I’ve got a question for all you pharmacists and other experts out there.

Is there some scientific basis why we laBEL mEDIcatION BoTtLeS liKE We’RE COMPuter HACKers?

The practice appears to me to be more commonplace, so I tried to find some scientific studies demonstrating its effectiveness.

While several articles show “tall man” lettering may improve drug name recognition, I was only able to find a reference to one “technical report” from Grasha et al. from 2000 that purportedly demonstrated an actual decrease in medication errors by capitalizing dissimilar parts of similar medication names. I wasn’t able to find any clinical studies demonstrating that the hacker labeling actually decreased medication errors.

If people who administer medications don’t know that 1000 phenytoin equivalents of “CereBYX” solution are given for seizures, that 20 mg CelEXA tablets are used for treating depression, and that 100 mg “CeleBREX” pills help alleviate arthritis pain, then they shouldn’t be administering medications. Similar concept to the MS04 and MgSo4 argument from years ago.

Is there other research showing improved safety of “tall man lettering” in clinical practice? If so, it should be widely disseminated.

If not, why are we basing the national standard for medication labels on a single “technical report”?

How do we know that writing names in this manner doesn’t cause more medication errors without performing double blind studies?

At some point, I think that “alarm fatigue” is going to set in and that “tall man” lettering is going to be used so much that medical providers will be conditioned to ignore the lettering completely.

There has been a lot of “spinning” of the tragic shooting that occurred in Colorado last week.

More guns. Less guns. Democratic policy issues. Republican policy issues.

I’m going to try not to add my spin to the mix, but I do want to raise one issue for everyone to consider.

As this event unfolded, there were many stories about how there were delays in EMS response and how police were “pleading” for ambulances to get to the scene. You can read about the issues involved at the link.

The point I want everyone to think about is the importance of emergency medical services.

I regularly post about hospitals closing their emergency departments. US cities have lost 30% of their emergency departments in the past 20 years. Earlier this week I posted an article about some “expert” in England who believed care would be improved by closing emergency departments and consolidating care.

There are many issues that influence the availability of emergency medical care which I am not going to list at this point to avoid trying to “spin” the issue. You all can debate them in the comments section if you’d like.

Just consider that when a mass casualty event occurs in the future … whether it is a natural disaster, a fire, large motor vehicle accident, a shooting, or an act of war … do we really want to make emergency medical care harder to access?

Few people appreciate the importance of emergency medical services until they are the ones having an emergency.

You know how when people talk about lice in the emergency department everyone starts itching?

The entire itching thing just evolved to a whole new level for me.

Usually I leave my backpack under the desk and I have books, medical equipment, some electronics, snacks and drinks inside.

Usually snacks include powerbars, dried fruit, almonds, and my homemade trail mix (cashews, dried cranberries, and raisins).

Well I was sitting at my desk typing up a note and I reached into my bag to grab a handful of trail mix, as I went to put some into my mouth, I noticed ants crawling all over my fingers.

I looked down and there were several hundred ants all over my backpack and in the trail mix bag.

Then I look around the floor and they’re crawling up my leg.

And they’re crawling up the bottom of the desk.

Every time there’s an itch, there’s a little ant crawling on my skin.

I’m still itching.

And I need a new back pack.

And I’m not going to be eating trail mix for a damn long time.

Gack.

Today marks the end of the fifth year that I’ve been posting drivel on the Internet.

It all started when some lady kept fretching in our emergency department and I had enough. I created a blog called WhiteCoat Rants, posted a little story about fretching, and since then, it has been a rollercoaster of a time.

I’ve made quite a few friends, probably a few enemies as well.

Your comments have made me laugh, made me roll my eyes, and best of all … have made me think. I’m a better person because of it.

To all of you who have stuck with me this long, I sincerely appreciate your readership.

Hope the next five years are as good for you as the past five years have been for me.

I’ve had an interesting couple of weeks.

My trusty Palm Pre died on me after a good few years. When I brought it to the customer service center, the whippersnapper working there said “Whoa! That’s an old phone!” Thanks. Amazing how something that was so “cutting edge” a few years ago is now pretty much a piece of garbage. So I upgraded to the brand new Samsung Galaxy S3 and its Android tracking, er, um operating system. As soon as you activate the phone, you have to agree to allow a bunch of programs the ability to access your contact list, identity, phone calls, and location just to get the phone to work. You can’t remove the programs from your phone and you can’t limit their access. So then I researched a bunch of programs that would prevent other programs from accessing my information. And I installed a program that makes my GPS think I’m wherever I program it to be. Currently, I’m in the middle of the Gulf of Mexico.
Overall, I have to admit that the phone is pretty nice. Screen is amazing. I can dictate text directly into the phone. Can do video chats with the kids. Can even control my computer at home from the screen on the phone. Kind of a learning curve on some of the programs, though. I’ll probably put up a few posts regarding my versions of the “best” Android programs to have on your phone.

