Posted in Education, Health, Millennials, news

College Student Health Awareness Day

Millions of students are working overtime to become the next generation of wage earners.  But in the process, unfortunately, all too many let their health slip down the priority list.  And when they do, a vicious cycle ensues where grades start going down, forcing a student to further turn to less healthy behaviors such as getting less sleep, eating the wrong foods for energy, or engage in risky behavior.

 

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College Student Health Awareness Day hopes to highlight the multiple health issues incurred by many our students.  These include:

  • Depression, stress and anxiety
  • Frequent colds, illness
  • Poor flu vaccination rates
  • Risky sexual behavior
  • Sexual Assault
  • Poor eating, sleeping and exercise habits
  • Poor study habits
  • Excessive alcohol use
  • Drug use

and more.

Burnout_lady

 

College Student Health Awareness Day will happen this Fall. If you’re interested in volunteering, please contact doctordaliah@hotmail.com or click here.

 

 

 

 

spanish book

Learning Medical Spanish is Easy!!!

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

 

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Posted in Education, Health, news

Falling Behind in School? Here’s Some Tips

As we turn the bend during the second semester of the school year we begin to face challenges.  For many of us the material seems insurmountable….maybe we perceive it as such, or maybe teachers realize they are falling short and rush to get all the information in before the school year ends.

Either way, students feel stressed, overwhelmed and many times unable to catch up. So what do you do when you find the material to be TMTH (too much to handle)?

You don’t have to learn EVERYTHING

Firstly, realize that you don’t have to learn everything.  Remember, the professor can’t test on EVERYTHING.  So don’t go at a packet, slide deck or book with the attitude that you have to know everything.  Find the Titles, the main point in the paragraph that follows, and any supporting info that seems to buttress the main point.  Careful with your use of highlighting if you’re tired and burning out because you’ll start to highlight everything.  Which brings us to….

Have a study buddy

Two heads are better than one. Sometimes three…but more than that may be distracting.  What you thought was important in class or on a sheet of information can be confirmed or denied by another student.  Moreover everyone has strengths and weaknesses so find one who can complement you and help you discern what’s important to know.

Be direct…ask the teacher

Rather than guessing, take 15 minutes to meet with the teacher to get an idea of what they find imperative to learn/know for the test.  But don’t go into their office asking “will this be on the test?” I would be direct, honest, but humble by asking:

  • “All the information you gave us is very important. What do you suggest we concentrate on?”
  • “I find myself wanting to memorize all the information you gave us due to its importance, but is there a better strategy?”
  • “I want to do well on the exam and not over-concentrate on the part of the material that will not be tested as it could take time away from my learning the other material that you want us to know.”
  • “I would really appreciate any advice you can give on how to approach the material being tested.  I enjoy your class and want to accurately demonstrate the effort I’m putting in to succeed in your course.”

Now many times the professor will oblige.  But if not, you need to indirectly determine what he/she is going to test.  This brings us to…..

Watch for the “Brush Over”

How was the material given?

If your professor brushed over it quickly in class, it could mean they don’t find it crucial enough to test or ….they don’t completely understand the material themselves.  Most likely this will not be tested.  However, if he/she brushed over it because it was given in a previous lecture, then its open game.

Demonstrations of the brush over include:

  • Skipping over to the next slide
  • Skipping over to the next sentence
  • Speaking quickly and less slow with regards to a certain subject matter
  • Speaking vaguely over the subject matter
  • Looking down and away when discussing the subject matter when he/she usually gives direct eye contact during lectures
  • Moving the laser pointer to an earlier point as he/she reinforces it.

Know your professor

Are they big on testing if you paid attention in class or knowing the information that’s necessary to succeed? Are they a jerk and will pick the most esoteric piece of content from a 1000 word slide or will they focus on main points? Get an idea on what makes them tick.

A test is a game

For some institutions the exam is to test competency. These are the most clear-cut, fair tests and to me, make the most sense.  If, for example, in medical school one is studying poor lung function and what a spirometer discerns, the inventor and history of the tool will most likely not be tested.  Keep in mind, your professor has bosses and they have bosses, so your competency reflects on them.

