What I read in 2014

2014 wasn’t a particularly big year for my library, but it is the first year I kept track of all of the books I read for pleasure, reproduced here in the order I consumed them:

  1. Steelheart by Brandon Sanderson (Reckoners #1)
  2. Divergent by Veronica Roth (Divergent #1)
  3. The Calling by Robert Swartwood
  4. Insurgent by Veronica Roth (Divergent #2)
  5. Allegient by Veronica (Divergent #3, finished the same day)
  6. Steps by Jerzy Kosinski (National book award-winner…in 1969)
  7. Cloud Atlas by David Mitchell
  8. Canticle by Ken Scholes (Psalms of Isaak #2)
  9. Gilead by Marilynne Robinson (a completely epistolary novel, rare form)
  10. Antiphon by Ken Scholes (Psalms of Isaak #3)
  11. The White Coat Investor by James Dahle MD (Basic financial literacy for physicians)
  12. Legion by Robert Swartwood
  13. The Dishonored Dead by Robert Swartwood (a highly unusual Zombie thriller)
  14. The Name of the Wind by Patrick Rothfuss (The Kingkiller Chronicle: Day 1)
  15. Requiem by Ken Scholes (Psalms of Isaak #4)
  16. The Wise Man’s Fear by Patrick Rothfuss (The Kingkiller Chronicle: Day 2)
  17. A Dance with Dragons (A Song of Fire and Ice #5)
  18. Maze Runner by James Dashner (Maze Runner #1)
  19. Cod by Mark Kurlansky (the spiritual prequel to Salt; that’s right, history through fish!)
  20. The Scorch Trials by James Dashner (Maze Runner #2)
  21. The Death Cure by James Dashner (Maze Runner #3)
  22. The Kill Order by James Dashner (Maze Runner Prequel)
  23. The Slow Regard of Silent Things by Patrick Rothfuss (Kingkiller side-novella)
  24. Light Boxes by Shane Jones
  25. Stiff by Mary Roach (cadavers do more than just get dissected; though that happens too)

Binge-reading young adult mega-hits over the course of a weekend off seemed to predominate interspersed with lengthy epic fantasy. For the record, the Maze Runner series isn’t as strong as either Hunger Games or Divergent. And truthfully, the weak third book in each of those trilogies almost ruins those series as well. Still can’t wait for Rothfuss to finish the Kingkiller trilogy; I almost wish I hadn’t already read the first entry so that I wouldn’t need to wait for the final/third book to come out!

Should your radiologist tell you the results of your scan?

Probably not. But some interesting lines from Gina Kolata’s article in the NYTimes.

Dr. Christopher Beaulieu, chief of musculoskeletal imaging at Stanford:

At that point the radiologist may be capable of transmitting the information but the obvious next question for the patient is, ‘What do I do now?’ which, as nontreating physicians, radiologists are not trained to answer.”

This issue here is not that radiologists aren’t “trained” in what happens next (in many cases, of course they are!)—it’s that radiologists don’t actually do what happens next. If you aren’t going to provide treatment, you probably don’t need to be offering patients their options, particularly if you aren’t privy to their history.

For now — with one big exception — how quickly a patient gets the results of a scan, including M.R.I.s, PETs, CTs or ultrasounds, can be idiosyncratic and depend on the particular doctor and the particular patient.

Yet patients want to hear from radiologists, the groups say. One admittedly unscientific indicator was patients’ comments to the American College of Radiology on Twitter. They said they did not want to wait for results and could not understand why a radiologist would tell a doctor their results but not them, said Dr. Geraldine McGinty, chairwoman of the group’s commission on economics.

Realistically, patients want their results quickly and probably don’t care who tells them. The main issue here is patient scheduling. It’s not fair to patients to have an MRI one day and then have an appointment with the ordering provider two weeks later. Many physician schedules are fully booked with routine follow-ups, leaving no room for add-ons when unexpected scan results come up. In some thoughtfully scheduled clinics, patients have a scan in the morning and are seen that afternoon. That’s ideal.

