almost done…

I apologize for the lack of updates since um… March… Surgery sapped the life out of me (despite what in retrospect was probably the lightest surgery rotation in the history of medical schools), I was running around traveling (including over to Asia) for a good chunk, got dropped into the ICU upon returning, and have been running pretty steadily since then from one rotation to another. 4th year definitely turned out to be a little more involved than I expected, but I’m glad I filled it as much as I did.

I think everyone’s already gotten the memo, but I wound up applying in Neurology. I had been debating between internal medicine and neuro, which here in the US requires an intern medicine year but other than that is a separate field. ultimately I decided that neuro was a better fit, and that if I didn’t do it I would miss it more than I would medicine, if that makes any sense. Now that I’m on my medicine sub-I I’m revisiting all the reasons I really enjoyed IM, and really, I would probably have been happy doing either. I think ultimately general medicine would have lost its charm though, and I can’t think of a specialty within IM that I would prefer over neuro. Again, if neuro were a subspecialty out of IM, this would all be moot. Silly America :P

As for location — the hope and plan is to stay on here at Wash U. I’m interviewing at a few other schools, mostly Penn + Midwest schools. Wash U’s program is one of the best though, so it would be hard to beat in any case, but moreover it’s extremely unlikely that I’m going to encounter a program that I like enough to make me want to suffer a long distance relationship again for at least a year if not two or more.

so the grand news is that I’m actually almost done. I have 3 more days of my last ‘rigorous’ rotation, and then I begin the interviewing/light rotation phase of 4th year. I’m doing 3 light rotations back to back (reading, advanced dissection, derm), then I’m sticking around 2 weeks or so for Match Day and then peacing out for what will hopefully be one of the best vacations of my life. I’ll circle back here for graduation in late May, and then I’ll truly be done with medical school… poofy hat, robes and all. I’ll likely have about a month to kill after that… which will most likely be spent cleaning this damn apartment and hopefully some local road trips etc around the US.

Vacation wise, the plan is to fly to Moscow (can you believe houston–>moscow is $436USD on SIA??), then begin a slow, overland journey from there to Singapore after a short detour for a few days in St Petersburg. I plan to make short stops in Irkutsk, Ulan Bator, Beijing, Hanoi, Vientiane, Bangkok and Penang. The entire trip should be doable by rail (yay) except for one grungy bus ride across the vietnamese-laotian border. I have the husband for company only up to Beijing, so if anyone wants to come hang out for any leg of the rest of it, definitely give me a holler :) Hopefully I’ll get my act together enough to photograph and blog about the whole overland trip… will post a link if I do, naturally.

In other news, I’m slowly getting used to treating my time as my own again. After a year and a half of feeling like I had no time to myself, now that I’ve had more I haven’t known quite what to do with it. Finally got myself to the library to pick up some fun sci-fi/fantasy per GRR Martin’s recommendations, and have raked up a few other recs from random folk. Feel free to throw more my way… I hope to do lots of fun reading between now and June :) fiction and non-fiction suggestions welcomed, but please, nothing remotely medical. Also, I have a large cross stitch project to pick back up, and perhaps I’ll start knitting again. I’m hankering to learn a new language/hone my spanish/mandarin so hopefully I get off my ass sometime and work on those. Perhaps I’ll try to pick up some russian before I head over there. Need a new exercise program as well… was doing well up till a month or two ago and then have just been sedentary since. :P

Aight, back to agonizing over how much this overland journey is going to cost me :P

a few updates

Surgery: I lucked out (from my perspective) regarding surgical rotations…. started on Rheumatology, which is bizarrely an option on Surgery due to its inclusion in the Musculoskeletal block. I really do like rheumatology… unsurprisingly I enjoy working up arthritis and the like, much as I previously enjoyed dealing with diabetes and hypertension. I like common problems, I guess. I like that in most cases they have reasonably straightforward solutions nowadays. Anyhow. have now continued on to Orthopedic Surgery at the VA — which has been fun, if dull. there is an unsurprising lack of thinking involved, but the surgeries are pretty fun. “Mallet!” And pretty damn effective and satisfying. And the hours have been fairly good, as far as surgery goes. I go on to Urology next and then Connect Care for my general surgery rotation. I hear that has decent hours AND you get to be fairly involved AND you see a lot of bread and butter cases. So I’m reasonably pleased. Would have liked to do anesthesia instead of urology, but I’m sure uro will be useful somehow. Does mean I’ll have to commit some time in 4th year to doing anesthesia though, because I really do think it’s a useful thing to learn about. I will say I like the manual aspect of surgery. If I could do something that sometimes involved short surgical cases (none of this being sterile for hours bullshit) and didn’t involve the hellish residencies and did involve the more intellectual side of medicine…. well, that would be appealing.

