(Part 3) Top products from r/medicine

I'm sorry this is a little late but I know how you feel and I can relate. I'm currently a junior in college taking my pre-req's and going forward with medical school. Like you, I love helping people, etc but what really solidified my career path was shadowing and talking with doctors who've been at this for years. One particular surgeon is 55 and is incredibly respected by his peers. His wife is a nurse (they have no children-didn't want any) but meeting them and listening to their stories along with residents, nurses, medical students, EMT's has really shown me what I'm getting myself into. Doing some research on what career path- family practice, surgery, nursing, etc really helps. I know this is cheesy but watching shows like Untold Stories of the ER, Boston Med, House, etc have really helped me. I grew up watching ER (med drama) and seeing how doctors lives were portrayed helped a lot to. There's a couple of great books out that I've read such as: The Real Grey's Anatomy, Intern, Hot Lights, Cold Steel
Let me know how these work and don't hesitate to ask any questions about my experience with school, shadowing, volunteering. (:

You would appreciate anything by Oliver Sacks. He was a celebrated neurologist who wrote a bunch of great books about consciousness and fascinating stories about conditions he saw in his practice from a very philosophical rather than strictly clinical point of view. You could start with The Man Who Mistook His Wife for a Hat, Hallucinations, or Awakenings. He gave a nice TED talk if you want to get a taste for it.

Hey y'all! I'm working with an otorhinolaryngologist who's become a facial plastic surgeon here in Mexico City. We've been getting into the practice of facial feminization surgery for transgender patients and this surgeon I work with has been working really hard to improve considerably. I was his first FFS patient (Type 3 forehead feminization, rhinoplasty and thyroid cartillage reduction) and volunteered as a beta tester for the frontoplasty. The results were adequate, although we noticed many things that could be improved about the forehead work.

This feedback was applied into some cadaver testing and it helped a lot with another two patients he had to do a frontoplasty on (One to remove an osteoma in the frontal sinus and another one for type 3 forehead reconstruction last Thursday. This last one went pretty well and I reckon he's learned a lot since mine). So much so that another world renowed FFS surgeon he's friends with praised my doc's work on the forehead through Instagram.

Now, we've been looking at a course this organization called Facial Team offers in Marbella Spain. The doc was part of the first webinar they ever organized in 2018 for trans facial surgery, and they personally invited the doc to the FFS training course in Spain, but we didn't have the resource for that at the time.

We are looking into enrolling to this course, but the problem is how much they're charging: Around $26,000 USD for ONE WEEK (Link to download last year's course HERE). We are located in Mexico and, the doc has always trained in public universities (Which here are completely free of charge) and been able to get scholarships (Full or partial) for high level specializations. We do question whether it's worth investing into this or not.

So, in your opinion, is it worth taking this course for him? We feel like it's just too much money for what they're teaching, and the doc's been learning plenty with books like the one released by Dr. Somenek and plenty of scientific research papers on the matter. Nevermind that he constantly updates his knowledge.

Your right about one thing, labs and imaging aren't perfect. But there are statistics that allow us to compare labs/imaging with physical exam maneuvers, they are called likelihood ratios, and depend on the sensitivity and specificity of the particular test (physical exam, labs, imaging, combination, etc).

Let's take PNA, since you imply that your physical exam is able to accurately confirm or exclude PNA as the diagnosis. Here is a paper from 1999 (when common chest Xray was both more expensive and less accurate at detecting PNA than it is now):

https://www.ncbi.nlm.nih.gov/pubmed/10335685

I'll paste the last line of the conclusion for those not wanting to click on the link - The traditional chest physical examination is not sufficiently accurate on its own to confirm or exclude the diagnosis of pneumonia.

