Episode 78: Did you know that without a Right of Sepulcher a gay/lesbian partner can be excluded from end-of-life care decisions and even funerals?
Medical Ethics for Gay and Lesbian Couples

* Wills
* Parental rights
*  Gay/lesbian/unmarried legal issues in time of incapacitation or death


Medical Ethics 102

Science & Medicine

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Educational Technology






Apparently, my podcasting days aren’t over… Who would have guessed a bioweapon would bring us back together? You could have guessed. If you understand the Medical Mastermind Community has always been about authentic leadership. From our research on disadvantaged students, to mentorship development programs culminating in the Bronze Outreach Award from my medical school. 



Thank you. Thank you for your support, and if you’re new to MMC – you owe a tremendous debt to the members that came before and built it up. Sadly, the membership software I’ve used for 14 years is no longer supported and it’s causing errors I can’t fix on the site. My project site is officially broken, after being available for free – with regular new sign-ups – for the past several years.







Are you ready for something new? No matter your specialty, your patients are no doubt fearful and anxious. Their hypertension and fatigue are off the charts and not responding to non-adrenergic mechanisms.



It’s not about burnout anymore



Folks, it’s time for our young leaders in medicine to rise to the challenges our world is facing during these trying times. 



That is why I’m announcing the PTSD Academy Podcast on this channel – and some you have already answered. I’ve got at least one person from the good ‘ole days of the MMC to come back on for another interview, but on my new channel. At least, that’s all I can commit to right now. I am a little busy, as you know.







Ever wonder what happened to the people we interviewed years ago? I’m extending invitations again for follow up, only this time it’s different.



Join the cause and prevent physician and student job dissatisfaction, burnout, depression and PTSD.



Tell your patients that can’t sleep to try out my free PTSD music therapy page. This is where I play live, improvisational guitar to help you fall asleep. Yes, I’m so sleepy on the guitar I’ll have you and your patients snoring.



So, shall we bring back the MMC?



 Let me know your thoughts.





Hope for PTSD in the Era of Coronavirus

Episode 104: Dr. Dan answers a listener question about how to scramble up an effective study approach during the first semester of medical school.
Getting Board Certified
Hi, this is Dr. Dan here with both the Medical School Podcast. I am sorry, it has been awhile since I have issued a podcast. I finished residency and am now board certified in Psychiatry by the American Board of Psychiatry and Neurology. It’s a bit of an interesting podcast in that we’ve had over a million downloads total. I started off in Emergency Medicine and video and audio log an entire transition of burnout in that field. Having a bad malignant residency experience, transitioning over to Psychiatry and doing a lot of self searching, and did that somewhat publicly for at least a private audience of the medical school podcasts.
MMC Mobile Listener Question
Today I’m going to cover a listener question. I’m going to read his question and reply to it. Here we go. This was written to me by a student several months ago so he was in his first semester of medical school. He says that he’s listened to many of my podcasts in the past but doesn’t recall if or when this particular question has ever been covered. In fact, it hasn’t.
Question
He says, “When we had our first block of exams finished a few weeks ago, I scored in the 50s range for anatomy, physiology, and biochemistry. Histology was the only exam that I passed. As time progresses more closely to exams, I grow more and more anxious which becomes extremely distracting. I limit all other distractions such as phone, computer, and noises but I’m still left with my worst distraction, my mind. I begin to think about irrelevant things in my life and get too anxious as I try harder to concentrate on material.” This leads to depression, even trying medication to help him regain focus and care for things again to try to get motivated. However, he feels that his issues lie in his inability to keep pace with the curriculum because for him to learn something he has to really go slow to digest it. Which of course is not something that the standard curriculum permits.
His father is a physician and suggests that he speak with Student Affairs to see if he can go into the five year program offered by his medical school, though he’s reluctant to spend any more time than necessary in medical school. He’s having a second biochemistry exam tomorrow which he doesn’t feel any more prepared for than the first one, but he will meet with Student Affairs afterwards. As far as his study techniques, he says, I use a timer and try to push myself to go faster. But I always slow down and never get everything done on my schedule. I’ve reviewed study habits exhaustively and attempt to be an active learner, but those habits take me too long and I fall behind. I suppose I am not all too sure what to ask you but I guess I could ask if there’s any active study method that doesn’t take a long time to do.”
Answer
That is the question, I’ll keep it anonymous, of course. I keep questions anonymous. I don’t say who is emailing me but this one sort of hit me between the eyes because, the truth is, that I taught a lot on study techniques. I have nine videos in the Medical Mastermind Community about study techniques. Even a speed reading course is in there. I even break down all the different classes you take in medical school and which study techniques for each one of those is the most likely to be beneficial. I have to admit, I’ve been doing the Mastermind Community and these podcasts for eight years now. I’ve always said that, based on my own experience, that it takes so long to learn different kinds of study techniques, that you don’t want that kind of distraction while you’re in medical school.

