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.

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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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. 


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. 


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. 


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).


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! 

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. 


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.  

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. 


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. 

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. 


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. 

Asker ramacero Asks:
In my health care ethics class I am currently taking, we are discussing medical enhancements and our book mentions the use of Adderall in medical students just to keep up. How many students would you think use Adderall in medical school, and would me not using it hurt my performance in my future career? It makes me nervous to think that I could be shoved out of competition because I refuse to use a medication for ADHD, which I don't suffer from, to make myself better in the medical school.
wayfaringmd wayfaringmd Said:

I’m not sure what percentage of people use Adderall (prescribed or not) in med school. In my class I knew of a few, but I expect the numbers have increased.

Let me rephrase your question a bit to this: will using a medication illegally or obtaining it under false pretenses for a condition I do not have possibly negatively affect my career?

The answer to that is a definite yes. I’m a big proponent for using the brains God gave you without using drugs you don’t need. Now if you truly do have ADHD, then by all means, take your medicine. But abusing a medication (and the system) is not a great way to start out a medical career. What will you do when you start residency or go out in practice and the stress and pressure increases? Keep searching for more and more substances to give you a boost? Sounds like a dangerous path to start down if you ask me.

Using meds that aren’t prescribed to you is not only dangerous to your health and illegal, it’s also cheating. And you certainly don’t want cheating on your transcript. That don’t look so pretty to residency programs. 

Thousands— millions—of doctors made it through without using stimulant meds. Heck, Cranquis made it through without caffeine, and I made it through with very little caffeine as well (and no coffee what?!). It absolutely can be done, and you don’t have to be a super genius or a 24/7 studying gunner to make it happen. 

Asker Anonymous Asks:
Will my medical school know if I have a medical marijuana card?
wayfaringmd wayfaringmd Said:

Hmm, I really don’t know. Marijuana isn’t legal in my state. But I would think that your medicine would be your business. But you need to look into your school’s and your clinical rotation site’s drug testing policies too.

Asker Anonymous Asks:
hey wayfaringmd! love your tumblr! I was wondering, how did you study for your third year of medical school on clinical rotations? Was there a syllabus that you had to follow? Are there any books you would recommend? Thanks!
wayfaringmd wayfaringmd Said:

No, we didn’t have a syllabus for our third year rotations. We usually asked 4th years which books helped them prepare the best for rotations. 

If I encountered a diagnosis or drug or treatment that I was unfamiliar with or didn’t understand, I usually looked it up on UpToDate or ePocrates. Those can be extremely helpful.  It’s a good idea to go home and read about your patients’ conditions every night in addition to your book reading to prepare for your test. That way you’re prepared for your test and your patient presentations and pimp questions and, well…life as a doctor.

I also stuck with 1 or 2 books per rotation so that I could actually get through them and absorb them. It’s been a while so I don’t remember all of them, but I remember I used Blueprints for OB/GYN, Step up to Medicine for IM, and Case Files for Surgery. I liked Case Files a lot as my back-up book for studying. And I usually had some sort of QBank that I would review during the rotation too, like MKSAP or USMLE or something like that. 

My advice to you: 

  • get a comfortable couch or desk chair. You will spend a lot of time sitting down and reading.
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  • get a copy of First Aid now and review it as you go along. 
  • come up with a standard snappy comeback for the aunts and uncles who will insist on asking you “so are you still single?” at EVERY FREAKING family gathering
  • get ALL the Goljan bootlegs (ask a second year. They’ll hook you up) 
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  • get some butcher paper and draw out the giant biochemical pathway chart with everything all interconnected. Hang it on your wall and stare at it for 15 minutes every day until you can see it behind closed eyes. 
  • dedicate a few t-shirts that you are “so over” to cadaver lab. Your good clothes will appreciate it. Goodwill scrubs are also excellent for this. 
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Asker Anonymous Asks:
Hello! I really enjoy your blog! I feel like you give a fairly accurate picture/ the truths of going through med school and being a doctor. Anyway, I was wondering what are the rotations available to you during medical school. Does it vary depending on the school? If so, could you tell me some of the basic ones that most schools would have? Thanks in advance!
wayfaringmd wayfaringmd Said:

All medical schools will offer the 3rd year required core rotations, though they may require you to travel to a different facility for some of them. These would include:

  • Family Medicine
  • Internal Medicine
  • Pediatrics
  • OB/GYN
  • General Surgery
  • Psychiatry

Some schools also require a neurology rotation during 3rd year. Mine didn’t, thank goodness. 

Electives vary widely and most people will travel for an elective or two during 4th year. Common electives would include (stars by things most schools will offer):

  • Internal Medicine sub-specialties: *Cardiology, *Nephrology, *Pulmonology/Critical Care, Endocrinology, *Infectious Disease, *Neurology, *Heme/Onc, *GI, Rheumatology, Allergy & Immunology
  • Peds subspecialties (these will likely only be at large academic centers or, of course, childrens’ hospitals): Cardiology, Behavioral Medicine, Nephrology, Endocrinology, Neurology, GI, Heme/Onc
  • Surgery Subspecialties: *Orthopedics, *ENT, Trauma, Vascular, Pediatric, Transplant
  • OB/GYN Subspecialties: Reproductive Endocrinology, *Maternal-Fetal Medicine, Urogynecology, GYN Oncology
  • Psych subspecialties: Child & Adolescent, Geri Psych, Neuropsych, Addiction Medicine
  • Dermatology
  • *Radiology
  • *Emergency Medicine
  • *Geriatrics/Hospice/Palliative Care
  • *Community Medicine/ Rural option
  • *Ethics
  • *EKGs
  • *Anesthesiology
  • *ICU/ Critical Care
  • *Pathology or forensic pathology
  • Ophthalmology
  • *Pharmacology
  • Pain Management
  • *Sports Medicine
  • Global Health
  • Physical Medicine & Rehab
  • Adolescent Medicine
  • Research

Any advice for an incoming med student? Like what was first year like & any tips/hints to help survive??  — lifeofastudentdoc

Part I: What will it be like?!

There will be lots of smart people there. Most of them will be smarter than you, or at least they’ll think they are. Being around smart people all the time will send you into a constant fluctuating state of confidence and crushing self-doubt. image

On the first day you will go home and crack open a book, read for 8 hours, and remark to yourself, “this ain’t so bad.” On the 4th day of such reading, you will start calculating how much debt you will be in if you quit on day 5. 


You will learn an entire new language made mostly of gibberish, Latin, and acronyms. Get to know your -ologies, your hypers- and hypos-, and always pronounce the word the way your professor does, even if there’s a perfectly acceptable alternative pronunciation.



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