The Medical Decoder Fall 2013

MD THE MEDICAL DECODER

Population Health:

Produced byPhi Delta Epsilon

IL Gamma Volume 2

A Glimpse at Future Health Technologiespg. 4

Making the Career Choice: What are Your

Options?pg. 29

Composure and Compassion: The Medical School Interview

pg. 10

A Call For Value-Based

Healthcare

Features

2 ■ The Medical Decoder ■ Phi Delta Epsilon IL Gamma

04 A Glimpse at Future Medical TechnologiesAsia Jaros

20 How Baby Boomers Will Change Orthopedic CareHeather Ables

32 Scalp Cryotherapy: Changing the Face of CancerDevora Isseroff

07 Where Does Alternative Medicine Belong?Roy Yu

23 Population Health: A Call for Value-Based HealthcareZach Snow

34 Primetime PrescriptionsRachel Sibley

10 Composure and Compassion: Medical School InterviewBen Fox

26 Emergency Contraception: A Quick Guide to the Morning AfterSarah Smith

40 References

Making the Career Choice: What are Your Options?Varsha Venkatakrishna

29

Cover photo courtesy of www.skeptikai.com

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Editors in ChiefAditya GhoshWCAS ‘15Sarah SmithWCAS ‘15

Associate EditorsSavan PatelSOC ‘13Mahir KhanWCAS ‘15Charlotte ter HaarMEAS ‘14Anthony AnguieraWCAS ‘14Kevin ZhaoWCAS ‘16Devora IsseroffWCAS ‘15Roy YuWCAS ‘16Alex PezeshkiWCAS ‘13

Writing StaffAsia JarosWCAS ‘14Ben FoxWCAS ‘13Zach SnowWCAS ‘14Roy YuWCAS ‘16Rachel SibleyWCAS ‘15Heather AblesWCAS ‘14Varsha VenkatakrishnaWCAS ‘16Devora IsseroffWCAS ‘15

Design StaffBrandon CaldwellWCAS ‘15Jess GuenzlWCAS ‘16

Creative DirectorSvetlana SlavinWCAS ‘16

PhotographerBryan HuebnerWCAS ‘16

ModelsTricia CruzWCAS ‘17Rachel SibleyWCAS ‘15 Roy YuWCAS ‘16Heather AblesWCAS ‘14Asia JarosWCAS ‘14 Kevin ZhaoWCAS ‘16Bethanie WillisWCAS ‘16

Volume 2 ■ Fall 2013 ■ 3

Left to right: Roy Yu, Arpan Patel, Charlotte ter Haar, Asia Jaros, Heather Ables, Rachel Sibley, Svetlana Slavin, Kevin Zhao, Aditya Ghosh, Bryan Huebner (not pictured: Sarah Smith, Savan Patel, Mahir Khan, Anthony Anguiera, Devora Isseroff, Alex Pezeshki, Ben Fox, Zach Snow, Varsha Venkatakrishna, Brandon Caldwell, Jess Guenzl, Trica Cruz, Bethanie Willis)

I n 1990, the US Department of Ecology and

National Institute of Health began its now

world-renowned Human Genome Project. The

project’s mission was to identify over 20,000 genes

in human DNA, sequence over 3 billion chemical

base pairs, and offer innovative treatment and di-

agnostic tools.1 At the time, the idea of sequenc-

ing a genome was a distant dream. Today, nearly

twenty-five years after the initial undertaking of

the project, genomic sequencing is available to the

public at $3,000-5,000

per genome, and costs

continue to decrease as

more efficient techniques

are developed.1

The medical field con-

tinues to move towards

new technologies, facili-

tation of treatments tailored to

the patient, and the use of less invasive medical

procedures. By the time our generation of physi-

cian-hopefuls leaves medical school, a new slew of

technologies and therapies will undoubtedly sup-

plement, if not replace, some of the current meth-

ods. With the advancement of medical care and

higher levels of disease control, researchers and

doctors have now started tackling more complex

pathology issues.

One such issue that Dr. Anthony Atala of Wake

Forest University Center of Regenerative Medicine

battles on a daily basis is the disparity between

organ availability and demand.2 While the exten-

sion of the average human

lifespan is considered

an achievement in the

medical field, Dr. Atala

reminds us of a painful

reality: as human lifes-

pan increases, the num-

ber of patients with fail-

ing organs increases. Yet,

the number of transplants continues to remain

nearly the same despite the higher demand for or-

gans and a low supply. Today, over 116,000 patients

By AsIA JAros

Color- Coded surgery and organ Printing

The medical field con-tinues to move towards new technologies, facili-tation of treatments tai-lored to the patient, and

use of less invasive medical procedures.


A Glimpse At Future HeAltH tecHnoloGies

anxiously await a new organ on the national trans-

plant list.2,3 Dr. Atala hopes to offer an innovative

approach to the organ shortage problem with an

unusual solution - organ printing.

At his laboratory, where he performs clinical trials,

Dr. Atala uses a CT scanner to scan the patient’s fail-

ing organ. This allows him to obtain exact dimen-

sions and densities of the specific patient’s organ

and customize the design. He then connects this

scan to a 3-D printer, similar to an ink printer. The

3-D organ printer uses cells extracted from the pa-

tient’s own tissue to recreate a copy of the scanned

organ.2

In his 2011 TED talk, Dr. Atala jokingly likened or-

gan printing to “baking a layered cake.”2 His pecu-

liar analogy rings true upon taking a closer look at

the biomechanics of organ recreation. On average,

the process of printing a complete organ takes ap-

proximately 7 hours.2 It requires a printer that can

elevate from level to level as it builds the organ, cell

by cell, similar to stacking and frosting a layered

cake. Although Dr. Atala has been able to recreate

several major organs including the heart and kid-

ney, his project is still in the clinical trial phase and

the organs have yet to be implanted in humans. His

current challenges are: the design of materials that

are not rejected by the patient’s body, the culturing

of stem cells outside of the patient (i.e. liver, pancre-

atic, and nerve cells which are particularly depen-

dent on a human environment), and tissue integra-

tion once implanted into the patient.2,3

Printed organ implants may not be the only nov-

elty on the medical horizon. Dr. Quyen Nguyen, the

director of surgery at the University of San Diego, is

researching the use of a fluorescent probe to flag

tumors and cancers excised during surgery.4,5 A ma-

jor issue with current tumor removal procedures

involves ensuring complete tumor removal during

surgery. This is generally based on a judgment call

by the surgeon about the margins of the tumor,

which are not easily seen with the

naked eye. Experienced surgeons

judge the extent of the tumor by

its size and location based on prior

imaging evaluation of the area,

proximity to other structures, and

by feeling the tumor. This method-

ology is not only inconsistent, but

also highly inefficient and time-consuming. Often-

times, residual portions of the tumor are left at the

margins of the excision area, and these portions re-

main undetected until the excised tumor has been

In an effort to reduce the number of nerve-related injuries surgeons are creating technology to tag nerves with fluorescent green molecules that can increase the visibility of these nerves drastically.

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analyzed by a pathologist. If residual, abnormal tu-

mor cells are present at the margins of the removed

mass, a patient may need to undergo multiple ad-

ditional surgeries, chemotherapy, or radiation to

eliminate the rest of the tumor.4

Dr. Nguyen’s approach involves using a molecular

marker made of fluorescently tagged-polycation,

polyanion, and a linker.4,6 Polycationic materials

tend to adhere to all cells, unless they are attached

to a polyanionic component. This polyanionic com-

ponent restricts the polycation from binding to any

cells. The key to tagging only cancerous tissues is a

linker between the polyanion and polycation por-

tions, which contains a specifically engineered cut-

ting site. This site is tailored so that it can only be

cut by tumor-specific enzymes, for example, prote-

ases, that are present only in cancer tissues. When

this three-part molecular marker is injected into a

cancer patient, enzymes within the tumor cut apart

the polycation from its polyanionic counterpart,

allowing it to bind to tissues and fluoresce. Dur-

ing surgery, the operating surgeon is able to see

exactly where the tumorous spots are by simply

observing fluorescent areas and removing them.

