I’m sure that many of my readers are wondering how they can be successful once they enter medical school. I thought I’d take the time to tell you some of the habits I picked up which will guarantee your getting AOA and landing the residency of your dreams.
The first step is to hoard all of the information for yourself, and make sure that none of it lands in the hands of your classmates. Common examples include creating an outline for all of the month’s lectures and then refusing to send it to the rest of the class; finding a website that is helpful in clarifying concepts and then neglecting to tell anyone about it; learning that someone else’s patient has had a change in status and then forgetting to tell your classmate so that he’ll be embarrassed on rounds the next day. These techniques may sound rude at first, but remember that your goal is to get your top pick for residency. And remember that all of your class to your competitors.
The second step is to take on extra patients. The higher the patient load, the more the residents and attendings will notice your hard work and will reward you for it. If all of the other medical students are assigned two patients, then you should get a third. You should readily and willingly take additional patients, even if it means pre-rounding on one of your classmates’. Don’t worry, you’ll do a better job of taking care of that person then the other third-years will anyway. That patient is now in better hands.
Finally, you should make sure that you are always visible, even when the resident has already told you to leave twice. When your classmates all agreed to go home after the afternoons lecture, you should very loudly state that you agree with them and that you will promptly leave campus once class is over. The moment everyone else is gone, you should immediately return to the hospital and ask the resident if there is anything else you can do. When the chief inquires as to why you were the only student who has returned, be sure to give some passive-aggressive answer such as, “I don’t know. I just sort of assumed that they got tired of being here.”
Don’t worry about what your classmates say about you. You’ll encounter many people who are jealous of your success. You might even hear sounds of “click click boom,” but you should ignore these. Remember, you’re the one who’s getting to go to the residency of your choice. Everyone else is going to end up in primary care out in the middle of nowhere.
Since you’re a reader of this website, you can print out these tips and keep them in the pocket of your whitecoat. Don’t share it with anyone, ever. In fact, don’t ever tell anyone that you’ve been to this website. Your competition will learn the secrets and may even employ them against you. You need to stay ahead of the game.
(Half M.D.: I wanted to post this on April 1. However, I will be out of town then and am forced to write it now. It’s a joke. Please don’t e-mail me asking if I’ve tried any of these methods.)
I watched my university’s Match with great anticipation. As a member of the military, I’m required to apply for military residency at the beginning of my fourth year. While the Air Force does grant deferrals to attend civilian programs, the military residencies have first dibs on the applicants.
I took some numbers from last week’s Match in emergency medicine and came up with the following:
1,235 U.S. seniors applied for 1,475 spots in emergency medicine nationwide. Of these seniors, 1,128 matched (91%), and an additional 22 seniors went into combined programs such as internal medicine/emergency medicine. 30 residency spots went unfilled.
Further, I went through the AAMC’s data on the applicants to EM programs. The average STEP I score was 220, half of the applicants did not have publications, and the vast majority did not belong to AOA.
In conclusion, looking over the board scores and other application data from last year, I’m reasonably sure that if I were a civilian, I would have no problem matching into EM.
But I’m in the military—which means that I only have a 30-50% chance of matching when I apply next year. That’s something the recruiters never told me when I took the HPSP scholarship. More likely, I will be forced to into a one-year internship and then released into the world as a flight surgeon. Just think, my career goals are about as far removed from primary care as they can get. And so what is the Air Force going to do? Force me into primary care along with 70 other fourth year medical students who had other dreams.
I recently stumbled upon the blog Stuff White People. Although not medically related, it’s very funny in that it touches upon many aspects of white culture and things that White people claim to love, such as coffee, Asian women, soccer, and Barak Obama. Using that site for inspiration, I wrote this piece about White people’s need to fix healthcare in America. I tried contacting the owner of the website to see if he wanted publishing rights. He never wrote back.
White people are always trying to collectively fix the nation’s woes. They figure that with all of their genius and talent, they should be able to come together as a group and clear any one of the country’s problems, usually as a result of what they’ve seen on the evening news.
