Trip To Betty Ford Institute In My Future

    I was three and she was 24 when we left – for years the alcohol and drugs precipitated the fighting, which brought on the feelings of guilt, which inevitably lead to more drinking. It was a vicious cycle that had to be broken and, no matter how much my he begged my mom not to leave with me, she knew we couldn’t stay.
    He’s a good man, my dad – a smart, hard-working, exceptionally talented man with a detrimental disease that makes people look at him differently when they find out. Two months after we left he checked himself into a rehab facility and, when they deemed him healthy enough to leave, he started taking me along to his weekly Alcoholics Anonymous meetings.
    I get my determination and persistence from my dad, an addict who has been clean and sober now for over 20 years.  I have a deep desire to be the doctor who knows addicts are real people who can be helped, a doctor who is compassionate to the struggles of those with substance-abuse issues and understands that addiction is a disease. One thing I don’t want – to be the doctor who passes over these patients as “drunks” or “druggies” who are passed the point of being helped. After all, there’s a good chance my dad wouldn’t have been around to walk me down the aisle two years ago had someone not believed that, when he finally hit rock bottom in 1989, he could still be helped.

I never got around to writing a post for my amazing Dad on Father’s Day, so I’ll talk about him a little here*. He has overcome so much for me and our family – fighting through the tough hand of addiction and trials he was dealt in his early 20’s, he managed to come out on the other side as an inspiring story of success. He truly is one of the most unfaltering and inspiring people I’ve ever known and I’m so lucky to call him “Dad.”


The fight he fought and the journey we travelled together inspired me to apply for an opportunity that promises to be life-changing – a week at the Betty Ford Institute during my Psychiatry rotation. A big-hearted donor, who fought addiction himself, sponsors four of our third-year students to spend time learning about addiction treatment at the world-renowned Betty Ford Institute during their Psychiatry rotations.


Along with @BChanMed and two others from our school I’ll be spending the last week of August submerged in addiction treatment. Although the other patients will know we are at the center for a learning experience and despite the fact that we will have lectures geared at treatment from a physician standpoint, a large part of our week will be active participation in the unique treatment program put forth by the center. We will learn the ins and outs of treatment by participating first hand in small group and counseling activities with other patients who struggle with various addictions.


The Betty Ford Center is the only US addiction rehab facility currently offering a program like this for medical students and I am so honored to be a part of the Summer Institute for Medical Students


First hand participation has been proven time and again to be pivotal in teaching us to be great physicians, but personal experience has taught me that physician-training in the area of addiction treatment is lacking, to say the least. It is not just those of us who choose Psychiatry as our specialty who will interact with people struggling with substance abuse or addiction – these are afflictions felt by patients from pediatrics to geriatrics and everywhere in between. I am so grateful to have this medical education opportunity and I hope that other programs will take note of the Betty Ford Institute’s revolutionary initiative and increase the number of medical students offered this opportunity by following suit to create similar programs. 

I anticipate a life-changing look into how professionals go about treating those who struggle with addiction and also help in teaching their family to be assets of rehabilitation. I am confident that I can take what I learn in my week at the center and translate that into compassion and understanding for the benefit of my future patients and I hope that this experience will enable me to be a better doctor, a better daughter and a better educator.


*My Step-Dad is also a huge influence in my life and if I were writing a post for Father’s Day he would most definitely be included. I’ve written a bit about him & organ donation advocacy here

Always Zip Your Backpack Pockets…

or risk losing your favorite study snacks to a vicious predator with long hair, big eyes and a wet nose that is apparently ridiculously good at it’s sniffing job.

Do I look sweet & innocent? Good, that’s what I’m going for…
I’ve often discussed the fact that I own dogs who could, if canine-psychiatry was a real life field, likely earn themselves a diagnosis of Oppositional Defiant Disorder. Generally, when I’m talking about my dogs thieving things it’s in reference to our Red Heeler procuring balls and other toys from the neighbors’ yards using her superhero-like skills to scale our 6-ft wooden picket fence…


but not this time.

In addition to supplying us with uncharacteristically good food, the hospital cafeteria attached to my medical school conveniently stocks little packages of peanut butter to put on toast and bagels. Occasionally when I eat there I will have a random package of peanut butter left over and I have taken to throwing them in my backpack with some saltines for a high-protein snack during study hours.


