2010 November | medaholic

Young Grasshopper

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There is a specific age group of patients I find particularly awkward to see, patients that are the same age as me.

I find it strange that they divulge their secrets and personal stories to me as if I’m an authority figure, I’m not. They ask and listen to my advice on how to treat their illnesses, even though I often struggle with mastering my clinical knowledge. They genuinely trust me and believe I will do the best for them, even when in the back of my mind I am thinking, “this is my first time doing this, you’re guess is as good as mine.” Though you are no older than them nor wiser, they let you poke needles into them, examine any part of their body, and tell you stuff they would never tell anyone else in the world, like when did they last poop and what color was it.

But perhaps why it’s so strange to see patients my age is because you can’t help but compare their lives to your own and appreciate the difference. I feel lagging in the game of life whenever a female patients my age tells me about her last three pregnancies and being a parent isn’t even on the horizon for me. It’s even weirder when they ask me about parenting and about their kid, despite my lack of children. They will tell me about their menstrual problems or STIs and I will tell them how to manage and treat it, despite never having experienced either. You get to see how people your own age are living their lives. Some are raising families, some are in gangs, some have substance abuse issues, some have made it big in their careers.

It is strange indeed, but also a privilege I appreciate. I am grateful that people will trust me based on just the fact that I am going to be a doctor. It really motivates me to do my best.

Being one of the youngest in the class doesn’t help much either, luckily I do look a bit older. When you realize that by the time you graduate, you’ll be younger than the average medical school applicant, it makes me all the more humbler. That even despite your age, people will trust you because of the doctor-patient relationship you share.

Tis the Admission Season

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Amidst the busy third year schedule, I almost forgot that the medical school admission season was well on it’s way. By now, every applicant has submitted their application and they’re all waiting and hoping to land some interviews for the spring.

If you’ve put in your hard work (good GPA, MCAT, activities) and applied to schools within your reach, I am confident you will get a bunch of deserved interviews. However, there are people who haven’t prepared properly who apply to medical school every year too. There is an odd chance that you might get an interview but I wouldn’t put too much hope into it. For the majority of applicants, the admissions committee do a good job of only interviewing the best applicants.

Being on the other side for my third year, I just want to say “getting into medical school isn’t the only thing that matters.” I know it sometimes feels that way, when you’re doing problem sets to keep your GPA up, when you’re studying for that dreaded MCAT and when you’re nervous about getting references and filling out those darned applications with ridiculous essay prompts.

All the other things in your life, your family, friends, hobbies, interests, matter and in the long run make you a better person. It makes you able to relate to others and keeps you motivated for the long road ahead.

I know, easy for me to say now that I’m on the other side, but I’m just passing down the advice I received from the people who have gone before me. Enjoy the journey, the whole process, every bit on the long road ahead. Because even if you have the most optimistic ideals, purest intentions and a heart of gold, there will be days where you feel tired, stressed and “sick” of medicine. It’s at those times that you realize that there are many things more important in your life than your career.

So go do something you enjoy that you haven’t done in a while because you’ve been working too hard towards your “goal”. It just make getting to your goal a bit easier and more enjoyable.

Clinical Knowledge

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Developing clinical judgment is a process that takes years of learning and experience. I am approaching the 4 month mark in my clerkship year and things are starting to make a lot more sense. As more and more of the knowledge I learned in the first two years is translated into clinical decision making at the bedside, I appreciating more than ever the process of learning.

In preclinical years, you build your foundation of medical knowledge, often times the boring stuff. The medical terminology, gross anatomy, physiology, pathophysiology, and other basic science knowledge. I thought most of this knowledge was irrelevant when I learned it, but as I see more patients and cases, the trivial knowledge becomes useful information.

As you learn how to manage diseases, you also learn the clockworks of how to do things. Writing notes, prescriptions, trade names, dosages, prices, side effects, and other nit picky information that you didn’t bother in the first few years. It’s not hard work. After a while, things get memorized. The treatment of a UTI becomes just like a formula you learn in physics class. Not hard, but necessary so things can be done.

And finally you learn about evidence based medicine (EBM). I’ll be honest, the first two years, it was hard to grasp what EBM meant and how you could use that knowledge. But as you start reading guidelines and review articles, you realize that there is an awful lot of things that we just don’t know. Is one drug better than the other? How do you know that? Which symptoms should you ask about, which one has a strong predictive value? Which test should be ordered, what do you expect to find, and how much can you rely on the result to be true?

I used to find EBM stuff pretty boring but now it’s probably one of the most stimulating things to learn about. It’s the frontier of medicine, it’s NEW knowledge.

And finally to become an effective physician, you must master the history and physical. It’s a skill they teach you on the first day of medical school that will be relevant in all your future patient encounter. Learning how to listen to answers and communicate effectively. Knowing which questions to ask, when to ask and how to ask them.

Overall, third year has been great so far. It’s intellectually stimulating and I’m having lots of fun on the wards and in the clinics. I’m reading more than ever on my own time, from old and new texts. I am updating my knowledge every day and sharpening my history and physical. Motivation is at an all time high.

Now… if I could only find some time to eat, sleep and exercise… =p

In Search of Excellence

I have people say to me, “I could never be a doctor, it’s too hard.” There is some truth to that but being a doctor isn’t all that difficult. Getting into medical school is hard, but once you get in, you’re 99% positive that you’ll graduate.

