2004-2025 Form

Am I the only combat medic to answer this so far?Yes you can. Medics are taught how to but not instructed to. There is a terrible and fine line out there in “the suck” that medics, and medics alone, are asked to walk.You don’t end a person’s life. Full stop. In the rare case that a soldier is mortally wounded (no way to maintain an airway or control bleeding and no higher medical assets within a reasonable time)… then a medic could administer an extra ampule of or two. Even though the doctors and instructors teach the medics this, in the end it’s on that one person’s shoulders. And conscience.Is it better to leave your friend/co-worker screaming in agony until they are too weak to yell? Then watch them convulse every few minutes for a couple of hours. Then finally they stop responding to your voice or even painful stimulus.Brain death is setting in. It takes a few minutes or a few days.Every minute you have a seriously wounded soldier in your unit you have medics that are out of the fight. You also have a much more complicated command situation. Nobody (NOBODY) makes this decision lightly. They also never talk about it.In the movies there is always an EVAC helicopter with escort available and ready to risk anything to get to the wounded. In combat it’s not always possible. “Birds” get grounded for many reasons and MEDEVAC Strykers are delayed by the need for escort vehicles/crews and IED laden roads. In almost all cases, the wounded will live to see the operating room. In some form.Combat wounded are intense. Gunfire is still raging in many cases. People are yelling, confusion is everywhere. The medic will be well trained but under a lot of stress. They know that they have to address breathing and bleeding in 2–3 minutes. They also need to avoid causing further injury and find any hidden wounds. While doing this they have to coordinate any available soldiers with combat lifesaver training to assist them with this or other injured. Finally, they also have to constantly keep the command apprised of the situation.Who has X injury?Can they return to the fight?Do they need to be evacuated from battle or can we take them with us?If they need to go NOW, how long do they realistically have?Can we ground evac through the combat or do we need a bird?While answering all of that the medic has assessed the wounded. Tried to control the bleeding and established a secure airway. Then they need to find a vein for an IV (super hard on a patient with blood loss or missing limbs). While doing this they also need to fill out the ‘9 Line’ medical evacuation form for the radio. Once this is done the medic will check the field dressings, the IV, the breathing. Record the wounds and vitals. Mark when/if was given (how much, when, where administered) and done so that the surgeon can see it and blood doesn’t wash it away. Often in black sharpie on the forehead if patient is unconscious- as awful as that sounds it works well.So, don’t talk about the morality of this until you walk a mile (or 26) in a medic’s boots. Don’t talk about what happens until you live and work with a small team of men and women in a combat zone for over a year at a time. Infantry units are closer than most marriages/families. Your platoon SGT is dad and doc is mom. It’s a horrific moment to see one of your guys literally torn in half and dying. It’s much worse to know that due to a sandstorm there aren’t any flights that day. It’s hell on earth when you realize nobody is coming by road because of the IED you just hit. It’s unimaginable when you realize you only have 2 ampules left and 3 critically wounded friends.I didn’t have to make the hardest choice. I wouldn’t tell you if I did. I sure as &$*# wouldn’t take any judgement from you in any case.Great question. I hope someone who actually held this responsibility in combat can clear it up a little.

Not at the diagnosis itself but getting here has been kind of amusing.A few years back, a doctor looking at a chest x-ray noticed that I had a healed crushed vertebra. I knew that I had hurt my back a year earlier but didn’t realize it was a crushed vertebra. When I told her that I got it lifting a shop-vac into my pickup truck, she was suspicious. As a (then) early 50’s male, I shouldn’t have bones getting crushed for something that innocuous. She ran some tests that showed that I had abnormally low bone density but everything else was fine. She suggested that I see a specialist.After a (long story) while I get to see an hematologist/oncologist. They start doing some measurements of protein in my blood. The value keeps rising. Bone marrow and biopsy tests from my hip shows unusual cells. The doctor says I have Waldenstrom’s macroglobulinemia. But … they keep testing and the protein value roughly stabilizes. It’s too high but not high enough for a definitive Waldenstrom’s diagnosis. I have Monoclonal Globulinemia of Unspecified Significance, MGUS. Treatment is to watch and wait to see if it develops into something more serious.This summer, I crush another vertebra lifting up a computer. MRI scan shows a tumor in the crushed vertebra and the vertebra next to it as well as some other damage. Diagnosis? Multiple myeloma.I get signed up for a clinical study for multiple myeloma. Doctors need to get another bone marrow and biopsy from my hip to baseline my condition before starting treatment. Diagnosis? Not multiple myeloma. It’s Waldenstrom’s.The hematologist wants to have a back specialist take a look. When I see the very experienced back specialist he says that he’s never seen Waldenstrom’s lead to crushed vertebra. Diagnosis? It’s probably multiple myeloma.But, importantly, he says we can’t keep guessing. We need to get a bone marrow and biopsy test from the vertebra to be certain. Result? It’s Waldenstrom’s. Everybody is now in agreement.I know way more about my immune system than I ever expected to know.

Usually there is a one or maybe a two-page form. I don't think they are that difficult to fill out. They copy my insurance card and that's it. Generally they include a brief list of history questions and current symptom questions. If it is a current doctor, only the current symptom questions. As I am not the one with the medical degree, I hope they use those answers to put two and two together in case my sore throat, indigestion, headache or fever is part of a bigger picture of something more seriously wrong. The HIPAA form is long to read, but you only need to do that once (although you'll be expected to sign the release each time you see a new doctor or visit a new clinic or hospital).

