Monthly Archives: July 2011

One more board exam

Tomorrow I am taking the Step II COMLEX. Then, I am done with board exams until I am a doctor.

I would feel some relief, but that just means I need to get my applications to residency in, and then start the interview process.

Eep.

Wish me luck, please, for all of the above.

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All board review and no play…

I have my USMLE Step II CK on Saturday, and my COMLEX Step II CK August 1st. So, sorry I haven’t had time or mental functionality to blog much. I have tons of stuff I have wanted to share. Let’s see if my medical fact clogged brain can remember a few of them.

NPR has been rockin’ lately. First, I heard Morocca say “hula doula” on Wait Wait, Don’t Tell Me” recently. They have been running a really great series on birth called “Beginnings: Pregnancy, Childbirth and Beyond”. It included a great piece on elective inductions that provoked a lot of comments when I shared it on my Facebook page.

NPR’s Facebook feed also tipped me off to a new report by the Institute of Medicine, “Clinical Preventative Medicine for Women: Closing the Gaps” which recommends mandating insurance coverage of contraception,” since it is preventative medicine. To quote Rachel from Women’s Health News, “Duh!”.

In addition to copay-free coverage of birth control, the Institute recommended:
screening for gestational diabetes:

*human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30
*counseling on sexually transmitted infections
*counseling and screening for HIV
*lactation counseling and equipment to promote breast-feeding
*screening and counseling to detect and prevent interpersonal and domestic violence
*yearly well-woman preventive care visits to obtain recommended preventive services

Hear, hear.

Anyway, I should be studying. Wish me luck.

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Sorta studying

I am doing daily board review. Today I did most of it in front of a Mystery Diagnosis marathon. That counts as review, right? I got a few of the diagnoses correct. And, I will remember the signs, symptoms and work up for the others.

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You gotta know when to hold ‘em

I have been thinking lately about practice patterns and interventions lately. I went for my annual female exam recently, and was chastised by the family medicine resident because I haven’t had a mammogram yet. Gizabeth wrote about a similar discussion with her physician at Mothers in Medicine. She opted to get the mammogram. I argued with the resident. I left with a prescription to get breast ultrasound, which I am unlikely to fill.

I have seen doctors recommend mammograms to patients starting at 35 or 40. I have never personally seen anyone go by the USPSTF recommendations for low risk women to wait until 50.

I told the resident I was going by the USPSTF recommendations, and I thought mammography would be a poor screening tool for me and my particular set of circumstances. I breastfed for a combined three and a half years. I don’t smoke or drink excessive alcohol. I have no relatives with breast or ovarian cancer. I had my first kid in my twenties. Never used hormonal birth control. I’m white. And, my breasts are quite large. There’s not particularly fibrous, I don’t think, but that’s a lot of tissue to try to squish and see through. A lot of tissue to be repeatedly irradiated.

I am not a complete Luddite. I think mammography is an imperfect tool, but obviously saves lives. A recent study called The Swedish Two-County Study showed a life saving benefit to mammography, but according to this Time magazine article (disclosure: I haven’t read the full study yet), “In the study, women aged 40 to 49 in the screening group received a mammogram every two years; those aged 50 to 74 were screened about every three years.”

ACOG recommends ” that women in their 40s continue mammography screening every one to two years and women age 50 or older continue annual screening.”

I am not sure which group recommends screening at 35. but there probably is some medical association representing a specialty that has guidelines starting that young. For myself, I am planning on doing a baseline at 40, then probably not getting many more until I turn fifty, unless something comes up. For my patients, I will start discussing their particular risks and priorities, and we will work from there.

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Night of the fourth year medical student

Yes, I am rising from the great beyond of rural rotations. I am, as of July first, a fourth year medical student. Hello, senioritis! I am doing a board review month. I am taking the MD and the DO boards. Soon. Eek.

I have a lot of posts jumbled around in my head. They may show up in one way or another soon, since I will want to procrastinate while studying.

Oh, and good luck to all of my former classmates who are starting their residencies. Double eek!

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