The Short Coat

Happy Thanksgiving! The crew--John Pienta, Marc Toral, Dylan Todd and new guy Jay Blomme--were lucky enough to hear from a couple listeners about our recent post-presidential election episode. For instance, Kayla called 347-SHORTCT to say thanks; we presume she had more to say, but she got cut off. We continue our discussions on logic and logical errors, considering the efforts that Facebook and Google are making to reduce the effects of 'fake news.' John has some suggestions on how to have a productive conversation with people whose opinions you don't share. Dylan is the master of strange analogies that ultimately are right on target. We discuss one idea in DIY medicine we might be able to get behind, a device that allows women to take some control of their breast reconstruction journey. And we mark the passing of 'The Radioactive Boy Scout,' David Hahn, who attempted to build a working nuclear reactor in his back yard as a teenager. And some podcasters who couldn't join us this week send in their thoughts on what they'd do with an extra day no one else could mess with. Listeners, share your thoughts with us each week. Call us at 347-SHORTCT any time, and see our Facebook page for a question to consider every Monday.

With the close of the election of 2016, many people, including us, found themselves dismayed and surprised by a great many things. But why were we so shocked? Now that our hindsight has been LASIK'd, some are noticing the truth that was hiding in plain sight: people were feeling ignored. And those people were the ones that the electoral college protects: rural Americans. In this episode, we (that is, Dave, Mark Moubarek, John Pienta, Rob Humble, and Amy Hanson) try to step out of our bubble. We cast our eyes on our own ignorance and speculate a little on what our fellow Americans want. We try to avoid politics in this episode in favor of thoughtful, empathetic consideration. Let us know whether or not we were successful.

John Pienta, Levi Endelman, Kylie Miller, and Adam Erwood get to answer some probing questions: what's the first thing a student wants to know upon starting a new clerkship? What's the most important skill they've ever learned? And what medical specialty should Vladimir Putin pursue? Also, if you're in a performance slump, science says you just need to be reminded that one day you will be worm food. And men seem to be having trouble with the idea of having minor procedures and experiencing side effects in exchange for the privilege of having sex without certain undesirable consequences like babies. And we discuss the apparent YouTube trend of DIY braces made by 13-year-olds from wires, superglue, and rubber bands. If you can ignore the risks of your face falling off, it's a real money saver!

Compassion fatigue is a problem for many practitioners. In medicine, some of the needs are so great, and the resources are often so finite. Aline Sandouk, John Pienta, Rob Humble, and Kaci McCleary discuss what happens when caring itself becomes a limited resource, the reasons empathy can dwindle, ways to cultivate it, and the role that compassion can play in caring for oneself. We also learn what monks and nuns are teaching us about how compassion manifests positivity and even neural plasticity. Also, in his role as showrunner, Dave talks with the group about whether it's a good time (or even a good idea) to spread the word through things like t-shirts (you can let him know what you think about it), and the crew visits with the strange patients over at Yahoo! Answers, where people are vibrating on command, accidentally pulling out their nerves, and considering cranial anatomy.

Halloweeeeeeennnn! It's upon us, and while we're women and men of science around here, we're not completely able to shed our lizard-brain's need to take shortcuts. Which is why we are not at all surprised to know that ER docs still think the moon's revolutions around the big blue marble are in any way important. Fortunately, the post-cave-dwellers at the Marburg Center for Undiagnosed and Rare Disease are putting IBM's Watson to good use by diagnosing--in seconds-- rare diseases that defy the efforts of meatier doctors. And a Rutgers study finds that med school faculty severely underestimate students' stress and mental health issues. But enough of that scariness; the Short Coat Podcast is fielding a team for the University of Iowa Carver College of Medicine's Trivia Night fundraiser, so we practice and accidentally learn a lot more than we thought we would.

WHO researchers in Uganda are keen to teach schoolchildren there how to spot dubious health claims. This leads Dave to ask Levi Endelman, John Pienta, and newcomers Alice Ye and Adam Erwood whether their generation was taught the principles of logic and scientific thought in a way more effective than his own generation was taught. On a related note, listener Jake writes in to remind John that even we on The Short Coat Podcast, careful as we are to disclaim any logic whatsoever, should be wary of "shallow/uncontrolled" arguments.  We discuss emerging ideas on treating ICU patients in ways that minimize ICU delirium and PTSD, a problem once known as ICU psychosis, including changing the ways patients are sedated, their environments, the emphasis on convenience for healthcare personnel, and other factors that may be making patients crazy. Perhaps one day, ICU patients might receive some benefit from Kratom, which the DEA has now removed from the Schedule 1 drugs list after public outcry.  And doctors are still better than online "symptom checkers" at diagnosing both common and uncommon illnesses.  Take that, Doctor Google.

