The Short Coat

What you get away with as an undergrad won’t serve you in med school. M2s Jacob and Maddie, M4 Mason and new co-host PA2 Mark take us through how they changed their study habits from undergrad through the clinical years. Dave reads an old German folktale about how to become a doctor. Hint: it’s harder today, and involves much less mansplaining, but there’s at least one feature that still exists from antiquity.

Dave declared this recording day to be “Effort Free Friday,” as it was officially Thanksgiving Break! That didn’t stop M1 Jeff Goddard from describing a recent meeting of the AMA Students Section that offered an object lesson on how policy is (or in this case, isn’t) made. Among many other topics, some students wanted the AMA to declare a position on the current Israel-Hamas war. In the end, the AMA declined to do so, perhaps deciding that it didn’t have the political capital on a divisive issue that could threaten its ability to participate in other conversations it has a more direct role in. Co-hosts M2 Happy Kumar, MD/PhD student Faith Goddard, and MD/PhD student Riley Behan Bush talk about their personal efforts to understand this compilated issue. And, In the spirit of the tenets of Effort Free Friday, Dave dragged Alex Trebot out from the AI closet to host a trivia contest.

A recent MedPage Today editorial shines a light on four traits that are crucial for every resident. These elements aren’t traditionally taught, but are key for future doctors. They encompass selflessness, optimism, personal responsibility, and a hunger for personal meaning. M4 Alex Belzer, who’s currently interviewing, and M2s Hend Al-Kaylani and Eric Vallin break them down, exploring how each can enhance both personal and professional interactions. And a New York Times editorial video tackles a darker side of medical practice – violence against emergency medicine providers. The challenges faced chuck yet another curveball into the complex reality of a physician’s work-life, the erosion of human connection in healthcare, and the necessity to spark change.

Dr. Michael Graham, a seasoned Nuclear Medicine practitioner and professor at the University of Iowa, reached out to us recently because at a national level his specialty is experiencing a shortage of new residents. The reasons for this include a less-than-perfect fit with the way it’s traditionally been lumped into radiology, a field with some parallels but some important training differences. M1 Fallon Jung, PA1s Olivia Quinby and Noah Vasquez, and M2 Jeff Goddard talk with Dr. Graham about how the field has evolved and changed the dynamics of patient care and medical practice.

We have GOT to get it together. What’s the best way to navigate a fragmented healthcare system? How are patients both the victims and unwitting custodians of their own medical stories? And can primary care address gaps in long-term cancer treatment? We had a fun conversation with Dr. Ilana Yurkiewicz, the author of ‘Fragmented, A Doctor’s Quest to Piece Together American Healthcare.’ Jeff, Fallon, AJ, and Alex walked away not only enlightened about the gaps in the contemporary healthcare system but also the importance of primary care and specialists working together to build patient relationships and keep clinical information flowing.

Dave’s been seeing a lot of videos on social media that suggest “You might have if you [trait or behavior that most people have or do to some degree]. Which is great–it’s always nice to know that you are not alone, that your experience is not unique. But how should physicians work with a social media self-diagnosis? There may some day be a vaccine against fentanyl, meant to protect against overdoses. This is great news, if it works out, because people die from fentanyl overdose every day. Who will get it, what affect it will have on anesthesia, and the parallels to how people view HPV vaccines will among the things we’ll be watching. And Dave has co-hosts Jeff, Jacqueline, Faith, and Riley practice their doctoring on each other.

Do docs and patients mean the same thing when they talk about ‘health?’ Fallon, Sri, Radha, and Kait discuss the concept of ‘health.’ What does healthy mean to our patients? What does it mean to physicians? The definition has changed over time–from freedom from disease to a more self-actualizing concept of thriving in one’s circumstances. Even the normal body temp of 37 degrees C is changing! Is nothing sacred?

As tuberculosis is on the rise once again in this country, it remains *the* cause of death around the world. But thanks to fans of the famous vlogbrothers, John and Hank Green, the world has some additional tools to fight a disease which we've been able to cure for decades, lacking only the will to do it. And Dave tells what he learned this week about Katalin Karikó, the Hungarian-born researcher who, despite being cast aside as a crank in the 1980s, received the Nobel Prize in 2023 for 40+ years of work that saved millions of lives in just a couple short years--and which is now about to revolutionize medicine.

As another physician shortage looms, M2s Jeff and Olivia and M1 Fallon look at the reasons–the market forces, political issues, and the missing incentives. There is some good news–a shortage of physicians means that residents get a ton of solicitations for post-training jobs. Elon Musk’s Neuralink might be bad for monkeys, but the FDA has cleared the way for human trials to begin. What place do techbros–who have a rep for “moving fast and breaking things”– have in medicine where lives are at stake? And Dave gives a pop quiz on this year’s Ig Nobel Prize winners--listen to learn more about the latest technology in excretion analysis!

Physician Associate (formerly Physician Assistant) students learn the preclinical curriculum right along side their Doctor of Medicine colleagues here at Iowa. Of course, that means they learn the same things, but also the level of trust and mutual understanding between the two professions is that much more explicit. October 6 to 12 is Physician Associates Week, and PA1 producer Noah Vasquez rounded up some classmates--Olivia Quinby, Emily Sarvis, and Noah Herkert--to talk about how they chose their future profession, what they're learning, and what their plans are after they graduate.

The beginning of the 20th century brought huge changes to medicine; we’re still trying to cope with them. Special guest Dr. Adam Rodman, visits with M1s Jeff, Faith, and Linda and PA1 Kelsey, to talk about “path dependency,” the idea that a complex system (like medical education) is almost impossible to change without starting over. The path we have taken to today constrains what we can do tomorrow. We discuss the founding of medical education as we know it today and how that has created an academic medicine system that values facts, science, and publication more than things like equity, empathy, and work-life balance. The good news is that very dedicated people are working to make the sorely needed adjustments to these areas and more…without burning it all down and starting again.

