The Residency Rush: How Today’s Docs Pick Their Fields

Each fall, when the weather turns gusty and romantic, the city’s fourth-year medical students embark on a mass professional mating ritual designed to hook them up with the residency program of their dreams. The ritual is known as the Match, and like all frenzied dating rites, it is as much about defining who the students are as about finding their medical soul mates.

 

Are they ultra-alpha gunners with a latent urge to slice and dice? Then perhaps they’ll become surgeons, overworked but well paid. Or maybe they tend more toward the brainy-hipster type, with dog-eared copies of Dora in their pockets. Then clearly psychiatry is the field for them.

 

This year’s match frenzy kicked off on Sept. 1, when a vast electronic database began accepting student applications. By now, most students have already dispatched their carefully crafted personal statements to 10, 20, sometimes 40 programs, but a few poor souls are still scrambling—still trying to choose a specialty, in some cases—by the Nov. 1 deadline.

 

Then it’s on to interviewing, praying and waiting for the big day: March 15, Match Day, when a giant HAL-like computer spits out a binding verdict for each student.

 

Why do some choose a life of treating rashes while others opt for curing cancer or fixing fractures?

 

The most popular theory of the moment is the aforementioned Lifestyle Theory. A slightly less cynical theory—in fact, a downright warm-and-fuzzy one—is the “mentoring” hypothesis, which states that students, like ducklings, follow the lead of their schools or advisors.

 

But at the end of the day, for many students, the big choice comes down, quite simply, to personality, attraction, even musk. Indeed, one of the great old medical-school clichés is that a practiced eye can identify which students will go into which fields on the first day of class. The Match, nearly four years later, just seals the deal.

So who’s going to be setting your sprains, delivering your tykes or—God forbid—changing your catheter? Whoever they are, we just hope they’ll take our insurance!

http://www.observer.com/printpage.asp?iid=13599&ic=Featurebox

Psychoneuroimmunology: What Is It and Can It Help Me?

Psychoneuroimmunology (PNI) is the scientific study of the interaction among emotions the brain, and the immune system, some of the body's most complex systems. It springs from healing traditions that are both ancient and modem, Eastern and Western. The emotions (the psyche), the neurological system (the brain, spinal cord, and other nervous system organs), the immensely complex immune system and the various interactions of these systems offer much that, when understood, can prove fascinating and useful to people with cancer.

http://www.bcaction.org/Pages/SearchablePages/1992Newsletters/Newsletter014C.html

The Psychoneuroimmunology Research Society is an international organization for researchers in a number of scientific and medical disciplines including psychology, neurosciences, immunology, pharmacology, psychiatry, behavioral medicine, infectious diseases, endocrinology and rheumatology, who are interested in interactions between the nervous system and the immune system, and the relationship between behavior and health.
http://www.pnirs.org/

Association for the Advancement of Applied Psychoneuroimmunology

http://www.lifecoachusa.com/aaapni/

The UCLA Cousins Center for Psychoneuroimmunology

• Psychosocial and behavioral influences on immunity and immune-mediated disease

• Effects of psychological and mind-body interventions on immune-mediated diseas

• Action of cytokines to regulate behavior and neuroendocrine function

http://www.cousinspni.org/research.htm

Gene variation affects pain sensitivity and risk of chronic pain

A new NIH-funded study shows that a specific gene variant in humans affects both sensitivity to short-term (acute) pain in healthy volunteers and the risk of developing chronic pain after one kind of back surgery. Blocking increased activity of this gene after nerve injury or inflammation in animals prevented development of chronic pain.

The gene in this study, GCH1, codes for an enzyme called GTP cyclohydrolase. The study suggests that inhibiting GTP cyclohydrolase activity might help to prevent or treat chronic pain, which affects as many as 50 million people in the United States. Doctors also may be able to screen people for the gene variant to predict their risk of chronic post-surgical pain before they undergo surgery. The results appear in the October 22, 2006, advance online publication of Nature Medicine.*

"This is a completely new pathway that contributes to the development of pain," says Clifford J. Woolf, M.D., of Massachusetts General Hospital and Harvard Medical School in Boston, who led the research. "The study shows that we inherit the extent to which we feel pain, both under normal conditions and after damage to the nervous system."