For other institutions it may be at the professor’s discretion.  So you need to feel out each teacher and see what they’re all about.  If they are big on class attendance and will weight the test towards those who showed up, expect questions on content that was highlighted in class.  And if they are big on seeing if you paid attention, you will be tested on something they impressed upon you sometime during lecture. So during the lecture watch for the following:

  • Long pause after finishing a point on a slide
  • Eye contact when delivering the content
  • Reiterating a point twice
  • The key word the professor stresses with his laser pointer

So after you’ve done your “homework,” how do you tackle your studies?

Map out your strategy

Your time is divisible so grab a calculator and aliquot into equal periods.  Make sure you have extra sessions included for breaks and catch up sessions.  Or you can use a calendar that is already compartmentalized on which to create your timetable.

timetable.jpg

 

Clean your desk!

A nice clean, crisp desk with plenty of pens and highlighters helps energize one more than cluttered paper.  Moreover have a second work space you can go to when you get sick of working at your desk.

desk.jpg

 

Prioritize

Now this is easier said than done. Some will put their hardest classes on their study calendar first, some the easiest.  There are pros and cons to both. What I suggest is alternating difficult and easy subjects.  You need the start of your day and initial power hours knocking out the difficult material, but then the easier classes will boost your confidence and sometimes energy.  So one option could be:

  • Study block 1:  Tough subject
  • Study block 2:  Easy subject
  • Study block 3:  Medium subject
  • Hour 4:  Review
  • With breaks, of course, in between.

 

Take real breaks!

You should design two types of breaks: Short and Long.

Your short break should be no shorter than 10 minutes.  During the break you must do the following:

  • Get up and stretch
  • Drink water
  • Eat a small snack
  • Go to the bathroom
  • Listen to some music, dance, phone a friend

call.jpg

Your long break should be no shorter than 45 minutes.  During these breaks you can:

  • Eat a regular meal, if due, and drink plenty of fluids
  • Take a small nap
  • Take a shower – helps refresh and energize
  • Check social media – stick to your time limit though!
  • Watch a 30 minute episode of your favorite sitcom
  • Exercise such as going for a run

 

run.jpg

 

Identify signs of burnout

If you’re “going through the motions” of studying and feel “burnt” you won’t be absorbing the material and subsequently you’ll be wasting precious hours.  You must identify burnout by looking for the following:

  • Apathy
  • Exhaustion
  • Poor sleep when you get done in the evening
  • Negative attitude towards school and others
  • Procrastinating your next study block
  • Being irritated
  • Feeling empty
  • Low energy
  • Thinking about quitting

 

Burnout_lady.jpg

 

How to avoid burnout

When studying you’re classwork it’s difficult to avoid the boredom and stress, but the following may help:

  • Study with friends
  • Mix up your study sessions with videos and flash cards if reading gets overwhelming
  • Watch a short funny video to get you laughing
  • Take regular breaks
  • Make sure you’re eating and sleeping well

 

Remember, we’ve all been there and school is supposed to be challenging.  Stay on course and get help if you need such as a tutor.   We all make it to the finish line….even if we’re a little bruised up when we get there.

 

spanish book

Learning Medical Spanish is Easy!!!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in Education, Health, medical school

Data Gathering During a Patient Encounter Made Easy

A Peek into How Doctors Think – An Introduction to “Columns”

Anyone who is on their path to becoming a successful physician needs to be able to take a good history and perform a thorough physical.  However in this day and age, patient care is performed in a very speedily process and thus the boards test a medical student on how succinctly they can perform a patient history.

Thus students and licensed medical providers need to be adept at “data gathering” no matter what the patient presents with.  Our job is to figure out what’s going on, no matter how difficult the task, and do so quickly.  So how do we accomplish this?

We start by looking at the cause and then breaking down what could be occurring resulting in that cause, or in other words, forming a differential diagnosis.  So if someone has chest pain, one may form a differential consisting of heart attack, pericarditis and costochondritis. But other issues may be at play such as a pneumonia or an esophagitis.

