Welcome to our third Topic Day on Mothers in Medicine! Throughout the day today, we'll be featuring posts about the advice we wish we had in medical school. What words of wisdom do we have for entering women students? For our younger selves?
Posts will be publishing at regular intervals today so be sure to check back. Feel free to add your advice in the comments section, or if you are currently a medical student, what you think of our advice!
Scroll down to see the posts...
Wednesday, November 12, 2008
A straggling piece of advice
I was held up yesterday so my post is late. Straggling, as it were.
People in my medical school did not talk much about life, the universe, and everything. We were concentrating on the cerebral aspects of medicine, not necessarily the humanitarian elements, and not the life outside med school.
So if I did medical school again (and, yes, I absolutely would), I would take this advice back with me: have a human perspective on all things. During my training, we all tried so hard to be professional, but I think that, in the process, we started to ignore or even invalidate our own feelings. Our emotions and reactions may not always need to be open and visible, but it's okay to feel the burden of your patients' experience and not be closed off to it. I think too many people have the fear that allowing themselves to feel too much will cripple their medical ability. I don't think so.
In my years since medical school, I have seen many of the best and brightest doctors from various disciplines getting their hands and their hearts dirty (so to speak). They have an intimate knowledge of their patients, and I see how they are invested in their patient's care. These professionals have taken down the wall that is supposed to exist between the medical brain and the feeling person underneath. I have immense respect for them and the care that they provide. They manage to be involved, yet they don't make inappropriate recommendations or have nervous breakdowns. They just see the patients (and themselves) as the human beings that they are.
These are my role models, from my unique spot from behind the microscope. But if I were a medical student again, I think I would allow myself to feel a little more sadness, frustration, helplessness, and love.
People in my medical school did not talk much about life, the universe, and everything. We were concentrating on the cerebral aspects of medicine, not necessarily the humanitarian elements, and not the life outside med school.
So if I did medical school again (and, yes, I absolutely would), I would take this advice back with me: have a human perspective on all things. During my training, we all tried so hard to be professional, but I think that, in the process, we started to ignore or even invalidate our own feelings. Our emotions and reactions may not always need to be open and visible, but it's okay to feel the burden of your patients' experience and not be closed off to it. I think too many people have the fear that allowing themselves to feel too much will cripple their medical ability. I don't think so.
In my years since medical school, I have seen many of the best and brightest doctors from various disciplines getting their hands and their hearts dirty (so to speak). They have an intimate knowledge of their patients, and I see how they are invested in their patient's care. These professionals have taken down the wall that is supposed to exist between the medical brain and the feeling person underneath. I have immense respect for them and the care that they provide. They manage to be involved, yet they don't make inappropriate recommendations or have nervous breakdowns. They just see the patients (and themselves) as the human beings that they are.
These are my role models, from my unique spot from behind the microscope. But if I were a medical student again, I think I would allow myself to feel a little more sadness, frustration, helplessness, and love.
My Two Cent’s Worth about General Pediatrics
A new doctor on the medical staff of my hospital parks his Rolls Royce in the MD parking lot. It sticks out among the Mercedes, Suburban’s,and Hondas that other doctors park there. It gives me pause to fantasize about the life this physician has and how different it must be from mine – no school loans, kids grown and out of college, retirement nearing with a nice nest egg (or at least decent after the recent downturn of last month’s market.) As a Pediatrician, I know this will not be my life, and I’m absolutely fine with it. As Nancy Snyderman, MD, told Matt Lauer recently on the Today show, “Pediatricians don’t go into medicine to get rich. They go into medicine because they love children.” Lesson #1: Think about another specialty in medicine or another career altogether if money is high on your life priority list. Don’t get me wrong. My family and I are comfortable, but there’s a reason (which is best left to a future post) pediatrics winds up on the bottom of the pay scale every year.
Lesson #1 has a couple of corollaries. The first is do what you love and the rest will follow. Sometimes what you love changes, and be willing to follow that path, too. It’s ok to reinvent yourself midlife (or sooner) if you decide another field suits you better. Six years ago, I decided to apply for dermatology residency. It was a period of time that had me reaching for the stars, but I had to do it to be happy with my choices. Derm programs are very choosey, and no program wanted to pick up a practicing pediatrician and put them back in the rigors of residency no matter how glowing my letters of references or work experience shined. Instead, I opened my own general pediatric practice, and have found success and happiness in the autonomy that followed.
Corollary number two is if you have wealth as a pediatrician, it is best not to flaunt it. Maybe your great, great uncle with no children left you a trust. Maybe you can get away with driving that Porsche in a really upscale area. In my suburban community, I often encounter parents and patients when I’m grocery shopping or making a Starbuck’s run. They check me out – what car I drive, whether it has a booster seat in the back, what shoes I have on, what’s in my shopping cart. There’s something about taking care of sick and miserable children and displaying luxury possibly gained (or not) from delivering this care that is incongruent to me. It may be the stuff of deep pockets that malpractice lawyers and litigious patients look for. Save the pictures of the fabulous vacation in the Caymans for home.
Lesson number two is that in pediatrics lifestyle and money are two choices (of many) that may determine your path to happiness. One of the beauties of my specialty is that it is family friendly and very flexible. One of my colleagues is getting back into the workforce right now after three years absence. She needed time to care for her daughter with Type 1 Diabetes. Other physicians choose to work part-time or job share. In my practice, I have learned that I deliver the best continuity of care with my patients if I am there at least three days per week (I average 4 days per week), but I also employ a physician who works two days per week and takes no call. My compensation is higher because I see more patients. Her lifestyle is different than mine because she is part time.
Primary care is a production business, and that’s something to consider as you make your choices in medicine. During a typical work day, I need to see at least 23 patients to be able to pay my overhead – office staff salaries, lights, medical supplies, insurance filing fees – before I pay myself. I’m conscientious of this because I own my own practice. Whether you work for yourself or are employed by a major healthcare system, general pediatrics is about seeing lots of patients. Employers track these numbers, too, and compensate you accordingly. So if you like to chat with your patients like I do, you’ll see fewer and be paid less than the guy down the street who sees 60 patients per day and says very little. My whole office is a beehive of activity each day to accomplish each patient encounter. When I hire new staff, I let them know up front that pediatrics is fast paced.