Dr. Woolf carried out the study in collaboration with Mitchell B. Max, M.D., of the National Institute of Dental and Craniofacial Research (NIDCR) in Bethesda, Maryland, and colleagues at the National Institute on Alcoholism Abuse and Alcoholism (NIAAA) and elsewhere. Dr. Woolf's work was funded by the National Institute of Neurological Disorders and Stroke (NINDS). The research team also received funding from NIDCR, NIAAA, and other organizations.

The researchers originally identified GCH1 by preclinical screening for genes that undergo significant changes in expression after sciatic nerve injury. GCH1 is one of several genes that code for enzymes needed to produce a chemical called tetrahydrobiopterin (BH4). Previous studies have shown that BH4 is an essential ingredient in the process that produces dopamine and several other nerve-signaling chemicals (neurotransmitters). It also plays other important roles in the body. However, this study is the first to show that GCH1 and BH4 play a role in pain.

http://www.eurekalert.org/pub_releases/2006-10/nion-gva101806.php

Living with chronic pain (click here)

The only time Michael DeGroote isn't in severe pain is when he is sleeping, or sitting perfectly still.

Since the wealthy philanthropist suffered a stroke five years ago, the slightest movement triggers a burning, stabbing pain on the left side of his body. Even the touch of clothing against his skin is painful.

Nothing has helped, not the 17 different medications or combinations of drugs, not hypnosis or acupuncture. His stroke damaged a part of the brain called the thalamus, a central processing site for pain, and he endured two operations in Belgium that required opening his skull to place electrodes on top of his brain. They didn't work.

Mr. DeGroote is one of an estimated five million Canadians who suffer from chronic pain, but, unlike most people, he faces no financial obstacles in seeking help. The former owner of the Hamilton Tiger-Cats and the waste-management company Laidlaw has sought out experts around North America and Europe without finding relief.

Hope, he has come to believe, lies in laboratories around the world, in scientists struggling to understand the biology of pain and figure out new ways to subdue it.

He is doing his part, giving $20-million to McMaster University in Hamilton to establish the Michael G. DeGroote Institute for Pain Research and Care, which seeks to find new ways to treat and manage chronic pain.

INTERNATIONAL SOCIETY FOR PANETICS

WHAT IS PANETICS?

Panetics is an integrated discipline to study and help reduce the INFLICTION of suffering by humans upon other humans. It was founded upon the conviction that a growing international consensus supports the right of people to be relieved from suffering inflicted by other people when they act through governments, institutions, professions and social groups. To that end, Panetics is an evolving, "pan-ethical" approach to research, policy analysis, decision-making and management."Panetics" is a term coined by Ralph G.H. Siu from "paneti" which means "to inflict" in Pali, the language of the Buddha.

http://www.panetics.info/

Finding Help for Your Pain - American Pain Foundation booklet

http://www.painfoundation.org/Publications/FindingCare.pdf

WebMD - Pain Management: Indie Cooper-Guzman, RN

Pain Management:

Indie Cooper-Guzman, RN

You can cope with pain! Indie Cooper-Guzman, RN, is here to answer your questions about the latest conventional and alternative treatments for pain management.

WebMD Home > Message Boards  > Chronic Pain

http://boards.webmd.com/topic.asp?topic_id=83

WebMD Pain Management Health Center - Information on pain medications and treatment options for chronic pain

Pain Management Health Center

Chronic pain affects an estimated 86 million American adults to some degree. Here you'll find the latest information on chronic pain treatments, as well as natural ways to manage your chronic pain. Plus, get help daily in our online support group.

http://www.webmd.com/diseases_and_conditions/pain.htm

Suffering: A Sociological Introduction by Iain Wilkinson

In Suffering Iain Wilkinson provides a compelling sociological exploration of human suffering, and its political and moral repercussions.Sociology is always concerned with the causes and consequences of human suffering in one form or another, yet there is no sociology of suffering per se. This book is written with the understanding that if sociology fails to attend to what suffering does to people then it is left with a severely diminished account of human experience. Wilkinson maintains that a sociological response to suffering must confront the most unsettling questions of meaning and morality. He argues that the apparent 'senselessness' of suffering has the power to transform dramatically the ways we relate to society and ourselves. The book explores some of the ways in which our sensitivity towards this 'problem of suffering' is related to a new 'politics of compassion' in modern societies.Powerful and timely, the book will have strong appeal to upper-level undergraduate students of sociology, anthropology, health, politics, and cultural studies, in addition to general readers concerned to understand one of the most pressing issues of our time.

