Top products from r/medicine

I came out of a program with an unknown name, but those that knew it, respected it. we had an extremely high volume for surgicals and cytopathology. Its not all about the name. But the name helps. For one, you'll get more interesting cases. You are a referral site as a larger institution, and you'll be at a program with "experts" on subjects. (maybe not totally true)Another benefit of a larger program is usually money in the department. Whether its money invested into informatics, molecular, or manpower, larger programs will usually have larger budgets.
Think of sub-specialties now. Very common fellowships are cytopathology, hematopathology, and I guess some surgical subspec. like GI, GU, GYN, derm, soft tissue, and Breast. But there are literally dozens of different fellowships (I didn't mention any of the CP ones) to choose from and different places to do them. It does help if you are an internal candidate.

Visit CAP, USCAP, ASCP and join if you can. I think some of them have medical student logins or would be free. You can see some stuff about being a pathologist that doesn't involve histology from these sites as well. speaking of histology, go ahead and read this book

Join AMA and visit the FREIDA website.

I would encourage you to look at programs with at least 3 per class as a minimum.

most importantly, talk to your institution's residency program director for pathology. They will be a great asset.

I was actually torn between path and pulm crit care. I think it just shows that you enjoy critically thinking.

I haven't read this book but it's a nice hardcover with beautiful historical illustrations and is not very expensive. I doubt it's comprehensive / definitive but you'll love flipping through it and it'll look great on your bookshelf:

https://www.amazon.com/Crucial-Interventions-Illustrated-Principles-Nineteenth-Century/dp/0500518106?ie=UTF8&*Version*=1&*entries*=0

Another area I've become interested in (in my own field of expertise, not surgery) is actually buying historical texts. Find a specialty used book store in your city and browse through their medical/scientific books. Even a standard (med school-level) text from 70 years ago is fascinating when understood in the context of what has come since. And the <100 year-old books are not expensive (<$100).

abebooks.com is full of cheap old used (and expensive old used) textbooks from many countries and areas of medicine.

When I am thinking about a disease that I encounter in my practice frequently (ex. Hodgkin disease), sometimes it's fun to dip into one of my old textbooks and read something like "Hodgkin's disease is a disease of the hematopoietic organs [...] It is invariably fatal. Whether it is neoplastic or inflammatory in nature remains a matter of dispute." (Boyd, 1947).

These old textbooks are very readable. That edition of Boyd's pathology belonged to my grandfather. Every single page of it is fascinating.

Sleep as much as you can. Get a very nice bed. Get black out curtains and make sure you have AC after night shifts so you can sleep well and get up and do it again the next night. Do not be late. 80% of success is showing up. Don't forget to eat, pee etc. - plan it into your day...you may find yourself irritable and forgetful at 4am and it may be you forgot to eat or pee.

Invest in your education, or use education money (we got ~$800) to have an "ectopic brain," reference smartphone app (I like PEPID (Emergency physician) but its expensive) to look up everything you are not sure of, or have never heard before. I used this , a high quality monthly podcast, and test questions to get 2nd highest inservice exam score in my residency without doing any book reading, which I hate. (WARNING! YOUR MILEAGE MAY VARY)

Trust no one - verify everything...you will get burned constantly by people telling you things then writing something else in the chart...think "prelim read".

Do it yourself - do not cut corners at this stage of the game - be complete. Never do the "patient looks good from door" note, or "nurse says patient okay".

Do it NOW...get things going early (consults, procedures, discharges, etc.)- write notes after if you are crunched for time. Short notes are much better than book chapters copied from the previous day's note. Think Haiku - focus on the salient points; minimize long swaths of negative this and that. Make sure the plan is clear and legible.

EXAMINE your patients! This includes looking under the diaper (peds and geriatrics!), looking in the ears, doing the rectal exam, practicing your fundoscopy, looking at the sacrum, taking off and examining all areas under dressings.

DO NOT LIE TO ANYBODY! "I don't know," or "I didn't check," is perfectly acceptable for an intern as a response. Lying will be quickly discovered and your reputation is all you got, my friend.

Do not accept abuse from anybody, especially attendings, senior residents, consultants, chief residents. Being called stupid or a dummy is NOT okay. That is completely unprofessional! But, do not respond, do not "fight back". --take it to your program director at once, let them deal with it, that is their job.

Do not feel inferior because you don't know something - if you didn't need to be taught, you wouldn't be in residency. Instead - bone up on the subject.