Why, you may ask, have you focused so much on the economics of medicine when all I need is advice about how to be a good clinician or balance my family life? The body of knowledge needed in medicine in infinite, and I am humbled daily by what I don’t know. Yesterday I encountered two new medicines I had never heard of before reading a specialist’s notes. Your focus in training needs to be on assimilating as much of this knowledge as possible. The reality, though, is that medicine doesn’t exist in a vacuum. Eventually you will need to take all you have learned and apply it to the world we live in with all of its variables (insurance, national quality guidelines, patient compliance – just to name a few) – broken healthcare system and all.
Lesson #1 has a couple of corollaries. The first is do what you love and the rest will follow. Sometimes what you love changes, and be willing to follow that path, too. It’s ok to reinvent yourself midlife (or sooner) if you decide another field suits you better. Six years ago, I decided to apply for dermatology residency. It was a period of time that had me reaching for the stars, but I had to do it to be happy with my choices. Derm programs are very choosey, and no program wanted to pick up a practicing pediatrician and put them back in the rigors of residency no matter how glowing my letters of references or work experience shined. Instead, I opened my own general pediatric practice, and have found success and happiness in the autonomy that followed.
Corollary number two is if you have wealth as a pediatrician, it is best not to flaunt it. Maybe your great, great uncle with no children left you a trust. Maybe you can get away with driving that Porsche in a really upscale area. In my suburban community, I often encounter parents and patients when I’m grocery shopping or making a Starbuck’s run. They check me out – what car I drive, whether it has a booster seat in the back, what shoes I have on, what’s in my shopping cart. There’s something about taking care of sick and miserable children and displaying luxury possibly gained (or not) from delivering this care that is incongruent to me. It may be the stuff of deep pockets that malpractice lawyers and litigious patients look for. Save the pictures of the fabulous vacation in the Caymans for home.
Lesson number two is that in pediatrics lifestyle and money are two choices (of many) that may determine your path to happiness. One of the beauties of my specialty is that it is family friendly and very flexible. One of my colleagues is getting back into the workforce right now after three years absence. She needed time to care for her daughter with Type 1 Diabetes. Other physicians choose to work part-time or job share. In my practice, I have learned that I deliver the best continuity of care with my patients if I am there at least three days per week (I average 4 days per week), but I also employ a physician who works two days per week and takes no call. My compensation is higher because I see more patients. Her lifestyle is different than mine because she is part time.
Primary care is a production business, and that’s something to consider as you make your choices in medicine. During a typical work day, I need to see at least 23 patients to be able to pay my overhead – office staff salaries, lights, medical supplies, insurance filing fees – before I pay myself. I’m conscientious of this because I own my own practice. Whether you work for yourself or are employed by a major healthcare system, general pediatrics is about seeing lots of patients. Employers track these numbers, too, and compensate you accordingly. So if you like to chat with your patients like I do, you’ll see fewer and be paid less than the guy down the street who sees 60 patients per day and says very little. My whole office is a beehive of activity each day to accomplish each patient encounter. When I hire new staff, I let them know up front that pediatrics is fast paced.
Why, you may ask, have you focused so much on the economics of medicine when all I need is advice about how to be a good clinician or balance my family life? The body of knowledge needed in medicine in infinite, and I am humbled daily by what I don’t know. Yesterday I encountered two new medicines I had never heard of before reading a specialist’s notes. Your focus in training needs to be on assimilating as much of this knowledge as possible. The reality, though, is that medicine doesn’t exist in a vacuum. Eventually you will need to take all you have learned and apply it to the world we live in with all of its variables (insurance, national quality guidelines, patient compliance – just to name a few) – broken healthcare system and all.
What My Medical School Acceptance Letter Didn't Say (but maybe it should have)
Congratulations! You've made it to medical school. All of your hard work, community service, pretending to be interested in anesthesiology in order to be able to shadow a physician (any physician), over-involvement in extra-curricular activities, long nights spent studying whilst your English major roommate goes out and enjoys the college experience, and never, ever getting to schedule all your classes on only Tuesdays and Thursdays (so the better to enjoy a 4 day weekend) has finally paid off. Well, sort of. We'll get to that "payment" issue in a minute.
Right now you are, no doubt, a very "big fish" in a little pond. You are probably known as the smartest, most ambitious, and most masochistic, ahem, of all your friends. In medical school, you'll be surrounded by 100 + of people just as smart, ambitious, and masochistic (if not more so) than you. You will probably be, maybe for the very first time in your life, average. And as much as that may give you angina right now, you need to know that "average" is actually ok! No, really!
You thought you studied hard in college, but you are in for a surprise. You *did* study harder, relatively, than anyone else you knew. You also routinely got paid off in As. In medical school, you will sit in the same position for 8-9 hours a day, pausing only for bathroom breaks and pasta, reading, re-writing notes, and reading again, only to score an 80% on your exam. You need to go to lecture, but if you don't go to lecture, then you need a good note service, and, unless you are a hell of a good transcriptionist, if your medical school employs a lot of professors with thick accents, then you will probably need to ante up the cash for someone else to transcribe "your share" of note service lectures. Take some time to go "off campus" for lunches with your friends, and allow yourself to skip a lecture for a mental health hour every now and then. It will be worth it.
The first two years of medical school, you will work, and study, and take tests, and drink copious amounts after tests, and wonder why in the world you ever wanted to go to medical school. Keep the faith. The MD/PhD candidate that sits next you in the third row and your gross anatomy lab group will likely form the core of your best friends throughout your four years together, even though at times you want to throttle all of them. Familiarity breeds contempt, but you are all going through the same hellacious experience. You will value these memories, even if you don't believe it now.
You will have a med school fling. It will be fun, but won't last (and you'll be totally ok with that.) You will make mistakes. You will fail (yes, I said FAIL) a test. You will cry, a lot. You will feel like everyone else smarter than you. You will wonder, more than once, if you have chosen the wrong path. You haven't. You will eat too much, drink too much, and exercise too little. Try to take better care of yourself, that extra hour of studying probably won't make a difference, but that hour of exercise could mean a healthier you four years from now. Don't forget about your family and friends. Try to stay in touch with the people that mean the most to you. Their support is important. Life is going on outside your little microcosm, and you'll be sorry that you lost touch with the friends that knew you before you became a med bot.
