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 "reality"
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. 

Hey wayfaringMD, I got C’s in gen chem, intro bio and the first half of orgo, I’ve yet to finish orgo 2. I just feel defeated by the intro sciences. I’m a bio minor and I’ve done well in other more advanced science classes but I’m worried I’ll crash and burn in med school, even if I want it badly. I’m feeling kinda lost, thoughts? -searchingforasofterworld

In all honesty, wanting something and doing something are two very different things. 

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Examine the reasons why you did poorly in your premed classes. Was it poor effort? Ineffective study skills? Did the classes go too fast? Lack of interest in the subject? What can you change to make things better? 

Even though the subjects in med school are entirely different than pre-med subjects, you do need a firm foundation to build upon. If a school isn’t convinced you can handle the pre-med curriculum well, they will not be confident that you can handle medical school curriculum either. 

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Also, the material is flung at you at 3x the speed it is in undergrad. If pace is already an issue, think about how you can correct the problem before it gets worse. If you have a weak study system now, it could be devastating in med school. A big part of making it once you’ve been accepted to med school is learning how to learn things on your own.

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On the other hand, if you are already performing at your best, ask yourself if med school is really right for you. Do you want to be a doctor, or do you want to be in medicine? Because you can be in medicine in many different ways without going to medical school. Also, examine the reasons why you want to be a doctor. Do some shadowing. Figure out if you are cut out for medicine and learn whether your current idea of what life is like as a doctor is accurate. 

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The best advice I can give you is what one of my professors told me as a freshman in college. Find the place where things you love to learn intersect with things you are good at. That’s what you should be doing with your life.Think about the classes you have done well in. What made you succeed in those classes that was different than in the ones you didn’t do so well in? Maybe a change of direction is what you need. 

There will come a time in your medical career (early in your career, I suspect, as it was in mine) when a patient will ask you to write a work excuse for them. Now when they’ve got the flu or had surgery or have some legitimate reason to be out of work, this is no problem at all.

But what if their reason is total crap?

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wayfaringmd:

I dont usually relate real life MD’s to fictional Tv series doctors. But I was curious to know can/are some doctors as really cynical,cold and aloof as Dr, Cox, Kelso, and House? If their are Dr. like this what got them to that point, and is it permanent/reversible? -illegallyawesome

Of course there are doctors like this. I think the big difference between the real life guys and the tv docs is that the real life guys (hopefully) don’t show their cynicism as blatantly to their patients. 

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How do doctors become cold and cynical? Personally I think they start out with a little of that in them already, and then it just grows through their career. I constantly hear snide remarks about patients in the “behind the scenes” times in the hospital. I know fellow residents, attendings, and students who very clearly hate patient care, yet they’ve chosen a profession that requires them to interact with people all the time. I’m not sure why people do this.

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If money is your goal, be a businessperson. If it’s prestige, do research and win the Nobel. If you love science but hate working with people, work in a lab. Get a PhD. Be a non-clinical physician. Don’t be a doctor if you don’t like dealing with people. 

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wayfaringmd:

  • For every cool medical show or funny story on a medical blog, there are hundreds of boring stories. 
  • Tv shows like House and even the ones on the Discovery channel are made for entertainment
  • They all have a morsel of truth (a very small morsel in the case of House), but it’s portrayed in such a way as to make it sensational so that more people will watch it. 
  • The boring parts like paperwork, charting, waiting for test results, dealing with insurance companies, and the tons of routine patient visits are left out because they don’t draw tv viewers (or blog followers…). 

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SP: Ok, I’m going to go get my attending now so he can check on you too.

Patient: Your what?

SP: My attending. I’m a resident.

Patient: What’s a resident?

SP: Did you ever watch Scrubs? Those are residents.

Patient: OH! So you get stepped on a lot, huh? 

SP: 

Pretty much…

I dont usually relate real life MD’s to fictional Tv series doctors. But I was curious to know can/are some doctors as really cynical,cold and aloof as Dr, Cox, Kelso, and House? If their are Dr. like this what got them to that point, and is it permanent/reversible? -illegallyawesome

Of course there are doctors like this. I think the big difference between the real life guys and the tv docs is that the real life guys (hopefully) don’t show their cynicism as blatantly to their patients. 

image

How do doctors become cold and cynical? Personally I think they start out with a little of that in them already, and then it just grows through their career. I constantly hear snide remarks about patients in the “behind the scenes” times in the hospital. I know fellow residents, attendings, and students who very clearly hate patient care, yet they’ve chosen a profession that requires them to interact with people all the time. I’m not sure why people do this.

image

If money is your goal, be a businessperson. If it’s prestige, do research and win the Nobel. If you love science but hate working with people, work in a lab. Get a PhD. Be a non-clinical physician. Don’t be a doctor if you don’t like dealing with people. 

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I understand how stupid it is to go into medicine solely based on a TV show but on a related note to that post, how often do you actually have puzzles to solve in family medicine? How many intellectually challenging cases would you, or a real-life doctor in a specialty similar to House's, get? Obviously you're not gonna be getting a case of smallpox from someone who was cut while diving in an 18th century shipwreck, but do you often have cases that are interesting and difficult to solve?
wayfaringmd wayfaringmd Said:

Whoa, I forgot this question was in my inbox. My bad. 

