2009 January | medaholic

Monthly Archives: January 2009

Premed: More Than Just About Getting into Medical School

One thing I want to talk about, that I think is quite important but often overlooked, is The Goal of Getting into Medical School

I know for most of my university readers, this is a goal that is probably near or at the top of their list of things to do. It’s their hidden motivation that keeps them going day in day out, through their classes and assignments, and makes them strive for excellence. It is a noble task to undertake and a difficult one too. It will drain you of all your energy, you will be filled with confidence and self-doubt many times, it is only the beginning of a long journey.

However, I urge you to not make this your ONLY goal

I know for me, I sacrificed plenty of things to accomplish this task. I fell out of touch with some friends I would have liked to keep in contact with. I delayed doing things I enjoyed, in order to get more studying done, research, etc. I wasn’t anti-social or completely devoted to medicine, but I frequently thought I would have time to do all those things later after I got in.

This feeling isn’t uncommon. In fact, you can ask almost any medical student and they will tell you their stories of studying on a Friday night, spending their summers in a lab, volunteering after classes etc.

It’s important to keep your perspective and remember who YOU are

I remember the strange feeling that initially overcame me when I found out I had been accepted into medical school. I was surprised the first emotion wasn’t happiness. It wasn’t a feeling of success either, although both did come seconds after. NO, the first thought that ran through my head was relief followed by the question, “Now What?

And now, halfway through my first year, I am beginning to grasp and actualize the simple idea that I am more than just medicine. My life is more than just my studies or chosen profession. You see, when I had finally accomplished the “goal” I had set out to do so many years ago, a passion that had consumed my teenage years, I was left with the question, Now What?

It wasn’t that I didn’t think over what I would do in medical school, specialties I would pursue, or patient interactions. I had simply pushed aside so many side goals and milestones I had set, that were equally as important to my identity, for the attainment of that “goal” that I was a very different person than when I began.

And now, it can be very easy for me to get back into the same cycle and work towards residency match – shadowing doctors, doing research, completing extracurricular activities, etc. But I think will take a different approach this time. I will still give my studies my very best. I will still pursue medicine with the same passion I had when I began. I still feel a calling to serve the sick and needy and I am still just as excited about the road ahead.

But I will remember, Medicine is too large an area for a single person to completely master. As human beings, we are way too complex and diverse to be defined solely by our professions. Every doctor is more than just his training and medical degree.

I just find it unfortunate that in medicine, we work so hard, for so long, to get a chance to save and help others and at the same time, it seems too easy to lose ourselves.

Medical School Grades

My first semester medical school marks have been posted up. I’m pretty happy about them. The only thing my transcript says is Pass!

Thank God for the Pass / Fail system.

The Business Model of Medicine and Money

Last week, The New York Times published an article titled, Putting a Price on Compassion by Dr. Pauline Chen which was a response to an opinion piece called Money and the Changing Culture of Medicine written by Dr. Pamela Hartzband and Dr. Jerome Groopman.

Now all three authors have been talking about a subject that has been on my mind recently, which is money’s role in medicine. We are currently in a dire situation. With the economy hurting, the fact that our health care cost is constantly rising with no reversing action in sight is disheartening and scary.

It seems to me that every health care policy maker or administrator has their own idea on how to heal the system. The government has proposed that electronic health care records will save hundreds of millions while others push for a European styled two-tier health care system that will reduce paperwork and provide unified health care.

Whatever the eventual solution is, it is undeniable that the role money will play medicine, and how we value the care provided, will be at the heart of health care cost. As Chen states, “Increasingly, we refer to patients as “clients” and “cases,” to doctors and clinicians as “service providers,” and to the very act of giving care as a commodity that can be graded, rated and quantified.”

There is a growing trend for patients to see themselves as consumers of medicine. Many now find their doctors through sites that provide ratings and reviews of physician performance. Patients can now shop around for the health team that can give them the best bang for the buck instead of choosing what might be best for their health.

I agree with the authors that putting a business model to medicine has helped improve the quality of service and responsibility in some areas. However, you must always remember that medicine is a profession,not a business.

