Tag Archives: How To Doctor

Standardize Me

I didn’t post at all last weekend, even though I really wanted to do so. There are a few good reasons why. Besides unsuccessfully fighting off a cold and studying for three exams this week, I am also incredibly lazy and didn’t have the time or motivation to sit down and write the post that has been on my mind for several weeks. It’s only fitting that I find this motivation shortly before my pathology final, most likely using a blog post as another reason to avoid studying  for this test. As one classmate posted on Facebook so accurately: “I find that I Netflix better with study going on in the background”.

I don’t even have to study all that hard for this exam. Because of our grading system (pass/fail) and the assignments and tests I have already completed give me all but six points I need to pass the class. To put in another way, I need to get just 6/100 questions correct to pass this class. I could do that in my sleep. Don’t worry, I will study hard and do fine. (Edit: I actually did pretty well on it).

Our Pathology overlords are doing us a bit of a favor, they tell us. All of their exam questions are “board style”, similar to the format we can expect when we take Step 1 next year. This means that we take the exams on our computers through secure browsers, and that some of the multiple choice questions have options a-h instead of a-e.

Our questions are slightly harder than this, by the way.

Another way we are being prepared for Step 1 is that we are doing everything way faster than previous classes have ever done anything. As I write this in the first week of March, we have already completed all of the Year 1 curriculum. Next week we will begin Year 2 curriculum. The benefits to us include more time to study for Step 1, and more time in rotations before having to make important residency decisions. This all seems like a good idea to me, but we are the guinea pigs in this little experiment, so only time (and our board scores) will tell how it worked out.

This got me thinking about all of the standardization we are receiving. The main goal of the first two years of medical education is to perform well on Step 1. My understanding is that this test makes sure new medical students have an appropriate amount of basic medical knowledge before entering the wards and practicing on real patients. This actually works out very well for me, as I have a long history of crushing standardized tests (including NBME pathology most recently).

Recently my brother-in-law graduated from the police academy. Police officers have a very important and challenging job not unlike a doctor. They have a huge body of knowledge to learn, including the geography of their city, procedures of their department, legality issues, physical ability to drive, arrest, restrain, and I know many cops that have a highly developed “sixth sense” that gets them out of dangerous situations. Even my limited EMS experience has shown me the value of this sixth sense, but I doubt it could be taught.

Now if the police academy worked like medical school, they would spend 2 years in a classroom watching powerpoint presentations on street layouts, with the dangerous areas highlighted. They would take multiple choice exams on how to handle interactions with dangerous suspects, maybe watch videos on driving skills. Thankfully, my brother’s academy didn’t work like this at all. He rode with cops, listened to their advice, and saw firsthand dangerous areas of town. He went to an abandoned runway and spent an afternoon learning defensive driving techniques.

Medical school isn’t taught like that, and I’m not even sure it should be. All I know is that medical school has been taught the same way for a very long time, which is why it is so standardized. There is a well defined process to becoming a doctor, steeped in tradition and learning. If improving the quality of medical education came at the cost of leaving behind those traditions, would anyone attempt it? Will there be a series of huge sweeping changes in the coming years, or will innovation come in small steps, creeping along over the years?

I’ll have to think more about this, but it’s something that will be on my mind as I work my way through medical school.

This post is now very late, but thank you for reading!

 

How To Embarrass Yourself While Shadowing A Physician

So you want to get into medical school, right? At some point you will likely spend quite a bit of time “shadowing” physicians. This is a time honored tradition where young students get in the way of physicians and look silly for many hours. The idea is that time spent following actual doctors around can give you a glimpse into life as a doctor, so medical schools look for it on your resume. It’s one of the “unwritten” requirements to get into school. I thought it would be helpful if I made a list of things I wish I knew when I began shadowing. Of course, much like medical school, I think I am far better at humiliating himself while attempting to “shadow”, so this list is composed entirely of things to avoid. I’m not saying I’ve done all of these, I’m just saying it could be awkward if you did.

