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add789: 分享下自己内科OB的经历 (Discussion)
作者:USMedEdu
发表时间:2010-09-20
更新时间:2010-09-20
浏览:1778次
评论:3篇
地址:24.
::: 栏目 :::
现代医学vs“中医”
社会、艺术与医学
住院/FELLOW单位
中外医学网站精选
国内外医学交流信息
生物医学人物
力刀美加医学教育专
临床见习/实习/义工
医学生理学诺贝尔奖
医生助理(PA)职业
医学书籍照片及图谱
社会与医学瞬间定格
医学典故/医史杂谈
USMLE复习和考试
申请和面试住院医生
住院医生生活和工作
FELLOWSHIP
医生就业、工作及生
医学科普及问题解答
美加医学院申请/MCA
中美医学临床教育比
医学新进展及新闻
社会医学伦理

发信人: add789 (Emma wanna a teacup poodle puppy), 信区: MedicalCareer
标 题: 我也来分享下自己内科OB的经历吧,顺便请教!
发信站: BBS 未名空间站 (Mon Sep 20 19:39:18 2010, 美东)

前面是天天找,天天盼,终于有“贵人”相助,介绍了一个。所谓“贵人”是指热心帮
助的好人,不过这人也还是医院的新人呢。

anyway,得到这个OB的机会后,天天都“怕”去了。原因很多,第一,我家住地远,为了
7点到病房,我最晚5:30am要起床,爬起来的时候真想哭。第二,组里都是AMG,
还有个medical student,不知道是不是因为他们都是男的,对我都很礼貌,但是就是
非常distant,我主动offer help,人家从来都是礼貌的拒绝。第三
,attending从来不理我,问问题从来都是点名回答,我从来都没有机会插嘴
,也就更不用说shine了。而且attending一周一换,resident每2周一换.还没
有熟起来,人就走了.总算还有个全内科的morning report,可以抢答问题,可是今天
去了一下,发现要不就是知识记的很模糊,要不就是语言上反映不够快,总是被印度人
抢了先。要说A3,只是不佩服不行,坐着的大多是AMG,可是有一两个A3几乎把所有问
题都抢答了.

上周的attending走了后现在的attending都不知道我哪里来的,不过他也不问.我也不
知道我还能赖多久.反正心里挺难过,而且很怀疑自己的能力,想想我都在国内做过2
年住院了,现在还这么挫...
不知道现在有没有其他也在做OB的同学,我们交流下哈?还有已经在做resident的同学
们,有没有人可以指点下呢?
--

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发信人: clamchowder (DDD), 信区: MedicalCareer
标 题: Re: 我也来分享下自己内科OB的经历吧,顺便请教!
发信站: BBS 未名空间站 (Mon Sep 20 19:55:09 2010, 美东)

你对自己要求好高,我觉得一般ob还挺难一上来就shine的。给自己些时间,住院医都
得几个月到半年才能适应。



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发信人: add789 (Emma wanna a teacup poodle puppy), 信区: MedicalCareer
标 题: Re: 我也来分享下自己内科OB的经历吧,顺便请教!
发信站: BBS 未名空间站 (Mon Sep 20 20:23:11 2010, 美东)

如果要这么长时间才能适应的话,我怕在要到推荐信之前就被他们踢出去了。

我们那里的PGY-1,也就是才开始工作几个月吧,我觉得他们都很得心应手了.
--

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发信人: DreamChaser (麦地 之 MDToBe - 该干嘛就干嘛), 信区: MedicalCareer
标 题: Re: 我也来分享下自己内科OB的经历吧,顺便请教!
发信站: BBS 未名空间站 (Mon Sep 20 21:08:28 2010, 美东)

说一下我自己的感觉:坚持就是胜利!设身处地地想一下,如果你是一个住院医或者主
治医生,突然来了一个“陌生人”要帮你照顾病人,你会马上接受吗?尊重还有信任是
需要时间来建立的,坚持下去我觉得你肯定能有收获的,混到脸熟以后主治估计就会开
始“pimp”你了,住院们也会慢慢接受你的帮助或者教你一些东西的。

千万不要学阿三那么aggressive,我觉得那样会起反作用的,另外就是把家庭作业做足
,如果碰到一些病例你很熟悉,可以放开胆子去试着回答一些问题或者甚至问一些问题
,慢慢你会给大家留下好印象的,加油……



--

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发信人: REDpersimmon (麦地大尾巴), 信区: MedicalCareer
标 题: Re: 我也来分享下自己内科OB的经历吧,顺便请教!
发信站: BBS 未名空间站 (Mon Sep 20 22:04:32 2010, 美东)

先恭喜找到inpatient的ob! 我从来都找不到inpatient的,说是医院有规定外来人员不
许ob inpatient 病人。象你说的确实蛮郁闷的,特别是如果你是冲着推荐信的话。但
不要急,慢慢来,就当不是来要推荐信的,是来多看多学习的。病房会比门诊多学到很
多东西,只是需要时间积累。我前几个月在一个中国医生那里跟outpatient,那医生就
要退休了,所以一天只看十几个病人,也不是天天看,所以有空跟我聊天,并不时提一
些问题,还把以前的病例讲给我听,问我怎么处理。我一开始是其他医生也跟的,其他
都是美国医生,一天看二三四十个病人,哪有空理我啊,我后来还是跟那位中国医生了
。而且大家都说,这个病人是pre-op, 那个是physical exam,没啥好看的,你就坐着
吧,一天下来我没见着几个病人。clinic离家也很远,堵车要一小时。后来也不去了。
说实在的outpatient真没有很多可以学,非常boring,就是些sore throat, poison
ivy, back pain, diabetes/hypertension follow-up. that's it.
--

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发信人: lingzMainz (lingzMainz), 信区: MedicalCareer
标 题: Re: 我也来分享下自己内科OB的经历吧,顺便请教!
发信站: BBS 未名空间站 (Mon Sep 20 22:16:34 2010, 美东)

刚开始不要着急,第一周要眼观四处,耳听八方,不要着急说话,耐心观察观察,找到
一个nice的residency,再想办法粘上人家,最好找个同性别的,容易沟通点。等混熟
了再看单下菜,不要老想shine。跟着学生学,看他们怎么做。坚持下来最后会有机会
的。早上起早,那晚上就少灌水,早睡觉,准时是非常重要的,别看attending没说话
,人家都瞧在眼里记在心里呢。我OB的时候连周末都一样参加morning report,周末去
的人少,咱就有机会发言了不是?要有破釜沉舟的决心,不要怕吃苦。我每天早上去医
院前还要把老公孩子的早点做好,然后把自己收拾整齐了再去医院。到了医院一边上楼
一边给家里打电话以免孩子睡过了误了校车,还得叮嘱孩子一定要吃完早点。但一进
conference room天塌下来我也不管了,就关掉手机聚精会神听周围人聊天或看看专业
书。晚上回来再累也要看书。对了,每天早上一定要喝一大杯咖啡提神,不然打瞌睡印
象分马上就下去了。无论多累都要装着精神抖擞的样子呀!我的一点感想,希望能对你
有用。
--

