Dear foreign doctor, are you dreaming of a medical specialty in Germany? Are you learning or planning to begin learning the German language? Some good news and bad news… But is the final balance more good or bad?

During the previous weeks, I and many of my doctor friends, were very frightened by the rumors that spread like fire in the German medical specialty-related facebook groups. These rumors, to the best of the understanding of me and some of my friends, talked about language and medicine exams for ALL foreign doctors coming to German. These rumors also profoundly shacked the German Residency dreams of us because they also talked how there will be no more thing as “Temporary Working Permit”. In other words, your parents should be affording the price of your stay in German (For weeks? Months? Years?) until you can pass these tests and be eligible for a working permit. Hence, starting to receive a salary. Is this true? This is very frightening! I tried to relieve my fears by not searching about the topic. Beside, rumors are still rumors. Nothing is 100% certain. When the next year comes, things would become more and more clear. Today, I found the following great German article which talks how one German state is doing to change how it deals with foreign doctors coming to work in it. This great article was posted at the Language Geneartion Center (LGC) facebook group by Frau Dr. Renat Asali. Dr. Asali is the head of the LGC center and a professor at the German department at the University of Jordan. Dr. Asali knows a lot about medical specialty in Germany. Moreover, I think that she has been so far teaching German in Jordan for +20 years. I am mentioning Dr. Asali’s qualifications mainly because I do not know how good the website that published the article (although it has a very excellent design like those of famous American newspapers). I cannot trust that website. However, I think that I can trust Dr. Asali! In addition to the above qualifications, I know Dr. Asali personally. Dr. Asali is now my German language teacher at LGC! With the help of Google Translate, I think that I understood most of the very informative article chosen by my teacher (Here is a link to the article translated by Google Translate). I will try to summarize what I understood. Hopefully, you can correct any mistakes I will make. Together, we can arrive at a better understanding. Let me start with some good news. The article confirms the shortage of physicians in Germany. The shortage of physicians is still in thousands. Certainly, this would not change in months or even years:

 

Here comes the bad news. The article talks how “in the past”, foreign physicians were allowed to work in Germany without having their “Language skills” examined:

So, having passed the B2 level is no longer thought of to be a good “surrogate” marker for the ability of the foreign doctors to deal with German patients. The article mentions example about how (1) foreign physicians are not communicating well with patients, that (2) they are not as good as their German counterparts, and unfortunately enough, and (3) that German patients are now forced to be treated by doctors from countries in which they would voluntarily not be treated by whom. "If I had the chance, I would not allow such a doctor to treat me!" An angry German patient not comfortable with his foreign physician Rheinland-Pfalz/Rhineland-PalatinateTherefore, “One” German state, wants to allow this situation no more. This German state is Rheinland-Pfalz/Rhineland-Palatinate.

 

 

 

Update 25/07/2014: Dear colleagues, I have published 381 posts in this blog since 2007. My blog post’s views show that this post is now the fifth most famous post in my blog… I was therefore encouraged to publish more about medical specialty in Germany. There is now a separate section in my blog titled “Doctors Going to Germany“. Moreover, I now have a Facebook group with the same name (Doctors Going to Germany)… Find the full details about how to explore my Blog’s posts and about hte Facebook group in this post:

Our Facebook Group for Sharing Information for and by “Doctors Going to Germany”

Prof. Jean Decety in Amman and an interesting Lecture about the Neurobiological Mechanisms of Empathy and Caring for Others

I had the honor of attending a lecture by a French American Professor called Jean Decety from the University of Chicago. The lecture took place in the building of the Jordan Society of Scientific Research (JSSR) in Amman on Wednesday, 11/09/2013 (If you want to keep updated with the activities of the JSSR, here is a link to their facebook page). The title of the lecture of Prof. Decety was:

 الآليات العصبية الحيوية التي تشكل الأساس للتعاطف و الاهتمام بالآخرين لدى الإنسان 
Neurobiological Mechanisms of Empathy and Caring for Others