Here is another nice write up about it from the University of Washington:

https://depts.washington.edu/physdx/pulmonary/evid1.html

Again, conclusions linked for those not wanting to click link:

Conclusions

Physician agreement about the presence or absence of pneumonia in patients with respiratory illness is relatively low.
No single symptom, historical feature nor physical examination finding is highly accurate in predicting pneumonia.
Prediction rules using combinations of findings are helpful in ruling out pneumonia but chest x-ray is required to accurately diagnose pneumonia.
A screening pulmonary physical examination may include percussion and auscultation for crackles. If abnormalities are detected or if pneumonia is strongly suspected, one may consider maneuvers such as egophony.

I think I've made my point but there's plenty more where that came from. CXR is required to rule in or out PNA, and no physical exam findings (or lack thereof) will change that. If you are using your physical exam findings to decide whether to treat patients or not, bottom line is you're treating patients who don't have PNA or your not treating patients who do, or both.

As for volume status, let me link this nice review:

http://onlinelibrary.wiley.com/doi/10.1111/j.1751-7133.2010.00166.x/full

I'll link a section here for brevity:

In one analysis of adults, dry axilla–supported hypovolemia (positive likelihood ratio, 2.8; 95% confidence interval [CI], 1.4–5.4), while moist mucous membranes and a tongue without furrows argued against it (negative likelihood ratio, 0.3; 95% CI, 0.1–0.6 for both findings).23 In the same analysis,23 capillary refill time and poor skin turgor had no diagnostic value, a finding supported by others. Finally, in a prospective study of blood donors giving 450 mL of blood,24 mean capillary refill time decreased from 1.4 to 1.1 seconds and had a sensitivity of 6% for blood loss. The authors concluded that the accuracy of capillary refill in a patient with a 50% prior probability of hypovolemia was only 64%.

Skin turgor (what you call skin tenting and claim has value) has NO DIAGNOSTIC VALUE according to this study and many others.

If you don't understand + and - likelihood ratios, I suggest reading Symptom to Diagnosis by Scott Stern et al, (https://www.amazon.com/Symptom-Diagnosis-Evidence-Clinical-Medicine/dp/0071496130). It details the evidence behind physical exam maneuvers and shows when its useful and more importantly when its not.

I did the same for neuroanatomy, I used this book, some of my classmates thought I was stupid for using it, but it's really helpful and easy. Coloring the structures while repeating the name as Buddhist monks pray really helped.

I learned medicine from Harrison's Textbook of Internal Medicine.

It might be available in your public library, so pick it up there before you spend $200 on it, and see if it's what you are looking for. You probably won't finish it in 3 weeks, but maybe you can renew it a couple of times <g>.

You probably don't need all that much biology background to read it. It's mostly just facts, and not much difficult to comprehend stuff. Most chapters are well written, and the subject is fascinating.

Special Tests - not made by Lippincott or any of our societies, can't help you.

Examination of Musculo - not made by lippincott

Physical Exam - not made by lippincott. wow this book is from 1976!

Nutrition for Healthy Living - not a lippincott book, and there is actually a newer edition for that title.
http://www.amazon.com/Nutrition-Healthy-Living-Wendy-Schiff/dp/0073522759/ref=dp_ob_title_bk

Nutrition 12/13 - a mcgraw-hill title, not lippincott.

sorry i couldn't help more. if you just want books that cover particular areas and don't need those specific books let me know and i'll see what coverage lippincott has

http://www.amazon.com/Understanding-Value-Healthcare-Christopher-Moriates/dp/0071816984/ref=sr_1_3?ie=UTF8&qid=1462330293&sr=8-3&keywords=Healthcare+economics

I always liked this one since it is clinician oriented, it assumes no prior knowledge
The best way to really learn how healthcare works is to purchase basic books in microeconomics, macroeconomics, business, and health policy. You really need to have a solid foundation across the board to understand why providers do what they do, why hospitals merge, why insurance does what they do. There is no short-cut. Reading the book I posted is a very general introduction and should be sufficient if you simply wish to have an idea of what is going on. But if you really want to understand it, you gotta put in the work.

Introduction to Diagnostic Radiology

Edit: This is a free website with great cases that I used as a med student.