Career decisions: Still bouncing between IM and Neuro. Leaning more towards Neuro over the last few days, but that really doesn’t mean much in light of all the back and forth that has been going on recently. It’s basically coming down to what I’m more ok with giving up. The satisfying part of all this angsting is that it’s become very clear what things I am totally comfortable giving up… like say, neurosurgery… or pathology… or radiology… or obgyn. which is not to say I won’t miss certain things about them, but that’s kind of on the same level as the part of me that wonders why I didn’t become a plumber or electrician or cook. have also for the most part ruled out peds and peds neuro. peds neuro comes back to haunt me once in awhile but it’s a distant enough third that I think I can feel pretty comfortable ruling it out at this point.

Life beyond medicine: planning a trip home in june (only 10 days though, sad!) and a trip to vancouver next weekend to visit mom… Axel (the cat) is settling in pretty well, although his new hobby is daily decimation of one of our dead plants. had a fun visit from my cousin last weekend that had the additional benefit of figuring out how to convert windowsills into bookshelves (thanks sam!). am biking again now that I have to schlep to the VA everyday, and my body is protesting slightly at this sudden onslaught of activity (hadn’t biked since last Sept when my bike got stolen). I’m sure it’s good for me though. today my goal is to unpick the massive patch of wrongness in my cross stitch project so I can start work on it again… also cook 2 meals. have resolved not to make any more cupcakes until we finish eating the last batch (I made 24 instead of 12 and had to bring 12 to school to help us out there)… if anyone wants a dark chocolate cupcake with cream cheese frosting, we still have 6 left in the fridge :P

When your words come back to bite you…

“I’m not sure that family practice is a good career choice for me but it does include all the stuff I like — adults, kids, ob, outpatient care, long term patient relationships, variety, etc…. Will most likely end up in med or peds though, unless I fall in love with neuro in a coupla months.”

Faithful readers will recognize the quote from a couple posts back. Between then and now, I have actively pursued the FM idea for all the reasons above, agonized over the outpatient-inpatient dichotomy, the adults-kids dichotomy, the generalist-specialist dichotomy, and of course, predictably, fallen in love with Neuro. :P

This is a problem!

It’s also a problem that I have to spend the next 3 months in SURGERY of all things, which means I can’t actively investigate any of the things I’m actually considering going into. But maybe that’s for the best. Maybe time and perspective will help. I remember doing a lot of soul-searching while retracting on Green Team. :P And maybe doing the things I don’t want to do will help me crystallize what I DO want to do. And I do anticipate enjoying my time on Surgery, other than being tired and annoyed with jackasses. I’m also kinda happy to be going into the 3 months knowing I don’t want to do it for life. It takes a lot of pressure off. And my reasons for that have nothing to do with whether or not I like surgery itself, so I don’t have to worry about another crazy career choice upheaval if I turn out to love it.

So yeah, I’m heavily in the not-surgery camp. Which is one big decision down. and wonderfully liberating to make.

As for neuro, well, it’s been a blast. And that has nothing to do with the rotation, which is very comforting to know. Because this rotation is horribly organized. I spend a lot of time sitting around waiting for attendings who are late, clinics who never happen, and doing ED scut. None of which I particularly enjoy. Which can only mean that it’s the content that I like. And that’s unsurprising. I’ve always had a neuro bent anyway. I like that much like psych, you’re dealing with the part of the body that makes people really feel like themselves. I like the breadth, and I like that it interacts with a lot of other organ systems. I like that on a Neuro ED consult you have to consider a lot of non-neuro options. on Ob-gyn consults, well…. if they’re bleeding from their vagina, it’s kind of a no-brainer, at least regarding which organ system you’re in :P I like how complicated the brain is, and I like that while there’s a lot of variety in presentation, things tend to fall in patterns. I like patterns. I’m good with pattern recognition. gestalts. NOT trivia recall. Of course, there’s a lot of that in neuro too, but for some reason neuro stuff sticks with me better, which is probably a sign.