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发信人: lzumc2008 (麦地乖乖虎), 信区: MedicalCareer
标 题: Re: 我也来分享下自己内科OB的经历吧,顺便请教!
发信站: BBS 未名空间站 (Mon Sep 20 22:38:49 2010, 美东)

理解你的苦处,住院医生都两到四周换一拨。我这里,每组都把病人尽量平均分给学生
。和大家都混熟,尽量跟着某一个住院医师和学生,熟悉他们手上的病人。有很多杂活
的,follow up lab,打打下手,主动要求去跑腿。很快就会处熟了,一熟了,场面打开
,大伙就会处的很开心了。我经常有学生会要求多干杂活的,我可开心啦,自然和他们
聊天啦如果闲的话,时间一长,也就知道哪个学生靠的住,不会忘事:)。

我自己总是认为不要认为OB一下,临床就提高多少。相反我认为OB应该让你学会如何和
你周围的人communicate,把自己除了医学知识外其它的charming side都显示出来,在
短期限内,给别人最好的印象。(可能我做OB那时侯,我临床经验很差的,除了虚心学
外,也知道自己在临床经验上是shine不了的,所以就从personality, outgoing, etc
上下手喽)。

几天前,在ICU刚忙完,回computer room休息休息。有个已经轮转了几周的学生进来拿
个化验单来问我,上面有一部分没copy下来,问我是什么,还说是intern马上present,
要他来find out.我可生气了,就和他说:I am ICU resident, not in charge of
floor and someone's presentation, it's you need to find out. Look at the
report, they have patients name, medical record number, date, u need to look
at it on the computer by yourself, not asking me. 所以说,问问题之前,也要
想一想,看一看,自己都能解决的,竟然还来bother我,我即使在take break,也不会
帮他的,he has the ability to figure it out, just think first, then figure
out, if still can't, then ask for help. 哪有一进来逮到个人就问的。那个学生可
真呆啊。偏又碰上我个脾气当时不太好的。我又没有义务去教他,他都来了好几周,
lab怎么可能不太会查呢?都当大爷,(其时我当时和另一个中国同事正聊天呢:),
可不高兴被打断。

你还是要坚持,不要太文静了,俺们上班啥都聊的:)。



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1   [USMcdEdu 于 2011-02-07 20:56:28 提到] [FROM: 199.]
发信人: USMedEdu (US_CMGs), 信区: Biology
标 题: Re: 生活是美丽的。
发信站: BBS 未名空间站 (Thu Jan 27 18:13:03 2011, 美东)

Terra Firma — A Journey from Migrant Farm Labor
to Neurosurgery

Alfredo Quiñones-Hinojosa, M.D.