Dr. Nguyen’s idea could have a profound impact

on all types of tumor removal, but especially for

tumors that are located in sensitive areas such as

the brain.6

The myriad of simple, yet ingenious medical

technologies doesn’t stop there. In fact, organ

printing and color-coded surgery just scratch the

surface of what is to come. Current research is be-

ing conducted on self-administered, high-speed

voice-based tests to diagnose Parkinson’s disease,

new gamma-ray cameras to detect tiny tumors up

to two-fifths of an inch within dense breast tissue,

implantable, radio-frequency identification chips

for humans that would carry our medical histo-

ries, insurance information, and more.5,7 It is our

responsibility and challenge as future healthcare

professionals to educate ourselves and continue

this legacy of innovation. If we can expand medical

research to incorporate non-traditional fields such

as mathematics, engineering, economics, psychol-

ogy, and other disciplines to supplement current

technologies, the results will definitely exceed our

current expectations and, more importantly, help

save lives.

For more information check out the online TED

Talks series: The Future of Medicine. ■ MD

For references, see page 40.

3D bioprinting holds tremendous potential for dealing with the rise in demand for organ transplants.

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g rowing up in a Korean-American home

has given me a unique experience that

enables me to find valuable lessons in a variety of

situations. My attitude toward health, for example,

is rather unorthodox because of the way my par-

ents dealt with sickness. Of course, I had my regular

checkups with the pediatrician like everyone else,

but there were several instances where my parents

would provide home remedies. In retrospect, I had

no idea why my parents’ methods worked.

When most people

have indigestion,

they may take an ant-

acid or Alka-Seltzer.

My mom, however,

would use a different home remedy: acupuncture.

First, she would rub my back and arms so that the

blood would flow towards my fingers. Then she

would tie my thumb with a rubber band to constrict

blood flow, prick the part of flesh where the thumb

meets the fingernail, and let the blood out. As she

gently pressed on my thumb, a dark maroon liquid

would ooze out. While the treatment may sound

like it would have no effect, from personal experi-

ence, I can testify that this works like a charm. Af-

ter about fifteen minutes, I would always feel much

better.

As I grew older, I became fascinated and intrigued

by the therapeutic effects of these treatments. Af-

ter doing a bit of research, the best explanation I

could find was based on

the concept of qi in Chi-

nese traditional medi-

cine. Qi (pronounced

“chi”) is the vital force or

energy responsible for controlling the human mind

and body. It flows through the body via channels,

or pathways, which are called meridians. Imbal-

ances in the flow of qi cause illness; correction of

this flow restores the body to balance. Each organ

About 40% of Americans are using some form of alternative medicine.

Where Does

AlternAtiveMeDicine

Belong?


By Roy Yu

has its own qi, whose activity is characterized by

the organ to which it is attached.1 In the case of an

upset stomach, these energies have collided with

each other. The human hand has certain acupunc-

ture points that are assigned to each qi. Therefore,

pricking the thumb tip sends signals to manage the

unbalanced qi.2

By now, you are likely

thinking that this stuff is

either really interesting or

a bunch of nonsense. How

can releasing a few drops

of blood cure indigestion?

When I try to explain it

to my non-Asian friends,

they look at me suspiciously or even laugh. While

it certainly may be a placebo effect of the interven-

tion, there is emerging literature that acupuncture

and other forms of alternative medicine can be ef-

fective for certain conditions or ailments.3

The National Center for Complementary and Al-

ternative Medicine (NCCAM) notes that the terms

“complementary, alternative, and integrative medi-

cine” refer to health care approaches with a history

of use or origin outside of mainstream medicine.4

They include natural products such as herbs and

supplements, as well as mind and body practices

such as acupuncture and massage.4 Other examples

include homeopathy and naturopathy. Homeopa-

thy is a system

of medicine that

involves treat-

ing people with

highly diluted

substances in

order to trig-

ger the body’s

natural system

of healing. It is based on the doctrine of “like cures

like”, which states that a substance that causes the

symptoms of a disease in healthy people will cure

similar symptoms in sick people.5 Naturopathy, or

naturopathic medicine, is a system of medicine

based on the healing power of nature. Naturopathy

is a holistic system, meaning that naturopathic doc-

tors attempt to find the cause of disease by under-

standing the body, mind, and spirit of the pa-

tient. Most naturopathic doctors use a variety

of therapies and techniques, such as nutrition,

behavior change, and herbal medicine.6

Over the recent years, as knowledge of alter-

native medicine techniques have evolved, the

medical field has started to understand the

Over recent years, as knowl-edge of alternative medicine

techniques have evolved, the medical field has started to understand the inherent

benefits of these techniques and has begun incorporating

it into medical care.

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inherent benefits of these techniques and has be-

gun incorporating it into medical care. About 40%

of Americans are using some form of alternative

medicine.4 Many medical schools are also starting

to teach these medicine techniques and theories.7

Several health care providers offer alternative med-

icine in conjunction with conventional therapies,

which is known as “complementary medicine”. The

main difference between alternative and comple-

mentary medicine is that while alternative medicine

is often used instead of conventional techniques,

complementary medi-

cine is used in addition

to them. The combina-

tion of complementary

and alternative medicine

(CAM) with mainstream

medical therapy is called

“integrative medicine.”

Integrative health care

programs are rapidly being incorporated into gen-

eral medical care, as there is new research demon-

strating the immense benefits of this type of care

for the patients. Some cancer treatment centers of-

fer services such as acupuncture and meditation to

help manage symptoms and side effects of conven-

tional cancer treatments, such as chemotherapy.3,4

The scientific basis of medical care emphasizes

that treatments be utilized when they have been

shown to be safe and effective. Some CAM thera-

pies have not shown significant benefit but do not

cause harm and the extent of relief for patients with

a certain therapy may be variable. There is scientific

evidence that supports the use of acupuncture for

cancer related side effects such as nausea, vomiting,

hot flashes, depression and insomnia.3 In another

study, cancer related symptoms of pain, fatigue,

anxiety and depression improved with massage

therapy.8 I am sure that some forms of CAM may

have shown little or no effect. However, research

has clearly shown benefits to certain patients with

use of CAM therapies.

As health care policy

makers decide which

types of treatment are

covered by insurance, I

hope that complemen-

tary and alternative

medicine treatments

are given more consid-

eration in the treatment of the patient. Ongoing

research on CAM can help ensure that patients are

benefited from combining variety of treatment mo-

dalities to ensure the best and sustained long-term

treatment success and health.

■ MD


Integrative health care programs are rapidly be-

ing incorporated into general medical care,

as there is new research demonstrating the im-mense benefits of this

type of care for patients.


‘r efreshingly finite’ is how I’d describe my

feelings as I traveled home from my medi-

cal school interviews. Although my interviews were

the challenging, final hurdles in an extended and

rigorous application to medical school, I walked out

feeling confident I had done my best in communi-

cating why I deserved a seat in medical school. As

I am now in medical school, and given my experi-

ences with this process, my goal is to communicate

the strategies I used while interviewing in hopes

that it can help improve your own interview per-

formance and allow you to also emerge confident

from your medical school interviews. While there is

certainly an exhaustive amount of published advice

on interviewing, I have boiled it down to the most

essential tips that I have learned over the course of

my application process. I will begin with a short in-

troduction to the interview process and then relate

twelve important tips that greatly improved how I

presented myself on interview day.

ComPosure andCompassion

The MedIcAl school InTervIew

By Ben Fox


Simply put, interviewing is perhaps the single

greatest opportunity you will have to prove your-

self to a medical school. Admissions officers review

thousands of redundant sounding GPAs, MCAT

scores, and personal statements that can all blur to-

gether after a while. Fortunately, the interview pro-

vides you with a great opportunity to distinguish

yourself from the sea of applicants. The interview

is your best chance for a medical school to ascer-

tain your character, motivation, and determination.

The written material in your AMCAS primary appli-

cation can only go so far in representing you as a

person, unlike interviewing, which provides you a

critical opportunity to relate to someone during the

admissions process. Your ability to interview can be

a deciding factor during the admissions process,

and if approached correctly, will convince medical

schools you are indeed a good fit for them.

Upon receiving your first interview invitation,

feel confident you will succeed, as much of the

pre-screening of applicants has already been per-

formed. Schools sometimes review upwards of ten

thousand applications and must be highly selec-

tive in who they choose to interview. Thus, a large

majority of applicants to most schools don’t receive

interviews - a disappointing but almost inevitable

outcome for many applicants. Do not feel discour-

aged if you are declined an interview by many of

the schools you apply to as almost all applicants

experience the same thing. In my case, I received

only three interviews after applying to thirty-plus

schools total! While frustrating, I made the most of

those three interviews and realized the high de-

cline rate was happening to most other applicants

as well. In reality, receiving an invitation is actually

more difficult than gaining admission after inter-

viewing. An applicant has anywhere from a 33-50%

chance of gaining admission after receiving an invi-

tation to interview. Thus, receiving an invitation is a

huge accomplishment in and of itself and a reliable

indication that the medical school already deems

you a worthy candidate for their program.