At home our office is the first stop from the back door after you make it through the laundry room and as such my 480 lb. backpack generally ends up living in the most convenient place to drop it when I come in from a long day of studying – on the floor by my desk.

I had been studying at home one day and, being the irresponsible dog-owner that I am, was paying more attention to charts on renal function than I was to Wrigley, my youngest “child,” and the un-zipped backpack sitting right next to me. A little bit later I walked into our bedroom and noticed shredded white paper all over the floor. At first glance I had no idea what it was and, since this dog’s favorite past time seems to be destroying paper towels and dryer sheets, I ignored it under the assumption he’d been dumpster diving again. Then…I smelled peanuts…and noticed this laying on his bed:


I walked back into the office to find a furry white body hanging out of my backpack, the head presumably attached to the front end of said body completely submerged in the front pocket of my backpack searching for a second peanut-buttery treat for the day:

I guess he knew I was about to steal away his tasty treat, so when he noticed me taking pictures he took off running. I tracked the deviant creature down in the kitchen and, naturally, snapped a couple more pictures before snatching away the prize he was so obviously proud of. 

Look Mom! It’s delicious, you should try it…
Not to worry, I was so proud of the little dude’s first cranial nerve and the fact that he had tracked down peanut butter at the bottom of my backpack and formulated a way to rip through the plastic packaging to eat all of it without me knowing, that I opened the package and let him and his sisters chow down. 

What can I say? I’m a bit of a pushover.

And the moral of the story is…
peanut butter is irresistible, zip your backpack pockets.

First: Do No Harm…Even To Colleagues?

Like many others I recently read a New York Times Op Ed piece entitled “Don’t Quit This Day Job,” written by Dr. Karen Sibert and I was immediately taken aback by what she had to say. I wanted to write this several days ago, but as anyone who has spent half a second perusing my blog or Twitter knows, I’ve been severely busy losing my mind for the past several weeks.

The first thing that struck me about this piece was not that she was stating her opinion, but that she chose to take the route of justifying her opinion by saying that medical education was “subsidized” by the government and women working part-time were the reason there was a shortage of physicians. She took two hugely complicated and multi-faceted issues, chiseled them into pawns that worked for her argument and held them up as shields for her below-the-belt shot at other women, all the while ensuring she herself came off as the martyr.

What I don’t understand is where she gets her basis for blaming the physician shortage, a crisis we can all agree did not start yesterday, on women working part time. She states that the part-time work force has grown 63% since 2003...two-thousand-three
…meaning, people started going part-time in large quantities well after we had identified that there would be a primary care physician shortage. There is so much more to this problem – to take a national platform like the New York Times and use it to place the blame for such a massive, cumulative problem on women working part-time is wholly and incredulously irresponsible.


It is ironic she chose to point her finger only at part-time women physicians with children, as if there are no men who are part time for their kids or no people of either sex who are part-time for other reasons (like research, academia, continuing education, volunteering, writing books or NYT Op Ed articles scaring females out of medicine, etc.).

Her choice to blame part-time women in particular makes it obvious that this article is less about the physician shortage or lack of healthcare and more about pointing her “you are weak” finger of medicine at the new generation of physicians and standing up on a pedestal to wave her holierthanthou
flag.

As a current female medical student I am well aware that medicine is a field in which it will be difficult to find a work-life balance. Coming into this we are not jaded to the fact that work-life balance is hard, nor are we ignorant to the fact that the generations of physicians ahead of us view medicine differently than we do. Dr. Sibert brings up some great points in her piece, but spends most of her time blaming this or that on other people.


Saying it is hard to find life balance is not the same as placing a blanket statement over women that they should not go into medicine if they are not going to work full-time. For one, it’s irrational – many medical students start medical school unmarried and not considering children…those people have no idea where life will take them in the next 10 or 15 years – life can change drastically in that time. Dr. Sibert judged an entire group of women whose lives have not been as easy as hers – women who went to medical school and decided they wanted kids but didn’t have the help she obviously had. She chose to use her platform as a place to pin these women as being less strong or less dedicated than she, while overlooking that you can be dedicated to medicine and still put your family first.