http://content.nejm.org/cgi/reprint/357/6/529.pdf
“You will spend the rest of
your life working in the
fields,” my cousin told me when
I arrived in the United States in
the mid-1980s. This fate indeed
appeared likely: a 19-
year-old illegal migrant
farm worker, I
had no English language
skills and no
dependable means of
support. I had grown
up in a small Mexican
farming community,
where I began
working at my father’s
gas station at
the age of 5. Our
family was poor, and
we were subject to the diseases
of poverty: my earliest memory
is of my infant sister’s death
from diarrhea when I was 3 years
old. But my parents worked long
hours and had always made
enough money to feed us, until
an economic crisis hit our country
in the 1970s. Then they could
no longer support the family,
and although I trained to be a
teacher, I could not put enough
food on the table either.
Desperate for a livable income,
I packed my few belongings
and, with $65 in my pocket,
crossed the U.S. border illegally.
The first time I hopped the fence
into California, I was caught
and sent back to Mexico, but I
tried again and succeeded. I am
not condoning illegal immigration;
honestly, at the time, the
law was far from the front of my
mind. I was merely responding
to the dream of a better life, the
hope of escaping poverty so that
one day I could return home triumphant.
Reality, however, posed
a stark contrast to the dream. I
spent long days in the fields picking
fruits and vegetables, sleeping
under leaky camper shells,
eating anything I could get, with
hands bloodied from pulling
weeds — the very same hands
that today perform brain surgery.
My days as a farm worker
taught me a great deal about
economics, politics, and society.
I learned that being illegal and
poor in a foreign country could
be more painful than any poverty
I had previously experienced.
I learned that our society sometimes
treats us differently depending
on the places we have
been and the education we have
obtained. When my cousin told
me I would never escape that life
of poverty, I became determined
to prove him wrong. I took night
Copyright © 2007 Massachusetts Medical Society. All rights reserved.
Downloaded from www.nejm.org at THE OHIO STATE UNIV on August 26, 2007 .
PERSPECTIVE
n engl j med 357;6 www.nejm.org august 9, 200530 7
jobs as a janitor and subsequently
as a welder that allowed me to
attend a community college where
I could learn English.
In 1989, while I was working
for a railroad company as a welder
and high-pressure valve specialist,
I had an accident that
caused me to reevaluate my life
once again. I fell into a tank car
that was used to carry liquefied
petroleum gas. My father was
working at the same company.
Hearing a coworker’s cry for help,
he tried to get into the tank; fortunately,
someone stopped him. It
was my brother-in-law, Ramon,
who climbed in and saved my
life. He was taken out of the
tank unconscious but regained
consciousness quickly. By the time
I was rescued, my heart rate had
slowed almost to zero, but I was
resuscitated in time. When I
awoke, I saw a person dressed all
in white and was flooded with a
sense of security, confidence, and
protection, knowing that a doctor
was taking care of me. Although
it was clear to me that our
poverty and inability to speak English
usually translated into suboptimal
health care for my community,
the moment I saw this
physician at my bedside, I felt I
had reached terra firma, that I had
a guardian.
After community college, I was
accepted at the University of California,
Berkeley, where a combination
of excellent mentorship,
scholarships, and my own passion
for math and science led me to
research in the neurosciences. One
of my mentors there convinced
me, despite my skepticism, that
I could go anywhere I wanted for
medical school. Thanks to such
support and encouragement, I
eventually went to Harvard Medical
School. As I pursued my own
education, I became increasingly
aware of the need and responsibility
we have to educate our country’s
poor.
It is no secret that minority
communities have the highest
dropout rates and the lowest
educational achievement levels
in the country. The pathway to
higher education and professional
training programs is not
“primed” for minority students.
In 1994, when I started medical
school, members of minority
groups made up about 18% of
the U.S. population but accounted
for only 3.7% of the faculty in
U.S. medical schools. I was very
fortunate to find outstanding
minority role models, but though
their quality was high, their numbers
were low.
Given my background, perhaps
it is not surprising that I
did not discover the field of neurosurgery
until I was a medical
student. I vividly remember when,
in my third year of medical
school, I first witnessed neurosurgeons
peeling back the dura
and exposing a real, live, throbbing
human brain. I recall feeling
absolute awe and humility —
and an immediate and deep
recognition of the intimacy between
a patient and a doctor.
That year, one of my professors
strongly encouraged me to
go into primary care, arguing
that it was the best way for me
to serve my Hispanic immigrant
community. Although I had initially
intended to return to Mexico
triumphant, I had since fallen
in love with this country, and
I soon found myself immersed
in and committed to the betterment
of U.S. society. With my
sights set on neurosurgery after
medical school, I followed my
heart and instincts and have tried
to contribute to my community
and the larger society in my own
way. I see a career in academic
medicine as an opportunity not
only to improve our understanding
and treatment of human diseases
but also to provide leadership
within medicine and support
to future scientists, medical students,
and physician scientists
from minority and nonminority
groups alike.
Terra Firma — A Journey from Migrant Farm Labor to Neurosurgery
Copyright © 2007 Massachusetts Medical Society. All rights reserved.
Downloaded from www.nejm.org at THE OHIO STATE UNIV on August 26, 2007 .
n engl j med 357;6 www.nejm.org august 9, 2007
PERSPECTIVE
531
My grandmother was the medicine
woman in the small town in
rural Mexico where I grew up.
As I have gotten older, I have
come to recognize the crucial
role she played not only in instilling
in me the value of healing
but also in determining the
fate and future of others. She was
my first role model, and throughout
my life I have depended on
the help of my mentors in pursuing
my dreams. Like many other
illegal immigrants, I arrived in
the United States able only to
contemplate those dreams — I
was not at that point on solid
ground. From the fields of the
San Joaquin Valley in California
to the field of neurosurgery, it
has been quite a journey. Today,
as a neurosurgeon and researcher,
I am taking part in the larger
journey of medicine, both caring
for patients and conducting
clinical and translational research
on brain cancer that I hope will
lead to innovative ways of fighting
devastating disease. And as
a citizen of the United States, I am
also participating in the great
journey of this country. For immigrants
like me, this voyage still
means the pursuit of a better
life — and the opportunity to
give back to society.
An interview with Dr. Quiñones-Hinojosa
can be heard at www.nejm.org.
Dr. Quiñones-Hinojosa is an assistant professor
of neurosurgery and oncology and
director of the brain-tumor stem-cell laboratory
at Johns Hopkins School of Medicine,
Baltimore, and director of the braintumor
program at the Johns Hopkins
Bayview campus.
Copyright © 2007 Massachusetts Medical Society.
Terra Firma — A Journey from Migrant Farm Labor to Neurosurgery
Pay for Performance, Version 2.0?
Thomas H. Lee, M.D.
“Old wine in a new bottle.” “A
financial gamble.” “An early
glimpse of the next generation of
pay for performance.” All these
appraisals have been applied to
Geisinger Health System’s new approach
to elective coronary-artery
bypass grafting (CABG), which
has been described with words
rarely invoked in health care, such
as “promise” and “guarantee.”
Geisinger, an integrated health
care delivery system in northeastern
Pennsylvania, promises
that 40 key processes will be
completed for every patient who
undergoes elective CABG — even
though several of the “benchmarks”
are to be reached before
or after hospitalization. And although
Geisinger cannot guarantee
good clinical outcomes, it
charges a standard flat rate that
covers care for related complications
during the 90 days after
surgery.
As a member of Geisinger’s
board of directors, I have watched
this program evolve over the past
year, and I see truth in all three
of the above assessments. Many
of the core components of the
program are familiar, but this
sort of application of those components
represents a foray into
the unknown. Since a front-page
article in the New York Times on
May 17, 2007, drew national attention
to the Geisinger program,
other hospitals have been
watching closely and wondering
whether they, too, should go
down this road. Those who examine
it closely will quickly discover
that the program is less
about cardiac surgery than about
the search for an alternative to
traditional fee-for-service care.
The basic concept is far from
radical. The seven cardiac surgeons
in the Geisinger delivery
system agreed on 40 processes
that should be completed during
the care of every patient undergoing
elective CABG. Most of
the “Proven Care Benchmarks”
come directly from guidelines
established by the American College
of Cardiology and the American
Heart Association (ACC–AHA)
(see box). These steps (such as
the administration of preoperative
antibiotics at a specified time)
are prominent in the critical pathways
in use for cardiac surgery
at many other hospitals.
The list does not force the surgeons
to practice “cookbook medicine.”
For example, they do not
necessarily have to use epiaortic
echocardiography to screen for
atheromata before manipulating
the aorta. But the protocol requires
that they consider this test
and document the reason if they
decide not to use it.
Closer inspection reveals some
other items on the list that would
be new to most critical pathways
for CABG. The first benchmark
that must be documented is a
statement of the indication for
CABG according to the ACC–AHA
guidelines.1 These guidelines de-
Copyright © 2007 Massachusetts Medical Society. All rights reserved.

Downloaded from www.nejm.org at THE OHIO STATE UNIV on August 26, 2007 .
--
力刀 于加拿大
北美中国医(学)生教育网站:
http://bbs.cmgforum.net or http://cmgforum.net
MITBBS_美国医学教育博客(USMedEdu):
http://www.mitbbs.com/pc/index.php?id=USMedEdu
MITBBS美加临床医学考版俱乐部(Pre_Resident_Club):

发信人: USMedEdu (US_CMGs), 信区: Biology
标 题: Re: 生活是美丽的。
发信站: BBS 未名空间站 (Thu Jan 27 18:13:03 2011, 美东)

Terra Firma — A Journey from Migrant Farm Labor
to Neurosurgery

Alfredo Quiñones-Hinojosa, M.D.

