Sat - January 21, 2006Been Quiet...The last six months in private practice have been
quite busy. Six months since I started working, I am finally getting into a
rhythm. My clinic slowly rounding itself out with patient handouts, patient
information, and other things which make it function and look like a real
physician's office. Last week I started to transition into an electronic medical
record system. This week I did my first intrathecal opioid trial since finishing
fellowship and it looks like I'll be doing the implants soon. I also got a
chance to go to Macworld again this year...
Thu - August 11, 2005Must stop to breathe...The last three weeks have been like a whirlwind. I
have started working as a pain management physician in San Francisco. My clinic
schedule has rapidly scaled up as well as my operating room
cases.
Perhaps the hardest part has been learning the business part of medicine. Frankly, I must admit that I have zero knowledge of business activities. The good thing is that the other partners in the group have been very helpful. So far so good... Thu - July 7, 2005It is doneFinally. After years of work, I have finished this
step in my medical education. Frankly, you really never stop learning and taking
classes. However, I am no longer a fellow. Technically I finished one week ago,
but it did not really hit me till I got up this
morning.
I am now getting ready to move to the San Francisco Bay Area to start working at St. Luke's hospital... Mon - June 20, 2005I am not DeadNot quite there yet.
I am currently getting ready to relocate from Los Angeles to San Francisco to start my new job in a private pain management setting. Naturally, I have trying to pack things up, figure out what the heck to with our condo, and finally where to live in San Francisco. Fellowship is officially done in two weeks. Counting down! Thu - May 26, 2005Happy Birthday to Me!Today I turned 31 years old. As luck would have it,
clinic was chaotic and I ended up leaving around 8:30 pm. I guess that this
weekend I will be celebrating.
Looking back at my medical education, there were many times I put my big foot in my mouth. Let me tell about one of the first time: First of all, medical education at UCSD is different from other medical schools in that anatomy is not taught till your second year of being a medical student. The rationale is that learning the physiology first will make learning the anatomy more relevant and easier to study. Now, my background before going to medical was in Chemistry and computers. So, there I was my first time in a clinic, knowing little basic anatomy, about to go into a room with a physician to examine a patient. Things were going pretty smoothly as the physician instructed me on the basics of the physical examination. The patient was very sympathetic as the physician carefully explained important findings. Then, it all went to hell... He asked the patient to open her mouth. "What is the name of that little structure hanging in the back of her mouth?" he patiently asked. I hesitated since I did not remember the technical name of it. I stuttered a bit. Then I blurted out: "That's the vulva!" There was immediate silence in the room. The patient turned red. A little bead of sweat trailed down my face as I realize what I had said. The physician looked awe struck. It really seemed like an eternity before anyone did anything. Then he politely corrected me, "No that's the uvula." Tue - May 3, 2005I got a Job!It is about time that I decided where to work. It
looks like I am going to be in private practice at St. Luke's
Hospital in San Francisco starting this summer. The good thing is
that I will be doing full-time pain management, specifically working with the
orthopedics department and the spine
patients.
Now I can start paying off my medical school loans... Sun - May 1, 2005Finally Published!Yup, I finally got an article into a medical
journal. It will be coming out in the May 2005 edition of Anesthesiology. It is a case report about the
first documented case of a lumbar intrathecal granuloma from a morphine pump. It
has been speculated that lumbar intrathecal catheters are safer in comparison to
thoracic catheters. D'oh! Think again...
Tue - April 12, 2005Finally DoneTook my anesthesia oral examination yesterday and
as expected, it was sheer torture. As usual, the exam (or examiners) put you in
horrendous situations which you must bail the patient out, and the entire time
they are riddling you with what ever questions the want, relevant or irrelevant.
Technically, they are not supposed to show any emotion and be as impartial as
possible, but I could not help feel that it was like a cat and mouse game. A
game in which they were trying to make me fail. In fact I have even over heard
some examiners proudly brag how they humiliate and fail anyone if they feel like
it.
