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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I finally got to click on the order for “scrotal sling”.

Also, checkout on this patient includes daily scrotal updates. 

Have you lost weight?

Patient who has known me for 3 days and clearly has some early morning delirium.

How does the transition from residency to a "real" job work? Do hospitals court residents? Do residents court hospitals? Is it a random application process?
wayfaringmd wayfaringmd Said:

Ooh, the transition. I’m trying to figure out how that works right now. Around the end of your intern year, you’ll start getting a slow trickle of offers from recruiters. As you progress, they roll in faster. 

Do they court us? Do they court us?! 

They do indeed.

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This is a screenshot from my personal e-mail inbox. I got all of these today. And there’s probably this many more in my work e-mail. See, there are recruiter companies out there that “do the hard work” for you and find you jobs that sound amazing but are generally in places no one really cares to work in. And once you sign your contract, they get a piece of your signing bonus. Not a good deal. I have no interest in these deals. The companies call you and ask you what area of the country you’re interested in (Southeast), and then they send you exactly ZERO offers in that area of the country. I mean geez, we got IL, WY, NY, TX, CA, AR, MA, OR, and some mystery places (which are probably North Dakota and Kansas or something). 

But to better answer your question, I’d say yes to everything. Hospitals like to recruit from within if they have good residents, or from the outside if they have no (or bad) residents. Our hospital tries to recruit pretty heavily from within. Pretty much every class has 1-2 people who stay within the system and another 2-3 who stay in about a 25 mile radius of here. 

Residents can also randomly apply to places or court other hospitals or offices. Most people apply in their hometowns or in cities they want to live in. There are so many options, especially in family medicine where you can work inpatient/outpatient/OB/no-OB/urgent care/ER/nursing home whatever. I’m sort of casting a wide net. I’m applying for a missionary job and I’ve talked to my hometown hospital system recruiter about outpatient/OB jobs and a hospitalist group so far. I’m not really sure where I want to practice or what kind of job I’m supposed to do yet. 

So basically, if a place likes you, they’ll offer you a contract. Then you get someone smarter than you to look over the contract and you decide if you want to take it. Luckily with the physician shortage, docs can pretty much find a job to suit any personality or lifestyle. 

Wayfaring’s grandma: when I was little we used to get these worms in our feet and they itched like crazy and they left a little trail on your foot! Have you ever heard of those? We called it ground itch. Is there a name for it? What is it?

Wayfaring: yeah, I’ve seen it several times. It’s called cutaneous larva migrans. It’s a hookworm larva that is crawling around in your foot. You get it from going barefoot in dirt or sand.

Grandma: well how did you know about that?!

Wayfaring: I went to medical school.

Grandma

What should you write / not write in your personal statement? How do you write something that will make you stand out?

If you stick to these guidelines, you will have personal statement that will stand out for sure. 

DO: 

Tell a story. Use narrative. Stories are so much easier for your reader to pay attention to and remember. And if there’s one thing you want to come out of your personal statement, it’s for people to remember you. 

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Use examples rather than blanket statements. Everyone knows you want to go into medicine to help people, but don’t just say that. Tell a story of a time you helped someone and relay how it affected you. 

Relate your outside interests to medicine. How has your love for sports/dance/music/mission work/travel/etc affected and strengthened your love for medicine? How will those interests make you a better doctor?

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- Leave ‘em guessing. Don’t tell your whole life story, but tell enough about your life or interests to make the reader want to find out more. That’s the stuff that makes for a good interview. Believe me, interviewers don’t want to just ask you all the same stuff you’ve already written.

Brag on yourself a little. The AdCom is looking to be impressed. Ask your friends what your best qualities are, and talk those up in your personal statement. 

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Talk about your personal experiences that have influenced you to go into medicine. But also be aware that everyone has a sick family member story, and that those stories are pretty common in personal statements. 

-  Give reasons why other careers are not for youSure, you love science. We get that. Go deeper. Why do you need to be a doctor of all things? Why is teaching chemistry not for you? Why didn’t you go to nursing school? 

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Remember that you can tailor your personal statement to each program. If you’re applying to a program that has a very distinctive feature, you may want to talk about how that feature interests you. But don’t throw that same statement out to every school. 

Ask for help when you get stuck. Check out Roheet’s (theBiopsy) service called LeanOn that helps folks like you with personal statement writing. It’s worth the price for sure. 

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DON’T

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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.

Hi wayfaringmd, I was wondering if you’ve ever had any run-ins with “gunners” before and had any advice about them?

Of course. Gunners are everywhere. Just remember that their gunning has nothing to do with you and shouldn’t affect you in the slightest. Most gunners gun either because of their own insecurities or because they’re mean spirited and want to make others look bad and make themselves look good.

