Identify this MRI

Can anyone tell me what's wrong with this MRI of the thorax, labeled for your convenience:



Answer will be posted tomorrow.

(Replies are screened)

EDIT: Yes, it's human.

Being treated by trainees

During my OB/GYN rotation in med school, I attended an outpatient clinic that was your typical mix of obstetrics and gyn patients. The model of the clinic was that the med students would see the patients first, then present to the resident who would do most of the work, and the lone attending would see the patient for about sixty seconds.

One morning in clinic, we had a patient with some chronic gyn issues (can't remember what) but she felt she'd "had enough" of telling her story over and over, so she refused to be seen by a student. The nurse who roomed her warned that this would result in a longer wait, but she was OK with that.

None of us had good feelings toward this woman we never met. In any case, she went to the back of the queue and stayed there. An hour and a half later, she still hadn't been seen by anyone... and only got seen because the nurse came back out and yelled at us.

It's hard, when you're in training, not to get angry at patients who don't want to be seen by a student or resident. If you go to a training hospital or clinic, I feel like you're obligated to allow it.

I've been on the other side, so I sympathize. When my daughter had a fever and was really irritable, I didn't enjoy holding her down twice so the resident could look in her ears too. I've gotten pelvic exams from med students and I've allowed an intern in the ER to stitch up my laceration while she got step by step instructions from an attending. So I'm not a hypocrite.

After all, how else are the going to learn? I'd rather be treated by a less competent supervised trainee than an incompetent unsupervised attending.

What do you think about patients who refuse to be seen/treated by trainees?

Lost in translation

This was my experience doing Pain Medicine:



A few more:

What the doctor says: "Can you point with one finger to where your pain is?"

What the patient hears: "Can you wave your hand around in a huge circle to tell me where your pain is?"


What the doctor says: "What is your pain level on a scale of 1 to 10?"

What the patient hears: "Can you review your pain level with every possible activity you can think of on a scale of 1 to 20."


What the doctor says: "What medications are you taking?"

What the patient hears: "Can you describe the color and size of no more than half of the pills you're taking?"


What the doctor says: "Do you have any other medical problems?"

What the patient hears: "Can you give me a detailed history of how all your other medical problems were diagnosed? And if you have any major medical problems, like diabetes, I don't need to know about those."

Grand Rounds at my place July 5!!!

OK guys, next week my parents are going to be out of town, so we're going to break into the liquor cabinet and have a huge GRAND ROUNDS party at my place on Tuesday. All the cool kids are going to be there: Potsie, the Fonz, Ralph Malph, Danny Zuko, Alex P. Keaton, Skippy, Boner, Ferris, Teen Wolf, iCarly, Kid & Play, Molly Ringwald, Hannah Montana, Zac Efron, Justin Bieber, and all of the Goonies. It's going to be freaking awesome.

The theme for Grand Rounds will be: Medical training.

I'd like to see posts and stories about medical training (including nursing, pharmacy, etc): why it sucks, why it's great, why you're glad it's over. I know some of you have a whole blog about this topic, so try to limit one post per blog. And please PLEASE, don't ask ME to pick the post.

(If you feel you have a post that doesn't fit the theme, but is so amazing that it is completely essential for the blogosphere to hear about this week, then by all means, send it along. But if it is off topic and doesn't fit those qualifications, then I reserve the right to send an email to Dr. Grumpy snarking you.)

How to submit: Please send your entries to fizzziatrist(at)gmail.com (note the three Z's). Put Grand Rounds in the subject line, and include the URL of the post in the message with a sentence or two about the post’s topic.

Deadline is Sunday July 3rd at 3 p.m. Eastern time. Late submissions will only be considered if they blow my mind with awesomeness.

Eat like a pig

"Boy, you must be HUNGRY!"

