The following is contributed by Half M.D., the author of www.halfmd.com

The two things that piss me off quicker than anything else are inefficiency and ignorance. So far, the people who run my family medicine rotation have shown both. I’ve had one setback after another in the months leading up to this clerkship. Back in January, I wrote the course director to tell him that I would be going out of town for a special conference during his rotation. He never wrote back.

So I wrote the co-director of the course and told her the same thing. She never wrote back.

Then I wrote to the secretary for this clerkship. It turns out that she had been fired and replaced. I then wrote the new secretary of the clerkship. She never wrote back.

I went to the third year coordinator for my university to ask what was going on. I should have known something was wrong when she suggested that I make a physical appearance to the family medicine office. At that time, I couldn’t figure out why no one in the department could reply to my e-mails.

I then tried calling… multiple times.

I finally got through and confirmed all the information I provided in my original e-mail. Heeding the advice of the third year coordinator, I went to the family medicine office last week to make sure that everything was intact for my clerkship. You can imagine my surprise when I discovered that the secretary denied having ever received any information from me about my absences or where I wanted to practice family med. I had saved the e-mails and pleaded, “Here’s all the information right here.” To which she replied, “You should have e-mailed me more than one time.”

Through talking to the secretary of the course coordinator, I had hoped that everything would have been figured out for this week when I finally started the clerkship. I was given the wrong phone number to my preceptor’s office. And then when I finally managed to get through to his nurse, I was given the wrong location of his office.

I showed up bright and early Monday morning ready to see patients, but found out that he had a second practice located across town. I tried calling him at his other office multiple times that morning until I finally reached him at 10:00a.m. Keep in mind that he was supposed to have arrived by 8:30. I had to drive like a madman across town to this other office just so that I could be two hours late to my first day of my clerkship.

If things continue like this for the next month, I think I’m going to punch someone before it’s all over. Today is Wednesday.

Just in case any attendings are reading this, if you ever happen to be in a position to lead medical students—especially as a clerkship director—make sure that you have a good support staff and that everything in your clerkship is well organized. There should be no reason why students are given the incorrect telephone number and address of their clerkship location. We are paying for that education after all.

Popularity: 11% [?]

Help offset your medical school loans by stealing body parts!

This story first came out in 2003, so I suppose they’re just now getting a trial together. The two guys stealing body parts had between 80-100 clients, and they illegally sliced & diced around 800 cadavers. The UCLA-based pair made $1 million before being caught.

Popularity: 3% [?]

Just as Match Week is about to kick off, here’s an awesome article that talks a little about the history of the match and discusses the match algorithm, an NRMP lawsuit, and implications that the match contributes to poor resident working conditions. It’s a somewhat long read, but definitely worth it.

Every March, hundreds of graduating medical students put themselves at the mercy of a mathematical algorithm that pairs them with the teaching hospital they’ll go to for their residency training.

Participating students and hospitals submit rank-ordered lists of their preferences; on Match Day, a computer comes up with a matching of students to programs that all participants must accept.

The system is based on an elegant mathematical theory dating from the 1960s, yet medical students, unversed in game theory, have trouble believing that it’s fair.

It’s not surprising, then, that three disgruntled physicians, fed up with the low wages and long hours that characterize medical residencies, are blaming the algorithm for their woes.

Are Medical Students Meeting Their (Best Possible) Match? [PDF]

Popularity: 7% [?]

I was browsing around the SDN forums the other day and came across a thread that quickly turned into the discussion of outsourcing. I was pretty interested in the topic, and came across an interesting article after doing some research. The article is two years old, but is a good read nonetheless.

I’ve always heard people say that outsourcing will never happen. This can’t be further from the truth. If you read the article, you’ll find that it is already happening. The reality is that residents and physicians don’t want to believe that it is happening as it imposes serious threats to their livelihood. If you dig further, you can find other stories as well.

The imaging charter was presented to the FDA and there was no objection from the FDA regarding conducting the review in India. This review resulted in cost and time savings for the sponsor, and demonstrates another avenue for US companies to reduce clinical trial expenses.

Radiology has been used as a test bed for outsourcing, primarily due to the digital nature of films and ease of transporting data quickly through network pipes to the other side of the world. There are now firms dedicated to reading films during “off peak” hours. They are often located in Australia or India, as this allows for our late-night films to be read by somebody who’s in the middle of their normal workday.

Of course this brings up concerns regarding accreditation and liability, but since the practice of outsourcing continues, the problems are most likely too minor to warrant any stop to sending films overseas. Despite some of these concerns, both sides of the fence honestly believe that outsourcing and telemedicine are the wave of the future. It simply increases productivity while decreases cost.

I’ve always said that medicine is simply business, and we’re beginning to see stronger evidence of that. With the exponential increase in technology advancements (via Moore’s Law), it’s only a matter of time until telemedicine becomes so cheap that it will be foolish for all hospitals not to adopt some form of it.

What does this mean for future doctors? I honestly don’t know. I do believe that some of the more technologically-advanced specialties such as radiology and even pathology will most likely become the ones that see mass outsourcing first. Outsourcing plain old patient care and physical exams probably won’t happen for awhile, but these types of specialties will have their own problems soon enough as more students favor lifestyle over brute force hours.

How do you feel about outsourcing? Will the ease of outsourcing have an effect on how you choose your specialty? Or, do you not feel that it’s something that you will have to worry about in your lifetime?

Popularity: 4% [?]

A derm doc at Harvard has developed tattoo ink in polymer bead form that looks permanent, but can be lasered & absorbed if unwanted. Sounds like a very practical idea. From a business perspective, I bet it would give tattoo parlors more business since people wouldn’t be as reticent to get a tattoo. From a health perspective, it allows people to easily change their minds about ideas or things they thought they’d never, ever, never-in-a-million-years change their minds about.

Interestingly, a tattoo guy comments that the erasable ink is “cheating permanence.” Note that the ink looks permanent, according to this article. (It essentially is permanent if you want it to be.) Also note that regular tattoo removal can cost up to ~$10K and still not be completely removed. Assuming this ink will be more expensive than run-of-the-mill tattoo ink, it sounds like a relatively cheap insurance policy.

You know, just in case you decide the Taylor Hicks tattoo on your chest isn’t your style anymore.

Popularity: 3% [?]