So when we look at a person with chest pain, we consider all the body parts or causes that could be causing the symptoms.

Hence with a patient presenting with chest pain, one would consider a cardiovascular cause, pulmonary cause, gastrointestinal cause, musculoskeletal cause, and even psychiatric cause.

This is the basis of forming one’s columns. For every chief complaint we form columns either mentally or on paper and then ask associated symptoms (or pertinent positives or negatives) to determine which column we’re in.  Usually a few “power questions” will help discriminate which column you are in. Once you hit the correct column you will ask further questions along that line.

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True there are many more questions we could ask than just the “power questions,” but during a time crunch we need to ask very specific ones to determine if we are on the right track.  If we receive multiple “no”s along a column, we know to move onto the next column.

Hence if a patient with chest pain denies dizziness and diaphoresis or sternal pain upon palpation but admits to cough, shortness of breath and sputum production, we have just narrowed down the chest pain patient to a pulmonary cause as opposed to assuming it was cardiac in nature. Then we would continue down the pulmonary column, thinking our differential may be a pneumonia/bronchitis/pulmonary embolism, and ask about hemoptysis, fever, chills, etc.

So for each patient one must create columns depending on the chief complaint and then ask power questions to help focus down your differential.

Now these columns can also assist with the physical exam component of data gathering.  If the above patient presenting with chest pain could have a cardiac/pulmonary/GI/musculoskeletal condition, one would examine his heart, lungs, upper abdomen and palpate the sternum and ribs.

For an added bonus, the columns can additionally assist one in forming their differential for the SOAP note. 

Chest pain r/o

  • Pneumonia
  • Bronchitis           
  • PE
  • MI
  • GERD
  • Costochondritis

If a case involves a not so clear-cut symptom, columns could be used as well.

For example a patient presenting with hair loss.  If one complains of hair loss, a variety of differentials could be at play.  One column could be an endocrinology source (such as hypothyroidism or diabetes), another could be psychological (such as stress or trichotillomania), a third could be medications (such as chemotherapy agents), and a fourth could include genetics.  Narrowing these down with power questions could exclude non-contributing columns.

So whether it’s a direct body system or cause, columns help one focus down the differential and allow an easy visual that enables one during a timed test to think quickly and know which questions to ask.

Again these columns are instituted after the History of Present Illness in which a student obtains onset/chronology, palliative/provocative factors, quality of symptoms, radiation, severity and timing (OPQRST).

They will be written down in the SOAP note after the HPI.  

Example:  Mary is a 25-year-old female presenting with acute onset right foot pain.  It began 6 hours ago after she went for a job. Ice provides some relief but walking on it worsens the pain.  The pain is sharp, constant with a severity of 7/10. She denies fever, chills, open wounds, swelling, redness, temperature changes, numbness or tingling.

Since during this step in the history most medical students find it challenging to know “which questions to ask.”  The columns and power questions simplify this.

To learn this method to improve one’s data gathering skills click here.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in Education, Employment, Health, Millennials, news

Personal Statement For Residency: Tips on Making a Great Impression

The trials and tribulations incurred during medical school culminate during one’s 4th year when they need to go on their biggest interview of their life: their residency interview.  But as with most interviews, one needs an excellent resume (CV) and cover letter to walk in the door.

Hence a student’s “Personal Statement” is what completes the package that is presented to residency directors who choose your fate.

An advantage to this is that it provides an opportunity to personalize your application, which unfortunately can look very itemized during the application process.

In communication we are successful when we use the “Three E’s.”  These stand for Engage, Educate and Enlist.  You engage a person by garnering their attention, then once you have their attention you educate them, and once they are educated you can enlist them (such as rank me for your residency).

So what makes a good personal statement?

Length

The length of your personal statement should be approximately one page.  This gives you 5-8 paragraphs to tell your story without boring one to death.  You don’t want to be too short and sweet but rather to the point and hammer your message home without getting into trouble saying too much later.