Once you start clerkships, you will remember why you started doing all of this in the first place. Taking care of patients! You will *like* what you are doing again, and, all of the sudden, some of the lectures that seemed like absolute nonsense will actually begin to become more clear. No matter what you think you may want to do, clerkships will change your perspective on everything.
Be a good student. Know your patients. Have the patient seen and the notes written before your (overworked) intern hits the floor. Keep a running list of scut that needs to be done on *all* patients on your service (not just *your* patients, remember, you are working as a team) and be sure it is done before you leave the hospital. Check in with your resident/intern often, they are too busy to page you, but you may get to see (and do) some cool stuff if you stay visible. Learn how to write orders and practice whenever you can. Do everything you can to make your resident's life easier. Write prescriptions, skeletonize discharge orders ahead of time, and offer to get them food if you notice they haven't eaten. Stick close to your resident on call, but *go to bed* if they tell you to go! Don't try to show off how much you know, it is obnoxious and will likely come back to bite you. One of your patients will likely die, and you will never forget it.
Once you find out what it is that you want to do when you "grow up," be sure to make yourself known to the residents and attendings in that specialty. Ask lots of questions. Find a resident that needs help with research and offer your data gathering skillz. If it is a surgical specialty, make an effort to scrub in on as many cases as you possibly can. Center your fourth year electives around the specialty early in the year, so you can make the proper connections for letters of recommendation. Make yourself invaluable to your team. It will serve you well no matter what specialty you choose.
Even if you have met the love of your life, and think that January is a wonderful time to get married, think twice about planning a wedding in January of your fourth year. That is right in the height of interview season, and you will cause yourself undue stress trying to plan interviews around your wedding! The good news is, it is quite possible to nurture a fledgling relationship through the stresses of medical school (and it will prepare your spouse to be twice as awesome as he supports you through the worse stresses of residency!)
When you finally finish medical school (it is a marathon, not a sprint!), you will not be the same person that you were. You will be in debt up to your eyeballs, literally. It will take you years (some as an indentured servant) to pay off hundreds of thousands of dollars just for the privilege of being tortured, erm, learning for these last four years. You will realize that you will never be "rich," like your classmate that quit second year because he was making more money day trading stocks than the average family medicine attending. However, you will be a physician...fallible, over-educated, and under socialized, and you are going to help patients in ways you never even considered when you first sent in your application.
All the best of luck (you could use a little of that, as well),
Future Dr. Whoo
Right now you are, no doubt, a very "big fish" in a little pond. You are probably known as the smartest, most ambitious, and most masochistic, ahem, of all your friends. In medical school, you'll be surrounded by 100 + of people just as smart, ambitious, and masochistic (if not more so) than you. You will probably be, maybe for the very first time in your life, average. And as much as that may give you angina right now, you need to know that "average" is actually ok! No, really!
You thought you studied hard in college, but you are in for a surprise. You *did* study harder, relatively, than anyone else you knew. You also routinely got paid off in As. In medical school, you will sit in the same position for 8-9 hours a day, pausing only for bathroom breaks and pasta, reading, re-writing notes, and reading again, only to score an 80% on your exam. You need to go to lecture, but if you don't go to lecture, then you need a good note service, and, unless you are a hell of a good transcriptionist, if your medical school employs a lot of professors with thick accents, then you will probably need to ante up the cash for someone else to transcribe "your share" of note service lectures. Take some time to go "off campus" for lunches with your friends, and allow yourself to skip a lecture for a mental health hour every now and then. It will be worth it.
The first two years of medical school, you will work, and study, and take tests, and drink copious amounts after tests, and wonder why in the world you ever wanted to go to medical school. Keep the faith. The MD/PhD candidate that sits next you in the third row and your gross anatomy lab group will likely form the core of your best friends throughout your four years together, even though at times you want to throttle all of them. Familiarity breeds contempt, but you are all going through the same hellacious experience. You will value these memories, even if you don't believe it now.
You will have a med school fling. It will be fun, but won't last (and you'll be totally ok with that.) You will make mistakes. You will fail (yes, I said FAIL) a test. You will cry, a lot. You will feel like everyone else smarter than you. You will wonder, more than once, if you have chosen the wrong path. You haven't. You will eat too much, drink too much, and exercise too little. Try to take better care of yourself, that extra hour of studying probably won't make a difference, but that hour of exercise could mean a healthier you four years from now. Don't forget about your family and friends. Try to stay in touch with the people that mean the most to you. Their support is important. Life is going on outside your little microcosm, and you'll be sorry that you lost touch with the friends that knew you before you became a med bot.
Once you start clerkships, you will remember why you started doing all of this in the first place. Taking care of patients! You will *like* what you are doing again, and, all of the sudden, some of the lectures that seemed like absolute nonsense will actually begin to become more clear. No matter what you think you may want to do, clerkships will change your perspective on everything.
Be a good student. Know your patients. Have the patient seen and the notes written before your (overworked) intern hits the floor. Keep a running list of scut that needs to be done on *all* patients on your service (not just *your* patients, remember, you are working as a team) and be sure it is done before you leave the hospital. Check in with your resident/intern often, they are too busy to page you, but you may get to see (and do) some cool stuff if you stay visible. Learn how to write orders and practice whenever you can. Do everything you can to make your resident's life easier. Write prescriptions, skeletonize discharge orders ahead of time, and offer to get them food if you notice they haven't eaten. Stick close to your resident on call, but *go to bed* if they tell you to go! Don't try to show off how much you know, it is obnoxious and will likely come back to bite you. One of your patients will likely die, and you will never forget it.
Once you find out what it is that you want to do when you "grow up," be sure to make yourself known to the residents and attendings in that specialty. Ask lots of questions. Find a resident that needs help with research and offer your data gathering skillz. If it is a surgical specialty, make an effort to scrub in on as many cases as you possibly can. Center your fourth year electives around the specialty early in the year, so you can make the proper connections for letters of recommendation. Make yourself invaluable to your team. It will serve you well no matter what specialty you choose.
