I think we may have interviewed this guy ....

I was catching up on my blog reading and ran across this on Scalpel or Sword. please don't try this at home.

Let's play the odds ....

“In all things it is better to hope than to despair”
~Johann Wolfgang von Goethe

The residency application year is about to begin and the same questions are being asked. "What do I need to score to get into an orthopaedic residency?" "Do I need research?" "How competitive am I?" I think these are the questions that we all had or have when applying to residency. I know I did. It seems like everyone wants the formula. If you have X honors with Z USMLE step 1 and Y letters of recommendation, you will be guaranteed a residency spot somewhere. I wish it were that simple.

I happened upon the statistics from last years match when looking through SDN. It was distributed by a young radiology resident trying to prove that they are as competitive as the big boys. I think he failed to actually look at the statistics and concentrated on the fact that the average USMLE step 1 & 2 score was 1 point higher than the average orthopaedic board score. But, that in itself does not make you competitive and I don't think that the 1 point difference reaches statistical significance. The competitive residencies have more applicants than spots, supply and demand. That is what makes them more competitive. So, he was a little misguided. I will give him the props that it is more competitive than I originally thought.

I think some of the interesting statistics from this report are that they looked at the the probability of matching based on USMLE score, number of programs ranked, and research and publications. They split things up based on U.S. Seniors in "other specialties" and in "Highly Competitive Specialties", and Independent Applicants in "Other Specialties" and Independent Applicants in "Highly Competitive Specialties" The highly competitive specialties are defined as specialties where the ratio of the number of U.S. seniors who ranked the specialty first to the number of available positions was 1 to 1 or greater. These specialties include: Dermatology, Orthopaedic Surgery, Otolaryngology, Plastic Surgery, and Radiation Oncology. This is an interesting document. It is all about statistics.

For those who want to know how competitive they are and want the actual numbers, this is the document you want. Good luck to you all.

“Doubt can only be removed by action.”
~Johann Wolfgang von Goethe

Liberty or ....

“Politics is a pendulum whose swings between anarchy and
tyranny are fueled by perpetually rejuvenated illusions.”
~Albert Einstein

I love this country. The founding principles are its heart, take them away and it dies. "Give me liberty or give me death," is one of the most famous quotes in our rebellion against the British. In this speech Patrick Henry's made to the Virginia House of Burgesses, he makes this statement:

... it is natural to man to indulge in the illusions of hope. We are apt to shut our eyes against a painful truth, and listen to the song of that siren till she transforms us into beasts. Is this the part of wise men, engaged in a great and arduous struggle for liberty? Are we disposed to be of the numbers of those who, having eyes, see not, and, having ears, hear not, the things which so nearly concern their temporal salvation? For my part, whatever anguish of spirit it may cost, I am willing to know the whole truth, to know the worst, and to provide for it. ...

We fought for the ability to speak freely. It is the first amendment in the bill of rights. As citizens of the United States, that is our birthright.

I have posted on a number of other blogs and forums pleading with residents and medical students to believe in the "system." I made the statement that the system has been put in place for a reason. I have pleaded with them to let the system work. Unfortunately, my blinders have been removed. I have made the realization that everything is political. The politics of a large medical center are sometimes overbearing. I have never played the political game very well. This is probably because I have a hard time being phony for the purpose of politics.

On a number of other blogs, there have been long discussions about the fear of retaliation from staff if a medical student or resident speaks their mind or states that there is a problem. I have seen a number of forum discussions on people feeling that the have never had their do process. My reaction to these complaints is that there is a system in place and you need to use it. It will all work out. The responses of medical students and residents is that there is no support. Students and resident have complained about having their lives monitored and somewhat controlled by the "system," medical school or residency. They complain that the new medium that they have been brought up on (myspace, facebook, blogs) is being used to monitor them and control their behavior. On forums such as SDN, there have been discussions of how their anonymous opinions about situations with a professor or their institution have been monitored and people have been disciplined for these honest opinions. Does this encroach on their rite of free speech?

This topic has been extended to medical blogging as well. The questions of whether or not medical blogging is ethical. With the increasing scrutiny of the 1000 or so medical blogs, there has been the development of a Health Care Blogger Code of Ethics. With cases like that against the fallen medical blogger Flea, people have become more and more concerned. Dr. K, who writes a blog titled That Mirror Belongs to Frank, changed her blog and deleted previous posts because she is going up for tenure and had a fear that the blog may be found and use against her in her quest for tenure. There has been a recent article addressing the issue of medical blogging on MDNG titled Medical Ethics and Blogging: Think Before you post. Is there a different standard?

In medicine, should we not express our feelings openly? Our we so immune to human condition that we can not express our emotion without fear repercussion? Should we fear openly expressing a opposing opinion? These our questions that I thought I knew the answers to, but know I question those answers. I am reevaluating my view of the system. I am reassessing my place in this world. Can I play the game?

