The Half MD’s specialty chooser

April 28, 2007 at 8:31 pm (Uncategorized)

One of the daunting tasks of going through medical school is picking a specialty that you believe you’ll be happy working in for the next 30 years. Many online quizzes attempt to point you in a direction to begin considering certain specialties. Here, I present my own, more realistic view of medical specialties.

1. How do you want to live?
A. In a mansion
B. In a suburban house
C. In a box

2. Your view of patients
A. I can’t get enough of them
B. I scream at their sight and run in the opposite direction

3. You are married to
A. Your spouse
B. Your pager

4. Your view of your children
A. I’m my kids’ mom
B. That’s what nannies are for

5. Your grades
A. AOA
B. Middle of the class
C. I make the top 50% possible

6. Your view of autonomy
A. I’m my own man
B. I work for the Man
C. I’m somebody’s bitch

7. Your view of procedures
A. Ewwweee… I can’t get that on my hands
B. If not for medicine, I would have become an auto mechanic

8. How did you get through med school?
A. Alcohol
B. Caffeine
C. Lexapro

Scorecard
1. A=2, B=1, C=0 (Money score)
2. A=1, B=0 (Patient contact score)
3. A=1, B=0 (Time score, add with question #4)
4. A=1, B=0 (Time score, add with question #3)
5. A=2, B=1, C=0 (Grades score)
6. A=2, B=1, C=0 (Autonomy score)
7. A=0, B=1 (Procedures score)
8. A=0, B=1, C=2 (Crazy score)

Next, use the chart below to line up your scores with your new specialty (opens in a new window):

Specialty Scorecard

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Time well spent

April 27, 2007 at 6:20 pm (1st and 2nd year)

Eager pre-meds often want to know what a typical day is like for a medical student. Below, I provide a breakdown of what we do during class:

Time Spent in Lecture

Since we do other things throughout the day, subsequent posts with touch upon patient contact, reading notes, brushing our teeth, and the other exciting things that we routinely get to do.

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Preparing to become a doctor

April 25, 2007 at 1:38 pm (Applying to med school)

Every week, some ninny starts a thread on SDN asking a question that goes something to the effect of, “I’ve been accepted to medical school. What should I do between now and August before matriculating?” Despite all of the calls from current medical students to take the summer off, many self-righteous dipshits other pre-meds will offer advice of studying anatomy or getting a job as an EMT to gain clinical experience.

All of those suggestions are nonsense. Medical school will teach you everything you need to know about being a doctor—including anatomy and clinical skills. Trust me, you’re going to get a lot of experience with patients. You certainly don’t need to start working with them now. If you’re going to ignore my advice and still feel the need to “do something” over the summer, I have two suggestions.

The first is to do an immersion program in Latin America to learn Spanish. If you live with a Mexican family and are forced to work on Spanish for as little as eight weeks, you’ll be conversational enough to at least be able to speak with your patients. Some immersion programs offer a hospital experience so that you can learn medical Spanish. These trips are relatively inexpensive—about $200 a week for everything—but will require some work on your behalf.

The second option is to hit the gym. Take a look at the figure below:

Obesity map of the United States

As you can see, the country is fat. All of those pounds take their toll on you, the healthcare worker. If you want to do your patients a service, bulk up with protein shakes and pushups so that you can successfully transfer your patients from their double-sized wheelchairs to the MRI bed. Otherwise, you could very likely strain your back trying to move patients. Also, chicks dig muscles—even on other chicks.

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Recap of first year

April 23, 2007 at 3:35 pm (1st and 2nd year)

The environmentalist group The World Wildlife Fund recently released a study claiming that humans are growing at a rate so quickly that by the year 2050, we will be out of food. This leaves us with only one course of action: to eat the homeless. That’s right, according to the Eat The Homeless Project, men and women in severely impoverished economic brackets could act as food staples for the rest of us. The FDA has conducted studies showing that the homeless have less fat than beef, more vitamins than chicken, and that their knapsacks make great surprise grab-bags. It would be like a hobo Christmas. Just imagine on December 25th when children come running down stairs saying, “What did I get, what did I get? Pots and pans, oh boy!”