Every school is a little different in terms of how

they interview, but generally, interviewing is con-

ducted in three broad ways. The first entails the

‘traditional’ one-on-one interview, where the appli-

cant is paired with a physician, faculty member, or

admissions advisor for anywhere between thirty to

sixty minutes to discuss the applicant’s motivation

for entering medicine. The second type consists

of a ‘panel’ interview where two to five applicants

are paired with one or two interviewers. Usually,

a question is given to all the applicants, who then

answer in turn. The final type of interviewing is the

multiple mini-interviews (MMI), which is a relative-

ly new interviewing style currently used by fewer

than twenty U.S. allopathic medical schools. Broad-

ly, MMIs have applicants answer eight to ten ques-

tions in separate rooms with different interviewers

over the span of an hour. For each room, the appli-


cant reads a question prompt for two minutes and formulates an answer. The applicant then enters the

room and discusses the answer for six to eight minutes with the interviewer who may provide new infor-

mation to the prompt. At time’s end, the interview repeats the above process until all rooms have been

completed. I encourage you to research the MMI process heavily if you interview at a school that conducts

them. There is definitely much more strategy and information on MMIs than can be related here. Overall,

each interview style presents its own unique challenges. As such, some schools use a combination of in-

terviewing styles or hold multiple interviews. For example, some schools have applicants complete both

a traditional and panel interview, while other schools may have an applicant complete two traditional

interviews with separate faculty.

Whatever the style, I am confident you will find your interview day to be really low-stress and very laid

back. It may feel daunting when twenty to seventy other applicants are interviewing alongside you, but

it is important to calm down either before or during the early stages of your interview. The schools know

interviews are highly stressful, and as such, they take steps to calm you down throughout the day. Many

schools provide a lunch, a Q-and-A session with current students, and a tour around campus. Impor-

tantly, schools do not want you to be distressed by the interview. They have spent a huge amount of time

and energy screening you and thus want to judge your calm and confident self when your motivations

for medicine are clearest. To help you convey your motivation clearly, I will now present the twelve most

important interviewing tips that I feel will help you in developing your interviewing skills. While some tips

seem obvious, you may be surprised when you find yourself making these common mistakes initially, as

many applicants do. However with practice, you will target your weaknesses and eventually become a

more effective and memorable interviewer.

twelve tiPs on mediCal sChool interviewing

1. do not rambleSometimes less is more. Rambling is one of the biggest mistakes made by novice interviewees. It con-

veys that you are nervous or feel unprepared to answer the question. Interviewers are constantly sizing

you up to see whether you would make a competent future colleague of theirs in the medical field where

communicating clearly is of utmost importance. Your goal then is to be logical, clear, and succinct when

speaking. If you do have a tendency to ramble, do not be discouraged as you can easily break the habit. By


mock interviewing with a friend or family member, you can quickly identify if you ramble and learn how

to break the habit. Importantly, your mock interviewer must be up-front and tell you if you are rambling,

which brings us to a second key point of interviewing preparation.

2. PraCtiCe with Friends and Family You must practice, practice, practice for medical school interviews. You have only one opportunity with

each school, so you will definitely to want prepare and make the most of it. I, along with other applicants

I knew, practiced primarily with friends and family who would give honest feedback about our interview-

ing skills. Either I would tell them a list of questions I wanted them to ask or allow them to surprise me

with their own questions. Importantly, I would explicitly ask them to tell me what they honestly thought

about the interview and where I could improve, no matter how harsh their criticism might be. You NEED

people to help you constructively and not try to sugar coat things.

To further simulate the interview environment, I also tried mirroring the actual conditions of the inter-

view based on descriptions found on studentdoctor.net, a useful resource for interview preparation. This

meant practicing in an unfamiliar environment (not your own living space) and mock interviewing for the

appropriate duration of time (45-60 minutes usually). It was also useful when my mock interviewer and I

would occasionally stop to review a question and determine how I could improve my responses.

3. PrePare For Questions Commonly askedThere are some questions you will encounter again and again while interviewing at different schools.

A list of twelve such questions will be presented in the next edition of the Medical Decoder. These are

questions for which you will certainly need well thought-out answers, and while they may not all be asked

in every interview, they come up on a consistent basis. You must practice what you are going to say for

them or at least have a good idea of how you will answer them. I found it useful to keep a word document

briefly describing my answers for each of the questions. I also wrote down my answers and took the sheet

to each interview for a last minute review.

At the same time, it is extremely important that your answers do not sound rehearsed. The interviewers

know that you have probably practiced for the interview, but they do not want to listen to a memorized

recitation. Your goal is to communicate your predetermined answer as though you have never answered


the question before - with passion and genuineness. I’ll stress again that you must practice. I had a friend

who hoped to sound more genuine and thoughtful by not practicing. Unfortunately on his interview day,

he became tongue-tied and came off as unprepared. While very intelligent and well qualified, he was

rejected. This goes to show that you cannot anticipate the environment or how you’ll be feeling on the

interview day. While you cannot control these factors, you can control how well you have prepared.

4. review your Primary aPPliCation, esPeCially the Personal statement

Your interviews will often focus on the experiences detailed in your AMCAS primary application. Even

if the interview is “closed,” meaning the interviewer has never reviewed your application, you can still

answer questions based on your experiences. Your college experiences, in some way, should relate to the

pursuit of your dream of becoming a doctor. Therefore, they should be easy to talk about since you are

already passionate about them. In general, for my experiences, I would sum up each one into two or three

important points that I could tie back to medicine and how it strengthened my resolve towards becom-

ing a physician. For instance, I used the time I spent volunteering at a nursing home as one of the college

experiences I brought up while interviewing. During my interview, I told how working with patients with

dementia was initially frustrating; I first arrived to a circle of seemingly asleep residents all in wheelchairs.

I came to realize that they were, in fact, awake, and that the stimulation I provided through fun activities

was important to their well-being. I managed to effectively communicate to my interviewer how each

lesson I learned during that volunteering experience related back to a quality of being a competent doc-

tor. To sum up, know your application. By re-reading your personal statement, and having two to three

important points to discuss for each of your experiences, you will come across as a smoother, more col-

lected, and an altogether more genuine and strong applicant.

5. Familiarize yourselF with issues ConFronting healthCare today

You must show interest in the field you desire to go into, plain and simple. In medicine, this means being

aware and moderately knowledgeable about larger issues facing modern healthcare. For example, I was


asked for my opinion about Obamacare twice, and it is very possible that depending on your major, i.e.

public health or political science, you could receive more questions on this topic. In general, I recommend

being aware of and retaining some general knowledge in the following healthcare issues: 1) Physician

Shortage and Their Crowded Distribution; 2) The High Costs of Healthcare; 3) Increasing Prevalence of

Chronic Disease; and 4) Understanding the Basic Goals of the Affordable Care Act (ACA). Interviewers do

not expect a 22 year-old premed to provide a panacea to these issues, as they are often complex issues

that have been around for decades now. Rather, they want to see that you are familiar with these issues

and can hold an intelligent conversation about them. It may best to be non-committal with these issues,

by addressing multiple sides that each issue presents and adequately demonstrating your knowledge. In

the end, questions dealing with larger healthcare issues probably will not make or break your interview.

After all, they do less in answering the interview’s overall purpose of why medicine is right for you in com-

parison to other questions. However, I do believe that schools respect an applicant more so if they can

demonstrate basic knowledge of these important health-related issues.

6. stay alert on your interview day Interviews days are not solely for conducting interviews. They may be 7 to 8 hours long and consist of

multiple presentations, a lunch, and a campus tour. While most of the material presented to you is infor-

mation you could easily find on the school’s website, the schools are in the business of attracting you.

After all, medical schools have selected you to interview after sorting through thousands of secondary

applications, and want to show that they offer a quality medical education. That being said, remaining

energized and alert is necessary throughout the interview day.

Generally, not all applicants will interview at the same time - some will be in the morning, some after

lunch, and others late in the afternoon. You have to be prepared to interview at any time of that day. I sug-

gest bringing a bottle of water that you can refill as needed and a quick snack such as a candy or a granola

bar. Another advantage of staying alert and not dozing off through the presentations is that the present-

ers may later be your interviewer! This is especially true in MMI interviews where at least 8-10 interviewers

are needed to fill all question prompts. Overall, the goal here is for you to walk into the interview room

feeling awake, confident, and ready and to give it your best shot.