http://content.nejm.org/cgi/reprint/357/6/529.pdf
“You will spend the rest of
your life working in the
fields,” my cousin told me when
I arrived in the United States in
the mid-1980s. This fate indeed
appeared likely: a 19-
year-old illegal migrant
farm worker, I
had no English language
skills and no
dependable means of
support. I had grown
up in a small Mexican
farming community,
where I began
working at my father’s
gas station at
the age of 5. Our
family was poor, and
we were subject to the diseases
of poverty: my earliest memory
is of my infant sister’s death
from diarrhea when I was 3 years
old. But my parents worked long
hours and had always made
enough money to feed us, until
an economic crisis hit our country
in the 1970s. Then they could
no longer support the family,
and although I trained to be a
teacher, I could not put enough
food on the table either.
Desperate for a livable income,
I packed my few belongings
and, with $65 in my pocket,
crossed the U.S. border illegally.
The first time I hopped the fence
into California, I was caught
and sent back to Mexico, but I
tried again and succeeded. I am
not condoning illegal immigration;
honestly, at the time, the
law was far from the front of my
mind. I was merely responding
to the dream of a better life, the
hope of escaping poverty so that
one day I could return home triumphant.
Reality, however, posed
a stark contrast to the dream. I
spent long days in the fields picking
fruits and vegetables, sleeping
under leaky camper shells,
eating anything I could get, with
hands bloodied from pulling
weeds — the very same hands
that today perform brain surgery.
My days as a farm worker
taught me a great deal about
economics, politics, and society.
I learned that being illegal and
poor in a foreign country could
be more painful than any poverty
I had previously experienced.
I learned that our society sometimes
treats us differently depending
on the places we have
been and the education we have
obtained. When my cousin told
me I would never escape that life
of poverty, I became determined
to prove him wrong. I took night
Copyright © 2007 Massachusetts Medical Society. All rights reserved.
Downloaded from www.nejm.org at THE OHIO STATE UNIV on August 26, 2007 .
PERSPECTIVE
n engl j med 357;6 www.nejm.org august 9, 200530 7
jobs as a janitor and subsequently
as a welder that allowed me to
attend a community college where
I could learn English.
In 1989, while I was working
for a railroad company as a welder
and high-pressure valve specialist,
I had an accident that
caused me to reevaluate my life
once again. I fell into a tank car
that was used to carry liquefied
petroleum gas. My father was
working at the same company.
Hearing a coworker’s cry for help,
he tried to get into the tank; fortunately,
someone stopped him. It
was my brother-in-law, Ramon,
who climbed in and saved my
life. He was taken out of the
tank unconscious but regained
consciousness quickly. By the time
I was rescued, my heart rate had
slowed almost to zero, but I was
resuscitated in time. When I
awoke, I saw a person dressed all
in white and was flooded with a
sense of security, confidence, and
protection, knowing that a doctor
was taking care of me. Although
it was clear to me that our
poverty and inability to speak English
usually translated into suboptimal
health care for my community,
the moment I saw this
physician at my bedside, I felt I
had reached terra firma, that I had
a guardian.
After community college, I was
accepted at the University of California,
Berkeley, where a combination
of excellent mentorship,
scholarships, and my own passion
for math and science led me to
research in the neurosciences. One
of my mentors there convinced
me, despite my skepticism, that
I could go anywhere I wanted for
medical school. Thanks to such
support and encouragement, I
eventually went to Harvard Medical
School. As I pursued my own
education, I became increasingly
aware of the need and responsibility
we have to educate our country’s
poor.
It is no secret that minority
communities have the highest
dropout rates and the lowest
educational achievement levels
in the country. The pathway to
higher education and professional
training programs is not
“primed” for minority students.
In 1994, when I started medical
school, members of minority
groups made up about 18% of
the U.S. population but accounted
for only 3.7% of the faculty in
U.S. medical schools. I was very
fortunate to find outstanding
minority role models, but though
their quality was high, their numbers
were low.
Given my background, perhaps
it is not surprising that I
did not discover the field of neurosurgery
until I was a medical
student. I vividly remember when,
in my third year of medical
school, I first witnessed neurosurgeons
peeling back the dura
and exposing a real, live, throbbing
human brain. I recall feeling
absolute awe and humility —
and an immediate and deep
recognition of the intimacy between
a patient and a doctor.
That year, one of my professors
strongly encouraged me to
go into primary care, arguing
that it was the best way for me
to serve my Hispanic immigrant
community. Although I had initially
intended to return to Mexico
triumphant, I had since fallen
in love with this country, and
I soon found myself immersed
in and committed to the betterment
of U.S. society. With my
sights set on neurosurgery after
medical school, I followed my
heart and instincts and have tried
to contribute to my community
and the larger society in my own
way. I see a career in academic
medicine as an opportunity not
only to improve our understanding
and treatment of human diseases
but also to provide leadership
within medicine and support
to future scientists, medical students,
and physician scientists
from minority and nonminority
groups alike.
Terra Firma — A Journey from Migrant Farm Labor to Neurosurgery
Copyright © 2007 Massachusetts Medical Society. All rights reserved.
Downloaded from www.nejm.org at THE OHIO STATE UNIV on August 26, 2007 .
n engl j med 357;6 www.nejm.org august 9, 2007
PERSPECTIVE
531
My grandmother was the medicine
woman in the small town in
rural Mexico where I grew up.
As I have gotten older, I have
come to recognize the crucial
role she played not only in instilling
in me the value of healing
but also in determining the
fate and future of others. She was
my first role model, and throughout
my life I have depended on
the help of my mentors in pursuing
my dreams. Like many other
illegal immigrants, I arrived in
the United States able only to
contemplate those dreams — I
was not at that point on solid
ground. From the fields of the
San Joaquin Valley in California
to the field of neurosurgery, it
has been quite a journey. Today,
as a neurosurgeon and researcher,
I am taking part in the larger
journey of medicine, both caring
for patients and conducting
clinical and translational research
on brain cancer that I hope will
lead to innovative ways of fighting
devastating disease. And as
a citizen of the United States, I am
also participating in the great
journey of this country. For immigrants
like me, this voyage still
means the pursuit of a better
life — and the opportunity to
give back to society.
An interview with Dr. Quiñones-Hinojosa
can be heard at www.nejm.org.
Dr. Quiñones-Hinojosa is an assistant professor
of neurosurgery and oncology and
director of the brain-tumor stem-cell laboratory
at Johns Hopkins School of Medicine,
Baltimore, and director of the braintumor
program at the Johns Hopkins
Bayview campus.
Copyright © 2007 Massachusetts Medical Society.
Terra Firma — A Journey from Migrant Farm Labor to Neurosurgery
Pay for Performance, Version 2.0?
Thomas H. Lee, M.D.
“Old wine in a new bottle.” “A
financial gamble.” “An early
glimpse of the next generation of
pay for performance.” All these
appraisals have been applied to
Geisinger Health System’s new approach
to elective coronary-artery
bypass grafting (CABG), which
has been described with words
rarely invoked in health care, such
as “promise” and “guarantee.”
Geisinger, an integrated health
care delivery system in northeastern
Pennsylvania, promises
that 40 key processes will be
completed for every patient who
undergoes elective CABG — even
though several of the “benchmarks”
are to be reached before
or after hospitalization. And although
Geisinger cannot guarantee
good clinical outcomes, it
charges a standard flat rate that
covers care for related complications
during the 90 days after
surgery.
As a member of Geisinger’s
board of directors, I have watched
this program evolve over the past
year, and I see truth in all three
of the above assessments. Many
of the core components of the
program are familiar, but this
sort of application of those components
represents a foray into
the unknown. Since a front-page
article in the New York Times on
May 17, 2007, drew national attention
to the Geisinger program,
other hospitals have been
watching closely and wondering
whether they, too, should go
down this road. Those who examine
it closely will quickly discover
that the program is less
about cardiac surgery than about
the search for an alternative to
traditional fee-for-service care.
The basic concept is far from
radical. The seven cardiac surgeons
in the Geisinger delivery
system agreed on 40 processes
that should be completed during
the care of every patient undergoing
elective CABG. Most of
the “Proven Care Benchmarks”
come directly from guidelines
established by the American College
of Cardiology and the American
Heart Association (ACC–AHA)
(see box). These steps (such as
the administration of preoperative
antibiotics at a specified time)
are prominent in the critical pathways
in use for cardiac surgery
at many other hospitals.
The list does not force the surgeons
to practice “cookbook medicine.”
For example, they do not
necessarily have to use epiaortic
echocardiography to screen for
atheromata before manipulating
the aorta. But the protocol requires
that they consider this test
and document the reason if they
decide not to use it.
Closer inspection reveals some
other items on the list that would
be new to most critical pathways
for CABG. The first benchmark
that must be documented is a
statement of the indication for
CABG according to the ACC–AHA
guidelines.1 These guidelines de-
Copyright © 2007 Massachusetts Medical Society. All rights reserved.

