Could Facebook Get Me in Trouble?

Question:

Like many of my friends, I enjoy using Facebook, Twitter, and YouTube. How can I keep my online presence professional and in accord with patient privacy rules?

Response from Megan L. Fix, MD Associate Residency Director, Emergency Medicine, University of Utah, Salt Lake City

Facebook, Twitter, and other social networking Websites are fun, and your online identity can be informative to future employers, patients, or colleagues. But involvement in social media can also get you into trouble if you aren't careful. Here are some suggestions for safeguarding hospital and patient privacy and your perceived professionalism online, both as a student applying for residency and as a medical professional.

Catching the ID Bug

In medical school, I was planning to pursue primary care when I landed in an infectious diseases (ID) rotation at the Veterans Affairs hospital in Portland, Oregon. The cardiology rotation I wanted was full, and looking at the elective list I thought, "What the hell, I'll try ID." All too often in my life, serendipity has led to life-changing circumstances. (Sometime I will tell you the story of how I met my wife.)

As a medical student I was amazed by the pathology in ID. A patient with mitral valve endocarditis caused by Staphylococcus aureus required acute valve replacement. A person with Pseudomonas meningitis from urosepsis died. I remember, like it was yesterday, the thin green slime of bacteria and pus covering the patient's brain at autopsy.

As a student, I was also impressed with my attending's breadth and depth of medical knowledge. Unlike my other attendings, who often seemed slightly bored and were going through the motions, the ID doctors were fascinated with medicine. ID doctors, then and now, get excited about a great case. I was hooked. As an intern I did an ID rotation and my addiction was confirmed. ID was the life for me, and I have never looked back. Including my fellowship, I have been an ID physician for 24 years.

To Cry or Not to Cry

Considering the tragedies that occur daily in the hospital, there are plenty of reasons to stop and cry, but should you? After talking with colleagues about this and being in many difficult conversations, the simplest answer is that if crying fits for you and for the situation, it can be positive in its ability to strengthen existing bonds. If tearing up in public is not your thing, don't go there.

As a palliative medicine physician, I encounter many sad, difficult, and trying situations that test my emotional stamina daily. In fact for some physicians, it may be that visceral connection to another human that attracts us to medicine. I was surprised in residency when I first discovered that ''breaking bad news'' and ''compassionate honesty'' led to praise and gratitude from patients and families who would cry, be angry, and eventually come to a certain peaceful but sad acceptance of dying. Using my medical knowledge to guide patients and families through this was personally rewarding and occasionally emotionally difficult, but I never cried in these meetings. But then, I also am firmly planted in the second half of the answer above: I don't cry in public.

Is Ob/Gyne for you?

"Ob/gyn is great because it's some medicine and some surgery," many students say when they choose the field of obstetrics/gynecology. Certainly, this specialty is more than just medicine and surgery, and it is uniquely different from either one, but the statement is fairly accurate. Ob/gyn has a significant surgical component. The rate of cesarean sections for many ob/gyn practices is 30%, and this translates to a reasonable volume of laparotomies. Vaginal deliveries in many instances require cutting, control of blood loss, and tissue reapproximation. If you enjoy surgery and like putting your skills to the test, the obstetrics aspect alone should keep you mostly satisfied.

In addition, there are "operative deliveries," many of which include the use of forceps. Although fewer forceps deliveries are performed as the years go by, forceps are good tools to have when the need arises. In many cases, their use has been supplanted by either the vacuum device or good old-fashioned patience. Of course, there are also the more pure surgical procedures performed by ob/gyn specialists, including myomectomies, hysterectomies, and laparoscopies.

What about the medicine portion of obstetrics and gynecology? Treating classic medical problems such as hypertension and diabetes is a small but important part of obstetric practice. Although most general ob/gyns do not treat nonpregnant women for basic medical conditions, such specialists have become uniquely qualified to treat other types of significant medical issues. Contraception, for instance, can for some patients become a very challenging medical treatment process, and the treatment of menopausal symptoms is routinely an even more difficult endeavor.

Teen Self-Embedding Behavior: A New Challenge for Primary Care Providers

May 10, 2011 — Self-embedding behavior (SEB) in adolescents is a type of severe self-injury presenting a new primary care challenge, according to the results of a retrospective study reported online May 9 and in the June print issue of Pediatrics.

"[SEB] is an extreme form of self-injury involving the insertion of inanimate objects into the soft-tissues, either under the skin or into muscle," write Gregory H. Bennett, BS, from the Department of Radiology, Nationwide Children's Hospital, and the Ohio State University College of Medicine and Public Health in Columbus, and colleagues.

Metal staples are shown on the X-ray of a teenage girl. Courtesy RSNA.

"To date, no case series data on this behavior among adolescents has been described in the pediatric medical literature.... The goal of this study was to define [SEB], develop a clinical profile of adolescents who engage in SEB, and emphasize the importance of rapid, targeted, and effective identification and intervention."