If a patient then still wanted to speak to a radiologist (leaving aside the issue of the non-reimbursable time spent), I think both the radiologists and the referring clinicians would be much happier having that happen in a context in which the definitive management discussion would happen immediately afterward and not in some yet-to-be-determined future appointment. If the patient finds out before the referring provider, then the system breaks down. And learning you have cancer only to be told you won’t be seen by the oncologist until three weeks later is also not therapeutic. We need to be more thoughtful in how patients are scheduled for follow-up—that’s the crux.

“The chance of your actually seeing a radiologist is almost zero,” said Steve Burrin, a physicist and retired vice president of The Aerospace Corporation. Mr. Burrin, 70, who has lung cancer and lives in Los Angeles, has so many scans — CT, M.R.I., PET — that he decided to take matters into his own hands. Now, he immediately asks for a copy of his scan and tries to understand it himself.

I do though think the current state of patient accessible information is problematic. More and more patients have access to their raw reports, which are written for a physician reader. 1 The information, terminology, and certain turns of phrase can be bewildering and frankly misleading to patients. If a patient report states there several “indeterminate renal hypodense lesions” which are “too small to characterize,” that sounds super mysterious. But they’re really just (essentially always) tiny cysts of no clinical consequence.

If the future is centered on more transparency and patient empowerment, it would probably be better if a patient-centered report was incorporated into the medical record with the salient points written in accessible language. This is similar to the approach used by WebMD and Medscape, which are owned by the same company, where there are pages on the same topic with one set of data shown to patients and another set to physicians.

  1. In many cases, the body of the report is actually geared for other radiologists and specialists and is confusing to most other physicians (which isn’t necessarily a good thing either)

In which Amazon realizes that I’m not a student anymore

It couldn’t last forever, and so today is the end of a personal era: Amazon figured out that I’m not a student anymore. Which is too bad, because now I’ll have to pay full price for Amazon Prime. I spent the last year of medical school (and two bonus years to hit three of the maximum total of four) thoroughly enjoying/using the “Amazon Student” service, which is Amazon Prime for half the cost, including their (nowhere near as good as Netflix) bundled video streaming service, free Kindle books, and tons of two day shipping. I first signed up for the six month free trial when I needed some holiday gifts quickly, and I haven’t cancelled since.

Upon receiving the email notification that my student membership was expiring and that I was going to be automatically “upgraded” to Prime, I immediately checked to see if there was a way to use an .edu address or student ID to continue being a student. My choices to confirm my “student” status were:

  • A transcript or class list for the current term (must include the date/term)
  • A copy or picture of your student ID (must include an expiration date or term)
  • A tuition bill for the current term (must include the date/term)
  • An official acceptance letter for the upcoming term (must include the matriculation date)

Er, so yeah. They thought this all out. None of that is going to happen.

Amazon may have some questionable/bizarre hardware efforts, but on the retail side, they figured out long ago that if they get you to sign up for prime, you get hooked/spoiled by unlimited two day shipping and then buy basically everything through Amazon.

Residency Consultants (and a big discount for Game Set Matched)

I get emails all the time asking for residency application advice. A lot of these come from IMGs, which isn’t surprising: applying to residency in the US from the outside is stiffly competitive, and the support/advice from home isn’t always sufficient. To profitably fill that void are the “residency consultants” and their ilk, like the folks who wrote The Successful Match who would also love for you to be their client on not one but two (ugly) consulting websites. A lot of these guys are former associate program directors in fields like internal medicine who applied to residency themselves in a different era. In many cases, the nitty gritty details and current application climate are probably better known by recently matched fourth years and residents in your specialty of choice, and being involved in interviewing and selecting candidates in one field at one institution doesn’t necessarily make you an expert in the whole process. Great consultants probably exist, but the credentials they spout are a red herring.

