Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.



Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes. Also, I am an anonymous internet person. Why should you trust an anonymous internet person to give you medical advice? Don't ask me, ask your doctor!
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Posts tagged "infectious disease"

Attending Dr. O, curbside consulting Dr. P, our infectious disease specialist via phone…

Dr. O: hey Dr. P, I’ve got a resident here who has done some traveling recently and has come back with fevers, severe myalgias and arthralgias, and marked distal muscle weakness. Reflexes are still normal. His CBC and CMP are normal, but his CPK is sky high. I’m checking him for Rickettsial diseases, West Nile, and Lyme disease. Do you have any other suggestions? 

Dr. P: (Charlie Brown teacher noises)

J, the sick resident:  So Dr. O, what did Dr. P suggest?

Dr. O: He’s stumped. He said we should google it. 

After crawling under my house on my day off…

Attending: I saw your adventures under your house video on Facestagritterblr… Pretty hilarious.

Me: Yeah except it was pretty terrifying.

Attending: It looked pretty clean down there though.

Me: It was cleanish, except it was super dusty so I was coughing and sneezing a lot down there. And pretty much the rest of the day.

Attending: probably from inhaling mouse poo.

Me: Exactly. So if I get some weird lung disease, please take care of me and know that I’m a DNR. 

Attending: What diseases can you get from mouse poo?

Me: Are you pimping me? I could have hantavirus right now and you’re pimping me!

Today, as I study about dengue and typhoid for my global health online course, I found out that a family friend who is a missionary is currently in the hospital with dengue. Small world.

If my testes were pouring pus, then I might consider taking antibiotics.

Same guy

#testespouringpus #wouldbeeasiertotreat #thanwhatyouhavesir

Patient with immune deficiency and serious bacterial infection, refusing antibiotics: I know about antibiotics. I’ve read the PDR and Taber’s medical dictionary…well, maybe a fourth of Taber’s. Probably like a tenth of Taber’s. But I know what’s best for me. 

Me (thinking): Maybe I should loan you my immunology book too…

I know I’ve answered this question before, but I can’t find it. And as the saying goes in medicine: If you didn’t write it down, it didn’t happen. So I gotta answer it again. Maybe my answer will be different this time.

The cop-out answer would be internal medicine, because it’s so similar to family. I could do without seeing pediatric patients (I LOVE kids, but as patients, not so much), but I think I’d miss the OB. I also briefly considered doing IM and specializing in Infectious Disease.

If not internal, maybe psychiatry. If I was a real glutton for punishment, I might would have done a combined family/psych residency program. But I don’t really like inpatient psych. I like the talk-therapy part of psych. 

My first medical ambition was forensic pathology. It is still very interesting to me, but I know now that I would miss the live-human contact. 

Notice that I’m not a big fan of sub-specialties.

**Fellow student (and weekend strong man competitor) downs a suspicious looking jar of whitish yellow goo in a few giant gulps.**

Student #2: Dude, what was that?!

Student 1: 4 raw eggs and raw goat milk.

Student #2 Um, Salmonella… Heard of it? 

Student #1

  • Student: Dr. M, why are you scratching so much?
  • Dr. M: Ugh, I think I got scabies from one of my disgusting patients. Wanna see the bites? It's a learning opportunity, right?
Asker breakempire Asks:
If I am interested in working as a doctor in a third world country, would getting a combined MD/MPH degree in Tropical Medicine be a good route? Or is it possible to go into tropical medicine during residency? I know I definitely want to get my MD degree, but I'm rather lost on the rest of it.
wayfaringmd wayfaringmd Said:

Certainly, an MD/MPH would be a great choice, but not a requirement for working in third world countries. 

As I mentioned before, Tulane is the only school I know of that has a combined MD/MPH that focuses specifically on Tropical Medicine.

I don’t know of any clinical tropical medicine fellowships (time after residency) off hand, but I’m sure they’re out there. The American Society of Tropical Medicine and Hygiene offers some research fellowships, though. Also, many residency programs (in ER, IM, FP especially) will offer tropical medicine or global health elective courses. Those would be short (2 weeks-2 months), but would be better than nothin.

The ASTMH offers a travelling fellowship in tropical medicine for medical students. It looks competitive, but super awesome. Check out their website. It has lots of useful info. And you can become a student member when you’re in med school so you can stay updated on the world of Tropical Medicine. 

If you were really interested in infectious disease, you could do an ID fellowship after an internal medicine residency. But that’s a lot of years and a lot of debt racked up before going to work in the third world, so keep that in mind. Personally, I’m taking the shortest route—a family medicine residency program that offers a global health elective. I won’t be an expert by any means, but I’ll at least get my feet wet. And really and truly, 2 years of ID/TM research isn’t going to teach you how to treat AIDS in Africa or TB in India, you know?

Another option would be to get a CTropMed, a Certificate of Knowledge in Clinical Tropical Medicine and Travelers’ Health. Information about that option can be found here and here 

Good luck!

Asker breakempire Asks:
I'm interested in the possibility of missions. how does this affect choosing residency programs? is it best to be a general practitioner, or does it just depend on where you want to work/what you want to do? and is it possible to study tropical medicine and things of the like only at certain medical schools? I'm a pre-med sophomore and I'm not sure exactly how to look into this direction.
wayfaringmd wayfaringmd Said:

GREAT Question. I’ve been meaning to make a post about this stuff for a while.