Even if you have met the love of your life, and think that January is a wonderful time to get married, think twice about planning a wedding in January of your fourth year. That is right in the height of interview season, and you will cause yourself undue stress trying to plan interviews around your wedding! The good news is, it is quite possible to nurture a fledgling relationship through the stresses of medical school (and it will prepare your spouse to be twice as awesome as he supports you through the worse stresses of residency!)
When you finally finish medical school (it is a marathon, not a sprint!), you will not be the same person that you were. You will be in debt up to your eyeballs, literally. It will take you years (some as an indentured servant) to pay off hundreds of thousands of dollars just for the privilege of being tortured, erm, learning for these last four years. You will realize that you will never be "rich," like your classmate that quit second year because he was making more money day trading stocks than the average family medicine attending. However, you will be a physician...fallible, over-educated, and under socialized, and you are going to help patients in ways you never even considered when you first sent in your application.
All the best of luck (you could use a little of that, as well),
Future Dr. Whoo
If I were a first year med student right now, I would...
As a third year med student, I was involved in some sort of group discussion session with first year med students. All of us older, wiser third years were offering advice to the first years in the form of "If I were a first year med student right now, I would..."
I had just finished a particularly grueling internal medicine rotation and I was feeling fairly disenchanted. When it came to be my turn, I said, "If I were a first year med student right now, I WOULD QUIT."
Everyone kind of stared at me in shocked awkward silence, then quickly went on to the next person.
But you didn't come here to read that kind of advice, so I'll give you some revised sagely advice from an even older and even wiser me: I wish I had taken a year or two after college to see what else was out there, instead of going straight through to med school.
It seems like the happiest people in med school were the ones who were in their mid-20s when they started out, instead of 22 like I was. They had taken a few years to see what else was out there and realize that it wasn't for them. Oddly enough, some of the people who were significantly older seemed to be just as disgusted as us young'uns, possibly because many of them had families that med school was taking them away from.
This is my graphic representation*:
I wish I had taken a couple of years off. At least then I could stop romanticizing all the stuff I didn't end up doing. Maybe I would have realized that being an actuary (i.e. calculating insurance rates for companies) isn't such a fabulous career, despite how nerdishly excited I get over making a graph (see above). And I could have written that novel I always wanted to write... about the compelling protagonist with an obstacle to overcome, where some friends become enemies, some enemies become friends, and at the end my main character is richer from the experience... (you get the idea)
*Graph not based on actual data
I had just finished a particularly grueling internal medicine rotation and I was feeling fairly disenchanted. When it came to be my turn, I said, "If I were a first year med student right now, I WOULD QUIT."
Everyone kind of stared at me in shocked awkward silence, then quickly went on to the next person.
But you didn't come here to read that kind of advice, so I'll give you some revised sagely advice from an even older and even wiser me: I wish I had taken a year or two after college to see what else was out there, instead of going straight through to med school.
It seems like the happiest people in med school were the ones who were in their mid-20s when they started out, instead of 22 like I was. They had taken a few years to see what else was out there and realize that it wasn't for them. Oddly enough, some of the people who were significantly older seemed to be just as disgusted as us young'uns, possibly because many of them had families that med school was taking them away from.
This is my graphic representation*:
I wish I had taken a couple of years off. At least then I could stop romanticizing all the stuff I didn't end up doing. Maybe I would have realized that being an actuary (i.e. calculating insurance rates for companies) isn't such a fabulous career, despite how nerdishly excited I get over making a graph (see above). And I could have written that novel I always wanted to write... about the compelling protagonist with an obstacle to overcome, where some friends become enemies, some enemies become friends, and at the end my main character is richer from the experience... (you get the idea)
*Graph not based on actual data
Answer to lingering questions...
I know you always wondered how preceptors graded you on the rotations. And you always wondered why your grade was less than what you thought it should be for the work and energy and time that you put in. Now as an attending I understand - those that clearly like the rotation, get jazzed about it, do the work in a way that you can trust them and not have to repeat the work, or just do it themselves to get it done right - those are the med students that do well during rotations. BUT SO WHAT!! you did everything you needed to do, studied the way you needed to to pass, slugged out a horrible internship year which made you question going into medicine at all. Then you saw the anesthesia light at the end of the tunnel and you're life only continues to get better from there. You chose the ABSOLUTE right profession. Yes, if someone said I could not continue to practice unless I go through med school again - I NEVER would do it. But now being at the other end, I'd NEVER give it up! My advice? If you've started - get through it and enjoy as much as you can without killing yourself... the results are worth it. If you haven't started DON'T unless you're ABSOLUTELY SURE!! And of all the people in my med school class, those that came with kids, those that had them during med school, residency etc, and those that went straight through - we are ALL satisfied about where we ended up!!
Note to self
Dear KC,
Hey you. I don't mean to blow your mind, but I'm you, writing from the future. No, you are not on Punk'd, I assure you. You don't believe me?
Well, I know you have a crush on that cute guy in your class you went to coffee with the other day. The one you talked to for hours, losing track of time. You are going to be married in 6 years. I know, score! Your wedding day is going to be the most perfect day, ever, complete with birds chirping and a gentle breeze blowing. Don't be scared by the weather forecast. The clouds will literally part that day.
Are you with me?
I wanted to pass on some advice because I think it will save you a lot of stress and anxiety. Listen, all of those years of stress and anxiety about everything from career choice to thoughts about the future and families really can add up (really add up = multiplying white hairs = a return to getting highlights again = major upkeep commitment = $$$). So, in essence, I'm saving you time and money by sending you this note.
1) Go with you heart when choosing a specialty.
I remember how much you wrestle with this. I know it's hard sometimes to imagine what you might like to be in the future, but whatever you choose will have to sustain you intellectually over the years. Do what you love. Do what challenges you. Your career is going to take a few unexpected turns (I'm convinced that it always does), but it will lead you to where you are now, in the future, and it is so meaningful and fulfilling for you. If you love what you do, you'll find a way to have the kind of life you want in that specialty. You'll "make it work," (reference to a show in the future that you will absolutely adore.)