When I was a resident, a female attending made the above comment to me during lunch when she saw what was on my tray. Way to make me feel self-conscious. What was on my tray:

--chicken salad sans dressing
--cup of cottage cheese
--one hard boiled egg (for salad)
--small bag of freeze dried fruit
--bottle of water

Admittedly, it did look like a lot of food because everything came in its own little container and the cafeteria just got a stock of new GIANT plates. But it was just some lettuce, cottage cheese, and fruit. The guy next to me had a salad that was as big as mine plus a whole plate of spaghetti and meat sauce drowned in parmesan cheese. So why did I get the irritating comment?

(Okay, I confess: there were like five croutons on the salad too.)

My other favorite comment that I got as recently as last week:

"How do you eat so much and stay so thin?"

I don't know, I guess I must have super duper special fast metabolism that allows me to eat like a pig and still never gain weight. Is that what you want me to say?

My husband, who eats dinner with me every night and knows that I generally eat about a quarter of what he does, would never ask me a question like that.

What about crack cocaine?

According to an attending I once had, the worst two "substances" that people take in are:

1. Cigarettes

2. Soft drinks

This is up for a debate, but I see where he was coming from. The argument for cigarettes is pretty obvious, but soft drinks maybe not as much.

About three years ago, I gave up soft drinks. I used to drink a can of Coke every night with dinner, and I decided to stop doing that. Partially because it was a little horrifying when my child would take my empty Coke can and pretend to drink from it when I was done, but also because I slept better without pre-bedtime caffeine.

My husband continued to drink Coke BID, including at dinner with us. He decided to give up with nighttime Coke when I relayed a story to him about a conversation I had with our daughter when he was coming back from a trip:

Me: "What are you going to give Daddy when you see him?" (I was looking for hug/kiss as the answer)

Daughter: "A coke!"

It can actually be challenging to only drink water when dining out. It's fine in a restaurant, but say we go to the food court at our local mall. If you ask the vendors for a cup of water, they'll look at you like you just asked to get your whole meal for free. Then maybe they'll give you some tiny plastic cup half-filled with water, about one sip worth. Sometimes I'll beg for a real cup, saying I'll pay for the cost of the cup.

The other option, of course, is bottled water. I hate buying bottled water. It's like $2 for something that tastes identical to the free stuff. Especially Dasani, which is like filtered tap water. It's an outrage that I have to pay more for water than for a soft drink.

Anyway, I'm getting a little off-topic here, but I do think it's wrong how soft drinks are forced on us.

Weekly Whine: Ladies Rooms

It seems like every time I use a ladies room, I get completely furious. Really, there's very little about ladies rooms that doesn't make me angry.

The thing that makes me angriest is the inequity of actual toilets for women versus men. Recently, my husband and I were at a mall, and I noted that there were four toilets in the ladies room (a horrible injustice, which actually makes me not want to go to that mall). I asked him what the men's room looks like and he said that while there were two stalls for men, there were also three urinals. So there were MORE places for men to pee than women.

What is wrong with that?

1) It should at least be equal.

2) Really, there should be twice as many toilets for women as for men. Women have smaller bladders, even more so pregnant women.

3) Women are usually the ones who take children to the bathroom. So basically ladies rooms are for women AND children. Whereas mens rooms are just for men. (Like that hair dye.)

It always makes me furious when I have to wait on a long line to use the bathroom, while my husband gets in and out in two minutes. It's not like it's so great for the men either, since they're stuck waiting for us. The only people who benefit from this is gay men who don't socialize with women.

And of course, the other issues: the fact that the stalls often don't have a place to hang up a coat, which sucks when you're obligated to sit down. This was especially annoying at the hospital when I was wearing a long white coat. Hospital bathroom stall hangers are notoriously broken. And trying to pee with my coat on generally meant the contents of my pockets would get emptied onto the floor and/or the toilet.

And finally, pee on the seat. I have never been to a person's apartment and used their bathroom and seen pee on the seat. Not once. So how come every goddamn public bathroom stall has pee on the seat?

