prone to such pansy things as crying. If you do not read this twice, momorize it, and put into practice ever skill it espouses... you are a cad and a fool! You should also check out the website from wence it came. I  do not personally approve of all the techniques that are illustrated on the site, but at least Dr. Fizzy McFizz actually created a website and wrote the book "A Cartoon Guide To Becoming a Doctor". Looks great on her CV and will only serve to propel her to a new level of personal greatness (even if that level will always be directly below the level I have already acheived in medical school). If you have any tips as sweet as these (hardly likely) that I could use to launch myself to further greatness, leave a comment above.

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Interview: Zubin Damania MD (ZDoggMD)

Interview with hard-rhymin rapper and Stanford hospitalist Zubin Damania MD (ZDogg MD) Slightly funnier than pacebo.

Did you ever wonder what kind of doctor you were going to be when you grew up? A hard-rapping stand up comic hospitalist with a penchant for drafting lyrics like, "I remembered she's demented with a nasty case of C.diff", and "I got one glove like Michael Jackson, but it's made of latex and it's your prostate I'm waxin'!" or calling Dr. Phil and Dr. Oz 'Sucker MDs' might not be it.

But that's exactly what Zubin Damania MD is doing... and it's working.

Zubin started out as a mullet-wearing, Costco card carrying rockabilly and ended up (so far) working as a hospitalist at Stanford and making video satire with his pediatrician buddy Dr. Harry on ZDoggMD.com (winner of the MedGadget Best New Weblog of 2010) as well as writing for Freelance MD. You can read all of Zubin's posts on Freelance MD here.

In this interview, Zubin discusses where he started and puts his current practice as well as his passion for combining entertainment and patient education in clear perspective.

ZDogg MD Video: Doctors Today

Interview with ZDoggMD

Part 1: Where did you come from?

In this video: oranges, UC Berkeley, UCSF, Stanford, Costco, physician parents, residency, Gastroenterology, feculent smelling burp juice, working for someone else, hospitalist, comedy, UCSF graduation speech, slightly funnier than placebo, youtube.

Part 2: Why are you doing what you're doing?

In this video: passion, entrepreneurship, opportunity, preventing ulcer disease, safe sex, physician burnout, testicular self exam, megalomania.

Part 3: What advice would you give to medstudents?

In this video: medical school advice, who you are, niches in medicine, pressure, jerks and homeless patients, kids, purpose and passion, picking a specialty, residency, real doctors, friends and rectums, vasovagal party jokes.

Part 4: What mistakes have you made and learned from?

In this video: Mistakes, lifeinthefastlane.com, Mike Cadogan, wasting time, making money, cynicism, jerks, doctors and credibility, Osamacare, targeting your audience, standup comedy, hearing aids and dying onstage.

Techcrunch Interview (includes Hemorrhoid rap!)

In this video from Techcrunch Rhymes and Medicine: Hemorrhoid rap, Snoop Dog, Tony Hsieh, Zappos, Delivering Happiness, educating, Youtube, unprofessional behavior, a human face on medicine, internet patients and Google, medical technology, iPad, medicines culture of unhappiness.

Like this interview with ZDoggMD? Leave your thoughs in the comments below.

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Interview With Dr. Steven Knope: Concierge Medicine, Medical School & Doctors Taking Control Of Their Careers

Steven Knope MD weighs in on concierge medicine, medical school, the future of healthcare, and doctors taking control of their careers.

The television show Royal Pains explores the thrills, challenges, and adventures of Dr. Hank Lawson an Emergency Room Physician who, through a simple twist of fate, became a concierge medicine doctor. Though I’m not an avid fan, I have seen a few episodes and remember thinking, “Sure it makes for great television, but nobody really does that...right?” Well I was wrong. Enter Dr. Steven Knope MD; he has become a leader and innovator in the field of concierge medicine. A quick look at Dr. Knope’s biography and you realize he is part physican, musician, athlete, and ninja. His bio includes a stint as a professional french horn player, triathlete who has completed four ironman triathlons, and a martial artist with a 3rd degree black belt in Kenpo Karate. He is a physician who has always been willing to chart his own course and follow his passion to deliver the best health care possible to his patients. I was able to catch Dr. Knope in between seeing patients and practicing Chuck Norris round-house-kicks to pick his brain a bit; here is what I learned.