I don’t think US allopathic students who are thoughtful and reasonably competitive for their respective fields generally have a significant need for a comprehensive application review. Depending on how supportive and useful your student affairs department and faculty advisors are, many US MDs who are reaching a bit (but flexible) are also likely doing just fine on their own for the most part. But for others, particularly IMGs, a service and all-around helping hand to go over every nook and cranny of your application, help you fix your mistakes and take the right angles, polish your personal statement, and prepare you for interviews is obviously of value. Given how much you have to pour into ERAS, traveling costs, etc–shelling out for a residency consultant may be too much insult to injury, even for those students who are among those who would benefit the most. While I’m generally suspicious of a lot of “advice” (and you often get what you pay for), but there’s no doubt that the perspective, experienced editorial services, and advice you get from qualified people who don’t know/like/love you is going to better approximate the things that will help you when the same sorts of strangers review your application or interview on the big day.


Game Set Matched is a residency consulting company with a polished online package. It’s a team of people with a network of contacts and not one random guy in one random place. So if your application requires unique expertise, they have additional folks who’ve matched in multiple fields in multiple places (and from multiple countries) who they can tap for additional knowledge. You create an account on website for free and then fill out the forms with your ERAS information including demographics, CV, personal statement, etc and then (once you pay) the folks at GSM respond to your application point by point. They edit your personal statement. They ask you interview questions, review your online answers, and then critique those too. When you have questions throughout the process, they will answer them. The whole package normally costs $999 (you can buy the components separately for $399), which–while entirely reasonable–is more than I would have ever considered spending from my loan coffers as a medical student.

Since the interview season has already begun, they reached out to me this past week with an offer for the readers of this site, $399 for the whole package by using the coupon code BW399 at checkout (good until rank order lists are due, 2/25/15). But better still, when I then asked if people could sign up now with the discount to use for next year’s application cycle, they said yes. 1

So if you sign up and are applying this year, they’ll help you prepare for your interviews. They’ll review your application and help you figure out how to communicate with programs and present yourself on the trail. If you don’t match, you can use it again next year.

But if you’re an MS3 or IMG who is planning on applying next year (2015-16) and think you could use all the help you can get, then this is the time to sign up, because $399 will get you a team of physicians working with you on everything from day 1. As a cost comparison, professional editing for personal statements runs around $150 on the lower end (and is not normally done by physicians, who are the actual intended audience). So while the deal for this year is good, the deal they’ve agreed to for next year is excellent. You have until the official end of the interview season, February 25, to buy GSM using BW399 at checkout.

And if you do sign up and use their service (or even other competitors!), please come back or send me an email to let me know how it goes. 2 The reason I began writing about medicine on this site was what I felt was a lack of reasonable information online when it came to medical education, and there’s still not enough.

  1. Full disclosure: “they” is actually a senior resident at my program, who is an employee of the company; I’ll also get a few bucks for referring you if you sign up, and you’ll get a warm feeling inside for supporting this site in the process.

  2. I’ve never used a residency consultant, and reviews for any of services/consultants out there are essentially nonexistent. I’ll update this post and/or write others when I get some more data!

Ebola Reading

The current Ebola scare and the growing story of its mismanagement made me remember two excellent books:

  1. The Hot Zone, the nonfiction thriller about Ebola that I found highly disturbing in middle school. For an even scarier read, try its spiritual sequel, The Demon in the Freezer (in which Preston details how much bioweapons grade Smallpox the former Soviet Union may have misplaced). I don’t know if Preston invented the nonfiction biomedical pageturner, but he was extremely good at it.
  2. The Stand. Stephen King’s magnum opus was re-released uncut and unedited (1200 pages!) in 2012. Viral apocalypse literature at its finest. It’s no spoiler to say that the government does neither a great nor honest job when faced with a deadly virus.

SPEAKING OF: Richard Preston reprises his old role to breakdown the current Ebola outbreak in the New Yorker.