1) Constantly be in the way –

Pretend you’re me for an instant. Pretend you are at a dermatology clinic associated with a large teaching hospital. Following a few residents and an attending for a morning. So each clinic room is approximately the size of a closet. The patient, of course, sits on the awkwardly tall bed with the paper roll. Throw in one or two family members, the attending by the bed, and the resident on the computer, and you’ve got a full room. That’s when I show up. Since I’m a shade under 6’3 and am close to a comfortably pudgy 195 pounds, I take up quite a bit of space. That means I get to stand in the corner where the door opens, the corner behind the bed, or spread myself around the room so that we all fit. The trick in this instance is to think ahead. When you are ready to leave, open the door and begin leaving before the attending gets to the door and realizes they can’t open it because you are standing there. I tend to do a lot of shuffling. You have to learn this when you are the newbie in an operating room, when you are useless but the attending feels a need to get you in close. Space is tight at the table already, then I show up to lumber around the OR I feel extra awkward. Good times.

2) Sit in the wrong chair –

If you arrive first for your shadowing day (and you should always be early), you may be faced with a terrible dilemma. While waiting for ______ to show up, you will inevitably be left by yourself for some amount of time. This may be in the doctors office, maybe at a nurse’s station, but the worst is the clinic doctor’s area. This is the space where 4-10 computers are reserved for the physicians to use, and where you have to pick your chair. Take careful note of objects left near computers that might signal that the chair is “taken” by a regular. White coat draped over the back of a chair? Stay away from that. Coffee thermos by a keyboard? Don’t do it. The next part is looking not bored. If the doctor is late (the chances of this happening are very high), you should not whip out your iPhone and play Flappy Bird at full volume (even if it helps you play better). This is hard for me, since I have the attention span of a child as well as an iPhone with 20 fun games to play.

3) Ask Dumb Questions/ Never Ask a Single Question

You are spending your day with this person to learn. Realistically, you probably won’t learn or retain any medically useful knowledge during your visit, but the idea is to get exposed to the kind of work you might end up doing and make connections with the people currently doing it. Most doctors will make sure to ask you if you have any questions at multiple times throughout the day. This is important! You want to ask good questions so that A) Conversation flows nicely B) Things don’t get awkward and C) You avoid embarrassing yourself. Bad questions have short answers. “What time do you normally get here?” will get you a short answer and an awkward pause. Good questions take a while to answer and are pertinent to your clinic or specialty. They are also usually somewhat interesting if you actually listen to their answers instead of thinking about your next question. A great fallback question for me is to ask about the mechanism of some interesting symptom or disease you may have seen with them (in general, asking why things happen is pretty safe). The flip side of asking dumb questions is never asking a single question. You could come across as uninterested and not have as good of a shadowing experience. Have questions ready before you ever arrive.

4) Talk Too Much –

While shadowing a physician, you obviously want to get the most out of your day. However, they still have work to do.When they are busy, it’s best to shut up and follow along. Be their shadow. There is a pretty amazing range of experiences to be had when shadowing. On one end, some doctors allow students to participate actively in procedures. On the other hand, you may have to wait outside during certain visits. Don’t expect your heart surgeon to let you scrub in to surgery, reach in, and get your hands dirty. I got to do that in undergrad and it was awesome. If you talk constantly, you could very possibly drive everyone crazy and get sent home early for an obscure reason. Not cool.

5) Put on a show –

Let’s face it. When you’re shadowing, you really don’t know much about anything. It just comes with the territory. If you knew almost nothing, you’d probably be doing an actual rotation on that service as a third/fourth year medical student. If you’re pre-med, just be cool with the fact that you know exactly nothing. Don’t try to fake knowledge when it’s not there, and don’t try to act any specific way because it seems right. This applies to life in general, as well as shadowing. Shadowing is like trying on clothes. You want to see if they fit and if they look good. You want to see if medicine is something you could do for your life, and trying to be someone you’re not to fit in to medicine is like buying a pair of flip flops that are too large because they look cooler than the ones that are your size. You can wear them out of the store, but it’s not going to be fun walking to the car.

