Monthly Archives: December 2011

The Life Changing Benefits of Reading

I’ve always been a bit of a bookworm. However, the benefits of reading didn’t really hit me until university. I went to a relatively average university. Although I enjoyed the new experience of college, I often found my courses intellectually dead. Classes I thought I would like ended up being dull. Tutorials were taught by TA’s who were less than enthused to teach. Classmates often wanted to get by with their assignments and tests than to really learn something.

Early on, I decided I would not let my schooling be the determinate of my education. Instead, I set out to learn from the best minds in the worlds, and made it a goal to read good books. I decided to read 52 books over the course of a year, one for each week. Although I fell short of that goal, I ended up reading a total of 42 books that year, many of which introduced me to new ideas and changed my world views. I still try to average a dozen or so books a year.

For instance, reading Richard Dawkin’s The Selfish Gene inspired and taught me more about evolution than any of my biology classes. My classes in physics became way more interesting after reading Richard Feynman’s adventures on learning and being inquisitive. For psychology, I “enrolled” myself in a Harvard course on Happiness. Due to my premed scheduling, I was unable to take any economics courses, but through extracurricular reading, I’ve gained at least a basic understanding of how market forces work.

Reading good books changed the way I thought about the world more than my university courses did. Well written books are often the results of years of research and experiences. They are much richer in content and thought out than blog posts or news articles. If you haven’t gotten into the habit of reading outside of the classroom, I would recommend you start right away!

I have created a books section on this website with a list of  books that I have personally read and recommend. I’ll be sure to add to the list and write reviews whenever possible. Although medical school can be quite busy and there is a lot of medical reading that needs to be done, I still try to find time for leisure reading.

With the holidays coming up, try to find time during your break to read something outside of academics. It might just be the best thing you could do for your education.

 

How We Should Die

A quote from a beautiful piece that has been going around the web by Ken Murray titledHow Doctors Die

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Many times in the last year I have seen patients suffer from inappropriate medical decisions. Metastatic cancer patients who receieve aggressive treatment despite of the physical, emotional and financial costs associated with it. A 94 year old post stroke brain dead patient being kept alive in the ICU by a ventilator and triple-pressor support because the family did not want to withdraw care. Dieing can be a messy thing.

In undergrad, I read a book titled How We Die by Sherwin Nuland, a physician practising at Yale, that challenged many of my pre-med notions of death. Particularly, it helped me understand how little mastery we have over our mortality and that death is a natural process of life.  People are always eager to tell you how we should live but few broach the topic of how we should die.

One of the tasks we do as a medical student whenever we admit a patient is to determine their code status. We ask questions that people are unfamiliar with. What should our medical team do if anything was to happen to you. If your heart stopped beating, do you want us to perform CPR? If your lungs stopped breathing, would you want a tube passed through your throat to help you breathe? Discussing code status is an often misunderstood topic. Many patients and families find it difficult to approach the subject.  Does this mean the medical team is giving up? Does it mean the patient won’t receive any help if anything was to happen? What the patient and their families often fail to understand is the difference between quantity and quality of life. Many times in the course of a disease, our medical interventions cross over from benefiting the patient to harming them.

During my Internal Medicine rotation, an attending taught me to be specific with my do not resuscitate orders. Explain what each aspect of their code status meant and clarify each point. No CPR, No ICU, No Intubation, No Heroic Measures.

Death is a terrifying event for patients and their families. I know my views on it have changed this last year after repeatedly seeing death firsthand. What I’ve learned is that we shouldn’t be afraid to talk about death. As health care workers, we spend most of our time talking about possible treatment options, even when there is none left. We don’t spend enough time explaining realistic outcomes to patients and discussing what their final wishes will be. Are we continuing treatment for the benefit of the patient or are we causing suffering to spare the emotions of those that are living. Becoming a doctor is more than just learning about how to save lives. In the process, you learn to respect human life and the complexities associated with it, and you begin to understand the possibilities and limitations of our art.

A Minimalist Life

A month ago, I came upon a collection of articles that challenged my ideas about time management. Being in medical school, there’ s often an endless list of activities to do – clinical duties, studying, research, volunteering, student groups. You get comfortable juggling multiple tasks, ambitious to do more. You begin to believe that doing more is better. These posts helped me reevaluate some of my priorities. I highly recommend reading them.

- focus: a simplicity manifesto in the age of distraction – by Leo Babauta of zenhabits

- Best New Year’s Resolution? A ‘Stop Doing’ List – by Jim Collins

- Better - by Merlin Mann (author of InboxZero)

I am now in my fourth and final year of medical school. Perhaps with some hindsight, I now see how distracting medical school really was at times. The clubs we were involved in, the group study sessions, the meaningless emails, the trivial tasks. You regret some of the priorities you sacrificed, your health, your hobbies, your friends and family.