Still though, I really want to be the ‘everything’ doctor. I want to be involved in primary care and kicking people’s asses and making them take care of their diabetic and hypertensive selves. :P I kinda want to run a primary care clinic for 2 days a week and neuro the rest of the week. with inpatient or ER responsibilities somewhere. Although I’m thinking that inpatient/ER work will get substantially less interesting after residency. Attendings seem to get 2 minute phonecalls about patients that have already been worked up, and they make a quick decision and move on. SOMETIMES they go see the patient. :P I dunno. It’s really hard to make decisions about careers when all you witness is residency training.

So I’m vaguely considering IM followed by Neuro. I got told yesterday that that was a ridiculous idea and hardly anyone benefits from it. But who knows, maybe i’m the outlier. One thing that America and Wash U have instilled in me is that it is both worthwhile and possible to carve out your niche. To make things work for you in particular. To break the mould. (mold?)

I also need to figure out if I want to be an inpatient or outpatient doctor. I really can’t decide. and the whole adults v kids thing…. *sigh*. WHY did I enjoy Peds? that just royally fucked everything up :P

Remembering to um… live.

yes, I haven’t posted in forever. I apologize. to myself, and to you, whoever you are that actually reads this drivel. :P this will probably be the first post in a string since my morning clinic got canceled and I’m feeling introspective. all contingent on me not getting paged to the ED suddenly.

So. it’s still winter and although warm for February, still too cold for my liking. Not that I don’t like the cold, but I’m not really in the mood right now. My SAD-like-whatever-it-is has kicked in with a vengeance, and while I’m still completely functional, I have so little motivation to do anything once the structure of the work day is over that I just wind up sitting. a lot. and I find myself really needy emotionally. in a really annoying way. which is a place I really don’t enjoy being in. it’s a damn good thing Ansel likes to cook and puts up willingly with my moods (there’s a reason that made it into our vows :) or I would probably be curled up in a ball on my floor slowly starving to death and failing out of medical school. Ok that’s a slight exaggeration. But still. Pick your man well!

the really shitty part of it all is that I just don’t do anything outside of work. I’ve been here before so I’ve been good about trying to get myself out to meet up with people and not just stare at the ceiling, but god it’s hard work. :P When I’m at home though I find myself almost always just sitting at my desk doing a lot of nothing. and then sleeping 2 hours too late. and waking up early. and feeling like you’ve done nothing for 5 hours is just depressing. which obviously doesn’t help.

So yeah. Having seen where this leads me if I don’t do something about it, this is me trying to do something about it. I need to give myself new defaults, I think. and have specific things to want to do. as opposed to just wanting to do ’something’. So here I go (and I suppose this will serve as some sort of an update as well) in an effort to remind myself of the things i like to do… and also the things that need to get done.

1) I really need to get my documents in order for next tuesday’s green card interview. I’m terrified that something is going to go horribly wrong, and as a result I don’t want to deal with any part of it. which is a recipe for disaster, obviously. Really all I need to do is make a pile of things to photocopy and a list of things to print and then do them. Yeah.

2) Cross stitch! I’m making painfully slow progress with the cross-stitch vows project. Not that it goes that slowly when I do it, I just haven’t picked it up much to work on it in awhile. I should print out the patterns so I’m not dependent on having a computer by me. But also I always feel guilty not studying… which doesn’t mean I study but means i feel unable to do anything else other than nothing :P

3) Knitting. I used to love to knit and I have no shortage of needles or wool. What I need is a project. Maybe something for the house. I dunno.

4) Home decor and organization. We need curtains and shelves. well we don’t NEED curtains OR shelves. I just want some. and I need to clean up and organize. We’re ALMOST done with laundry! (the dryer wasn’t working for awhile so there were large piles to work through when it got fixed). The walk-in closet desperately needs re-organizing though. We also need stuff to make it up on the walls. which I’m uncomfortable doing until we have shelves. but this waiting game is not going to go anywhere :P

5) Cook something, dammit. I love to cook. I just haven’t mustered up the energy in awhile. This definitely needs to get restarted before surgery hits in 3 weeks. Alternatively i should bake more. Have been baking a little, mostly out of guilt because of how much Ansel cooks :P but could definitely get into it more.

6) I really need a bicycle. I feel trapped without one, and I could definitely do with the exercise. :P i should get my ass down to the bicycle works place pronto.

