At the Trailhead

I had so much fun last weekend Asheville. I visited a friend of mine from medical school. We hiked to Looking Glass Rock and took these photos. 

It felt like fall: leaves changing colors, cooler air, shorter days. It also signaled that my summer of away rotations was coming to an end. 

Monday I start on a different trailhead: the residency interview trail. I'll be flying out for my first interview of the season, literally a quick 30 hour stop. I'll be back in Atlanta to finish my last week at the CDC, then drive back across the country. The interview trail will begin in earnest then because I have several consecutive interviews.

Thank you for reading this blog.  I've had some kind of internet writing up since Xanga when I was in middle school. It's nice to have an audience!  

Is Downton Abbey making a case for primary care? (or is it just me)

Downton Abbey

It's no secret on this blog that I will be a family physician, as I have said in previous blog entries here. It's not secret that I believe in primary care, as I have said here.

But now I'm bringing in my non-medical life to this blog: I wholeheartedly love Downton Abbey. I have shamelessly watched every episode at least once. Downton Abbey is about a British aristocratic family of a husband, wife, and their three daughters, and their servants set in the 1910s-1920s. They have a huge mansion in the British country side. 

I tell you this because this is relevant to my medical life! Downton Abbey shows that family doctors are important. Dr. Clarkson is the GP in the village where they live. There aren't other specialists in the village because, well, it's a village. 

I won't give away any plot points from season 3 but I will say that Dr. Clarkson's relationship with the family members was important to the care he provided. In one episode, a specialist was called in by the family to assess Sybil, another daughter. But this specialist hadn't known Sybil before whereas Dr. Clarkson had known the three daughters since they were girls. Because of this Dr. Clarkson picked up on a mental status change in Sybil, another daughter, when the specialist missed it. This missed sign led to a serious deterioration in Sybil's health. 

In the most recent episode of Downton Abbey last night, Dr. Clarkson mentioned that he was proposing to the hospital board to opening an out clinic. Don't worry, this is a minor plot point so I haven't given much away. 

Dr. Clarkson: I'm just on my way to convince the board of the merits of an out clinic so people can come early for treatment. 

I think "out clinic" meant an outpatient clinic for less-acute problems. Later Robert, the patriarch of the family, dismissed at the idea of the out clinic saying that it would make people go to the doctor more often than is necessary. Basically Robert's character is old-fashioned so it doesn't surprise me that he disagrees. 

Robert: Aren't we encouraging a nation of hypochondriacs if people rush to the doctor at every twinge? 

Isobel: On the contrary I think it encourages people to look after themselves, and not become a burden. 

There, I'm quite pleased to find common ground between primary care medicine and Downton Abbey! 

Dr. Clarkson

Greetings from Atlanta

The non-essential staff at the CDC, including me, are at home because of the government shutdown. I'm supposed to be working in the Division of HIV/AIDS Prevention on a perinatal HIV transmission policies. It's really exciting stuff, though I've only been on the job for a week. So I've had a couple days off to be contemplative, or bored perhaps.

These past few months on away rotations I felt similar to when I studied abroad during my last year of college. The similarities is the constant stimulation of new experiences. There is always some new to do, a new restaurant to try, new people to meet. I'm in a new part of the country I had never been to before. I'm planning to go to a Korean Southern restaurant.

Today really felt like studying abroad because I had a Google Hangout with some classmates in Flint.When I was studying abroad I Skyped frequently with friends in the U.S. Today was actually for a med school committee I sit on, so it was for business. I've met other medical student doing this elective but it was nice to see some familiar faces of my classmates today.

Just like when I was in Denmark, I had so many new and exciting experiences but I also missed the familiarities of home. It's a bit wearing to always be navigating an unfamiliar city, always answering the same questions from new acquaintances. I never thought I'd say this but I kind of miss the Michigan fall. I find the climate here in Georgia strange.  It's literally 80-85 degrees here. It's October! I do a doubletake when I see Halloween merchandise in stores because it feels to me like summer.