The topic of the lecture seemed strange to me. For minutes, I thought of not attending this lecture. Firstly, I could not imagine about what this lecture would be. Secondly, I did not know how important Prof. Decety is. Nonetheless, because I trusted my friend who recommended this lecture for me (Thank you Dr. Ali Alfar) and because I am interested in psychiatry my possible future specialty, then I googled the name of Prof. Decety. Quickly, I discovered that there is a detailed Wikipedia page about Prof. Decety. Can anyone have a detailed wikipedia page? I also found multiple articles mentioning him. Therefore, I decided quickly to attend because I thought that I would benefit something from this lecture no matter how boring the topic turned out to be.

A friend of mine and I decided to go to this lecture. My friend is also interested in psychiatry. We arrived a few minutes before the lecture started. Prof. Decety then arrived. From the first few minutes, I could deduce that he is a jolly person, funny, and to my relive, that I would not bored by the “weird” lecture that was to come.

The lecture started. A Dr. Rana Dajani introduced Prof. Decety. I understood that Dr. Dajani and Prof. Decety conducted are conducting researches together.

The lecture started with Prof. Decety talking a little bit about his family (From my short experience in attending conferences, this is something usual with western doctors). Prof. Decety explained briefly about the research center in which he works “The University of Chicago Social Cognitive Neuroscience Lab (SCNL).” Prof. Decety is the head of this center. This information really impressed me because Prof. Decety is French. He had his Bachelor degree, three master degrees, and PhD in France [1]. Nonetheless, Prof. Decety’s un-American origin did not prevent the University of Chicago from appointing him as a head of a research center as important as the SCNL. What matters are qualifications! This reminded me of multiple articles that spoke about how the USA attracts scientists from all over the world. Why would not it? Is not the story of Prof. Decety an excellent example why this occurs?

As the topic of the lecture became more and more clear to me, I started enjoying the multiple researches about which Prof. Decety spoke. I was impressed a lot with a sentence that Prof. Decety used to describe himself: “I am an Evolutionary Psychologist.” I have never heard about a branch of science with that name. However, it was not hard for me to expect what this branch of study is about: Explaining pychology in view of evolution! [Here is a wikipedia article about Evolutionary Psychology]! This is very amazing! I love evolution and I think it is very logical to use it to explain biology. It turned out that it can also explain “psychology”… Those atheistic infidels!

Prof. Jean Decety, with active use of body language, answering the audience questions.

Prof. Jean Decety, with active use of body language, answering the audience questions.

Prof. Jean Decety, with active use of body language, answering the audience questions.

From the very first minutes of the lecture, Prof. Decety mentioned the “taboo” of evolution. An attending student raised his hand and asked a question that initially appeared to be related to the lecture’s topic. Nonetheless, because I come from this society, I knew from the beginning that it was a matter of the speaker wanting to prove that evolution is wrong. The questions did not stop and were more and more indirectly revolving about the correctness of Evolution. It is really a pity that many of the people around me still discuss whether evolution is correct or not! The world is way ahead of us. I do not think that this should be a topic of discussion anymore. The debate increased and another student joined. It was then consuming a lot of time that Dr. Dajani finally intervened and said (something like): “The discussion is now about Evolution and it will not end! Evolution is compatible with religion. Some think that it is not. Here at the society we will have a lecture that shows the compatibility of evolution with religion. Let us continue the lecture.” The lecture finally resumed!

Religious explanations are so wide! I really do not understand how accepting evolution contradicts the belief in God! // Source: religifake.com

Religious explanations are so wide! I really do not understand how accepting evolution contradicts the belief in God! // Source: religifake.com

Prof. Decety then explained about multiple studies. Of interest, Prof. Decety talked about the findings that the hormone oxytocin increased empathy. Prof. Decety then suggested jokingly, but also, almost seriously as of someone really concerned:

"Some studies show that the hormone oxytocin increase empathy in human beings" Prof. Jean Decety, the University of Chicago.