Downloaded from www.nejm.org at THE OHIO STATE UNIV on August 26, 2007 .
--
力刀 于加拿大
北美中国医(学)生教育网站:
http://bbs.cmgforum.net or http://cmgforum.net
MITBBS_美国医学教育博客(USMedEdu):
http://www.mitbbs.com/pc/index.php?id=USMedEdu
MITBBS美加临床医学考版俱乐部(Pre_Resident_Club):

发信人: USMedEdu (US_CMGs), 信区: Biology
标 题: Re: 生活是美丽的。
发信站: BBS 未名空间站 (Thu Jan 27 18:13:03 2011, 美东)

Terra Firma — A Journey from Migrant Farm Labor
to Neurosurgery

Alfredo Quiñones-Hinojosa, M.D.

http://content.nejm.org/cgi/reprint/357/6/529.pdf
“You will spend the rest of
your life working in the
fields,” my cousin told me when
I arrived in the United States in
the mid-1980s. This fate indeed
appeared likely: a 19-
year-old illegal migrant
farm worker, I
had no English language
skills and no
dependable means of
support. I had grown
up in a small Mexican
farming community,
where I began
working at my father’s
gas station at
the age of 5. Our
family was poor, and
we were subject to the diseases
of poverty: my earliest memory
is of my infant sister’s death
from diarrhea when I was 3 years
old. But my parents worked long
hours and had always made
enough money to feed us, until
an economic crisis hit our country
in the 1970s. Then they could
no longer support the family,
and although I trained to be a
teacher, I could not put enough
food on the table either.
Desperate for a livable income,
I packed my few belongings
and, with $65 in my pocket,
crossed the U.S. border illegally.
The first time I hopped the fence
into California, I was caught
and sent back to Mexico, but I
tried again and succeeded. I am
not condoning illegal immigration;
honestly, at the time, the
law was far from the front of my
mind. I was merely responding
to the dream of a better life, the
hope of escaping poverty so that
one day I could return home triumphant.
Reality, however, posed
a stark contrast to the dream. I
spent long days in the fields picking
fruits and vegetables, sleeping
under leaky camper shells,
eating anything I could get, with
hands bloodied from pulling
weeds — the very same hands
that today perform brain surgery.
My days as a farm worker
taught me a great deal about
economics, politics, and society.
I learned that being illegal and
poor in a foreign country could
be more painful than any poverty
I had previously experienced.
I learned that our society sometimes
treats us differently depending
on the places we have
been and the education we have
obtained. When my cousin told
me I would never escape that life
of poverty, I became determined
to prove him wrong. I took night
Copyright © 2007 Massachusetts Medical Society. All rights reserved.
Downloaded from www.nejm.org at THE OHIO STATE UNIV on August 26, 2007 .
PERSPECTIVE
n engl j med 357;6 www.nejm.org august 9, 200530 7
jobs as a janitor and subsequently
as a welder that allowed me to
attend a community college where
I could learn English.
In 1989, while I was working
for a railroad company as a welder
and high-pressure valve specialist,
I had an accident that
caused me to reevaluate my life
once again. I fell into a tank car
that was used to carry liquefied
petroleum gas. My father was
working at the same company.
Hearing a coworker’s cry for help,
he tried to get into the tank; fortunately,
someone stopped him. It
was my brother-in-law, Ramon,
who climbed in and saved my
life. He was taken out of the
tank unconscious but regained
consciousness quickly. By the time
I was rescued, my heart rate had
slowed almost to zero, but I was
resuscitated in time. When I
awoke, I saw a person dressed all
in white and was flooded with a
sense of security, confidence, and
protection, knowing that a doctor
was taking care of me. Although
it was clear to me that our
poverty and inability to speak English
usually translated into suboptimal
health care for my community,
the moment I saw this
physician at my bedside, I felt I
had reached terra firma, that I had
a guardian.
After community college, I was
accepted at the University of California,
Berkeley, where a combination
of excellent mentorship,
scholarships, and my own passion
for math and science led me to
research in the neurosciences. One
of my mentors there convinced
me, despite my skepticism, that
I could go anywhere I wanted for
medical school. Thanks to such
support and encouragement, I
eventually went to Harvard Medical
School. As I pursued my own
education, I became increasingly
aware of the need and responsibility
we have to educate our country’s
poor.
It is no secret that minority
communities have the highest
dropout rates and the lowest
educational achievement levels
in the country. The pathway to
higher education and professional
training programs is not
“primed” for minority students.
In 1994, when I started medical
school, members of minority
groups made up about 18% of
the U.S. population but accounted
for only 3.7% of the faculty in
U.S. medical schools. I was very
fortunate to find outstanding
minority role models, but though
their quality was high, their numbers
were low.
Given my background, perhaps
it is not surprising that I
did not discover the field of neurosurgery
until I was a medical
student. I vividly remember when,
in my third year of medical
school, I first witnessed neurosurgeons
peeling back the dura
and exposing a real, live, throbbing
human brain. I recall feeling
absolute awe and humility —
and an immediate and deep
recognition of the intimacy between
a patient and a doctor.
That year, one of my professors
strongly encouraged me to
go into primary care, arguing
that it was the best way for me
to serve my Hispanic immigrant
community. Although I had initially
intended to return to Mexico
triumphant, I had since fallen
in love with this country, and
I soon found myself immersed
in and committed to the betterment
of U.S. society. With my
sights set on neurosurgery after
medical school, I followed my
heart and instincts and have tried
to contribute to my community
and the larger society in my own
way. I see a career in academic
medicine as an opportunity not
only to improve our understanding
and treatment of human diseases
but also to provide leadership
within medicine and support
to future scientists, medical students,
and physician scientists
from minority and nonminority
groups alike.
Terra Firma — A Journey from Migrant Farm Labor to Neurosurgery
Copyright © 2007 Massachusetts Medical Society. All rights reserved.
Downloaded from www.nejm.org at THE OHIO STATE UNIV on August 26, 2007 .
n engl j med 357;6 www.nejm.org august 9, 2007
PERSPECTIVE
531
My grandmother was the medicine
woman in the small town in
rural Mexico where I grew up.
As I have gotten older, I have
come to recognize the crucial
role she played not only in instilling
in me the value of healing
but also in determining the
fate and future of others. She was
my first role model, and throughout
my life I have depended on
the help of my mentors in pursuing
my dreams. Like many other
illegal immigrants, I arrived in
the United States able only to
contemplate those dreams — I
was not at that point on solid
ground. From the fields of the
San Joaquin Valley in California
to the field of neurosurgery, it
has been quite a journey. Today,
as a neurosurgeon and researcher,
I am taking part in the larger
journey of medicine, both caring
for patients and conducting
clinical and translational research
on brain cancer that I hope will
lead to innovative ways of fighting
devastating disease. And as
a citizen of the United States, I am
also participating in the great
journey of this country. For immigrants
like me, this voyage still
means the pursuit of a better
life — and the opportunity to
give back to society.
An interview with Dr. Quiñones-Hinojosa
can be heard at www.nejm.org.
Dr. Quiñones-Hinojosa is an assistant professor
of neurosurgery and oncology and
director of the brain-tumor stem-cell laboratory
at Johns Hopkins School of Medicine,
Baltimore, and director of the braintumor
program at the Johns Hopkins
Bayview campus.
Copyright © 2007 Massachusetts Medical Society.
Terra Firma — A Journey from Migrant Farm Labor to Neurosurgery
Pay for Performance, Version 2.0?
Thomas H. Lee, M.D.
“Old wine in a new bottle.” “A
financial gamble.” “An early
glimpse of the next generation of
pay for performance.” All these
appraisals have been applied to
Geisinger Health System’s new approach
to elective coronary-artery
bypass grafting (CABG), which
has been described with words
rarely invoked in health care, such
as “promise” and “guarantee.”
Geisinger, an integrated health
care delivery system in northeastern
Pennsylvania, promises
that 40 key processes will be
completed for every patient who
undergoes elective CABG — even
though several of the “benchmarks”
are to be reached before
or after hospitalization. And although
Geisinger cannot guarantee
good clinical outcomes, it
charges a standard flat rate that
covers care for related complications
during the 90 days after
surgery.
As a member of Geisinger’s
board of directors, I have watched
this program evolve over the past
year, and I see truth in all three
of the above assessments. Many
of the core components of the
program are familiar, but this
sort of application of those components
represents a foray into
the unknown. Since a front-page
article in the New York Times on
May 17, 2007, drew national attention
to the Geisinger program,
other hospitals have been
watching closely and wondering
whether they, too, should go
down this road. Those who examine
it closely will quickly discover
that the program is less
about cardiac surgery than about
the search for an alternative to
traditional fee-for-service care.
The basic concept is far from
radical. The seven cardiac surgeons
in the Geisinger delivery
system agreed on 40 processes
that should be completed during
the care of every patient undergoing
elective CABG. Most of
the “Proven Care Benchmarks”
come directly from guidelines
established by the American College
of Cardiology and the American
Heart Association (ACC–AHA)
(see box). These steps (such as
the administration of preoperative
antibiotics at a specified time)
are prominent in the critical pathways
in use for cardiac surgery
at many other hospitals.
The list does not force the surgeons
to practice “cookbook medicine.”
For example, they do not
necessarily have to use epiaortic
echocardiography to screen for
atheromata before manipulating
the aorta. But the protocol requires
that they consider this test
and document the reason if they
decide not to use it.
Closer inspection reveals some
other items on the list that would
be new to most critical pathways
for CABG. The first benchmark
that must be documented is a
statement of the indication for
CABG according to the ACC–AHA
guidelines.1 These guidelines de-
Copyright © 2007 Massachusetts Medical Society. All rights reserved.