Eekos Peekos Penis

Nauseous

Name the quote:

"Look, it’s about my mother. She’s getting on now and she doesn’t have much of a life. And she doesn’t want to do anything or go anywhere and she literally hangs around the house all day. I mean, it’s very frustrating..."

"I’m sorry Doug, can we just go back a second? You said your mother literally hangs around the house. Well, I suppose it’s a pet peeve of mine but what you mean is that she figuratively 'hangs around' the house. To literally hang around the house you’d have to be a bat or spider monkey. Now, back to your problem?"

"Do you mind if we stop while I tell you my pet peeve?"

"Not at all."

"I hate it when intellectual pinheads with superiority complexes nit-pick your grammar when they come to you for help. That’s what I got a problem with!"

"I think what he means is, that is a thing with which he has a problem."

I do actually hate the way people use the word "literally" when they mean "figuratively." I was watching MasterChef the other day and a contestant said, "This is literally the beginning of my life." And it wasn't a newborn who said that.

When I was in medical school, I had an attending who was obsessed with the correct use of the word nauseated. Any time an intern or student would present a patient and say that the patient was "nauseous," he would jump all over them.

"It's nauseated," he would say. "The patient isn't nauseous, unless she's making you nauseated."

I finally looked it up and it seems like "nauseous" is one of those words that got misused so much in the English language that it's basically come to have the same meaning as "nauseated." So it really isn't incorrect to say that the patient is nauseous. And it's also a little less pretentious.

Except every time someone says a patient is nauseous, I still hear that attending yelling in my ear. I can't seem to turn it off.

Charging for residency

In light of the infamously controversial New York Times Op Ed piece, an attending colleague of mine in practice for many years prophecized that in twenty years or so, in order to deal with the physician shortage, the training process will have changed in the following way:

1) Medical school will be free

2) Residents will pay for their training, instead of vice versa. Residencies where doctors earn less will cost less or be free.

She said that it would cost the same but you'd pay money later rather than sooner. Making residents pay for their training would help fund more residency spots, which would deal with the physician shortage. And charging less for primary care spots would deal with the primary care physician shortage.

I argued that there is NO WAY this would ever happen.

In large cities like New York, residents earn upwards of $70K per year. How could you possibly take that money away and tell them that they now have to pay for training? Residency unions would never allow it. Furthermore, at the point that people are in residency, they are now in their late twenties or thirties... they are married, have kids, mortgages, etc. You can't expect all of these people to exist for 3+ years on no income and even having to PAY money. Paying for education is much easier to swallow when you're young and unattached.

And there's no way that the cost would be equivalent either:

Current model: Pay $40K/year for 4 years of med school + earn $50K/year for 4 years of residency = +$40K

New model: $0/year for med school, then pay $X/year for 4 years of residency = -$4X

Looking at it this way, under the current model, you at least come out ahead financially (although barely) at the end of your training. (Although obviously you're not ahead due to cost of living.)

This colleague of mine insisted, however, that this was a valid model and that it was likely to be implemented in the near future. I'm thinking not so much.

Most common passwords for doctors

Haiku: Second Year

Best wedding present EVAH

This is from like a billion years ago, but I couldn't resist displaying it. Someone thought it was an appropriate wedding present to give us two million dishes. This was our attempt to put them away:



We actually had a registry but they decided they "didn't like anything" on our registry. That baffles me a little bit because isn't the present for us, so shouldn't WE be the ones who like it? Anyway, six crates worth of dishes was clearly a much better present. We calculated that we would only have to do dishes like once a month, as long as we were OK with a huge sinkful of dishes with rotting food on them.

Another annoying thing was that we didn't even end up using those cups at all. They were just too small to be useful for drinking water from, because they could only hold a few sips worth, resulting in a need for constant refills during a meal. I guess they might have been OK for hot drinks, but neither my husband nor I are coffee or tea drinkers. So I'm not sure we ever used any of those cups.