Speaking about phones, I saw someone pushing the envelope with cell phone etiquette at a restaurant recently. It’s not just that the person’s cell phone was turned on. It’s not that the cell phone was out on the table. The person actually brought a stand to set the cell phone on during dinner so that she didn’t miss that ever important text message (the picture was taken from across a restaurant, so don’t give me grief).

Dogs are doing great. Had fun at the park the other day digging into the woodchips on the playground until someone yelled at me through the trees that they were “destroying” the playground. Destroying wood chips. Right. I was going to squat over one of the holes and smile at him, but figured that all that would do is get me arrested. Yes, I filled in the holes. I always fill in the holes.

Went out with Mrs. WhiteCoat to a wine tasting event over the weekend. Had lots of fun and didn’t even purchase a bottle of wine. Met a guy who appeared intoxicated. We talked for a while and then he had to leave. He was driving. Offered to get him a cab, but he lived 40 miles away. Thought about calling the police, but then if he wasn’t drunk, I’d look like a jerk. Besides, he’d surely be gone by the time they got there and I had no idea what route he would be taking. So I watched him leave the event and wondered if I should have gotten physical with a stranger to keep him from driving. Then I wondered how I’d feel if he hit and killed someone. The whole situation bothered me the rest of the night.
I got home and began brushing my teeth before bed. The toothpaste tasted funny. That was because it was my daughter’s facial moisturizer. Hey – it was dark and the tubes are almost exactly the same size. She’s lucky that she’s not grounded for … summer … for leaving that stuff in my drawer.

For the past few days we’ve been dealing with another problem. The air conditioner broke and it’s 105 degrees outside. What did people do before air conditioning? No one was available to come and look at the problem until the next day, so we had to use fans to keep us cool. That didn’t work well. Dogs were up pacing and panting all night. Even thought the windows were open, it was still 90 degrees inside. Didn’t want to go buy a window air conditioner for one night, so we slept in the heat. Woke up in a pool of sweat. At least I think it was sweat.
The AC repair guy came out and told us that he was working 18 hour days during the heat wave. Apparently if there are large fluctuations in voltage, the capacitors in the AC units burn out. He’s been replacing them all week. Replaced our capacitor and the AC kicked back into action … for about six hours … then it went dead again. Now we have to replace the whole AC unit. Grrrreat. However, he said that a lot of people get scammed into purchasing a new AC unit when all that is wrong is the capacitor. You all can learn from our experiences, though. If you have central air that goes out on you, check the capacitor first. Literally takes 15 minutes to replace. Our system … that’s another story.

Kids have been auditioning for several movies and commercials. A couple of them are going to be on a national talk show in the near future. During one audition, they asked Mrs. WhiteCoat to audition for another part. She shows them my picture and they want me to audition. Now both of us may be extras on a television series. I keep telling Mrs. WhiteCoat that we need to be thinking more about the rocks.

Whether you’re starting medical school or beginning your second year, this post is for you. Will probably work just as well for PAs, NPs and any other health professional student who hasn’t started clinical rotations.

Our former babysitter just graduated from medical school and the WhiteCoats are just as proud as her parents are. Then I started thinking … what advice would I give to students starting medical school?

Our first day of class, one of the professors got up in front of the class, spent a minute or so giving every student a  stare with the “eyeball” for which he was famous, then gave us this brief warning before launching into a discussion about the Krebs Cycle (which has absolutely no practical application to clinical medicine whatsoever) …

“If you want to graduate from this medical school, there are two rules: Don’t fall behind and don’t fall in love.”

Most of us sat there pondering his statement while comments about fumarate and oxaloacetate went in one ear and out the other. By the way, I still remember the mnemonic for the Krebs Cycle after all these years: “Attention Oll Comanche Indians — Killing Season Starts Friday Morning Officially.”

In the end, everyone fell behind, and a lot of us fell in love. Medical school is where I met Mrs. WhiteCoat. We all still managed to graduate.

Here are some of the things that will help you in your studies:

1. Cramming is bad. Everyone does it, but it doesn’t help you learn. To me, learning was understanding the concepts, not memorizing the words. Even anatomy and pharmacology were about memorizing relationships. They still are. I learn directions by seeing where things are on a map and by relating those things to the place I am going. I learned medicine in the same way.
I also used to try to read ahead in the books so that when a professor addressed a subject and I didn’t understand it, I could ask questions in class about it. Didn’t always work out that I could read ahead, but when I did, it seemed to help my understanding and retention.

2. Avoid study groups. There were always people in our class who studied together. They always used to interrupt each other’s studying with unrelated questions or with discussions about the latest TV show. When crunch time came for tests, they knew what was happening on “Friends” but didn’t always have a grasp of the concepts for the tests. That wasn’t for me. I would just bring my book to a secluded spot in a little known building on campus, plug my headphones into my CD player, and listen to instrumental music (George Winston – you’re the man) while I studied. Scary that MP3s weren’t even around when I was in medical school.