What is obvious in her writing is that Dr. Sibert either had the luxury of a nanny to raise her kids or had a husband and family who could pick up the slack when she was working “full-time.” It’s easy to judge from that side, when you’ve never lived 400 miles away from your entire family, been a primary care physician who didn’t make enough money to hire a full-time nanny, found yourself suddenly a single mother or the parent of a child with a disability requiring full-time assistance…or simply decided your family wasn’t going to be put on the back burner.

It was irresponsible and unfortunate for her to choose to address a subject warranting so much discussion by placing the blame of the current physician shortage on women who work part-time. Where she could’ve stimulated productive conversation, she instead shattered alliances and discouraged female physicians. Her words are absolutely and incredulously wrong and her assumption that these women are less dedicated to their profession is blatantly out of line. The blame for the physician shortage doesn’t go to part-time women, it goes to a culmination of events that have played out beginning many years ago and including, but not limited to, decisions made by politicians.



It is commendable, from a professional perspective, that Dr. Sibert has chosen to work full-time. However, it is also commendable from a parenting perspective those that have sacrificed themselves to do what they felt is right for their children. These are not situations requiring blame or shame, they are choices. Dr. Sibert is blessed to have a job she loves and a family with enough support that she can work full-time in that field. Many of the “part-time” women she is referring to still work 40 hours/week…an amount considered full-time by most all standards. They are doing the best they can – for their patients, their family and their colleagues – they don’t deserve the blame given.

If nothing else Dr. Sibert has done a supreme job of building a huge wall between her generation of physicians and my generation of physicians when we need their mentoring and guidance the most. We aren’t here to be judged, we’re here to live our lives and learn how to be the best doctors we can. From there, we will make the best decisions we can to ensure we stay good physicians by maintaining not only our skills, but our personal mental and physical health…even if that means less hours per week than Dr. Sibert. It saddens me that she has discouraged potentially great future female physicians from choosing medicine as a career path and, frankly, I expect more out of her as a woman, a mother, a mentor and, mostly, as a colleague.


Images Courtesy of Sura Nualpradid.

Medical School in the UK, Residency in the US

Today’s Medical Education Monday post is one I have been looking forward to reading since he offered to write it for me a few weeks ago! Nick Bennett (@peds_id_doc) is a Pediatric Infectious Disease Fellow in Syracuse, NY and he has a very unique perspective to share with the Mind On Medicine readers today. Dr. Bennett went to medical school (and got his PhD…overachiever…does that mean we call him Doctor Dr. Bennett? I think it does.) in Cambridge, UK, but chose to do his residency in the United States. Medical school in one country, residency in another – what a unique and valuable addition to to this series!! In addition to being a bug-killer extraordinaire, he is interested in teaching communication skills, antibiotic stewardship and software-driven data analysis (from what I’ve gathered on Twitter he’s the owner of some geeky computer skills – something I’ve come to regard highly after marrying a software developer – that stuff is no joke). I hope his information can help someone looking to do something similar, but I can assure you that his story is a great read even if you never plan to practice medicine somewhere other than your country of training…actually even if you never plan to practice medicine at all.

I’m in the interesting position of someone who went to medical school in one country (UK) but completed residency in another (USA). My reasons for doing so are, on the surface, fairly simple (my wife is an American) but it goes a bit deeper than that. One issue that was important was the fact that in the UK the junior doctor jobs often involve moving from hospital to hospital, spending only a few months in the same place. The alternative was to move once and stay at the same hospital for several years. It seemed like a simple decision!

The problem I immediately ran into was – just how the heck do I do this? There was absolutely no careers advice for those of us who wanted to leave the NHS (National Health Service). I’d even been to careers advice forums where the speaker opened with, “This is really for all the scientists here, as doctors have it pretty much sorted out.” Yeah, thanks.

Searching online revealed two basic hurdles – exams and visas. The US assumes that every other medical school in the world has exams that aren’t reliable. You not only have to graduate from your medical school (if it is on the list of acceptable schools!) you have to pass US medical school exams as well – the USMLE Step 1 (the test I take Friday
and 2. For most people this is an annoying formality, but there are two issues here: Step 1 is basic science – you may be many years from your pre-clinical training and hence quite rusty (as I was) by the time you take it – and Step 2 has a heavy US bias, so you have to re-learn minor facts of epidemiology as well as have a basic knowledge of US geography and the medical conditions, typically infections, that are more common in certain states.

