Disabling proquota.exe in XP Home Edition

Windows is not a normal topic of discussion here, but I struggled to find any information to help me with this problem, so I thought I'd post my solution.

After running combofix to clean up some viruses, proquota.exe was found to be missing from my system32 folder and combofix kindly reinstalled it. Unfortunatly, proquota.exe limits the profile size of user accounts, meaning that you can only store so much (10 MB in my case) on your profile (which includes your Desktop, MyDocuments folders, etc.). As a med student, I have a LOT of documents that I like to store in MyDocuments, so this was unacceptable.

If you have XP Pro or Server2003 you can easily find instructions to disable proquota; however, if you have XP Home, you're more or less hooped.

To disable proquota I had to make the following change to my registry (remember, hacking your registry is ALWAYS risky if you don't know what you are doing):

First, go to Start->run and type in "regedit".

Then in the Registry Editor, go to HKEY_CURRENT_USER->Software->Microsoft->Windows->CurrentVersion->Policies->System

Finally, double-click on EnableProfileQuota and set it to 0.

Restart your computer, and proquota will not bother you again.

Engineering vs. Medicine

When I was accepted into medical school, many people congratulated me with a "dude, you're leaving a good job to go back to school, med school's tough, why would you bother?!"

Friends who had graduated from engineering like I did responded a little differently, "dude, you're leaving a good job to go back to school, oh well, med school can't be that much tougher than engineering."

Having been through 1.5 years of medicine, I can certainly say that the engineers were very wrong. Conceptually, I don't think any single topic covered thus far in my medical education is any more difficult than the topics covered in electrical engineering. In fact, I would argue that courses on quantum mechanics and nanotechnology were probably more difficult to understand than anything I've been taught in med school. However, the major difference is volume of information. A single week in med school seems like at least half of an undergrad course. We have to read, understand, and memorize a ridiculous amount of information.

Which brings me to another difference between engineering and medicine. Engineering required very little memorization. For the most part, in engineering, you only have to memorize first principles and then you can usually derive any other equation you need. There is no way to derive the cranial nerves and their functions, nor is there any way to derive the different pathologies responsible for papulosquamous eruptions...there's no way around it, you have to memorize in medicine!

The workload in engineering is above and beyond that seen in most other university programs; however, the workload is much, much greater in medicine than even engineering. The only consolation med students have is that most schools grade on a Pass/Fail system, as opposed to a letter grade system. So for the most part,in med school, getting a 60% is as good as getting a 90% on an exam (not from the patient's point of view obviously), you don't have to worry about getting A's anymore.

The last difference that became very apparent to me last month is the difference in exams. My engineering exams were almost entirely math based; I don't remember ever seeing multiple choice on any of my exams. Med exams are entirely multiple choice, and there are a LOT more questions asked, which makes sense considering the significantly greater volume of information taught. After completing an engineering exam, most students have a good idea about how they did in that exam. After completing a med exam, most students have no clue how they did in that exam! A number of my classmates have seriously believed that they failed an exam, only to later find out that they aced it.

Why Nerds Wear Glasses

Society and pop culture paint a picture of the smartest, most intelligent people (nerds) wearing thick glasses and rocking pocket protectors. Admittedly, I would normally advise against buying into stereotypes, but there may actually be some validity to this particular generalization.

Studies looking at myopia (nearsightedness) have found that the more educated a person is, the more likely they are to have myopia [1, 2]. Another study showed a correlation between myopia and time spent reading in children. This correlation may indicate that "close work", including reading or any other activity that requires the eyes to focus on some nearby object, results in myopia. Of course, correlation does not necessarily indicate causation, but the theory reconciles the two aforementioned findings nicely. If increased reading causes myopia, it is not surprising that a higher degree of education is associated with an increased likelihood of myopia as more educated people probably tend to read more.

Now, why do nerds wear pocket protectors?

What they don't tell you before med school: Choosing where you work

Each year medical schools in Canada are flooded with more and more hopeful applications from students who are praying for the chance to wear a white coat and introduce themselves as "Doctor". These students have put forward superhuman efforts to achieve: they have great grades and solid MCAT scores; they have resumes polished with extracurricular activities showing their leadership, determination, and compassion; and they have spent hours on end crafting essays describing exactly why they want to enter the field of medicine. The competition is so steep in Canada that thousands of students are rejected time and time again, causing many to go off to international schools in the Caribbean, Australia, and Ireland.