2) Having children does not mean giving up on your career.
Hey you. I don't mean to blow your mind, but I'm you, writing from the future. No, you are not on Punk'd, I assure you. You don't believe me?
Well, I know you have a crush on that cute guy in your class you went to coffee with the other day. The one you talked to for hours, losing track of time. You are going to be married in 6 years. I know, score! Your wedding day is going to be the most perfect day, ever, complete with birds chirping and a gentle breeze blowing. Don't be scared by the weather forecast. The clouds will literally part that day.
Are you with me?
I wanted to pass on some advice because I think it will save you a lot of stress and anxiety. Listen, all of those years of stress and anxiety about everything from career choice to thoughts about the future and families really can add up (really add up = multiplying white hairs = a return to getting highlights again = major upkeep commitment = $$$). So, in essence, I'm saving you time and money by sending you this note.
1) Go with you heart when choosing a specialty.
I remember how much you wrestle with this. I know it's hard sometimes to imagine what you might like to be in the future, but whatever you choose will have to sustain you intellectually over the years. Do what you love. Do what challenges you. Your career is going to take a few unexpected turns (I'm convinced that it always does), but it will lead you to where you are now, in the future, and it is so meaningful and fulfilling for you. If you love what you do, you'll find a way to have the kind of life you want in that specialty. You'll "make it work," (reference to a show in the future that you will absolutely adore.)
2) Having children does not mean giving up on your career.
You may think now that choosing to have children early on in your career will necessarily mean a hiatus from doing anything productive, career-wise, for many, many years. You may be resigned to not being able to accomplish your career goals because of this. Don't. Because I'll tell you that having time constraints because of your family can make you that much more productive during your other times. You'll have rushes of creativity, of ideas, moving ahead productively in ways you would never have imagined.
3) Having children will make your life unbelievably rich.
It's amazing. It's all that you dreamed of and more. Go for it. (But, no need to rush in - enjoy the alone time with your husband - travel, explore, really solidfy your two-ness. Children are wonderful but you'll miss that two-ness later on.)
4) Take calcium supplements now. Hello, peak bone mass?
5) When making your residency rank list, remember that it is MOST important to be around people you love who can support you, not the fine details of the program.
6) Dream big.
Don't stop setting high goals for yourself. Don't settle. As a woman in medicine, as a mother in medicine, you can do great things. Dream big.
See you in the future,
Me
Years from Now
Dear Fat Medical Student,
You worry too much. It's gotten you this far, but enough is enough.
Years from now, it won't matter if you get a 92% instead of a 100% on an exam. You won't care if a resident thinks you are lazy for wanting to leave just two hours late. You won't even remember your step one score, but you'll remember the hangover from the celebration upon passing the test. Years from now, your patients will love you because you care. They won't care if you don't know all of the answers as long as you know how to find them.
You'll be a family doctor, a combination of all of your "favorites"...internal medicine, pediatrics, obstetrics/gynecology and psychiatry. You'll know a little about a lot of problems but not a whole lot about any of them. You will be comfortable referring to specialists. People will tell you their deepest secrets and will care about your opinion. Don't let them down.
Years from now, a lot of your "hero" teachers will seem emotionally immature to you once they are your colleagues. You'll watch them be cruel to ancillary staff, students, their families and, heartbreakingly, some patients. You'll feel superior to them in all ways other than raw knowledge. Don't put them on a pedestal until you are sure they deserve it.
Don't be so desperate to find a mate now. You will marry your best friend and have happy children. You'll see.
Years from now, you'll be sorry you quit walking the dogs when you got a fenced yard. You'll regret those drug-rep bagels, too. Stop when you are 15 pounds overweight and you'll never be 140 pounds overweight.
You will hurt many patients...not with malice but with honest mistakes, misjudgments and quirky fate. Decide now how you will handle it so it doesn't kill you. You'll cry about these circumstances because you are a good person, but don't let the bad outcomes make you jumpy.
Years from now, you won't care about money because you'll have some. Save for retirement and live below your means. Your loan payments will be a small part of your overall salary because you borrowed wisely.
Years from now, you'll find yourself wanting to snap at people in "ordinary" life. Practice now how to manage fatigue so you don't become an ass. Medical students will turn to you for a kind word or emotional support and you should give it. Always.
You'll be glad you spent time with your nieces and nephews even when finding time was difficult because the children make your life whole. Invest love in them and it shall be returned when you are back in diapers.
Years from now, you'll be a generally happy person. Of course, you'll wonder what might have been in you hadn't chosen medicine. You'll consider chucking it all and going to cosmetology school. Don't let your mind go there. On the day when you decide you are in the wrong career, a patient will tell you that they credit you for helping change his or her life. It will feel good.
Enjoy the success...it's what you wanted.
XOXO,
Future Fat Doctor
Express Yourself
Most medical schools have satirical student productions. The most rewarding thing I did in medical school was to be deeply involved in ours, called the second year show. I can still remember classic skits: the first year student doing a physical on a cadaver and missing that the patient was dead, for example. The accompanying song still runs through my mind whenever I teach phyisical diagnosis. Playing music, singing and dancing with classmates is a tremendous counterweight to both the isolation and the competitiveness that seem to be a leitmotif (or maybe I mean heavy motif) of medical
education.
education.
Oh the Places You'll Go!
8/ 01/1997
Dear RH+,
Well here you are…. All grown up and getting ready to start Medical School. The things you are going to experience are going to blow your mind. No matter how hard things get I want to let you know its all worth it. In the future you are happy and love your profession. But, there are just a few tidbits you should know:
Those student loans are really hard to pay back. Don’t take out any more than you need. Also read the book “The Millionaire Next Door” as well as “The Richest Man in Babylon” the summer before you start med school.