At the center of every business is the first priority to make a profit and be self-sustaining. Though companies and corporations can provide many great products and services to consumers, the bottom line is they must break even and see profits. If not, they have failed as a business.

And at the heart of medicine and the health industry is patient care. The sick and dieing are first priority. Though many professionals make a living helping patients, when a patient’s health has been compromised, we have failed as health care workers.

The Secret to Success

Why do people succeed? How do they do it? Don’t we all want to know the secret to success? Countless numbers of self-help books have tried to discover it. The media always speak of the latest success story. And no matter how old it gets, we still love hearing about rag-to-riches stories. What is the key to success?

One way I have tried to tackle this question is through biographies. I have always been curious to see how the rich, famous and powerful found their success. What special activities did they do? Who did they know? What was their motivation and their inspiration? Because of this natural fascination, I must have read at least fifty different biographies and autobiographies in my lifetime. It didn’t matter who the person was – businessman, scientist, doctor, writer, politician, holocaust survivor – I was always looking to see how other people did things differently.

And my conclusion is…

There is no Secret

There is no single piece of advice – a secret limited to only a select few – that will make you successful. In fact, you already knew that.

You see, when I say there is no secret to success, what I mean is that everyone already knows the secret(s). A formula for success most certainly exists. In fact, you have heard it hundreds and thousands of times. They are:

Work diligently, be passionate – love what you do, be kind to others, have patience, know thyself, think positive thoughts, step outside your boundaries, think outside the box, have a commitment to service, dream big, have persistence, be courageous, respect others, speak up, be yourself, be grateful, have a good attitude, follow your dreams. And so on…

All these cliches advices, adages and old sayings are the keys to success. These lessons have been learned, followed and shared for thousands of years, from the earliest Greek Philosopher’s to modern day blog posts.

There is nothing new under the sun…

Yet, each time I read these words of wisdom, I find something new. No matter how many times I have heard them, they mean something different to me each reading. There is a reason I believe these “secrets” are called secrets. Because we are able to draw fresh inspiration from these proverbs over and over again, their renewable nature is the mystery itself.

Much like the classic vase and faces optical illusion, the common wisdom we all know and take for granted is in fact not so common at all. Each person will interpret the “secrets to success” differently. Some people will see the vase, some will see the faces. As with the secrets to success, each saying can be viewed in infinite ways.

For example, the advice of “hard works pays off” meant different things to me at different stages in my life. When I was preparing to take the MCAT, I could see the correlation between time and effort studying to a good test score. The more I studied, the better I did on practice tests, and the better my eventual score. Similarly, there were other times when I saw what would happen when I did not put in any effort. After each experience, I would view and reaffirm the concept “hard work pays off” in a different light.

One habit I frequently do is to take a old saying, motivational quote, proverb, verse, prose or any advice and dwell on it for a week. For instance, I would choose a quote that particularly speaks to me such as “Success is the ability to go from one failure to another with no loss of enthusiasm.” And for that entire whole week, I would start my days thinking about this quote and throughout the day see what it means to me. And sure enough, throughout that week, what turns out to be a simple sentence becomes a profound life lesson. I start noticing areas where I fail at because of lack of enthusiasm. I become more aware of the powerful effects a contagious enthusiasm can have on others. And at the end of that week, I have gained a very valuable and powerful lesson of success.

So really, there is no secret to success. At least not in the hidden sort of way. Instead, we all already instinctively know the secrets to success. The real mystery is decoding what they mean to your life at this point in space and time. If you can unravel the secret from these timeless words of wisdom, you will have found your secret, and your success.

Forgetting What It Means to Be Normal

I can feel the slow changes of medical school in me.

Some days I forget what my life was before this journey began.

As a premed, I thought I would be different, I would be immune to the challenges and difficulties.

I can start to see the long road ahead, the debt, dangers, disease, death and despair.

Today, I saw some kids get grossed out by some images of the body’s innards. I didn’t give it a second thought.

Rare and complicated diseases are becoming interesting subjects instead of the sad human conditions they are.

