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. Also, I am an anonymous internet person. Why should you trust an anonymous internet person to give you medical advice? Don't ask me, ask your doctor!
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Posts tagged "med school"

So I recently switched undergrad programs and because I’m so busy and don’t know anyone in my new program yet, I worried that I’m gonna end up as a lone wolf. So I was wondering if you ever struggled with solitude, given that med school and residency are so time and energy demanding? Or perhaps making and maintaining friendships came naturally to you? Thanks for answering, and keep posting! :) -pseudonymous-md

Oh dear, did you ask this at the right time. 

Let me explain a little about myself: I am an extroverted introvert. I can do well in groups (for a short period of time) if I’m comfortable with the people, but I’d prefer to be with just 1 or 2 at a time, and I definitely don’t mind being (and actually need to be) alone a lot of the time.  I am just extroverted enough that I am friendly with people and make friends (in a very Facebook sense of the word) easily. But like a true introvert I have few really close friends. And I’m a terrible maintainer of friendships. I usually wait for a friend to send me an “are you still alive” email, and then I’ll email back and forth 3 or 4 times before dropping it again for another 6 months. 

So being an introvert, I do value my alone time to a degree. I can tolerate a lot more alone time than some could and actually look forward to it a little on my really busy rotations. But with that being said, know that Wayfaring gets lonely too. Whoa, I’m about to get all introspective and raw with emotions and feelings and other such touchy feely junk that makes Wayfaring uncomfortable in real life. Good thing this isn’t going on the internet for nearly 10,000 people to read or anything. 

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As a current medical student in the armed forces, a lot of emphasis is placed on leadership as a way of life, not as something to be “checked off” on a residency or medical school application. I happen to be pretty shy and soft-spoken, and I don’t eloquently vocalize my ideas on the fly like many extroverts and practiced students can. How can I develop my leadership skills as an introvert, and how can a quiet student get noticed in a positive way during rotations? -lisypants

Remember that leadership involves much more than words. Good leaders live out the principles that they hope to pass on to others. It is possible to lead quietly and lead well. 

A good way to get noticed as a med student is being a great team player and encouraging the others on your team to do well too. Practically, this means showing up on time, never complaining about work, getting your crap done in a timely manner and then offering to help others when they’re behind. That stuff gets noticed. 

Being pimped is difficult for introverts. If you’re like me, your brain flickers the blue screen of death when an attending asks you a point-blank question.

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So if you have a hard time being noticed by answering all the questions, at least be seen reading. Then jot down questions after you read to ask on the wards so you don’t have to come up with spontaneous questions. Also, write thorough, thought out SOAP notes. Even if an attending never mentions them to you, I promise you they’re being noticed. 

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Any tips on how to get the "cadaver lab" smell off? Sometimes I feel like I still smell like it after I shower...
wayfaringmd wayfaringmd Said:

It’s probably not you that stinks. It’s probably your nose. The smell can stick in your nose even after you’ve showered. 

Sniff a dryer lint sheet or lemon (or lemon scented candle). They’re strong enough to usually wipe out the smell. 

Hey! I was wondering, how did you study in third year? For us we spend 1 week on each “system” so we had our first week on cardiology, and I noticed we get very few lectures and a lot of it is just learning on the wards. It seems like we’re just expected to do our own readings and figure stuff on our own!? Any advice!? -mediocremedstudent

Well, mediocremedstudent, welcome to your first taste of being a doctor. 

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In the real world, doctors have to do this silly stuff called continuing medical education. It’s one of those little requirements for maintaining board certification and licensure. And guess what? No one holds your hand. You are expected to do readings on your own and learn on your own. Sure, there are lectures and conferences that will spoon feed you material, but you have to dig around and find those for yourself too. 

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Welcome to being a grown up. 

Third year is your introduction to real live medicine. You’ve read the book stuff. Now you have to learn how it translates into real life. On the wards, there’s no set syllabus. There’s no “examine 5 COPD patients, admit 5 chest pain rule outs, diagnose 5 strokes.” You don’t just learn by watching docs treat patients. You gotta pick it up as you go along. Every single patient you see can teach you something.

So when you interact with a patient, write something down about their case that you don’t understand. Why did they have XYZ exam finding? What was that new drug the doc prescribed? Why did they adjust their insulin that way? How did the patient present, and what other diagnoses are in the differential? That’s how you find stuff to read. For each new diagnosis you encounter, read up on it - how it presents, how it’s diagnosed, and how it’s treated and what evidence-based guidelines you can find. 

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Now where you find that information to read is also up to you. Ask questions of your attendings and residents (if they’re not up to their necks in work).

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UpToDate is my jam. Most hospitals these days have access to it. The Blueprints and Step Up review books are also good. Ask someone who is ahead of you or who has already been on the rotation you’re on to recommend a book for you. Your down time on wards should be spent reading to replace that formal teaching time you’ve lost. 

4th Year Med Student: Wayfaring, what can I do now to really prepare me for intern year? I don’t wanna look stupid. 