Don’t become a D.O. Right now you are sure that you are going to practice rural family medicine, this will change when you start rotating through different specialties. You are being told that being a D.O. will not affect your ability to get into residency. This is not true. You will seek to match in a competitive specialty, and it will be harder for you to get a spot. It will also make it harder to get a fellowship. (This is not meant to spark controversy. I feel my Osteopathic training was outstanding and I love the profession. It was however detrimental to applying for residency positions and I was mislead on this issue when I entered school)
It will all work out. Don’t freak out when you realize that you want to be an OB/GYN. Do what you love. YES, you will be able to have a family and a somewhat balanced life.
SUPPORT you fellow female students/residents when they say they are being sexually harassed. Never just think they don’t have a sense of humor. Never look the other way when people say sexist or racist comments, even if they are your superior, stand up for what is right.
When you are an intern you will be convinced that your Chiefs are evil (well one of them is, but she will get fired). They are not. They really are trying to help you and they are just trying to survive as well.
Don’t eat so poorly as a resident. If you eat a second “dinner” at 3 am, you will, in fact, gain 20 lbs in 6 months.
Nothing I can tell you now will prepare you for having a baby. Just a hint, there is nothing better in the world than seeing your child for the first time. Your heart will grow in the most dramatic way. The nausea, constipation, Mag….. all worth it.
Shave your legs with your left hand. This will help improve your dexterity and surgery skills.
Don't wish away your life (except intern year. It will be awful and life will be significantly better when its done). Enjoy each stage as much as you can.
You husband, family and friends are amazing. Don’t ever take them for granted.
Enjoy the ride!!!
Love,
RH+ 11/2008
Dear RH+,
Well here you are…. All grown up and getting ready to start Medical School. The things you are going to experience are going to blow your mind. No matter how hard things get I want to let you know its all worth it. In the future you are happy and love your profession. But, there are just a few tidbits you should know:
Those student loans are really hard to pay back. Don’t take out any more than you need. Also read the book “The Millionaire Next Door” as well as “The Richest Man in Babylon” the summer before you start med school.
Don’t become a D.O. Right now you are sure that you are going to practice rural family medicine, this will change when you start rotating through different specialties. You are being told that being a D.O. will not affect your ability to get into residency. This is not true. You will seek to match in a competitive specialty, and it will be harder for you to get a spot. It will also make it harder to get a fellowship. (This is not meant to spark controversy. I feel my Osteopathic training was outstanding and I love the profession. It was however detrimental to applying for residency positions and I was mislead on this issue when I entered school)
It will all work out. Don’t freak out when you realize that you want to be an OB/GYN. Do what you love. YES, you will be able to have a family and a somewhat balanced life.
SUPPORT you fellow female students/residents when they say they are being sexually harassed. Never just think they don’t have a sense of humor. Never look the other way when people say sexist or racist comments, even if they are your superior, stand up for what is right.
When you are an intern you will be convinced that your Chiefs are evil (well one of them is, but she will get fired). They are not. They really are trying to help you and they are just trying to survive as well.
Don’t eat so poorly as a resident. If you eat a second “dinner” at 3 am, you will, in fact, gain 20 lbs in 6 months.
Nothing I can tell you now will prepare you for having a baby. Just a hint, there is nothing better in the world than seeing your child for the first time. Your heart will grow in the most dramatic way. The nausea, constipation, Mag….. all worth it.
Shave your legs with your left hand. This will help improve your dexterity and surgery skills.
Don't wish away your life (except intern year. It will be awful and life will be significantly better when its done). Enjoy each stage as much as you can.
You husband, family and friends are amazing. Don’t ever take them for granted.
Enjoy the ride!!!
Love,
RH+ 11/2008
Things I wish I knew in medical school
Things I wish I knew in medical school (and beyond):
-When starting, I wish someone would have told me that the daily grind of medical school would be the hardest thing that I’d ever done to that point.
-The smell of the anatomy lab will eventually fade. With luck, everything you learned there won’t.
-It’s OK to not know what you want to do with your life; spend your time during rotations and clerkships learning as much as you can. Likewise, it’s OK to be completely grossed out by sputum samples.
-Learn to listen to your gut regarding patients and yourself. It’s part of the art of our profession.
-Every once in a while stop to thank your support systems: parents, siblings, friends, significant others, spouses. Med school is a tough row to hoe (so to speak), and they’ve got your back while you’re cramming for yet another exam. Don’t get crazy - you haven’t got that kind of time.
-You’ll never know it all, so don’t panic when you realize you don’t. This profession is built upon learning regularly, so learn to learn quickly and efficiently. And teach what you’ve learned – it’s the best way to reinforce your knowledge and pay back those who you feel were good teachers.
-Above all, remember that you're never alone. Don't be afraid to ask for help.
A
-When starting, I wish someone would have told me that the daily grind of medical school would be the hardest thing that I’d ever done to that point.
-The smell of the anatomy lab will eventually fade. With luck, everything you learned there won’t.
-It’s OK to not know what you want to do with your life; spend your time during rotations and clerkships learning as much as you can. Likewise, it’s OK to be completely grossed out by sputum samples.
-Learn to listen to your gut regarding patients and yourself. It’s part of the art of our profession.
-Every once in a while stop to thank your support systems: parents, siblings, friends, significant others, spouses. Med school is a tough row to hoe (so to speak), and they’ve got your back while you’re cramming for yet another exam. Don’t get crazy - you haven’t got that kind of time.
-You’ll never know it all, so don’t panic when you realize you don’t. This profession is built upon learning regularly, so learn to learn quickly and efficiently. And teach what you’ve learned – it’s the best way to reinforce your knowledge and pay back those who you feel were good teachers.
-Above all, remember that you're never alone. Don't be afraid to ask for help.
A
Guest Post: You can have a child (or four) during medical school
I recently read an article in Newsweek by Dr. Nancy Andrews, Dean of Duke Medical School encouraging students and faculty to "go out and do whatever they want to do." And that reminded me that I wanted to echo that sentiment here by writing about having babies in medical school. A few months ago, I read a funny yet less than positive post on here outlining how really there is no perfect time to have a baby in medical school. There is a lot of legitimacy to that type of post: It is hard. True enough, there may not be a perfect time but that is not the same as saying there is no time. And for the nontraditional female student who feels trapped and conflicted about whether to do medicine or do to a family, there are fulcrums to that tension. You can have a child in medical school and you can do it with assurance that that baby will turn out just fine.