I'm on my third and last away rotation of my fourth year. But I don't think I will feel like I'm home for some time. When my elective ends at the end of October, I will continue to travel. I'm planning to interview in November and December so I expect a lot of traveling, staying in hotels, and living out of suitcases yet. And still yet after that I will be living in a sublet apartment in Flint.

It had been and will be a nomadic year. Next summer I will have a place of my own, at an as-of-yet unknown city for residency. Maybe then I will feel like I am home.

I know the kind of doctor I want to be

When I think about all that I've done in the past few months I feel giddy like I'm in love. I'm currently in Chicago on an elective rotation. Before that I was in New York City for another elective. They were in family medicine and reproductive health.

It's wonderful because I'm learning all the things I want to know. During the last couple months I think I've better than the average 4th year student at placing a speculum and finding the cervix. I probably get it 9 times out of 10! Too bad I can't write "pretty good at finding the cervix" on my CV. I'd really like to. I'm proud of it.

It's wonderful because I feel I'm going to provide a really necessary service as a doctor. I had a patient thank me even though I really didn't do anything. I told her my name and, "I'm a student doctor working with Dr. So and So." Then I basically stood behind the doctor. But I feel very touched by this, more so than a lot of my other achievements because I think she really meant it.

It's wonderful because I'm meeting people like the kind I want to be, attendings, residents, and people who share and support my passions. They understand reproductive health and reproductive justice. They get it. They're really smart and down-to-earth.

Surprisingly, I've been treated better on my electives. Being treated like a person is something I believe all people deserve, even medical students. I hope it's because I know more medicine now because I do. I hope it's because I have better articulated what I want to do as a doctor because I have. I also hope it's because I've found "my tribe" because I have.

I will be applying to family medicine residencies that include training in family planning and a strong academic component. In the long run I'm hopeful that I will do all the things I care about: be a good full-spectrum primary care doctor for my patients and a proponent of this work via research or public health or advocacy.

80 hours

I was going to write about how the following week will be nightmarish for me because I have three calls in seven days. I thought to myself, that is SO MANY HOURS so I will add up the hours in quantify my misery and self-pity. 

(Call is when you get to the hospital at the regular time and stay at the hospital longer than than usual. For me the calls are until midnight.)

So I added up the hours I will be working. 

Monday       7a-12a 17 hours

Tuesday      7a-5p   10 hours

Wednesday 7a-5p   10 hours

Thursday     7a-12a 17 hours 

Friday         7a-4a     9 hours

Saturday     OFF!! 

Sunday       7a-12a  17 hours

It's 80 hours. 

I'm free* Friday at 4pm all the till Sunday 7am! That's 39 hours! 

*I'm going to sleep and study for an exam I have the following Tuesday. 

I thought to myself only 80? I thought it would be more hours. 

Then I realized that medicine has so messed with my mind because I think 80 hours shouldn't be that bad. Residents work 80 hours/week ALL THE TIME. There have probably been only a few others week in my third year that I have been at this hospital this much. So basically I felt like I shouldn't complain now because it's going to get worse when I'm working 80 hours/week for many months. 

two things

Yesterday my housemate told me that I looked like I was really tired and stressed, to which I replied, "It's because I really am tired and stressed." It's been a really difficult past couple weeks in part due to my rotation schedule and figuring out what specialty I want to do. 

But there are two things that make me happy:

1. I'm going to be a doctor. What kind of doctor, I don't know, but a doctor with MD after my name. 

It's very like that I will finish medical school and get a residency position somewhere barring any disasters in the next 11 months. Of course there are programs that I think will better fit my goals and those are competitive. But so far I'm pretty sure I'm going to match somewhere. I feel that I have (almost) survived the brutality of third year because I have only 4 weeks left, even though it's going to be a miserable 4 weeks because I have q3 call for the next two weeks, then the shelf exam, and then moving out of Flint. 

2. I have friends and friends of friends who don't even know me at all who have offered me housing during my away rotations. This has been a huge source of stress removed. Thank you. 