It feels like I speak a new language full of medical jargon and acronyms.

My number of non-medical friends I keep in touch with is gradually shrinking.

I’m eating, sleeping, breathing medicine.

I’m not sure if this is the type of person I want to become.

I will surely come out a different person.

I want to be a good doctor, but do I want to become a medaholic?

Strong Opinions

A trait I’ve noticed in medical students is that they’re strongly opinionated. Compared to undergrad students, medical students have something to say about everything. Not convinced, ask your average college student about health care, politics, economics, social issues or poverty. A good majority will not know about the topics, be undecided or have mild answers.

Ask a medical student and expect to listen to an earful.

Part of this phenomenon is due to a self-selection bias. The type of students who are admitted into medical school tend to be curious, vocal, and passionate. They get involved with student politics, world issues and have given most of these things much though. I’m not saying that you can’t be an outspoken student as an undergraduate, the incidence just happens to be much higher in med school.

Sometimes the intensity does get to me. It can create a divisive environment where neither party is willing to back down. Students will impose their views on others and make their voices heard.

On the flip side, being passionate and strongly opinionated, holding to one’s opinions unreasonably or stubbornly can be admirable. It’s what makes physicians such good advocates. It’s what drives student to strive to do what’s best for the patient. It’s strong-minded people that push for improvements in the status quo, and ultimately those who persist, through criticism and self-doubt, are those who get the job done.

Adcom Advice #6 – Quantitative Descriptions Over Qualitative

While marking medical school applications, one reoccurring mistake that many students commit is thinking more is better. Less is more. Less is better. Quality over Quantity always. A few meaningful commitments, excellence in an area of sport, music, leadership, etc., will be scored higher than a laundry list of shallow activities.

Adcom advice #6 is on how to effectively present your activities in the best light. You want admission committee members to understand your responsibilities and not miss any key points. That is why when describing your extracurricular activities, You must write quantitatively.

You must present your autobiographical sketch in a way that makes sense to the medical school admissions board.

For Scholarships / Awards – A bad example would be, “I was given the Chancellor Award for exceptional academic achievement and community service.” The problem with this description is the marker receives no actual information to work with. On the other hand, a good example would go like this, “Chancellor Award given to the top 20 students entering University for academic and community excellence, valued at $18,000 over three years.” Now, the adcom has a sense of why you got the award, how many people receive it, how much it’s worth and how competitive it is.

For Sports / Music / Extracurricular Activities - Similarly for non-academic activities, you can always quantify the level of involvement you were in. A bad example would be, “I have played in a volleyball team for the past 3 years. We were able to place 1st in a local tournament” A good example would be, “I was a co-captain of a competitive community volleyball team for 3 years, averaging 5 hrs of practice a week. We placed 1st in a local adult’s tournament of 12 teams.”

If you play piano, indicate the level you’ve played up to, any contests won or awards received. If you play a competitive sport, indicate your time commitments, quantifiable achievements, special accomplishments.

Volunteering – Bad: I have been volunteering my time and talents to the choir for many years, starting out as a singer and than becoming a pianist. Good: I was a singer and pianist for my church’s choir for the past 5 years, practicing 2 hrs/week.

Leadership - describe what roles you played, what specific actions you did, how many people you managed, what directions or changes you initiated.

The concept with all these examples is to give specific and relevant details to your activities. You want to sell all the good points and key facts about your activity, without sounding arrogant or false. Using objective numbers is a good way to do this. It also helps focus your answers and makes sure that only relevant information is provided.

There is also room in your application to describe the lesson’s you’ve learned through each activity, your travels and life experiences. Just make sure to put the quantifiable information down first, and then the subjective.

Use Qualitative Descriptions. Choose Quality Activities over shallow commitments.

