Wayfaring MD

I am a family medicine resident who likes to highlight the hilarious in medicine as I write about patients, medical school, residency, medical missions, and whatever else strikes my fancy.



Disclaimer:
HIPAA is for reals, folks. All of my "patient stories" have been changed to protect patient privacy. I will change any or all identifiers, including age, location, race/ethnicity, sex, medical history, and quotes.
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Posts tagged "med school"

lactosefreeninja:

Of obvious and grave importance: how do folks dress in medical school?

On class days during the first 2 years, most folks are jeans and t-shirt types. We even had some PJ bottom folks in our class. Occasionally (like when everything else is dirty), folks get fancy. Some schools mandate business casual, but that’s rare. Our school only required us to dress up on days where we interacted with standardized patients or real ones. Since we were a PBL school, we had mandatory attendance, so we didn’t have the pantsless-at-home option on group days. 

In the second half of medYes, I am taking scar stories. I had to turn off submissions a while ago because of pr0n blogs, but I can turn it back on tonight when I’m home. school, folks go with business casual at the hospital. That usually implies dress pants and nice shirt, +/- tie for the guys, and dress pants + blouse/skirt/dress for girls. Some places are even more casual, like my current workplace, and allow jeans on Fridays. 

Asker Anonymous Asks:
Hey! Do you know of anyone who has gotten their masters in global/public health before or after going to med school. Im very indecisive about this..if you have any followers who did this or anything that would be great!
wayfaringmd wayfaringmd Said:

I do. We had 2 or 3 people in my class who got MPHs before med school. It can be helpful in boosting a mediocre application, but don’t do it just for that. If public health is something you’re interested in and can see yourself being continually involved with as a physician (whether in practice or research), then go for the MPH. If you will use the degree and the knowledge you gain from that training, then it’s worth doing for you.

Edit: some med schools actually have joint MD/MPH programs, which might be ideal for you. I hear Tulane has an excellent program.

Making good grades, working hard, and studying do not make you a gunner. Those things make you a successful student and are the qualities that get you in and through med school. Everyone who expects to do well in their studies should adopt those qualities.

To say that you can be a good doctor without great grades is only partially true (yeah you can get in med school with a C here and there) and is certainly not an ideal worth striving to live up to. Good doctors don’t just get by. They work hard. They may bomb some tests here and there, but it’s not for lack of trying. There’s a huge difference in being an average or non-stellar student and being a slacker.

Gunners have these hard working values as well, but they purposefully make others look bad to make themselves look good. They take “hard work” to the extreme, to a point where they memorize useless details just to say they did, and more importantly, to make everyone else fear a bad grade because they didn’t. At their core, they are malignant in their work ethic. They take the mindset of self above all else, and will trample anyone who gets in the way of their ambitions.

Asker Anonymous Asks:
Any patient interviewing tips? I'm having difficulty wording my questions to ask the appropriate questions in asking patients their symptoms. for example pain. I need to ask things like site, severity, quality, etc, but I just seem to always miss a few points. And sometimes I just get such a word block from being so nervous.
wayfaringmd wayfaringmd Said:

PRACTICE, PRACTICE, PRACTICE. 

If real patients make you nervous, have your family members or friends play patient for you so you can work on your interviewing skills. These people know you well and will be able to read if you’re too nervous. Ask them to critique you. 

Before you go in to see a patient, you usually have at least their chief complaint available to you. So take a few seconds to think about that complaint. Come up with a quick differential and remind yourself of a few questions you want to be sure to ask.

Don’t try to be fancy. Use simple terms. It will help you be less nervous and your patient understand you better. 

As for remembering question about pain, stick with the same order every time. I used the OPQRST mnemonic in med school, which stands for Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Time. Sometimes I’d even write the letters down on my little paper I used to take notes when I interviewed patients. I promise you, once you do it 50 times, you won’t need a mnemonic. The same goes for any patient interviews, not just questions about pain. If you ask things in the same way every time, you don’t have to come up with proper wording every time. 

Remember to also start broad and open ended and then narrow your questions down. 

Also as you’re interviewing a patient, keep a differential diagnosis running in your head. If you’re thinking their abdominal pain could be cholecystitis, appendicitis, peptic ulcer, GERD, pancreatitis, hernia, ovarian cyst, PID, diverticulitis, etc, then you can think of some other review of systems to ask them to help you narrow down your differential. 

Example after the jump:

Read More

Asker waitwahttt Asks:
have you ever been rejected from any school you applied to (undergrad or med school) ?
wayfaringmd wayfaringmd Said:

Nope, but I’m a really odd case.

I applied early decision to both my undergrad and my med school and got in both times, so I never had to apply elsewhere. That turned out to be really good because I’m not sure that I would have liked any of the other schools in my state.