The gold standard in emergency medicine is Tintinalli's (https://www.amazon.com/Tintinallis-Emergency-Medicine-Comprehensive-Internal/dp/007179476X/ref=sr_1_1?ie=UTF8&qid=1504698322&sr=8-1&keywords=emergency+medicine+study+guide) although it is a massive book both in size and in depth.

Physiological medicine (https://www.amazon.com/Physiological-Medicine-Clinical-Approach-Physiology/dp/0070381283/ref=sr_1_1?s=books&ie=UTF8&qid=1504698440&sr=1-1&keywords=%22physiological+medicine%22) is amazing.

Pathophysiology of Disease is also good (https://www.amazon.com/Pathophysiology-Disease-Introduction-Clinical-Medicine/dp/0071806008/ref=sr_1_1?s=books&ie=UTF8&qid=1504698512&sr=1-1&keywords=pathophysiology+of+disease).

Complications is worth your time. I am currently reading Mountains Beyond Mountains and really enjoying it so far.

The Citadel isn't authored by a physician or surgeon, but it's a compelling classic novel about a young doctor.

I love this book, it lead me in to medicine, it was a game changer for me.

https://www.amazon.com/Pills-Potions-Poisons-Medicines-Other/dp/0198504039?SubscriptionId=AKIAILSHYYTFIVPWUY6Q&tag=duckduckgo-osx-20&linkCode=xm2&camp=2025&creative=165953&creativeASIN=0198504039

Not a constructive answer to your question per se, but you may find this an interesting read if you want some more insight into psychogenic, functional, factitious disorders and the like:

https://www.amazon.com/Its-All-Your-Head-Imaginary/dp/0099597853

Written by a British neurologist. I am about a third of the way through the book myself and it's helped me think about some of these types of patients that we see at work fairly often.

A lot of the everyday knowledge needed to be an internal medicine doctor is contained in Harrison's http://www.harrisonsim.com/ Similarly, a lot of the knowledge needed for emergency medicine is contained in Rosen's http://www.amazon.com/gp/aw/d/1455706051?pc_redir=1397068775&robot_redir=1 or Tintinalli's http://www.amazon.com/gp/aw/d/0071484809?pc_redir=1397103426&robot_redir=1 however I completely agree with the people saying that this is just a fraction of what you learn in medical school and residency. The experience is at least as important, if not more so, than memorizing this info. There are similar books covering every specialty, but for surgical specialties I'd say the experience is even more important than for medicine specialties.

http://www.amazon.com/Ultimate-Getting-Physician-Assistant-Edition/dp/007163973X/ref=sr_1_1?ie=UTF8&qid=1394385772&sr=8-1&keywords=physician+assistant

Start here. It gives a good general background on getting into a school and what to expect.

Most of us felt Guide to the Canadian Family Medicine Examination was more than enough. https://www.amazon.ca/Guide-Canadian-Family-Medicine-Examination/dp/0071803424

Maybe see if this is in your library:

http://www.amazon.com/Ultimate-Guide-Choosing-Medical-Specialty/dp/0071479414/ref=sr_1_1?ie=UTF8&s=books&qid=1303639843&sr=8-1

Also see https://www.amazon.com/Witchdoctors-Psychiatrists-Common-Psychotherapy-Revised/dp/0060970243/ref=sr_1_1?ie=UTF8&qid=1496036538&sr=8-1&keywords=psychiatrist+witch+doctor

Also relevant to the discussion is https://www.amazon.com/Depression-Cure-6-Step-Program-without/dp/0738213888/ref=sr_1_1?ie=UTF8&qid=1496036595&sr=8-1&keywords=ilardi+depression

Ilardi says that tribal people don't have deep fryers, TV, the splintering of the family unit, or medications that have lots of dangerous side effects. We also walk around with clothes from our wrists to our necks to our ankles, and they don't. They get a lot more exercise every day than we do. Their food isn't covered in pesticides. They wake up with the sun and go to sleep in the dark. All of those things add up.