7. Provide memorable examPles

Interviewers need something to remember you by. One of my interviewers told me she was my ‘advo-

cate’, and it was her job to present my interview summary to the admissions office. Your advocate should

be able to convey not only their general impression of you but also your memorable and meaningful an-

swers. For example, if asked, “What has prepared you for a career in medicine?” or “What is your greatest

strength?” you should avoid being vague. If you are vague, you risk sounding like another average appli-

cant. Instead, you should focus on a few strong personal examples in some detail that work to distinguish

you in a positive light. Your examples could include a value you stand by, a specific person you’ve worked

with, an interesting class that stuck with you, or an experience from your primary application (that’s why

having 2-3 talking points per experience can be extremely helpful!). Overall, personal examples allow you

to showcase your personality, help you relate better to the interviewer if they’ve had a similar experience,

and above all, give you the best chance of turning the interview into a conversation. If you can develop

stretches of good conversation rather than a question-answer-repeat format, then you will have a suc-

cessful interview.

8. use three talking PointsDuring interview preparation, you will often wonder if your answers are too lengthy, too short, or lack-

ing substance. A great solution that a friend relayed to me is to divide your answer into three talking

points. Her idea was that two points tends to be too short and four points brings the risk of you rambling.

Three points strikes a happy medium, giving you the best chance of being succinct yet complete. While

by no means set in stone, I found using three points to be extremely helpful. For instance, my “why medi-

cine?” answer consisted of three larger points describing my healthcare-related experiences growing up,

in college, and desired ones in the future. Moreover, using three points was essential during my MMI

interview as I had only two minutes to read a question, consider my answer, and formulate what I would

start off presenting, which almost always consisted of three talking points. I simply could not remember

much more than three main points anyway after a quick two minutes.


9. answer Questions while aCknowledging all Parties involved

You will want to consider all people’s views in a complicated interview question. Doing so shows you

can relate to others and identify their motivations while being the advocate for the patient, an impor-

tant skill for all physicians. Though you want to apply this advice to all questions, this tip applies very

well to two questions you might encounter. The first concerns a fellow medical student who you know

has cheated on an exam, but no one else does. Instinctively, you might alert the professor immediately;

however, doing so bypasses your classmate, risks your friendship with that person, and potentially blows

the problem out of proportion. In general, you want to handle situations with the least amount of drama

possible. In this case, confronting the classmate privately and encouraging them to seek out the professor

on their own is the advisable action - you have considered and involved them in the decision. Put another

way, what would you want your friend to do if you were the cheater: rat you out or talk to you on his or

her own? The second question you may encounter concerns the hypothetical situation where an elderly

patient is diagnosed with a terminal illness, but a family member does not wish for the patient to know

in fear that the truth will be devastating. Here, you have to balance your patient’s needs along with the

family member’s and be able to recognize what each would stand to gain or lose based on your decision.

No matter how you answer, explore and consider each party’s needs and then adequately communicate

to the interviewer you have done so.

10. ask For time to ColleCt your thoughts“Can I take a few seconds to think about it?” I must have said this a dozen times while interviewing.

While initially practicing, there was always that urge to begin answering right away, and typically, my

responses would be disjointed, as I was using too much effort to both talk and think at the same time.

After a friend suggested that I take time to formulate an answer, my response would almost always come

out better and more logical, showing me that taking time to think was absolutely necessary for difficult

interview questions. Many questions are geared to make you think critically and thereby require time in

order to clarify your thoughts and come up with a coherent answer. Although it initially felt awkward ask-

ing for additional time, my interviewers never had a problem with it and would wait patiently for ten to

fifteen seconds sometimes before I began. By asking for time, you improve your chances of avoiding long


winded or boring answers that verge on rambling. In my opinion, asking for time is another way you show

poise while interviewing - you come across as a more thoughtful interviewee.

11. ask genuine Follow-uP Questions Again, interview days are both for schools and applicants. Therefore, feel free to ask one to three ques-

tions at your interview’s conclusion to further familiarize yourself with the school. For example, you could

ask about a unique aspect to a particular medical school such as a strong public health component in the

curriculum or interesting summer research opportunities. You could also ask about the student body,

the atmosphere within the school, or life outside the school. While these questions can vary greatly, your

overall goal is to be genuine in your asking. Three well thought out questions can go a long way rather

than tacking on three piecemeal questions at the end.

In general, I would advise preparing one to three genuine questions before arriving at your interview

day. While you do not have to use them, it’s good to have these back-ups if other questions do not come

to mind on the interview day. All in all, asking good questions is another important way to show interest

in the school and that you’ve done your homework on the school’s specific program. This is attractive to

medical schools and lets them know you have seriously considered their program.

12. ComPosure, ComPosure, ComPosure

If I had to summarize what applying to medical school was like, I’d say it was all about maintaining com-

posure. The application process is extensive and must be balanced with other course work and responsi-

bilities. Through it all, you will help yourself by maintaining your composure, especially during interviews.

Some questions are just intended to be tricky and difficult. Indeed, the follow-up questions during my

MMI interview seemed geared to make me second-guess or reconsider my first answer. Generally, I stood

by my first answer since I believed it to be right; however, the more important goal was to maintain my

poise and not appear rattled. I would rationally consider the new information and use it to support my

first answer. This showed self-confidence, which is a quality your interviewer will definitely be looking for.


ConClusion

Interviewing really is one of the only opportunities to put a face to your application. While GPAs

and MCAT scores certainly weigh heavily, interviewing provides the admissions officers with a

unique perspective of you as a person - one that can be a deciding factor in their decision to accept

you.

On the day of, I think you will find your interview not to be too stressful. Obviously walking into

the room can be daunting to anyone, but you will become comfortable after a little while. From

that point, maintain your composure and be passionate about what you speak of. Try your best to

prove to the interviewer that you are a worthy future colleague of theirs in medicine. Be sure to sit

upright, vary the tone of your voice, answer with an appropriate level of enthusiasm, and turn your

interview into a conversation. By doing these things, you give yourself the best chance of coming

across as likeable yet professional.

I also encourage you to enjoy your interview day and the interviewing experience in general. For

many applicants, interviewing entails traveling to new parts of the country and meeting applicants

from other schools. Talk with these other applicants and have some fun with the process. Not only

will you learn a lot from other applicants, but you will also calm down before your interview.

In the end, medical school interviewing is all about communicating your passion for medicine. If

you can demonstrate your passion for helping others, your interview will be successful, regardless

of whether or not you occasionally stumble on a question. The above tips will hopefully help you

best prepare to communicate this passion in the clearest manner. From here, continue practicing

your interviewing skills and asking your friends and family to critique you while doing so. These tips

are meant to be a foundation for you to build upon. By utilizing these tips and maintaining your

composure, you will undoubtedly succeed during your interview and end your medical school ap-

plication on a resounding high note. ■ MD


how baby boomers will Change

orthoPediC Care

GPA, MCAT, and the coveted MD. The lives of premed students are flooded with acronyms. At the under-

graduate stage of an aspiring doctor’s life, it is easy to get caught up in the preparations necessary to gain

acceptance into medical school and lose sight of the challenges that we will face when we finally have

become doctors.

While I frantically refresh CAESAR during grade posting time, I also dream of becoming an orthopedic

surgeon. However, it was only recently, after I had a shadowing experience with a physician that I realized

I knew surprisingly little about the future of the profession and the obstacles I might face. This experience

was the first time that I was challenged to look beyond just the task of becoming a doctor and consider

the larger impact that I hoped to have on the medical field. After shadowing, I realized that my responsi-

bilities as a practicing surgeon would depend largely on the patient population that I would be account-

able for.

Those of us who will soon be entering medical school will be responsible for the care of a unique group

of elderly patients: the Baby Boomers. According to the United States Department of Health and Human

Services’ Administration on Aging, in 2009, 12.9% of the total US population was over the age of 65. By

the year 2030, this percentage is expected to rapidly increase to 19% as the Boomers will begin seeking

By heATher ABles

Medical advancements made during Baby Boomers’ lifetimes such as the polio and measles vaccines, as well as new surgical

technologies, have allowed them to live lon-ger and have raised their expectations of

medical care.


more medical treatments.1 This rise would correlate

with an increase in the number of elderly individu-

als seeking healthcare services in order to manage

chronic pain conditions and combat the woes of

aging.

