Why Do You Blog?

The past week I’ve been meandering down the interview trail hoping to avoid death by dysentery along the way…ugh…wait…wrong trail.

Anyhow, I really have been traveling around Central Texas the past week for residency interviews and along the way the most commonly asked question has been:

“Why exactly do you blog?”

Most often the question has been posed with genuine interest and good intentions, but it has been occasionally paired with a single raised eyebrow and skeptical tone. Both reactions I understand and both are great reasons for me to address the question here. Would it be appropriate to refer someone to a URL mid-interview?

No? Oops…maybe I really have been in the blogosphere too long.

So, here are the 6 best reasons I can come up with on this half-cup of coffee I’ve had:

#1: I enjoy it.

I initially started writing in this blog 2 years ago (holy wow, have I really been typing random rants and information for two full years? You people are so tolerant.) because I felt like medical school had sucked the creativity out of me. I can’t paint or draw (except those awesome stick figures cursed with Streptococcus agalactiae and Pseudomonas), so naturally blogging was my only option.

#2: Before medical school I worried…about work-life balance, about studying, about family.

I feel like I have a perspective to share that would’ve given me hope as a pre-med. I wanted to write about whatever we might sit down and talk about over coffee. I wanted to show that a work-life balance was not impossible for a woman in medicine and I wanted to share my experiences. Everyone doesn’t go to medical school, but a lot of people seem to be genuinely interested in our experiences here, particularly those considering a career in medicine. This feeling to share the possibility of balance in medicine became even more urgent after seeing that everyone was not promoting the fact that it is possible.

#3: Our patients are online…and they have so much to teach us.

I feel like I’ve now written ad nauseam about the utility of hearing people’s stories…feel free to hop on over to “Following Patients On Twitter…” or “What Medical School Doesn’t Teach Us” for my take on learning from patients online.

#4: Our pateints are online…and they have a right to reliable information.

We have this unique opportunity to share information on things we are passionate about and know to be evidenced-based, like flu shots and how they’re safe in pregnancy or the fact that endometriosis is related to infertility. Though I don’t blog in this manner too often at this point in my career, I do plan to share more health information in the future (you know…when I’m really a doctor and stuff).

The bottom line is our patients are going online to find their health information and, in my eyes (and the eyes of some awesome health bloggers like SeattleMamaDoc) that means we have a responsibility to be online with them.

#5: It’s a fun challenge.

Make no mistake, friends – maintaining a blog is no easy feat. It’s a fun and interesting endeavor, but it does take some time and patience. I’ve enjoyed seeing Mind On Med evolve into what it is today and I’m excited to see where it’s headed in the future. I love the challenge of putting my thoughts into words and of designing and orchestrating the back end of the blog. It’s exciting to see what posts get a lot of chatter on the Twitters (usually not the posts I expect) and it’s fun to hear others opinions on what I have to say.

#6: I get to learn from people I never would’ve met if I wasn’t online.

I’ve interacted with people from more countries than I can count, specifically through the Medical Education Monday series. People from all over the world have taught me what it’s like to train to be a physician in their country and I’ve had the opportunity to share it with y’all. I’ve also had the chance to meet (or “meet”) medical students, doctors, and other providers from around the US and learn about how medicine is practiced in different parts of our country. These are not conversations I would have had without my involvement in social media and I think there’s a lot to be said for a tool that makes it so easy for us to step outside of our little bubbles…and comfort zones!

Why are you involved in social media and/or blogging…as a patient, provider, or student? I’m interested to hear what keeps you coming back to the wonderful web-world every day.

Stanford Medicine X – Student Voices

20120930-104433.jpg

Let me start off by saying I’m learning so much at this conference. Dr. Larry Chu has done a fabulous job organizing and orchestrating, a true class act of knowledge, technology, and passion.

Everything about this conference has me nodding my head and saying, “Yes! THAT is why I’m involved in social media & health technology.” Med X has maintained a human side by giving a loud voice to patients, something I think is incredibly important to maintaining compassion in healthcare, and still managed to be on top of medical information by including a great mix of emerging health technology.

We’ve heard from patients, investors, lawyers, doctors, professors, engineers, computer scientists…all kinds of people.

So, what’s missing? The voice of students.

