• Journaling: it’s so wonderful to indulge in your own mind. It’s like taking a walk after a long day of sitting at a desk. You forget you had such wonderful muscles/thoughts.
  • Learning so much from my attendings (my old ICM preceptors…we go way back)…Dr. H and Dr. S have both taught me so much about not just diagnosis and management of specific disorders, but clinical thinking and management. Here are some examples -
    • Be mindful of the labs & tests you order: Don’t order a set of labs just because some preceptor at some point taught you to do so, think about whether or not the results would actually change your treatment plan. For hyponatremia, if you have a clinical diagnosis of true hypovolemia causing a hypotonic hyponatremia, then just start a trial of IVF hydration, and see what happens…if they respond, then that confirms your diagnosis! If you actually got labs, and the results point more toward SIADH, then what are you going to do with that information? Give the patient a vaptan or demeclocycline when they’ve already responded to IVF hydration? No.
    • Just because a patient’s outside PCP or previous physicians have decided that the patient is at her baseline but she’s clearly still hypertensive or hyperglycemic, don’t just assume this is just her normal. It’s not normal! Don’t give into clinical inertia!
    • Anticipatory medicine: even though the bump in creatinine might not be technically acute renal failure (>0.3 increase in Cr, >50% increase in Cr, or UOP <0.5L/kg/hr over <48 hours), doesn’t mean it won’t be by the next AM labs.
    • Look at everything in the patient’s clinical context! If the patient is floridly psychotic and/or unstable, you worry more about their mildly abnormal lab values and vitals than if they’re clinically normal and at baseline. You widen your differential to include more rare and scary diagnoses, and order more labs to rule them out.
  • Even when I’m at my loneliest and most down-trodden moments, I’m so appreciative of the support and love I have from my friends. Remember that love. Remember all the moments we’ve shared together and will continue to have together and let that give you strength!
  • Getting that 7-8 hours of sleep Wednesday night. It’s true. Your brain performs better on more rest than on more information.

Interesting idea. But still some obvious flaws. Must be some self-reporting bias among other biases…

"This was the first time that I realized that my own country, where we lament bad health care and florid corruption, could be seen as privileged. No child here has to die from hydrocephalus. That day I realized that the people for whom I advocate are more than the people of South Africa, more even than the people of Africa. As I walked out of the orphanage, all I could think of was how to fix this – this country I had never before seen nor felt particularly drawn towards. In the global village, the disenfranchised of Vietnam – and of any other country – are our compatriots, too."

Lessons Learned Circumnavigating the Globe

The most powerful thing you can do is to simply write about what you know.

Resolution #15: read 4 books this year…1 book/3 months.

Update: already read 3 books at the halfway point! Kafka on the Shore, The Princess Bride, and The Cooked Seed.

  1. One of the first and most important lessons I learned was that earlier in your career, you will receive far more than you will be able to give.

  2. Nonetheless, they were still important because they taught me the complexity of navigating research design and protocol in other  countries, the uncertainty involved with international endeavors, and the persistence that differentiates those who remain in global health and those who come to visit for a short time.

  3. They [the patients] sacrificed, not necessarily because they believed it would make a difference in their lives, but rather because in poorer regions of the world, relationships and hospitality are valued sincerely.

  4. Another important insight I gained only by taking chances was that you are your only limitation.

  5. One last lesson I learned was that as a student in global health, your biggest contribution will be determined by the greatest need.

AMSRJ Spring 2014 Vol. 1, No. 1

Perfection is impossible. So if that’s what you’re striving for, of course you’ll never be confident.

Striving to be perfect actually keeps us from getting much of anything done

Nervousness is normal.

Stop projecting what others are thinking.

Fake confidence doesn’t work: Anderson thinks the reason extremely confident people don’t alienate others is that they aren’t faking it. They genuinely believe they are good, and that self-belief is what comes across. 

Power poses: sit up straight, nod, chip up.

Risk taking, failure, and perseverance are essential to confidence-building.

I identify with this paragraph SO MUCH it’s sad: “Which is why any discussion of this subject requires a major caveat. Yes, women suffer consequences for their lack of confidence—but when they do behave assertively, they may suffer a whole other set of consequences, ones that men don’t typically experience. Attitudes toward women are changing, and for the better, but a host of troubling research shows that they can still pay a heavier social and even professional penalty than men do for acting in a way that’s seen as aggressive. If a woman walks into her boss’s office with unsolicited opinions, speaks up first at meetings, or gives business advice above her pay grade, she risks being disliked or even—let’s be blunt—being labeled a bitch. The more a woman succeeds, the worse the vitriol seems to get. It’s not just her competence that’s called into question; it’s her very character.

But, “For now, though, for Rebecca and for most women, coming across as too confident is not the problem." True. That was more a case of an unfortunate meeting with a jerk.

[Confidence] is the factor that turns thoughts into judgments about what we are capable of, and that then transforms those judgments into action.”

Presentation today, presentation tomorrow. Never-ending consults. Consults consults consults. #goingcrazy on #psychiatryrotation