The bowls were also kind of too small. Whenever I put cereal in them, I'd end up spilling milk on myself. I like my cereal milky.

(FYI: All the dishes were either given or thrown away along with most of our belongings during a giant move.)

Food theft!

At the hospital where I work, there is a "kitchen" on each unit. The kitchen has a microwave, toaster oven, and refrigerator, as well as being stocked with various foods, condiments, plastic utensils, an ice machine, whatever.

We have a break room where I store my lunch, but I do use the kitchen a good amount. Like in the morning, I use it to microwave my muffin or toast my toast. And I get condiments, utensils, and water from the kitchen, rather than go all the way down the to cafeteria for the exact same stuff.

And OK, I confess, I do occasionally take food from the kitchen.

Like sometimes I'll take one of those little packages of graham crackers. And in the morning, sometimes I'll take one of those little tiny juice cups. And during the winter, when I got sick and my throat was killing me, I'd make a hot cocoa packet. And a few times, I took a ice cream dixie cup. I mean, we're not talking about grand theft here. I would have happily gotten food from the cafeteria instead if it wasn't so far away. I don't think anything I've ever taken has been worth more than like a quarter.

Nobody ever said anything to me about it. In fact, once I was looking for some condiment in the kitchen cabinet and one of the guys stocking the kitchen said to me, "Tell me what you want, doc, and I'll have it stocked for you." I was pretty sure I'd seen other people taking stuff, although I guess it could have been for a patient. When I wasn't feeling well one day, another doctor who'd been working there for years got me a bunch of dietary supplements from the fridge that were clearly meant for patients. (Mighty Shakes? Yuck!) So I really never thought it was a big deal.

But this week, someone put up a sign on the kitchen refrigerator that says: "FOOD IN THE KITCHEN IS FOR PATIENTS ONLY!!!" Actually it originally said "food and water," but someone crossed out the water part.

Naturally, I'm incredibly paranoid and feel this is directed at least partially at me. Yet I can't seem to stop myself from taking my apple juice or graham crackers. Considering how hard I work for them and the salary they give me, why would they honestly care that I'm taking about five cents worth of food each day? Isn't my job satisfaction more important than maybe $10 worth of crappy snacks the whole year?

How to keep sterile

Yes, I'm still baffled.

Weekly Whine: Sub-I, part 2

Last week, I whined about an annoying co-sub-I I had during my medicine sub-internship. Anyway, as it turned out, I honored that rotation. I'm pretty sure it was a general rule that everyone had to honor their sub-I, to boost our chances of landing a good match and help our school's reputation. But I did get very nice comments from my attending and the senior resident, so I was happy about that.

One thing I wasn't too pleased about was the comments from the intern on the team, Betty. Her one-line comment was: "Did adequate job. She was quiet and I couldn't assess her knowledge base."

That one sort of pissed me off. I'd worked closely with Betty all month, been on call with her, helped her with scutwork, etc. Plus she'd gone to my med school, so I knew her from before that rotation too. Hell, I'd been to her home before. On the last day of the rotation, Betty burst into tears because she was overwhelmed and I spent over an hour talking to her and trying to comfort her. That evaluation sounded like it was for someone she'd just passed by in the hallway a few times.

The one thing I could think of was that Betty was kind of angry that me and the other sub-I left the rotation a bit early. It was a July sub-I, but July 31 fell on a Sunday, so the clerkship director officially gave the sub-interns permission to have that weekend off since many of us would be starting outside rotations on Monday. Considering I had an away elective starting Monday and had to permanently move out of my apartment, it was nice having a FULL WEEKEND to move everything I owned to a different state. But I knew Betty was not happy about this. She pissed and moaned about the fact that we weren't going to be there, and insisted we write skeleton notes for our patients for the weekend, which we did.

Also, she was pretty miserable. Possibly one of the top 5 most unhappy interns I've seen, including myself.