Motherhood is a revered institution in many cultures, but in the good old US of A there's one area where mothers are being failed: medicine. Maternal mortality continues to increase to alarming levels, especially among people of color. We explore our thoughts on why, and what doctors can do in an environment in which financial profit is a prime motivator for health systems, rural areas are losing OBs, and nurse staffing levels are too low. Plus, we hear from some influencers with their health advice in a game of unnecessary censorship.

How should Thomas choose between his great career options? We’ve all been there: faced with some good options, which one do we choose? Listener Thomas wrote in with his dilemma: he studied and loves engineering, but what about medicine? M1s Jacqueline Nielson, Fallon Jung, and Sri Nandakumar discuss what they studied as undergrads, what made them realize that medicine is the right path, and how to become certain about that. Also, women surgeons are better than male surgeons, according to yet another study, and a supermarket’s chatbot recommends meals for busy people, like delicious chlorine gas.

Why docs don’t like the word “provider,” and the surprise dealt to the AAMC by OB residency programs a Delaware-based health system, is taking a stand against the use of the term “provider” to describe physicians. The AMA agrees, saying they oppose the term “provider” as inadequate and urging MDs to insist on being identified as "physicians." Co-hosts Nicole (Pathology Extern), Riley (MD/PhD student), and Jeff (M2) discuss why "provider" might not capture what doctors do. In the mid 90s, OB/Gyn residencies helped to pilot the Association of American Medical Colleges’ Electronic Residency Application Service, or ERAS. This year, to the “surprise and dismay” of the AAMC, the OB residencies are jumping ship this year and starting their own system. Despite the oft-repeated trivia, urine isn’t sterile. I know! mind blown.

Why do we struggle to change when our world changes around us? Philadelphia’s Mütter Museum is beloved by its visitors. Styled as an homage to Victorian displays of medical and biological curiosities, its exhibits include human remains with extreme pathologies…and sometimes dubious provenance. Once such items were joyfully collected by rich men to fill their cabinets of curiosities. But times have changed since the museum opened in 1863. The museum’s leaders have decided to reassess the exhibits’ ethical and moral qualities, despite the anger of devoted fans who like it fine the way it is, thanks. Dave, M2 Jeff Goddard, and new co-host M1 Fallon Jung discuss our all-too-human resistance to change, as well as a proposal by a consumer group to open access to a ‘secret’ database of state medical boards’ disciplinary actions against physicians, which they hope will prod medical boards to do their jobs better.

AI chatbots can help brainstorm ways to communicate more compassionately. We’ve talked about the study that found patients rated responses by the recent generation of AI chatbots significantly better in both quality and empathy than physicians. We decided to test ourselves on our efforts to bring up awkward topics with patients and others by comparing our answers to those provided by Anthropic’s Claude-2. Did M2 Jeff Goddard, M3 Betty Tu, M2 Yumi Engelking, and MD/PhD student Riley Behan-Bush do better than a bot? Betty and Yumi told us about CCOM’s new First Generation and Low-income in Medicine Association chapter. And we review some of the health advice found on social media, including videos by Tik Tok’s urmomstoering, angelapharmd, heyitskikiiiiii, and mirandaksmith.

Meet one doctor working to counter once-fringe anti-vax conspiracy theorists. M2 Jeff Goddard invited internationally-renowned virology and immunology expert Dr. Paul Offit on the show to talk about his lifelong struggle to fight vaccine misinformation. MD/PhD Students Riley Behan-Bush, and Madi Wahlen join Jeff to talk with Dr. Offit about his work educating politicians and policy-makers (as well as battling anti-vaxxers like 2024 presidential candidate RFK, Jr.) and with the Vaccine Education Center at Children’s Hospital of Philadelphia. One thing is for certain: though fear and doubt about vaccines have existed since the first smallpox vaccine, in the age of social media educating the public about vaccines and science hasn’t gotten any easier. More about our guest: Website: PaulOffit.com Substack newsletter: Beyond the Noise

How do you choose between jumping in with both feet vs. watching and learning? Listener Jordan DM’d to say that she’s having trouble finding the right balance of initiative and observation in her clerkships. To stand out, should she jump into situations and try to contribute? Or is it better to step back and observe? M2s Trent, Bridget, Maddie, and Yumi discuss their ideas about it, and we ask some faculty and experienced students to weigh in. Plus, a dumb folktale by chatGPT offers us the story of radiologist Dr. William his magical radiograph-reading chicken Clara.

[A Note to Listeners: this episode features discussions of sex abuse, rape, and other crimes that many listeners will find disturbing.] Insights From the Bench on How Doctors Can Work With The Law To Protect Victims of Sexual Assault. The Honorable Rosemarie Aquilina–the judge in the Larry Nassar USA Gymnastics Sex Abuse trial–talks with us about how even well-meaning doctors can ruin prosecutions of sex abuse cases. Trauma informed care, restorative justice, and compassionate advocacy are all tools that must be shared between the law and medicine. As Aline and Jessica discuss very sensitive and disturbing topics with her–listeners beware–we think you’ll find Judge Aquilina’s courage and values resonant with attributes of the best medical practitioners.

Recognizing good advice and discarding the bad is part of the admissions process. Aline has finished her PhD! She walks Jeff, Riley, and AJ through what defending a dissertation is like, and looks back on some of the things she’s learned about herself and about science. And, bad advice is like a leaky umbrella that lets you down when you need it most. So how do you recognize good advice and distinguish it from bad advice when you’re applying to medical school?