Advice for recent college grads and me

I usually don't read advice letters to recent college grads because I'm not a recent college grad but mostly because I find them insipid drivel. But this from Jezebel spoke to me because I have been thinking a lot about what specialty of medicine to put down on my residency applications this September. 

I don't want to turn you into a misanthrope at such a tender age, but listen: most people do not have your best interests at heart. I now see that most of the idiots who told me I'd surely fail were projecting their own insecurities onto me.

I knew that all the people who told me that I should choose one of the ROAD* specialties weren't giving me good advice. Nobody has said that I would fail if I did any other specialty, but they have given me this look of pity, like I'm going to be miserable and disillusioned in a couple years time. (Radiology, Ophthalmology, Anesthesiology, Dermatology. These are very high paying specialties with comfortable work hours.)

When I think about the next few months: moving out of Flint and going to an away elective IN ONE WEEKEND, endless traveling for electives and residency interviews, graduating from med school, interviewing for residency, starting residency, having real responsibilities to keep people alive, I'm so overwhelmed! Then I felt better when I read this:

I've slowly gotten better at dealing with overwhelming responsibilities and terrifying experiences because I've been through similar overwhelming responsibilities and terrifying experiences before and I know I'll pull through. 

When I think back on the past few years, I have already so much that was overwhelming and terrifying, like pass Step 1, move to Flint, work with doctors, talk to real patients, navigate a hospital. That was all SO terrifying but I've made it to today. And that is a little bit reassuring. 

I don't want to wear a white coat.

When I was a second year medical student, I volunteered at a primary care clinic called Care Free. On my first day, I brought along my white coat and stethoscope like I did for every situations where I expected to see patients. I was working with an older medical student there who told me, "White coats are actively discouraged here," and had me set it down in the office for the rest of the afternoon I was there. I was a little confused at first but none of the other doctors, residents, or medical students there had white coats and I didn't want to look like an anomaly.

I think the non-medical public associate closely white coats and doctors. Even before my third year of medical school, I thought I would like wearing a white coat. 

Now that I am more familiar with the medical field, I hate white coats. I want to disassociate them from medicine. For me, the white coat represents an attitude to patients. It means that I'm really smart and important and you must talk to me. I'm more comfortable talking to patients when I'm not wearing my coat. 

This was actually one of the reasons I disliked my Internal Medicine rotation. Everyone wore white coats all the time. When we were rounding, I felt the residents, attendings, and students were ghosts huddled together and whispering. 

When I am I doctor, I will get some more freedom to decide the kind of practice I want. I'm sure that don't want to wear a white coat. 

To specialize

When I introduce myself as a student to patients, the more pleasant patients respond by asking what kind of doctor I plan to be. (There are much less pleasant ones too.) I say that I haven't decided yet.

One patient's family member told me, "Don't specialize."

I was so confused by this. I explained that the purpose of this year of medical school is to experience different specialties. He then explained that he thought I should do "general practice". I explained to him that family medicine is a specialty, so when I said that hadn't decided what to specialize in, I meant that family medicine was still on the table.

I was irritated because it was another example of the fact that family medicine is misunderstood. This was evident because this person didn't consider it a specialty. I see how people think that family docs are less "specialized" because they are see pediatric to geriatric patients. Most specialities are based on either patient population (e.g. pediatrics, OB/GYN, general internal medicine) or organ system (e.g. every field ending in -ology.)

Family physicians are specialists. They specialize in care for  all people with an emphasis understanding the patient's family and community. It saddens me that people don't think it's a skill to understand patients, to be engaged in the patient's community, to advise patients on lifestyle changes, to keep people healthy in the first place.

I also don't like it when people who don't know me at all think they should tell me what to do. I understand that probably they are trying to be nice since they're engaging me in conversation at all. This is better than complaining that they don't want to be seen by a student. But I don't think it's necessary for people to pinpoint what specialty I should do. I hate "advice" like that.

The best thing they could say to me also seems to be the most rare: 

I hope you find what makes you happy and good luck.