Using a database assessing 600 patients who were percutaneously treated for soft-tissue foreign body removal, the investigators identified adolescents with foreign bodies self-embedded in the soft tissue and described their demographics, psychiatric diagnoses, and characteristics of SEB.

Increased Opportunities for International Medical Students

May 11, 2011 — As of April 15, 2011, only 12,200 H-1B petitions have been filed — a much lower number than in years past — indicating that H-1B visas should be available for international medical graduates (IMGs) through March 2012, creating increased opportunities in the United States. H-1B visas are a skilled worker's visa.

Employers "are not able to just offer H-1Bs willy-nilly," a US State Department official told Medscape Medical News. "They have to prove that the foreigner has certain skills that they cannot find in the normal employment pool."

A total of 85,000 H-1B visas are awarded per year to IMGs and other non-US citizens with professional-level credentials. H-1B visas enable IMGs to be employed in the United States for up to 6 years as trainees in their specific field. They are issued by the US Citizenship and Immigration Services, a branch of the US Department of Homeland Security.

Time is Right for Anesthesiology

I don't think there has ever been a better time to be an anesthesiologist. The role of the specialist is evolving, in part through the introduction of new technologies such as video laryngoscopes for airway management. The breadth of subspecialties, from critical care to pain medicine, has similarly mushroomed. As a result, research questions abound. Amazing advances, such as the imaging of nerve blocks and cardiac ultrasounds for noncardiac cases, have come about in the past few years and new developments are on the horizon. And, of course, guiding patients who are fearful about an invasive procedure and taking them safely from induction to recovery is an enormous honor and privilege.

Finding the right specialty will in many ways determine the quality of your life, both at home and in the workplace. Fortunately, within the same specialty -- anesthesiology included -- there are myriad types of roles, including teachers, researchers, quality managers, administrators, and mentors. There are also many different practice settings. That gives you limitless choices and opportunities within a particular field.

Keep in mind that your choice of specialty will be affected by chance events: the resident or attending who mentors you during your rotations; the location of your clerkship, whether it is an inpatient or outpatient experience; the patient population; even the condition of the physical plant where you are trained. For better or worse, these different experiences can transform your desire to enter a particular specialty. It may not be possible, in such a short time span, for you to get an accurate glimpse into all available specialties.

Preparing for Residency

Question

My internship is coming up soon and I'm nervous. What can I expect?

Response from Geoffrey A. Talmon, MD Assistant Professor, Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska

Medical students spend 4 years waiting for the magic of graduation day. My own graduation ceremony made me feel like a transformation had occurred in me and my colleagues. We put on our robes, wore costume-like hoods, and heard a lot of Latin words. Soon after, my parents and nonmedical friends started calling me "doctor" and asked medical questions with more frequency. I remember feeling a twinge of excitement when I started signing checks with an "MD" after my name. Throughout all of it, though, I was terrified for July 1, the start of my internship. Nothing particularly magical -- no epiphanies of knowledge or confidence -- had occurred when I received my diploma, and I had heard plenty of stories about "intern mistakes."

10 Unwritten Rules About Surviving the Third Year

We took the boards after second year and celebrated our achievements. Overnight, we became third-year medical students. The beginning of a new world awaited us as we wore our white coats and strode through the doors of the hospital. Excitement, mixed with a sense of uncertainty, lingered in our minds. We were unfamiliar with the hospital environment.

There are many reasons to celebrate being a third-year medical student. Medicine becomes more practical and hands-on; there are no more endless lectures packed with information. You get to "play doctor" and meet the patients you read about in the books. You apply what you've studied -- or at least see it applied practically to real patients. You experience different aspects of medicine that will help you decide what you want to do for the rest of your life.

Unfortunately, there are also reasons to feel anxious about third year. You will miss having a flexible schedule. As a second-year medical student, your attendance was not mandatory, and you had the luxury of listening and relistening to lectures in the convenience of your own home. In third year, however, rotations are more like work: You never want to be late. If you are on surgery rotation, you have no option but to be there at 6 AM or earlier for the entire rotation. And because you're not in a classroom you no longer have a structured schedule. In addition, you and your classmates will get different experiences and learn different things. You will be tired after rotations and you won't feel like studying at the end of the day. Many third-year students will tell you it is vacation time. Should you believe them? No!

Bacterial Pharyngitis

Background

Pharyngitis, or sore throat, is often caused by infection. Common respiratory viruses account for the vast majority of cases, and these are usually self-limited. Bacteria are also important etiologic agents, and, when identified properly, may be treated with antibacterials, resulting in decreased local symptoms and prevention of serious sequelae.

The most common and important bacterial cause of pharyngitis is Streptococcus pyogenes. When suspected, bacterial pharyngitis can be confirmed with routine diagnostic tests and treated with various antibiotics. If left untreated, S pyogenes pharyngitis may lead to local and distant complications. To a lesser extent, bacteria other than S pyogenes are known to cause pharyngitis, and these are discussed in Causes.