7) I suppose I should also study at some point :P

ok i think that’s enough for now. will post separately about school/career/life etc. hopefully the greencard thing goes through and then I can start thinking about travel again. that usually jumpstarts me pretty nicely :)

The late belated update

I was informed recently that I was late posting my late updates, so here it is, all rolled into one :) I do apologize to everyone for being kinda non-comunicado for awhile… things have been hectic and such, what with buying the condo, mother visiting and transitioning from obgyn into psych. So. in brief:

Condo — we close tomorrow. Praying we don’t get mugged between our front door and our realtor’s car on monday morning. :P Some not very descriptive pics are online here. Will post more after we’ve moved in, obviously. Am excited about moving but pretty much just want to be done. Am REALLY sick of packing. or thinking about packing.

Peds — I turned out to really like my peds rotation. I think I would be sad to not take care of kids, but I wouldn’t want to not take care of adults. So I’m in a bit of a bind. I’m not sure that family practice is a good career choice for me but it does include all the stuff I like — adults, kids, ob, outpatient care, long term patient relationships, variety, etc…. Will most likely end up in med or peds though, unless I fall in love with neuro in a coupla months.

I really enjoyed the nursery. could never work in a NICU (i really can’t justify economic support for NICUs. just can’t.) but neonatal resuscitation was very gratifying and taking care of well-babies was good times. I think a lot of that though was just feeling useful, i.e. has more to do with the rotation than the field. Good also to know that I’m pretty comfortable with crying babies now :)

Ob — loved ob, couldn’t stand my team. didn’t help that we were on nights. Dr Stephens, if you’re reading this, for the love of God stop putting people on 2 weeks of night shifts for no reason. but anyway. delivering babies and general perinatal care was pretty rewarding. note:stat c-sections are fucking barbaric. I’d better not ever need one.

gyn — ambulatory was great, i’m finding I really like outpatient care. didn’t even mind doing a crapload of pelvic exams like everyone else seems to. (side note: colposcopies really do smell of fish and chips. figure it out yourself. :) was nice to find obgyns that aren’t psycho — the attendings were great, esp in comparison to the multitude of psycho residents that barnes seems to spawn.

gyn surg was less than great. great team, just kinda boring. I’m finding that surgery doesn’t excite me very much, though perhaps that will change on my surgery rotation. But while blood and guts don’t bother me, I definitely don’t relate to the notion that having a body open on the OR table is the coolest thing ever. Nah. not for me. and I really don’t like having to stay sterile all the time :P but anyhow — I had really liked ob and amb-gyn, so had thought that maybe i should consider obgyn more… but then it turned out that I found most of the obgyn surgeries to be just dull, frankly. can’t get excited about yet another hysterectomy, no matter how distorted the uterus is. I don’t know. I was just kinda struck by how UNexcited I was to see a human body opened up in front of me :P laparoscopy I found kinda fun.

psych: i alternate between being fascinated and bored. the latter is mostly to do with the fact that the service at barnes is really slow at the moment. My team has a whopping 3 patients. anyhoo. I think the mental conditions you deal with are interesting, but I don’t know that that’s what I want to be treating all day, everyday. I think I wouldn’t mind a smattering of it here and there as part of internal medicine or something, but that’s about it. Also, this rotation is making me realize that I really dont’ want to be a specialist too soon. I really don’t watn to be the person who feels the need to call a medicine consult for diabetes or hypertension. would rather be able to deal with most common problems on my own. yknow an obgyn fellow told me once over dinner that the best way to pick a specialty is to think about what ‘being a doctor’ means to you. I think for me there’s a strong generalist component to it. I could see myself specializing later on, AFTER a good generalist’s training…. pity adult neuro is usually not a double boarded program.

well, we’ll see. for now, I need to pack and get this apartment in shape to move :)

p/s: winter break will be spent training around the country visiting relatives (apparently more relatives than I thought now) and going to weddings. Should be fun :)

overdue updates

so apparently it’s been more than a month since I last posted anything. it’s kind of weird this year how times seems to crawl and fly simultaneously. anyhow. quick nugget-style life-in-general updates (it’s not like you don’t all have my email address if you want details :P) in this one, then one for finishing peds and if i’m still awake, one for being 2/3 through ob/gyn.