As I reflected on what might be helpful, I came to the conclusion that some of the best support I received along the way was hearing other women's stories. For me, it helps to have anecdotes of success to reassure me along the way. Nothing has been more uplifting than knowing that I am not alone in this journey of motherhood and medicine. It has been other women's random stories, hodgepodged together, that have given me strength, motivated me, and given me ideas on how to improve: do it differently, do it better.
The other day I was at my pediatrician's office with one of the boys. I encountered another pediatrician who was substituting that day in the clinic. "Dr. K, I'd like to introduce you to MSM, she is a med student with three boys and another baby on the way." Dr. K looked up from her chart and flashed me a huge smile. She pulled me aside and immediately introduced herself and gave me her story.
"Oh, I started medical school 8 weeks postpartum with our third child. In the summer after second year, I gave birth to our fourth. I wanted to take a year off to be at home with my kids. I suggested to the dean that if men were allowed to take a year off between second and third years to 'find themselves' that I was already 'found' and needed to cultivate it. I took the year off and returned to school; subsequently, I matched into a peds residency on a part-time basis for the first year and then finished full time."*
She then continued on as I stood there with my mouth open. Rarely do I encounter women with stories quite so similar to mine.
"If you ever feel like quitting, if you just have one of those weeks and everything feels overwhelming and not worth it, if you feel like your babies don't know who you are and you're stressed, call me. I can guarantee that I have been there. Many times, in fact. But I can tell you, for me, it has been worth it. And I would be more than happy to help if it ever comes to that for you, too."
She then handed me her number and went on to see the next patient. I have to say this made up for all the times that people have looked aghast when I tell them that, “Yes, we are having a baby. And no, it's not our first or even our second, but our fourth.” I feel like a rare irresponsible bird, which I loathe. I suspect they think I must have slept through the reproductive medicine lecture on IUDs, and what a wonderful contraceptive device they are. But ultimately, I've learned not to say anything. I often hear from fellow classmates, "I don't know how you do it. I can't even take care of myself." Despite the desire to retort, "I don't know how you go out drinking as often as you do and still make it to class, functioning no less." I decide not to. Since it's rhetorical anyway. Right?
But here's my long winded point: so far I've experienced a pregnancy in every year of medical school. I had an infant when I started first year. Halfway through that school year, we started trying for number two and ended up with a bonus (I got pregnant with twins). At that point, I took a year off to do research and to care for the babies. The following year, I returned full time and got pregnant at the end of second year. I passed step 1 and started my third year with my surgery rotation. There have been good and bad points along the way. But for me, it has been an extremely rewarding, incredibly busy, but amazing period of my life.
The chaos that accompanies four small children (or even the kids themselves) is not for everyone. I’m definitely not recommending this path to everyone- but to the women out there contemplating entering medicine but hesitating because they feel overwhelmed by the impossibility of family, school and medicine, I can finally return some of that reassurance I have received over the years. Follow your dreams: their individual paths diverge less than you fear, and you can always problem-solve ways to bridge the divide.
*I didn’t have the chance to ask Dr. K’s permission to share her story so I changed any identifiable details, though, I don’t think she would mind inspiring or reassuring anyone out there.
MSM is in her third year of medical school and has just had her fourth child. She enjoys running, cooking and being with children. It will come as no surprise that she's planning on going into pediatrics.
As I reflected on what might be helpful, I came to the conclusion that some of the best support I received along the way was hearing other women's stories. For me, it helps to have anecdotes of success to reassure me along the way. Nothing has been more uplifting than knowing that I am not alone in this journey of motherhood and medicine. It has been other women's random stories, hodgepodged together, that have given me strength, motivated me, and given me ideas on how to improve: do it differently, do it better.
The other day I was at my pediatrician's office with one of the boys. I encountered another pediatrician who was substituting that day in the clinic. "Dr. K, I'd like to introduce you to MSM, she is a med student with three boys and another baby on the way." Dr. K looked up from her chart and flashed me a huge smile. She pulled me aside and immediately introduced herself and gave me her story.
"Oh, I started medical school 8 weeks postpartum with our third child. In the summer after second year, I gave birth to our fourth. I wanted to take a year off to be at home with my kids. I suggested to the dean that if men were allowed to take a year off between second and third years to 'find themselves' that I was already 'found' and needed to cultivate it. I took the year off and returned to school; subsequently, I matched into a peds residency on a part-time basis for the first year and then finished full time."*
She then continued on as I stood there with my mouth open. Rarely do I encounter women with stories quite so similar to mine.
"If you ever feel like quitting, if you just have one of those weeks and everything feels overwhelming and not worth it, if you feel like your babies don't know who you are and you're stressed, call me. I can guarantee that I have been there. Many times, in fact. But I can tell you, for me, it has been worth it. And I would be more than happy to help if it ever comes to that for you, too."
She then handed me her number and went on to see the next patient. I have to say this made up for all the times that people have looked aghast when I tell them that, “Yes, we are having a baby. And no, it's not our first or even our second, but our fourth.” I feel like a rare irresponsible bird, which I loathe. I suspect they think I must have slept through the reproductive medicine lecture on IUDs, and what a wonderful contraceptive device they are. But ultimately, I've learned not to say anything. I often hear from fellow classmates, "I don't know how you do it. I can't even take care of myself." Despite the desire to retort, "I don't know how you go out drinking as often as you do and still make it to class, functioning no less." I decide not to. Since it's rhetorical anyway. Right?
But here's my long winded point: so far I've experienced a pregnancy in every year of medical school. I had an infant when I started first year. Halfway through that school year, we started trying for number two and ended up with a bonus (I got pregnant with twins). At that point, I took a year off to do research and to care for the babies. The following year, I returned full time and got pregnant at the end of second year. I passed step 1 and started my third year with my surgery rotation. There have been good and bad points along the way. But for me, it has been an extremely rewarding, incredibly busy, but amazing period of my life.