I’m so disappointed in the lack of involvement given to those of us in the throws of medical education. We are here. We are watching. Many are even help organize and offer ideas to the planning of the conference. But, we have no voice…

This is not a new thing at medical conferences, medical students and young physicians (residents, newly practicing docs) are often left out of speaking positions and panels. Perhaps it’s due to time and money constraints. Or maybe the reason is that we don’t have the expertise that many of these wonderfully seasoned docs have and we aren’t a traditionally valued opinion group. I don’t think those are great reasons, though. In fact, I think that lack of experience is a great reason we should have a voice.

Why do we deserve a voice?

We are in a unique place in our lives – not quite general population, but not quite healthcare provider. We still have the idealism that not fully understanding the medical system allows, but we have enough insight into the medicine to express ideas that are consistent with medical practice.

Why are we valuable in the ePatient realm?

One of the biggest echoings I’ve heard from the amazing patients here is that their stories aren’t being heard by their providers. I talk a little in this post about our role as medical students allowing us to be more present with patients. We have time to listen to patients. We are afforded an opportunity to hear their stories, because we don’t have 25 patients to round on – we have 2. We can offer an infantile medical perspective mixed with a healthy naivety of knowing patient stories.

We deserve a voice at these conferences, because we have a lot to offer. We deserve a voice, because we are the future. We deserve a voice, because sometimes being an expert isn’t always the best way to develop new and innovative ideas. Steve Jobs could’ve told you that.

Following Patients on Twitter – The Other Side of the Chief Complaint

I recently tweeted asking about favorite patients, physicians, and students on Twitter and was met with a plethora of shocked tweets at my inclusion of patients as potential Twitter interests.

Perhaps other medical friends interpreted this as being similar to meeting people in clinic and asking for their Twitter handle (which is not something I do) or maybe people really think it’s wrong to follow patients on Twitter, I don’t know. However, I do know y’all should be aware of why following people who tweet about their medical problems is beneficial to me as a future physician.

I don’t follow all that many people on Twitter – I find it overwhelming to keep up with too many people. Dr. Vartabedian at 33 Charts expressed my sentiments on this perfectly in a recent post, “How I Avoid Filter Failure on Twitter.”

So why, with my limited “following” numbers, do I preferentially follow people who tweet about their experiences as patients?

How often in medicine do we forget that on the other side of that chart and chief complaint is a person?

What if we are forced to understand that a person’s ailments and the way their physician treats them often directly affects their entire life?

I’ve mentioned before how incredibly eye-opening it has been for me to follow people in the infertility community. I’m currently on my Ob/Gyn Sub-I and am keenly aware of how heart-breaking infertility, high-risk pregnancy, and pregnancy loss can be for my patients, purely because I’ve been exposed to some of these women’s stories online.

@EndoJourney is struggling through this right now and her story is one of many that makes me so exquisitely cognizant that the worries of pregnancy (and the heartbreak and fear of pregnancy loss) do not end when a patient leaves our office. Some of these women (often along with their spouses and families) are forced to worry 24 hours a day that a very wanted child may never be in their arms.

Medical problems permeate lives. When we, as healthcare providers, forget that our actions, our words, our demeanor truly affects the well-being of our patients we easily lose compassion and gain complacency.

So, yes – I follow patients on Twitter. Not my patients, but patients who share their stories. I follow patients who explain how their doctors have affected their mental and physical health – how their physicians have failed them or fought for them and how it made them feel.

I follow patients to understand…to avoid complacency…to maintain compassion.

I learn from these people on a curve much different than that of traditional medical training, because through them I learn to be acutely aware that my actions – both positive and negative – are not quickly forgotten.

I am sharply conscious that an ounce of honest compassion can significantly improve someone’s mental well-being…and that a moment of carelessness can destroy it.

And that, my friends, is not something that can be learned from a textbook.

Anatomy Scan

21 weeks + 2 days

Today we had our “anatomy scan” where they basically do a detailed ultrasound of the baby to look for various fetal anomalies or malformations. We got great news – everything is looking perfectly on track for both Little Elves*! Basically each appears to have a three vessel umbilical cord (which mean two arteries and one vein per cord), two kidneys, a cute little round stomach, a four-chambered heart with good outflow tracts, no obvious brain or spine malformations, etc. We are so overwhelmingly happy and feel absolutely blessed!