The exams are required for certification by the ECFMG – the Educational Commission for Foreign Medical Graduates. Along with your medical school records, passing the Step exams is needed to obtain ECFMG certification, which is required to start a training program in the US as a Foreign Medical Graduate (FMG). It is quite expensive in terms of fees and exam costs, but if you want the training you have to invest the money.

The second issue of a Visa was one I was thankfully helped with by marrying an American! The more typical approach is to obtain a H1B or J1
training visa. These are sponsored by the residency program or the ECFMG, so you have to have been accepted by the program before that can move forward. Not every program will sponsor training visas so focus your efforts on those that do. FMGs are often at a competitive disadvantage compared to US graduates, but some programs are very supportive so it can pay to do your homework about a particular place to find out how they stand on that issue. If you have contacts in a residency program in the US that’s probably the best way to get the inside scoop.

I was very lucky in getting the program I wanted – I was taken “outside of the match” which means I didn’t have to deal with the NRMP (National Resident Match Program), which I gather can be quite stressful and complex, especially for non-US graduates. As such, I’m rather odd in that I can’t offer any advice on visas or matching! I did it through networking and spending time here as a student doing an elective. That kind of exposure is priceless when it comes to applying for a residency position (spending time doing away rotations in places you want to do residency is sound advice for ALL medical students, not just for those looking to go to a new country to finish their training)
.

There are a few websites out there with advice on moving to the US. They’re worth reading to be prepared for some of the inevitable culture shock. Oddly enough, the effect was perhaps weirder coming from the UK. Enough of the lifestyle and society was similar to the UK that when something WAS
different it seemed more of a surprise. Silly things like having to add sales tax onto prices and paying for checking (current) accounts were hard to get used to,  you get used to it, though.

Once I was here a few things became quickly apparent. The first was that although it seemed as if my medical school training gave me an excellent basic medical science background, but I felt wholly unprepared for actual patient care. The US students were given more responsibility and seemed more involved in patient care that I had been. The other FMGs that were starting with me tended to have already completed a residency in their own country. I was lucky in having a graded experience working up from the newborn nursery to the ER and excellent senior residents, but I know that had I started out in the ER things might not have gone so well! My learning curve was near vertical, but I kept my head above water enough to keep going. Once I was settled in it was also clear that despite all I had heard about the “evil US profit-driven healthcare system”
, the actual practice of medicine was basically the same as it was in the UK. Docs still made decisions based on best practice and in the patient’s best interests, at least in the academic setting. Only rarely did insurance ever come into play – usually when patients didn’t have any and we had to cut corners to save them some money.

Later, as a Fellow, I ran into the issue far more frequently, when having to obtain “prior authorization” for treatments that insurance companies would rather not pay for. I’ve also heard and seen more discouraging practices from the non-academic world, which although not unique to the US are far less likely in the system I came from. Everything from pharmacy costs to malpractice premiums is shifted upwards, and it’s easy to see how the US ends up spending twice as much as any other developed country for no additional benefit.

There were several advantages to coming here that I really didn’t anticipate. Back in the UK I recall asking my research supervisor how I could get to be someone like him. He replied that I should focus on medicine for the first 10 years or so before trying to come back to research. When I asked the same of my mentor here in the US he said “Well, you’ll have to wait until at least the second year of Residency…!”  As it happens, in my Intern year I started writing online medical review topics, helped out with clinical trials and started a new medical education initiative for the students. It seems as if people are very willing here to support junior doctors in the kinds of extra-curricular activities that would otherwise have to be put off for years in the UK. That’s not to say that every FMG becomes a world-famous clinical educator or researcher, but that it just seemed to me that the opportunities were better for me here. In addition, it’s very clear that people do all kinds of things with their medical training here. In the UK I felt as if I was being channeled into the NHS and it seemed there was no way to easily merge education or research into my daily activities. In the US it is equally valid to choose private practice as it is to choose academics, industry, or government work – in fact, many mix and match.