Always jump at the opportunity to teach, do case write-ups, short lectures - this is the best way to learn.

If you have tests in your future, study a little bit (15-30 mins) every day without fail and you will do well without freaking or having to cram too much.

Read House of God Timeless wisdom, like "gomers go to ground", and "if you don't want to find a fever, don't take a temperature".

Exercise every day - again - 15-30 mins is perfect...can be as little as a walk outside to a round of situps and pushups - mene sano en corpe sano!

I could go on forever. Before you know it, intern year will be over. THERE IS AN END TO INTERNSHIP!

Good luck!

It may be a bit much for 3rd years, but during 4th year I think everyone should read White Coat Investor, Medical Student Loans if they have student loans, and
The Millionaire Nextdoor. Those that have any interest in finances will take them seriously and continue to read beyond these. Those that don't really care will have at least been given a quick Finances 101 course for doctors and have somewhere to turn. I think a large problem is many medical students have no concept of what a dollar is even worth. Many grow up in upper-middle class America with parents supporting them through college if not further and then have essentially unlimited loans during medical school. We know nothing about finances in general and these give a good baseline for which older physicians can then build on. I would also recommend every 4th year start a budget, either on pencil/paper, Excel, Mint, YNAB, or something to at least track their expenses and have better money management skill in residency that lend themselves to later in life when they are making more money.

Careers in Medicine is also a decent resource all most medical students should have access too

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 am not a doctor but I had a good experience in cadaver lab. We were very respectful. I did read this book. It convinced me that I really did want to donate my body to science.

I'd recommend anything by Roy Porter. His Greatest Benefit to Mankind is a great overview. And he also edited the Cambridge History of Medicine. But as a study of a single event, I have to give a shout out to Michael Bliss's Discovery of Insulin.

http://www.amazon.com/gp/aw/d/0805395695/ref=mp_s_a_1_1?qid=1426092681&sr=8-1&keywords=anatomy+and+physiology+marieb+8th&dpPl=1&dpID=51oYx0qmpDL&ref=plSrch&pi=AC_SY200_QL40



Sorry for the long link, on mobile and can't be bothered to fix it. That's Marieb's Anatomy and Physiology, 8th edition. They're up to the 10th now, but if you're just reading for your own knowledge it should work just fine, and it's quite a bit cheaper.

It might be a little daunting getting into this stuff at first. If you're a student right now, I'd recommend taking an anatomy course, or maybe Human Biology if that's offered. If you're not a student, check out some local community colleges, or look into online courses.

Can I ask why you're interested in this?

If you're interested in a great book that explores the clash between medicine and culture I'd recommend The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures

Every Patient Tells a Story by Lisa Sanders MD is excellent.

It's certainly not as heady as anything by Gawande, a little pop, but I guess that's to be expected from a NY Times columnist and the HOUSE MD technical advisor. Very enjoyable.

https://www.amazon.com/dp/0767922476

Go read the very excellent book evidence based physical.

http://www.amazon.com/Evidence-Based-Physical-Diagnosis-Expert-Consult/dp/1437722075

So much good stuff in there. I heard there is a PDF copy floating around the internet, should you willing to be a swarthy medical pirate.

The M.D. was the first doctorate awarded in the US. That is, it pre-dated the PhD in America by about 100 years.

The D.O. came about when a group started offering chiropractic treatment for illness in lieu of pharmaceuticals, believing that all disease came from musculoskeletal misalignment. The D.O.s started having pretty good outcomes compared to the M.D.s who were randomly dispersing toxic meds they knew little about. Eventually, educational requirements for docs began getting more intense and the D.O.s followed the M.D.s in increasing the rigor of their schooling. They became parallel, redundant degrees. Source: http://www.amazon.com/The-DOs-Osteopathic-Medicine-America/dp/0801878349/ref=sr_sp-atf_title_1_1?ie=UTF8&qid=1373072965&sr=8-1&keywords=the+dos

As a side note, I thought you guys in Australia still went by "Doctor So-and-So." Isn't that still using an inflated title?

If you want to understand the history of healthcare economics in the United States, I think this is an excellent place to start:

http://www.amazon.com/Social-Transformation-American-Medicine-profession/dp/0465079350

Every PGY-1 at my program gets a copy of Molavi which is a great intro text but is obviously more focused on surg path and less applicable to forensics. DiMaio has a good, affordable book that's more specific.