In Suffering Iain Wilkinson provides a compelling sociological exploration of human suffering, and its political and moral repercussions.Sociology is always concerned with the causes and consequences of human suffering in one form or another, yet there is no sociology of suffering per se. This book is written with the understanding that if sociology fails to attend to what suffering does to people then it is left with a severely diminished account of human experience. Wilkinson maintains that a sociological response to suffering must confront the most unsettling questions of meaning and morality. He argues that the apparent 'senselessness' of suffering has the power to transform dramatically the ways we relate to society and ourselves. The book explores some of the ways in which our sensitivity towards this 'problem of suffering' is related to a new 'politics of compassion' in modern societies.Powerful and timely, the book will have strong appeal to upper-level undergraduate students of sociology, anthropology, health, politics, and cultural studies, in addition to general readers concerned to understand one of the most pressing issues of our time.

http://www.amazon.ca/Suffering-Sociological-Introduction-Iain-Wilkinson/dp/0745631975/sr=8-1/qid=1161347208/ref=sr_1_1/701-6553950-2961958?ie=UTF8&s=books

The Body: The Complete HIV/AIDS Resource

The Body's mission is to:
Use the Web to lower barriers between patients and clinicians.
Demystify HIV/AIDS and its treatment.
Improve patients' quality of life.
Foster community through human connection.
http://www.thebody.com/index.html

Pain Management
http://www.thebody.com/treat/pain.html

Pain.com - A world of information on pain

To be the premier educational and informational resource on the
Internet for health care professionals and consumers who have an
interest in pain and its management.

The Dannemiller Memorial Educational Foundation affirms its
commitment to researching, developing, and providing quality
medical educational and informational content to our users
absolutely free in a quality online format. By providing a variety
of accredited activities for physicians, pharmacists and nurses,
the Dannemiller Memorial Educational Foundation seeks to
foster an environment where health care professionals can grow
in their knowledge and management of pain and its management.

The Dannemiller Memorial Educational Foundation further seeks to
empower pain sufferers and their caregivers with information to
better equip them to work in partnership with their physician to
actively manage their pain.



http://www.pain.com/

Ask The Pain Doctor

Welcome to "Ask the Pain Doctor" - designed to allow you to Ask The Pain Doctor a question and obtain general advice from a practicing pain professional. Pain.com is not in position to independently evaluate any of the advice or claims on behalf of any particular therapy. Pain.com offers the Ask the Pain Doctor forum to provide additional resources to patients, who would be prudent to learn as much as they can from as many sources as possible.

» Submit a question to the pain doctors

» Read today's questions

» Read about our doctors

http://www.pain.com/sections/consumers/ask_the_dr/

Musculoskeletal Pain Resources for Pain Guidelines

American Pain Society A position statement on pediatric chronic pain » http://ampainsoc.org/advocacy/pediatric.htm Swedish Medical Center Chronic Pain & Prescribing Swedish Pain Center's Guide » http://www.swedish.org/documents/All%20Services/Swedish_Pain_Prescribing_Guide.pdf National Guideline Clearinghouse Manual medicine guidelines for musculoskeletal injuries » http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=6423 National Guideline Clearinghouse Guidelines for adult low back pain » http://www.guideline.gov/summary/summary.aspx?view_id=1&doc_id=8150 Morecambe Bay Musculoskeletal Pain Commission Group Musculoskeletal Referral Guidelines » http://www.mbpct.nhs.uk/SouthLakesLHG/_pdf/muskuloskeletal_referal_guidelines.pdf#search='Guidelines%20for%20musculoskeletal%20pain Massacheuttes General Hospital services » http://www.massgeneral.org/painrelief/Guidelines/Ten%20Guidelines.pdf American Pain Society Principles of Analgesic Use in the Treatment of Acute Pain and Cancer Pain » http://www.ampainsoc.org/pub/principles.htm American Academy of Pain Mediciney Position and Consensus Statements » http://www.painmed.org/productpub/statements/index.html American Academy of Pain Medicine / American Pain Society The use of opioids for the treatment of chronic pain. A consensus statement » http://www.painmed.org/productpub/statements/pdfs/acute_cancer_pain.pdf Royal College of General Practitioners Recommendatons for the appropriate use of opioids for persistent non-cancer pain » http://www.britishpainsociety.org/pdf/Pub_FINAL_opioid_March%202005.pdf International Association for the Study of Pain Task Force on Guidelines for Desirable Characteristics for Pain Treatment Facilities » http://www.iasp-pain.org/desirabl.html American Pain Society Public Policy Statement on Rights and Responsibilities of Healthcare Professionals in the use of Opioids for the Treatment of Pain » http://www.asam.org/ppol/Opioids%20for%20Treatment%20of%20Pain.htm American College of Rheumatology Ad Hoc Committee on Clinical Guidelines Guidelines for the Initial Evaluation of the Adult Patient with Acute Musculoskeletal Symptoms » http://www.rheumatology.org/publications/guidelines/musc/musc-dis.asp?aud=mem American Chronic Pain Association Guidelines for selecting a pain management program » http://www.theacpa.org/pf_02_05.asp Agency for Helath Care Policy & Research Acute Pain Management: Operative or Medical Procedures and Trauma » http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.chapter.8991 Agency for Helath Care Policy & Research Acute Low Back Problems in Adults » http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.chapter.25870

