Supervisor...

I was checking my blog and I just noticed that I haven't posted since I started my FIRST SUPERVISOR MONTH! Phew... it's been a ride for sure. I can say one thing - I'm learning a ton every day and I'm grateful for that. I am building confidence faster than I thought possible. I don't think I've had this feeling since I started residency more that 16 months ago... I just hope that I can sustain my energy level from here on out - it'll be tough.

Oh yeah, I passed Step 3! Now I can look into moonlighting next year. Extra cash = good! So... it's actually getting late (I know, 9:30 doesn't seem that late but believe me, I'm so sleep deprived I could go to bed at 6). Here's to a future of responsibility and (hopefully) rewards!

Neal Anson, MD

Home again!

Well I'm back home for one day before I have to go back to work - though as you could probably tell from my prior posts, this month is not that stressful. Next week, I'm taking my third round of licensing board exams known as "Step 3". I've been preparing for it by studying here and there but really have not put forth a concerted effort to hit the topics I've missed out on during residency. I'll be trying to play catch-up this week to get where I need to be. Right... that's it!

Neal Anson, MD

Vacation Amazin!

It's been far too long since I've updated the blog site. I'm out of the NICU and on Dermatology. What a great rotation. I'm learning a lot of good information about rashes and other diseases that will be useful in private practice. At the same time, I'm not having to work all that hard because this is my "call free" month. Currently, I'm in Pittsburgh, PA enjoying my vacation with my brother-in-law and sister-in-law. It's just nice to be able to go to bed and wake up on my schedule...

I'll soon be starting my first month as a supervisor. It'll be on hospital medicine also which makes me a little nervous. I'll be responsible for all the codes in the hospital - scary. I'll be studying up on my ACLS cards before then. I know other residents go through the same anxiety and soul searching I am before they supervise other interns, but that doesn't really make it any easier. I think it just takes practice to really feel comfortable in the role.

Neal Anson, MD

NICU Round 2

So, I'm back in the NICU and it's a whole different experience the second time around. I'm at a bigger hospital in CMH and there are more interesting cases to see. I think that I may be getting to a point where I am starting to enjoy residency a bit. I think after you get over the first year stressors or "intern blues" things really do get better.

I'm also excited for some upcoming time off. I am taking some vacation time in October - exciting stuff. Haven't yet decided what I'll do but right now it doesn't really matter to me much - I'll be off work and that's enough for me.

The next step coming up is starting my supervisor roll - at SLH. That will be interesting. I'll need the time between the switch to prepare myself for the medicine side again. Yikes! Anyway, that's all I have energy enough to write about for now.

Neal Anson, MD

Resident Work Hours

Here's an interesting new article in USA Today about resident work hours... and the study was done in the field of pediatrics.

Article

Neal Anson, MD

Upcoming Elections

Well, since I've had some free time this weekend I thought it was important to read up on the presidential candidate's health care plans and to be completely honest, they are both very vague and mostly similar. As could be expected, they are worded in a way that would appeal to the broadest of groups but I can say the following about the plans:

- Obama's plan is very heavily dependent on the federal government. There will be a National health insurance "exchange" which he states would "help individuals who wish to purchase a private insurance plan". He goes on to state that the plan would act as a "wachdog" for private insurance companies and would act as a "standard".

- McCain's plan emphasizes the importance of placing the control of health care back with the "patient's themselves". The major way he plans to do this is to provide tax incentives in the form of $2,500 for individuals and $5,000 for families to find additional plans other than what their employers already provide. He also talks about a guaranteed access program (GAP).

I can find problems with each viewpoint.

First off, I feel that Obama's plan essentially expands medicare to the entire population which would likely do two things:
1. decrease the overall quality of care across the population (i.e. providing minimal coverage to uninsured while lowering standards for those who are insured already)
2. provide incentives for a further split between those who can afford quality care and those who cannot. In other words, his plan would drive a wedge further into the disparities already present in our system...