Downloaded from www.nejm.org at THE OHIO STATE UNIV on August 26, 2007 .
--
力刀 于加拿大
北美中国医(学)生教育网站:
http://bbs.cmgforum.net or http://cmgforum.net
MITBBS_美国医学教育博客(USMedEdu):
http://www.mitbbs.com/pc/index.php?id=USMedEdu
MITBBS美加临床医学考版俱乐部(Pre_Resident_Club):

 
2   [DrNewbie 于 2010-11-22 00:16:35 提到] [FROM: 98.]
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共有1条评论
1 [DrNewbie 于 2010-11-21 16:10:39 提到][删除][修改] [FROM: 98.119.]


Medi is back to its glory days in the absence of the obnoxious barking from the MadDog!!! Does anyone think there are some indispensable tips he actually learned from his private club? His club is such a joke.

I cant believe this kind of idiot exists in this world. Two words to describe this piece of human trash: shameless and stupid. USMedEdu, aka, MadDog, put the following thread in his blog and bold it in the front page. Yet, clearly, the answers he endorsed are the worst answers. The answer I provided got a nod from an English forum. Does he understand the concept of shame or logic? Not only he speaks/writes shitty English, he cant think straight either. And now he wants to drag everyone down with him. PITY! What kind of dumb ass slaps his own face in public? What a joke!
无极: 住院医生面试碰到的尴尬事( 力刀评注推荐及麦地网友讨论)

Doc has successfully sabotaged a good learning club. At the peak, the pre_resident_english_corner had over 95 members and hundreds of posts. Congratulations! I will jot down a few expressions and new words here and there for myself mostly. Sorry friends. I let you down. You guys are the only losers as the bystanders caught in the cross-fire between the two warring parties. Ironically, both of the two people at war came out as the only two 'winners'. Doc can claim his star power. I can focus on my study.

Clearly, this USMedEd cant think straight anymore at his age. To give his credit where credit is due, he is still good at copying/pasting of the posts written by others. Follow his rubbish advice at your peril. We can write a laundry list of his shitty advice. This is a guy who cant keep his job for long. I am still wondering why he had to side with the losing party in a political struggle at work as he put it in one of his posts. Most people would not get involved. Only confrontational and aggressive douche bags would go for it. They can be burned again and again and are still clueless as it is just bad luck and not their faults whatsoever.

It is not just me saying this. Read this:
[snowfox01 于 2010-11-02 17:25:32 提到] [FROM: 134.74.]
Dr.Newbie:Please be nice to this old man。
难道你没看见你把他生命中唯一的支柱----收集各种贴子,然后大言不惭的copy&post 到自己的网页。给打碎了。同时,他在麦地的“一手遮天” 用那二十年前的狗屁经验来误导新人,也让你给揭穿了。我能理解他的恼羞成怒。他也没几天了,就让他乐呵乐呵吧。

There is no doubt that my English is better than anyone else including Eric and that lumcsomething. I was actually touched by the applications to my club every day during this short time. While I am still trying to figuring out the best way to get people energized and the best way to help, it went kaboom. It is such a pity. Just imagine how much more I can help once I get into residency and finish it.

I am sorry it has gone this far. This dokknife has been attacking me relentlessly on anything I write for no good reason. I have to stand up for myself. He said it himself: He does not care whether I am right or wrong. So he makes it personal. Now, he got it. It is personal between him and me.

Feel free to say hello to me at your leisure. I dont have time to play with this piece of human trash and a sadist who excels in copying/pasting and who cant keep his jobs for long. Let him have his schadenfreude from how the ex-boss who canned him got divorced. Let him brag how successful he is in dismantling a learning place.

Lets watch which comes first: I get into residency or he got fired.