“Some studies show that the hormone oxytocin increase empathy in human beings” Prof. Jean Decety, the University of Chicago.

I did not feel the time pass before the lecture ended. At his last slide, Prof. Decety had put the links of the facebook pages of his two lab: The SCNL and the Child Neuro Suite. He asked if we could like it (The link for the SCNL is here and the link to the Child Neuro Suite is here). Next, the audience asked some questions and Prof. Decety happily answered them.

Next, I smiled a lot when I saw Prof. Decety holding a camera. What made me smile was that Prof. Decety was more interested to take photos more than the audience members who wanted to be photographed with him. When I saw the situation like this, I happily asked my friend [Thank you Dr. Fadi Walid Farah] to take a photo of me with Prof. Decety. Here I am now publishing it proudly (I hope that Prof. Decety does not mind that).

Jameel Hijazeen with Prof. Jean Decety, Amman, Jordan, September, 2013

[1] Jean Decety, Wikipedia, www.en.wikipedia.org/wiki/Jean_Decety

Children of War Symposium at King Hussein Medical Center – Amman 2013

Jameel Khaleel Hijazeen with Dr. Andrew Ordon

Today, with Dr. Andrew Ordon at the Children of War Foundation Symposium – Amman 2013, King Hussein Medical Center, Amman, Jordan.

Dr. Andrew is a volunteer in a US organization called “Children of War Foundation”. During the previous days, outstanding surgeons from this organization were performing free operations on complex surgical cases at King Hussein Medical Center.
Dr. Andrew, along with his fellow American volunteers of the Children of War Foundation, gave lectures related to plastic surgery (You can see the schedule of this symposium at the events section of Medical Conferences in Jordan facebook page). They were very sophisticated lectures to the degree that I almost understood nothing! I am not embarrassed to say this because these guys were brought to Jordan, in the first place, to operate on inoperable cases that our Jordanian surgeons needed international experts to help them operate on!It was a nice experience. It is amazing to meet people whom every minute of their time counts! As long as these people are in Jordan, a smile is brought to the faces of many children and their families. Of interest, the team leader, a Japanese-American doctor, Dr. Mark M. Urata, said:

“I don’t treat my children, Japanese children, or Jordanian children… I treat the world’s children”.

Moa'bite and Anas Abu Saif, with Mark M. Urata DDS MD at the Children of War Foundation Symposium - Amman 2013, King Hussein Medical Center, Amman, Jordan.

Not only the children or their parents are happy. Surgeons of the Jordanian Royal Medical Services should be happy too. Today, Dr. Andrew was not able to give his scheduled lecture. The reason? He didn’t have a voice! So, I could deduce easily how much explanation has Dr. Andrew been giving!

All in all, one stands in awe in front of people who are spending their precious time, time in which they can easily make thousands of dollars, to help children they don’t know… Not children of my relatives, my tribe, my country, my religion… the world’s children 🙂

Logo of the Children of War Foundation

The Children of War Foundation: Thank you 🙂

The Ninth Scientific Conference of the Faculty of Medicine at Mu’tah University, Karak, Jordan, April 10-11, 2013.

A banner hanged on one of the doors of the basic faculty building: Under the patronage of his Excellency the president of the university of Mu'tah\ Inauguration of the ninth scientific conference of the faculty of medicine\ Mu'tah University, 10-11/4/2013.

A banner hanged on one of the doors of the basic faculty building: Under the patronage of his Excellency the president of the university of Mu’tah\ Inauguration of the ninth scientific conference of the faculty of medicine\ Mu’tah University, 10-11/4/2013.