On that note read this book: https://www.amazon.com/White-Coat-Investor-Personal-Investing/dp/0991433106

Small things that she will appreciate:

Black out curtains. Her hours are going to be irregular and after a night shift there is nothing better than coming home to completely dark room in the bright morning to sleep.

A nice pair of trauma shears like Leatherman Raptors.

There is a nice account of a blind physician in the book Every Patient Tells a Story, by Lisa Sanders. He still had some vision during medical school, but eventually went into rehabilitative medicine, rheumatology I think, because it had a lot to do with physical aspects he could feel.

As a bonus, she's a consultant for the television show House.

Osteopathy in Europe != osteopathy in the US. One is exclusively manipulation, the other is a full fledged, fully trained, medical doctor who took an extra class on manipulation (albeit at the cost of less basic science classes and possibly a rotation in manipulation in lieu of one in something else). Most DOs don't use manipulation to any significant degree.

The history behind it is interesting. I refer you to Norman Gevitz's The DOs. In short, the late 1800s/early 1900's had a lot of wonky areas claiming to be medicine. Things like electricity, magnetism, naturopathy, old school allopathy, homeopathy, etc. Many of the better aspects of these fields consolidated under the allopathic banner and with the Flexner report, most of the ones that didn't were regulated out of mainstream existence. I'd be remiss if I didn't mention the report was commissioned by the AMA and critiqued by many as an example of regulatory capture.

For some reason osteopathy tended to remain it's own thing, and while many osteopathic schools closed due to Flexner report, enough were found competent to teach medicine and flexible enough to change curriculums as needed, and remained open to have a significant influence in certain areas of the country and the field developed as a kind of offshoot of the allopathic model with their own board exams and residency training. In WW2 there was a shortage of MDs in the army so they allowed DOs in which greatly increased mainstream acceptance. In the 1950s there was talk of integrating the California osteopaths and/or schools into the allopathic organization which culminated in UC Irvine being bought out and the california DOs being able to buy an MD title. This led to more mainstream acceptance though with the large cost of losing one of our best schools and much influence in the west coast. In short it's a complex, long, and hard fought history that got us where we are.

As far as EBM and the litigious culture, I honestly have no idea why most of this stuff is reimbursed. There really isn't much level 1 research on the stuff and the cochrane review for LBP pain and manipulation says its no better than other interventions. A tylenol is a lot cheaper than an office visit... I don't mean that in a disparaging way but just to highlight the lack of quality research.

If you have a couple of hours to spare and want more than a cook-book approach to fluid and electrolyte management , I recommend the following book. Very practical and readable , just the right length and I feel it's the appropriate level for a Intern and anyone else whose not critical care/nephrology. I used to hand out my copy to residents rotating in nephrology

Acid-Base, Fluids, and Electrolytes Made Ridiculously Simple

https://www.amazon.com/Acid-Base-Fluids-Electrolytes-Ridiculously-Simple/dp/0940780984

What I started with: Stethoscope, sphygmomanometer or a sphygmomanometer for the lazy, pulse oximeter, reflex hammer, tuning fork, a pen light, notebook, Maxwell, pocket medicine, clipboard, 48 pens (of which I somehow only have 2 left), and finally a pack of decoy pens to hand out to people that need to "borrow" a pen but never give back.


Seriously where do all of my pens go??? It turns out half them went into my gf's bag x(.

What I was given or picked up along the way: scalpel, needle drivers, tweezers, scissors, various types of vicryl, bandages, gauze, alcohol wipes, surgical lube (that I took from the hospital when no one was looking ;) ), and a pocket CPR mask. I took a bunch of normal saline and IV kits as well but they don't fit in the bag.

There's a book on this: https://www.amazon.com/Ending-Medical-Reversal-Improving-Outcomes/dp/1421417723

Haven't read it but it has good reviews.

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.

These are a few that I really liked:

Lisa Sanders, Every Patient Tells a Story

Norman Doidge, The Brain That Changes Itself

It's a well-documented phenomenon that catastrophic events are simply the last occurrence on a long chain of small, otherwise trivial mistakes. I really enjoyed this book on the topic if anyone wants to further their knowledge.

Annnnd jzc pointed out the 'Swiss Cheese Model' below. Such a great analogy.

That sounds like an interesting read when I have some time off...

http://www.amazon.com/Cambridge-History-Medicine-Roy-Porter/dp/0521682894

Link for the lazy.

https://www.amazon.com/Evidence-Based-Physical-Diagnosis-Steven-McGee/dp/1437722075

If you can find a copy, this book is interesting. There is a JAMA one too.