While the expanding number of healthcare servic-

es that Baby Boomers will require poses a challenge

to medical specialists, this patient population also

brings another challenge due to its unique posi-

tion in history. Medical advancements made during

Baby Boomers’ lifetimes such as the polio and mea-

sles vaccines, as well as new surgical technologies,

have allowed them to live longer and have raised

their expectations of medical care. According to a

2007 report by the American Hospital Association,

new pain management techniques and the option

of joint replacement surgery have allowed aging

Baby Boomers to maintain a more active lifestyle

than their ancestors.2 As a result, these patients are

anticipated to continue to seek orthopedic services

that emphasize mobility and independence.

Unfortunately, it does not appear that the

increase in healthcare services needed by a

growing patient population will be met with an

equal increase in the number of doctors avail-

able to provide them. Between 2000 and 2020

the supply of orthopedic surgeons is predicted

to increase by only 2%, while the demand is ex-

pected to increase by 23%.3 During my recent

shadowing experience, I was surprised by the

number of older patients who sought medical treat-

ment for joint pain. For many, the quick fix seems to

be a minimally invasive cortisone injection about

three or four times a year. For others, whose pain

was more debilitating, the only option to alleviate

their chronic conditions, like arthritis, was joint re-

placement.

This option has only become popular within the

last forty years, but in that time hundreds of pros-

thetic joints have been created, tested, and mar-

Unfortunately, it does not appear that the in-

crease in healthcare services needed by a

growing patient popu-lation will be met with

an equal increase in the number of doctors avail-

able to provide them.


Cour

tesy

Hea

ther

Abl

es

keted. The rapid evolution of joint replacement and

other surgical techniques will undoubtedly be an

asset over the coming years as the Baby Boomers

steadily age and cause an increase in the average

age of patients seeking treatment. In the future,

surgeons hope to use techniques that will allow for

the treatment of more patients, quicker recovery

times, and shorter hospital stays.2

The Baby Boomers have grown up with a focus on

education, and many have been fortunate enough

to pursue advanced degrees.4 Therefore, this pa-

tient population has tended to be more engaged

in its own medical care than previous generations

have been.4 In fact, throughout my shadowing ex-

perience, the orthopedic surgeon had to explain

to several adamant individuals under the age of

fifty why joint re-

placement should

be postponed for

younger patients

like themselves.

Due to joint re-

placement’s abil-

ity to confer optimal mobility, it can be inferred

that this procedure will appeal to Baby Boomers

as it can drastically reduce pain levels. Studies are

showing that joint replacement surgeries are on

the rise. It is projected that nearly eight times more

knee replacements will be performed in 2030 than

take place today.5 However, prosthetic joints are

not made to sustain intense physical activity. As

surgeons who operate on younger patients are al-

ready seeing, these patients tend to put excessive

stress on the joint, risk wearing it out more quickly,

and need follow-up operations.

It is undoubtedly im-

portant, as future doc-

tors and healthcare pro-

fessionals, to recognize

how our patient popula-

tion will change in the

coming years and re-

spond by appropriately altering our care and deliv-

ery methods. Not only in the field of orthopedics,

but throughout medical practice, a rigorous focus

on wellness and prevention today will be key to

managing the chronic conditions of tomorrow.

■ MD


After shadowing, I realized that my responsibilities as

a practicing surgeon would depend largely on the

patient population that I would be accountable for.

Cour

tesy

Hea

ther

Abl

es


PoPulation health

In terms of gross domestic product (GDP),

healthcare constituted more than 17.9% of total

U.S. expenditures in 2012, more than the coun-

try’s highly-controversial defense budget.2,3

With medical spending projected to reach

$4.8 trillion by 2020, experts have deemed the

conventional payment structure known as the

“fee-for-service model” as the primary obstacle

to achieving cost-effective healthcare. In fee-

for-service, which is the traditional model for

By ZAch snow

A cAll For vAlue-BAsed heAlThcAre


How do YOU value good health? How much is

good health worth? The average American spends more than $8,000 in medi-cal expenses each year. That’s nearly two and a half times more spent on healthcare than France, Sweden, or the UK.1

payment in many hospitals and health systems

across the U.S., physicians are paid based on the

number of medical services they provide. The

doctor profits directly from the sheer number of

operations, procedures, and tests ordered; care is

based on quantity but not necessarily quality.4 In

this model, medical professionals financially ben-

efit most from ordering a multitude of services for

temporary fixes to the patients’ conditions, rather

than from designing treatment plans to improve

patient outcomes and keeping sick people out of

the hospital in the fu-

ture.

Considering the

United States’ global

influence in scientific

research and medi-

cal innovation, why

is it so difficult to cre-

ate a workable, cost-effective system for keep-

ing our citizens healthy? Grounded in traditional

approaches for treating patients, what America’s

medical system needs the most is an alternative

business model, one that incentivizes keeping

people healthy rather than solely treating those

who are already ill.

Population health is a term used to describe

a system of care that seeks to assess the health

needs of a target population and proactively

provide services to maintain and improve the

health of that population. This unique approach,

which has recently garnered significant atten-

tion throughout the healthcare industry, differs

considerably from how most healthcare systems

work today.

The principal difference between population

health and the current health care model is that

population health is focused on caring for groups

of patients rather than individuals; it’s more

about the ‘health’ than the ‘care.’ As an alternative

to utilizing the traditional fee-for-service model,

hospitals seeking to

partake in population

health employ a value

rather than volume-

based method of care.

Value-based care means

that federal health plans

such as Medicare and

Medicaid as well as commercial payers such as

Blue Cross Blue Shield fiscally incentivize hospi-

tals and health systems to limit patient volumes.

In this way, both parties profit from the insur-

ance companies’ savings. Financially speaking,

in the fee-for-service model, hospitals will try to

fill beds; in the population health model they will

try to help empty them.5 The health industry is

actively transitioning to a value-based payment

structure that rewards those who do the best job

at keeping their patients healthy.

The doctor profits directly from the sheer number of operations, procedures,

and tests ordered; care is based on quantity but not

necessarily quality.


But how are they doing this? First, significant

advances in technology have enabled physicians

and medical facilities to extend healthcare out-

side of the traditional acute-care setting. Tele-

health vendors such as Bosch market products

in remote patient monitoring that can monitor

heart rate, glucose levels, blood pressure, and

other vitals all from within the comfort of the

patient’s home.6 IT solutions such as this, in ad-

dition to physician video-conferencing and mo-

bile phone health applications, are extending

care outside the hospital, thereby freeing beds

for patients with more serious conditions, sav-

ing exorbitant urgent-care costs, and maintain-

ing a healthier environment throughout the

entire population. Furthermore, complex analyt-

ics, like those offered by Explorys, a population

health corporation from the Cleveland Clinic, sift

through petabytes of unstructured medical data

from insurance claims, labs, prescriptions, etc., to

evaluate the risk that certain patients will utilize

emergency hospital services in the future. As a re-

sult, medical professionals can intervene early to

reduce the likelihood that these specific patients

become sick, thereby reducing medical costs and

improving overall population health.7

Despite the need for a hefty investment in new

technologies, the most significant obstruction to

transitioning from volume to value-based care

is reluctance on the part of physicians and other

medical professionals to change their ways.

The population health model requires physi-

cians, particularly primary care providers, to per-

form additional activities and make less money

for them. According to experts in the healthcare

industry, physicians must begin to modify much

of what has been hardwired into their current

practices, experimenting with interventions, re-

configuring office workflow, and delegating more

responsibility to an extended care team.

Still, doctors in contention of this value-based

model ought to remind themselves of the under-

lying principle behind good healthcare: to help

their patients get healthy again. In collaboration

with the innovators making America the global

leader in science and industry, physicians have

the opportunity change the health system, re-

duce the national output of medical costs, and

inevitably, make patients better. That’s the value

of a good healthcare system. ■ MD



The health industry is actively transitioning to a value-based payment structure that rewards those who do the best

job at keeping their pa-tients healthy.

emergenCy ContraCePtion

A QuIck GuIde To The MornInG AFTer

u nprotected sex happens frequently on college campuses and can have a plethora of negative

consequences, from STI transmission to pregnancy. A study by the National College Health Risk

Behavior Survey found that 15% of college students have, at some point, become pregnant during their

college careers.1 Studies have shown that among this high-risk group of college students, knowledge of

emergency contraception is relatively low. While female college students might know of key words like

Plan B or the “morning after pill”, many are unaware of the function and accessibility of an effective means

of pregnancy prevention post-sex.1 Increasing awareness of emergency contraception (types, how they

work, where they can be bought, regulations, etc.) among college-age women is crucial in order to pre-

vent unintended pregnancy.