Okay, now McCain's program seems more concrete but is probably just a bandaid over the hemorrhage within our healthcare system. His GAP program is not fleshed out enough and the tax incentives will work for those who already pay taxes. Unfortunately, the under/uninsured patients will not see these incentives because they would be unlikely to even file taxes. So... they remain under/uninsured in the end. He also mentions expanding health savings accounts but doesn't say how he will do this.

The rest of their ideas are worth mentioning but are universal within each proposal, so they do not help in defining the candidate. They are:
- promoting preventative medicine
- increasing IT funding for advancement toward a universal medical record
- lower drug costs via reimportation of medications
- tort reform
- making healthcare available for traditionally "uninsurable" patients (i.e. pre-existing conditions).

It should mentioned that Obama makes a point to insure all children while this point is notably absent from McCain's website. This is a strike against McCain in my opinion.

Ultimately, I feel that neither offer a clear solution at this point and both plans make me a little depressed about where we are headed in the future but based solely on this issue, I would put my weight behind McCain. I can't see expanding an already very flawed system like medicare.

Check out the websites for yourself and I'd love to hear comments on this:

McCain

Obama


Neal Anson, MD

Back to the Heart

So I started the cardiology clinic today and it was suhweeeeet. I really do love the things you can do and see in cardiology. Now, I can even see why pediatric cardiology is interesting - so many congenital defects that can be surgically corrected to give somewhat of a normal life to a child who would have most likely died otherwise. Amazing!

I'm really looking forward to the next month and all that I intend to learn. Don't get me wrong, the NICU was great too but this outpatient stuff is just fantastic! Plus, I have NO OVERNIGHT CALL this month - I'm stoked. Alright, enjoy the following video of a crazy german guy simulating EKG tracings with his body..... wild stuff....



Neal Anson, MD

The weekend

You have no idea how nice it is to actually have a weekend off. I can't remember the last time I had both Saturday and Sunday to recharge for the week ahead... I definately have to try to do this more often. Unfortunately, most of my rotations only allow me to have 4 days off for a whole month so if I take a weekend, half of my days off are used up. Days off are like solid gold in residency. I look forward to sleeping and relaxing on these days. I rarely force myself to do anything work related. I also use these days to do normal things like get my hair cut, go to the dentist, shop for things I need and clean the house. Oh yeah, most of my days off are spent mowing the grass as well.

So this weekend I crammed a whole bunch of things in. We went to see the new batman movie (excellent by the way!). We also went to a cirque du soleil show here in KC. I've laid around and slept quite a bit also. Glorious! The only bad part is that I have to go back to work on Monday and I'm on call. Cross your fingers that it's a quiet one.

Neal Anson, MD

Tests...argh...

So today was my intraining exam for pediatrics. These tests are supposed to show everyone how much you've learned and advanced throughout your residency. Unfortunately my time as a pediatrics resident has amounted to a whopping 4 months compared to a whole year that my classmates have had. Needless to say, I felt a little behind in taking the exam. The good part was that on questions involving teenagers, I think I did pretty well since they usually are treated much like adults. I guess the verdict will be out until I have my mid-year review...

At least it's an excuse to go out and have a few beers to supress my self-pity.

Neal Anson, MD

Back on Peds

"The Switch" - that's what we call it when we go from internal medicine to peds or vice verse. I "switched" last week and am fully immersed back in the world of pediatrics again. I started off this month in the NICU - totally different from the adult world but interesting nonetheless. The NICU is a slightly strange and mystical place. Small people are in incubators hooked up to machines that tend to ding at regular intervals. Strangely enough, it's a relatively quiet place aside from the aforementioned dings. The babies generally don't cry much there - after all, they normally would still be in their mother's wombs.



Here's a very funny youtube video about the NICU set to a MTV cribs style interview:


Anyway, I'll try to post a little more often now that I'm back on peds!