I just finished Do No Harm. It's memoirs of a neurosurgeon and each chapter is structured around a particular neuro tumor/disease, so as a neuropathologist it was quite a fun read.

>there are also surgical anatomy electives you can take later that involve surgeons (and aspiring surgeons) doing specific operations on one or more parts of your body.

This is also mentioned in the book "Stiff: The Curious Lives of Human Cadavers."

Anesthesia at root is applied physiology. If that appeals to you, give it a shot.

Others may disagree, but I found that The House of God was tremendously helpful in thinking about things. Read it before and after third year med school and before and after internship. It pulled everything together for me - I got to the end of third year thinking "you know, I haven't just loved any of these things..." and decided to give anesthesia a try. Came home from the second day of my M4 rotation and told my wife I had decided what to do.

http://www.amazon.com/Atlas-Human-Anatomy-Student-Consult/dp/1416059512/ref=dp_ob_title_bk

If you want more recommendations let me know. Look for my discount code tomorrow.

The Gawande books are good. Another one I've liked recently was "The Emperor of all Maladies" - it's essentially a biography of cancer.

https://www.amazon.com/House-God-Samuel-Shem/dp/0425238091

the Maxwell quick reference is handy from time to time. otherwise, i use uptodate or epocrates on my phone.

Non-mobile: http://www.amazon.com/dp/0805395695/ref=mp_s_a_1_1?qid=1426092681&sr=8-1&keywords=anatomy+and+physiology+marieb+8th&dpPl=1&dpID=51oYx0qmpDL&ref=plSrch&pi=AC_SY200_QL40

^That's ^why ^I'm ^here, ^I ^don't ^judge ^you. ^PM ^/u/xl0 ^if ^I'm ^causing ^any ^trouble. ^WUT?

The Social Transformation of American Medicine is the most oustanding book I've ever read on the history of medicine in America and how we got to the system we have now.

The Emperor of all Maladies is a brilliantly written book documenting the history of cancer, told through a human lens.

Do No Harm

http://www.amazon.com/Hope-Hell-Doctors-Without-Borders/dp/155407634X

Hope in Hell. It's sort of frontier medicine - an intro into MSF.

Also not medically related, but science/outdoorsy - Deep Survival by Laurence Gonzalez (http://www.amazon.com/Deep-Survival-Who-Lives-Dies/dp/0393326152) is really good nonfiction looking at why some people survive disasters and others don't. It's sort of pop sociology.

Alright well all those books on negotiation that the MBAs were readings? Get a couple. People are a pain in the ass so:

Power of a positive no

http://www.amazon.com/The-Power-Positive-No-Relationship/dp/0553384260

3D negotiation

http://www.amazon.com/gp/aw/d/1591397995/ref=mp_s_a_1_1?qid=1426162478&sr=8-1&keywords=3d+negotiation&dpPl=1&dpID=41zewhv9BfL&ref=plSrch&pi=AC_SY200_QL40

And of course
Getting past No - for when they are especially thick

http://www.amazon.com/gp/aw/d/0553371312/ref=mp_s_a_1_1?qid=1426162632&sr=8-1&keywords=getting+past+no&dpPl=1&dpID=41nqwjOnSiL&ref=plSrch&pi=AC_SY200_QL40

Just remember facts don't matter and sometimes explaining yourself isn't always the right path.

I have a 1-page cheat sheet which has a 4-step process with relevant equations and most common DDx if you want it. I made it after reading Acid-Base, Fluids, and Electrolytes Made Ridiculously Simple.

I am sure a lot of medical professionals that were in school recently were forced to read The Spirit Catches You and You Fall Down by Anne Fadiman, but this topic brings my thoughts back to it.

It deals with the struggle (from both sides) on how you cross cultural barriers when dealing with resistant patients. Where do you draw the line? When can you force your beliefs (as founded in evidence as they are) onto another? Do you call child protective services? Do you just let the family go, knowing their child will die due to their inaction?

It also really resonated that you should never be lazy. A patient in the book was a frequent patient who had the same small-ish problem every time she came to the ER. They would treat her and she would leave. When she presented another time with similar symptoms, they didn't think anything of it. They overlooked some big symptoms and misdiagnosed her, leading to a more critical situation. All because they were not critically evaluating the situation like it was a new one.

I don't know who is wrong or who is right. It is still an argument I struggle with.