Five Important Things In Life

We’re always in a hurry to do something. Everyday, we go to school, work, play, sleep and repeat often without any conscious thought. We get so caught up in the routine called “living” that we don’t find time to relax and appreciate the best things in life. Having had some time over the Christmas break to be at home really got me thinking about what matters to me. I’ve conjured up a list of five F’s to summarize them. Each of these items is something I value. Naturally, getting into medical school or getting the best grade was not on this list. It’s dangerous how easily one can get caught up in whatever they’re doing, whether that’s getting an A, climbing the social ladder or accumulating knowledge, but we need to focus on the right issues to keep us on track. So if you haven’t already this new year, come up with a quick list of the things that matter to you, it doesn’t have to be long, usually in a few minutes you can get a pretty good list. Here are my Five F’s of important things in life.

Family

I suspect family is something we all treasure but often forget about. Whether it is your parents, kids, siblings, grandparents, relatives or significant others, these are the people who will stick with you through thick and thin. Their unconditional love allows them to forgive your mistakes and wrongdoings and then truly forget them. Families are the functional units of society, the cells of the body. All my individual efforts, hard work or smarts are nothing compared to the advantage of a loving family.
Friends

We cannot choose the family we are born into but we can choose our friends. Friends are the spice of life. To find someone you can share and enjoy our short stay on Earth with is a blessing. Friends inspire us. They make us laugh, cry and think. Recently I had a chance to meet up with some close friends I haven’t seen in years and the amazing part was we continued our friendship right where we left off, as if nothing had happened in between.
Feelings

Emotions are neither good or bad, only the motivation and cause determines that. Feelings represent what we are thinking about. It is one of the irrational aspects of life that we can’t live without. Even scientists and mathematicians are susceptible to the feelings of love, happiness, anger, passion, frustration, pride and compassion. Emotions make our life exciting and interesting. If friends and family are the important people in our lives, it is because they make us feel alive and full with emotions.
Function

Function – or what you do – matters. We will spend up to a third of our lives working. A large sense of self comes from what we do. Therefore it is important to find a job that you enjoy doing. Obviously function will be tied to finances, but there is so much more to work than just the money. For me, work should be something that excites me and captures my imagination. Meaningful work can motivate you to wake up in the morning and keep you up at night.
Faith

Lastly, there is faith. This encompasses both belief in a creator and a belief in science. It includes the spiritual nature of mankind and the everyday trust we have in each other. There is faith in the divine and faith in the goodness of humans. Whether you are religious or not, we all have faith of some sort; without faith, true relationships cannot form but with faith, our trust in each other and the world can grow.

This is my shortlist of my priorities and how I see life. Please feel free to share your own ideas, or any points I missed out on (whether or not they start with an F).

A Disconnect Between Work and Reward

Those three things – autonomy, complexity, and a connection between effort and reward – are, most people agree, the three qualities that work has to have if it is to be satisfying.

-Malcolm Gladwell “Outliers”

The following phrase caught my eye while I was reading Outliers written by one of my favorite authors, Malcolm Gladwell – author of The Tipping Point and Blink. It neatly sums up what I believe is a common frustration amongst doctors.

The work in medicine is complex. Most people will agree that diagnosing and treating disease in itself is fascinating. Communicating effectively with people and helping patients live better healthier lives is difficult but rewarding.

However, modern medical practice is facing ever increasing pressures from government, health insurers and patients themselves to change how health care is delivered. There is less and less autonomy for doctors, who now have to follow countless guidelines and documentation. A lot of the new regulations are good, but many are set in place for legal reasons in case of lawsuits.

Medicine is also becoming more complex. Complexity is a good thing in one’s work according to Gladwell, however medicine is speeding towards an information overload. With health care information, genetics, new synthetic drugs, treatments and legal issues arising, doctors are faced with ever increasing workloads. Sure, doctors today work less than the medical generation before, but the current system is severely understaffed and overburdened.

Finally, the connection between effort and reward is becoming strained. Doctor compensation especially in primary care roles aren’t being addressed. Taking extra time to see a patient, which requires more effort and hopefully leading to a better outcome, isn’t rewarded accordingly. Preventative care which requires enormous efforts on the parts of both health care providers and patients isn’t reimbursed.

Many of these factors are out of the doctor’s and health care provider’s control. There needs to be a repairing of these broken connections in order to improve future medical costs and care.

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