There are many (many) reasons - so I'll list a few of the ones that I can think of off-hand.Here in the U.S. - we have a multi-party system: Provider-Payer-Patient (unlike other countries that have either a single payer - or universal coverage - or both). Given all the competing interests - at various times - incentives are often mis-aligned around the sharing of actual patient dataThose mis-aligned incentives have not, historically, focused on patient-centered solutions.  That's starting to change - but slowly - and only fairly recently.Small practices are the proverbial "last mile" in healthcare - so many are still paper basedThere are still tens/hundreds of thousands of small practices (1-9 docs) - and a lot of healthcare is still delivered through the small practice demographicThere are many types of specialties - and practice types - and they have different needs around patient data (an optometrist's needs are different from a dentist - which is different from a cardiologist)Both sides of the equation - doctors and patients - are very mobile (we move, change employers - doctors move, change practices) - and there is no "centralized" data store with each persons digitized health information.As we move and age - and unless we have a chronic condition - our health data can become relatively obsolete - fairly quickly (lab results from a year ago are of limited use today)Most of us (in terms of the population as a whole) are only infrequent users of the healthcare system more broadly (cold, flu, stomach, UTI etc....). In other words, we're pretty healthy, so issues around healthcare (and it's use) is a lower priorityThere is a signNow loss of productivity when a practice moves from paper to electronic health records (thus the government "stimulus" funding - which is working - but still a long way to go)The penalties for PHI data bsignNow under HIPAA are signNow - so there has been a reluctance/fear to rely on electronic data.  This is also why the vast majority of data bsignNowes are paper-based (typically USPS)This is why solutions like Google Health - and Revolution Health before them - failed - and closed completely (as in please remove your data - the service will no longer be available)All of which are contributing factors to why the U.S. Healthcare System looks like this:===============Chart Source: Mary Meeker - USA, Inc. (2011) - link here:http://www.kpcb.com/insights/usa...

There are many types of misconceptions about physicians.The worst type of misconception is what I would like to call the “conspiracy theorist” misconception. There are many folks out there who imagine that physicians get kickbacks (illegal) for everything they do, from giving vaccines to writing prescriptions to ordering lab tests. Nope. Sorry to disappoint. We get paid for the visit, and we get reimbursed for procedures. The same conspiracy theorists often speculate that we are “hiding the cure” for everything from cancer to diabetes, in order to…um…make you all sick so we can make money off of your misery. These people fail to make the important connection that if I had the “cure” for anything, I would be fabulously wealthy. Cures would be selling like hotcakes! We would not hide them, we would be appearing on Shark Tank looking for investors. And we would be giving them to ourselves instead of dying like the rest of you.Next up is the “perfection” misconceptions about doctors. People imagine that doctors don’t get sick, don’t get cancer, don’t die just like everyone else. They have NO IDEA what we are going through as we smile and care for them. Many of us are hiding chronic pain, cancer, loss, depression, and every other malady known to man. We just don’t tell you when you walk in to see us. In fact, doctors have the highest rate of SUICIDE among all professions. Mostly because we are not permitted to seem weak, fallible, or depressed, while at the same time being held to expectations of perfection that are impossible for ordinary humans to meet. There is an old saying that “nobody is perfect.” Doctors are not perfect, but if we do not perform perfectly, we could be responsible for someone’s death or disability. Every decision that you make, every single day, bears this burden. It is a heavy burden.Another misconception is that we are fabulously wealthy. Yes, in our mid life, we do make very good salaries. But people do not have the slightest idea of what happened to us before the good salary came along. We bought 4 years college, 4 years med school, we have enough debt to buy a nice house, then we go to residency for 3–7 years (11–15 total years of training), where we get the equivalent of minimum wage as we work 80–120 hours per week, and defer the loans we can’t afford to pay back. We give up our twenties. Yes, the best decade of our life and youth is absolutely sacrificed for the profession. We do things like sell our blood, sell our bone marrow, sign up for drug tests, sign up for cosmetic testing (ever wonder how “animal free” testing works? They test it on medical students). I rummaged through the trash for return bottles, dragged furniture off the curb on trash day. Now I make six figures. There are easier ways to make a buck. I am not fabulously wealthy. It hurts when people make sarcastic remarks about my “money” as people often do. “You are a doctor, give me some of your money,” is something I have heard (literally, those very words) multiple times. Typically with a sneer.There is one thing that is portrayed in the media that is absolutely true, though. We are all “super hot” and “mcSteamy + mcDreamy” gorgeous model worthy people who go through every day with perfect hair, buff bodies, witty banter, and oh yeah we have liasons in the broom closet with one another. Jealous? Of course you are.

I was selected for a summer internship 2016.I tried to be very open while filling the preference form: I choose many products as my favorite products and I said I'm open about the team I want to join.I even was very open in the  location and start date to get host matching interviews (I negotiated the start date in the interview until both me and my host were happy.) You could ask your recruiter to review your form (there are very cool and could help you a lot since they have a bigger experience).Do a search on the potential team.Before the interviews,  try to find smart question that you are going to ask for the potential host (do a search on the team  to find nice and deep questions to impress your host). Prepare well your resume.You are very likely not going to get algorithm/data structure questions like in the first round. It's going to be just some friendly chat if you are lucky. If your potential team is working on something like machine learning, expect that  they are going to ask you questions about machine learning, courses related to machine learning you have and relevant experience (projects, internship). Of course you have to study that before the interview. Take as long time as you need if you feel rusty. It takes some time to get ready for the host matching (it's less than the technical interview)  but it's worth it of course.

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