3. Focus, dammit. Turn off your internet connection. Shut down your computer. Don’t even take it with you. Stop checking your e-mail messages on your phone. Don’t take it with you, either. Or take it and pull the battery out of it. Take your book, some ear plugs, an MP3 player, some paper, a pen, and take notes on what you’re trying to learn. Writing things out helps you remember concepts. All the other distractions make it harder for you to concentrate on learning.
We didn’t have “smart phones” when I was in medical school, so I didn’t have to worry about that distraction. Think about it now, though. Does it really matter whether you get your BFF’s text message immediately or a few hours from now? Do you really need to check your e-mail that often? Does it matter that you won’t get to read my latest post for a few hours after I hit the “PUBLISH” button? If there’s something that important pending, then deal with it before you go to study. When you study, focus on studying.

4. Get copies of old tests. This is VERY IMPORTANT! Most professors are not industrious enough to create new questions for each exam. And there are only so many questions you can ask about the same topic. Therefore, many questions are repeated. Some may have wording changes, but most questions have the same concepts. By learning and understanding what concepts appeared on previous tests and are therefore important to the professor, you’re well on your way to learning the concepts — and passing the tests. Back before we had all these fancy computers and scanners, the students used to have a copy service where we paid extra so that we could get paper copies of previous test questions.

5. Don’t get down on yourself. You’re going to do poorly on tests. I did. Almost everyone did. Don’t you just feel like bopping the guy in the head who aces every test and then sits there with his smug grin bragging about it in the study lounge? You may be smart, but you’re a tool, pal.
You know what they call the person who graduates lowest in his medical school class? …. Doctor.
You don’t need great grades in every subject to be a decent doctor. Trust me. I’m living proof.
Study hard, do your best, keep plugging along, and don’t get discouraged. If you put in the effort, you will graduate.

6. Learn what medicine is all about. Don’t just stick to the textbooks. Read journal articles or medical blogs about topics that interest you. Yeah, it’s more reading, but those articles are only a few pages, will hopefully be more enjoyable, and will help bring together all of the facts that you are learning to show you how to apply them. There’s a big difference between “book sense” and “common sense.” You need both to succeed.

7. You’re not a doctor. Don’t act like one. We had one guy in medical school that used to wear scrubs and a white coat while he was in the grocery store. He drove a nice car and used to pick up on a few women that way. Total fool. Most of the people in school rolled their eyes when he walked by – even when he was dressed normally.
Even I wasn’t immune to the allure of being called “doctor.” Funny thing is that now I detest being called “doctor.” When I was a student, I used to carry a medical bag in the back of my car wherever I went. Still do now, but at least now I have the proper equipment and I know how to use it. Then — well, I’m not sure how many accident victims would benefit from me testing their reflexes or doing a funduscopic exam on them. I also had a large bore needle that one of our more senior professors said we could use as a “makeshift cricothyrotomy to establish a temporary airway.” Then we thought how cool we would be saving someone’s life by sticking an IV needle in their neck. Now, I still laugh at some of the stuff I used to carry in that bag. Thank goodness I never actually pulled the bag out of my trunk.
People will ask you for medical advice. Tell them you aren’t a doctor and you don’t know. Or tell them you haven’t studied that topic yet. Don’t act like you know what you’re talking about. More often than not, you’ll give them the wrong advice and you could get yourself into trouble in the process.

8. Set aside a day to relax. All work and no play makes Jack a dull boy. We usually had our exams on Monday mornings. Most of us studied all weekend. Sometimes during weeks with less difficult tests, we’d take a Saturday night off and go to the bars. However, Monday afternoon and evenings after school, everyone relaxed, partied, went to the beach, played cards, and acted like normal people. Some of the fondest memories (and the most incriminating pictures) I have from medical school were from events that took place on Monday nights. Make friends and have fun. It’s a school, not a prison.

9. Don’t forget your family. Your family is proud as heck of you for making it into medical school. Call them once in a while. Better yet, write them an e-mail and send pictures. Chances are that they sacrificed a lot so that you could go to medical school and they probably brag about you to all their friends. Give them some material to brag with. Without your family, you probably wouldn’t be where you are right now. Trust me … you’ll miss them when they’re gone.

I’m sure that there’s more stuff buried in the back of my mind. Maybe I’ll add it in an update to this post. Start with these bits of advice and you’ll be way ahead of the curve.

And if some day you see a contracted old curmudgeon in diapers mumbling about how he used to write a medical blog, take pity on your old pal WhiteCoat.

While celebrating this great day, remember that the holiday wasn’t created for picnics, it wasn’t created as an excuse to shoot off fireworks, and it wasn’t created so that most of us could get another day off of work.

Always remember the ordinary people who became extraordinary by leaving their families to travel far away and to put their lives and safety on the line so that we can all be free to celebrate this holiday.

Have a safe and happy holiday. And please be careful with fireworks.

Time to go to a parade to give as many veterans as I can find a handshake and a thank you.