At this time in my career, after thirteen years of education, passing more than six national examinations, it is almost insulting to be belittled and harassed about handling a difficult situation. When placed in those situations, you don't stop and create a detailed justification for you actions. Your training and experience take over and you "know" what needs to happen. If you don't, chances are that you can temporize the situation as anesthesiologists often do to give you time to formulate a treatment course. For example, a patient has borderline unstable V-tach, do you shock or treat with medication? My inclination is to shock because it will likely deteriorate to something worse while you are messing around trying to get medication ordered and infused. In the real world, I would not sit there and wait for things to worsen. Naturally, at the same time I would be thinking of what has precipitated this problem. Now, does having taken this examination make me a better anesthesiologist? I seriously doubt it. My skill as a anesthesiologist has been honed through the rigors of the excellent training I had at UCLA. Part of the justification for this examination is that they, the American Board of Anesthesiology (ABA), wants to make sure you can give a safe anesthetic. Your knowledge base was supposedly already tested in the written boards. To me it seems more like part of the initiation by the "good old boys" in which you end up paying for the hazing. To give them credit, the grading system has been recently standardized so that it less likely that they using subjective methods. Still, it is a human endeavor and clearly, some examiners still don't get it. In my opinion, there is a better way to test. Get rid of the examiners and make this examination completely objective. You can do this by using a patient simulators. Real cases with live interpretation of scenarios and your subsequent actions. The cases can be standardized and can cover a wide range of situations. Many of these system are so detailed that you can even inject medication and have the "dummy" patient appropriately react to it. Furthermore, many large academic institutions already have a simulator program for teaching their residents. Creating regional testing centers would essentially be trivial. Right now the ABA rents a several floors of a luxury hotel twice per year for a whole week for testing. Then the examiners have to be flown in an set up in that same hotel. I can't imagine the cost for these events. Certainly, have s simulator system would be cheaper in the long term. There are other potential advantages. Since these simulators are already present, the examinations could be held more often than twice a year giving much more flexibility for scheduling. The results would also probably be available faster than the six weeks that it takes currently. Well, that's my rant about the oral anesthesiology exams. I doubt anything will change anytime soon, but one can be hopeful. Sun - April 3, 2005It has been a long time...The last month has been quite a roller coaster. My
wife, who was about 32 weeks pregnant at the time, was hospitalized for several
days with complications from back pain and preterm labor. After that, she
basically had to be resting at home, so taking care of our other little boy was
difficult. Yesterday she finally gave birth to healthy boy after about two hours of labor.
I am fairly tired now, but I still need to survive my oral anesthesiology boards next week. Updates will become more regular once I get back from Florida where the exam is at. Sun - February 27, 2005I have been neglicting my BlogI guess I really should not complain, but trying to
figure out where I am going to work next year has been a major
pain. I
have several offers that I am considering, but every week it seems that the
situation changes and my mind leans to a different possibility. Well, I still
have time to decide...
Sun - February 13, 2005It has been quiet...I have to admit that my blogging has significantly
slowed down so far this year. There are several very good reasons. First of all,
I am facing yet another hurdle in finally getting board certified as an
anesthesiologist. I passed my written boards, but in April of this year, I have
the oral boards. If it was not bad enough, if I survive this exam, then I have
the pain management examination in the fall. It never
ends...
Then, I also have a new baby on the way! My wife is due at the end of April. As a strong believer of Murphy's law, I suspect that my wife will go into labor when I am in Florida taking my oral boards. Fortunately, we have friends and support arranged so that things should not be too hectic. Finally, I have started to look for a real job. I will finish my fellowship at the end of June, so I have been busily weighing my options and alternatives. It is weird to think that I will start making a good salary after working for years for less than minimum wage. Frankly, I have been used to scrapping by, so having "extra" money will certainly be odd. So, if anyone is interested in hiring an interventional pain management physician, by all means, please email me. Thu - January 20, 2005New Photographs..I finally got around to scanning all the pictures I took on my vacation over Christmas.
Naturally, I did not post all the pictures, instead I chose about fourteen of
the best. I still have tons of video that I need to edit...
Wed - January 5, 2005I'm Back...I spent the last two weeks back home in Santiago,
Chile. It was good to spend some quality time with all my relatives. My wife and
son also really enjoyed the trip.
I'm back to the grind now :) Sat - December 18, 2004Taking some time offIt has been a long time since I have had any
significant amount of time to relax and spend time with the family, so what
better time to do it than now. I will not be updating things for about two
weeks. I will still check my email, but not very often. Happy
holidays!
Tue - October 5, 2004Back from ColoradoSpent this last weekend in Denver at a conference
for pain management fellows from across the United States. Although I did not
get a chance to check out Denver, the entire trip was a lot of fun. We got a
chance to network with several established pain physicians from both academic
and private practices. It is amazing to see that almost every single physician
had different way of doing the exact same thing.
As in many things in medicine, you start taking little bits of knowledge learned from different people, and slowly start developing your own techniques/approaches. It was also important to see that even some of the physicians that had been practicing pain management for over twenty years, were still avidly learning new things. |
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Total entries in this category: 50 Published On: Jan 21, 2006 08:40 PM |
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