Hello I was wondering, do you know of anyone who went from being an RN to a medical doctor? What was their experience. I always wanted to be a doctor but I did nursing as my first degree for financial and family reasons. Also do you know of any blogs of nurses who took this route?? Thanks!!!
wayfaringmd wayfaringmd Said:

I don’t know of any bloggers off hand who went the RN to MD route, but check the Medblr spotlight to be sure. I did go to school with a guy who had a nursing background first though. He didn’t use nursing as a stepping stone to his MD though. He really wanted to be a nurse and then several years later changed his mind and went to med school. I think his experience really helped him at the beginning of his clinical years.

As long as you go and get your pre-med pre-reqs done, you’ll be fine. Your major really doesn’t matter going into medicine, but I’d say that your nursing background will definitely help you, especially if you have a few years of work experience under your belt. 

Asker Anonymous Asks:
As a resident, how much down time do you have? What about med students?
wayfaringmd wayfaringmd Said:

Downtime varies a lot by what rotation I’m on. When I’m on an inpatient service month, I get 4 days off a month and work 70-85 hours a week. At my program, interns do 8 service months, second years do 6, and third years do 3.  On these rotations, I pretty much go to work, eat all 3 meals at work, come home, go to sleep, and start it all over the next day. Off days are spent reading, sleeping late, doing laundry and house/yardwork, and tumbling.

When I’m off-service, I work anywhere from 40-60 hours a week and get most weekends off, depending on the rotation. We’re only allowed to take vacation on these months, and my program gives a pretty generous 21 days a year.  

So yeah, downtime is slim at first but gets better the farther you progress. Also remember that I’m in family medicine, one of the more family-friendly, work-hour rule-abiding specialties out there. Surgery and OB schedules can be more grueling and often don’t let up as much in the subsequent years.

I definitely had more down time in med school, though I spent a lot more of it studying than I do now because of tests and such. I think the med students who rotate at my program have it a little easier than I did. They do 4 or 5 30-hour calls per rotation, whereas we did q4 call most of the time (or its equivalent, but not so nicely spaced). We also were required to round before the residents did, and we usually carried 4 patients at a time, whereas our students only carry 2. 

Asker kwolfsbane Asks:
When learning about diseases in med school, do you often think you have it?
wayfaringmd wayfaringmd Said:

Absolutely you do. Even in residency you get a bit of hypochondriac in you. 

Pre-meds and med students, take notice. This is 100% real life. 

The only statement I can disagree with in this article is “Most nights, physicians go to sleep fulfilled and grateful for the honor of becoming a part of their patients’ lives.”

Most nights, I go to sleep tired. Real tired.  

Asker Anonymous Asks:
I was wondering if you have ever seen or heard of any discrimination against gay doctors, gay medical students, or gay applicants?
wayfaringmd wayfaringmd Said:

My experience in this area is admittedly pretty thin, and I can’t pretend to know or understand the experiences of LGBT students and doctors. We had one gay person in our med school class, and I didn’t see any discrimination against her among students, although I remember her mentioning that some faculty had made some sketchy statements to her before finding out about her orientation.

I’ve only had contact with 2 gay attendings before (that I know of) – one a specialist at my med school who was made fun of a bit because of his flashy wardrobe choices and progress notes written in purple ink. The other was my personal doctor, who I didn’t know was gay when I picked her, but it never really mattered to me either—she was recommended to me by a friend who worked with her. 

As for schools and residency programs, the official answer is that they can’t discriminate against applicants, students, or employees based on sexual orientation, but I’m sure it happens. It probably depends on location. If you’re applying to a small school in a suburban area in the South, you’re probably more likely to be discriminated against than if you apply to a school in a more diverse urban center. I wrote a post a while back about whether to be out in your personal statement that may be of some help. 

Asker aperuri Asks:
What is your opinion on using tumblr as a source to upload all your medically-related activities in case residency directors have something to refer to if they choose to at all in the future? I'm currently a 1st yr med student. One of our professors suggested it's a nice way to show longevity and evidence of your medical interests/work. I am planning to use my for this reason and throw in fun and interesting art/science topics I come across.
wayfaringmd wayfaringmd Said:

Ooh, tread lightly there, my friend. 

If I were a residency director, I wouldn’t take the time to look up your blog to see evidence of your interest in medicine or my specialty. That’s what your residency application (ERAS) and personal statement are for. If it’s not apparent in your application, I’m not going to go digging for it. Also, your ERAS application will also have places to list your medical work, whether it’s volunteer, research, or paid, so you won’t need to have a separate platform for this either.