Well, every patient you see is a puzzle. The puzzles range from 10 piece kiddie puzzles to 1000 piece 3D jigsaws. Some don’t require much thought, while others can be very challenging. 

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Many patients will have something about their case that makes you go “hmm”. It may be something like “what drug did they overdose with,” “why is their sodium 124,” “what’s causing that weird feeling I get when I talk to the family,” “they’re allergic to every antibiotic I want to give them” or “is this appendicitis or something ovarian”. 

In the hospital, I’d say that maybe 1 in 40 patients is a real head scratcher. In an outpatient setting, it’s less. But almost all patients have some element of mystery. Also, every patient is different, so patient X with electrolyte imbalances may be handled very differently than patient Y with the same thing. That’s where your intellectual challenge comes in to play. 

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Regardless of your specialty, you’ll get challenging cases. You don’t have to be double boarded in nephrology and infectious disease (which is totally random, btw) like House to get good cases. 

Asker nonametk12 Asks:
My mother is a nurse, and I'm aware of how much time she spends charting. I was wondering about much doctors chart. Do they chart as much as nurses? Do attendings spend more time charting than a resident? And finally, how do you find time for charting in your busy schedule?
wayfaringmd wayfaringmd Said:

Well since I haven’t been a nurse, I can’t say for sure, but residents probably chart just as much as nurses. And it’s about the same or more for attendings. We just chart different kinds of things. All that charting is a big part of what makes a resident so busy. 

If I didn’t have to worry about charting, I could see 10 times as many patients. To give you some perspective, my residency director told us we’d probably do about 200 office visits this year (in addition to all our inpatient time). I saw something like 150 patients on my mission trip in 5 days. I didn’t have to keep records on those patients, though, so everyone was in and out. 

You just have to get really fast and efficient at charting. It took me forever to write the note on my first patient in clinic today because I haven’t gotten the hang of our computer system yet. But once I get a rhythm down, I’ll be much quicker. The same goes for dictations (my peds discharge dictation today took me like 15 minutes, and half of that time was pauses and “umms”). 

And neglecting charting is a cardinal sin in medicine. They don’t go away! They pile up and if you’re really negligent, the hospital will fine you (well, doctors anyway. Not sure about nurses). 

  • For every cool medical show or funny story on a medical blog, there are hundreds of boring stories. 
  • Tv shows like House and even the ones on the Discovery channel are made for entertainment
  • They all have a morsel of truth (a very small morsel in the case of House), but it’s portrayed in such a way as to make it sensational so that more people will watch it. 
  • The boring parts like paperwork, charting, waiting for test results, dealing with insurance companies, and the tons of routine patient visits are left out because they don’t draw tv viewers (or blog followers…). 

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Hey I'm in the uk about to embark on studying as an ODP (operating department practitioner) i am hoping this will give me a good insight on the surgical arena and push me to become a surgeon I obtained good grades in high school but not in maths or science I only got C's in both. I am a mature student at 23 so I figure if I work hard on the ODP degree i.e. obtain a 1st( if I can)and enter into medicine this way? I just wondered what were your thoughts on this! Ps your blog rocks!!
wayfaringmd wayfaringmd Said:

Whoa, alls I know about the UK is tea and guys outside the palace with big fuzzy hats. I don’t know anything about what an ODP does, and I’m pretty clueless about the UK med school system. So unfortunately, I’m not real qualified to offer advice. Maybe some of my followers in the UK could help you out?

But here’s what I can say: be realistic about your goals. If math and science were a challenge for you, think about why they were difficult. Was it bad teaching? Poor study habits? Lack of interest? Figure it out, because the road to being a doctor is pretty much nothing but math and science. Ultimately, work your tail off if you want to be a surgeon. And be ok with working your tail off for the rest of your life, because surgeons are the hardest working bunch of people I’ve ever encountered in my life. 

Asker hayqurlhay Asks:
Weird question, but if I'm still in high school, and I'm not exactly the best student (pretty scary in a bad way GPA although I'm trying to bring it up T_T, not the best SAT scores), what advice would you give them if they wanted to become someone in the medical field and wanted to start now? :c
wayfaringmd wayfaringmd Said:

For starters, check out this post I wrote to another high schooler about where to start in a journey toward medical school. 

But your question is a little more specific, so I’ll try to give you a decent answer. 

First things first: Be realistic about your expectations. Medicine is awesome, but not everyone is supposed to be a doctor, for many reasons. Out of the lecture hall full of pre-meds at my school freshman year, only about 5 of us went to medical school. You’re at a point in your education where you don’t have to know what you want to do with your life yet. So don’t get stuck saying you’re going to do one thing and ignore all your other options. Research your options - nursing, PA/NP, MD, PT/OT, RT - all the acronyms. 

Next, no pain, go gain. You can’t make it in medicine (regardless of the specialty) without busting your butt. Even though schools look at the “whole person” and not just grades, grades are certainly important. You have to study hard. But working hard is more than just studying and doing well in school. It means volunteering, being active in clubs, shadowing, working, etc. too. 

Good luck!