 

 

Basic Faculty Building (Years 1-3), Faculty of Medicine, Mutha University, Jordan (Date 11.04.2013)

Basic Faculty Building (Years 1-3), Faculty of Medicine, Mutha University, Jordan (Date 11.04.2013)

Today and yesterday, April 10-11th, 2013, the 9th scientific conference of our faculty took place. In it, for the second year in a row, I was a speaker. On behalf of some dear friends of mine, I presented a paper entitled:

A cross-sectional study on the prevalence of cardiovascular risk factors among patients hospitalized for complicated hypertension at two Jordanian Hospitals.

First slide in our presentation - A cross-sectional study on the prevalence of cardiovascular risk factors among patients hospitalized for complicated hypertension at two Jordanian Hospitals.

First slide in our presentation

My friends with whom I worked on this project were: Oday Zayid Al-Ma’aitah, Mahmoud Yaseen Abuznaid, Ahmed Nader Abo.sharak, and Khaled Ali AlShar’. Thank you all.

We were supervised by Prof. Imad Farjou, Department of Pharmacology, Faculty of Medicine, Mu’tah University.

Prof. Imad Farjou, our great supervisor and the conference organizer. The paper on the desk in front of him is the abstract of our research :).

Prof. Imad Farjou, our great supervisor and the conference organizer. The paper on the desk in front of him is the abstract of our research :).

It was a very nice experience. So, I thank Prof. Imad very much for having dedicated some of his precious time to introduce me and my friends into the “beautiful world” of research.

Our research (top left) as present in the schedule of the 9th Scientific Conference of the Faculty of Medicine at Mu’tah University 2013.

Our research (top left) as present in the schedule of the 9th Scientific Conference of the Faculty of Medicine at Mu’tah University 2013.

Conference bag and the certificate of being a speaker - The 9th Scientific Conference of the Faculty of Medicine at Mu’tah University, Karak, Jordan, April 10-11, 2013.

Conference bag and the certificate of being a speaker – The 9th Scientific Conference of the Faculty of Medicine at Mu’tah University, Karak, Jordan, April 10-11, 2013.

Here is a piece of news in Arabic about the conference from the Jordanian newspaper Alghad:

 

انطلاق أعمال المؤتمر العلمي الدولي التاسع لكلية الطب في مؤتة

هشال العضايلة

الكرك – انطلقت في جامعة مؤتة أمس، اعمال المؤتمر العلمي الدولي التاسع لكلية الطب بالجامعة، بمشاركة باحثين من مختلف المؤسسات الطبية والاكاديمية الاردنية.
واشار رئيس الجامعة الدكتور رضا الخوالدة خلال افتتاحه المؤتمر الذي تنظمه الكلية بالتعاون مع القطاع الطبي الخاص والخدمات الطبية الملكية ووزارة الصحة وكليات الطب في الجامعات الاردنية، أن ما حققته كلية الطب في مؤتة خلال فترة قياسية جعل منها اسما لامعا بين بقية شقيقاتها من كليات الطب في الجامعات الاردنية التي سبقتها. ولفت  الى ان المؤتمر العلمي الذي يتناول جملة من القضايا الطبية من مختلف التخصصات كالجراحة العامة والخاصة والنسائية والتوليد والامراض الباطنية والجلدية والعلوم الطبية الاساسية وامراض الاطفال والعيون وجراحتها، دليل على نهج قويم ينهجه ارباب الاختصاص من العلماء الذين سخّروا كل ما لديهم خدمة لمسيرة مباركة وطموحة جعلت من المستحيل ممكنا ومن الحلم واقعا ملموسا.
وبين عميد كلية الطب الدكتور بسام نشيوات ان الكلية تعمل بجد من خلال التعاون مع العديد من الجهات الطبية في القطاع الخاص ووزارة الصحة والخدمات الطبية الملكية والجامعات الاردنية بهدف الارتقاء بالتعليم الطبي في الكلية، مشيرا الى تخريج ما يزيد على 600 طبيب وطبية يمارسون المهنة في وزارة الصحة والخدمات الطبية الملكية والقطاع الخاص.
ويناقش المشاركون في المؤتمر على مدى يومين اوراق عمل حول الجراحة العامة والخاصة وجراحة الكبد والبنكرياس والقنوات المرارية وجراحة التجميل والجراحة العامة والتخدير، والامراض النسائية وتنظيم الرحم، والطب الباطني والامراض الجلدية والعلوم الطبية المساندة.