Baby A Information

This is a picture of Baby A with left arm over left eye and hand on head. This little guy/girl wouldn’t cooperate long enough to let us get a really good face shot! I think this one is still adorable, but of course I’m a bit biased. 🙂

  • Heart Rate: 152
  • Approximate Weight: 14 ounces
  • Position: During the scan this little one went from vertex (head down) to transverse left (horizontal with head on my left) to breech (head up by my ribs) without me even being able to tell gymnastics were happening in my belly! It was the craziest thing.

Baby B Information

This is a picture of Baby B with one arm/hand up over the right side of the face and the other under the chin! This little one was slightly more cooperative with face shots, but still wouldn’t let us get a full-on picture.

  • Heart Rate: 155
  • Approximate Weight: 14 ounces
  • Position: Breech on my left (so curled up a bit with head near my left ribs).

 
 
 

*Since we don’t know the sex of either baby (and aren’t finding out until they can show us in person themselves) we are lovingly referring to them as “The Elves.” This name came about because they will hopefully be here around Christmas time…oh and also they looked a bit elfin in their early scan pics. 🙂

Life As Of Late

This year is flying by and I am definitely enjoying being a fourth year! It’s almost surreal that I’m over 75% finished with medical school and I’m starting to see the light at the end of the tunnel. Watching our new MS1 class wander the halls in their tell-tale green Anatomy Lab scrubs makes me a bit nostalgic – it surely doesn’t feel like it’s been over 3 years since I was in their shoes!

So, what’s life been like the past few months? Let’s recap…it’s been a while since I wrote a personal post around here and we all know how I like to share my life with the internetz.

Real Life Stuff

  • We took a couple miniature vacations/weekend trips this summer.
We made a trip to Ikea in Frisco…
and did some swimming in Fort Worth.
13 Weeks Pregnant with the Elves
Then we headed to the water park for some fun in the sun!
And watched the Rangers and fireworks in Arlington.
And took my sister to visit Texas A&M.
  • My belly is growing at astronomical speed! As of today we are 21 weeks into this pregnancy, over half-way done – by Christmas we will be a family of 4 Humans + 3 Dogs.
21 Weeks Pregnant with The Elves

 

  • This past weekend we subtracted a guest room and added a nursery in our house…my Dad helped me paint painted and I posed with a roller brush.
My Dad and I Painting the Nursery

 

Medical School Stuff

  • Passed Step 2 Clinical Skills and Step 2 Clinical Knowledge. What does that mean? Basically, I don’t have to take any more exams as a medical student. NONE! As long as I pass my clerkships this year I will really, truly be an MD in May!
  • Completed 4th year rotations in Geriatrics, Pediatric Genetics, Emergency Medicine and (almost) Endocrinology.
  • Next week I start my Ob/Gyn Sub-Internship rotation. I am SO excited to see what I can learn!
  • Residency applications are nearing completion. I will submit them on September 15. Fingers crossed for some interviews!!

Coming Up

  • Stanford MedX Conference at the end of September!!
  • Hopefully lots of residency interviews…stay tuned for the hilarity that will be maternity suits for interviews.

Imprinted Experiences

Coming into medical school I think many of us have an image in our head of all the great things we’ll get to do. In general most of them probably include a collage of things like saving lives, using defibrillators, performing surgery…you know, TV medical drama-esque stuff.

In reality, medical students very rarely save anyone’s life and generally the extent of our surgical experience stops at holding bladder blades and retractors.

That’s not to say that we are not sometimes a very integral and important part of the healthcare team, only that it’s often in the patient’s best interest if we learn slowly. Fortunately for you all, that typically means starting with small things like sutures and staples, not being in charge of stopping a bleeding great artery or removing an infected appendix.

However, one relatively universal opportunity we get before giving up our “MS” designation is the chance to deliver a baby.

And by chance I mean, if you don’t deliver a baby you will not pass your Ob/Gyn clerkship.

So, last semester I got to deliver babies…with the help of some well-versed doctors, of course.

During my Ob/Gyn clerkship it was me, on several occasions, who handed a tiny little body to it’s exhausted mother as she took in the image of her child’s face for the first time. I was given the privilege to be the one who wiped a precious little face and whispered, “Look momma! A tiny baby boy…he is absolutely perfect!” while tears of happiness mixed with droplets of sweat and settled on her relieved cheeks.