However, being a good doctor is hard work. Working in the wards, you can immediately tell when a patient is in good hands and when they are in mediocre hands.

It’s the strive for excellence that requires relentless determination. It’s the desire to be a thorough doctor that keeps you reading into the late hours of the night and to be disciplined to continue with your self learning.

Sometimes, I’m too tired after a long day and I give myself a break, perhaps watch some TV and just bum around. But I know that in order for me to give the best care, it requires more effort than just learning on the wards. You have to keep up with your readings, master your presentation skills, keep your knowledge up to date, and continue to improve on your clinical skills.

It’s the unattainable quest for perfection that makes becoming a good doctor so difficult. So yes, you can be a doctor that works part time and just does easy routine checkups, but you’ll be doing a disservice to your talents and to your patients. If you cut corners and do less than your best, you put patients at risk.

So don’t be afraid of the medical student who admits he doesn’t know it all but tries his best. Beware of the student that thinks he knows enough to get the job done, because complacency is a dangerous thing to have.

Ectopic

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6PM – my overnight call shift had just begun. After a whole day of assessing laboring mothers and getting in a few deliveries, I was a bit excited to be paged to go down to the ER to see something different. “We need an obstetric consult, we have an ectopic pregnancy in B9.”

There’s an old piece of wisdom that they teach every medical student who rotates through obstetrics.

Every women of reproductive age is pregnant, and every pregnancy is an ectopic pregnancy until proven otherwise

Although that saying does not apply most of the time, the consequences of an ectopic pregnancy are so severe, you should always have a high clinical suspicion for one. I had just recently reviewed the topic in my studies, so I was naturally curious to see how it would present. Would it be a ruptured ectopic, was she hemodynamically stable, would we have to rush her to the OR? These thoughts swirled in my head as I briskly made my way to the ER. When I finally met Mrs. C, it ended up being a different lesson that I will always remember.

Mrs. C was a pleasant 32 year old lady who had come in to the ER because of vaginal bleeding that morning. She was alert and stable and seemed to be well composed. The history went by quickly, her condition seemed stable. It wasn’t until I asked her how many pregnancies she has had that the mood changed completely. G3A2P0. She and her husband had been trying for 10 years to have a child and they really thought this time it was going to happen. She had a previous ectopic pregnancy and a previous therapeutic abortion ten years ago, her mind probably scarred over that decision she made when she was younger. The HSG showed that one tube was completely blocked and the other was barely patent. My heart sank for her. All I could say was, “I’m so sorry to hear that, this must be so difficult for you.” She broke down into tears. I could barely contain the water in my eyes.

In medicine, there are tears of happiness and tears of sadness. Earlier that day, I had witnessed mothers and fathers overcome with joy as they held their first child in their arms. And in that same day, I was now listening to the sobs of a mother who was running out of hope. It wasn’t fair. There were probably 3-4 unwanted pregnancies back in the caseroom waiting to be seen and here was a woman so deserving of a child contemplating whether or not she could ever have a natural pregnancy.

The attending was called and surgery was booked for that night. The ectopic pregnancy was flushed out, the tubes left intact because the mother wanted to try once more.

I’ll probably never see Mrs. C again but I know her story will always be with me, and I know I am changed because of our encounter. What I initially thought would be an interesting case to see became a lesson in empathy. We don’t just treat diseases or cases, we take care of patients. As Hippocrates so wisely said, “Cure sometimes, treat often, comfort always.”

Disclaimer: The details of this event have been changed and modified so that they are fictional and that they protect patient confidentiality. If this story resembles any story you have heard, it is purely coincidence.

Financial Stressors

I’ve been quite blessed financially for my undergraduate degree and first few years of medical school. I received several scholarships that helped offset the high cost of tuition and have been lucky to keep student debts low. The thought of not having enough money never really crossed my mind. However, since clerkship started, I’ve been having these irrational thoughts about my finances. They say an average Canadian medical student will graduate with around $100,000 in debt. My finances are no where near those levels, but I just can’t help but have these thoughts about money.

Maybe it’s because it no longer feels like I’m in school. My days feel more like work: show up in the hospital, see patients in the clinic, dress and act professionally, be a helpful part of the health care team. Maybe it’s from my friends who graduated with other degrees (engineering, accounting, business) who are now starting their careers and making a living. Maybe it’s from all the recent bills I’ve been receiving, flights and electives I’ve needed to book and scholarship money drying up. My bank account has been in financial free fall, spiraling hopelessly towards the red line.

I never went into medicine for the money. Yet I am beginning to understand and empathize with how financial reimbursement can influence the decisions medical students make, including choosing lucrative residencies, completing shorter programs or avoidance poor paying specialties. It’s stressful when you spend 40-60 hours each week working, but to have only a loss of income to show for it. Or it’s hard to be a medical resident, going through the toughest times in your training, but to receive the same pay as a high school kid working at McDonald’s.

Money, it’s taboo to mention it in medicine, but everyone’s got to make a living somehow, right?

In no way is this post about physician salary, are they paid too much/to little, the differences between specialty pay, etc. It’s just a quick reflection of something that’s been on my mind lately, that’s quite new to me.