并爱好给人改错的蠢人的发言更充分地反映出其愚蠢和无知,她的所谓良好英语在她的愚蠢脑袋支配下成了砸她自己脚的石头。此人在麦地已经贩卖了无数的垃圾和错误得东西。我实在无法忍受这种蠢人无休无止地误导CMG.
-----Doc.
乌龟总是对眼王八,狼和狈总是为奸。
你和这个混球对上眼很正常。装糊涂装黄花大姑娘真有坐台小姐得姿态嘛。
-----Doc
你这WSN还真是咸吃萝卜蛋操心.
-----Doc
耗子乌龟王八苍蝇和垃圾.
-----Doc
狗屁不懂的蠢货,愚蠢跳粱BSO牛Xer还真是第一次出现。各位可以饱眼福了.
-----Doc
换王八壳子来口水的蠢货的蠢言蠢语愚不可及的暴露,她懂个狗P.
-----Doc
我当我的医生,真也是撑了的,给你这号250上课来了还指望你懂人话呢。俺还真不如去打兔子大雁打网球去了。你这号真是纯粹的生物WSN德性。
-----Doc
向你这号又哭穷和没地方找饭碗,还不愿去换个活法,才真让人烦的WSN德性呢!真该去CT或MRI了!
-----Doc
你丫的又该酸掉几个牙?尔等难怪人家说生物萎缩,真TMD不亏!
-----Doc
说你等装B萎缩吧,你还扭扭捏捏跟坐台的要装黄花大姑娘似的。想来邪的,俺不是
不会更不是没掐过。
-----Doc



You all think this is acceptable and a good presentation of character? What I said back is half what he has said to me. Every time I make an apology to him, I got spit-at-your-face response in return.

It is a pity to see a good club falling apart. At least I have the decency not to use my club as a venting joint. I am sorry that you are put between a rock and a hard place. I will understand if you have to quit the club. You are always welcome to use a majia and check us out. This club is not intended as a base for isolation or a launch pad for personal attacks. It is a place purely devoted to English skills. It is a really a shame that Doc would pull people out of a club just to make people take sides. I dont see how he sabotages an educational club would help his cause. Yes, he has succeeded in pulling 20 people out of my English club and he can claim it is a win-lose-lose situation for himself. But ultimately, it is a lose-lose-lose situation.


1 [DrNewbie 于 2010-11-08 22:03:16 提到][删除][修改] [FROM: 98.119.]
Do you have any traces of honor and integrity left in your body? What a piece of human trash. How hard is it to admit you were wrong? What a stupid, arrogant, crazy bitch. Your bark is worse than your bite. Pathetic loser. You promote a 'clean' medi. Yet, you started a club for the sole purpose of shitting in it.You are a disgrace to the human race.

Read this and you know how it started and what I said is exactly what Doc said to me in English. And he said it a dozen of times to me.

http://www.mitbbs.com/pc/pccon_7773_142905.html

1 [DrNewbie 于 2010-11-08 23:51:41 提到][删除][修改]

What I said is half of what you have said to me. What are you whining about? Be a man. Fight fair and square. Dont just shit in your own compound. You thought you will get sympathy from your followers? What you get is despise from your sympathizers.

2 [DrNewbie 于 2010-11-08 23:05:40 提到][删除][修改]
Clearly you have no comprehension of English. You have a low EQ. You are clueless here. Why dont you shut your mouth? Be a man and make an apology to me. I have apologized to you a dozen of times. What I get is spit-at-my-face every time in return. Do you have any integrity and honor left in u?

3. All said and done. You truly think you gain the upper hand by locking me outside? You truly think I will lose without getting into your club? Seriously, dont flatter yourself. I have connections to match into a good University program already. I personally know a couple of Chinese PDs and American PDs. Give me a break already.

Lexian (蒙古大夫) 于 (Thu Feb 11 12:11:31 2010, 美东) 提到:

I think you are pointing this to me. I can honestly tell you i don't have
any MaJia. never had and never will. I don't hold personal grudge against
anybody, especially this one. it's not worth my time.

However, i think you are biased by assuming people who are against tyranny
and unjust are against anyone specifically. I can only speak for myself
because i really don't know anyone else that got into similar kind of
argument with him. I have no intention of "打击正在做的人", but that doesn't
mean i won't say "WAIT A MINUTE, THIS IS NO RIGHT" when i see posts like
the one i respond to.

As i have stated long long time ago, CMG's history in this country are short
. Our mission goes far beyond getting into residency. A public forum that
attracts examiners, residents and PRACTICING PHYSICIANS is very important in
exchange information and experience. I just can't help laughing when i see
some guy who happen to got into residency wants to "harmonize" the forum. I
can honestly say the game just starts AFTER you graduate. Please refrain
from your "GOD" like euphoria of getting into the residency,

发信人: amanda12 (digest08), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Fri Oct 22 08:01:00 2010, 美东)

我想说的是,作为一名医生,应该有更高的道德标准,宽容心和同情心,医生是和人打
交道的职业,会碰到各种各样人,首先我们想到的是他是我的病人,不管他是杀人犯还
是某某人大代表,穷人和富人,都要统一对待。不会因为别人过激言语或者什么而去计
较,要这有宽容心,能站在他人的角度去理解对方,这才会得到对方的信任。不要动不
动就对别人丢WSN。。。你只会显出你心胸狭隘,既与你的医生身份不配,也会让人鄙
视!以前看过你在丁香园的帖子,貌似你没完成专科移植是因为2老美因为你手术做得
好排挤你。
别人稍与你意见不同就恶言相向,言辞激烈,这是你说服别人的办法吗?是从一名医生
口里出来的话吗?要得到别人的尊重和赞美,同时需要你在本专业的优秀和个人魅力,
一言一行感动别人,取得别人信任,医生更是如此。尊重别人的同时,别人才会尊重你
也许力刀的初衷是好的,但是从他的言语看来,更让人觉得是个暴发户。。。。

发信人: Viky (转身插口袋), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 20:03:42 2010, 美东)

只有250才会在网上显摆自己的薪水,当年这厮也显摆自己在osu的薪水,现在总算得到
头的"亲徕"了

发信人: redasuka (EVA-02), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Fri Oct 22 03:59:15 2010, 美东)

没啥奇怪的,考版的那些人本身就花了比一般PhD多得多的时间和精力,当然希望能换
来一点优越感。何况不少大陆的MD最后在北美都是在做内科儿科什么的,每天工作也很
压抑,只好靠贬低别人获得一点心理安慰啦。

说实话,我在这边认识的混得好的中国MD还没有Bio/BME的faculty比率高,绝大多数30
-40岁的Attending还是处在天天接待黑哥们的境界,收入税前也就100k多点。真正混得
好、拿大钱的的MD,那是少数,而且基本都是白人。

不是说老中没有MD混得好的,只不过那些混得好的是人家真牛,在哪一行能牛起来。至
于只是为了混碗饭吃的,还是要多掂量几下自己折腾的起不。

发信人: Kiwixi (kiwi), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Fri Oct 22 04:05:37 2010, 美东)

这斯绝对是凭着CMG来美国弄了一个博后的位子。可想而知,实验室做的一塌糊涂,老
板天天骂,连老婆也看不起,留空就跑到楼外面捡烟屁股抽。
然后就考了版,摇身一变就成了医生。