In the past White people have tackled airline safety, rebuilding New Orleans, and Terri Schiavo. This year White people have decided to take on healthcare. They like to throw around words like “health disparities” and “47 million uninsured Americans.” Never press a White person for further clarification as to what a disparity is or why having uninsured Americans is so bad. You’ll only create problems for yourself. Instead, simply nod your head and say, “We’re the only industrialized nation that doesn’t have a national health plan.”
While White people are eager to increase access to physicians for other people, they are wary of the black magic and side effects that result from using Western medicine. They are quick to point out that herbal remedies can be used to treat depression, lower blood pressure, and cure cancer, all without any of the side effects that prescription drugs cause. If you would like to open an herbal remedy store and make lots of money from a White person, be sure to use a least two of the following buzzwords:
Endorsed by Chuck Norris
Occasionally, a White person might demand more information about a particular remedy you’re suggesting. In that case, be prepared to print out an article from Wikipedia, as it usually has all the answers. White people never bother to look farther than that.
I started this blog one year ago today with the hope that I could share some insight with life as a medical student. I wanted to cover everything from admissions to medical school, to funny patient encounters, to all the asinine hoops that we have to jump through to get an M.D.
I’ve written over 70 articles, have had more than 32,000 visitors, and have been cited by several respectable names in the medical field. I’ve also had quite a bizarre list of searches end up on my doorstep. The host of this blog, WordPress, can track what users are searching for online who eventually stumble upon my website. Below are some of the real phrases that people type into Google and somehow find this place:
death to men
i’m a nurse how do i date this MD
My first enema (three times!)
when a cna spread rumors about you
medical students with nice breasts
can men take correctol
quick boner pills
running long distance with a catheter
i’m half assing my clinical rotations
sexist men (twice)
sake compared to other alcohol
I’m shocked. People must think that I’m a sexist man who is handing out dating advice while inserting catheters into athletes, giving enemas, and rating the best sake in town.
It’s been a great year—and I’m hoping that the next 12 months are equally enjoyable. I started family medicine this week and have already had one person suffer a transient ischemic attack (a mini stroke), a psychosomatic woman who walked into the office and asked for a handicapped parking decal, and multiple cold sufferers who think that we can magically cure their illness while at the same time they get pissy because they have to sit in the waiting room. I’m already cooking up some new stories.
Also of note is that tomorrow is Match day for civilian medical students. I want to wish everyone good luck in landing the residency of their dreams. Who am I kidding? All of the fourth year medical students are too busy celebrating right now to read this blog.
This week I’m finishing up my psychiatry rotation. I’m sure I won’t ever have another experience like this where I get to meet patients and physicians who are both so disorganized that I can rarely tell the difference between the two. Before I tell my last story, I just wanted to share with you what one of my attendings said today. As he was filling out my evaluation he noted, “I’m giving you the highest grade I’ve ever given to a student before. You are very talented and I would love to see you go into psychiatry.” He gave me a B+.
Now on to the story:
I had a 30-year-old, 400 pound schizophrenic woman come into the emergency department seeking a medication refill. She is very well known to the hospital as she frequently visits for a variety of complaints. She’s extremely abusive toward staff and has been committed on multiple occasions for violent behavior towards others. She also has a very unique behavior when trying to get the attention of others. The last time she was in the emergency department, the psychiatrist said something to her that she didn’t want to hear. She responded by defecating on the floor. Supposedly, she became so famous after this incident that no one in the psychiatry department wants to deal with her.
When I went to interview her, I wanted to prevent any bad behavior from occurring this time. I decided to talk to her outside. If she was going to pop a squat, at least I could just hose off the sidewalk. For a moment I was tempted to interview her while making her stand in the flower garden. I figure that if life gives you lemons, you should make fertilizer.
She was doing very well with the interview. She was telling me that she no longer heard voices, no one was after her, and her thoughts seem pretty organized. Then I asked her if anyone was jealous of her. She threw up her hand and replied, “They’re all jealous of me!” When I asked her who, she started pointing at every woman outside of the hospital saying, “She’s jealous of me! She’s jealous of me! She’s jealous of me!”
