The Short Coat (Audio): An Inside Look at Getting Into and Getting Through Medical School

Close your eyes, and picture an opioid abuser. If you're like me, you see a man in a flophouse or dark alley. He's cooking up heroin in a spoon over a lighter. Maybe he has a loop of tubing around his upper arm, and he's shooting the heroin into a vein in the crook of his elbow. Once he's done with the injection, he leans back with a euphoric sigh. Fade to black.

Maybe it's just me, but this is the image that, for years, mediated my perception of the opioid epidemic, but it's a stereotype created by television and movies. Even as a stereotype, it's outdated, though. For decades, now, much of the epidemic is one of prescription drugs. The CDC says 78 people die from opioid overdoses every day. At least half of all opioid overdoses are from prescription drugs. Meanwhile, deaths from illegally made opioids, like the synthetic Fentanyl which is often mixed with heroin or cocaine to increase the high, increased 80% from 2013 to 2014. The American Society of Addiction Medicine says that prescription pain reliever overdose deaths among women increased more than 400% from 1999 to 2010, compared to 237% among men. In 2014, 168,000 adolescents were addicted to prescription pain medications. More than 2 and a half times that number of kids were taking prescription pain relievers for non-medical uses.

Next week, from September 26 to September 30, 2016, the University of Iowa Carver College of Medicine will host the Opioid Overdose Prevention Summit. Second-years med students Sarah Ziegenhorn, Petra Hahn, and Cameron Foreman helped organize the conference, in which students from the Colleges of Medicine, Dentistry, Pharmacy, Social Work, Public Health, and Nursing will join together to increase their knowledge and to influence public policy and legislation; personal perspectives; and student advocacy. , Sarah, Petra and Cameron were joined by Assistant Dean Denise Martinez and Nurse Kim Brown, whose son Andy died of an overdose, to talk about the issues of opioid addiction, treatment, and overdose prevention.

This week, Dave volunteers to wear a device that's received a lot of buzz lately, Pavlok. It's creator says that through classical conditioning it will help eliminate bad habits--nail biting, unhealthy eating, procrastination, for instance. It's ubiquity on Dave's social media feeds this past summer got Dave thinking about how much of human disease is based in behavior, bad habits. So Dave asked the company to send it's crowdfunded, wrist-mounted electrical shocker for evaluation, and they inexplicably said yes. Aline Sandouk, Lisa Wehr, and Nick Sparr all had a crack at it, and share their experience. Along with Rachel Schenkel, they attempt to use it to teach Dave not to say "Uh." Is it effective and worth the $169 price tag? Are its integrations with the Internet of Things or its Chrome plugin a help for those looking to kick their bad habits? Are there better, cheaper alternatives? Also, the Affordable Care Act has begun withholding Medicaid reimbursements to hospitals based on patient satisfaction surveys, and giving bonuses to those which do well on those surveys. We explore medical education's trade-offs in a game of what if. Hint: it turns out that our little group members are a bit mercenary.

Stress is a part of medical school. Worrying about tests, studying until you drop, late nights, early mornings, and drinking from the firehose all seem to promote the idea that med students should do nothing else but study. Dave, Aditi Patel, Marc Toral, Levi Endelman, and Kylie Miller agree, which is one reason Aditi and Dave put on a monthly Art Club. Students get together over lunch and have fun with paints, ceramics, drawing, whatever! No pressure, just an hour away from medicine. And speaking of being away from medicine, a listener calls into 347-SHORTCT with a question about how best to keep in touch with family and friends who might not understand the demands of medical school. And we discuss Aditi's family (who just happen to be the subject of a documentary available on Netflix) and the methods they're using to select her future husband. And we play Superfight!

Dave, John Pienta, Mark Moubarek, Matt Maves, and Levi Endelman are aware that the world is full of questions.  Nowhere is that more true than on the saddest place on the Internet, Yahoo! Answers. There folks ask the kinds of things that a primary care physician might have to answer.  What is the worst way to get rid of acne scars?  What could be the cause of blisters on one's lips after kissing one's dog?  How much milk should one use in one's bath?  There are no stupid questions. But first, since Matt has returned from a year in Des Moines doing clerkships there, we discuss what that's been like and the benefits of doing some clerkships outside a more academic setting.  We also discuss the psychiatric disorder pica and the kinds of things people swallow on purpose (or by accident).  Also we talk about drug maker Mylan's difficulties with, well, everyone after we collectively realized they're gouging patients who need epinephrine auto-injectors to keep themselves alive.  Meanwhile, a company is offering a supplement that its CEO, a pioneering MIT aging researcher, and it's Nobel-prize festooned board of scientific advisors say might just be a way to extend the human health span.

