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 "medical school"
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:

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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. 

To the 4th years: May the odds be in your favor. May your families realize how Big of a Deal today is and celebrate it just as much as they will graduation day. May your parties be awesome and your hangovers minimal. 

To those already in residency: I hope your new interns are awesome, and I hope you are still as happy to be where you are as you were on your Match Day. 

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. 

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 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…

Hi there Dr. Wayfaring! I’ve been deciding between PA and med school for the longest time. I am not keen on med school because of all the testing. Step 1 terrifies me in addition to all the other block exams in classes during M1 and M2…and then there are shelf exams in third year, then Step 2 in 4th! I do find myself fascinated by med school life and medicine otherwise. I’m just a terrible test taker. What do you think, because I don’t know if this is a good reason to rule out med school. Thanks! -anon

I don’t think tests are a good reason to rule out any profession. Whatever you do, if it involves grad school, there will be tons of testing.

I’m not sure that med school has more than PA school, actually. From what I’ve seen and read about PA school (help me out here PAblrs), many of them have tests weekly or every other week. Med schools generally do tests monthly or every 6-8 weeks. Of course, they covers more material, but they’re less frequent. PAs have licensing exams too, so don’t think you’ll get off easy there either. 

If you go into school knowing that you’re a poor test taker, hopefully you could figure out some study methods and test taking skills to try to overcome it. You may even qualify for certain testing accommodations to assist you. 

There are tons of good PAs and doctors out there who weren’t great test takers. Don’t let that be your reason for not pursuing your dream. 

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Hello there, Do you have a timeline for usmle exam too? When is the most recommended time to take it? Hear from you soon…

That one’s a bit easier. 

Step 1: 

Most schools have a time set aside for you to study for and take step 1 at the end of your second year. Don’t put it off till you’re in your clinical years. You’d be amazed how quickly you forget gluconeogenesis and steroid hormone synthesis and the coagulation cascade. 

Step 2 CK/CS

I took CK at the very beginning of my 4th year. Again, some schools will give time for studying for this. Mine recommended we all take 2-4 weeks of “home electives” so we could study. 

I took CS later in the year, only because it was the only test date I could get. I recommend getting both of them over with early in the 4th year so you can focus on the important things like interviews, moving, match day, and the suuuuper chill schedule that is the blessing of the 4th year. 

Step 3

This will vary by your residency program. Some people will actually take Step 3 before graduating med school. That’s totally fine. My program required us to take it before the end of first year. I think this is a pretty solid plan, especially if you’re going into a specialty that isn’t going to be covered much on the test. You wanna take that test before all your general medicine knowledge leaves you. For those of us in family medicine, we mostly took it in the second half of our year so we had about 6 months of core rotations down. It was sort of “real world studying.” 

Also, how I studied for the Steps. 

Asker Anonymous Asks:
In the beginning were you afraid to do anything to patients (any treatment, procedures, etc)? How did you get over this? Learning the theory/procedure is one thing, doing it is another, and it is terrifying!
wayfaringmd wayfaringmd Said:

ABSOLUTELY. 

With every new procedure, medicine, or exam technique comes a little (or sometimes a big) twinge of fear. 

I remember my first:

  • use of my stethoscope (learning to take blood pressure on fellow classmates, thinking “am I supposed to be hearing something?”)
  • venipuncture (lil old lady with thin skin and rolly veins. nailed it.)
  • surgery I scrubbed in and assisted on (C-section on a 400 pound woman. nailed cutting those suture tails.) 
  • pelvic exam (I feel like “nailed it” is not the proper comment here.)
  • vaginal delivery (sweet couple in grad school. baby and mom peed on me. had a shoulder dystocia. nailed it.)
  • prescription I signed as an MD (ironically enough, for narcotics, which I’m still not a fan of)
  • joint injection (nailed it. sort of.)

And guess what: all of them were scary as POO. 

