To Attend or not to Attend, that is the Question.

I decided to hold off on writing anything regarding the omnipresent question of medical school--attending lecture--until I had a better grasp on how I felt about it and some understanding of how I could convey that.

As a first year student I attended lecture religiously, for the first week maybe two.  Then the alarm would ring at 7:45 and very quickly my warm, snuggly bed became far more appealing than at 8:30 lecture about biochemistry that I wasn't going to understand anyway.  Thats when they pile up.  All of a sudden you're 13 lectures behind and you don't know how it happened.  But then you get through it.  Double speed.

The problem I found was that I always intended to go to class and felt bad skipping.  Inevitably I would skip the class anyway but somehow didn't feel as bad.  Its the thought that counts, right? I found that this was the biggest flaw in my logic.  You have to commit.  Either you go to class or you don't.  Otherwise your scheduling gets out of control.  During M1 year I mixed it up, sometimes I went sometimes I didn't and that kind of instability makes scheduling nearly impossible.  You can't develop a system if you go to a few classes then have to come home and watch a few more.

So this year thats what I did.  After the first week I decided I wasn't going to go to class anymore (except of course for mandatory sessions which I do not condone skipping).  Every school has some kind of system for recording lectures and some even have the convenience of them being podcasts/vodcasts you can subscribe to and automatically downloads.  My goal was to watch all of the lectures the day after they occur that way all of the recordings are up and available and all cued up in my iTunes.  So here I am a few weeks later and all I have to do is watch two pathology lectures from yesterday and I'm caught up.

I myself am shocked at how well this works but I found that the largest hurdle was really my own personal feelings about attending class.  We are all "good" students, thats what brought us this far, and for that reason we feel compelled to attend class.  It is so engrained in our minds that going to class is an absolute necessity that we would much rather sit in a classroom playing text twist or on whatshouldwecallmedschool or surfing facebook than be at home or in the library using that time to actually learn the material.  The goal of these years is to become effective learners and masters of this material and unfortunately these lecture settings are not the best way for each of us to learn.

I know back in the day there was no such thing as lecture capture but they had co-ops which were effectively a note taking service so that if students missed a class or wanted to review they had notes from classmates to look back on.  We have to disabuse ourselves of this notion that skipping class means we're bad students.  If skipping class means watching it later (maybe even on 1.2 speed instead of 2 since you know, you aren't 183094 lectures behind) and being able to pause it and rewind and pick up details that were confusing, maybe its really your best bet.  Frustratingly watching a lecture on 2x doesn't mean you actually learned anything all it means is that you let it play and watched it go by.

I now find that I have time to look up things I feel confused about or to spend a little extra time hammering down a concept because I'm not rushing through frantically trying to keep up.  Thats the worst feeling, drowning in a sea of work and all you see is a deadline, the exam. The jury is still out for me because we haven't had our first exam yet but I can say that I feel a lot better about my study habits now than I did last year.

IM AN M2

yes, I made it out of the single most academically grueling year of my life, in one piece (more or less)

This song best expresses how I feel: http://www.youtube.com/watch?v=F_7baOCYg-Q

When signing into one of numerous back to school first week activites/lunch talks (ie free food) I accidently wrote M1.  Embarrassing.  I still have a whole list of topics I generated regarding first year and will continue to finish those up before delving completely into second year and will hopefully be caught up before our clinical experiences begin so those can be reported in totally honest, real time fashion.

Check back soon for more posts including topics like what extra curricular activities to engage in and the age old question: to go to class, or not?  Thanks for sticking around!

Sometimes I Feel Like A Thankless Child

To those of you who are still in the midst of  pursuing a seemingly elusive goal of being in medical school I highly encourage you to take a few moments and jot down why you want it so badly.  Make a quick list of all the reasons why you want to be a doctor and how you will feel once you achieve that monumental goal.  For those of us in the thick of it, in medical school or beyond, try as hard as you possibly can to mentally rewind back to that point.  Remind yourself of the passion and burning desire that brought you to where you are, especially one the days where all you want to do throw in the towel and curl up and sleep.  The following is an anecdote that a woman shared at an informational meeting I decided to check out (a little because I was interested in the group and a whole lot because I wanted some free Thai food) early on in my first year and has haunted me, in the best way possible since.

***

It was a beautifully sunny day as everyone filed into the windowed room and took seats around a large, oblong table and scattered seats along the wall.  Students chit chatted about needing to get back to class and wondering when the main attraction, free thai food, would finally arrive.  Meanwhile quietly in one corner a young woman sat with her hands neatly folded in her lap with a white lab coat.  She didn't make conversation but smiled politely.

