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I'm confused, is Harvard NP Naturopathic or Nurse Practioner? What does HST stand for?
Well, I called Case and they told me to email them to ask for an extension, haven't gotten any word back yet. So if they don't allow it, then Miami it is 😀
Man, I had some weird dreams last night, I can't remember any specifics, but I can vaguely remember choosing Case and trying to cook crack....
Susan Mackie said:The Value of DNKs
Smiling and joking, having realized that her medical problems were in good hands, Ms. W. rose to leave my exam room. Knowing that my residency is limited in time, she asked nervously how long I would be in the practice — and expressed relief when I told her that I would be here with her for the next few years. I returned her smile, and the warm emotion I expressed was genuine. I had helped her, she trusted me, and I was doing what I loved. Ms. W.'s appointment was my last one for the day. I would go home and rest on my laurels. I was a good primary care doctor.
As I closed the door and slumped into my chair to begin my tedious dictation routine, I thought about the previous day. Then, my clinic had felt frenetic, I had felt cynical, and I know that my patients had left dissatisfied. What had changed? There were many possible factors — from what I had eaten for lunch to the traffic my patients had fought on their journey in — but one difference stood out in my mind: DNKs. DNK (pronounced "dink" and always uttered wistfully by the residents in my program) is the abbreviation that appears on our online schedule when a patient "did not keep" an appointment. DNKs obviously represent suboptimal care for the DNKing patients, as well as a financial loss for the practice. But as residents, we have all been guilty of hoping for DNKs in our schedule. I had always thought of this desire as a sign of laziness, but on that day, I began to suspect that the reason I felt I was a good doctor was largely the result of my two DNKs. DNKs create time. Time allows us to build relationships. And what is primary care about if not relationships?
My preceptor, a seasoned primary care physician, has been teaching me how to "make a 10-minute visit feel like a 60-minute visit." I've learned to incorporate some of her tricks — constructive listening to demonstrate empathy, adept questioning to elicit pertinent information, and good doses of eye contact thrown in at every step. These strategies have been immensely helpful as I strive to develop the effectiveness I see in my primary care mentors.
But when I consider the pivotal role that a few extra minutes' time played in the quality of the care I was able to provide, I question the validity, or at least the completeness, of this approach. Today, I am confident that Ms. W. is taking her medications as prescribed. On my advice, she is also planning to incorporate deep-breathing exercises into her daily routine to manage her anxiety-associated abdominal pain. These valuable conversations would not have happened without the extra 20 minutes we spent together. Although I have only 18 months of experience as a primary care physician, I have 28 years of experience as a human being, much of which has been spent developing relationships. My impression of that process thus far is that there is no substitute for time. Either I am not skilled enough to make 10 minutes be 60 minutes, or there is something real about clock time. I suspect it's the latter.
As I progress in my career, pressures to improve the quality of the care I provide will inevitably grow, as will my patients' expectations. Less certain is what will happen to the amount of time I can devote to the care of each patient. Enthusiastically, and perhaps naively, I have mentioned to my mentors that I look forward to a future in which I will be able to share responsibilities with nurse practitioners and physician's assistants in such a way that my appointments with patients will be fewer, more thorough, and more satisfying for everyone involved. None of the experienced physicians I've talked to have confidently embraced this vision. Perhaps they have seen too many changes for the worse to believe that a change for the better is possible.
I don't know the solution to the complex problem of payment for health care. Even in a hypothetical world with unlimited funding for primary care, I couldn't profess to know the ideal format for a patient's interaction with the health care system. Yet I firmly believe that adequate time — not simply perceived time, but real time — is an indispensable component of our encounters with patients if we are to be good doctors. How sufficient time can be most effectively incorporated into the structure of primary care delivery, given its payment constraints and expectations of quality, should be the subject of ongoing research, as new policies are codified. In the meantime, I will continue to take guilty pleasure from DNKs.
I'm confused, is Harvard NP Naturopathic or Nurse Practioner? What does HST stand for?
really? COMPLETELY different? I didn't even know that. so I guess we wont even see you. haha
I'm confused, is Harvard NP Naturopathic or Nurse Practioner? What does HST stand for?
Maybe it's a sign, picking case = smoking crack?![]()
NP = New Pathway (not so new. just straight M.D. path)
HST = Harvard & MIT Health Sciences & Technology (joint classes at MIT. used to make physician-scientists. kinda the halfway point between MD and MD/PhD. would you say, jla?)