We fear the unknown. We fear hurting a patient. We fear messing up and looking stupid. But medicine (especially residency) is all about learning and doing new things. Each new exam and procedure is a milestone. When you get past the everyday stuff like violating people’s personal space, asking them awkward questions, and doing basic procedures like pelvic exams, the next hurdle doesn’t seem so scary. 

As you progress, the hurdles get bigger, but you also become better equipped mentally, intellectually, and emotionally, to handle them. But in the end, this is why we have supervision in med school and residency. Your residents and attendings are there to make sure you don’t hurt people. 

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Asker Anonymous Asks:
Currently junior in undergrad. Where to start when you are ready to apply to med school? I feel so lost and stressed :(
wayfaringmd wayfaringmd Said:

How to apply to medical school:

  • Print out this timeline and keep it on your wall so you know what your next step will always be. Write all the big application deadlines in so you are sure to not miss them. 
  • Get organized. Make yourself a physical or digital file with all med-school related stuff in it so you don’t lose stuff. 
  • Find out if your school has a pre-med advisor and a pre-med committee to write you a letter of recommendation. If you don’t know how to find them, ask a biology professor. Guaranteed they know which way to point you. Set up an appointment with the advisor to figure out exactly where you are and what you need to do next. 
  • Finish all your pre-med classes
  • Study for and take the MCAT.
  • Research medical schools, starting with those in your state and moving outward. The MSAR can help you with the search. 
  • Fill out your giant AMCAS application (if in the US)
  • Pay AMCAS a squillion dollars to apply to however many schools you want
  • Submit your application.
  • Wait for secondary applications to come to you, and fill those out.
  • Wait for interview invites.
  • Interview.
  • Get in. 

The AAMC has some great factsheets for aspiring doctors, applicants, med students, and residents with frequently asked questions, so I encourage you to check those out. They pretty much lay out everything you need to do to apply. 

Hi there. I’m a 3rd year university student and medicine has always been my dream route after graduating. However, last year I was going through a tough time and as a result my grades suffered. I still meet the minimum requirements for admission to most med schools but I lost my scholarship and it’s not likely I’ll get it back. My grades have improved but I’m scared I won’t get in to med. I’m worried that if I can’t substantially bring up my GPA, I’ll just get ignored in my application. I would consider myself to be well rounded but I don’t know if it’s enough. I just don’t know what I’d do if I don’t get into medicine. I used to have back up plans but I just don’t want to do them anymore. I am so set on med school. Any advice? :/

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Part of wanting to go into medicine is being ok with not making it there in the “traditional” timeline. This whole thing is a gamble. Only a handful of people in my class in med school went straight in from undergrad. You could have a 100% perfect application and still not get in (don’t freak out!) because there simply aren’t enough spots for all the qualified applicants. 

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What’s important is doing your best. If your grades, MCAT score, and extras represent your best effort, be proud of it, regardless of the outcome. If you don’t get in on the first time around, be persistent. It’s not the end of the world. Half of my class in med school had already applied once and were denied.  Find out what you can do to make your application even more desirable and work on that for the next year. 

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Be careful not to idolize a career in medicine either. EVERYTHING, even the things you absolutely love, has a downside. Regardless of how much shadowing you’ve done, you can’t really know what medicine is like until you’ve “made it,” so to speak. If you hold medicine up on a pedestal, you are liable to be disappointed when you eventually do make it.  What if you work so hard to be a doctor, and when you finally get there, you hate it?

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Also, don’t expect that fear of not making it to go away once you’ve secured an acceptance to medical school. Next you will fear dropping out, failing your classes, getting a bad score on Step 1, and looking stupid on clerkships. Then when you graduate you will fear looking dumb compared to your fellow residents, hurting a patient you have been trusted to care for, missing an important diagnosis, getting sued, and on and on and on. 

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A little fear is healthy. It keeps you humble and keeps you learning. But too much fear, which I think you’re bordering on, friend, can hold you back from doing amazing things in life. What if you’re not meant to be a doctor? What if you’re meant to be an amazing biology teacher? Or a pharmaceutical researcher? Or a nurse? Or a PA? What if your insistence on being a doctor is preventing you from excelling in something else?  Just think on that.