The meeting began after everyone was done scooping little heaps of pad thai into their plates and shuffled back to their seats around the table.  Some introductions of board members were made and the general idea of the student organization was described.  At the close of the meeting they asked for any questions or comments and after some expected questions the young woman in the corner raised her hand and said "could I please share a story with the group".

The club president smiled at her and replied "of course"

"I had always wanted to be a doctor, it was just something I never thought was possible for me.  I was married very young.  I spent most of my life in Africa and when I came to the United States I did not think that even going to medical school was an option for me.  I was always one of the brightest girls in my class and I even went to college but it all seemed so far away. By that time I was already a mother of two young children that made a very busy schedule for me.  Somehow I managed to secure admission into a program that allowed me to do some coursework and upon successful completion they would allow me to go to medical school.  I could not believe my eyes or ears and I worked hard, so hard to make sure I could do it.  My grades were all very good.  But then I started to notice that my youngest son was not speaking as he should be, he was not developing at a proper pace. The doctors said that he had autism.  He would need speech therapy and physical therapy.  Hours of individual attention was needed and my husband he worked.  He told he he could not do anything we needed the money, he had to go to work.  I was left with no choice and I had the acceptance letter in my hand and I declined my admission to medical school.  After all of that work, someone had to take care of my son.  I had to care for my child and I had to give up my dream for it.  I wish my husband had supported me more, so I could achieve my dream.  Even today when I walk on the sidewalk and I am walking in one direction and one of you, a medical student, is walking the opposite direction and passes by me in a white coat.  I stop and I turn around and I look at you walking away, I see my dream that I had walking away from me.  I am so happy for each of you and I am so sad for myself, that I did not find a way to make my dream"

The entire room sat in silence.

***

Sitting in that room with nothing on my mind besides needing to get back to class at the end of the lunch hour this woman's story really touched me.  I could feel tears welling up in my eyes.  This story just serves as a stark reminder that this is an opportunity that we were lucky to have been given.  It sucks sometimes.  Its really hard.  It makes you want to punch the wall.  But no matter why you did it, there was something that drove you.  If you can keep a piece of that with you, remember back to the time you would have traded anything to be where you are today, everything gets a whole lot easier.

Money, Money, Money, Money . . . MONEEYYY!

note: the title of this post was to belted out a la the apprentice theme song (if you need a little refresher click here)


There is no sense in denying the fact that one factor that often pulls people towards a career in medicine is the financial compensation.  For some reason it feels like a taboo topic, to admit out loud that the of course you have  passion for helping people and a strong desire to serve and it doesn't hurt that you're going to be making a fairly comfortable living.  Nobody gets upset at lawyers for being money grubbers (but then again, aren't we all just looking for an excuse to hate them) or accountants (although being such a personality less number-cruncher should have some kind of upside) for pursuing opportunities that pay the highest.  Its a very strange phenomenon that I think we somehow hold ourselves to a higher standard as well, when I consider my future I feel bad weighing the options because of how much pull salaries can have.

All that being said the more important point I wanted to bring up was that if you intention is to become very rich, very fast I implore you to explore other career options.  Although the compensation is likely in the 6 figure range even for those pursuing primary care positions the fact remains that compared to other career paths this one pays out far too slowly to be a viable option for those looking for quick monetary gains.  Let me explain a little bit of why I find this to be the case with a look at some numbers as well as some anecdotal experience.  Once again I have to emphasize this is how I have come to see the world, at the end of the day its my opinion and please take it as just that.

So lets look at a timeline of education and earning.  According to the AAMC the average age of matriculation to medical school for women is 24 and for men is 25 so lets put that at 24.5 years old (source).  Medical school across the board is always going to be four years and theses years have to be billed as negative income especially because as of this year all loan money is UNsubsidized which means every cent that you borrow will collect interest from the day you start to borrow it, this is a serious bummer for graduate students (source).  In any case if you bill each year at about 40,000 a year (this figure is debatable but just for argument's sake I picked a round number that comes close for many people) x four years according to the AMA the average medical student graduates with $157,944 because lets not forget the interest that will be accruing at about 7% which will be compounded at the end and you will be charged interest on the interest once you graduate (source).  So you finish medical school at 28.5 and finally start making money and residency is anywhere between 3 - 5 years during which according to the AAMC you will make an average of $48,4600 (increasing incrementally each year) (source)  So at this point you're between 31 - 33 and are about to plunge back in for some more training i.e. fellowship or you're out into the real work making some real monies.

If for example you decided to become an accountant at about 23 and start making $50,000 a year and lets say a very modest 3% raise per year, in the ten years your buddy was in medical school you've made about $570,000 assuming no bonuses or proper pay increases.