Open with a grab, but don’t choke them…

The average person puts down an article, book, essay within the first sentence if it doesn’t catch them.  So avoid opening your personal statement with “I’ve always wanted to be a doctor…”  Putting your future residency director to sleep seven words in prevents him from remembering your application and choosing you for his program.

So instead you should focus on a personal story that led to your resolve to dedicate your life to others.  Examples of this include:

My decision to pursue medicine began when I came to the United States with my family to start a new life……

The art of medicine compels one to study the canvas before haphazardly wielding a paintbrush.  I learned this when……

But don’t be too flowery. Get to the point early on in your first paragraph on how life experiences affected your decision to pursue medicine and the specific specialty for which you’re applying.

Which brings us to….

Know your specialty

If you are planning to pursue a career in Family Medicine, don’t discuss how you want to become a “Jack of all Trades.”  This isn’t what family medicine is about.  Just as the specialty of surgery isn’t all about “cutting.”  Let them know in your statement that you get it by saying something like…..

Understanding the wide range of pathologies that may affect a patient of any age is paramount to becoming an excellent family physician.

Being an advocate for my female patients and enabling them to bring life into this world attracted me to the field of obstetrics and gynecology.

Show you’re a team player

The residency director, who’s interviewing you, needs to know you play well with others.  The team with which you will work includes senior residents, attendings, nurses, ancillary staff and administrators to name a few.  So incorporate in your letter how you are cognizant of how a patient’s success is dependent on a hospital’s “team approach.”

Avoid negativity

Avoid insulting other specialties or specialists…which may occur inadvertently when describing why you chose your specialty.  For example, in one personal statement I edited, the student wrote, “I didn’t want to be a doctor who just cuts, so I chose primary care instead.”  

A better approach would be, “I found being a front-line provider, making the initial decisions in a patient’s care, to be exciting.”

Do your research

Most students begin their personal statement at the end of their third year, when actually it’s during your third year when you can gain much insight into how to write it. So questions you may want to ask your preceptor are:

How do you define family medicine (or the specific specialty)?

How did you come to decide to pursue medicine?

What do you look for in a personal statement?

If you could give me any advice on what to include in my personal statement what would that be?

Additionally, ask your clinical education department for resources or examples of good personal statements.  Prior graduates who secured their top five choices may have offered their personal statements to the medical school for others to use as a guide.

Have a format

Even though personal statements vary in length, creativity, subject matter and prose,  there is a general format most appear to follow.

Part 1 – your eye-catching opener that gives the program director a glimpse into your passion, personality, and plan (entering the field of ……).

Part 2 – a patient case or moment in your past that led you to forming this educated decision to pursue a specific specialty.  Don’t go into too many specifics regarding the patient due to HIPPA, and make sure your decision to pursue a particular field was not done on a whim or at the last minute before fourth year.

Part 3 – explain why you would be a good candidate for their residency program.  What makes you a good student, doctor, leader, team player, educator (you will be teaching medical students) and person.  Don’t itemize every accomplishment on your CV, but highlight some of your finest accomplishments and strengths.

Part 4 – after you’ve engaged and educated the reader, you are ready to enlist them.  The final portion of your personal statement reinforces why you are an excellent candidate for their program and how your goals are aligned with theirs in terms of providing good patient care, educating others, and giving back to your community.  This is also where you can suggest what you are looking for in a residency program, such as one that offers research opportunities.

Remember to end the personal statement with a note of gratitude, such as, “Thank you for considering my application to your residency program.”  A piece of humble pie goes along way.

Have it edited

When you have completed your personal statement, make sure you have someone else read it and find any grammatical and spelling errors.  Although most residency directors do not expect you to be a professional linguist, errors in one’s statement may suggest that you are haphazard, inattentive, have a lack of care for details, or lazy.

So in summary, being given the opportunity to market yourself is a gift.  So don’t put it off until the last minute and pray one draft does the trick.  Write this as it’s the most important 500 – 800 words of your life….