If writing is something you’re interested in, by all means, keep a blog. But be extremely careful what you put on it. If you plan for the blog to be public and visible to potential employers, you need to make 100% sure that what you post is 1) your own opinions and writings, 2) properly sourced and referenced, 3) not a poor reflection of your school or residency program, and 4) HIPAA compliant. You probably shouldn’t write all your whines about school or residency or patients in a blog you’re going to share with a program director, either. And no patient stories.

I think MedicalState, theBiopsy, and theDifferentialDiagnosis are good examples of the type of blog that can reasonably be mentioned in a residency application. Mine however, is not ;). 

Asker kwolfsbane Asks:
I'm a pre med student, and I have visible tattoos (writs down) and I was wondering if that will effect admissions to Med school, residency, and future work as a physician.
wayfaringmd wayfaringmd Said:

This question comes up a lot.

I generally recommend that people keep them covered for interviews and clinical activities, just because you don’t know what your interviewers’ or your patients’ preferences and sensitivities would be. But tattoos really shouldn’t affect anything. I know LOTS of docs, nurses, pharmacists, and other hospital staff with plenty of tattoos (even full sleeves). Our hospital requires employees to keep them covered at work, but they don’t mind you having them, and it doesn’t affect employment.

I work with one male physician who has pierced ears and pierced nipples that are generally pretty visible under his ratty Affliction t-shirts. On weekends he walks the halls with ripped jeans, boots, and a leather jacket, and patients who don’t know him assume he’s a visitor, but he’s an excellent physician, so no one says anything about his wardrobe choices. Ultimately, what matters is whether you’re good at your job or not. Ok, but maybe don’t go this far. 

Asker kwolfsbane Asks:
So I don't have the best math skills, but I have the capability and drive to do my mathematics classes for Med school. Will having a B brain for math make a big difference on be coming a physician?
wayfaringmd wayfaringmd Said:

Not at all. I have a terrible math brain. Once you are done with your premed pre-reqs, the only math you do thereafter is pretty basic. No worries friend. 

Asker Anonymous Asks:
Hi! Ok so I've been accepted to med school, what should I do between now and when it starts to prepare myself (emotionally, academically, etc)?... or should I just hibernate? Thanks!
wayfaringmd wayfaringmd Said:

Hibernating sounds real good. 

Like reeeal good.

But srsly though. Don’t do ANY studying before you start med school.  No one else out there will be studying. And if they tell you they did, avoid them, because they are the gunners of the class. This is your last chance pretty much ever to relax, so take advantage of it.

I took a super light schedule the last semester of my senior year because I already had acceptance to med school and I didn’t want to work my tail off. So I took the last few required classes and dropped 2 400-level science electives to give myself a whopping 12 hour schedule. It was glorious. 

Emotionally….

umm, I’m not sure you can prepare for this, other than going ahead and researching area counselors ;). Just get rested up. Find yourself an awesome place to live, because coming home to a nice place does wonders for the morale.

Get an animal to take care of (probably a low maintenance but furry one like a cat or bunny) because they will help de-stressificate you.

And get all your life stuff together. Anything that requires paperwork or an appointment should get done before school officially starts. Go to your doctor and your dentist for check ups before you start, because you may not see them again for the next few years. 

Asker Anonymous Asks:
Any advice, either from your experience or your classmates, on how to approach a Rank Order List?? It is upon us now!
wayfaringmd wayfaringmd Said:
  • Do not rank any program you would not be happy matching at, regardless of how good their reputation is. 
  • Geography matters. Consider the short time you will have to visit family or have fun on the weekends. Pick places that have things you’re interested in nearby. 
  • A program’s “personality” can mean much more than its reputation or prestige. You gotta work there for a minimum of 3 years. You might as well pick a program full of people you can easily get along with. 
  • Programs with happy residents should be ranked higher than programs with exhausted looking residents.
  • Consider your spouse or significant other’s ability to find a job and their feelings about the program. They have to live there, work, and make friends there too. 
  • Stay in touch with the programs you’re most interested in. Let them know you like them. It may improve your rank on their list. 
  • Consider fellowship possibilities. Most programs prefer to “promote from within”, so to say, so your residency choice can majorly affect your fellowship opportunities. 
  • Go with your gut. Don’t agonize over your decision. 
  • Evaluate the education you’ll be receiving. If the upper levels seem clueless, that should count against the program. Do you trust the upper level residents to teach you and be your back ups? This is why away rotations at your tops programs is important. 
  • Don’t assume that they love you, even if they told you so. Be very cautious with considering e-mails and phone calls from a program when you’re making your rank list. Many programs (like mine) are very forthcoming and open about who they like and don’t lead people on, but others send candy canes to everyone. 
  • Think about salary. What is cost of living like? Can you support yourself and your family?
  • The match isn’t a trick or a gamble to be outwitted. It’s math. Don’t treat it like a poker game that you can bluff. 

Stay Tuned for Secrets of the Magic Match Computer…