Wayfaring: Pretend that you’re an intern now. Take responsibility for your patients. Know everything there is to know about them. Read their old reports, dictations, and labs, even if you don’t think they apply right now. Think hard about what evaluation you would do to figure out their problem. Think about how you would treat them — not just the medication, but the dose too. You wanna be a good intern next year? Be a good intern this year. 

Hey there! I'm a current M1 and am already feeling the pressure to perform in the top. We had our first test, and I passed, but didn't get a great grade. We do have a P/F system, but my grade still placed me in the bottom half of our class (though just barely). I'm worried because I keep seeing posts about how some people can never make it out of the bottom in med school due to the high caliber of students. In your experience, was this true? Or do you think lots of hard work pays off in the end?
wayfaringmd wayfaringmd Said:

Oh my - I’ve had this in my drafts and forgot to post it! Sorry bout that!

Of course it’s true that some people never make it out of the bottom. Someone has to be the bottom. Everyone can’t be on top. Being on the bottom of the top 2% of people in academia is still pretty great. Think about that. You beat out tons of people to get into medical school. Even at the bottom, you’re still at the top overall. 

I never paid much attention to class rankings in med school. We were told that only the top 10% got reported (at least at my school) anyway. I’m sure I was somewhere around the middle to lower end, but it didn’t really matter cuz I got in to my #1 residency program. 

Every school has a bottom. Even Hopkins has a bottom. People on the bottom still match and still get jobs and still enjoy their residency programs. But you have SOOOO much more time left, friend, so don’t worry about your rank yet! You haven’t taken any Steps and you haven’t done clinical rotations yet! 

After evaluating an elderly man in the ER with vomiting…

Wayfaring to 4th year med student: So what’s your differential for this guy?

Student: Well I clicked a button on the ER template and it put in a differential for me. It said GERD, gastroenteritis, appendicitis, cholecystitis, pancreatitis. 

Wayfaring: image

 But the point of a differential is to think of things that could be causing the patient’s problem, not to fill a blank on a form. So considering that you have actually evaluated the patient and the computer hasn’t, what’s your differential?

Student: Well um…

Wayfaring: Considering his nausea and vomiting?

Student: ok, gastroenteritis, food poisoning, GERD…

Wayfaring:

And his age and other medical conditions?

Student: uh, medication side effect, UTI, esophageal stricture…

Wayfaring: and his distended abdomen and abdominal pain?

Student: constipation or impaction, bowel obstruction, bladder obstruction, bowel ischemia…

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Wayfaring: and considering his cachexia and weight loss?

Student: Oh yeah, the cancer. 

Wayfaring: image

And now you see why we don’t let the computer think for us. 

Asker quietbang Asks:
Hi- I'm currently in my third year of a 5 year program, and I'm getting ready to apply to med school. I'm a wheelchair user- I have an SCI and rheumatoid arthritis- and many people don't think that wheelchair users should be doctors. I want to be a doctor so I can be a positive influence in the lives of children with disabilities and their families-- should I say that in my app? Or should I give another reason that doesn't disclose my disability? They'll find out when they interview me anyway.
wayfaringmd wayfaringmd Said:

Absolutely you should say that! 

As far as I know, schools cannot deny you admission on the basis of your disability. Unless it would completely prevent you from doing your duties as a med student or doctor. And your personal statement is all about YOUR personal experiences, so if your medical history has influenced your decision to pursue medicine, you should definitely talk about it! And who better to be an advocate for patients with disabilities than a doctor with a disability? 

Asker Anonymous Asks:
Hi! I'm a 30 year old freshman with kids and a husband. Over the last few years It's become clear that I can't shake my interest in medicine. I love the use of science for healing. It's absolutely beautiful. Unfortunately I feel selfish and indulgent considering pre-med with the intention of applying to med school. It's a really long road to drag my family through. In your opinion, at my age, am I fooling myself thinking that I could start a career as a doctor?
wayfaringmd wayfaringmd Said:

It’s certainly not too late to start a career in medicine. There’s a guy in my program who didn’t start college until his mid-30s and is now a 2nd year resident! From what I’ve seen, the non-traditional students tend to be the best ones because they’re the most driven and serious about their studies, plus they have some life experience under their belts. 

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It’s gonna be hard though. It was super hard going through it single, so I’m sure going through it married will be tough. But you have a built-in support system, which is awesome! And people do it all the time, so don’t feel like you’re the only one. 

If going back to school makes you feel selfish, you need to have a talk with your husband and kids. More than once. Like before the beginning of each semester. They’re a part of your life, and their opinions count too. If they are fully supportive of your aspirations, then go for it! You still have several years before you have to decide about med school, so y’all have some time to see how things work with you being in school.  

dashedcircles:

mistressofsurgery:

if there is one thing med school has really taught me to appreciate it is the post-ten-hours-of-holding-it-in pee/poo.

wish i had done bladder control exercises in high school or something man

Things not usually spoken of…but very seriously true.

Especially if the hospital bathrooms are a bit manky.

Hence the importance of finding your secret bathroom. It’s like the room of requirement, guys. It’s been there all along in a fairly obvious place but no one has been using it and it’s wonderful. 