Last semester I got to deliver babies. As it turns out that experience, one I never expected to be so supremely moved by, will soon become a part of my career. However, everyone doesn’t end up going into Obstetrics and Gynecology, but even so most remember their first experience with birth. Some will recall it as shocking or scary, others as bloody and jarring, but almost all will tell you it’s nothing short of amazing…even if they hate obstetrics.

 

There are few things we will distinctly remember from these years, but here’s a few experiences (some wonderful, others painfully heart-wrenching) that I will never forget:

  • My very first patient.
  • My first patient who died (who also happened to be my very first patient).
  • Witnessing the preterm delivery of a baby at just 24 weeks gestation.
  • My first day in the OR and how lost I was scrubbing in.
  • Suturing something other than a pig’s foot for the first time.
  • Finding fetal heart tones for the first time.
  • The deafening silence of not finding fetal heart tones when they should be there.
  • How quickly blood can fill an abdomen.
  • Seeing a patient’s blood pressure drop to 45/?? on the monitor during surgery.
  • My first patient who miscarried.
  • My first experience with serious, life-threatening trauma.
  • Holding a patient’s hand as they were told they had cancer.
  • Watching major abdominal surgery on a preterm baby <6 lbs.
  • Holding the hand of a woman who had experienced a horrifying tragedy.
  • Talking with a truly manic patient for the first time.
  • Watching an infertility couple cry at the site of their baby’s heartbeat on ultrasound.

There are probably so many more, but these are some of the things that have imprinted themselves on my brain forever. These are experiences I carry with me – some I hope to experience many more times, others the opposite – all I hope have made me a more caring, compassionate future doctor.

What are some things that are imprinted on your mind from many years ago in your career? If you’re a medical student, what experiences will you never forget?

Image 1: FreeDigitalPhotos | Apple’s Eyes Studios
Image 2: FreeDigitalPhotos | arztsamui

Reflections on Third Year

The past year has been one of unexpected and broad personal discovery, involving aspects of heartbreaking disappointment and sheer, unsurpassable joy.

Since July of last year, when I started third year, I’ve met amazing people, learned incredible things (including learning how much I don’t know) and been afforded unique opportunities.

I can confidently say that the third year of medical school was one of the most life-changing years of my life. Not only did I (finally) figure out what I want to be when I grow up, but I experienced breathtaking highs, gut-wrenching lows, unexpected humor, and a back door glimpse into a mysterious side of life…and death…that many never see.

Overall, I feel like this year, both personally and professionally, I’ve truly experienced an overwhelming breadth of humanity…and honestly, I never saw it coming.

I just wanted to thank y’all for making this journey with me. I have received so much advice, support, encouragement, and love from Mind On Med readers and through Twitter. I am continually thankful that I choose to share my experiences here – not only to give others a glimpse into this life, but so I can look back someday and remember how pivotal these years were in helping me become the physician I will eventually be.

I’m expecting that the next year will be an adventure in itself – two new babies (!!) who will hopefully keep cooking until December (oh, did you miss that – yah we aren’t getting another dog – no my friend, we met our four-legged & furry quota long ago), residency applications and interviews, Match Day in March, and all kinds of fourth year fun (hopefully involving significantly more DIY projects than third year). Thanks for sticking with me through the craziness!

Ok, I do believe that is enough mushiness for one year.

Here’s a few of the most viewed posts on Mind On Med from the past year:

Image: FreeDigitalPhotos.net | Ambro

Medical School in Denmark

Today we have a wonderful guest blogger, Andy Skovsen, with us to talk about medical education in Denmark! Andy lives in Copenhagen, but seems to have been a bit of a nomad having lived in the US a while and just returned from working in South Africa! He has also spent some time in the Danish Military and still works part-time with them. I must say, I’m a little jealous of all the great culture and scenery he seems to have experienced. Andy graduated from medical school in 2008 and has been pursuing a career in Surgery, with a particular interest in trauma and emergency medicine. He has a great blog called Doctor’s Without Filter, which is co-authored by himself and two others in Danish (Go-Go Google Translate). Andy got married last summer (Congrats!!) to a doctor who is currently pursuing a career in Cardiology and in his free time (which sounds like it might be severely limited!) he enjoys sports like skiing, mountain biking, diving, and surfing! I have to admit, I want to be friends with Andy – he sounds like tons of fun!