http://www.pain.com/sections/categories_of_pain/MUSCULOSKELETAL/resources/guidelines/index.cfm

Pleasure and pain: Study shows brain's 'pleasure chemical' is involved in response to pain too (click here)

Using sophisticated brain-scanning and a carefully controlled way of inducing muscle pain, the researchers show that the brain's dopamine system is highly active while someone experiences pain – and that this response varies between individuals in a way that relates directly to how the pain makes them feel. It's the first time that dopamine has been linked to pain response in humans.

The finding, published in the October 18 issue of the Journal of Neuroscience, may help explain why people are more likely to acquire a drug addiction during times of intense stress in their lives. It may also yield clues to why some, but not other chronic pain patients may be prone to developing addictions to certain pain medications. And, it gives further evidence that vulnerability to drug addiction is a very individual phenomenon – and one that can't be predicted by current knowledge of genetics and physiology.

"It appears from our study that dopamine acts as an interface between stress, pain and emotions, or between physical and emotional events, and that it's activated with both positive and negative stimuli," says senior author Jon-Kar Zubieta, M.D., Ph.D., professor of psychiatry and radiology at the U-M Medical School and a member of the U-M Molecular and Behavioral Neuroscience Institute and U-M Depression Center. "It appears to act as a mechanism that responds to the salience of a stimuli – the importance of it to the individual – and makes it relevant for them to respond to."

Patient reviews of TENS units (click here)

About six years ago, I fell down a stairwell onto a concrete floor and damaged my spine permanently. I have had endless treatment, although I believe that over the years, back pain is one thing that never really goes away. I also believe that having suffered a serious injury to the back, the problems of age do exaggerate back problems, and over the past six years, this really has been proven to be true in my ...

Nurse Ratched's Place

My mother was thrilled when I told her I wanted to be nurse. I was 5 years old. To her, going to nursing school was the fastest way of finding a doctor and getting him to the alter. Yes, in 1959 being Mrs. M.D. was the American Dream. Many years later, I broke her heart when I married a furniture salesman. 

After my divorce, I said I would never date a doctor. Why would I? After working all day in a hospital, I wanted to go out with someone who wasn’t in health care. But then I met an Aussie emergency room physician, Dr. Hot Stuff. He was dreamy. The blond hair, the blue eyes, his sharp wit, he was everything I was looking for in a man. And I always was a sucker for an Australian accent. My mother loved the guy. She started planning our wedding.

The nurses I worked with adored my suitor. When they called him for orders, they would ask him to repeat himself two or three times. He asked me if people couldn’t understand him because of his accent. I told him the nurses understood him; they just wanted to hear his sexy voice. 

Unfortunately, all good things come to an end. I dumped him when I found out about his wife and six kids back in Australia. Yeah, he said they slipped his mind.

http://www.nurse-ratcheds.blogspot.com/

"Pain Man" cartoon by cartoonist Mark Fiore

http://oldsite.mpp.org/hincheyvote/fiore.html

AllPsych Online - The Virtual Psychology Classroom

 

AllPsych Online is one of the largest and most comprehensive psychology websites on the Internet.  Inside the site you'll find over over 920 individual, cross referenced, web pages and an estimated 3000 pages of printed material.  AllPsych is referenced by over 100 colleges and universities in ten countries and receives an average of 3,000 unique visitors and 10,000 page views every day.  Please use the links below to learn more about AllPsych.