My point here was not to frighten you away from you dream of being a physician but rather to deter those who pursue this career path for reasons based in financial success.  Yes you are rewarded handsomely  eventually, but the road there is a long, long one.  If you don't do this because you absolutely love it you will without question be miserable.  Once you become a doctor paying back these loans is a matter of budgeting and financial savvy, nbd.  But the path there can be absolutely miserable.  I try to bring this back whenever I can but the best way to make it through medical school is to understand as a student (which you arguably will be for at least 7 years and longer when fellowship is considered, and don't even get me started on those MD/PhDs but most of them don't pay very much so thats a different story) your life doesn't end.

Medical education and training is a journey meant to run parallel to your life story, not completely take it over.  With that attitude you will be able to enjoy all of what your life experiences bring you instead of constantly looking to the end and making promises of what your life will be when you are finally a doctor.  I think what i'm trying to say is carpe diem (I refuse to say YOLO although it seems pretty appropriate here).

Oh yeah, with the average internist being offered $205,000 without bonuses and incentives x however may years you work for the rest of your life, I think at some point you will be able to recoup any and all  losses you have incurred.  Maybe you can even take your accountant friend out for lunch.

Teachable Moments I

**please note: names have been changed for reasons of privacy**

Finally, no more shadowing and awkwardly stumbling around while my overly dressed up self scrambled to follow a doctor from room to room, nope because I’m a medical student.  It was time for me to get assigned to my preceptor for the year!  If you’re as confused as I was about what that is let me explain: physician shadowing, except this time you get to wear a white coat and a stethoscope.

 As first year students we come equipped with a severe lack of any clinical knowledge juxtaposed with a strong desire to act cool in clinic.

 A memory I know that I will reference for a long time in the future, as a yardstick for measuring how I have connected with a patient and family is from a day that I spent in the hospital with my preceptor rounding on patients on the Family Medicine service.  The day was essentially over and he decided to go check up on a few patients before heading out for the day.  One of the last patients we saw was an older African American man who was recovering from a brain surgery after a severe stroke.  The following is my recollection of that encounter:

“Hi, I’m Michael Parker, I’m one of the physicians taking care of your loved one today”.  Can we stop right there? Have you ever heard a doctor introduce themselves as not doctor? I feel like by the time we complete all of our training we wear our title of doctor not as a badge of honor but rather a triumph.  Maybe it was unintentional, maybe not, but in knocking on the door and simply stating his own name he put himself at the level of the patient and his family.  It made him immediately accessible.  There were two women and one man visiting the patient and he was wavering in and out of consciousness.  He was not able to interact at all, at that point the doctor would probably not have much to do, right?

Dr. Parker took the time to introduce who I was to the family and ask if it would be okay if I stepped into the room, they were more than happy to allow that.  He then inquired about how the patient was recovering from surgery and the family related that they were unsure how he was doing because of the unstability of his consciousness.  

Here it comes, teaching moment for life.  Dr. Parke proceeded to relate to me how difficult it can be for a family when they are going through a recovery process from such a major surgery especially when the course of recovery can be so varied.  He addressed me but also engaged the family in the conversation and they could be heard expressing hushed agreements—“mmhmmm” and “that’s right”—and nodding along as Dr. Parker conversed with me.  He then turned back to the family who had been listening to him with rapt attention and asked them again if they had any other questions.  The woman sitting at the patient’s bedside echoed some of the sentiments that Dr. Parker had shared with me while the other family members nodded in agreement.

It was amazing for me to see how in such a creative way he was able to express the uncertainty of the situation for their loved one without robbing them of hope or giving a promise of too much.  By the time we were ready to leave the room the patient’s visitors were wishing me the best of luck in my career and relating that they had a niece who had similar aspirations.  Before we left Dr. Parker thanked the family for allowing us to speak with them and noted that someone would check in with them again shortly. 

The lesson I’ve learned from Dr. Parker is that we will have an urgent responsibility as physicians not only to treat patients but also to effectively interact with the environment around them. In that conversation there was nothing Dr. Parker did directly for the patient, but he reinforced the support system that will be vital to this patient’s recovery, something that is integral albeit indirectly to the patients health.  In that moment he transcended race, gender, age, ethnicity and socioeconomic status.

It is of great surprise to me to know that no matter how much we prepare and study it will only be with time and an active desire to improve that we will come close to delivering optimal care to our patients, I think I now have a greater understanding of why we practice medicine. 