薪水涨了,心魔却去不了,跟同行比,口音重,年龄大,还是来这里显摆,
打着普渡众生的幌子,年复一年贴几个链接,满足自己的虚荣心。本来考版当医生就是
一个职业,非要搞成一个崇拜一个图腾,入门的教众齐颂文成武德哈里路亚癫狂不已。

你那几个链接还是自己留在记事本里吧。不需要你这样自上而下的伪善。

最后送你几句话,真的是为你好,淡定一些,从容一些,都快半百的人了。

他人骑大马,我独跨驴子,回顾担柴汉,心下较些子。
发信人: snowfox01 (白面狐), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Fri Oct 22 14:16:58 2010, 美东)


我可以理解许多国人为五斗米折腰,想得到需要的信息。但是十年前的经验今天不一定
适用了。而且他像传销一样给许多老CMG False hope,一些老毕业生像打了鸡血一样跟
随他, 做了不且实际的选择, 也不知害了多少家庭。精神病人很可怕, 若他再领着
一帮人, 这帮人真是可怜。 take a look:

发信人: USMedEdu (US_CMGs), 信区: MedicalCareer
标 题: Re: 考版俱乐部(Pre_Resident_Club)成立!
发信站: BBS 未名空间站 (Fri Oct 22 10:45:26 2010, 美东)

click the link and go to club site to apply. Once you apply there, your ID
will be in waiting list for approval.

发信人: lostknife (麦地俯卧撑), 信区: MedicalCareer
标 题: Re: 考版俱乐部(Pre_Resident_Club)成立!
发信站: BBS 未名空间站 (Fri Oct 22 13:03:31 2010, 美东)

I fully support the idea and be happy to join.
But it shows:抱歉, 缺少参数, 加入俱乐部失败!
please advise what I should do to join the club.
Thanks.

发信人: lostknife (麦地俯卧撑), 信区: MedicalCareer
标 题: Re: 考版俱乐部(Pre_Resident_Club)成立!
发信站: BBS 未名空间站 (Fri Oct 22 13:05:16 2010, 美东)

By the way, I am a good-egg who hate the bad-egg!

【 在 meigui0714 (rose) 的大作中提到: 】
: 谢谢你的(USMedEdu)忠告。"听人劝,吃饱饭"。我会好自为之的。
: 但是,一个好的论坛氛围,需要大家的努力。我们做为老生,应该已实事求是的态度引: 导后生们走好,走稳自己的路。人生只有一次,尤其是毕业时间长,没有经历过美国正: 规教育的老生们,我们已经没有"试验”"尝试"的时间了。三思而后行, 一旦做出了决: 定,就不要犹豫,大刀阔fu, 勇往直前。
: 尊敬的老前辈,这里是公共论坛,不是你个人的博客。老了,不但应该"自尊,自爱",: 更要尊重他人的不同看法,意见,这样才能赢得更多的尊敬。“唯我独尊”“我是老: 大我怕谁”的心态是万万要不得的。这里不是"黑色会”,这里不需要“教父”!: 读者的眼睛是雪亮的,这个论坛的读者们都是受过高等教育的,相信他们清楚,谁更浅薄。


发信人: Oncogene (何时问天), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Wed Oct 20 18:22:24 2010, 美东)

不要再“尔等,尔等”的了,让人看了烦。身边考版做医生的太多太多了,也没见几个
这么嚣张的。

我不相信这世界有啥救世主。试图做救世主的,脑袋真的需要MRI啦

发信人: yoyoch (yoyoch), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Wed Oct 20 23:39:59 2010, 美东)

素质,素质。
风度,风度。

发信人: KeeVan (Kevin), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Wed Oct 20 23:57:59 2010, 美东)

你说你瞎急啥。就是因为你没说赚多少钱,但是又说生物wsn泛酸,我没看明白人家为什么泛酸。讨论讨论问题不行啊,你这素质也太低贱了,我看还是别行医了

发信人: pigsun (屁哥~~大圣教候补二师兄), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 01:07:33 2010, 美东)

散了吧,老刀确实不是来劝退的,也不是故意显摆,其实,他就是专门来找抽的...
--
哈,说出来心里舒服多哩

发信人: Oncogene (何时问天), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 01:25:47 2010, 美东)

我都懒得抽她。这么大年纪了,好好说话会死啊??

发信人: Oncogene (何时问天), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 01:33:02 2010, 美东)

最后回你一贴吧:
你还是真是个幻想狂人唉。还有吧,就你这口气和心态,现实中能过得舒服还真是见了鬼了。算了,刚才说了,说你也是白说。你还是好好找工作吧,最好找个$1million/yr的,可千万别把自己的高等生活给葬送了呀,走到今天(昨天)也怪不容易的。。。

发信人: Oncogene (何时问天), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 01:48:19 2010, 美东)

^_^,你这风向转的还真快

靠骂别人或者教训别人是不可能有效传播自己的信息的。就这种性格,他下个工作也
干不久,哪个上下级能受得了这种人啊。好象别人没见过钱没见过医生没见过成功
人士一样,一副高高在上的架势,受不了。

发信人: newlily (lily), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 09:18:43 2010, 美东)

老刀,本来我是挺尊敬您的,想从您的帖子学点东西,结果谩骂满篇,没有一点有用的东西。

发信人: Viky (转身插口袋), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 11:19:53 2010, 美东)

这厮两次被fired了,还特喜欢到处指手画脚

标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 14:10:26 2010, 美东)

1.相信大家都有北美工作经验,新chair来了,就辞掉所有的人,可能吗?道是有可能
。。。。,

2.“加拿大拿的工资比美国大学薪水要高一倍可工
: 作量才是美国的1/4(其实俺每天1小时就干完了!)” 这种事情只会发生在社会主义
中国。 加拿大? 你可别弄的跟唐骏似的。
3.你是为了祖国加拿大的医学发展,毅然决然放弃了美国的高薪
工作,回到了加拿大了吧。

发信人: Viky (转身插口袋), 信区: Biology
标 题: Re: 给生物同学们: dojo: 走进美国医学院之旅
发信站: BBS 未名空间站 (Thu Oct 21 11:31:42 2010, 美东)

正常个p, 被fired了就是被fired, 没见过这么不要脸的


【 在 USMedEdu (US_CMGs) 的大作中提到: 】
: 窝草! 俺自己在网上说过,还怕你来拾俺的鞋后跟泥巴砸俺不成?
: 被新chair辞了,换朝换臣找新工作在北美不是常事吗?哪个医生老死在一个单位的?
: 俺要再显摆一把告诉你俺现在在加拿大拿的工资比美国大学薪水要高一倍可工
: 作量才是美国的1/4(其实俺每天1小时就干完了!)你丫的又该酸掉几个牙?
: 尔等难怪人家说生物萎缩,真TMD不亏!




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共有2条评论
1 [Viky 于 2010-11-12 09:42:23 提到][删除] [FROM: 152.11.]
劝 lz别跟那个老250浪费时间了。。
 
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