 

Getting In:

How old is one when they begin medical school?

Usually around 18-20. Some gain entrance through a separate set of university specific merits and tests, and are usually a couple of years older.

What exams does one have to take to get in?

Entrance is granted through application. You take finals from “gymnasium” (roughly equivalent to last year of high school and first two years of college in the US). Entrance is based on your GPA after this. Approximately 10% gain entrance through a separate quota system, which is defined by each of the 4 universities in Denmark offering a medical education and usually involves testing as wells as merits.

Is there any required pre-requisite coursework?

Certain levels of Maths, Danish, English, Physics and Chemistry are required to apply. These can be supplemented post-gymnasium graduation.

Is it a competitive occupation?

Very competitive. The number of applications far exceed the number of places. At the moment, it’s the most sought after university degree in the country.

What are you called at this stage of training?

Medical student.

 

Being In:

How long is it?

6 years. After 3 years, you are given a Bachelors diploma, which is pretty much useless unless you want to transfer to a different Masters degree.

How are the years broken down?

This varies from university to university, but generally broken into 12 semesters with the first 6 being pre-clinical, and the last 6 being clinical.

Describe your typical day.

Varies immensely for each semester/rotation. The common denominator seems to be end-of-semester exams, which increases workload and hours hitting the books to all waking hours and eliminating partying to zero.

If you choose a specialty, when do you have to decide by?

After graduation you do one year of internship, then you apply for positions in your specialty.

What are you called at this stage of training?

Medical Student

 

Getting Out:

What exams do you have to take?

Once you take your final exams from medical school, you’re pretty much done with exams.

Do most people graduate?

Students drop out of medical school mostly to switch to other degrees. I remember starting medical school, during the first lecture, we were told to “look to your right and look to your left, those two people will not be here when you graduate.” A rough estimate tells me that about 1/4 to 1/3 of starters do not finish.

When are you finally considered a “doctor?”

After passing the final year of medical school you get your diploma, then you sign the Hippocratic Oath and become a doctor.

Do you have additional training after MS or do you start working immediately?

One year of internship is mandatory. The internship is split into two 6-month positions, the first usually being in a hospital, and the second often (80%) being in primary care/family medicine. Each year is a lottery, where all graduates are assigned a random number correlating with the amount of graduates is a number internships. The graduate that received number 1 in the lottery gets first pick and so fourth. Positions are all across the (small) country. The system is perceived as unfair by many, but is not looking to be changed any time soon.

What’s the average debt for attendance?

None! Medical school is paid by the state. When attending university, you also get a small allowance (about $750/month) to live on, but books you must pay for. Living expenses are rather high, especially in Copenhagen, so many students work and may also take loans.

What are you called at this stage of training?

Doctor, Intern or Resident.

 

Being Out:

What’s the average salary?

Salary is fixed. Currently base salary is around $4,500/month on top of this you get a small remuneration for being on call, etc. Usually comes to around $5,000/month. On top of this comes taxes (50%+). Through your career your salary increases in increments.

Is the job security good?

It’s good. 100% of graduates are employed in internships. In the long run, some specialties are very difficult to get into and others you can walk right into after internship.

Can you switch specialties?

Yes, you can switch, but you start back from the first year after internship.

What are you called at this stage of training?

Doctor or Resident

 Image By Andy Skovsen | Available on Flickr

Very interesting! Thanks so much for sharing, Andy – I really enjoyed reading about medical education in your country and I know these posts are some of the most popular on Mind On Medicine, so I’m sure others enjoyed the information as well.

Other Medical Education Monday posts can be viewed here!

Surgery Clerkship

I finished up my Surgery Clerkship a while back and thought it was about time I gave you guys a peek into the daily life of a medical student rotating through surgery! I was a little terrified going in, but the residents all mostly turned out to be very down to earth (hard-working and busy, but down to earth) and helpful.

Surgery

A specialty that encompasses a variety of sub-specialties and involves a lot of…surgeries…who’d have guessed it? The residency for general surgery is usually five years and fellowships to specialize in other things are an additional 1 or more years after that. All in all – it’s takes a lot time to become a surgeon.