I think I got a great education from the UK, and I didn’t leave specifically because I couldn’t get what I wanted there – it was for personal reasons, but it turns out that making this move to the US was a really great professional decision, too.


Past Medical Education Monday Posts

Medical School in the UK Post

What Is USMLE Step 1, Anyway?

I’ve been tweeting things like USMLE, Step 1, ginormous exam, boards and ohmygoshimfreakingout a lot lately and today it occurred to me that a good number of my followers are not in medicine and may have absolutely no clue what I’m talking about. I wrote a little about USMLE in my Medical Education in the US post, but I thought I’d share a bit more detail about the reason behind why I won’t be tweeting next Friday, as I’m sure my absence will be painfully obvious (addicted, me? oh, stop it).

Original Photo Courtesy of Flickr Creative Commons User: WaltStoneburner

United States Medical Licensing Exam – Step 1
There are 3 Steps taken over the course of one’s medical education, the first, which is what I am about to take, is after your second year* of medical school. This exam is basically a final over what you learn your first two years.

Cost:

$525 for the exam itself, additional if you take a review course. Most choose to take some sort of review course, but not everyone. A good chunk of my classmates chose Doctors In Training, which is basically as inexpensive as they come at $770 (or approximately the amount of money I have spent on caffeine and ibuprofen in the past 6 weeks).

Length:

322 Questions divided into 7 blocks of 46 questions
60 minutes alloted per block, 15 minutes for tutorial, 45 minutes for break time
Total – 8 hours

Subjects:

  • Anatomy
  • Biochemistry
  • Histology
  • Physiology
  • Neuroscience
  • Psychiatry
  • Genetics
  • Pathology
  • Microbiology
  • Pharmacology
  • Molecular Biology
  • Immunology
  • Statistics
  • Epidemiology
  • Medical Ethics

Scoring:
Passing: 188
National Average: 221 with a Standard Deviation of 24 (for 2010 test-takers)

So, you just have to pass, right? Right.


Well, kind of…


We are required to pass in order to progress on to third year, this is true. However, the score on this exam is heavily weighted for residency applications. There are a lot of other things that go into residency apps but…let’s just put it this way…Step 1 is not the one you want to blow.


When you finish Medical School you do a residency in your chosen specialty…assuming you are accepted into it. Here’s some average USMLE Step 1 scores for US Seniors accepted to various residency programs in 2009:

  • Dermatology – 242
  • Family Medicine – 214
  • Emergency Medicine – 222
  • General Surgery – 223
  • Obstetrics/Gynecology – 220
  • Orthopaedic Surgery – 239
  • ENT Surgery – 241
  • Pediatrics – 219

Average scores will obviously vary from program to program, with those affiliated with bigger name hospitals and research institutions tending to have averages that are a bit higher.

The problem with quoting all these averages and determining the score you “need” from them is that most second year medical students have no idea what they want to go into and, to avoid not being competitive for something they end up enjoying, are under a lot of pressure to get the best score possible (which, I mean, we’re medical students…I think it’d be safe to say we’d all put that pressure on ourselves even if we were planning to graduate and become Stay-At-Home-MDs).

So, that’s what I’m up currently up against and it’s also the reason I’ve been using Twitter to study with other nerdy med students by tweeting things like “Acid Fast organisms, go!” and discussing everyone’s responses. So, if you’re not a geeky medical nerd in your 2nd year of med school and you’re still following me come June 17, thanks, you’re kind of awesome.

Next Friday, while my sister-in-law is delivering our brand new little niece (with the help of a talented Obstetric surgeon who was likely sitting right where I am not so long ago), I’ll be clogging my external auditory meatuses (quick med geeks, name the associated embryonic structure!) with squishy earplugs, parking my rear in a chair for 8 hours and praying that my contact doesn’t fall out**. Happy thoughts welcome!

Now, if you’ll excuse me, I have some studying to do…

Original Photo Courtesy of Flickr Creative Commons User: Wysz
*Some schools have recently gone to a slightly different schedule, where the first 2 years are condensed to 1.5 years…I’m not sure when they take their exam).