 

http://allpsych.com/

Allen Brain Atlas

Welcome to the Neuroscience Gateway, a comprehensive source for the latest research, news and events in neuroscience and genomics research developed collaboratively by the Allen Institute for Brain Science and Nature Publishing Group. The Allen Brain Atlas is a freely available scientific resource developed by the Allen Institute, which provides maps of the expression of approximately 20,000 genes in the mouse brain. Together, the Neuroscience Gateway and the Allen Brain Atlas are new tools to help researchers navigate neuroscience and genomics research.

http://www.brainatlas.org/aba/

The Last Word on the Last Breath - New York Times

But the question of who has final say over whether CPR should be attempted on a gravely ill patient — the doctor, the patient or the patient’s representative — is live and unsettled in law and medicine.

+++

The debate over who makes the decision raises fundamental challenges to medical integrity as well as patients’ rights and can rub feelings raw for all concerned. Hospitals around the country and some state legislatures have wrestled with how to balance these competing values, reaching different conclusions.

+++

Dr. Fins thinks that the focus on D.N.R. orders is in itself misguided.

“D.N.R. is a game plan for the last 15 minutes of your life,” he said. “By planning for those last 15 minutes, we’re distorting priorities. Instead of talking about futility, we should be discussing what has utility, like pain management, comfort, closure. Recasting the discussion has led to turning irresolvable dilemmas into problems that can be addressed.”

http://www.nytimes.com/2006/10/10/health/10dnr.html?ex=1318132800&en=e75a2513acdb86a0&ei=5090&partner=rssuserland&emc=rss

Friends for Life: An Emerging Biology of Emotional Healing - New York Times

Research on the link between relationships and physical health has established that people with rich personal networks — who are married, have close family and friends, are active in social and religious groups — recover more quickly from disease and live longer. But now the emerging field of social neuroscience, the study of how people’s brains entrain as they interact, adds a missing piece to that data.

The most significant finding was the discovery of “mirror neurons,” a widely dispersed class of brain cells that operate like neural WiFi. Mirror neurons track the emotional flow, movement and even intentions of the person we are with, and replicate this sensed state in our own brain by stirring in our brain the same areas active in the other person

http://www.nytimes.com/2006/10/10/health/psychology/10essa.html?ex=1318132800&en=bc81f39f082cfaa0&ei=5090&partner=rssuserland&emc=rss

Pain: Hope Through Research: National Institute of Neurological Disorders and Stroke (NINDS)

http://www.ninds.nih.gov/disorders/chronic_pain/detail_chronic_pain.htm

NIH Pain Consortium - Homepage

http://painconsortium.nih.gov/

Pain

About this blog

I’ve been in chronic pain since I was a year old, have paid a huge price for this, and spent the last few years reading widely on the subject. This blog contains my own essays as well as links to other writers who interest me.

http://tonycole.wordpress.com/

The crucial health stat you've never heard of. By Darshak Sanghavi - Slate Magazine

Suppose that 100 people with high cholesterol levels took statins. Of them, 93 wouldn't have had heart attacks anyway. Five people have heart attacks despite taking Pravachol. Only the remaining two out of the original 100 avoided a heart attack by taking the daily pills. In the end, 100 people needed to be treated to avoid two heart attacks during the study period—so, the number of people who must get the treatment for a single person to benefit is 50. This is known as the "number needed to treat."

Developed by epidemiologists in 1988, the NNT was heralded as a new and objective tool to help patients make informed decisions. It avoids the confusing distinction between "relative" and "absolute" reduction of risk. The NNT is intuitive: To a savvy, healthy person with high cholesterol that didn't decrease with diet and exercise, a doctor could say, "A statin might help you, or it might not. Out of every 50 people who take them, one avoids getting a heart attack. On the other hand, that means 49 out of 50 people don't get much benefit."

But drug companies don't want people thinking that way; whenever possible, they frame discussions of drugs in terms of relative risk reduction. That's why the package insert for Pravachol highlights the 31 percent reduction and mentions the NNT not at all.

http://www.slate.com/id/2150354/fr/nl/