Mark Mubarek, Amy Young, Rob Humble and Corbin Weaver are here to discuss the AMA's policy to support the ban on direct to consumer advertising of drugs and implantable devices, and how such advertising makes the doctor-patient relationship complicated. Will drug companies retaliate by advocating for bans on advertising doctors and hospitals to patients.  Researchers in the UK may be about to get the green light to edit the genes of human embryos seeking answers to why some miscarriages happen.  Are we approaching the slippery slope? A neurologist wonders why Ted Cruz's face is so unsettling.  And we note with interest a number of recent public health news stories in which officials suggest that women have the primary role in undesirable health consequences, including Zika/microcephaly and alcohol-related unwanted pregnancies; now South Africa has chimed in by tying scholarships for young women to virginity in order to prevent the spread of HIV. And Dave forces everyone to practice their clinical skills by answering random people's "health" questions from the Internet.

This week, Dave, Aline Sandouk, John Pienta, Doug Russo, and Tony Rosenberg reflect upon the joy that podcasting brings, as we were recording the show on International Podcasting Day (Sept. 30).  Something else to celebrate: Doug (and Rob Humble) got to chill with an actual hobbit.  Or maybe it was Sean Astin, it isn't entirely clear. But whoever it was, Samwise was in Iowa stumping for Hillary Clinton. Hobbitses are very liberal, what with their hairy feet and pipeweed. Meanwhile, Doug was listening to the recent show in which Mark Moubarek discussed Rhoto eye drops, and bought some for us to "do." After the burning subsides, we discuss the advice from an attending overheard should everyone really try to know everything?

After listening to our recent show that featured a review of a wrist-worn device that you can shock yourself with to punish you for engaging in bad habits, listener Paulius drops us a line to ask what Amy Young, Corbin Weaver, Aline Sandouk, and John Pienta do to reward themselves when they do the right things. Like watching YouTube videos of people doing things well. Or turning your life into a video game. Next, Amy attempts to learn some sort of lesson about clinical medicine as a result of her recent nasty bike wreck. And Dave's fear of ending up on YouTube in a video recorded while he recovers from anesthesia leads to a discussion on online privacy

Close your eyes, and picture an opioid abuser. If you're like me, you see a man in a flophouse or dark alley. He's cooking up heroin in a spoon over a lighter. Maybe he has a loop of tubing around his upper arm, and he's shooting the heroin into a vein in the crook of his elbow. Once he's done with the injection, he leans back with a euphoric sigh. Fade to black. Maybe it's just me, but this is the image that, for years, mediated my perception of the opioid epidemic, but it's a stereotype created by television and movies. Even as a stereotype, it's outdated, though. For decades, now, much of the epidemic is one of prescription drugs. The CDC says 78 people die from opioid overdoses every day. At least half of all opioid overdoses are from prescription drugs. Meanwhile, deaths from illegally made opioids, like the synthetic Fentanyl which is often mixed with heroin or cocaine to increase the high, increased 80% from 2013 to 2014. The American Society of Addiction Medicine says that prescription pain reliever overdose deaths among women increased more than 400% from 1999 to 2010, compared to 237% among men. In 2014, 168,000 adolescents were addicted to prescription pain medications. More than 2 and a half times that number of kids were taking prescription pain relievers for non-medical uses. Next week, from September 26 to September 30, 2016, the University of Iowa Carver College of Medicine will host the Opioid Overdose Prevention Summit. Second-years med students Sarah Ziegenhorn, Petra Hahn, and Cameron Foreman helped organize the conference, in which students from the Colleges of Medicine, Dentistry, Pharmacy, Social Work, Public Health, and Nursing will join together to increase their knowledge and to influence public policy and legislation; personal perspectives; and student advocacy. , Sarah, Petra and Cameron were joined by Assistant Dean Denise Martinez and Nurse Kim Brown, whose son Andy died of an overdose, to talk about the issues of opioid addiction, treatment, and overdose prevention.