Unfortunately there are many negatives to being a doctor that you just don't hear about when you are applying to medical school. One major drawback is the limitations placed on where you can live when you finally graduate. Medicine is touted as a very stable profession in Canada, one that is "recession proof". This stability is due in part to the major physician shortage we have in Canada. However, this shortage is not ubiquitous in location or profession.

If you want to be a family doctor, you're set, you can basically work in any city and you will be able to find patients and establish a practice. However, if you are a heart surgeon, you may complete your residency without a job available. Imagine that, finishing 4 years of med school and 6 years of residency without a job to show for your efforts. The lack of employment is simply because there are only so many facilities that can offer cardiac surgery and there are more graduates than there are retiring surgeons whose spots need to be filled.

Even if you are interested in a specialty that does provide employment opportunities for its graduates, you may still have little say in where you are employed. For instance, I was talking to an ENT surgical resident who was complaining that he will definitely not find work in Vancouver when he graduates because everyone wants to work here; thus, only the most experienced and capable surgeons are hired (good news if you have an ENT problem in Vancouver).

Some may argue that this problem is not unique to medicine because many occupations force people to relocate to where work is available. However, this is especially unfortunate in medicine because many people go into med school without being aware of this reality. Going tens of thousands of dollars into debt, slaving through med school and then residency, to realize that you have to move far away from your family and friends to find work can be a rough fact to deal with...so try to deal with it before you apply to med school. Either that or be comfortable entering a specialty with more flexible options...

An Untold Fact About The GP Shortage

General practice is in a bad state in Vancouver, and probably most of Canada, because of the well known shortage in general practitioners. Many people can't find a GP and those that have one hesitate to visit their doctor because they know that they're doctors are overbooked and appointments need to be made far in advance. Somewhat nonsensical because most of us can't predict that we will be sick two weeks ahead of time. This leads to obvious problems because if patients don't see their doctors regularly, their doctors cannot catch their illnesses early and control their disease before it becomes more harmful to the patient and more expensive for the system.

Doctors, educators, and public health officials often discuss these issues when they publicly debate the GP shortage. However, an aspect of the problem that is not discussed as often are the unnecessary mistakes made by physicians who are overwhelmed with an unrealistic schedule. Doctors know that there is a GP shortage, so they often find it difficult to turn away a new patient who has nowhere else to go; thus GPs tend to have too many patients.

Next, consider the fact that these GPs develop very close relationships with their patients and feel obligated to see them as soon as possible when they become ill.

Having a large patient population and wanting to ensure no patient is turned away means that GPs will have many patients to see each day.

Then realize that these doctors have lives, families waiting at home, and that they can't stay in the office all day. They would stop time for you if they could, but they can't, really.

Many patients + wanting to see all of them + time is finite = 10 minute visit

The 10 minute visit is an attempt to maximize efficiency while minimizing any potential harm to patient care. However, any time you speed up ANY process, you risk making silly mistakes. These errors are often easily correctable, but sometimes they aren't. Compromising patient care is something no doctor ever wants to do, but it is something that will happen. Even in a perfect system, doctors will make mistakes (sorry, they're human too), but in an imperfect system, doctors will make more.

There are two ways to resolve this problem:

1) We can improve the system. This would mean improving general practice and luring more med students into the field so that there will be fewer patients per general practitioner and then each doctor can spend more time with their patients.

2) We can make perfect doctors. That means they would have to be robots. Getting a DRE sucks now. It'll probably be a lot worse if it's done by a robot.

Malpractice: Don't Rush The Surgery

Take a look at your palm. Now make a fist as tight as you can. Chances are you can now see two seperate tendons running over the middle of your wrist. One of these tendons is the tendon of palmaris longus. 10% of the population will NOT see this tendon when they make a fist because they were born without it. It's not a big deal, the tendon is pretty useless functionally. Thus, when a patient tears an elbow ligament, surgeons often scavenge the palmaris longus tendon and reattach it to the elbow in place of the torn ligament.

We were told an unfortunate story about a surgeon who rushed a surgery and cut into a patient's wrist, hoping to scavenge the palmaris longus tendon. Turns out that this patient was in the 10%, he did not have the tendon. Guess what is usually underneath the tendon? The median nerve. This surgeon cut clean through the nerve controlling the muscles of the patient's thumb, index, and middle finger. These fingers are now non-functional for this patient. A really tragic case and a reminder to all physicians not to rush their surgeries.

Reminder: Wrist Bone Pneumonic

So Long To Pinky Here Comes The Thumb

Scaphoid, Lunate, Triquetrum, Pisiform. (Proximal)
Hamate, Capitate, Trapezoid, Trapezium. (Distal)