المصدر: موقع جريدة الغد الأردنية، إضغط هنا.

My photos while presenting the results:

The PowerPoint Presentation:

http://de.slideshare.net/slideshow/embed_code/34114416

My video while presenting the above results (in the PowerPoint file above) today at the conference:

.

What is a gallop rhythm? Is it tachycardia plus S3 and/or S4?

Firstly, what is a gallop?

Oxford Advanced Learner’s Dictionary, 8th edition
gal • lop verb, noun BrE / ˈɡæləp / NAmE / ˈɡæləp /
noun
1 [ singular ] the fastest speed at which a horse can run, with a stage in which all four feet are off the ground together
He rode off at a gallop .
My horse suddenly broke into a gallop .

2 [ countable ] a ride on a horse at its fastest speed to go for a gallop
3 [ singular ] an unusually fast speed
She always lives life at a gallop.
© Oxford University Press, 2010

This animation beautifully illustrates the “state in which all four feet [of a horse] are off the ground together“.  Actually, the story behind this animation is very interesting. It was to answer “a popularly debated question of the day [in 1872] — whether all four feet of a horse were off the ground at the same time while trotting“. You can read more here: http://en.wikipedia.org/wiki/Sallie_Gardner_at_a_Gallop
Some people define gallop rhythm as:

Gallop rhythm = S1 & S2 + S3 or/and S4 + Tachycardia

Today,this topic was raised in front of me. When I commented that the definition doesn’t include tachycardia. My colleagues were either silent or against my notion. Finally, the doctor said: “I have never heard of a definition of gallop rhythm that doesn’t include tachycardia!”. Well, all the following sources have something else to say. They all agree that:

Gallop rhythm = S1 & S2 + S3 or/and S4 (The definition ends here! No tachycardia!)

In more details: Gallop rhythm = S1 & S2 + S3     OR     S1 & S2 + S4     OR     S1 & S 2 + S3 & S4

Third and fourth heart sounds: These are pathological.

– A third heart sound is due to rapid ventricular filling and is present in heart failure.

– A fourth heart sound occurs in late diastole and is associated with atrial contraction.
Either, singly or together, will produce a gallop rhythm.

Source: Kumar & Clark’s Clinical Medicine, 7th Edition, 2009, p. 692:

Gallops — An abnormal S3 and S4 tend to be louder and of higher pitch (sharper) and are frequently referred to as gallops. S3 is the ventricular gallop and S4 is the atrial gallop sound. S3 and S4 can be fused during tachycardia to produce a loud diastolic filling sound, termed a summation gallop.

Source: Uptodate website and the citation of the above paragraph is: Shah, PM, Jackson, D. Third heart sound and summation gallop. In: Physiologic Principles of Heart Sounds and Murmurs, monograph No. 46, Leon, DF, Shaver, JA (Eds), American Heart Association, New York 1975. p.79.

Gallop: A triple cadence to the heart sounds; due to an abnormal third or fourth heart sound being heard in addition to the first and second sounds, and usually indicative of serious disease. Syn: bruit de galop, Traube bruit, cantering rhythm, gallop rhythm.

Gallop sound: the abnormal third or fourth heart sound which, when added to the first and second sounds, produces the triple cadence of gallop rhythm. See Also: gallop.

Source: Stedman’s Electronic Medical Dictionary, 6th edition, 2004.