Or maybe she honestly felt that after spending 3-4 hours rounding with me every single day for a month, watching me get pimped countless times, and having countless conversations with me, she still knew nothing about me.

Gray hairs

I'm not sure anymore what to do about gray hairs.

The first time I saw one a few years ago, I immediately yanked it out and made a blog post about OMG I'M SO OLD I HAVE GRAY HAIRS NOW. Now I see one every month or two.

One problem is that my hair is dark but not uniformly so. Meaning I do have some blondish strands. So occasionally a blond hair will catch my attention and I have to isolate it and examine it to determine if it is in fact gray or blond. I feel slightly ridiculous while doing this.

I realize at some point, I'm going to need to stop yanking out gray hairs or else face baldness. I'm just not sure what the critical amount of gray is where it's better to dye than yank. Also, I always thought I'd be the kind of person who would totally be okay with having gray hairs, but I guess no woman is excited about looking older.

Tales from Residency: Checking out the chief

My 45-ish, Married, Male Attending: "So I was leaving the gym yesterday and I saw this attractive woman leaving who was all dressed up in this little workout outfit, with a tight shirt and short-shorts... with writing across the butt. Looking really fit, you know?"

Male Resident: "So she had it going on, huh?"

Attending: "Yeah, exactly. So I was checking her out when I hear a voice say to me, 'Hi, Dr. Johnson!' It turned out it was [your chief resident]!"

Me: "Um, that story totally isn't appropriate to tell to other residents."

Attending: "Really? But I keep my pants on in this version."

(Okay, I made up that last line. Or at least, I borrowed it. But the rest is true.)

The 32 Types of Medical Students

Most Anal Attending Ever

As a resident, I had one attending who I liked a lot in general, but she was definitely the most anal attending I'd ever had. Here are a few examples to demonstrate her anality:

1) I typed the H&P on a new patient I saw and she went through it line by line, pointing out all the mistakes I made. What were these horrible mistakes that took us like an hour to fix?

--In a few places, I accidentally put two line breaks instead of one

--A list I made got slightly misformatted by Word's autoformatting, meaning some list items had two spaces between the number and the text, and some had one space

--Certain words were bolded incorrectly

2) Apparently, the way our hole puncher was set up, the holes are about 3-4 milimeters off from where the pre-punched holes are on our progress notes. So when you put a paper in the chart that came from the printer or something, the pages are misaligned about 3-4 milimeters higher than rest of the pages in the chart. The attending paged the charge nurse overhead and pointed this out as "a big problem" that needed to be fixed right away.

3) She was constantly correcting the times written on my notes. The exact time. Like the time on my note would say "9:00" and she would cross it out and change it to "9:10".

4) Once she called me over because she didn't like the way I had written an order. this was the order:

Metoprolol 25mg PO BID
Ditropan 5mg PO BID

How is your anal insight? What do you think she thought I should have written differently?

Weekly Whine: Annoying sub-I

In med school, I had a friend named Olga. She was a bit of a fair weather friend in that she was never really there for me in any times of crisis. But then again, she never did anything to make me dislike her.

We were reasonably good friends during the first two years, but of course, things changed during the clinical years when everyone's real personality came out. Olga was going out for a moderately competitive field and she was worried about her mediocre pre-clinical grades, so she wasn't messing around.

I heard some stories about Olga being somewhat difficult to work with on rotations. But she wasn't one of the huge gunners and she didn't do anything egregious. So I was pleased to be assigned to work with my friend during our sub-internship.

(For those who don't know, a "sub-internship" or sub-I, also called an AI (acting internship), is a rotation you take during your fourth year of med school where you basically act like an intern who can't sign orders. It's a great opportunity to see how incompetent the real interns are and therefore feel more confident about yourself.)

Anyway, I'm fairly sure this rotation killed our friendship.

A few choice offenses that Olga committed:

1) When the attending was quizzing (i.e. pimping) me, she would mumble answers to the questions as I was answering them. It sounded like she was giving me the answers or something. I mean, they were easy questions and I certainly didn't need her to mumble the answers.

