Month: August 2013

Alex Rodriguez MD

The recent suspension of Alex Rodriguez (famous baseball star, accused of using performance enhancing drugs) has me thinking. The debate about performance enhancing drugs (PED) is an interesting one. On the one hand, the sanctity of baseball and doing things the right way, makes me think “PED” use is wrong. On the other hand, they are entertainers, and if they want to damage their own body, so be it. They’re not hurting anyone. Would I do it, if I was a professional athlete and millions of dollars were at stake? I can’t say for sure honestly.

Some say “Every man has his price.”
You don’ have to be an athlete. In all walks of life, there are temptations to stretch your morality for personal gain. Medicine, like anything else in life, is no exception to this.
And just like professional athletes, there are significant dollar figures at stake.
Recent studies have indicated the significant differences in life time earnings between various specialties.
The numerical value is in the millions. Here’s a link to one of these studies

Lifetime Earnings for Physicians Across Specialties

When millions are at stake, are our future doctors facing the same dilemma as professional athletes?
If so, what is the “PED” of choice?
If I had to guess, it would be stimulants. This might be one of those dirty secrets of medical school.
Listening to medical students and residents, the question isn’t whether students are doing it, it’s how many?
And there’s also some literature to suggest its a problem.

Prevalence of stimulant use in a sample of US medical students

Here’s a blog post, based on the same article

Stimulant Use Exceptionally High Among Medical Students

And so, those same questions of money, morality, right and wrong that has me  interested in the Alex Rodriguez story, has me thinking about our medical students. Athletes are entertainers that hurt only themselves and the integrity of the game.

Medical students that excel because of stimulant use in theory are helping people and excelling at a noble cause.
There are some potential long term harmful individual effects of stimulant use, but are they hurting the integrity of our noble profession? This is a question we need to start asking ourselves.

Baseball, has been dancing around the issue of performance enhancing drugs for over 30 years, and now after years of struggling, we have a watershed moment to help the game move forward.

I suspect PED use in medicine (especially medical school) is a growing problem. It’s important we bring this issue out into the open with more research, more root cause analysis and delve further into the medical ethics of this issue.

When patient care is involved and the question of right or wrong is debatable, it cannot be a dirty little secret no one wants to broach.

“Every man has his price.” This is not true. But for every man there exists a bait which he cannot resist swallowing. To win over certain people to something, it is only necessary to give it a gloss of love of humanity, nobility, gentleness, self-sacrifice – and there is nothing you cannot get them to swallow. To their souls, these are the icing, the tidbit; other kinds of souls have others.

Friedrich Nietzsche
German philosopher (1844 Р1900)  

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An Intern again

I am an intern again. Not literally.

I still remember some of the raw emotions from my first few weeks of internship at Hahnemann Hospital at Drexel in Philadelphia. July 2005.

I was afraid.
I was afraid of actually being responsible for things, and making a mistake.

I felt clueless.
I felt clueless, because I was in a new place, unfamiliar with all the rules and regulations. I didn’t know anyone. I didn’t who or where to call for help.

I felt pressure.
I felt pressure to impress. I knew a lot was riding on my performance and I wanted to impress my senior residents, faculty and program directors.

I feared the fire.
I feared being the only physician around when a patient was crashing, with the task of putting out the proverbial fires.

“Where’s my senior?”
I constantly needed my senior resident to guide and educate me.

But above any negativity, I was excited.
I was excited because despite the fear, pressure and lack of knowledge, I was given a rare opportunity to make a difference. Despite having worked hard for this opportunity, I still felt lucky to be given the chance to be a physician.

Almost ten years later, I feel like an intern again.

Recently, I was given the incredible opportunity to be Co-Program director of our Med-Pedes combined residency program here at Stony Brook. I couldn’t be happier, despite experiencing some of these same intern emotions.

I am afraid once again of making mistakes. You never want to mess up with other peoples’ careers in your hands.

I feel clueless once again, dealing with all sorts of new regulations, accreditation bodies and numerous new administrative responsibilities.

I feel pressure once again, to make the program even more successful than it already is. As always, there are people above watching. You want them to know they made the right choice.

There are still fires to put out, but different.

I still need a “senior resident.” My more experienced Co-PD and other faculty mentors have been incredibly supportive and helpful with my transition to this position. Not a day goes by that I don’t have questions.

But most importantly I am excited, yet again. Despite a recurrence of some challenging emotions, they are overridden with an immense sense of pride and excitement to be given the opportunity to serve an absolutely wonderful cast of residents.

The years have changed, but the message hasn’t. You have to keep pushing yourself to the next internship. You have to keep putting yourself in positions that are not in your comfort zone. Only through this process, can you grow as a person and eventually be given opportunities to make an impact.