The following information comes from leading institutions and research journals focused on reproduc-

tive health and emergency contraception research:

By sArAh sMITh


what is emergenCy ContraCePtion?Emergency contraception (EC) is a form of birth control, used after sexual intercourse to pre-

vent pregnancy. It is both safe and effective, with no long-term or serious side effects.2 In fact,

EC is even considered safe for those whose healthcare providers recommend not using hor-

monal birth controls out of fear of possible side effects including blood clotting and breast

cancer. This is because emergency use of hormones does not carry the same risks associated

with taking daily oral contraceptives.3

Depending on the type, EC can prevent pregnancy up to five days after sex. However, the

longer the time elapsed between having sex and taking the drug, the less effective the drug is.

Therefore, time is of the essence when using emergency contraceptives.

what are my oPtions?There are three main types of emergency contraceptive pills available in the U.S.: progestin-

only, ulipristal acetate, and combined progestin and estrogen pills.2 Plan B, a progestin-only pill,

is likely the most easily accessible type of EC for college students. In June of 2013, after years of

debate, the FDA has finally approved Plan B for over-the-counter sale with no age restrictions,

meaning that Plan B is readily available in most neighborhood drug stores.4 Especially in college

towns where waiting in line at the pharmacy can be a hot spot for running into peers, the abil-

ity to grab Plan B from the shelf and purchase it without having to show ID can come with the

advantage of discretion. It is not uncommon to find women who keep a dose of Plan B available

in their homes before any accident occurs, so that they can be preemptively prepared.

While Plan B is the most recognized brand of EC pills, it is certainly not the only one. Other

brands available in the US include Next Choice One Dose, Next Choice, ella, and more. While

these brands require a prescription (and a visit to a healthcare provider), they also can provide

advantages depending on the circumstance. For example, while Plan B is effective for up to three

days after sex, ella, an ulipristal acetate pill, is effective for up to 5 days after sex. In fact, ella has

been cited as being more effective than Plan B.2 There are multiple brands of EC pills on the mar-

ket, and it is wise explore those options before the need for EC arises.

Certain brands of daily birth control can be utilized for emergency contraception by taking

combinations of pills. Certain brands of combined progestin and estrogen birth control pills can


how do they work? Much of the controversy that surrounds emergency contraceptives has emerged from questions re-

garding their mechanism of action, i.e. the biological mechanism by which EC prevents pregnancy.

And the truth is, study of the mechanism of action of many emergency contraceptives has not been

100% conclusive. While it has been established that EC works primarily by blocking or delaying ovu-

lation, questions remain regarding their ability to prevent an already fertilized egg from implant-

ing.4 These questions are vital in the debate on ECs, as many believe that blocking the implantation

of a fertilized egg would make emergency contraceptives abortifacients (drugs that induce abortion).

While literature exists arguing both sides of the debate (either affirmative, some kinds of EC can block

implantation or negative, ECs cannot prevent implantation), there is a rising general consensus that these

contraceptives do not prevent the implantation of a fertilized egg, and therefore do not act as abortifa-

cients (note: this is less established in the case of ulipristal acetate and Copper-T IUDs). The inability of

Plan B to prevent implantation and the pill’s non-abortifacient nature have been well established. How-

ever, it is important to note that emergency contraceptives do not protect against transmission of STIs.

ConClusion

Mistakes happen. Emergency contraceptives can offer a simple solution to avoid unwanted pregnancy

in the face of unprotected sex. While avoiding unprotected sex should obviously be a priority, it is also

important to know what to do if a mistake has been made in order to prevent pregnancy. ■ MD


be taken in higher doses to prevent pregnancy.3 However, it is important to consult with a healthcare

provider before utilizing this method as many women experience side effects like nausea and vomiting.3

EC does not come exclusively in pill form; in fact, the most effective form of emergency contraceptive

is the Copper-T intrauterine device (IUD), which is also used by many women as a form of regular birth

control. While a doctor or trained clinician must insert this form of EC into the uterus, he or she can do

so up to 5 days after sex and this has been shown to reduce a woman’s chance of getting pregnant by

more than 99%.3


Since the 8th grade, I had a wildly idealistic vision for my future. It involved a crisp, white mono-

grammed lab coat, a shiny stethoscope, and a stack of business cards reading Dr. Venkatakrishna.

My parents, of course, were thrilled by the prospect of having a second doctor in the family and heavily

supported my decision. In fact, when I entered Northwestern University as a freshman, it was with their

assurances that lead me to start my collegiate journey as a premed student.

It has been quite a journey. Between finding a new passion for both creative writing and political sci-

ence, to landing a compelling summer internship in a lab, I waned in and out of being premed at least

fifty times during my first year. In fact, having a weekly career crisis was nothing out of the ordinary by the

time spring rolled around. It was torturous living life on the fence, being too hesitant to commit to either

side; however, when I realized I didn’t have to give up one passion for the sake of the other, I was relieved

of my anxiety.

It is estimated that 30% of incoming freshman across the country share my story, entering as a premed,

but switching to other fields as they progress through their college careers.1 While some of these students

choose to switch to entirely different areas of study, others, due to their affinity for the medical field, opt

for medically-related career paths that accommodate their widening interests.

making the Career ChoiCe

By vArshA venkATAkrIshnA

whAT Are your opTIons?


Career Path Job Description

Education Needed Salary Job Outlook

Health Administrator

•Oversees vari-ous departments to keep up with the fast-paced changes to the medical field•Coordinates quality of care3

•Bachelors in Healthcare Ad-ministration for lower tier jobs•MBA with a background in science or healthcare pre-ferred for upper tier jobs3

•Mean an-nual salary of $104,0003

•Projected 22% growth from 2010 to 20203

Healthcare Attorney

•Oversees risk management and malpractice litigation.•In charge of general corpo-rate manage-ment issues in healthcare5

•A bachelor’s degree and then completion of law school5


•Projected 14% growth from 2010 to 2020

Job in Bioethics

•Very wide range of oppor-tunities•Positions in ethics commit-tees • Work for non-profit organiza-tions•Hospital chap-laincy1

•A bachelor’s degree in biol-ogy is required, but a master’s or PhD is prefer-able for higher tier positions13

•Because of the wide range of options in this field, a salary range is difficult to pinpoint13

•Average job growth of 34% from 2010 to 202013

It is understandable why students interested in the medical field would opt out of the traditional route

to medicine (i.e. premed, medical school, residency, etc.). And while I attribute a few of these reasons to

the highly demanding coursework of being premed, many students simply find that their passions lie in

areas apart from medicine after they have been exposed to different academic fields.

Luckily, in today’s job market there are a plethora of options for cross-field careers. I have detailed only a

few of these options below, in regards to job description, level of education required, the salary each path

can provide, and the overall outlook for those career paths.


Career Path Job Description

Education Needed Salary Job Outlook

Patent Attorney

•Plans and di-rects any legal issues regarding patents•Determines who owns rights to inventions7

•A bachelor’s degree in a sci-ence field and completion of law school. The Patent Bar Exam is required to practice law. 7



Scientific Consultant

•Conducts research in various fields of biotechnology and other life science-related disciplines to create innova-tions for cus-tomer projects9

•A bachelor’s degree is re-quired for lower tiered jobs, a master’s degree in a science dis-cipline is neces-sary for upper level jobs9



Forensic Pathologist

•Conducts ap-plied or aca-demic forensic pathology•Uses scien-tific reasoning to help legal matters involv-ing human remains11

•A master’s de-gree or PhD in biological an-thropology11



The medical field has more options than one would think. If your end goal is to attain the title of MD at

the end of your name, then that is fantastic. It is also important to realize that the medical field has a much

wider range of career paths though; it is flexible, integrative, and multifaceted. In short, you can find a

career path in the medical field that best fits you.

I still have not decided on a career path, and by the end of the month, I may have tossed out another

dozen possibilities. Though the process of choosing a career path still seems daunting as I head into my

sophomore year, it is comforting to know that when I do choose one, I don’t have to sacrifice one interest

for the other. There are still many career opportunities out there, and I have the ability to find a career path

that combines my passions. ■ MD For references, see page 41.