2) Olga would keep going on and on about how proud she was of all the work she did and how amazed she was at how productive she was. She actually commented to me in front of the third year med student, "Why am I so busy and you always have nothing to do?"

My response was to look at the med student and say, "You see what she says to me? Can you believe this?"

3) She would treat me like I was her student or something. I remember she said to me one morning, "I have such an interesting patient. I want you to take a look at her neck." I want you to? When she did become the boss of me?

4) One day, I was helping our senior resident put in a difficult peripheral line on one of my patients. Olga saw I was helping him and she she decided to help too and completely took over everything I was supposed to do. Everything the resident asked for, she was like, "I'll do it." And she was even saying comforting words to the patient. WTF? She stayed with us doing this for like 40 mins, after telling me how much important work she had to get done.

5) During rounds, she would write orders on MY patients before I could do it, then ask the attending questions about my patients. At one point, she ended up doing a presentation on one of my patients. It was kind of ridiculous.

6) She laughed hysterically at everything our attending said, then nudged me and repeated the joke, as if I wasn't just standing there and heard it myself.

7) During patient assignments, she would always jump to decide which patient she wanted before I could say anything. I just ended up taking whichever patient she didn't want.

8) At one point midway through our rotation, I wanted to sign out for the day at 4:30PM. I only had one patient who was completely stable. Unfortunately, the evening person was at clinic at the VA thirty minutes away and had only just left. So I approached Olga:

Me: "Olga, are you leaving any time soon?"

Olga: "Well... not for a little while at least. I have to take care of some things with my patients."

Me: "Oh good. Because the sign out guy isn't here yet and I was hoping you could sign out my one patient for me. He's totally uncomplicated, no issues."

Olga: "But I have to leave too!"

Me: "But you just said you were staying..."

Olga: "No, I just have to write this up, then I'm going."

Me: "But we can't leave until the signout person.... All right, never mind..."

Olga: "No, it's OK. I'll do it. Tell me about the patient."

I tell her about the patient, taking all of thirty seconds.

Me: "Are you sure it's OK with you?"

Olga: "Yeah, I'll do it... but one day this week, you're going to sign out for ME."

I didn't like the way she said that. It sounded like some kind of threat, like she was going to wait for a patient to be on the brink of crashing them sign him out to me and go home. She was acting like this was such a big deal. So I told her to forget the whole thing and just sat around for thirty minutes for the signout person.

Anyway, it wasn't just me. All the other people in our class who were sub-interns at the same time thought she was being obnoxious too. They were all doing impressions of her, along the lines of: "Oh, my patient is so sick! Why do I always get these patients?"

That's right. Her patient. Singular. She only had one through most of the rotation, yet somehow she was more busy than even the interns.

A conversation with my husband

This is a conversation I had a bit ago with my husband, while I was still in residency (we're now both older than 30):

Me: "We're so OLD! We're going to be 30 in only a year! Can you believe that??"

Husband: "I guess."

Me: "Doesn't that seem OLD to you???"

Husband: "Yeah."

Me: "I can't believe my twenties are almost over! They went so fast. I feel like I wasted them. I spent my entire twenties doing medical training."

Husband: "What would you have rather done instead?"

Me: "Dunno, enjoyed myself?"

Husband: "So if you could be 20 again, what would you do differently?"

Me: "Not go to med school."

Husband: "What a surprise."

Me: "Well, it's not like anything would be different between us. I mean, it's not like I met you in med school and if I hadn't gone, we never would have met."

Husband: "So what if it was a choice between not going to med school and meeting me?"

Me: "I guess.... I would go to med school if meeting you depended on it."

Husband: "Aw."

Me: "But really, if my mind were like a blank slate and I had to do med school again, then... I think I would just have to kill myself instead."

Husband: "I think you should quit med school."