From here on out, I am choosing to make my daily life simpler. I want to take on less tasks in hopes that I can do my important tasks better. I have unsubscribed from medical blogs that I don’t really enjoy reading, and spent a bit more time reading around the patients I see. I spend less time in my inbox and more time with friends. On this blog, I am focusing less on advertising and revenues and more on writing and reflection. I am slowly minimizing my distractions so I can focus on things that do matter.

Are there things in your life you can simplify? What’s distracting you from doing your best work?

Post CaRMS Application Tips

And I’m back! I’ve been busy completing my applications for the Canadian Resident Matching Service (CaRMS)

Having survived the CaRMS 2011 Application Submission Deadline, I was going to share some of the lessons I’ve learned from this stressful experience. Overall, I think I did most things well but could have done many things better. Thankfully, you only apply for residency once… (hopefully). Here are some of the lessons I learned.

1. It’s Ok to Highlight Your Best Traits! – It definitely felt strange having to sell yourself. It was like applying to medical school all over again, but this time with more on the line. List all your accomplishments, talk about strengths mentioned in your clerkship evaluations, describe all the activities you did. You want to put your best foot forward, not shoot yourself in the foot. Don’t be afraid to brag and boast as much as you can, but do it discretely.

2. Start Planning Early – It’s never too early to start planning. First and second year medical school is a great time to start thinking about residency. Know which specialties you want to apply to and which cities you could live in. Keep track of all your leadership, volunteer and research activities. Update your CV annually. It was able to complete the activities section quickly because I had carefully recorded all my activities and interests in the years before.

3. Be Organized- When the Applicant Web Station (AWS) went live and all the program descriptions were up, I spent an hour creating a master excel sheet to help me stay on top of things. I listed all the programs I was going to apply to along with their descriptions, requirements, essay questions, number of references needed and personal comments.

I also created a checklist of things to be done, a tracking sheet for my references and a timeline of the whole application process. This streamlined my application and enabled me to concentrate on the task at hand, without worrying about what to do next.

4. Get the Best References Possible – Ask all your preceptors you did a rotation with to write you a strong reference letter. That way, when it comes time to apply you’ll have more referees to choose from than required. Ask months in advance. Send your referees packages with your CV, evaluations and clear instructions.

A good reference letter is one that highlights your strengths, is written by someone who knows you well and from someone who has some influence. Don’t be afraid to ask for a reference letter from someone you didn’t spend a lot of time with, often times you only need a day or two to impress someone. Also, ask all your referees to complete their letters online. It’ll save you money and a lot of stress wondering if your letter has arrived at the CaRMS office yet.

5. Take a Professional Photo – Good lighting makes a big difference. You are applying to a professional job, look the part! Plus you can use this photo for the next twenty years or so… at least that’s what all my residents and preceptors seem to have done.

6. Milestones are there for a Reason – Milestones are suggested dates of when parts of the application should be completed. They are there to remind you to not leave everything to the last minute. In general, they mark out a good timeline to follow. If you keep up with them, you’ll be pretty stress free.

7. Don’t CRaMS! – Unfortunately, milestones are only “suggestions” and I found myself cramming a lot of writing in the final week of the CaRMS application. Suffice to say, it was a stressful final week.

8. Get Some Rest – Coupled with the fact that I was still on clinical rotations, I ended up sleeping less than 5 hours (sometimes 3-4hrs) a night during that last week. If you can, I suggest taking a week, either the final week or a week or two before, off to get your CaRMS application done. Also, don’t stay up writing when you can barely keep your eyes open. I’ll guarantee you will write better and grammatically correct sentences after a good night of sleep.

9. Get a Second (Non-medical) Opinion – Ask your friends and family to look over your application. Does this letter represent who you are? Does it sound like the person they know? Try to avoid getting too many classmates and other applicants to look over your stuff. They will have their own skewed view of the CaRMS process and may not offer you the best advice.

10. Don’t Go Looking at Other People’s Applications – The more applications you look at that aren’t yours, the harder it will be to be yourself. You’ll be influenced by what they are saying in their letters or how they have formatted their application. Focus on your own application and your true self will come through.

Just ten simple tips to make the whole CaRMS application process a bit smoother. Actually the whole process was pretty straightforward minus the personal letters. Speaking with residents, they say it’s a lot better for the R-3 match because all your previous documents are saved in the CaRMS systems. Plus most fellowship and +1 years only requires a one-page letter and you apply to fewer schools. Oh how I don’t look forward to CaRMS round 2.