Neal Anson, MD

Almost the end of the month

Okay, so it's about time for the next rotation to start and that means big changes for me. First off, it's July which means that new interns will be starting. I'll be through my first year of residency. Technically, in my program you have to have 16 months of residency before you supervise interns so I'm a "super-tern" for four more months. This is COMPLETELY fine with me since I'm still nervous about having more responsibility. It's really intimidating.

Second, I'll be switching back to pediatrics - I better dust off my pedi-scope! I'm in the NICU (Neonatal Intensive Care Unit). This will be kind-of new stuff for me because it's been a long time since I've taken care of NICU babies or done any circumcisions but I'm excited to have the chance.

So, that's about where I'm at right now. Nervous.... excited... all at the same time.

Neal Anson, MD

Doomsday

Man, this day was aweful. I'm so tired - I never knew someone could get this tired after a normal number of working hours. I think it's because I'm getting stressed about the future of this month. I don't want to mention any details but just know that tomorrow on a service usually with 5 residents, I'll be the only one that's normally there. They took a float resident to help cover the service but we have over 40 patients, half of them in the ICU and just me and the fellow to see them. I guess I won't be getting any sleep again tonight and you can kiss morning report goodbye again... Damn it!



I know that residency is hard and that there is a service component to it but there are times when I feel like this program prevents me from learning as odd as that sounds. I'm exhausted when I get home so I don't typically read much. I'm busy during the days and can't follow-up on everything like I would like to do. It's just very frustrating.



And... I'm on short call the last day of the rotation right before I switch - I think I may have mentioned that before but I'll say it again because it SUCKS. No wonder this job drives so many people to drink. Just have to push on and hope that greener pastures await.



On a lighter note, I've gotten a bunch of complements on my new haircut - check it out:





















Whatcha think ;)...
Neal Anson, MD

New Week - New Outlook

Alright, it's time I stopped complaining about what I do... I chose this profession and I truly do love it. For instance, today I was able to do a procedure that I love doing - it went well and I felt good that since I've started residency I've gained enough confidence and knowledge to do this without much hesitation. Maybe one day, I'll feel that way about most of what I do... maybe.

I'm a little scared about going back to pediatrics in a couple of weeks. I'll be in the NICU and I haven't stepped foot in one since I interviewed. The good thing is that I'll be there in July - the highly anticipated month when all interns across America begin their residencies. I'll probably just blend in like the rest of them. I will have an edge though since I know the hospital system and the computers...

Oh yeah - I shaved my head... pictures to come later ;)

Neal Anson, MD

Waiting

So I'm sitting in the resident lounge, waiting to checkout my patients - feels like the medical school days... Usually, I'm so busy with patients that I just have enough time to see them before rounds begin. Today is a little different. At least I feel a little more rested today - I slept in until about 5 this morning... Can't wait to do it all again tomorrow.

First Blog

Hey everyone,
This is my first blog... don't judge me too harshly. I'm getting ready to go to bed and get ready for an early morning in the hospital. I'll be working up until I have the wedding tomorrow. Something I've realized up until this point in my residency is that time is precious. Sometimes I wonder if I've really done the best thing by going into this field. It's true that there are many rewards to be experienced but at the same time, that comes at a price. I know that things will eventually get better but the journey is pretty rough right now.

I feel like I'm changing through this in order to survive. I eat meals in less than five minutes. I can work on less than 6 hours of sleep regularly. I am able to locate a coffee pot on any floor in any hospital... these skills are important if a person is going to survive the daily scut that is medical residency.

When you work the kind of hours a resident does, you begin to really value the time away from the hospital - it feels like stolen minutes that becomes your currency. Unfortunately - I feel constantly overdrawn. There are so many demands on my time because the people I love are saving up the things they want do to with me until I get home and all I can think about is sitting/laying/falling down and closing my eyes for a few minutes... that rarely happens though. I find myself trying to keep going until I know in my brain that if I go any further the next day will be impossible to work through. In short - I have no FREE time. I wish I had valued the time in college and medical school more. Oh well, they tell me that things change - I can only hope for that...

Until next time...
Neal Anson, MD