Introduction

The books arrived yesterday. My 2-volume 17th edition of the new Harrison's Principles of Internal Medicine was sitting outside my door when I got home from work. Normally, I would have opened them right away, but one of my coworkers was on her way over. P. had spent a month in Kenya working with a team of other doctors, and between the weeks I has spent at other hospitals and working as the critical care senior resident, I hadn't seen her in months.

So my books sat on my couch while I caught up with my friend, and it was only afterwards that I ripped the package open. The books were a more eye-catching blue with high-tech graphics rather than the seriois black 16th edition that sat on my shelf.




We have come a long way since the very boring cover of the 15th edition.



As I flipped through the book, I noticed that there was a lot more color in the text. And more diagrams. In fact, it looked almost like a children's science book. It looked like fun. But for some strange reason, it made me wonder if it had been dumbed down.

I put the books aside and got some work done. I was presenting a case for resident report the next day and I needed to go over the deatails. Resident report used to be morning report as it probably still is in many other hospitals, but we have it at 11am before our noon lecture. I had a patient who had cryptosporidum causing diarrhea who I thought was worth of mention.

Later, I looked at the books again more closely. The pictures on the front cover looked like still shots from a high tech computer animation and graphics program. It made me think of Hybrid Medical Animation in passing because I saw their demo real recently and was stunned at how they made science look so beatiful.

They also had a link to a 60-minutes segment that talked about a man with leukemia who came up with a novel treatment for cancer - using radio waves with gold nanoparticles to kill cancer cells.

I flipped through the book some more and scanned the table of contents. I noted that there was a CD that contained dozens more chapters that were not able to be published in the book. It looked exciting.

At this point I should mention that the reason I ordered the new edition was for this new project of mine. I wanted to read Harrison's Principles of Internal Medicine from cover to cover. I was inspired to do this after reading "The Know-It-All" by A.J. Jacobs where he takes a year to read the Encyclopedia Brtiannica from cover to cover.



Of course, he read through about a stack of books that reached his chest and doing the math it looks like it was about 100 pages a day, but I'm a doctor and this is my spin on the project. Of course, a lot of people have read Harrison's from cover to cover, but the majority of internists haven't. It's a whooping 2754 pages of fine print that holds essential information that could make me a better doctor. I've decided to blog about it as well because I want to record all the things I have been learning.

I'm a internal medicine resident reaching the end of my second year. With one year left to go, I am already sensing some of the anxiety of not being in training any more. After this I could be an attending physician which means that there will be no one to double check my work. There will always be colleagues to ask for advice, the decsions I make will be final. I may have learning a lot during during my medical school and training years, but there is are always new developments to read up on. By far, the best advice I got was from the man who was regarding as the brightest physician in the hospital who tells all the residents to spend an hour a day reading. I've been trying to read lately and here are some neat things I've learned.

- A recent New England Journal of Medicine (NEJM) letter to the editor recently brought up the idea of talc ingestion as a possible cause for gastric cancer. This was in response to why gastric cancer in prevalent in Japan. The link to nitrites which are found in lunch meats has been hypothesized for a long time an here is another theory. The talc is found on the surface of rice and is removed by washing the rice before cooking it. I guess I need to be a little more diligent about washing rice.


- A new study of type 1 diabetes shows that a GAD vaccine may preserve beta cell function. Will this prevent long term complications?
- Kids with speech problems can have hundreds of different problems that are genetic. I can't imagine what a speech therapist has to figure out: if they are deaf, if they can't process, if they can understand, if just can't speak.

Anyhow my goal is to read this book in year, document what I learned from it and also mention the other things I learn along the way and fear I will forget. The math works out to about 7.5 pages a day and that is very do-able even with all my hard rotations coming up.

So anyways, the project tonight is to read about dysphagia and the attending said we need 15 causes. Without opening the book, here's what I am thinking:

1. Schatski's ring
2. Plummer-Vinson's syndrom
3. Esophageal cancer
4. Esophgeal diverticula
5. Achalasia
6. Stroke
7. ALS
8. Brain tumor
9. Esophageal spasm
10. GERD

Argh - only 10!!! I need to read (and work on fellowship applications. Until tomrrow!