tPA is indicated for up to 3 hours past the onset of a stroke. But what to do when >80% of patients come after that?
1. Intracerebral tPA for up to 6-8 hours
2. MERCI catheter: an intra-cerebral catheter placed DIRECTLY into the brain to remove the clot! WOW!!!
Take a Look at www.Youtube.com and search the latest video!! New procedures to remove clot and REVERSE a stroke!!! Seriously
Search as ‘Routine Miracles Stroke treatment’
Letters are very positive in over 90% of cases. How then, can tehy be used to tell the difference between candidates?
If EVERYONE is said to be GREAT, then who is truly great?
Most letters are outright useless. They tend to all sound the same. Many letters often re-state the CV and that is useless. Although it is nice that letters say things like ‘Bob is smart” and “jane is hardworking” that is the same in all of them.
I never saw a letter that said “Bob is a Moron” ‘Jane is and incompetent idiot”
QUESTIONS:
1. Status of letter wrtiter VS Content: It is BETTER to have a really distinct letter that says something about you as a person, than to have a superficial letter from a ‘big’ person. It is better to have big CONTENT rather than superficial content from a big PERSON.
In 95% of cases or more, the reader is NOT going to know who the writer is. Hence, saying something about you as an individual is more important.
If the Chief Justice of the Supreme Court wrote a thin letter about me, I think it would be okay, but short of that, content rules
2. IMG’s : Yes, it is OKAY to use letters from your own country. People understand that you can’t all have US letter
3. Family: Try not to have all your letters with the same last name as you.YOu think I am kidding?
“Dr A. Patel is supported with four letters from Drs. B. Patel, C. Patel, D. Patel and E. Patel”
I wish it was a joke
Remember, content is more important than the person.
Research done by most residents is largely a pro-forma illusion to give program directors the impression you have done something worthwhile.
I rarely have seen a resident sincerely interested in advancing medicine. I see people EVERY DAY competing for high payed subspecialty fellowships.
Oh how I long for a genuine desire to eradicate illness.
Research is hard to measure for most program directors. A published article in peer reviewed journals is very clear, but “I was in the lab” for a few months is hard to measure.
If there are two applicants of equal value, both with similar school and USMLE scores, then research will make a difference.
A small project completed all the way and presented at a meeting of for publication is MUCH better than just a rotation.
Those with illness deserve to be taken care of no matter who they are.
Each life has intrinsic value irregardless of the ability to pay.
No one is in the position to determine that any person’s life is unworthy of the cost of their health. Even the most reprehensible personalities deserve kindness. Mercy is the only solvent for hatred.
Cost should NOT be the FIRST concern in our debate on healthcare. Life alone, simply being alive, has greater value than payments.
In our civilization, the world looks at American values. They can’t avoid it even when they want to. As the leading exporter of movies, TV and entertainment, our cultural values are observed by everyone on this planet.
They are watching us now.
They are watching to see if we, who rightly so, pride ourselves on fairness, justice, freedom and hope, will make a commodity of our citizens’ lives.
We are under the microscope.
Everytime a fool on TV insists the United States cannot pay for healthcare for its own citizens, we degrade our whole civilization and embarass ourselves in the eyes of the world.
Every time we allow someone to screach hysterically about a non-existent ‘death panel’ or ‘who’s going to pay for this healthcare plan?” we diminish our ability to stand up for what is best in human civilization.
To unleash the explosive creativity of the human spirit and to protect the weak must be the goal of our world’s civilization.
Every mind in the world can spill into each other with tweets. Yet, 1000 people a week feel hopeless enough to commit suicide from depression, loneliness and despair
Corn is produced at such velocity and volume that a single country can supply the world, yet 20% of children go to bed hungry each night.
Racial understanding progresses to the point that the most powerful man in the world is an elected black man, yet ethnic tribalism, and “honor killings” of women exist unregulated. This week’s Journal of the American Medical Association reports a 30% rate of intimate partner violence against women in India.
We are on the cusp. Which shall it be?
Let’s stay on course.
Our moral authority in the world evaporates a little every moment we delay in providing healthcare for all of our citizens. Our political power to stand up against outrages in other countries is lessened.
Today in our country, someone will die of an illness that could have been prevented had they access to care.
When you stand up for universal healthcare, you stand up for a great civilization. When you oppose the histrionic hatred of someone demanding that we show payment before providing help you are protecting everyone in the world.
The world is watching how we treat the most vulnerable in our own society.
The cost of leaving them unprotected far exceeds any dollar amount. We will NEVER be heard when we speak out against a human rights abuse in another country, when we allow the abuse of human rights at home
A day delayed in providing universal coverage is a human rights abuse. The height our civilization can reach is being measured by our action on healthcare reform.