Scalp cryotherapy: changing the Face oF cancer

A patient facing cancer confronts more than

a battle with a life-threatening illness. Many

patients with cancer must face a battle with the

mirror. Of the 1.6 million Americans who will be di-

agnosed with cancer this year, more than half will

be treated with hair loss-inducing chemotherapy.1

Hair has a distinct function in our society. Hair can

signify health, youth, sexuality, and individuality.

It can enhance body image, self-esteem, and self-

expression. One popular British magazine esti-

mates that the average person spends almost ten

days per year styling their hair!2

Although concerns about hair loss have long

been dismissed as purely cosmetic or superflu-

ous, studies show that hair loss can have a major

psychological impact on patients. Watching your

own hair fall out can be a highly traumatic process

and can cause patients to feel as if they are losing

a part of themselves. One study found that breast

cancer patients are more worried about losing

their hair than losing their breast.3 The loss of hair

takes the privacy out of a patient’s cancer treat-

ment. Patients have described going bald as feel-

ing as if they are wearing a sign that says, “Ask me

about my cancer.” Fear of hair loss is sometimes so

severe that patients will choose not to receive or

prolong a recommended treatment in an effort to

keep their hair.3-5

What many cancer patients and even some phy-

sicians do not know is that there are options cur-

By devorA IsseroFF


rently available that can prevent this unfortunate

side effect. Since the 1970s, scalp cryotherapy (lit-

erally, “ice healing”) has been a standard hair loss

prevention method in Europe and Canada.6-8 This

method involves strapping a bulky cap, called a

cold cap, to the scalp of a patient receiving che-

motherapy. Though caps are often cooled to near

0˚C temperatures, they are generally well tolerat-

ed. Major complaints are limited to headache and

sensations of cold, but these complaints rarely

lead to patients discontinuing their cold cap treat-

ment.

The very cold tempera-

tures of the cold caps

are hypothesized to

limit blood flow to the

scalp, therefore decreas-

ing the concentrations

of cytotoxins from the

chemotherapeutic drugs

reaching and killing hair

follicles. Researchers also believe that the cold

temperatures reduce the uptake and metabolism

of the chemotherapy in hair follicles.9,10 Studies of

scalp cooling show that a patient has about a 50%

chance of keeping all of his or her hair.11 However,

the extent of hair preservation often depends on

the dose and type of chemotherapy used.

Despite the long history of the effective use of

scalp cryotherapy outside of the U.S., it has yet to

be approved. The FDA discontinued review of the

method in 1990 after physicians voiced concerns

that the treatment may allow for vagrant cancer

cells, known as metastases, to grow unharmed in

the scalp. Today, a number of studies have been

published indicating that, at least in solid tumor

patients, rates of metastases are the same as those

in patients not receiving scalp cooling.

However, patients wishing to use scalp cooling in

the U.S. still have access to organizations like Pen-

guin Cold Caps Co. or the Rapunzel Project, both

of which provide cold caps to patients. A study

of a Swedish

cooling machine

from the compa-

ny Dignitana, the

DigniCap, began

recruiting pa-

tients in the sum-

mer of 2013. The

company hopes

to gain FDA approval in the near future.7

Cold caps provide cancer patients an effective

and innovative means to avoid much of the trau-

ma of a cancer diagnosis. They are an important

victory against one of most painful and perhaps

dehumanizing effects of living with cancer. ■ MD


The very cold temperatures of the cold caps are hypoth-esized to limit blood flow to the scalp, therefore decreas-

ing the concentrations of cytotoxins from the chemo-therapeutic drugs reaching

and killing hair follicles.


“y ou’re turning white,” Dr. House said to

the pale, sickly looking African-American

man lying in the ICU. “What does that mean?” the pa-

tient’s mother asked in a concerned tone. Dr. House

retorted, “It means he doesn’t need football to get a

good job anymore.”

This completely inappropriate yet entertaining

dialogue occurred in an episode of the acclaimed

medical drama House. The show, which features the

brilliant, emotionally unstable, and drug-addicted

character Gregory House, was nominated 159 times

for awards from American television organizations

throughout its 8 seasons, winning two Golden

Globes.1 House is also very popular with students

who are preparing for health professions with 65%

of nursing students and 76% of medical students

tuning into House on a weekly basis, according to a

2008 survey conducted by researchers at the Berman

Institute of Bioethics at Johns Hopkins University.2

Another widely watched medical drama is Grey’s

Anatomy. In the week of March 29, 2013, Grey’s

topped the Thursday rating chart with 8.8 million

viewers.3 The famous medical TV show ER was no

prIMeTIMeprescrIpTIons

Writers are constantly caught in a balancing act between sticking to the facts and bending the truth for the sake of

entertainment.


By rAchel sIBley

less popular, winning the People’s Choice Award for

“Favorite Television Dramatic Series” every year from

1995 to 2002.4

Yet, the precedent for hospital dramas on network

TV was set long before ER and Grey’s. The first medi-

cal TV shows began in the 1960s, with Ben Casey and

Marcus Welby, M.D., who earned the title of “Amer-

ica’s family physicians”. In these past five decades,

not one year has gone by without a medical drama

gracing cable television.5 The genre’s unperturbed

success stems from the lure of life and death deci-

sions, blood, gore, mystery, ethics and romance – all

plot components that make for irresistibly compel-

ling television.

However, medical professionals claim that these

medical dramas and others misinform audiences

on most aspects of real-life medicine, from specific

procedures to the interactions between different

members of the healthcare system. But who cares?

Why bother to criticize these shows when they are

grossing millions of dollars and racking in Emmy af-

ter Emmy?

Television writers are the ones responsible for

maintaining medical accuracy in their episodes. In

order to create plot lines and impressive dialogue,

the writers behind these successful shows rely on

consultations from doctors and healthcare experts,

provided by groups such as Health & Society, the

Centers for Disease Control and Prevention, the Na-

tional Institutes of Health, and the USC Annenberg

Norman Lear Center.6 However, writers are constant-

ly caught in a balancing act between sticking to the

facts and bending the truth for the sake of entertain-

ment. Of course, more often than not, they choose to

sacrifice medical accuracy in order to create gripping

television. But how much do they sacrifice and why

is it important?

A plIGhT For nurses

One group that has protested against the inaccura-

cies of medical dramas is nurses. Nurses argue that

hospitals on TV seem to operate completely without

their assistance. Stating that their portrayals are rare-

ly accurate, nurses have observed that these dramas

tend to omit their roles as influential individuals in

the medical setting who make decisions daily that

save lives. Nurses are often absent in medical dramas,

while doctors are shown doing nurses’ jobs. Sandy

Summers, the director of the Center for Nursing Ad-

vocacy, a Baltimore-based non-profit, cites many

television occurrences of physicians acting in the

role of nurses. Summers cites an episode of House in

which a doctor helps a postoperative patient to the

bathroom – a task performed by nurses in real hospi-

Nurses have observed that these dramas tend to omit their roles as influential individuals in the medical setting who make daily decisions that save lives.


tal settings. In 2006, the Center for Nursing Advocacy

even included Grey’s Anatomy on its list of the “10

Worst Portrayals of Nursing in the Media” during the

Golden Lamp Awards, a ceremony which ranks the

best and worst depictions of nursing in mainstream

media.7 In one episode of the show, the interns mon-

itor a premature infant through the night shift in the

neonatal intensive care unit. Summers pointed out

that trained neonatal nurses are actually responsible

for this job.

One major concern that has propelled the backlash

against medical dramas in the nursing community is

the current nursing shortage in the US. According to

the American Nurses Association (ANA), the current

median age of nurses is 46 and more than fifty per-

cent of the nursing workforce is close to retirement.

