The Short Coat

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?

Speaking up for your patients will have profound impacts. Short Coat Savannah’s previous work in mental health settings exposed her to situations where she had to report abuse. She left us a message at 347-SHORTCT asking us to talk about patient advocacy. MD/PhD student Riley, PA1 Faith, M1 Jeff, and M3 Happy–along with some of our faculty–look at what doctors actually do to advocate for their patients in that situation, as well as other more common situations. Plus, Jeff licks an elephant to right an old wrong.

The Supreme Court has struck down the use of race-conscious admissions practices--affirmative action--that many colleges use to counteract bias against admitting people of color. Short Coats Hend (M2), Nicole (M3), Faith (MD/PhD) and AJ (M4) discuss why that's a problem for patients, and what might happen now that AdComms are forced to use proxies to diversify their classes. Harvard continues it's run of bad legal luck with the news that its morgue manager has been selling body parts. And chatbots are helping docs talk to their patients with more empathy. Dave subjects his co-hosts to another concoction of food items.

M2s Trent Gilbert, Olivia Jenks, PA1 Faith Anton, and M4 Sarah Costello discuss what it might mean that doctors recently discovered a group of patients, previously diagnosed with schizophrenia, who might actually have other treatable immunological disorders that present as psych disorders. We also discuss other news of the week, and Dave subjects his co-hosts to a pop news pop quiz.

Think of it as education you don’t have to pay for! In an episode best described as…laid back?…calm?…sleepy?…Nicole, Alex, and Sarah discuss why those AdComm-required experiences are actually important. Both the colleges and the applicants themselves benefit from them, but in the rush to ‘get them over with,’ their utility gets overlooked. Instead, they’re often seen by applicants as a means to an end, not an end in and of themselves.

[We'll be back next week with a new episode! For now, take a listen to this re-run!] Decisions made at the end of life are among the most complicated. M1 Jeff, M3 Ananya, and MD/PhD students Riley and Miranda discuss what they’re taught about the ethics surrounding death. What are the physician’s responsibilities? How do they balance the patient’s wishes, the family’s desires, the directive to do no harm and to provide the best possible care, and the need to ensure that such considerations are supplied to any and all patients. Add in the myriad cultural and religious beliefs that doctors, patients, and families have, and you get quite a difficult set of calculations to ponder.

Med students are smart, but how much useless info can they spout? It’s Spring Break, so we’re taking a break from our usual content to bring you a trivia contest featuring M4 Emerald, MD/PhD students Riley and Faith, and CCOM Learning Communities Coordinator Cody. Dave created a trivia bot using chatGPT, and to ratchet up the tension, he poured some shots of mysterious and probably unpleasant liquids to punish his co-hosts’ wrong answers. Happily for his co-hosts, it didn’t work out well for Dave.

First year of med school contains many life lessons. We Want to Hear From You: YOUR VOICE MATTERS! No matter where you fall on any spectrum, we want your thoughts on our show. Do you agree or disagree with something we said today? Did you hear something really helpful? Are we delivering a podcast you want to keep listening to? We’ll be sure your ideas are heard by all–leave a message at 347-SHORTCT (347-746-7828) and we’ll put your message in a future episode (use *67 to be an “Unknown caller”). We want to know more about you: We do more things on… https://www.instagram.com/theshortcoat You deserve to be happy and healthy. If you’re struggling with racism, harassment, hate, your mental health, or some other crisis, visit http://theshortcoat.com/help, and send additions to the resources there to theshortcoats@gmail.com. We love you. Music provided by Argofox. License: bit.ly/CCAttribution DOCTOR VOX – Heatstroke: youtu.be/j1n1zlxzyRE Catmosphere – Candy-Coloured Sky: youtu.be/AZjYZ8Kjgs8 Hexalyte – Wandering Hours: youtu.be/FOAo2zsYnvA…

The importance of getting your head outside of medical school. Lots of people have hobbies, and perhaps many of those people use them to step outside their day-to-day lives for a while for a peaceful break. Is there time for a hobby or three in medical school? M3s AJ and Alex, M1 Hend, and MD/PhD student Sam say there absolutely is! In fact, it’s possible the importance of finding time for your outside interests is greater in medical school than any other time!

Burnout is the wrong word for what’s ailing healthcare workers. The term burnout doesn’t really cover what happens to physicians and others in healthcare. Dr. Wendy Dean and others are coming around to the idea that what’s really happening is moral injury–what happens when you want to do the right thing but aren’t allowed to do it. M1s Jeff, Faith, and Linda visit with Dr. Dean to talk about moral injury, what people are doing about it, and what still needs to be done. Her book, If I Betray These Words, is available everywhere, and is a great read for anyone interested in knowing why their doctor can’t just do what’s right for their patient.

Some stories from history that remind us medicine has come a long way. Podcaster Ryan Nanni, of the Shutdown Fullcast, joins M2 Matt, M1 Jeff, Md/PhD student Riley, and Communities Director Cody to talk about some ‘fun’ stories from history. For example, how did a man named “Doctor” (his first name) probably kill President Garfield? And what was the dumbest, most dangerous marathon in Olympics history? Plus, the disease that helped make the cowboy hat a thing.

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.