In the tragedy of having your friends mother hit by a car, can you imagine the horrible thought of having to think at the same time about how to pay for it?
What kind of country are we living in, where someone has to say “Do everything, we will pay for it! We will even sell our house”
That is what I heard this morning and I think it is wrong to have to put anyone in this position.
There is a great moral challenge in front of us at this moment. I encourage you to remain awake during a great revolution. Many are asking ‘Do we have to pay for those who are UNdeserving?”
Who will choose “Undeserving?”
Am I my brother’s keeper?
The answer to that is supposed to be yes.
“Dr Fischer, is it okay to apply to two programs in the same hospital?”
ANSWER:
NO problem!
First of all, there is NOTHING unethical or unprofessional about doing this. Second, there is virtually no chance of anyone knowing.
Try not to interview with both places on the same day:)
For example, you do not have to go in disguise, removing glasses or a new hat to hide yourself.
Also, it is like looking for a new husband. Is it okay to see two men living in the same building? YES!
Should you tell them “By the way, I like this building I just went on a date with your next door neighbor last night!”
NO! Just like dating, don’t tell people about the competition. that is different.
Again it is NOT unethical or illegal to apply to two programs in the same hospital.
Pat Imperato is the Dean of the School of Public health and a man who worked on Smallpox eradication in the 1960’s.
He was the Commisioner of Health of NYC in the past. His story truly spans, in a single lifetime, the eradication and control of many of the most horrible of diseases and tragedies for humankind.
If you are feeling turmoil about medicine, watch this and feel our triumph!
The issue of healthcare reform must be framed as one of asking “What is the nature of the civilization in which we wish to live?”
Is it true that if we lift up ‘the bottom” of the society that EVERYONE moves up? My impression is that this is true. I am deeply disturbed by those viewing the healthcare reform debate as one of economics.
The point is compassion. We will not, in this country , have to choose between a new pair of shoes for our children and the healthcare of ourselves. We do not diminish our own level of healthcare by making sure others have theirs.
That is an incorrect fear.
What will we choose? Fear of our own loss? or the reality of another person’s injury? Will you allow a group of people hysterical with the panicked fear of an imaginary injury to kick people out of the lifeboat that has room enough for all?
Many are terrified of their not being ‘enough’ for everyone. I am writing to assure you that there is, indeed, ‘enough’ for everyone to be covered, and to be covered well. Will you, in good conscience, tell someone ‘You don’t DESERVE to have your coverage payed for?”
We are giving $4,500 for new cars just to stimulate sales. $4,500 is enough almost to cover one person’s insurance for a year.
How about a ‘Cash for people” program? Are you proud to tell people that you live in a country where supplementing payment for a new car is an EASY and POPULAR societal goal, but making sure someone does not die from undetected colon cancer or go blind from untreated diabetes is NOT a goal?
I am embarrassed by the smallness and meanness of things that people have said.
We are trying to make sure people are protected from injury, illness treated and death prevented.
How is it that we are allowing this debate to be characterized by voices of hatred, outright hatred of simple sick people?
I believe it is our duty to stand up for those less fortunate than ourselves and to take care of them.
In a civilization you can be proud of, even those considered ‘undeserving’ have to be taken care of. If commerce is our highest goal, then let us eliminate all charities, all generosity. Let us introduce a bill to ban kindness. Does kindness generate income?
then, let us elimate Art, Music and the study of history and theology, unless they can be made self-sufficient economically.
We have a duty to take care of sick people even if some people think they don’t “deserve it”.
Our greatness, our Nobility as individuals is enlarged simply because it is NOT a matter of profit to take care of them. Let us grow the large heart of a society that we wish to be Noble.
Okay Dr. Fischer, You have badmouthed all the crappy personal statements, now, what would you actually do to make a good one?
1. What are your core values?
2. What do you REALLY care about?
3. Tell a story
The subject does NOT matter. What matters is that you write about something you care about and worked on and learned something from
It can be in medicine, it can be art work. It should be a ‘Life-defining” event
25% of my book “Routine Miracles” could be thought of as an elaborate personal statement.
I once knew a guy, who put in his personal statement
“To See a world,
In a Grain of Sand,
And Heaven in a wild Flower,
Hold infinity in the palm of your hand,
And eternity in one hour”
The student’s counselor said “Aren’t you weird ENOUGH? You need to take this OUT”
So, I kept it in.
The ONLY place that commented on my personal statement was the place I put number FOUR on my rank list.
I matched there.
One person’s “Weird” is another person’s “Interesting”
BE TRUE TO WHAT YOU CARE ABOUT~!!!!
You will notice, that the main bulk of anxiety about a personal statement is based on trying to fake it, to tell them what you THINK they want to hear.
Intercourse ($(#@^) them!!!!
Just get the punctuation right!
🙂
Conrad Fischer's Blog 