How did you get started doing Concierge Medicine?

I was actually asked to start a concierge practice by 4 of my patients 11 years ago.  They wanted more of my time and more access to their physician. They liked my care, but they didn’t like having office visits limited to 10 minutes. They wanted a more personal relationship with their doctor. After they approached me with this request, my initial thought was that this type of practice model was “elitist” and “unethical." How could I limit patients access to my services to only the few who have the means to pay up front? These thoughts forced me to do a lot of reading and soul searching. I ultimately came to the conclusion that our current third-party system was in many ways unethical in it’s own right, and I decided I wanted to begin treating patients on my own terms. So, I started a pilot concierge program with just 4 patients, and it slowly grew into my present full-time practice.

What do you like best about being a concierge doctor?  

I enjoy having the time to practice good medicine and the freedom from corrupt insurance companies, HMOs and the U.S. Government in the form of Medicare.  In short, I am intensely individualistic, and I like practicing medicine on my own terms. For example, in addition to helping my patient when they are sick, all of my patients have a customized nutrition and exercise program. This type of freedom comes with a price, but I feel it is worth the price.

What does a day in the life of a Concierge Medicine Doc look like?  

Every day is different, which is why I like it. In my old practice, I used to see 30 to 40 patients every day!  It was mind-numbing. Every day was the same, and I was always running, always buried in trivial paperwork, always trying to meet my overhead – as Medicare, insurance companies and HMOs determined how much money I was allowed to make.  If you like servitude, you’ll love third-party medicine.  If you are an independent soul, you’ll need to get outside of this system.

What where some of the key lessons you learned while making the switch from a more traditional medical practice to becoming a concierge doctor?  

You have to develop entrepreneurial skills that you never were taught in medical school.  You have to learn to follow your own path and not pay attention to the crowd.  You have to question some of the group-think mentality that was taught in medical school.  As an example, I’ve publicly debated medical professors from academic centers on ObamaCare.  These people pretend to be geniuses in the field, yet they can’t, or simply refuse, to do the simple arithmetic and see that Medicare and Medicaid are going bankrupt. It really does not take a genius to realize that ObamaCare is insane.  They are ideologues, not thinkers.  Learn medicine from your professors, because this is what they know best; but don’t internalize their liberal, socialized medicine dogma without thinking long and hard about it. It is just a simple fact that many academics could not run a private medical practice if they wanted to because they simply do not understand the first thing about making a payroll, paying an overhead, or the basics of “eating what you kill."

What is the best piece of advice you would like to give to today's aspiring doctors?

Think for yourself!  Internal medicine and family practice has sadly become a bad job under the third-party system; there is just no other way to put it. It is almost no longer a profession. The word about primary care has gotten out to students, and very few young doctors are going into these areas of medicine. However, this means that there will be a shortage of primary care doctors, as the demand is continually increasing. There will be great opportunities for young doctors in these areas, provided that they are willing to go into direct practices, without the interference of third-party payers.

You have had some critics. What advice would you give to students on dealing with criticism?

Listen to the criticisms objectively, think about them, and then make your own decisions.  If you think the criticisms are baseless, ignore them.  It doesn’t matter what other people think of you.  Period! Personally, I could give a rat’s ass about what other people think of me.  I’ve written an entire chapter in my book, Concierge Medicine, on the ethical arguments on this topic.  I happily challenge any doctor to debate me on the ethics of our current third-party payer system.  The current system just doesn’t work.  It is corrupt and unethical to its core.  And if you think socialized, government-run medicine is the answer, reflect back on your experiences at any VA hospital.  Does the government provide great care to our veterans?  Not in my experience.  Big government, big business, and crony capitalism are not the answers for our broken system. These things are what broke the system in the first place.  We need to return to the days when doctors ran their own, small private practices if our goal is to provide compassionate, quality, personalized medical care to patients.

