The COVID Files: Deep dive on MDs, DOs, MCATs & possibly Accountants

I figure there has to be more to it, but everything you explained seems quite intuitive and obvious.

I guess to me it seems like learning a foreign language. For example, If I’m learning Spanish, I know what a “fork” is, what I’m learning is how to say it in Spanish.

When I passed I was numb for like 30 minutes. The whole experience was absolutely awful.

Yes, it is literally learning a different (enormously useful) language!

Idk about you but that summer of studying for the bar was fantastic. MrsCooler would go to work, I’d study in the morning from like 7-11, hit the gym/lunch, study some more in the afternoon, happy hour or golf with my buddies after they got done with work, repeat.

Another funny story is second day lunch hour of the exam I’m wearing basketball shorts, a hoodie, sandals and walking to grab a coffee from Dunkin in downtown. I run into one of my buddies from high school I hadn’t seen in years out on his lunch from his corporate finance job and he goes “Cooler, hi…are you okay?” For a Wednesday at noon wearing a hoodie in the middle of summer I definitely looked like I had made some poor life decisions.

You’re thinking of a bookkeeper. Accountants (CPAs especially) have to have a ton of in-depth business knowledge.

I had a bunch of friends at university who were in the math/accounting CPA program. They were, by far, the most overworked people I saw on campus. It’s a ridiculously demanding program.

When I was in school I had one pretty good friend who was an accounting bro. He was a sharp guy, but he certainly wasn’t going to win any awards for most overworked.

I had the same experience. In 2001 I wrote one exam and basically every insurance company and actuarial consultant in town offered me a job after a one hour interview.

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My interview with the career advisor we had to have at 16 wasn’t what I hoped for. When she saw I was taking maths exams early she said “Oh how nice to have an easy one after the last few - you’re going to be an accountant”.

My dad’s reaction was “Don’t pay any attention to her - that’s deadly dull”.

That summer was probably a little too fun for me.

I feel like I barely passed the bar because I didn’t do half the shit Barbri told me to do and I definitely didn’t know some of the NY specific stuff on the exam.

Didn’t take bar exam

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Yeah, after my first exposure to the Florida-specific questions, I realized that they were all horribly written and much more vague relative to the multi-state portion, so I spent most of my time studying the MBE portion.

https://twitter.com/40oztoian/status/1312921949228601345?s=21

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I guess everyone is over this discussion but just chiming in to say that in my experience the difference between DOs and MDs in general practice is negligible.

I swear I thought the video continued on for another 5-10 seconds with Olbermann just staring speechless into the camera after hearing that.

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Continuing the melatonin discussion from the main thread…

I have a circadian rhythm disorder and have been on the shit forever. A few observations:

(1) If you feel unusually groggy the next day, you probably took too much.
(2) If it “didn’t do anything,” you probably didn’t take enough.
(3) Whether you took too much or too little likely isn’t your fault because
(4) the variability in actual vs. advertised dosage is massive (see paper below).
(5) It can also contain impurities like seratonin (same paper).

This study quantified melatonin in 30 commercial supplements, comprising different brands and forms and screened supplements for the presence of serotonin.

Results: Melatonin content was found to range from −83% to +478% of the labelled content. Additionally, lot-to-lot variable within a particular product varied by as much as 465%. This variability did not appear to be correlated with manufacturer or product type. Furthermore, serotonin (5-hydroxytryptamine), a related indoleamine and controlled substance used in the treatment of several neurological disorders, was identified in eight of the supplements at levels of 1 to 75 μg.

And a commentary of the findings here:

The AASM issued a clinical practice guideline update in Feb 2017 (weakly) recommending clinicians not to use melatonin as treatment for chronic insomnia. It is still recommended as treatment for circadian rhythm disorders:

  1. We suggest that clinicians not use melatonin as a treatment for sleep onset or sleep maintenance insomnia (versus no treatment) in adults. (WEAK)

Also, I think in one of those articles they point out that melatonin might have a tendency to degrade pretty easily. For example, see:

The results show that UV irradiation of melatonin (0.1 mg/mL) using a 400-W lamp for 2 hr caused a significant decline of melatonin to 18% of its original concentration after 20 min, with the decline continuing until the melatonin concentration reaches zero at 120 min.

I dunno what the “good” pharmacy/supermarket brands are. Lab-quality melatonin exists but I’m not sure how to get it as a non-practitioner. It’s interesting that in the AASM guidelines they weakly recommend ramelteon for sleep onset in chronic insomnia. Ramelteon is a melatonin receptor (MT1 and MT2) agonist with high binding affinity; in other words, a pharmaceutical-grade melatonin. It makes me think the weak evidence against melatonin is precisely because of the terrible quality of OTC supplements, but I’m not digging through the metas to find out.

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I haven’t looked into it in a while but last I remember the data showed that melatonin was helpful for jet lag (presumably a disorder of the circadian rhythm) and there wasn’t much evidence on it for sleep, which would jive with what you posted. Anecdotally have heard mixed results but the risk seems fairly low unless you can’t risk being knocked out the next day.

https://twitter.com/whiotv/status/1313092601944342528?s=21

That’s a misleading headline. The work in question says 10% maximum and the math inside it suggests we are probably quite a bit below that.

melatonin is my go to for shift work causing sleep disturbances

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