(Dedicated to oldmdgirl)

Writing Club

In addition to joining a book club, I also joined a writing group this year at the local public library. Or at least, I attempted to.

The first meeting of the group was in October. As I walked into the room, I felt like I was entering the set of Golden Girls. Nobody in that room was under 60 years old. And I would bet that there was at least one or two women in her 80s. I felt totally out of place.

Then some of the women read samples of their writing. This woman who was so old, she looked like she was about to turn to dust at any second, read this endless story about breaking down crabs. Also, the woman who was running the meeting was one of those old people who just never shuts up. If she were my patient, I would have been interrupting her every thirty seconds. But since she was running the meeting, she had free reign to just babble on and on till I wanted to throw up. I felt so helpless. It was sort of like being stuck in a room with a talkative patient and an attending who won't interrupt them.

Finally, one woman started reciting poetry. And I had to sit there and pretend to find the poems amazing, even though I truly hate poetry.

By the end, I couldn't wait to get out of there. I couldn't believe I had voluntarily subjected myself to two hours of old people prattling on about stuff. I have to do that enough at work. I decided never to go back, if only because I was worried that if I was there long enough, I might get confused and start listening to their chests with my stethoscope.

That said, they now will not leave me alone!

I made the horrible, horrible mistake of writing down my actual real phone number on the sign-up sheet. So every month now, they call me about the next meeting. And they always call during the day, when I'm at work, and I pick up because I don't recognize the number and think it might be the daycare or something important.

I have not been to one other meeting. I asked them to stop calling and they didn't. I finally told them I was moving to another state, and they still gave me a reminder call this month. It's horrible. Who knew that the library writing group would be harder to get out of than the mafia?

All Research is Actually Made Up: A Clinical Trial

Introduction
Since the beginning of time, people have been making things up. First, the Pilgrims made up that the earth was flat. Then Watson and Crick made up DNA. Also, dinosaurs are clearly made up.

Roughly one billion scientific studies are published yearly. It is a well known fact that people are really lazy; therefore, it would be impossible for that many people to go through the amount of work required to complete a randomized control trial. It in fact seems unlikely that even one person could complete such a trial. This provides an explanation of why there are so many contradictory results, like how one year they tell you to put your newborn to sleep on its stomach then the next you’re supposed to put it on its back, so what’s up with that?

The primary objective of this study is to prove conclusively that all research is made up. Secondary outcome measures include figuring out where all that money comes from to fund all this made up research when there’s a freaking recession going on.

Methods:
132 “researchers” were recruited for this study from various places. They were assigned to write a one page essay on whatever subject they wanted in one month’s time. Since the average Institutional Review Board (IRB) proposal for a clinical trial must be much longer than one page, the researchers’ inability to complete this much simpler task is evidence that no actual real IRB proposals ever get written. I mean, have you seen one of those things? They’re, like, ridiculous.

Results:
Of the 132 subjects recruited, there was a drop out rate of 80% for some reason. Of the subjects who remained in the study, 10 handed in a one-paragraph essay with coffee stains on it, 5 handed in a page ripped from Merck’s Manual, 5 handed in a copy of last week’s TV guide, 2 handed in a cocktail napkin with someone’s phone number on it, and 3 handed in some sort of pornographic drawing. Only one subject completed the entire page, although that essay was typed in 32 point font and was only 10 words total. And the last two of those words were “The End.”

We analyzed the data utilizing a Mann-Whitney square dance multivariable nonlinear regression analysis of variance. Using a confidence interval of 95%, all research was still made up. Also, here’s a figure:



Discussion:
The inability of even one researcher to write even a single page means that obviously, all research is definitely made up. Alternately, it might be possible that there was one single real study from hundreds of years ago, probably written by Plato or Aristotle or Zeus, and all future studies were plagiarized from that first study.

Conclusion:
In conclusion, it is clear from our results that all research is actually made up. Or it would be, if we hadn’t made up all our results.

Music of the OR

Note: Cartoon inspired by Jess