Shortie: Tuba Player

Top: One of the jazz greats, Louis Armstrong. Image found via Google Images.
Bottom: A CT scan of a kid with Parotitis. From the New England Journal of Medicine.

One of the biggest figures I associate with jazz during the 20th century is Louis Armstrong. Known for his quite exquisite trumpet playing and great scatting, I've actually associated him with another distinctive visual quality:

BIG CHEEKS.

February 2009. I remember logging into the New England Journal of Medicine website to start to see what the world of truly revolutionary science could be. I came across that day an article with a title was simple (at least more simple than I'd expect from a medical journal): A Tuba Player with Air in the Parotid Gland. Keeping it simple, the parotid gland is one of the glands that's critical for producing your saliva in your mouth.

When playing the tuba, one of life's truest physical properties comes true: If something gets trapped, it needs a way out. Playing the tuba requires physical air pressure in your mouth to get the instrument to play. However, because 1) blowing against a tuba (or other wind instrument) creates air resistance, and 2) Your body has locked the air in the oral cavity (keeping it simple again, your mouth), there's only one other way for that air to go... the force to play that instrument actually flies down the tubes that connect your mouth to the glands that produce saliva. The scientific name of this phenomenon is: pneumoparotid.

With the origin of the name including that for "air" (pneumo-), this diagnosis stays true to its name. The air that gets blown into those glands gets trapped, resulting in enlargement of the glands, with enlargements appearing around the point where your jaw pivots to open: the place that the glands are located.

Hence: Big Cheeks.

Folks, I guess I can come to this conclusion: If your kid can't play the tuba, your kid might be able to pull off the look.

Source: Mukundan, J. and O. Jenkins. 2009. A Tuba Player with Air in the Parotid Gland. New England Journal of Medicine Vol 360. p.710.

Perspective: Private Practice

^ Above: Neil Patrick Harris as Doogie Howser in the famed early 90s sitcom.

"INDEPENDENT PRACTICE HAS LONG BEEN THE

BACKBONE OF AMERICAN MEDICINE."

It might not be an accurate representation of the medical field, but one of my sweet tooths for television is the show Doogie Howser, M.D. (I hope y'all aren't too old to hear this). For those of you who don't know about the show, Doogie was a 30 minute sitcom that aired from 1989-1992, starring Neil Patrick Harris (currently on How I Met Your Mother, CBS) as a 16- year old medical child prodigy and his adventures of being a teenager and dealing with the stresses of a career in medicine. Throughout the show, there were attempts to pull him from his niche at the hospital. At one time, his dad tries to convince him to join him in his family practice in the neighborhood, and at another, a local pediatrics group is trying to get Doogie to move in with them, luring him with higher pay. However, each time, a specific case, patient, or colleague he cares about leads him to stay where he is.

And what does a 16 year-old prodigy have to do with a 23 year-old typical medical student?

I FACE A SIMILAR BATTLE... Do I really want to work in a hospital environment or do I want to try to establish my own medical practice? Each one has their pros and cons. However, I was reading an article in the New England Journal of Medicine about the decline in the independent practices over time. The amount of costs (everything from getting electronic medical record keeping systems to the tradeoff for independence for declining incomes) has driven many independent physicians towards working in groups (usually as employers) or as a person who works salaried in the hospital.

Most americans get their care from private practices (about 9 out of 10 of us), the NEJM article above has shown. Some studies have showed that being a private consultant has given patients better and more flexible treatment and care, others don't. Independent practices also allow doctors to build the rapport to improve patient compliance, resulting in better results (remember, that although a doctor might give out a treatment, its really up to the patient to improve their lifestyle or take their medications appropriately).

In my case I value working in a hospital or a group, because there's that support network available. In case I or one of my colleagues come upon a case that's pretty darn complex, I can network with them towards a quick solution. However, independently, I would either have to refer my patient or take some time off to do some research on my own and make some phone calls. The negative part to all this is the backbone as to which hospitals have to allot their care: will it limit my decisions to provide treatment?

The independent practice releases me from that (don't get me wrong, I still have to work underneath limitations & restrictions imposed by law & insurance). According to the NEJM article, there is an increased amount of charity care that takes place among independent physicians, improving their role in underserved and poor populations. I'd like that extra freedom to have an option to treat these patients appropriately in this case. However, don't get me wrong, I still want to make an enjoyable living. The ratio of amount of work to amount made to make a living is pretty poor, compared to working in private groups or in the hospital.

I guess everything is a trade, right? I haven't completely thought this out, but I hope that going through rotations and doing some more research can help me get a greater understanding of what's right for me: to play a role on ER or Private Practice?

Stay tuned... :P

Source: Isaacs, Stephen L., Paul S. Jellinek, and Walter L. Ray. "The Independent Physician - Going, Going..." New England Journal of Medicine 360 (2009): 655-57.