Unfortunately, cannibalism should be reserved for Plan B. Plan A is finding unique opportunities to keep the population going. Hence, I entered medical school. From classes to patient encounters, let me tell you about my first year here at the University of the State.

Things were going well enough in the fall until along came anatomy. Now I knew that the human body was complicated, but when we started dissecting the peritoneal area, things got messy. There are so many veins, arteries, and nerves just in the sphincter that it would seem as if potty training is what separates us from the animals. Here I thought that it was the brain, but it seems as if the butt is the pinnacle of human evolution. And if that’s not bad enough, you have apply this knowledge in the clinical setting.

You’ll get thrust into a room where a 4th Year will invariably say, “I want you to listen to this heart murmur.” And just like that, the story of The Emperor’s New Clothes comes into effect. “I hear a murmur. Only smart people can hear a murmur. Do you hear it?”

“Um… yes. Yes I do. Just to make sure we’re listening to the same thing, what does a murmur sound like?”

“You know, like a murmur. It’s very murmurish.” And then she’ll quickly change the subject to avoid a real explanation.

After class, you’ll then get the opportunity to test your new knowledge on real patients at a variety of health fairs. You’ll get to see new cultures and even learn a new language. I, for one, have become quite fluent in Spanish since moving here. I can now say, “no habla espanol” much more convincingly than I could in the past. I also got to see what happens when we have limited supplies for helping the poor. I went to Central America for Spring Break where we gave ibuprofen for every disease our patients had. We even gave ibuprofen for gall stones. Giving Advil for gall stones is like using hugs to fight cancer. Mmmmmm… take that melanoma!

So enjoy the first year. It’s the most fun you’ll never want to have again.

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Quick and dirty guide to medical school: Physicianship Training

April 21, 2007 at 3:44 pm (1st and 2nd year)

In the 1930′s, the United States suffered through a horrible depression. Many Americans were jobless, food was scarce, and the nation needed someone to lift them out of this decade of misery. President Roosevelt came up with The New Deal to rejuvenate the economy. His plan involved giving jobs to people just for the sake of having employment. For example, a person might dig a hole on Monday, and then fill the hole back up on Tuesday. These employment systems were put into place to take up time so that people would have something to do during the day. In a similar fashion, my school created a course entitled Physicianship Training for no other purpose than to keep us busy during the week.

The class runs the entirety of the first two years of medical school. We undergo everything: clinical skills training, diversity training, ethics, professionalism, geriatrics, and evidence-based medicine every Tuesday and Thursday afternoon during M1 and M2. Physicianship is the bane of my existence. I’ve already mentioned my experiences with complementary and alternative medicine. The two biggest evils of this course come in the forms of geriatrics and evidence-based medicine.

As part of geriatrics training, we have to adopt an elder member of the community and then interview that person throughout the year. My first elder buddy got cancer after our first interview and had to drop out of the program. My second partner also got cancer and had to leave the state. My dean was so worried that I might kill someone that he told me to make up the results of my third interview. To make matters worse, I didn’t get the cuddly Wal-Mart greeter type of geriatric friend. Instead, I managed to adopt the senile, hates young people type of elder person who spent the whole time criticizing doctors.

Another component of Physicianship Training involves the cult of science known as evidenced-based medicine (EBM). Every month I have to do a directed search on PubMed, the government’s storage house of medical literature. Keep in mind that PubMed is a boolean search engine and works the same way as Google; but for some reason, my university has librarians descend upon us monthly so that we get to learn new ways of using AND/OR/NOT to find journal articles. What really surprises me is that whole books have been written about evidenced-based medicine. Never mind that using the principles of EBM will not lead to better clinical answers. The school just needs to keep the students busy so that we don’t go off and try to study for class or the boards.

While the stated goal of Physicianship Training is to prepare us to become doctors—to teach us the soft skills needed to practice medicine—I don’t know how coddling dinosaurs and sitting through presentations on using the Internet is supposed to make us better prepared to diagnose and treat diseases. Probably the biggest farce to come out of the Physicianship class is professionalism. According to this principle, our interactions with patients and colleagues should be strictly professional. The down side is that one of the instructors routinely hits on female medical students, telling one that she “has nice breasts and skin.”

In the spirit of soft skills, I leave you with this haiku on professionalism:

Professionalism:
Do as I say, not I do—
The bane of med school.