The Clerkship

  • 8 Weeks – Five weeks are split between the services covered in our hospital, including (but not limited to) trauma, vascular, general, burn (and burn ICU), SICU, etc. We also spent one week on a specialty (mine was Pediatric Surgery) and one week on Urology with the final half-week reserved for shelf-studying.
  • Occasional lectures, grand rounds, tumor boards and meetings.
  • Eight overnight calls – Basically arrive at the hospital around 5:30am as per usual and leave the next day around 8am or so.

Daily Life

  • Usually arrive around 5:30am or 6:00am and round on your patients, be ready for morning checkout by 7:00am.
  • Morning Checkout: Goes through all the patients admitted overnight and ensures all surgeries for the day are scheduled and covered by residents and attendings.
  • The rest of the day is reserved for surgeries, it’s really dependent on what service you’re on.
  • Typically home between 5pm and 8pm, depending on the service & how busy they are.
  • Occasionally you’ll go to clinic in the afternoon instead of scrubbing into surgeries.

Surgery Clerkship Books

    

  • Pestana Notes for Surgery – Easily the best and most used resource for this shelf exam, you can read about it here. Our school provided copies of it, so I’m not sure where to buy them.
  • NMS Surgery Casebook– Highly rated and easy to read, tons of relevant cases.
  • NMS Surgery Textbook – I didn’t use this, but heard positive things about it from people who wanted more text than just cases.
  • Surgical Recall – MUST HAVE for pocket book on this rotation! This book is so useful, even for other rotations. I guarantee it will have 85% of the pimp questions you receive on this rotation right there inside it. I used it to review relevant chapters before surgeries.
  • Overall  – This shelf exam is very Internal Medicine heavy, don’t just study surgery books! I made the mistake of sticking solely to Surgical books and while I still did okay, I think reviewing some internal medicine would’ve served me well.

What I Like

  • Working With My Hands: This field is centered greatly around the use of tactile skills. I liked that we were always doing something and getting immediate feedback on whether our interventions were successful or not.
  • Trauma Call: I did not expect to love trauma call, but it was so fun! There’s something exciting about being able to immediately solve an awful problem with your own two hands (and by “own two hands” I mean…other people’s hands…because let’s be honest, my hands don’t solve anything other than AgenesisOfTheCoffeeCup at this point).
  • Pediatric Surgery: This field was so fascinating to me. I saw an extremely skilled surgeon operate on a teeny, tiny 2 month old baby (who was born around 24 weeks). It was amazing. The whole week I was on Pedi Surg I was in love – it was great. However, in the end I knew it was not for me…mostly because I have no interest in doing 5 years of general surgery to maybe or maybe not get into one of the most competitive fellowships out there.

What I Dislike

  • Constantly Standing In One Place: Some surgeries are LONG – particularly some of the trauma surgeries and vascular surgeries – and standing in one place for 10 hour surgeries on a regular basis makes me wanna vomit. A couple days per week operating sounds great to me, but some of these surgeons are operating 5, 6, 7 days a week for 10 or 12 hrs a day. I just don’t have the stamina for that.
  • Variety: I can’t decide if there was too much variety or too little. All we did was operate – there was nothing else! There was tons of variety in that they possess the skills to do a huge number of different surgeries, but all they do is surgery!
  • No Pregnant Women: Unless it’s a dire emergency, general surgeons do not operate on pregnant women. I missed that patient population terribly.
  • Lack of Relationships: Except in very rare circumstances, these doctors are (rightly) not focused on getting to know their patients or developing long-term relationships with them. I missed getting to know my patients and having some continuity of care.
  • Often A Sad Specialty: A lot of surgeries end up with less than optimal outcomes, especially in trauma surgery. Most of the patients are very sick and many of them don’t make it. I missed having the occasional healthy or happy patient.

Overall, I enjoyed the rotation, but it was extremely exhausting and very emotionally taxing. The hours were long (often students were exceeding the intern hour restrictions) and the work was very different than what I want in my day-to-day life. While I enjoy utilizing my tactile skills (or, developing them, rather), I don’t want surgery to be the sole focus of my career. I really enjoy being a part of a patient’s care long-term and getting to know them a bit better and I’d miss that if I were to decide to go into this specialty.

Information on Other Clerkships!

 

 

Image: FreeDigitalPhotos.net | jannoon028