So there you have it. A friend at my medical school told me of a shadowing experience he had when he was a freshman in undergrad. The nurse in the OR mistakenly told the doctor he was a medical student, so the doc began quizzing him on some anatomy and histology stuff. Of course he knew none of it, but he was too scared to tell the doctor that he was a freshman in college, so the doctor went on this big rant about how terrible the next generation of doctors were going to be and how dumb medical students are these days.

Thanks for reading! Check out my blog at sortadr@wordpress.com, or email me directly at sortadrwordpress@gmail.com.

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What is Happening?

As I sit in my comfiest chair with sweet tea on the table next to me and no class until tomorrow (yes, I am done at noon today), I can’t help but marvel at what a glorious week of medical school this has been. After miraculously beating the average on the last exam (despite spending hours doing house projects with my wife), this week has been cake. A main focus has been epidemiology and biostatistics, which sounds hard, but really it’s just common sense with a little bit of math thrown in. There have been a few Cell Biology/Metabolism lectures thrown in, but we have covered a fraction of the material I was expecting. The rest of the time has been taken up with optional small group exercises (nope), clinical skills groups (already done), and sessions on our non-optional electives.

Ah yes, electives. Electives are courses you want to take, right? I took some in undergrad, like swimming, wine tasting, etc. Not in medical school. My university has decreed that between now and April, we will occasionally be given an afternoon off to pursue our individual interests, so long as we are interested specifically in their University sponsored electives. A quick glance at the offerings is not encouraging. Research, while helpful, has so few spots that 4% of our class will fill it up. Some bogus options include an online Sexual Health and Gender Studies course, which isn’t actually accredited, but somehow counts as an elective, as well as the ridiculous and potentially hilarious seminar called “Acting Like A Doctor”. There are some other electives that involve health literacy advocacy, disparity in health outcomes, and even lobbying stuff for local legislation.

I should be fair and say that there are some legitimately good options here. For example, I would enjoy tutoring immigrant high school students in math and science. I have a strong background in tutoring and really enjoy it, so a position like that sounds great. Unfortunately, the good options are so few that they will be gone faster than the Jimmy John’s turkey sandwiches at a lunch meeting. I should also mention that the popular electives are filled by lottery. I have a pretty solid history of never winning anything that involves luck, so that rules me out of any good lottery electives.

My last hope, of course, is the vague and potentially awesome “Self-Designed Electives”. I have a few ideas that fit nicely with my interests, as well as the reasons I will be using to encourage their approval.

1) Gainful Employment – In the interests of not being broke, I would like to utilize this time to make money, so that I can put gas in my car and drive to school every day of the week. I have worked enough places in the past that I could likely find a job near my house. I could probably tutor local undergrad and high school students as well (I already hope to do this on the side, I could just do a lot more on my afternoons off- I mean “doing electives”)

2) Self Designed Study – Effects of consistent napping on memory retention. In this individual study I will compare my ability to study with or without a nap. My controls will be every day that isn’t elective day, when I study without a nap. On elective days I will nap (they recommend spending at least 4 hours per day on your elective) for at LEAST 4 hours, then see if I am able to recall more material after studying. I have to admit, this sounds like an ideal elective.

It also sounds vaguely scientific.

3) Dietary Education in the Community – In this activity (which would probably require funding), I would spend time in the community gathering information that would directly enhance the lives of my classmates. Specifically, I would eat at multiple local restaurants and determine which places serve great food. Because there are so many restaurants in this city, this elective could potentially last for two years, if the funding is there.

4) Writing and Self Development – In this elective, I take entire afternoons to not study. Instead, I could write for my readers on this blog, work on my book, and develop my self. This sounds pretty great, especially if my book were more than a 20 page Word Document and a notebook of scribbled ideas. Oh well.

On a more serious note, I will probably find a decent elective and do something productive. Hopefully.