The need for more nurses will become even more

apparent in the future. As the baby boom generation

grows older, their health needs will increase, put-

ting a strain on the health system. Additionally, the

new health care reforms have given millions more

people access to medical care, adding to the strain

on hospitals and clinics.8 Nurses partially blame this

shortage on the portrayal of their profession on

the small screen. Rebecca Patton, President of the

American Nurses Association, claimed “Young men

and women are choosing other professions instead

of nursing, in part because of the negative portrayal

of nurses in the media”.7 While some doubt the im-

portance medical dramas’ depiction of nurses has on

this shortage, television has been shown to have a

powerful influence on the careers that today’s young

men and women choose. Annual surveys revealed

that in 2004, forensic medicine ranked 33 on the list

of most popular career choices, while just one year

later in 2005, forensic medicine jumped to 23 on the

list, a dramatic increase in popularity that was attrib-

uted to the late 2004 premiere of CSI: New York.7

The IMpAcT oF hollywood on MedIcAl schools

Unfortunately, nurses are not the only ones nega-

tively impacted by Hollywood hospitals. There is a

growing concern among medical educators that their

students, the young future physicians of America,

are subconsciously using medical TV shows as a type

of informal curriculum. Dr. Elizabeth Sinz, a professor

of anesthesiology at the Penn State Milton S. Her-

shey Medical Center, said “People learn from TV, they

learn from reading, they learn from what I’m teach-

ing in a lecture. It all has to come together.”9 One of

Sinz’s main concerns is that TV shows unrealistically

depict teamwork, especially in emergency settings

where TV doctors often make decisions completely

on their own. In addition, these fictional TV physi-

cians never discuss the concerns that real-life doc-

tors grapple with, such as paying back student loans

or fighting to get Medicare claims reimbursed.9 Ad-

ditionally, medical school professors are worried that

their students might treat these shows as lessons in


medical ethics. “In a 2008 survey published in the

April Issue of Journal of Medical Ethics, researchers

catalogued 179 depictions of bioethical dilemmas

in 50 episodes of House and Grey’s Anatomy that

aired between fall 2005 and spring 2006. Of those,

49 involved not obtaining informed consent for

treatment from patients or their loved ones. In some

instances (43%), the characters behaved according

to professional codes of conduct, but in most cases

(57%) they missed the mark completely — as when

TV doctors failed to obtain any consent at all for a

procedure or brazenly lied to patients to get them

to sign off (two scenarios particularly common on

House)”.2 Dr. Vineet Arora, the assistant dean at the

University of Chicago’s Pritzker School of Medicine,

has taken action in the classroom to combat the im-

pressions that medical dramas have given medical

students. Dr. Arora created a new class called “Medi-

cal Professionalism in the 21st Century: A Real World

Approach” in which she plays segments from “ER”

that showcase patient-physician interactions. She

then has the class critically discuss the clips after-

wards, highlighting the inconsistencies that many of

these dramas have with the real world of medicine.9

The InTerFerence wITh pATIenT cAre

While medical schools can reach out to their stu-

dents using progressive new curriculums similar

to Dr. Arora’s, it is more difficult to reach out to the

general population of patients. A main misconcep-

tion that patients might have is the survival rate for

cardiopulmonary resuscitation (CPR). In 1996, the

New England Journal of Medicine reported that

CPR occurs successfully in 75% of cases presented

on TV. However, even optimistic real-life estimates

suggest that CPR is successful only 15% of the time.

Some fear that this will give people unrealistic ex-

pectations, although this has not been studied ex-

tensively.9 Medical television has also been shown to

influence viewers’ expectations about their chances

of getting sick. A survey of almost 1,300 participants

presented at the British Psychological Society’s con-

ference in Bath, England revealed that participants

who watched the most medical programs were ten

percent more afraid of falling ill than others. The Brit-

ish Heart Foundation (BHF) also realized that medical

television gives the public unrealistic expectations.

In 2008, BHF cautioned that “Hollywood-style” heart

attacks, in which actors clutch at their chests and fall

to the floor, are misleading and might cause people

to ignore some characteristic symptoms of a heart

attack. In response, BHF produced its own short film

called “Watch Your Own Heart Attack,” combating

television portrayals and publicizing the true symp-

toms of an attack.10

Susan Morgan, associate professor in the Depart-

ment of Communication at Purdue University and

author of Entertainment (Mis)Education, spoke out

regarding what she sees as the most detrimental

effects of inaccurate medical dramas on patients.


Morgan was the co-author of a study published in

Clinical Transplantation in 2005 that revealed that

the majority of patients who are unenthusiastic, and

even pessimistic, about organ donation frequently

cite television as evidence for their opinions. In-

deed, most TV episodes that feature organ dona-

tion dramatize the situation by including plot lines

about black markets for organs, doctors not saving

potential donors’ lives, or wealthy patients receiv-

ing higher priority on waiting lists.11 Morgan specifi-

cally recalled an episode of Grey’s Anatomy in which

“a patient was prematurely declared brain-dead so

her organs could be procured”.6 Morgan fears that

inaccurate portrayal of organ donation will dissuade

people from becoming donors, an issue which poses

as a major problem because, in the United States

alone, there are roughly 118,000 people on waiting

lists for life-saving transplants.12 Morgan stated: “You

could start drawing this out to real human lives be-

ing lost.”6

However, in 2007, hope came in the form of Do-

nate Life Hollywood (DLH), a campaign specifically

launched to eliminate the “stolen-kidney” story-

line and other inaccuracies in Hollywood related to

the depiction of organ, eye, and tissue donation.

In response to Morgan’s groundbreaking research,

Tenaya Wallace, director of DLH stated: “The organ

and tissue donation and transplant community has

been upset by inaccuracies in the past but we have

not taken action. Now we have hard evidence that

what viewers think about donation is directly related

to what they see in television storylines. This is not

just about creative license. We want Hollywood writ-

ers, producers, and executives to consider the pub-

lic health impact of their donation storylines. That is

why we are launching Donate Life Hollywood.”11 In

order to pursue these goals, DLH discourages writ-

ers and producers from negatively featuring organ

donation by distributing to TV networks a “top 10

list of storylines that are most harmful to the pub-

lic’s perception of the donation process”.11 If a film,

TV episode, or commercial contains any of these

top 10 storylines, DLH recruits volunteers across the

country whose lives have been positively impacted

by organ donation to write letters to those network

executives.11 On the other hand, the campaign also

praises programs that accurately and positively fea-

ture organ donation. For example, one episode of

Extreme Makeover: Home Edition followed the story

of a mother whose son had died in a car crash and

donated his organs. DLH applauded the episode

and “after the show aired, online donor registration

increased 200% in California over the previous week,

a spike the campaign attributed to the show”.6

An AccurATe MedIcAl drAMA show

Thankfully, there is one popular medical drama that

has continually been praised for its accurate repre-

sentations, and it is a show that people might be least

likely to guess: Scrubs. Unlike the shows mentioned


It is important to remain aware of the inaccuracies that are present in medical dra-mas and differentiate

fact from fiction.

thus far, Scrubs does not deal with life or death sce-

narios in every episode and doesn’t end with a sur-

prise diagnosis – it focuses on ordinary cases. The

show’s narrator and central character is Dr. John “J.D.”

Dorian (played by Zach Braff), and it focuses on his

progression from intern to resident to full-fledged

doctor. In particular, real physicians identify most

closely with J.D.’s portrayal of the ups and downs of

medical residency. He reveals most of his feelings

through his internal monologues. Questions that J.D.

asks in his internal monologues, such as “Am I hurt-

ing the patient? Am I learning what I should? Am I

kissing up too much to the attending?”13 are typical

of the real doubts that go through a resident’s mind,

according to Jonathan Samuels, doctor at the NYU

Hospital for Joint Diseases.13

Scrubs is able to achieve such accuracy because

the show’s creator, Bill Lawrence, based the show

on the experiences of his close friend, Dr. Jonathan

Doris, throughout his internship and residency. Do-

ris is now a cardiologist in LA and a medical advisor

to the show, and many of his experiences from his

residency at Brown University have been featured

in Scrubs episodes. For example, Doris once hid in a

closet in order to avoid being the first doctor at the

scene when a patient was coding. “In the pilot, J.D.

performs a procedure called a paracentesis to drain

fluid from a patient’s distended belly; he turns away

for a moment, then looks back to discover a geyser

of fluid gushing into the air. It happened—just like

that—to a fellow resident at Brown.” 13 Dr. Paul Pir-

raglia, an internist in Providence, Rhode Island and

another resident in Doris’ class explained “Being a

resident is a strange place between officially being

a doctor, which you are, but also really not knowing

it all…You get this level of authority that you don’t

think you deserve. All of a sudden you’re the doctor

and people are going to listen to you.”13

Even though Scrubs has been lauded for its realism,

it remains to be the one of the only major TV produc-

tion that has consistently stuck true to the medical

facts. Next up on the agenda for medical television

series is Hostages, an new drama that aired on CBS

in September of this year. The series stars Toni Col-

lette, a high profile surgeon recruited to operate on

the President of the United States.14 It is clear that

regardless of the plot line, the actor, the location, or

the negative effects of inaccurate representations:

America just can’t get enough of Hollywood hospi-

tals. Whether we like it or not, this television genre

is here to stay. It is important to remain aware of the

inaccuracies that are present in medical dramas and

differentiate fact from fiction. ■ MD For references, see page 42.


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