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

Posted in drugs, Education, Health, news, opioids, sex, suicide

Is Your Teen in Trouble? Your Guide to Their Code Words

This generation of teens communicates differently from any others as smartphone technology has outpaced the normal evolution of day-and-age vernacular. As a result, adolescents use abbreviations and emojis to convey their thoughts while parents and society scramble to catch up.

What Are They Saying? Your Guide to Teen Slang

However, within these bite-size “codes” could be volumes of meaning, some delineating at risk behavior, some foreboding suicide.  These codes many times come from the letters that correspond to the key pad on a phone.  So here’s a guide to some of the unfamiliar terminology the young ‘uns are using:

 

Sex/Love

text night.jpg

  • NIFOC – nude in front of computer
  • CU46 – see you for sex
  • 8 – “ate” used in discussions on oral sex
  • 831 – I love you – “eight letters, three words, one you/meaning”
  • 143 – I love you (denotes letters on keypads, or #’s of letters in each word (love has 4 letters)
  • 2N8, 2NTE – tonight
  • 4AO – four adults only
  • 2B@ – to be at
  • 4EAE – for ever and ever
  • 53X – sex
  • 775 – kiss me
  • ?^ – hook up?
  • BAE – before anyone else
  • IWSN – I want sex now
  • ITX – intense text sex
  • NP4NP – naked pic for naked pic
  • 1174 – strip club

 

Unhappy/Angry

 

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  • < 3 – broken heart or heart
  • 182 – I hate you (1 stands for “I”, 8 stands for “hate”, 2 stands for “you”)
  • 2G2BT – Too good to be true
  • 2M2H – Too much to handle
  • Blarg, Blargh – similar to “darn” but deeper
  • Butthurt – receiving a personal insult
  • Salty – being bitter about something or someone
  • Watered – feeling sad, hurt
  • Wrecked – messed up
  • 4FS – For F***’s Sake
  • Poof – disappearing
  • ::poof:: – I’m gone
  • Ghost – disappear
  • 555555 – sobbing, crying one’s eyes out
  • ADIH – another day in Hell
  • KMN – kill me now
  • VSF – very sad face
  • KMS – kill myself
  • KYS – kill yourself
  • 187 – homicide

 

Drugs/Risky Behavior (to be revisited more in depth)

drugs.jpg

  • 420 – marijuana
  • 420 – let’s get high
  • A/S/L/P – age/sex/location/picture
  • A3 – anytime, anyplace, anywhere
  • LMIRL – lets meet in real life
  • WYRN – what is your real name?
  • Chrismas tree – marijuana
  • Catnip – marijuana
  • Gold – drugs
  • Gummy Bears – drugs
  • Blues/Bananas – narcotics
  • Bars – benzodiazepines
  • Smarties/Skittles – Adderall/Ritalin
  • Ski Equipment/Yayo– cocaine
  • Cola – cocaine
  • Candy/Chocolate Chips/Sweets/Smarties/E – ecstasy
  • Crystal Skull/Wizard – synthetic marijuana
  • Hazel – heroin
  • Gat – gun/firearm
  • Lit – getting high/drunk
  • Smash(ed) – getting drunk, stoned, or having sex

 

Parents nearby

parents.jpg

  • 9 – parent is watching
  • 99 – parent is not watching anymore
  • P911 – parent alert (parent 911)
  • PAL – parents are listening
  • PAW – parents are watching
  • POS – parents over shoulder
  • AITR – adult in the room
  • CD9 – code 9 – parents in the room
  • KPC – keep parents clueless
  • RU/18 – are you over 18

 

And the above is just a small sample of some of the terms used these days.  This list continues to grow by the day so parents need to always be aware.  Kids want to KPC and avoid POS so be ready for the next group of codes being created as we speak……

 

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

 

Posted in Education, Health, Millennials, news

Finals Week: Your Survival Guide

Millions of high school, college and graduate students are entering the most stressful time of the semester: Final’s Week.  Here’s your guide to getting through it:

Map out your strategy

Your time is divisible so grab a calculator and aliquot into equal periods.  Make sure you have extra sessions included for breaks and catch up sessions.  Or you can use a calendar that is already compartmentalized on which to create your timetable.

timetable.jpg

 

Clean your desk!