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All of this and no recess?

April 18, 2007 at 9:18 pm (1st and 2nd year)

My biggest complaint of medical school so far is all of the busy work. I’ve had to write three reports within the past three days on everything from my feelings on alternative and complementary medicine, a presentation on obesity as I would give it to a lay audience for preventive health week, and a patient write-up for preparation for 3rd year—as if I won’t get enough opportunities to do patient write-ups in the near future. Add to these assignments never ending PowerPoint presentations for my PBL class and today’s surprise assignment of writing an essay on sex in media, and you’ll soon see why I’m constantly frustrated with school. I should be studying for boards right now, not doing reaction papers as if I’m in elementary school. Then an epiphany hit me: medical school is a lot like elementary school.

The author of medschoolhell has already mentioned the busy work that happens in med school: go yonder and stand here, and at this time go there and hold these retractors. What’s next, writing 100 times, “I will not talk in class?” From my point of view, if we’re going to be treated like small children, we should at least have the perks. I demand 20 minutes of recess every day so that I can climb on the monkey bars. I also want nap time in the afternoon.

As part of the complementary and alternative medicine (CAM) health fair, we were given patient scenarios and asked how we would use CAM to help the patient. My case dealt with an older gentleman with chronic leg pain. After visiting the Scenar booth, I wrote the following real report:

According to the “doctors” touting this device, the Scenar uses electrical pulses to activate the C fibers, thereby forcing the brain to respond to that area. According to one website, the Scenar is “cheap and effective against almost any condition, from treat sports injuries, strokes, angina, acute infections, back pains and irritable bowel disease (as well as pre-menstrual tension and post-surgical complications) and even defibrillating hearts!” I tested the device for myself for my chronic shoulder pain. While I did feel electrical pulses—and I’m sure that it could relieve pain acutely—my pain returned the next day. I could not get the presenter to give a substantial explanation for how the devices works. He mucked up the description of electronics, could not point to any published reports, and would not even give me a cost for each treatment.

I did a PubMed search and found only two published reports have ever been written on the device. Unfortunately, both of the papers were in Russian. I found Scenars for sell on eBay, ranging in price from $500-$2,000, depending on the features. Overall, I would call the device a scam.

I would recommend electrical pulse therapy to this patient if he were willing to give it a try. However, given the chronicity of his pain, he may have to go on a Neurontin regiment to take care of his aches. If nothing else, I have a Taser that the patient could use. It has electrical impulses, too. I’ve shocked myself before and, after the initial sting, my shoulder felt pretty good afterward.

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How to behave on an interview

April 17, 2007 at 11:15 pm (Applying to med school)

If you’re lucky enough to be invited for an interview for medical school, take a moment to breath a sigh of victory.  Smile at your hard work.  Feel free to slip in passive-aggressive comments to other pre-meds such as, “What’s new with you?  By the way, did you hear that I got an interview for med school?”

There are tons of guides out there about how to properly answer questions that might be posed.  While those books and websites are fine for the 30 minutes that you’re in front of a member of the admissions committee, my goal is to tell you that you need to act properly during the rest of the interview day.  In other words, don’t be a jackass on the school’s tour.

I’ve been a tour guide for the past year for my university.  While most students are so nervous about their interviews that they’re quiet for the bulk of the day, I’ve met some real a-holes who make me want to run straight to the admissions committee and scream, “You can’t let this person in here!”  While most student guides will preface the tours by saying, “I don’t report to the admissions committee; you can ask me anything,” if you are unbearable during a 30-minute journey through the school and hospital, you won’t be matriculating there during the fall.  I can think of one instance off the top of my head where an applicant was outright insulting toward other students and even a physician.  He didn’t get in here.

Although I meet several quirky applicants each week, there have been a few occasions where I’ve wanted to personally sign rejection letters for the outright losers who make the tour difficult for me.  Therefore, I offer these tips to avoid pissing off the medical student volunteers:

1. Don’t interrupt.  There is no question so important that it can’t wait until the end.  I once began a tour by saying, “Here is the student lounge where we…” when some girl jumped in with, “What’s you student-to-body ratio in anatomy?!?”  For whatever reason, this question gets asked every week.  I don’t know why the student-to-body ratio is so important to pre-meds.  I’ve never met a person who made his decision on where to go to medical school based upon the student-to-body ratio.  Yet every week, I know it’s coming.  That being said, don’t interrupt your tour guide.