This week, Dave volunteers to wear a device that's received a lot of buzz lately, Pavlok. It's creator says that through classical conditioning it will help eliminate bad habits--nail biting, unhealthy eating, procrastination, for instance. It's ubiquity on Dave's social media feeds this past summer got Dave thinking about how much of human disease is based in behavior, bad habits. So Dave asked the company to send it's crowdfunded, wrist-mounted electrical shocker for evaluation, and they inexplicably said yes. Aline Sandouk, Lisa Wehr, and Nick Sparr all had a crack at it, and share their experience. Along with Rachel Schenkel, they attempt to use it to teach Dave not to say "Uh." Is it effective and worth the $169 price tag? Are its integrations with the Internet of Things or its Chrome plugin a help for those looking to kick their bad habits? Are there better, cheaper alternatives? Also, the Affordable Care Act has begun withholding Medicaid reimbursements to hospitals based on patient satisfaction surveys, and giving bonuses to those which do well on those surveys. We explore medical education's trade-offs in a game of what if. Hint: it turns out that our little group members are a bit mercenary.

Stress is a part of medical school. Worrying about tests, studying until you drop, late nights, early mornings, and drinking from the firehose all seem to promote the idea that med students should do nothing else but study. Dave, Aditi Patel, Marc Toral, Levi Endelman, and Kylie Miller agree, which is one reason Aditi and Dave put on a monthly Art Club. Students get together over lunch and have fun with paints, ceramics, drawing, whatever! No pressure, just an hour away from medicine. And speaking of being away from medicine, a listener calls into 347-SHORTCT with a question about how best to keep in touch with family and friends who might not understand the demands of medical school. And we discuss Aditi's family (who just happen to be the subject of a documentary available on Netflix) and the methods they're using to select her future husband. And we play Superfight!

Dave, John Pienta, Mark Moubarek, Matt Maves, and Levi Endelman are aware that the world is full of questions.  Nowhere is that more true than on the saddest place on the Internet, Yahoo! Answers. There folks ask the kinds of things that a primary care physician might have to answer.  What is the worst way to get rid of acne scars?  What could be the cause of blisters on one's lips after kissing one's dog?  How much milk should one use in one's bath?  There are no stupid questions. But first, since Matt has returned from a year in Des Moines doing clerkships there, we discuss what that's been like and the benefits of doing some clerkships outside a more academic setting.  We also discuss the psychiatric disorder pica and the kinds of things people swallow on purpose (or by accident).  Also we talk about drug maker Mylan's difficulties with, well, everyone after we collectively realized they're gouging patients who need epinephrine auto-injectors to keep themselves alive.  Meanwhile, a company is offering a supplement that its CEO, a pioneering MIT aging researcher, and it's Nobel-prize festooned board of scientific advisors say might just be a way to extend the human health span.

yan Gray, MD, was a physician in the Air Force. He'd planned all along to be an orthopaedic surgeon...but the military had other plans for him: aerospace medicine. Later, when a diagnosis of multiple sclerosis forced him to give up flying, his career plans changed once again, and he decided to set aside the practice of medicine to focus his growing business as the proprietor of MedicalSchoolHQ.net where he advises pre-medical students on their efforts to get into medical school. He's also a podcaster in that vein, as the host of The Premed Years podcast, the OldPreMeds Podcast, and The MCAT Podcast. As Dave, Nicole Morrow, Amy Hansen, Alex Volkmar, and Tony Rosenberg found, not only is Dr. Gray a thoughtful adviser, but he's a lot of fun to talk to. His thoughts on being a non-traditional medical student (he was one himself), the efforts of some schools to create competency- and systems-based curricula instead of exam-based curricula, and the types of students admissions committees are most interested in are definitely worth knowing. And check out Dr. Gray's new book, The Premed Playbook: Guide to the Medical School Interview.

Just hours before a new crop of medical students are to be welcomed into the world of medicine, Kaci McCleary, John Pienta, Aline Sandouk, Mark Moubarek, and Lisa Wehr confront one of the most uncomfortable topics in medical education: physician and student suicide.  Among doctors, suicide rates are much higher than among the general population.  The long hours, high pressure (from both one's internal monologue and from outside sources) to succeed, fear of public humiliation regarding one's shortcomings, isolation, inadequate supervision, the stigma against mental illness, the career penalties faced by those who admit to unwellness, and more, all contribute to the problem.  Institutions also have a difficult time addressing incidents of physician suicide effectively, as they try to walk a tightrope strung between respect for the privacy of the deceased, the needs of colleague survivors to talk about it, the desire to avoid adverse publicity.  Meanwhile, the work does not stop. The only breaks are a moment of silence, a visit with a grief counselor, or an "open forum" to discuss one's feelings.