Asker Anonymous Asks:
Any anecdotes/advice for going through a bad day in the medical field? Whether it be getting yelled at by an attending, a patient, feeling like you don't know anything, feeling like you're the only one who knows anything, etc?
wayfaringmd wayfaringmd Said:

Step 1: SLEEP ON IT. 

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Bad days happen fairly frequently, but you can’t let them stick with you. Sometimes crappy stuff happens because other people are having a bad day and they take it out on you. Do your worrying and fretting for that day only, and then sleep on it. Choose not to obsess over it the next day. However, if you sleep on it and it still really bothers you, proceed to step 2.

Step 2: Complain to someone else about it.

Ideally, this person would be a fellow student who can commiserate, or maybe your mom. Moms are good at giving appropriate pity or telling you to suck it up and move on. Fellow med students can understand your situation better than your mom can (unless your mom went to medical school too) and support you through it. Then, if you are still bothered, move to step 3.

Step 3: Do something about it.

Was your attending just being a jerk? Let it out on your rotation evaluation. Or maybe you got yelled at for a good reason. Examine your own actions. Did you not know your patient’s labs? Work on being more organized so you can keep track of that stuff. Did you make a mistake? Read about the problem and learn from it so you don’t do it again. Ask someone who is getting things right to help you and give you direction. Let that bad day motivate you to do better next time. 

Chin up, greyface. 

I saw your other question about being young and being in medical school. What exactly is a young age? And how do they treat you differently? Is height a problem? Because I'm going to be 20 when I enter medical school (I'll be 21 that December I enter school). I am also 4' 7", I've heard comments about it but I usually ignore it but I just want to know if that's going to be a problem in medical school for the staff? Like seeing surgeries and stuff.
wayfaringmd wayfaringmd Said:

According to many of my patients, anyone who doesn’t have some gray around the temples or wear bifocals is too young to be a doctor. How quickly we forget Dougie Howser.

Most folks in my class starting medical school were between 24-29. I was a week into being 22. Don’t worry about your age. If you show a patient that you are competent and confident, they have no reason not to respect you.

As a doctor still in training, some patients are always apt to treat you with less respect than they would attending docs. I don’t think I’ve ever had a patient be outright rude to me about my age though. Mostly people just mistake me for a nurse or a student.

Your height may be a bit of a problem. There are always stools and things to stand on in surgery, but you may have difficulty doing procedures. There was a guy in my class who was an achondroplastic dwarf, and he was allowed to sit out of procedures because he had decided that he wanted to do psych, so he didn’t need to know how to suture and retract.

Asker Anonymous Asks:
Hey! I'm in high school and have have rheumatoid arthritis. I really want to be a pediatric rheumatologist but my entire family doesn't want me to go to med school because of my health. Is medical school really as bad as they say?
wayfaringmd wayfaringmd Said:

Um, yes, it really is as bad as they say. That’s why they say it. Med school is HARD.  And that’s even if you have the grades and extras that it takes to get in. Getting through is tough

That doesn’t mean you can’t or shouldn’t go for it though. It just means you have to be really sure you want to dive in and can dive in before you actually dive in. You have to be aware that your illness is going to affect your ability to study well or manage the stress or work extremely long hours without a break. 

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Realize that you will incur mountains of debt (if you are like the vast majority of med students who are not independently wealthy) and that there’s the possibility that you may not finish school if your health becomes prohibitive. 

I don’t mean this to sound harsh or pessimistic. I want you to be realistic. Your health conditions don’t have to keep you out of medical school, but you do need to realize that you can’t make it through on optimism and hope alone. There is a lot of struggle and stress that comes along with med school.

My best advice for you would be to talk to your own rheumatologist. Ask him or her how stressful med school was for them, and whether they think you can handle it. Talk to them about getting your rheumatoid under the best control possible to lighten the burden on you a bit. And ask to shadow them! See what they do on a daily basis and decide for sure if it’s really for you. 

Asker Anonymous Asks:
so how long would it take to pay off all the crippling debt on average
wayfaringmd wayfaringmd Said:

Depends on what payment plan you pick. Most of us go with the income-based plan now, which requires you to make 120 payments (yup, 10 years) and the amount is based on how much money you make. The new deal is that after those 120 payments, you’re done, even if there’s a balance left on the principal payment.

Then you’ve got the Standard plan, where your payments are based on how much money you owe. They are often structured over 10, 20, or even 30 years. But people who are really motivated or who have great jobs sometimes pay them off in as little as 5 years.

Right now I’m doing the income based plan because my debt is so high it’s the only way I can afford to pay anything. I haven’t paid anything on my principal yet. Not even covering my interest actually. It’s still compounding.

Asker breakempire Asks:
What was your fav part of the first year of medical school? (I just started!)
wayfaringmd wayfaringmd Said:

My favorite day was probably the afternoon that I found out I passed my first test—when I realized, hey, maybe I can do this. 

Overall though, my favorite things in first year were the times that I was allowed to work with real people instead of books. I loved anatomy lab and I loved my community medicine placement in a family practice office. I didn’t love the massive paper I had to write on community med, but I did appreciate the break from the books and the fact that my preceptor let me see patients on my own even as a first year.