You seem to have a lot going in and out of medicine.  How do you stay at the top of your game as a doctor while still maintaining an active balanced lifestyle?

I love medicine, but there is more to life than medicine.  I’m a martial artist and an athlete.  I believe that being physically and mentally strong makes me a better doctor.  You only live once.  You want to be more than a doctor in your short time on this planet.  Be the person you want to be first; this will determine the kind of doctor that you become.

If you could recommend that every medical student read one book what would it be? (In addition to your book, of course)  

Atlas Shrugged by Ayn Rand!  Trust me on this one.  It is a long book, but it will change your life.  If you don’t have time to read it now, put it on your list and read it later.

More: Listen to an hour long interview with Dr. Knope from Medical Spa MD

Options: The Light At The End Of The Medical School Tunnel

Knowing what's possible after medschool makes all the difference.

Thoughts are swirling around my head at a centrifugal pace that would dizzy even Oksana Baiul. So many new ideas and options to consider. Options, that’s what I’m excited by the most. I now feel I have the ability to plot my own course through this perilous and stormy sea of arduous and often aggravating academic acrobatics known to the lay person as “medical school.” That ability is priceless to me.

I am someone that will happily wade through any amount of crap, provided : 1) I have some degree of control over what particular flavor of crap it is and 2) That I see some higher purpose to the wading… the proverbial “light at the end of the crap”. Med School isn’t crap per se, but if we’re being honest with one another… it seems suspiciously similar to it at times. This is especially true when the light at the end of the tunnel seems to be flickering and desirable options seem scarce.

That flickering light strengthened a little when I ran across the freelance MD website. I had been scouring the internet looking for ideas on innovative and interesting outlets for someone with an MD degree. In short I was looking for options. It’s not that I absolutely abhor the thought of a traditional clinical practice, but I wasn’t all too excited by it either. What gets ME pumped is the the world of ideas, possibilities, and innovations. How can I improve the process? Are there better ways of being an MD?

These are the questions for which I was seeking answers. There were scattered accounts of doctors working on their own terms; perhaps on as an expedition doc to the jungles of Africa, or making a career of disaster relief consultancy, or gallivanting off to Alaska for 6 months as a locum tienens doctor. These ideas excited me, but I had no mentors to council me on how to steer myself toward this type of career or whether it was possible at all. If I told someone about these ideas, I often got a “Yeah, go for it man (eye roll)” or “Don’t mind Jeremy, he’s a little crazy” response.

Then one friday afternoon after slogging through some scintillating biochem, I stumbled in through the front door of freelanceMD.com. Five hours of reading later, I realized that this was the group of people I had been looking for. People that are innovating and LEADING in their non-traditional medical fields. Wilderness medicine, International Medicine, Concierge Medicine, Disaster relief and humanitarian medicine, Medical Entrepreneurship, Internet Medicine, Medical Writing, and on and on. The possibilities astound. It didn’t take me long to realize that medical students need access to minds like these.

My internet search had taken me to a thousand different sites with a juicy tidbit here or there, but I was always left wanting more. I hadn’t found the consolidated source of information on non-traditional medical routes I was looking for until I ran across Freelance MD. And so… we’ve decided that medical students need exposure to these ideas, they need options. They need mentoring from inquisitive and innovative minds in medicine. They need to network and dialogue with like-minded students DURING medical school and they need to see the light at the end of the crap and put themselves in a position to effect change in the medical status quo. Hopefully this site can do that for you. Here, we’re about doing things a little differently. If any of this resonates, then you’ve come to the right place. Welcome.