If you refuse to let them influence your work habits, they are basically powerless. Ignore them when they brag. Refuse to answer (or better yet, be extremely vague) when they ask you how you did on a test. I had a friend in med school who had huge gunner tendencies who would always ask me how I did when we got grades back. I’d just say “as expected” or something like that so she had no idea if I did well or if I failed.

Don’t judge yourself by their standards. Work hard and do your best and forget the rest. 

Don’t ask them for resources and don’t give them yours. I say this not to be mean (because I am all for sharing resources) but because in my experience, gunners want everyone else’s resources but won’t share their own. School is a place to learn to work together—especially med school—and if they can’t learn to play nice with friends and share, then maybe they need to sit in the corner alone for a bit.

Again, don’t worry about the gunners. Let them do their gunning thing and you do your thing. And remember, gunning and making all As does not equate to being a good doctor/nurse/teacher/banker whatever.

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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Man, this guy’s got Spring break in his urine!

- Fellow resident re: patient with a pan-positive Urine drug screen.

Bacon is like a woman. Even the worst I ever had was still pretty great.

super adorable old man who was disappointed that bacon was not included in his gastroenteritis diet.

- start the day with an unbelievably low census

- discharge 2

- tap a belly and get 5 Liters of pale ale ascites off. Patient says we are “all right after all” as he jiggles his now loose belly. Hopefully we won’t have to put that third pressor back on.

- troll the ER for admits cuz my intern needs some practice.

- why do I care how many admits we get? I’m off this weekend.

- chest pain / Shortness of breath rule out. Yes please.

- pneumonia. Sure, also can. 

- diarrhea / dehydration. Sounds good to me. Keep ‘em coming.

- Getting close to quittin’ time. Got some patients on the census without having to work too hard. Excellent.  

- Hey you want this lady? Her hemoglobin is 2.8 but she’s doing surprisingly ok. 

- There’s gotta be a catch. There’s always a catch.

- Anemic lady is chillin, eating a turkey sammich. She’s hungry because, you know, her cocaine and booze wore off. Not what I wanted to deal with an hour before check out. 

- Discuss anemic lady while ER doc tells us we have another one ready for admission. Hurry though, because his Creatinine is SEVENTEEN (YES! a new record for the team!) and his potassium is 8. 

- Can’t. Must. Blood. Also the blood pressure.

- Call ALL the nephrologists. Call the dialysis folks. Might as well call a code.  Just get ready.

- Not expecting him to be on the census on Monday when I return. 

- OTD, dinner, sleeeeeeps

We’ve all seen patients whose personalities grate on our nerves or even outright infuriate us. Someone recently asked me how to deal with difficult patients, but I lost their question. So how do you get through a tough patient encounter in such a manner as to maintain your professionalism, your courtesy to the patient, and your sanity? 

1. Bite your tongue. Not everything you think needs to be said to the patient. Write a blog post about your frustration later. 

2. Be attentive to what they’re saying. Acknowledge their concerns by paraphrasing them or echoing them back. 

3. Thank them for their concerns or even their complaints. My program director sometimes answers complaints with something along the lines of “thank you for letting us know about that. We want your experience in this office to be a good one, and we can only change and fix problem areas if patients like you make us aware of them.” We don’t always change, but it does help the patient feel like their complaint has been validated.

4. Realize that personality disorders are a real thing, and your patient may have one. If you think something’s off, or the patient is always difficult to deal with, maybe that’s your answer. 

5. Realize that your own personality isn’t for everyone either. Some people just don’t gee-haw, as we say in the south. 

6. As my psych attending in med school taught us, never try to reason with an unreasonable person. If the patient is talking completely crazy because they’re mentally ill, don’t try to reason with them. They will not see things your way. You’ll end up with a headache.

7. For the patient who has been seen 10 times already for fatigue or headache or vague symptoms, organize yourself before you see them. Try to anticipate questions they may ask you and be prepared with an answer. Come up with a plan to address their problem, and ask for help from other docs. Sometimes they may come up with something you haven’t thought of. 

8. Set an agenda for the time you have available with the patient and have the patient prioritize their concerns. Let them know that their concerns are important to you and that they each need proper attention, and that may not be possible in one office visit.

9. Set your emotions aside. You can be boiling with rage or feel like you’re about to melt in a puddle of tears, but don’t let the patient know. If you let your frustrations take over, the encounter will go all to poop. Save your tears/screams/punches for a broom closet later. 

10. Kill ‘em with kindness. Don’t put on a fake smile or be patronizing, but think about how you would want to be treated, especially by your own doctor. Try being as nice as possible to them, even if you’re mad, and see if the interaction doesn’t improve. Even if the patient is still rude, you will feel better about your part in it. And the patient will gain no ammunition from your behavior to use against you. 

**Discussing 52 year old patient who has great-grandchildren**

Intern: Her chest pain is pretty atypical. 

Attending: Does she have any family history of sudden premature death?

Intern: No, but it appears she has a family history of sudden premature pregnancy.