in no particular order…

1) we’re condo hunting! we finally bit the bullet and called a realtor, and then randomly hit up a coupla open houses on Sunday… saw 5 more tuesday night, 4 more last night (with some repeats…). it’s been a bit of a whirlwind. at the moment it looks like we’re probably going to settle on a large-ish 1BR in the debaliviere area. I’m not convinced it’s the most frugal option, but there are sometimes things i value more than money. really. i’m not kidding :P then again they say frugality is about value not about cost. at least some people do. maybe? :) In any case we crunched the numbers today and over 5 years we should come out ahead of the corresponding rent-and-invest scheme even leaving room for the economy to recover and housing prices to stagnate. and if we break even at least we’ll be living in nicer digs :P

2) we finally got a pepper grinder. this has been bugging me for forever. I was all happy when I got my last one on a whim and then realized when it was almost empty that it was a disposable, non-refillable thing. this of course after I bought a huge thing of peppercorns from jay’s :P Anyhoo. we have one of those funky rabbit head crunchers now, and it’s actually a lot of fun. whee!

3) we also have a paper shredder. Now I can actually be sort of HIPAA compliant and chop up those stupid credit card offers to boot :P

4) we’ve been cooking a ton. Actually, Ansel’s been cooking a ton. have i mentioned that i really lucked out with this whole marriage thing? (oh btw Ansel also moved to St Louis permanently. I forget if everyone knows that yet…) And we got a bunch of fun kitchen stuff (pepper grinder being one, ooh and a chef’s knife! Well. A Santoku. but whatever.) with our Macy’s gift cards from the wedding. (Btw, if you ever have a Macy’s gift card that expires, they don’t really expire, just take it to customer service.) Now I just need to start baking more. I think it’s pie-time…. or at least pastry time. [update 2 days later: apparently it's shitty weather time. bah.]

5) we are actually thinking about kids in the near future. yes. the rumors are true. ok. you can all stop being shocked or weirded out now. No really. Please. Let’s all try to remember that academics are actually not the norm and that it is really not that strange a thing for a 27yo to become a mom. really. or if you can’t not be weirded out… just don’t tell me. i’m saving up all my tolerance for the obgyn residents next week :P

6) We finally moved into the 2nd room in the apartment. Subletter got out on Nov 1, and now we have a nice little home officey type setup. It’s awesome. of course it will probably go away if we move into a 1BR, but we can enjoy it for now.

7) We want a cat. In fact, I can’t wait till we actually move (or decide definitively to NOT move) so that we CAN buy a cat. (I believe in moving felines as little as possible.)

8) We got a DVD player! Now if only I could stay awake long enough to watch a movie…

9) Inhalers do indeed work better if you prime them.

and last but not least…
10) Just Bunches tastes weird. Kashi’s Go Lean tastes worse.

AMSA conference

Have been sort of popping in and out of the AMSA conference today. Walked out of the keynote address last night because apparently Dr Ross only ever gives one talk, regardless of its title. that and I keep forgetting I don’t actually like food from Sapphire all that much :P

Today though we had a talk from Lipstein (aka BJC CEO). Interesting take on healthcare plans and the implications of single-payer systems, etc. More striking than the actual content of his talk (which was in and of itself quite thought-provoking), was looking down there and seeing someone who I could respect for both his knowledge base and his IQ. :P My knowledge base is kinda skimpy — all who know me know I have a hard time retaining facts — so I have no difficulty recognizing that many people know way more than I do. But I do have a hard time with learning as much as I ought from people who are knowledgeable but not all that bright, and it was really refreshing to not have to wrestle with that :)

Falling further down the rabbit hole

Yesterday was my last day on General Pediatrics… which for my schedule also marks my last day of Pediatrics as I think of it, having now done 4 weeks of inpatient Pediatrics and being about to move on to newborns — which in my mind falls into a whole different category. Babies aren’t really kids, they’re a completely ‘other’ entity.

Anyway, I figured this was a good time to add to my Peds musings. This last week has been better, which cements the idea from before that my shitty peds experience last week had more to do with my crazy resident than anything about the field in particular. All in all, the 4 weeks have been good ones. I can see being my interns, I can see being my residents — in that I can see myself being satisfied and challenged by their day to day experiences. Not surprising — Peds isn’t all that different from Medicine in terms of what you do day to day, logistically. But content wise, the diagnostic challenges can be quite different… and I must say I like the breadth of knowing about a whole range of stuff (newborns vs adolescents… oy), which is kind of fun and daunting at the same time.