2. Don’t lead the tour.  No matter what you’re read online about the school you’re interviewing at, you don’t know anything about the university.  I had one interviewee who started telling other appicants that first-year students perform surgeries without assistance.  She even tried to show off the computer lab and the microscope lab.  Aside from getting several critical pieces of information incorrect, she undermined my tour and spread false rumors.  To make things worse, she had never visited the campus before.  I don’t know where she got her information.

3. Don’t ask stupid questions.  I know you’re dying inside to find out the school’s student-to-body ratio.  Hold off for a few minutes; I’m sure that the tour guide will tell you.  Some other things you shouldn’t ask (yet I’ve heard from applicants) are:

- Do you have a gym?  Seriously, I get asked every week if we have a gym.  I don’t know of a university in the entire country that doesn’t have a gym.  But somehow every week some woman asks.  It’s always a woman.

- Do you have a library?  I never saw that one coming.

- (In our Windows-only computer lab): Can I request a Macintosh instead?  No, you can’t have a different computer simply because you’re on a self-righteous trip to rid the world of Microsoft.

- What are the names of the dermatology professors here?  One guy pulled out a sheet of paper and was ready to start taking names.  There’s a faculty roster near the building’s entrance.  You’re welcome to spend some time there.

- What’s your student-to-body ratio?  Never ask this question.  I wish a had a trap door in the anatomy lab so I could send applicants away who feel the need the ask.  “You want to know our ratio, eh?  Just take two steps to the right and one more step forward.”

I hope this list helps.  Please do your tour guides a favor by quietly listening to the monologue, laughing at the jokes, and nodding your heads in firm agreement to whatever opinions he/she may offer.

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The Physician’s Pursuit of Happyness

April 14, 2007 at 8:08 pm (Uncategorized)

Many people not in the medical field have an idealized view of physicians. Somehow, by making lots of money, doctors are the happiest people around—they’ve got the perfect house, the perfect car, and 2.5 perfect American children.  What the fans of Grey’s Anatomy don’t know is that physicians have lots of personal struggles. The big 3 areas of psychosocial problems that every pre-med needs to be aware of are suicide, alcoholism, and divorce.

According to this study, doctors have a higher rate of suicide than the rest of the population.  Psychiatrists seem to take the lead among the specialties.  The dire predictions from some would have us believe that shrinks should never be left alone.  However, as far as I can tell, the suicide rate is only modestly elevated for physicians versus other occupations.

When they’re not in the OR, surgeons are out drinking themselves to death.  One author’s hospital shows that more than 7% of the residency program’s graduates become alcoholics.  Another hospital found that 14% of its employees are confirmed or suspected alcoholics. When compared to the national average for alcoholics (5%), I’d say that physicians—with their easy access to narcotics and benzos—put themselves at an unnecessary risk whenever they try to self-medicate.

Finally, realize that if you decide to pursue medicine, you’ll be at an increased risk for divorce.  According to this article, some specialties have greater than a 50% divorce rate.  Again, the psychiatrists take the lead, followed closely by surgeons.  What I find particularly surprising is that psychiatrists are supposed to be experts of communication.  Since we’re always hearing that divorce occurs because of a lack of communication, I wonder what the shrinks are doing wrong.  My personal belief is that psychiatrists are all really crazy—as in, they’re insane enough to become each others’ patients.  Shrinks believe their own nonsense to the point that they don’t realize that their marriages are quickly spiraling out of control.

From getting pulled away from home to work on patients they barely know to spending more time in the hospital than at home, the stressors that doctors face are insurmountable.  If you want to read more, Medscape provides a nice summary of physician obstacles.  While I don’t want to discourage anyone from pursuing medicine, I would say that you should join the Peace Corps if you want a fulfilling life without the extra baggage.

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Ask the Half MD: Do Med Students Date?