What does everyone think of the design here? My very talented brother in-law helped me design it, and I think it’s awesome. If you also think it’s awesome, let me know in the comments.

Thanks for reading!

Don’t Be That Guy

At this phase in my life I have memorized a short, succinct answer to several questions. Lately the most common question is “Hey I heard you did an Ironman! How far is the swim/bike/run again? How was it?” 

There is no possible way for me to casually describe such a crazy day, especially during one of those quick conversations that occur with people you see every now and then. So I usually reply with something like “Well, I had a really good time. It was a long day, but I am happy with the outcome.” All of that is true, but it skims the surface of a goal that has taken me years to accomplish.

A few weeks ago the most common question was this:

“What are you doing now that you have graduated from college?”

Me- “Well, I am going to medical school in the fall at _______ Medical School” This was followed immediately by.

“What kind of doctor are you going to be?”

Me- I have some ideas, but I likely won’t decide for a while. I want to get some firsthand experience first”. 

Once again, that is true. I have some ideas of specialties I am interested in, but I am not interested in deciding for this reason right here:

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I see all of that green as a vast, lush field of….ignorance, I guess.

See, since I have this vast sea of ignorance to overcome, I can’t make a remotely informed decision. I understand that some students come from a family of cardiologists, or that they have had their hearts set on pediatrics since they were little, but I have none of that background. I have absolutely zero health care workers in my family, and my motivation for becoming a doctor is based mostly in a desire to help others and an above average aptitude for biological sciences and problem solving. It’s my belief that there is no “ideal field” for me, the only place I will be truly happy as a doctor. Instead, I think there are likely many areas of medicine in which I could practice and be satisfied with my choice, but I have no way of deciding between them until I get in and experience medicine firsthand. 

Back to my point. After I tell people I am undecided on a specialty, I sometimes get feedback like this. 

“Well I had this doctor once. Man, he never listened to me. Every time I was in his office I had to wait for 3 days to get seen for 4.7 seconds, then he would just prescribe whatever drug was on his pen. He was rude, smelled bad, and scheduled me for a follow up in a week. Follow up for what? I was only here for a bit! He told me I had cancer but it was just GERD. Bla bla bla bla…..yeah so don’t be that doctor.”

You, the reader (hopefully I have more than one eventually), may have done this yourself at some point to another prospective medical student. I don’t understand this. This doesn’t happen for other professions

“Well I knew this architect who built a building and then it fell down and killed a bunch of people, so he went to jail. Don’t be like that architect.”

“I have a friend that’s in sales! He can be really pushy and annoying, trying to sell me stuff all the time, and just doesn’t know when to back down. Don’t be like that.”

“We hired an interior designer once to do our conference room. She picked these horrible colors that we didn’t like, then went on vacation and didn’t call us back. She also only spoke French. Don’t be like that!”

My cousin’s boss was in management! Yeah….turns out he embezzled a bunch of money from a non-profit that runs an orphanage and used it to buy a private jet. Don’t be like that guy.”

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Seriously. I am certain this experience is not unique to me, and I will count on other medical students out there to back me up if they have been through this bizarre ritual as well. First of all, I have no idea what to say to someone who gives me that “advice”. There are better ways to make small talk with people embarking on new career paths, people.

Thankfully, I have had so much genuine support from friends, family, co-workers, and doctors. The people closest to me have been universally encouraging, often telling me that I will make a terrific doctor someday. That’s good to hear, especially from some of those who know you the best.

As always, there is a lesson to be learned here. Physicians treat people that are often in very stressful and emotional situations, so every thing they do is magnified. See, people tell other stories about doctors as well. Doctors that cared for children, parents, and friends during cancer, births, surgery, etc. Doctors that may not have spend much time with these patients, but nevertheless had a huge influence on them. These doctors were compassionate, respectful, and friendly. Even though the stories I hear may be 20 years old I can still see the respect and love in their eyes as they tell me about a good experience they had with an excellent doctor somewhere. That’s the kind of doctor I hope to be.

Thanks for reading!