Volume 4
Pathways Through Medicine: Specialty Choice
Committing to medicine as a career represents the culmination of a long and perhaps convoluted decision-making process, but the process does not end here. How medical students pick their specialties is another process with its own twists and turns. In addition to offering insight into the Match process, current and prospective residents share their stories on why they avoided certain specialties, how far they deviated from their initial choices, and how they ultimately fell in love with their chosen specialty.
In Defense of Pharmacoepidemiology — Embracing the Yin and Yang of Drug Research – An NEJM Perspective Article
J Avorn, NEJM, November 29 2007, Vol 357 (22), 2219-21
Pharmaceutical companies often study drug effects on an epidemiological scale, observing large numbers of patients in settings of routine care. Pharmacoepidemiology can offer insights not given by the randomized, controlled trial, the traditional means of assessing drugs. Although several notorious examples of misleading epidemiological studies mar the practice of observational study, the author defends pharmacoepidemiology as a budding, promising tool for drug evaluation.
Electroconvulsive Therapy for Depression – An NEJM Clinical Therapeutics Article
SH Lisanby, NEJM, November 8 2007, Vol 357 (19), 1939-45
Electroconvulsive therapy (ECT) applies electricity to the scalp to induce seizure activity as a treatment for depression. In this NEJM feature, a case vignette of a woman with a history of depression is presented, followed by extensive discussion of depression and characterization of ECT as a valid treatment alternative. The author then gives her own clinical recommendation for the patient.
Incidental Findings on Brain MRI in the General Population – An NEJM Original Article
MW Vernooij et al, NEJM, November 1 2007, Vol 357 (18), 1821-8
Magnetic resonance imaging of the brain has improved considerably over the past decade, allowing the detection of unexpected brain abnormalities such as brain tumors and aneurysms. The authors studied 2000 patients of the general population to determine the prevalence of these abnormalities. They document a surprising prevalence of incidental brain findings, suggesting a valuable role of neuroimaging in preventative treatment.
Health Information in Developing Countries
While accessing health information in the United States may be a simple task, it is profoundly difficult for many clinics in resource-poor settings. In this article, we describe health programs that face obstacles in the absence of an information infrastructure. We also discuss the performance of innovative programs to bring new information technology to developing countries.
Unlinking Poverty and Poor Health
How much can you do in fifteen minutes of contact with a patient? Some physicians feel that the answer is “much less than ideal,” when it comes to treating patients afflicted not just by immediate illnesses, but by a grander issue–poverty. Next Gen presents some of the challenges and frustrations related medicine in light of greater social contexts; and features an organization, Project HEALTH, that has started to tackle the problem, to involve students, and to infuse a sense of optimism
Pathways Through Medicine: Pediatrics
Imagine tending to patients who do not know how to describe their symptoms well, who are dependent on other people for decisions, whose bodily systems work differently from the majority of the population, who are prone to injuring themselves, who are ever changing…And imagine caring for them for decades at a time. This is the job of a pediatrician. Think you have what it takes? Dr. Sean Palfrey from the Boston Medical Center describes his specialty.
We Can Do Better—Improving the Health of the American People – An NEJM Special Article
SA Schroeder, NEJM, September 20 2007, Vol 357 (12), 1221-8
United States healthcare has been ridiculed for spending the greatest amount per capita yet achieving mediocre health results. In this special article, Dr. Shroeder of UCSF suggests that the greatest opportunities to improve health lie in improving personal behavior and addressing the health of the poor. He then speculates that lack of social advocacy for the poor and the laissez-faire health system encourages poor health outcomes.
Guilty, Afraid, and Alone—Struggling with Medical Error – A NEJM Perspective Article
T Delbanco and SK Bell, NEJM, October 25 2007, Vol 357 (17), 1682-3
Medical error creates an agonizing experience for patients, family members, and clinicians alike, and feelings of guilt or blame hinder closure and forgiveness. Dr. Delbanco describes cases of medical error and perspectives from all sides. He then suggests that honest and direct communication may be the best antidote, especially when doctors are paralyzed by shame or fear of legal repercussions, and patients and families struggle to understand their situation fully.
Human Papillomavirus DNA versus Papanicolaou Screening Tests for Cervical Cancer – An NEJM Original Article
MH Mayrand et al., NEJM, October 18 2007, Vol 357 (16), 1579-88
The sexually-transmitted human papillomavirus (HPV) is a necessary factor in almost all cases of cervical cancer, and early detection can ward off serious complications. While the Pap smear is the most common test worldwide, testing for DNA of HPV may be superior in sensitivity. Dr. Mayrand and colleagues report the first screening round comparing DNA testing and Pap testing in parallel and finds DNA testing more sensitive for detection of cervical cancer.