First Year Study Method

Episode 103: Brain trauma, intracranial tumors, birth defects and infections – all in the head.


Neurology lecture

Episode 102: This is a sample of the Master the USMLE audio program online at MMC.works
NUTRITION
I. Eating disorders – includes obesity, anorexia, bulimia


Difference between anorexia and bulimia?
A. Anorexia
Distorted body image; women with anorexia can have distorted image; control issue; they have lost control of everything in their life, and the only thing that they can control over is what they put in their mouth. With a decrease of body fat and wt, GnRH decreases, therefore FSH and LH also decrease, leading to low estrogen; as a result, amenorrhea occurs, AND predisposes to osteoporosis, as if pt is postmenopausal.  Anorexic people will eventually develop osteoporosis. Rx – convince person to gain enough wt to bring period back; not birth control. (ie first step in management of HP/diabetes = wt loss; as you lose adipose,  you upregulate insulin resistance). In anorexia, usually die to cardiac dz (heart failure: heart just stops).
B. Bulimia Nervosa
1. Metabolic Alkalosis: It’s not a body image problem – they can be obese, normal or thin (no weight issue); however, they binge (eat a lot), then force themselves to vomit. Pic on boards: from vomiting, wear down enamel on teeth; so, brownish stuff seen on teeth is just dentine (erosions seen on teeth). Metabolic alkalosis from forced vomiting will be seen. Metabolic alkalois is bad b.c there is a left shift curve, and the compensation is resp acidosis, which drops pO2, therefore will get hypoxia with metabolic alkalosis, and the heart do not like that. The heart already with low O2 will get PVC’s (pre-mature ventricular  contractions), R-on-T phenomenon, then V-fib, then death. Therefore, met alkalosis is very dangerous in inducing cardiac arrythmias, and this commonly occurs in bulimics due to forced vomiting. Pt can also vomit out blood – Mallory Weiss Syndrome – tear in distal esophagus or proximal stomach.
2. Borhave syndrome, which is worse. In the syndrome, there is a rupture and air and secretions from the esophagus get into the pleural cavity; the air will dissect through subcutaneous tissue, come around the anterior mediastinum, which leads to Hemimans crunch – observed when dr looks at pt’s chest, puts a stethoscope down, and you hear a ‘crunch’. The “crunch” is air that has dissected through interstial tissue up into the mediastinum, indicating that a rupture occurred in the esophagus; this is another common thing in bulimics. So, there are 2 things imp in bulimics: 1) Metabolic alkalosis from vomiting (which can induce arrthymias 2) Borhave’s syndrome
C. Obesity
With obesity, using a diff method: BMI: kg’s in body wt/meters in body ht’2. If your BMI is 30 or greater, you are obese; if your bmi is 40 or greater, you are morbidly obese. Main complication of obesity = HTN; with HTN, leads to LVH, and potentially heart failure. MCC death in HTN = cardiac dz. Other complications of obesity include: gallbladder dz, cancers with a lot of adipose, you aromatize many  17-ketosteroids like androstenedione into estrogens. Therefore, will hyperestrinism (all obese women have hyperestrinism), you are at risk for estrogen related cancers – ie breast cancer, endometrial carcinoma, colon cancer.
II. Malnutrition
Protein-calorie malnutrition:
1. Marasmus – total calorie deposition, and wasting away of muscle; however, high chance of survival if they get food
2. Kwashiorkor – prob gonna die; have carbs, but no protein; also have anemias, cellular immunity probs (ie no rxn to ags), low albumin levels, ascites, fatty livers. These kids are apathetic and need to be  force-fed; therefore, kid with kwashiorkor is more likely to die than child with Marasmus. Example: kid with edema, flaky dermatitis, reddish hair (Cu def) – kwashiorkor
III. Vitamins
A. Difference between fat and water soluble vitamins:
1. Fat soluble vitamins dissolve in fats,

USMLE Nutrition and Eating Disorder

Episode 101: Note packets and syllabi usually have scribble notes all over them, but how can you judge, in a moment, whether you have high yield USMLE Step 1 notes in your hand? Listen to the podcast and find out how.
USMLE Step 1 Lecture Notes (click)
While most are electronic now, beware. There is evidence from law schools that electronic curriculum is associated with poorer test scores.
Remember, there are different types of learners. Kinesthetic learners can’t simply learn on an iPad and take it all in, one-way.
Calling all Scribes
These notes are iconic and help students that sleep in (or in class) to recall the human emphasis. I recommend watching all video lectures for this important facet.
There are a number of things to look for when choosing the USMLE Step 1 lecture notes to review:

* A recent publication date
* Trustworthy author
* Scribe notes or faculty note packets?
* Recommended from upper levels?
* Purpose of the notes – strategically select resources depending on the phase of the exam cycle

* Content review
* Practice questions
* Practice tests



 
 

Medical Ethics 102

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