Doctors: Humanitarians First, People Later

Warning: I may get a little preachy here, the line between opinion and fact will be blurred, but please try to look past that and understand what I'm trying to get at

Whether you are currently a medical student or even a doctor or just beginning to contemplate the idea of pursuing a career in medicine you have at some point pondered what has pulled you that way. Stock answer "i want to help people".  We're so programmed to think that and to say that but I feel as though the true force behind that statement has been diluted.

What prompted me to write this post was the onslaught of status updates via different social media regarding the absolutely horrific events that unfolded at the Batman movie premiere.  There were a variety of different reactions as well as differing levels of sensitivity (or insensitivity) that got me to thinking.  I realized then that insensitivity (be it online or otherwise) strikes a chord with me the most when the individual is a medical student (and as the slow progression up the totem pole of medical education occurs for me eventually it will be residents, fellow doctors, etc).  No matter how human we may be by taking on the role of physician we are answering a higher calling.  People expect more.  There is an expectation that you are more caring, more understanding, more sensitive and more skilled in empathy than the average person.  Additionally, we are all in this thing together, if one med student is a jerk I feel like it reflects on use poorly as a community.

Maybe there isn't an expectation and I came into this with my head in the clouds but I do feel that way. We owe it to ourselves as well as our future patients to shift our world views in a way that allows us to empathize first, judge and mock later

One of the hardest lessons the past year has taught me is that although I chose medicine because I absolutely am enthralled by the inner working of the human body and because talking to people, learning their stories and understanding how I can bridge the gap between science and medicine and society and culture, not everyone does.  Sometimes people want to go to medical school because they have a passion to serve the underserved while others crave the honor and prestige of being a world renown surgeon while others still simply want to secure themselves a certain type of lifestyle.  The toughest pill for me to swallow is that its okay.

Medical school gives you ample opportunity to self reflect from a pit of angst and rage, it is easy to forget the optimism and lofty ideals that may have brought you where you are, but I implore each and every one of you to look deep down inside you and hang on to that thinnest thread of wanting to care for people.

I am a firm believer that little things like that can truly change the face of medicine.

Life Lessons on Public Transit

As future or current medical students something that we all likely envision is ourselves in our white coats.  Although I touched on this earlier there is a definite sense of accomplishment and pride that is associated with this simple garment.

I remember getting my white coat and gently running my fingers along the slightly raised letters that spelled out my name.  Its seriously awesome.  But a giant lesson I learned is that wearing a white coat is an exclusive privilege of a clinical setting.  No matter how cool you think you look wearing your white coat down the street and/or the bus or train, you aren't.

Nothing crystalizes some facts of life like seeing some reflection of yourself in another person and what follows are two stories that have helped shaped my understanding of white coating.

*     *     *

The rickety back and forth motion of the train made it hard not to look up occasionally and make sure the train was still on a track and nobody else was panicking.  The doors slid shut and out of the corner of my eye I caught a flash of white and looked up to see a full on white coat.  Additionally the student doctor was also from my own institution as evidenced by the patch on her coat.  In my head I rolled my eyes, really nobody wants to see that.  Nobody is sitting there thinking 'oh wow, she's a doctor' they're all wondering why the F you wore your work clothes onto the train.  It would be like if a chef walked onto the bus with his giant chef had still on, makes zero sense.  I went back to reading my book and at the next stop approached glanced up again and there wasn't a white coat to be found.  Initially there was confusion, but standing in the exact spot was just another urbanite getting from point A to point B.  As soon as she had hopped on the train she had removed the coat and stashed it away probably because she had to rush to catch the train and didn't have a chance to remove it before.  For some reason I just really appreciated that she had done that, maybe its just me but that really resonated with me.

*     *     *

Its rush hour, the bus is packed and at least twelve more people just got on.  I'm putting that out there because I was already on the edge of my seat (both literally and figuratively) so my toleration for irritation was far lower than usual.  In the hustle and bustle of all of this one guy sticks out, like a sore thumb.  Who would that be? The obnoxious medical student that is dressed in plain clothes and his white coat.  The best part is that the only people who ever do this are medical students and weirdo lab techs (I also have no idea why they do that either).  I'm still not sure if this is also slightly a part of my imagination or not but I felt like white coat guy was looking around with a stupid sneer on his face to see if people were looking at him and his white coat.  Whether or not he was I contend that wearing a white coat in public, in non-clinical or non-clinic related settings is attention seeking behavior.  You're essentially trying to make a spectacle of yourself.

*    *    *

Don't get me wrong here, if you want to be that guy, then go ahead.  By all means, wear your white coat down the street and all the way home in your heading thinking you look like BAMF when in reality everyone is whispering about how you look like a total a**hole OR not even noticing you.

Maybe some of you disagree but the verdict is: no white coats in public