 

A pathologic S3 or ventricular gallop sounds just like a physiologic S3. An S3 in a person over age 40 (possibly a little older in women) is almost certainly pathologic, arising from altered left ventricular compliance at the end of the rapid filling phase of diastole.62 Causes include decreased myocardial contractility, congestive heart failure, and volume overloading of a ventricle, as in mitral or tricuspid regurgitation. A left-sided S3 is heard typically at the apex in the left lateral decubitus position. A right-sided S3 is usually heard along the lower left sternal border or below the xiphoid with the patient supine, and is louder on inspiration. The term gallop comes from the cadence of three heart sounds, especially at rapid heart rates, and sounds like “Kentucky.”

Source: Bate’s Guide to Physical Examination and History Taking, 10th edition, 2009, chapter 9.

Gallop rhythm is an auscultatory phenomenon in which a tripling or quadrupling of heart sounds resembles the canter of a horse. Tachycardia need not be present.

Source: Gallop rhythm, R A O’Rourke, Calif Med. 1972 May; 116(5): 85–86, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1518412/?page=1

Even Merriam-Webster website does not mention tachycardia in the definition:

gallop rhythm noun

Definition of GALLOP RHYTHM

: an abnormal heart rhythm marked by the occurrence of three distinct sounds in each heartbeat like the sound of a galloping horse—called also gallop

Source: http://www.merriam-webster.com/medical/gallop%20rhythm

For Medical Students: Normal values for laboratory investigations, BP, and BMI (USMLE-friendly)

We teach our students that they should not believe us. Do not believe your professors! - Dr. Kevin Hantrey

How can you trust the summarized information in the below documents? If some professors, somewhere, are teaching their students not to trust them, how come that you trust a colleague of yours? I head the above statement personally from Dr. Hanretty at a conference here in Jordan. “I should not believe what you have been telling me so far?” I exlamied perplexed after I heard that weird statement. Dr. Hanretty then explained to me that what he means is that students should always look into the correctness of the information given to them by their professors and not take things for granted. Respect!

Therefore, the  source of the normal lab values below are:

Unless specified, most of the values are from “Step 1: Content Description & General Information 2012”, p. 22, www.usmle.org/pdfs/step-1/2012content_step1.pdf. The remaining few are from “Reference Intervals for Laboratory Tests & Procedures”, ch.708, Nelson Textbook of Pediatrics, 19th ed, 2011.

The following a printer-friendly PDF version. I designed it so that the most possible information will fit in one page. The page has zero borders.

Download (PDF, 462KB)

In case you wanted to make any changes to my file, then this is word version:

Download (DOC, 244KB)

Is there a safe drug? Is there a drug without any side effects?

According to what my professors at medical school taught me, and to what I had learnt through my so far sixth-year long journey in medicine, the answer is: No! There is no drug without side effects.

To make sure of this conclusion, I searched google for terms like “drugs without side effects”, “a drug without side effects”, “no side effects drug”… etc. The previous search terms didn’t lead me to a name of a drug or a group of drugs that do not have side effects. In fact, these terms did not lead me to a single webpage that addresses this issue.

Happily, I reached a WHO page that helped me to confidently remove any possible doubts that I had:

No drug is without risk and all medicines have side effects, some of which can be fatal.

Source: “Medicines: safety of medicines – adverse drug reactions”, Fact sheet N°293, Updated October 2008, http://www.who.int/mediacentre/factsheets/fs293/en/index.html 

About one month ago, I came up with a statement that reflects this very important fact. That statement came to me in an epiphany after at least a 30-minute-long talk of rebuke by Dr. Eiad Tamimee, a Pediatric Gastroenterology doctor of mine at Mu’tah University, on the importance of us on over medicating our patients. After all, rebuking others can sometimes bring the most out of students! This might be the case with me!

I came up with my statement after remembering a statement I know that stresses the importance of asking questions:

What is a stupid question? 

A stupid question is the question that you do not ask. Or as my doctor answered after my asking him this question, “there is no stupid question”.

My suggested statement to reflect that all drugs have side effects:

What is the drug that does not have any side effects?

The drug that does not have any side effects is the drug that you do not take!

Did anyone else come up with the same statement? Am I copying this statement and attributing it to myself? Well, here are google results for this statement:

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