Archive for October, 2012

Advanced Trauma: Head and hypotension

A discussion of patients who present with hyperurgent head and hyperurgent abdominal injuries. I discuss my decision tree and algorithm for care. Thanks for listening. JY.


We discuss hypotension. Recognition, therapy, decision making, and some new developments in fluids and goals of resuscitation. A little original music I wrote for my daughters at the beginning and end. Thanks for listening. JY

Orange County Fire EMS Video educational series – Lactate use in the field

I would like to thank Orange County for inviting me to this panel. Please check it out.

Getting into medical school part 2: extracurricular activities

So…if you’ve got a GPA over 3.8 and MCATs in the top  5 percent, you don’t really need to read this. As long as you don’t come across as a shut-in or an axe murderer, you will probably be accepted to at least a few, if not all of the medical schools you apply to. But for the rest of you, let’s talk about the other parts of the application, namely what you did with your spare time in college.

First thing, no one cares what you did in high school. Eagle scout, all-county football, whatever don’t embarrass yourself by putting that on your med school application. They don’t care what you did when you were 16. Now as far as what you did (or should do) in college to prepare yourself, and make yourself attractive to medical schools, here’s my take on it. I gave you my qualifications to make these opinions in my previous post.

Clinical experience: I think it is vital that you touch patients enough to know whether being a doctor is the right thing for you. Even if you think you are going to be a pathologist, you are going to spend a whole lot of time with patients in med school, and you better at least tolerate it. Volunteering in the hospital is more of a high school thing, and is not looked upon with favor.

The choices are: follow a doc around (maybe your parent if you’re lucky) enough to be able to write in your essay how much you feel medicine is a “wonderful mix of science and art where I get to combine my love of the scientific world with my humanistic nature”. Don’t copy that, but I must have seen it on 75% of the applications I reviewed.

Next: be a scribe. This is something that was not around when I was in college and is an interesting choice if you don’t want to expend the effort to become an EMT, or an ER tech, or something else more hands on. You get paid, and you get to be a transcriptionist. Don’t mean to belittle this experience, but you are not making medical decisions, you are not examining patients and synthesizing their  history, physical, and lab data into a diagnosis and formulating a treatment plan. It does demonstrate that you went to the effort to actually work in the hospital, and you get to hang around with docs and residents and maybe get invited to a few parties. Many people do this, and a lot of them get into medical school, but I’m not sure if that’s true, true, and unrelated.

Next: be a lab tech, ED tech, burn tech, etc. These jobs require some training, and you are actually working on the front lines, touching patients, drawing blood, changing dressings, etc. There is a possibility this will turn you off from being a doctor, but better to find out now than when you start your third year. This is impressive because you were willing to get your hands dirty and get in the fight.

Next: be an EMT, Medic, and/or firefighter. This is what my wife and I did, and it pretty much changed our lives for the better. We met people who are our friends after 30 years, it gets you around great guys and gals that you wouldn’t normally be with in college, and it gives you the best possible clinical experience. This experience is that you get medical training, you apply it through direct patient interactions where you actually have to make critical clinical decisions, and most importantly you are exposed to medical error and corrective actions, which are very important to see. It requires you to take time to get trained, to study, take tests, demonstrate your competence, and run shifts. Needless to say, this is my recommendation.

Finally, to make yourself the ultimate triple threat, you need research (grades, clinical experience, and research is the triple threat). It is not hard to find research opportunities if you go to school near an academic medical center, but it takes effort to get something worthwhile out of the experience. I have been the “mentor” for quite a few college students who didn’t do squat, and a few that worked their butts off. It is pretty much up to you. When I did this, I just looked in the back of the scientific journals, and wrote letters to people I wanted to work with. Usually they know people where you are and can hook you up. Also, many colleges have summer and school year research programs that are easy to get into. Research is also interesting. It is important to learn the scientific method, and how to design and interpret an experiment. My research experience has made me a better doctor by teaching me how to evaluate scientific evidence. I think if you can do it, research is very important. You probably will not get to publish anything unless you get real lucky, but the letter of recommendation from the research mentor will be helpful.