Most people I know who are going into medical missions are either doing Family Medicine (with an optional extra year of OB) or general surgery. There are a few others doing OB, Peds, and Internal Medicine too. Family medicine and General surgery can be extremely useful because of their broad nature. If you plan on doing career missions, it’s a good idea to do something broad so you can be of the most help to the community you work in.

That’s not to say there’s not room for specialists, though, especially if you are thinking more toward short-term missions. Lots of specialists will do 2 week - month long trips and see huge numbers of patients who need specialty care. 

Tropical Medicine would be something you would have to focus on more in residency. I’m sure some schools have stronger infectious disease curricula than others, though. Tulane University in New Orleans has a Tropical Medicine program that is supposed to be really good, and they offer an MD/MPH&TM (Master’s of Public Health and Tropical Medicine) combined degree program. Of course, you could also go the Internal Medicine / Infectious Disease route if you wanted to focus just on that.

As for residency programs, I did a good bit of research on family medicine programs that were missions-friendly. Below is a list of my favorite ones (these are all distinctly Christian and are all excellent programs), and you can check out a complete list of family medicine programs that offer international rotations here

Christ Community Family Medicine/UT St. Francis - Memphis, TN 

In His Image Family Medicine - Tulsa, OK

Via Christi Family Medicine - Wichita, Kansas

Valley Baptist - Harlingen, TX

Enjoy!

DISCLAIMER: Below is my opinion of homeopathic “medicine”. It is an opinion. I am a student in allopathic medicine, so you can probably guess that I believe in medicines that have been tested extensively rather than medicines that someone’s uncle said helped them feel better. I am not here to argue with anyone over the merits or possible benefits of homeopathic remedies, so please don’t start. This is an anonymous internet rant about people who take chances with their own health and safety rather than trust the miracles of modern medicine. 

/Commence Rant/

When I was in India in 2009, I stayed in a hut in the Himalayas (yes, for reals) for my first 2 weeks with a missionary family. They had another girl staying with them who had come a week or two before me. This chick was an extreme homeschooler from West Virginia (maybe regular Virginia) studying midwifery who ONLY took homeopathic remedies. The only vaccine she had taken in her whole life was the yellow fever shot REQUIRED for entry into India. 

The day after I arrived she got dysentery. The family we were staying with had a very good water filtration system, but sometimes things slip through the cracks. Most likely she had brushed her teeth with water that hadn’t been filtered yet. It’s also possible she got it from drinking raw buffalo milk even after being warned not to (because she drinks raw goat milk all the time at home, duh!). Anyway, she got diarrhea somethin fierce. 

My doctor had prescribed me enough Cipro to get through 2 bouts of dysentery. She did this on purpose in case anyone else on my trip needed it and didn’t have any of their own (smart lady). So I offered the girl my Cipro. She refused it, saying she would just take her Grapefruit seed extract and a few cloves of garlic. I argued with her, saying that her homeopathic stuff might have worked for her in the US, but these were germs her body hadn’t seen before. I mean, would you want to get extremely dehydrated and super sick if you were 4 hours up a mountain from civilization with no electricity, phone, or clean water? Seems to me that a reasonable person would go with the Cipro in such a situation. 

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Doc, this patient doesn’t need antibiotics. He has gram negatives and gram positives in his blood, so they cancel each other out, right?
Question from a nurse (who obviously doesn’t have much infectious disease experience), overheard by one of my classmates.

Developing bronchitis and keeping my cough at bay with lemongrass green tea. 

Add “Infectious Disease Rotation” to the list of times a med student is guaranteed to get sick

mylifeismedschool:

Got a staph infection during our microbiology block. Great.

#MLIMS

I told you

Apparently I’m the go-to blog for herpes questions. What’s up with that? Anyway, I got this question recently, and I wanted to answer it publicly but take the questioner’s name off for their privacy. 

This may sound silly, but if you have herpes labialis, can you still become a doctor?

Of course you can! Before I started med school, my school required every incoming student to have a physical (ugh). Your doctor had to fill out some paperwork saying that you didn’t have any disease or disability that would prevent you from working with patients.

I don’t know much about this, but I think the list of disabilities that can keep you from being a doctor is pretty short. Mainly it would include things like end-stage diseases, extensive sensory or cognitive impairment (like being blind and deaf), and easily communicable diseases like active TB. But herpes definitely won’t keep you from being a doctor. If so, 90% of people wouldn’t be eligible to be a doctor. You shouldn’t be kissing, having sex with, or sharing needles with your patients, so the probability of you passing something along to a patient are very slim.

I know two doctors who are missing limbs and one who is an achodroplastic dwarf. I know a doctor who found out he had cancer during medical school (and responded well to treatment and didn’t even have to delay graduating). I know a doctor with Hepatitis C and I know of a pharmacist with HIV. Now some blood-borne diseases may prevent you from doing procedures where you have the potential of sticking or cutting yourself, but I don’t think it would prevent you from doing non-surgical specialties.  

Does anyone know more specifics about the medical restrictions that could keep you out of med school?