**True Story: My contact fell out the day of my med school interview at the school I now attend. I had to leave the presentation (being given by the Dean of Admissions, no less) to go to the admissions office and find someone to take me to where all the interviewees luggage was stored. Then I had to shift through 40 people’s stuff to find my suitcase, rummage through random clothes & shoes until I got to my extra contacts (look at me thinking ahead – extra contacts, check) and then find a bathroom so I could wipe the scary black streaks created by mascara and contact solution off my very red cheeks. 

Why I Don’t Blog Anonymously

In my last post, the one in which I temporarily lose my mind and decide to take on a slightly controversial and hugely important subject as my next blogging endeavor, I discussed how it seems some are lagging behind in seeing the benefits of Social Media in the realm of Medical Education. Today I’m going to talk about what I see as an important aspect of my personal Social Media experience – anonymity, or lack there of. Next time, I’ll introduce you to some tweeters and bloggers who have impacted me and try share a few of the really great responses I received on my last post. 

Photo Courtesy of Flickr Creative Commons User: iamtheo
People have written anonymously for as long as publishing has had a place. Samuel Langhorne Clemens, Charles Lutwidge Dodgson, Eric Arthur Blair…* Not ringing a bell? I bet you’re familiar with their writing…

The Adventures of Huckleberry Finn or Tom SawyerAlice’s Adventures In WonderlandAnimal FarmNineteen Eighty-Four – any of those sound familiar? I don’t think anyone would argue these works being written under pen names, which is not so different than the current trend of establishing an anonymous, yet prominent and consistent, online identity, led them to achieve less than their maximum level of influence. However, they also did not become classics because they were written under pen names.

Obviously, I choose to blog without anonymity. Having my name permanently attached to everything I write makes me consider a post just that much more before I hit “publish.”
Without the mirage of personal protection anonymity brings I will never feel justified in writing snarky or compromising details about patients or using this public domain to vent my frustrations concerning colleagues or classmates. That is not to say that all anonymous writers use their space in that way, but I can think of at least a few prominent medical bloggers who abuse their anonymity as a method of personal protection in order to mistreat or poke fun at their patients.

This blog isn’t really about medicine or patients anyway, in fact I don’t think I’ve ever even blogged about a patient encounter. Mind on Medicine is really kind of a confused blog floating around a big blog-sea, transitioning between personal stories, education endeavors and bad attempts at humor without picking one category to dive head first into.

Photo Courtesy of Flickr Creative Commons User: Erichhh
I enjoy not being anonymous for several reasons, not the least of which being I’m not nearly creative enough to come up with believable and interesting stories that don’t give away information about who I am. As an example of effective anonymous blogging I’ll share with you Apotential, one of my favorite med student blogs. As a comment on my last post the author of Apotential made a great point about anonymous blogging and specialty choice that had never crossed my mind:
“I’ve actually thought a lot about un-anonymizing myself, but in the end, I’m too interested in psychiatry to take that chance. Most physicians can get away with having a professional personality or voice, but psychoanalysis requires anonymity even in the analytic session itself. (Not saying that’s my future career, but I sure haven’t ruled it out yet). So I’m anonymous as far as google is concerned. If I end up going into something else, I’ll eventually de-anonymize. :)”

Other reasons people shared included things like fears of repercussions when applying to residency or jobs, not being comfortable with colleagues reading their writing, protecting family/friends and the very real threat of writings being used against us (out of context) in the future. Personally, I think these are all really great reasons to blog anonymously.

While in my eyes all the reasons for blogging anonymously may seem insignificant when compared to the actual process of keeping a blog anonymous, others may value their anonymity to a greater degree. While I would rather have my writing out in the open when I apply for residencies, because I feel it’s an asset that contributes to me as a whole, others may be more cautious due to the fact that not everyone in this field has caught on to just how beneficial the use of Social Media can be.

I am fully aware of the very real chance that I may someday need to verbally back up not only how I share my thoughts and experiences, but also why I share them. I’m not so naive to think that publishing my writing online will never prompt a negative response, but it’s a chance I’m willing to take in exchange for all the great things I have gained from having a presence in Social Media.     

Or maybe Danielle Jones is just my pen name…



*Mark Twain, Lewis Carroll, George Orwell