A nice clean, crisp desk with plenty of pens and highlighters helps energize one more than cluttered paper.  Moreover have a second work space you can go to when you get sick of working at your desk.

desk.jpg

 

Prioritize

Now this is easier said than done. Some will put their hardest classes on their study calendar first, some the easiest.  There are pros and cons to both. What I suggest is alternating difficult and easy subjects.  You need the start of your day and initial power hours knocking out the difficult material, but then the easier classes will boost your confidence and sometimes energy.  So one option could be:

  • Study block 1:  Tough subject
  • Study block 2:  Easy subject
  • Study block 3:  Medium subject
  • Hour 4:  Review
  • With breaks, of course, in between.

 

Take real breaks!

You should design two types of breaks: Short and Long.

Your short break should be no shorter than 10 minutes.  During the break you must do the following:

  • Get up and stretch
  • Drink water
  • Eat a small snack
  • Go to the bathroom
  • Listen to some music, dance, phone a friend

call.jpg

Your long break should be no shorter than 45 minutes.  During these breaks you can:

  • Eat a regular meal, if due, and drink plenty of fluids
  • Take a small nap
  • Take a shower – helps refresh and energize
  • Check social media – stick to your time limit though!
  • Watch a 30 minute episode of your favorite sitcom
  • Exercise such as going for a run

 

run.jpg

 

Identify signs of burnout

If you’re “going through the motions” of studying and feel “burnt” you won’t be absorbing the material and subsequently you’ll be wasting precious hours.  You must identify burnout by looking for the following:

  • Apathy
  • Exhaustion
  • Poor sleep when you get done in the evening
  • Negative attitude towards school and others
  • Procrastinating your next study block
  • Being irritated
  • Feeling empty
  • Low energy
  • Thinking about quitting

 

Burnout_lady.jpg

 

How to avoid burnout

When studying for finals it’s difficult to avoid the boredom and stress, but the following may help:

  • Study with friends
  • Mix up your study sessions with videos and flash cards if reading gets overwhelming
  • Watch a short funny video to get you laughing
  • Take regular breaks
  • Make sure you’re eating and sleeping well

 

seb-graph1.jpg

 

Finals week is never supposed to be easy so accept it and own it!  But put your health first since you can always make up a test……

 

dw sketch.jpg

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

Posted in Education, Employment, Health, news

Woman Arrested After Passing Gas and Then Pulling Knife on Offended Bystander

Embarrassment many time leads to violence.

This week a woman who was embarrassed by a remark after she passed gas pulled a knife, threatening to “gut” him.

thelist-embarrass-primary-100607167-large

37-year-old Shanetta Wilson was standing in line at the Dollar General Store in Broward County, Florida, when she let loose some loud gas.  When a man confronted her on how loud it was, she allegedly pulled a knife out of her purse, threatened she would “gut” him and appeared to lunge.  She was arrested with a charge of aggravated assault with a deadly weapon (the knife, not the fart).

 

shanetta_yvette_wilson-m

 

Does embarrassment lead to violence?

One of the most undercited reasons for violence is embarrassment.  Violence that ensues after one is fired, rejected, ousted or expelled appears to occur fairly often.

Last year in the same county, 17 people were killed at Marjory Stoneman Douglas High School by Nicholas Cruz, who was previously expelled by the school.

Last month a man rejected by his fiancée killed her and two others at a Chicago hospital.

In August a 14 year-old Oklahoma teen stabbed a 16 year-old 11 times after she rejected his request for a relationship.

Now, most likely many of these soon-to-be-violent individuals are rejected due to their odd behaviors.  However, the time surrounding the “embarrassment” may be the most dangerous.

Hence society’s approach to stopping domestic and workplace violence may need to tap in on key times that surround one’s expulsion.

 

 

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Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.

She is also a Board Certified Family Physician and Assistant Professor at Touro University Nevada