A couple of points that were made to me about career choosing by random attendings this month (mostly at least somewhat paraphrased, due to my lousy memory):

“It’s striking though, you know, every ‘interesting case’ always has a neuro component.” (from the peds neurologist)

“In all your choices, start with this: Kids or adults, and to cut or not to cut. That’s the bulk of it.” (another peds neurologist)

“Being natural with kids is less important than having a good mind for peds disease processes. The older I get, the less I value being able to ‘play with kids’ as part of my skill set. You’re the boss. Just go in and examine them. The important thing is that they get examined, not that they have a good time.” (Peds ID attending)
(this guy also made the point that while Med-Peds is appealing from a personal edification standpoint, it’s really only useful in primary care, and is a pain in the ass to accomodate in academic settings)

“I realized I loved kids, but I just wanted to be their mom, not their doctor.” (Peds neuroradiologist)

“One of the best things about radiologists is not having to know about medications. Medication knowledge is not true knowledge. In 10 years, it’ll all have changed. But disease processes, that’ll always be true.” (another peds neuroradiologist)

So we’ll see how the babies fortnight goes. But if I had to pick between Med/Peds right now… I honestly don’t know what I’d pick. Maybe some of my time back at Barnes (even in other specialties) will be illuminating. I foresee having to do Sub-Is to figure this out. But I think it’s telling that I consider not-getting to manage things like HTN and DM as a loss, not a gain :P hmmmm.

confessions

Because of this, I’ve decided that I somewhat respect and like Josh Groban, even if I would probably never buy his albums or listen to his English tracks voluntarily :P

Learned helplessness

So there’ve been a lot of discussions recently about grades and the unfairness of it all. I don’t think anyone can argue that our grades are particularly fair this year. One could argue that the randomness should average out over time, so better students SHOULD do better, but I would argue that the variability and subjectivity would require a much longer time frame for things to average out.

One can definitely argue that grades don’t really matter, and honestly i don’t think they matter much in the long run. But it IS frustrating to be evaluated KNOWING that it’s unfair AND that you can’t do anything about it.

In fact, once you put it that way, it brings to mind the old Seligman theory of learned helplessness — Seligman et al basically gave a bunch of dogs unpleasant shocks or something, and the ones that didn’t have any control over whether they got the shocks basically sat down and stopped trying. Moreover, in a later trial where they COULD have escaped the shock, they still didn’t bother to try. which makes perfect intuitive sense really and you wonder why they had to piss off a bunch of dogs to figure it out. if life sucked and it seemed like nothing you could do would change it, then it stands to reason that later on if faced with something sucky you COULD change, it would take a boatload of convincing for you to believe you could change it. we learn from experience, or so the behaviorists believe at least. and in fact, not all of us do. Some people are just constantly optimistic — ok well i suppose you could say they DO learn from experience, but they just attribute it to something external, transient and mutable. (here we’re muddling seligman with beck, but nvm they’re quite compatible)

anyway. my point is that once you lay it out that way it looks like an unfair (or just random and subjective) grading system ought to induce learned helplessness in medical students (esp since we all care way too much about grades. and by we i mean they. at least most of the time. :). So, helplessness about what? Well, what’s the stimulus? A bad grade. What does one usually do to avoid bad grades? One studies, works hard, etc. So if our grades are effectively random, people will just stop trying. the problem here is that ‘trying’ affects more than just our grades. It affects our knowledge base and our competence as future physicians. At least a little :) So — by placing us in a random/subjective system, the school robs us of our motivation to do the things that would make us better doctors.

There are a few solutions to this. You could a) get rid of grading — make it pass/fail. Probably too progressive for this particular school. You could b) make the grading less subjective. It’s not possible, not with a class this large and rotating attendings. Unless you made it all about the shelf, which is stupid because that’s not the bulk of what you learn third year. Or, you could c) somehow dissociate the grades from the actions mentioned above (working hard, learning, etc). That’s just a theoretical stab for completeness. Obviously, it’s not actually enforcible (enforce-able?) with a systems-level approach, although individuals may have some success. (I do try!)

So… in summary I think (a) is the best option, but not one that the school will take up any time soon. With that in mind, the only thing we can do is raise awareness of this psych phenomenon (will anyone listen?) so people are more… empowered?…and i suppose encourage optimism, or at least the happy triad of attributing bad things to external, transient and mutable sources. Go Beck.