Well that’s it. Hope this was helpful. Don’t hesitate to contact me if I can help.



A discussion of sepsis for pre-hospital and hospital providers. I go over the causes, signs, symptoms, and emergency treatment of sepsis and septic shock. A little original gospel sax at the beginning and end. Thanks, JY

Getting into medical school: Part 1, college choice and grades

Since so many people reading this could be working in fire and EMS to get prepared for medical school, I thought I would take a little time and talk about my thoughts on this. For the people reading who are in med school already, go back to studying or go see your patients.

First, my qualifications to talk about this. Other than being an MD for 24 years, and getting into med school along with my wife, my wife and I were both on the admissions committee at MCV/VCU in our senior years and participated completely: evaluation of applications, interviewing applicants, and sitting in and voting on final decisions. Also, I have worked with hundreds of medical students over these 22 years, and I always make a point of finding out: where you went to college, what your major was, and your path to medical school. From this, I have been able to draw many conclusions about how to become a physician. I have little or no experience with DO admissions, but in general, everything is fairly similar, except your GPA and MCAT scores can be lower (about 0.2 for GPA, and about 15% lower for MCATS, these are estimates). Also, all my sons want to be physicians, so I have had to relearn some of the statistics and strategies.

Lets go through the factors and my strong opinions about them. If you are medical student or college student and think I’m wrong, you are probably wrong. If you are a Dean of Admissions at a MD or DO school and think I’m wrong, please write in and tell me where I am incorrect so the readers get the best information.

College choice: In my opinion, meaningless. There is  absolutely no reason to choose an Ivy league school over a state school solely for the purpose of improving your chance of getting in. Can you get into med school from VCU? Absolutely. Can you get in from Elon college? Absolutely. Can you get in from Liberty University? Absolutely. I have worked with multiple medical students at UVA from all these colleges. In fact one of the physicians I respect most went to community college for 2 years, then finished his degree , and was accepted at multiple places. Med school costs money, and debt hurts. While there may be other solid reasons to go to Harvard over Penn State, improving your chances at med school admissions is a very weak one. Spending $50,000/year at Princeton vs spending $15,000 at Ohio State will increase your debt by $140,000 BEFORE YOU EVEN BEGIN MEDICAL SCHOOL. And then you add the debt from medical school. If you know you want to be a physician, go to a solid school and do well and you’ll get in. If you go to Yale and have a 3.2 GPA and get a 21 on your MCATS will you get into med school? You probably have less than a 15% chance of getting in. If you go to Iowa Stae and have a 3.7 and a 28 on the MCATS, you have a 60% chance. Nuff said

Grades: You only need to remember one thing: GPA, GPA, GPA, etc. What does it mean to a med school admissions committe if you have a 3.2? It means you have trouble gathering information, processing it, and delivering that information when asked for. What do you do in med school? Gather information, process it, and deliver it. What do you do as a doctor? Gather information, process it, and deliver it. If you cant do that, you’re screwed. Do med schools care if you’re taking the high level organic chem, vs the low level “pre-med” organic chem? If someone told you they do, think of this: that admissions committee sees 10,000 applications, often they have a GPA cutoff before they even open your file (usually around 3.1-3.2) so you have a 3.0, you’re gone and they wont open your file and know what course you took. Lets say they dont filter and the file makes it to a reviewer, do you actually think that the admissions committee member knows the difference between organic chem 2301 at Harvard and organic chem 252 at UVA???  They have no idea. Maybe if youre from the same institution, they have some concept of the numberic of honors courses, but invariably they dont. So get as high a GPA as humanly possible, especially your science GPA.

I recommend you take the lowest level science courses you can for pre-med unless you are CERTAIN you can get an A. Talk to people who have taken the higher level course, look at the grade distribution, go to the web and research. If 10% of students get an A, there’s a 90% chance YOU WON’T. Will it make a difference as to the type of doctor you will become? No. Will it prepare you better for med school? Simple answer, no. More complex answer – maybe, but if you dont get into med school, you’ll never know if it prepared you better.

Next post – extracurricular activity and medical experience.