yan Gray, MD, was a physician in the Air Force. He'd planned all along to be an orthopaedic surgeon...but the military had other plans for him: aerospace medicine. Later, when a diagnosis of multiple sclerosis forced him to give up flying, his career plans changed once again, and he decided to set aside the practice of medicine to focus his growing business as the proprietor of MedicalSchoolHQ.net where he advises pre-medical students on their efforts to get into medical school. He's also a podcaster in that vein, as the host of The Premed Years podcast, the OldPreMeds Podcast, and The MCAT Podcast. As Dave, Nicole Morrow, Amy Hansen, Alex Volkmar, and Tony Rosenberg found, not only is Dr. Gray a thoughtful adviser, but he's a lot of fun to talk to. His thoughts on being a non-traditional medical student (he was one himself), the efforts of some schools to create competency- and systems-based curricula instead of exam-based curricula, and the types of students admissions committees are most interested in are definitely worth knowing. And check out Dr. Gray's new book, The Premed Playbook: Guide to the Medical School Interview.

Just hours before a new crop of medical students are to be welcomed into the world of medicine, Kaci McCleary, John Pienta, Aline Sandouk, Mark Moubarek, and Lisa Wehr confront one of the most uncomfortable topics in medical education: physician and student suicide.  Among doctors, suicide rates are much higher than among the general population.  The long hours, high pressure (from both one's internal monologue and from outside sources) to succeed, fear of public humiliation regarding one's shortcomings, isolation, inadequate supervision, the stigma against mental illness, the career penalties faced by those who admit to unwellness, and more, all contribute to the problem.  Institutions also have a difficult time addressing incidents of physician suicide effectively, as they try to walk a tightrope strung between respect for the privacy of the deceased, the needs of colleague survivors to talk about it, the desire to avoid adverse publicity.  Meanwhile, the work does not stop. The only breaks are a moment of silence, a visit with a grief counselor, or an "open forum" to discuss one's feelings.

Is Dave ready for Snapchat? Corbin Weaver, Cole Cheney, Taz Khalid, and Tony Rosenberg try to convince him to start one up for the show. Are antibiotics really dead, now that the first totally resistant E.coli bacteria has been found in a US patient? Amazon reviews of common medical equipment leave everyone a bit unsettled. We explore Corbin's reflections on psychiatry and whether patients are helped or hindered when healthcare does the tasks of everyday life for them. And since dental health is so important for overall health, Dave creates some savory alternatives to traditional toothpaste flavors, and the crew tests them out, to see if any of them are a good idea.

Dave is excited to meet some new people who are getting ready to don the short coat this coming week. Kylie Miller, Brady Campbell, Kyle Anderson are all new students at the Carver College of Medicine. Each of them would be called a non-traditional medical students, either because they come to med school with a college degree outside the usual pre-medical subjects, or because they took a break between college and medical school. This summer they all participated in the Introduction to Medical Education at Iowa program, and along with their teaching assistant Vivian Zhu, were adventurous enough to take the microphones for a spin. What other things these guys did to prepare for starting their medical studies? Have they experienced any doubt? Have they considered the emotional challenges med school offers in addition to the hard work?

Dave's feeling a bit concerned for the future of the world these days. As a consumer of science fiction movies and books, he's long noticed a theme therein: that of the old people holding on to the reigns of power, both economic and political, while the young people struggle for a foothold.  As society continues to skew older--with medicine becoming better and better at keeping the elderly healthy longer--will the youngsters lose whatever agency they have?  John Pienta, Nick Sparr, Tony Rosenberg and Taz Khalid humor Dave by talking about it.  Also, since Tony's here, there is  somehow more talk of poop.

Do you, dear students, have tons of money? No? Weird. Luckily, Joe Saul-Sehy of the Stacking Benjamins podcast joins us on the show this week.  Joe was a financial advisor for many years, he was known as the Money Man  on WXYZ-TV in Detroit, and he’s a financial columnist in a bunch of places around the print and web news media. He and his wife Cheryl, a pediatrician, have gone through all the stages that pre-meds and med students go through. So we asked him to join us to talk about the strategies they employed to claw their way back from med school debt, educating yourself about how money works, having fun with  managing your money, and why it's particularly important for doctors to understand money.  Joe's got plenty of information, resources and 'fintech' apps to recommend for succeeding in this area that many people (never mind med students) have not adequately explored.