Maybe it's a sign, picking case = smoking crack?![]()
you are faster than me. yeah HST is very academic and seems to be well suited for engineers. something like 1/3 of HST is MD/PhD, and 1/3 extend their studies to do a fifth year of research.
jolt are you all set on HMS??
NP = New Pathway (not so new. just straight M.D. path)
HST = Harvard & MIT Health Sciences & Technology (joint classes at MIT. used to make physician-scientists. kinda the halfway point between MD and MD/PhD. would you say, jla?)
Yeah, you guys have a block schedule but we have a semester format (4 classes/semester). Makes it hard to overlap 🙁 but we do get the same orientation!
NP = new pathway, HST = health sciences & technology. They're the two tracks at HMS that both lead to an MD degree (although HST is also a graduate program with PhD students in it)
crack is whack
Let's keep the streak of us answering questions for each other going:
Yes, he is.
well so far, we've only been answering questions for jolt 😀
well true, i guess i thought oakland's question was directed toward you.
i suppose we're just too fast for jolt, or that we hang around sdn too much. i prefer the former explanation 😀
aaaaaawwwwwww.
mornin (well afternoon) ya'll. I miss anything good? Been a crazy couple of days...
going to get worse though - this is Columbia's study week and most finals are on 5/10 or 5/11 so I've got an insane amount tutoring sessions 🙁 Guess I shouldn't really complain though![]()
More sticky pedals, this time at Chrysler. Same supplier as the Toyota ones.
http://news.yahoo.com/s/nm/20100503/us_nm/us_chrysler_pedals
a booby?
![]()
Wow... This thread has moved so fast. I think its bc of the regular night crew now. The hours of 130 to 6 am are covered
100,000 posts is basically inevitable now. Same with 2014 pages.
might be interesting but i dont think it would help that much. every med student i talk to either from other schools or even read on sdn, say that pbl is utter crap and they all hate it. I think its one of those things that is great in theory but in practice fails miserably. Sadly every school does some pbl now...at least the ones im going to limit to a few hrs a week 🙁My school is offering a PBL undergraduate special interests class on Diabetes, taught by a Biochem professor who used to teach at Duke's med-school. This class will offer me nothing towards my degree, but do you guys think it would be good to take it to help for the adjustment into PBL?
I like boobies.
Last couple of nights haven't moved much, but it was the weekend.
might be interesting but i dont think it would help that much. every med student i talk to either from other schools or even read on sdn, say that pbl is utter crap and they all hate it. I think its one of those things that is great in theory but in practice fails miserably. Sadly every school does some pbl now...at least the ones im going to limit to a few hrs a week 🙁
does your school do pbl yoda? (where do you even go? 😕 )
The headquarters is a pretty cool complex.Oakland University is like a mile down the road from the HUGE Chrysler plant.
IMO PBL isn't hard to get acclimated to, so I don't know if I'd take it for that reason. It could be a neat class though if your interested in diabetes or just seeing the diagnostic thought process.My school is offering a PBL undergraduate special interests class on Diabetes, taught by a Biochem professor who used to teach at Duke's med-school. This class will offer me nothing towards my degree, but do you guys think it would be good to take it to help for the adjustment into PBL?
I like boobies.
PBL would be neat if everyone took it seriously.
That HQ looks sweeet.
Bout to be an uncle in a few hours. strangee.
"Hey!" ... ::gone for 4+ years::. Hope I'm not the awkward absent uncle. Hahaha
Congrats!!! Is it a boy or a girl?
Yeah, nothing is ever a lock. But it's always useful to know someone...There's an office in the Chrysler logo of the tall building. It's pretty sick.
I'll still talk to my adviser about that class just to see what he thinks, (he will be an adcomm as well). My physio prof told me I'd be a lock at OU's med-school if I took it, I'm not sure if I believe that statement, but that is the reason I am looking into it.
Congrats.That HQ looks sweeet.
Bout to be an uncle in a few hours. strangee.
"Hey!" ... ::gone for 4+ years::. Hope I'm not the awkward absent uncle. Hahaha
Sameeee heree.
I felt like **** on Day 2 of my second look and have been sick since... I blame the hotel room (I turned the fan on the air conditioner on high because I can't sleep without some noise...probably a bad idea)
No one knows..not even my sister. (well, besides whoever imaged it)
She wanted it to be a surprise. Also, we don't know any name options either... more surprises haha.