I asked her what she had that these other women wanted. She replied, “They want my SEXY body!”
I refilled her Haldol and sent her on her way.
Whenever a patient visits the doctor’s office, there is always an idealized hope that the patient and physician will work together to come up with a treatment plan. Part of the management of disease involves making sure the patient understands the risks and benefits of a particular therapy. In order to do so, patients must have capacity to understand what treatment entails. The patient may refuse any treatment for any reason, so long as he has the capacity to understand what the risks are when refusing treatment. For example, a Jehovah’s Witness could refuse to take a blood transfusion even when his anemia is so bad that he could die from poor oxygen perfusion. Similarly, any adult can fill out a Do Not Resuscitate order with the understanding that if he should have a heart attack and suffer cardiac arrest, no one will come to his aid.
In psychiatry, however, many of our patients lack capacity. One might be so psychotic that he does not understand his negligence may cause harm to himself or others. Psychiatrists are constantly asked to determine a patient’s ability to understand treatment decisions. Sometimes, a person might be forcefully admitted to a hospital for treatment if his mind is so disorganized as to cause immediate, life-endangering health problems. Psychiatrists can hold a patient in a hospital for a given number of days to provide treatment for medical or psychiatric illness. During this time period the patient has the right to legal representation and may petition a court seeking discharge from the hospital.
Today, I got to sit in on a court hearing for a patient to was so psychotic that he did not notice that the cellulitis on his legs had become necrotic. In my state, the district attorney’s office serves as the hospital’s legal representative to keep the patient involuntarily committed for treatment. The public defender’s office represents the patient. Our attending began giving a summary of the patient’s hospital stay over the previous week. He mentioned that the patient has been washing his face in the toilet, shouting racial slurs, making sexually inappropriate comments about nurses, and talking about the fourth Reich. At this point the patient then began doing the Nazi salute and stated, “Black people are dangerous.” When the defense attorney began questioning the patient, the conversation with something like this:
Attorney: I understand that you are a veteran. Are you willing to take treatment at the VA?
Patient: They are all robots there. I would kill every one of them.
Attorney: Do you want to stay here in the hospital? And if so, how long?
Patient: I want to stay here for 60 years.
Attorney: Do you understand that you are sitting in front of a judge and have the chance to be discharged from the hospital? Now I’m going to ask you again, how long do you want to stay in this hospital?
Patient: 60 years!
Attorney: What do you plan to do once you’re discharged from the hospital?
Patient: I want to go to the South hospital for six years.
I was pretty sure that our side was going to win the verdict when the judge began laughing.
Nothing’s scarier in a psychiatric hospital than seeing a patient who was brought in by police officers with his hands handcuffed behind his back. My hospital has a separate psychiatric emergency department that is located away from the rest of the hospital. For whatever reason, please officers often arrest violent individuals and then bring them in for us to deal with. Usually, I’m pretty confident interviewing one of our attempted murderer guests when they’ve been drugged up on Ativan and tied to a bed. Last week police officers Baker Acted a 250-pound antisocial gentleman who was stopping Hispanics and violently demanding that they show him their papers. The officers brought the man to the psychiatric hospital, took off the handcuffs, and left him alone to be interviewed by me.
I went through the regular interview and noticed that the patient was becoming more and more agitated. In these situations, we are supposed to immediately end the interview and leave the room. When I was trying to walk out on this particular patient, he decided to charge after me. I quickly tried to close the door lock the patient in this room, be forced the door opened before I could get my key into the slot. He tried to take one swing at me, but by that time a police officer who just happened to be walking through the hall pulled out his Taser and yelled, “If you take one more step forward I’m going to shoot you!” The patient backed down, the nurses restrained him, and we gave him a nice shot of Haldol and Ativan to chemically control him.
I had hoped that the hospital had learned a lesson about restraining patients before interviewing them. You can imagine my surprise then, when my last patient of the day produced as his only form of identification a card that read “Corrections Inmate.”