Wayfaring MD: Missionary Physician

No matter how much learnin’ you’ve accumulated, there’s always someone that knows more than you. That doesn’t mean they’re better than you. It just means they’ve had more training and experience.  The best thing you can do with intimidation is use it as a motivating force to learn more. 

So what I’ve found myself doing when I’m very intimidated (usually it’s when I’m working with my mentor, Dr. S) is just ask questions. Why did you choose drug X over drug Y for this patient? Can you show me physical exam finding again? Why this diagnosis and not that? Why did you send this person for a CT? 

In a group setting though, it may not be as easy to ask questions. To keep from being the annoying tag along kid, choose your questions wisely; don’t bombard the group with queries. Maybe ask a resident or the attending while you’re walking between rooms instead of in the patient’s room. On rounds like you’re joining in on, time is of the essence. Slow the process down and everyone will resent you. 

Obviously as a pre-med you’re not going to understand everything that’s going on, so ask about things that are recurring in conversation—what does this acronym mean, what is that drug for, etc—so you’ll be a little more fluent in the language of medicalspeak.

Also, be respectful. Academic medicine is a hierarchy, so be aware of where you fall on the totem pole. For future reference, it’s something like attendings —> fellows —> residents —> nurses —> custodians —> interns—> hospital gift shop volunteers —> Med students —> parking lot attendants—> —> pre-meds.

It’s not a great system, but it’s what we got. Basically, don’t pretend that you know more than you do, or you’ll end up looking stupid. 

We had a high school student (a doctor’s child, I believe) tag along on rounds with us one day, and everyone got really ticked off at her because she had gone out and bought a long white coat and had her name embroidered on it. To most medical students, the long white coat is a mark of distinction, and it is something to be earned, so people were just looking at her like

. Plus she would. not. shut. up. —but not with questions, just being generally chatty. We wanted to focus and be done with rounds, not chat about the Kardashians.

*end rant* Anyway, if you don’t know what to do, just stand and listen. No one will fault you for that.  

Congrats on getting in!

Family in Poland, huh? Sounds like you’ll be getting to know them a little better now.

Sorry, let me just take a moment to chuckle at “8 months a year”. I don’t know, maybe things are different in Poland, but in America, med school is year-round (well, I got 6 weeks off after first year, but after that, nada). No more summers like in college. Get used to it. 

I am close-ish with my family. Well, my mom and grandparents. I hardly ever talk to my crap-ton of siblings. I’m extremely independent, so I don’t have to be all up in their business all the time, and I don’t really miss them (yeesh, that sounded cold) because I try to get very involved in whatever city I’m living in. However, I talk to my mom on the phone almost daily, and to my grandparents 1-2 times a week. Nothing lengthy, though. Just little updates. 

I got to the point where I had made my own little family of med school and church friends, and I felt just as bad about not seeing them sometimes as I did about not seeing family. 

My medical school (and undergrad) was about 2 1/2 hours from my hometown. In undergrad I started out going home every 2-3 weeks, and it gradually lengthened to every 6 weeks or so. In med school it stretched even further, to every 8-10 weeks, and my visits home were shorter. And now that I’m about to start residency, it’ll get even longer between visits because I now live a 6 hour drive from home and, well, residency doesn’t allow for many breaks. So I’m going to have to make my few breaks really count. 

Yeah, medical school sort of runs your life. Residency is worse, I’ve heard. Any time I went home during medical school (except 4th year), I had to study while I was there, which was near impossible, or I had to get ahead on my studying so I wouldn’t feel guilty for taking a day off. And don’t forget that once you start this whole med school process, it leads to residency, which likely will not be in your hometown, either. 

But being overseas doesn’t mean you have to cut off contact.

Get webcams for your family and have regularly scheduled Skype chats or something. Seeing people’s faces is better than phone or e-mail conversations. 

Separating from your family is not a bad thing. It’s important to learn how to be independent and function separate from your family.   If you do end up going to Poland, it will probably be very hard at first being so far from home, but in the end you will be a stronger person for it. It’s a little tougher to learn how to depend on yourself when mommy and daddy are close by, you know what I’m saying? You will learn a lot from being away from home. 

Hmm, well usually if I was getting overwhelmed, it was because I had a lot to do and didn’t know where to start. So I’d stop and organize my notes, make a To-Do list, and then make a schedule of how I was going to get stuff done.

I might not stick to the schedule, which was ok, but at least I had things prioritized and had a system. I would break things down in to more manageable chunks, and then it seemed like I could get through things easier. It’s like the old “how do you eat an elephant” joke. 

And hey, I know school is hard and time consuming, but you have to take a break every now and then to keep your sanity. As I’ve said before, I’m a fan of no-study Sunday afternoons. 

As for distractions, you just have to get away from them. I was a home-studyer, so I cancelled my cable, which helped cut down distractions a lot. You can schedule 15-20 minute breaks every 2-3 hours or so to piddle on the internet or do something distracting, just to get your fix without letting it take you over. If that doesn’t work, you just have to go somewhere else to avoid the distractions. For board study I did all my studying in a room in my church that had no tv, no internet, and no phone. It was boring and terrible, but I stayed focused. 

Well friend, good luck staying whelmed (not over, not under, of course), and keeping those distractions at a minimum. 

In general, medical school is medical school. There’s so much stuff you have to learn in 4 years, it would be very difficult to have a more intense focus on any one subject. So I don’t know of any medical schools whose curriculum is slanted toward global health. 

However, there are schools that offer masters and PhD programs, certificates, or electives in global health that you can do in addition to your MD program (often requires an extra 1-2 years). Ones I know of are all schools with great reputations that are notoriously hard to get into: Tulane, Harvard, Stanford, Temple, Robert Wood Johnson, just to name a few. 

Now if you’re like me and can’t get into are too good for these schools, or you don’t want to give up those extra years, do not fear! You still have options. 

1. Take a Public health or global health class while you’re still in undergrad. This will introduce you to some important concepts. 

2. Global health electives as a fourth year med student. Many medical schools offer these. At my school we have one in Africa and one in Asia, but they also allow us to create our own elective if we want to go elsewhere. AMSA has a decent page that can help you get started in international health. 

3. Choose a residency program that will teach you some global health stuff. Most commonly, these would be Family Medicine or Internal Medicine programs. The AAFP has a list of family medicine programs that offer, at the very least, international rotations here. And AMSA has a short list of International Health residencies, too. You can also check this post for more programs that have a specific bent towards global health/medical missions.  

4. Learn it on your own time. Read books. Go places. The best way to learn global health is to just do it. If you have time off, go overseas or volunteer at a clinic for migrant workers (check your health dept—they can usually tell you when/where those are). Some people are more interested in the public health aspect of global medicine. I’m more of a “teach me how to treat the locals” kind of person, and you can’t learn that stuff without meeting the locals, you know what I mean?