April 12, 2007 at 11:28 pm (Ask the Half MD)

A pre-med asked me earlier this week about the social lives of medical students.  She particularly wanted to know if we have the time to date.  While you’ll do a lot of studying in medical school, you’ll certainly have free time for going out like you did in college.  One trend I’ve always thought peculiar is that students—after spending 8 hours a day with each other—then want to spend their nights and weekends together.  Since many of us came here without knowing anyone before school started, we usually don’t have friends outside of our classmates.  We usually don’t branch out to meet others.  Hence, we also end up dating each other, too.

You’ll hear lots of warnings about dating classmates such as, “Just remember that things are going to get awkward in the anatomy lab once you break up.”  I’ve also heard the colorful advice, “Don’t shit where you eat.”  While I imagine that there’s some truth to feelings that you two might have towards each other when the relationship ends, I have two cautions of my own.

First, medical school is just like high school: you know all of your classmates and you know all of their business.  My campus is not alone in spreading gossip through the school.  Some things are true—such as two students having an affair—and some are just plain false—such as two students having an affair.  The problem comes in when everyone else believes these rumors to be true and then, finding them to be too juicy, will pass them on to other members of the class.  If you want a private life, you must realize that other students are off-limits—including upper classmen.

The second warning is about the small selection of datable students.  Some people will already be married or in other long-term relationships.  Many of the women will be asexual (i.e., they aren’t looking for a relationship of any kind).  Therefore, the pool becomes very small.  To compound that problem, let’s take a moment to look at the type of person that decides to become a doctor.  Everyone of my readers is well aware of the sacrifices that must be made to get to medical school.  The applicant must be near flawless in every part of the application: good grades and scores, the right extracurriculars, saying the right things during interviews, etc…  The only type of people who would willingly put themselves through this kind of torture would have to be crazy—literally.

I’ll be the first to admit that I’m a bit weird, but compared to my classmates, I’m probably the most balanced one here.  One artist has stated that there are 12 types of medical students.  I’ll just summarize as saying that they’re all nuts.  The women here have more issues than a magazine stand.  These people could fill psychiatry textbooks as case reports.  Just keep that in mind when you start flirting with one of your classmates.  Also, several students are completely controlled by their parents.  Usually mommy, M.D., is footing the bill, meaning that mom comes on the dates with you.  Seriously, I knew one girl who had certain rules for her condo because her mother told her to enforce them.

Go on a clinical rotation, find yourself a nurse, and never look back.

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Why PBL is the Suck

April 10, 2007 at 7:48 pm (1st and 2nd year)

One trend in medical education is to force students into a learning style called problem-based learning.  You and your team are given a fictitious patient with a variety of symptoms and laboratory values with the goal of figuring out what’s going on.  You’re never given the answers outright, and have only limited information to work with.  The idea behind PBL is that when you are forced to look up information about a particular disease and then present it to your classmates, you’ll better learn the material and gain the important skill of working through a differential diagnosis.

At first, PBL sounds like a great idea.  It gets you out of the classroom and allows you to think for yourself.  If you take a quick look through SDN’s pre-med forums, you’ll see lots of college students creaming their pants at the hopes of joining a PBL school.  My guess is that they’re sick of lecture halls and want a more intimate teaching environment.

PBL sounds like playing a grand master in chess who will lead you through the game, while he teaches you new moves on the board based upon your successes and failures.  In reality, PBL is like playing a five-year-old where the child constantly changes the rules and then kicks you in the testicles to make sure that you won’t ever have a chance of winning.  As the semester drags on, your group mates will get sick of making presentations and will eventually bail out of putting together any useful information in hopes that they can skate by with the just the bare minimum.  Then, they’ll kick you in the nuts and go back to studying for the USMLE.

Case-based learning is not all bad.  When there is an intended end and the preceptor is experienced in the subject, the material can indeed be learned quite readily.  Lately, however, I feel as if I’m languishing through the module with the desire to put a bag of ice on my crotch, all the while saying, “I’m taking my toys home and never playing with you again.”  Consider today’s case: the patient had tons of blood work, an endoscopy, a colonoscopy, a full-body CT scan, an abdominal ultrasound, and an MRI of the head.  From all of these expensive tests we still don’t know the diagnosis.  What he really needs is a biopsy and a physician to tell him to stop drinking so much.  Or maybe someone to practice NOT my problem-based learning.

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