The chaos that accompanies four small children (or even the kids themselves) is not for everyone. I’m definitely not recommending this path to everyone- but to the women out there contemplating entering medicine but hesitating because they feel overwhelmed by the impossibility of family, school and medicine, I can finally return some of that reassurance I have received over the years. Follow your dreams: their individual paths diverge less than you fear, and you can always problem-solve ways to bridge the divide.
*I didn’t have the chance to ask Dr. K’s permission to share her story so I changed any identifiable details, though, I don’t think she would mind inspiring or reassuring anyone out there.
MSM is in her third year of medical school and has just had her fourth child. She enjoys running, cooking and being with children. It will come as no surprise that she's planning on going into pediatrics.
Monday, November 10, 2008
Too swamped to write
Well, I have been meaning to post here for months and after several good-natured nudges by our organizer I finally made it! I am amazed that you all have been able to share so much and maybe that's what I am here to share- that I've felt so swamped the last year I haven't even felt I had time to write about it. I have definitely found that as our 3 children get older I have felt that although there is a certain freedom that I appreciate in them having independence like getting bathed and dressed alone, keeping track of homework, playdates and sleepovers and reminding me about birthday parties, I also dread other aspects of their independence- like my nine year old daughter insisting on walking a mile to school without a parent when I have to race out the door to work, leaving me feeling very unsure about her safety and wanting to hold her hand all the way to school. Another whammy that came recently was when she cried so hard at bedtime saying "why do you always have to go to work and just leave us with babysitters our whole life"-- wow, that one was unimaginably painful! Like many of us I presume, I alternate between periods when I feel quite happy and satisfied w/ work and home life and then others when I feel I am drowning- this is one of those drowning times so I'll spare you all any more of this debbie-downer post and look forward to returning when I'll have something more cheerful to write about :) Go moms!
Sunday, November 9, 2008
Pretty girls don't need to be doctors!
On my last rotation, I was sharing an office with a former beauty pageant winner. She was gorgeous. And you can imagine how terribly attractive this made me feel, what with my wrinkled white coat, my shirt stained with baby food that didn't come out in the wash, and shoes that are probably similar to the ones your grandma wears. But she was such a nice girl, it was hard to feel too badly about it.
Anyway, Miss Beauty Queen was interested in going to med school.
Over the course of the rotation, I did my damnedest to talk her out of it. Every single day, I told her a different true story, some titled "Med School Sucks", others titled "Being A Doctor Sucks", most under the general heading of "I'm Really Tired". Some of those stories were lifted right off this blog. Also, she would be a little older than the traditional students and I reminded her that OMG, your biological clock is ticking! Babiezzz!!!
She was very surprised by some of the things I told her. She said that most people were really encouraging when she told them she was thinking of going to med school, especially when she told them she had doubts about it. (I was surprised by that, because I thought all doctors were bitter.)
Whenever I meet a pre-med, as a rule, I always try to talk them out of going to med school. It's not so much that I think nobody should go to med school. Clearly, there are people who are born doctors and love it. And if nobody went to med school, I'm pretty sure everyone would end up getting diagnosed and treated by Dr. Wikipedia.
So I'm not against med school. But I figure if there's something that I can say that is enough to talk a person out of going to med school, they're probably better off changing career paths now than when they have negative $200,000 in their bank account. Because medical training is damn hard and most people just don't understand that, I mean really understand that, until they're in too deep. I feel like if I can keep even one person from making a mistake, it's worth it.
On the last day of the rotation, Miss Beauty Queen told me she was going to business school.
Anyway, Miss Beauty Queen was interested in going to med school.
Over the course of the rotation, I did my damnedest to talk her out of it. Every single day, I told her a different true story, some titled "Med School Sucks", others titled "Being A Doctor Sucks", most under the general heading of "I'm Really Tired". Some of those stories were lifted right off this blog. Also, she would be a little older than the traditional students and I reminded her that OMG, your biological clock is ticking! Babiezzz!!!
She was very surprised by some of the things I told her. She said that most people were really encouraging when she told them she was thinking of going to med school, especially when she told them she had doubts about it. (I was surprised by that, because I thought all doctors were bitter.)
Whenever I meet a pre-med, as a rule, I always try to talk them out of going to med school. It's not so much that I think nobody should go to med school. Clearly, there are people who are born doctors and love it. And if nobody went to med school, I'm pretty sure everyone would end up getting diagnosed and treated by Dr. Wikipedia.
So I'm not against med school. But I figure if there's something that I can say that is enough to talk a person out of going to med school, they're probably better off changing career paths now than when they have negative $200,000 in their bank account. Because medical training is damn hard and most people just don't understand that, I mean really understand that, until they're in too deep. I feel like if I can keep even one person from making a mistake, it's worth it.
On the last day of the rotation, Miss Beauty Queen told me she was going to business school.
Friday, November 7, 2008
WAKE UP CALL
Okay, I'll just come right out and say it: I was T-boned by a bus on Tuesday and have a type III odontoid fracture. I am now in a neck brace for 6 months but lucky to be alive and not paralyzed. I cannot even begin to explain all the thoughts and emotions that one goes through - from the coldly rational (wow, this is what it's like on a backboard, in a collar, in MRI) to the wildly emotional (DAMN DAMN DAMN, there goes the concert I was going to give, there goes the clinical study that was going to make JAMA, there goes the dressage show I'm ready for, and there goes vacation with the kids in the Carribean). But the one thing that is the MOST heartbreaking: not being able to scoop my kids up into a big bear hug.
Trying to be the optimist I'm struggling with what to do with months of non-physicality. Go ahead I think, perfect that Spanish, read all the library books, type up my diaries, catch up on all the movies - but somehow it pales in comparison to the dreams I was already embarking upon and achieving. And although I'll be home (always), I'll see the kids less because I won't be taking them to piano and swim and school and birthday parties like I usually do. But it's early yet - perhaps as a result, the kids and I will have more bonding time with the hubbie and our nuclear and extended family as well as friends may become closer still.
The weirdest thing is (harkening back to psych) that my schema of myself is slow to change. I keep having to remind myself that IF I move my neck the wrong way, or trip and fall, it could be disastrous. But it still doesn't seem real until in moments of sobbing I realize it is. Now excuse me while I go cry.
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