One thinks that if you are in a university or college, true free thought would be encouraged. Opposing opinions would be encouraged. Our job is to encourage and stimulate young fertile minds. We are here to help in the advancement of medical education as well as medical knowledge. When is it that we teach how to navigate through the political cesspool known as the Medical Community? Are those in positions of power the best for the position or the best positioned?

Will I play the game well? Probably not, because as you know the color of my brain is red. I will continue to fight the good fight. We are in a free country and should encourage differences of opinion. We should encourage the dialog. I would hope things would be done directly instead of behind closed doors. We should not let the fear of something happening prevent us from acting. The fear of a new medium is what we are seeing now. It is a new fronter of communication. As with most things in our country, we react to the fear of the unknown by trying to control it. So when all is said and done, will it be liberty or death?

A Dream Within A Dream

Take this kiss upon the brow!
And, in parting from you now,
Thus much let me avow--
You are not wrong, who deem
That my days have been a dream;
Yet if hope has flown away
In a night, or in a day,
In a vision, or in none,
Is it therefore the less gone?
All that we see or seem
Is but a dream within a dream.

I stand amid the roar
Of a surf-tormented shore,
And I hold within my hand
Grains of the golden sand--
How few! yet how they creep
Through my fingers to the deep,
While I weep--while I weep!
O God! can I not grasp
Them with a tighter clasp?
O God! can I not save
One from the pitiless wave?
Is all that we see or seem
But a dream within a dream?

~Edgar Allan Poe

“The secret of happiness is freedom.
The secret of freedom is courage.”

~Thucydides

Clearing head ....

“Life is full of beauty. Notice it. Notice the bumble bee, the small child, and the smiling faces. Smell the rain, and feel the wind. Live your life to the fullest potential, and fight for your dreams.”
~Ashley Smith

For those who frequent my blog, you know that I run. It is my time. It is when I do most of my thinking. No kids to bother me; no wife to nag; no residents to teach. It is me, the road, and my Ipod. Over the past months, I have been plagued with injuries and have not been able to devote much time to running. This last month I have been able to increase my mileage without incurring any injuries. Today, I had one of my better mid distance runs. It was phenomenal. Why, you may ask? There is a point you reach while running when it becomes like a trance. The head clears. The legs move effortlessly. This is when I have my best thoughts and ideas. Today was one of those days.

REFLECTION
I have come curiously close to the end, down
Beneath my self-indulgent pitiful hole, defeated I
Concede and (Concede and) move closer (Move closer),
I may find comfort here
I may find peace within the emptiness, how pitiful

It's calling me (Calling me)
It's calling me (Calling me)
It's calling me (Calling me)
It's calling me

And in my darkest moment, fetal and weepin'
The moon tells me a secret, my confidant
As full and bright as I am, this light is not my own and
A million light reflections pass over me

It's source is bright and endless, she resuscitates the hopeless
Without her we are lifeless satellites dreamin' dreams
And as I pull my head out, I am without one doubt,
don't want to be down here soothing my narcissism, I
Must crucify the ego before it's far too late,
I pray the light lifts me out

Before I pine away
Before I pine away (Pine away)
Before I pine away (Pine away)
Before I pine away (Pine away)

So crucify the ego before it's far too late to leave behind this place,
so negative and blind and cynical
And you will come to find that we are all one mind,
capable of all that's imagined and all conceivable
Just let the light touch you and let the words spill through,
just let them pass right through, bringin' out our hope and reason

Before we pine away (Pine away)
Before we pine away (Pine away)
Before we pine away (Pine away)
Before we pine away

Over my last 2 of 7 miles, I listened to a great Tool song off of Lateralis called Reflection. For those who are unfamiliar with Tool, there is much more to the music than meets the ear. It is poetry. It is a mathematical problem being solved; it is geometric. This is a wonderfully long song and perfect for running. The instrumental potion is increasingly intense with the ebb and flow of drums, base and guitar. The voice of Maynard placed slowly into the mix. It gets increasingly emotional. The emotion rising and falling like increasingly excited breath. It climaxes at the end with all of the instruments and vocals coming together to complete the emotional experience.

How does this relate to anything? This was like a reset for me. It helped me to recenter. I think we all need a reset button. We all need something that reminds us why we are here, to redirect a lost focus. Every morning I run. In the rain or snow, hot or cold, I put my shoes on and run. Why, because it centers me. It helps me to balance the trials of the days. It is my time. The practice of medicine can wear any of us down. We all need something to rejuvenate us. I have been rejuvenated. I plead to you to find what will center you, rejuvenate you. Don’t let medicine consume you.

“Dream as if you'll live forever, live as if you'll die today.”

~James Dean

How's my life going?

I took the life test. It said I was doing FFT.

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