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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Asker Anonymous Asks:
Hey Wayfaring! Just curious. What did you do about the lonely patient? You don't have time to talk with him while rounding, right?
wayfaringmd wayfaringmd Said:

Oh, I sat down with him then and chatted for a few more minutes, and then I came back that afternoon after rounds to check back in with him. I do like to be punctual, but I don’t consider rounds to be a good excuse to leave a dying man hanging. I usually show up pretty early anyway. I like to have plenty of time to see patients and not feel rushed in their rooms.

Do you have a few minutes to stay and talk to me? It doesn’t matter what you talk about. I just get lonely sitting in this room all day.

Newly diagnosed cancer patient with very poor prognosis in the ICU, to me on my morning rounds

Asker Anonymous Asks:
What is a pseudoscientific claim you encounter at the hospital most often? If none, from a medical point of view, which do you deem to be the most ridiculous?
wayfaringmd wayfaringmd Said:

I think the one I get the most is “I got sick because I went out in the cold” or “I got sick because I got my hair wet in the cold”. It’s insane how much I hear those. 

Ever heard of germs? And viruses? 

Cold, please. Like maybe if I stand in front of my open freezer door I’ll catch pneumonia. 

Seriously?

My other favorite is “I don’t have allergies. It’s just sinuses.”

Um, no. It’s allergies.

You don’t have chronic sinusitis. You do have a pollen allergy. Ever notice how your “sinuses” flares up in the spring and fall? Pollen.

Take a dang Zyrtec. Good grief. 

Asker Anonymous Asks:
I know someone who is entering his 2nd year of emergency medicine residency, and was wondering what stuff he would learn/deal with. I don't want to sound ignorant or anything :p
wayfaringmd wayfaringmd Said:

Mostly ER residents just work in the ER, but they also rotate with trauma surgery and different ICUs to learn more critical care skills. Other common rotations include cardiology, neurology, toxicology, and anesthesia or radiology.From what I’ve seen, ER residents spend the majority of each year working in the ER, working their way up from minor issues to more critical patients and to heavier patient loads.

ER docs learn how to work up patients’ complaints and stabilize them for admission, transfer, or discharge. They do a lot of procedural work including suturing, splinting, intubating, I&Ds, etc. They have to develop a working knowledge of radiology so they can read their own x-rays and scans and not have to depend on radiologists’ readings in emergency situations. They learn how to manage psychiatric patients, overdoses, and accidental ingestions. They have to become proficient in reading EKGs and spotting heart attacks and strokes. 

ER docs have to learn how to stabilize trauma patients and people who are very sick with medical illnesses. They start with the immediate things that will kill them—lungs not ventilating, heart not pumping—and then move on to the things that might kill them in the next few hours or days. To do this stuff they have to understand when a person needs to be intubated or sent immediately to surgery or had their chest pumped on for a while. 

From what I can tell, becoming an ER doc is all about being exposed to as many patients as possible and learning how to stay cool under pressure. There’s not as much separating out the disciplines (like peds, OB, surgery, etc) like we do in family medicine. They take it all as it comes and learn along the way. 

Shiny…

my response to the night backup’s question, “How is Mr. B’s scrotum today?”

**Checkout on a patient with anasarca, massive ascites and horrible scrotal edema

Day Intern: He might die tonight, so listen out for codes. Unfortunately he’s still full code, so it’ll be ugly. 

Night Intern: Geez. There’s no way he’s gonna live through a code. How far should we take it?

Day backup: You should probably stop if his stomach or scrotum explodes. 

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.