W, on patient with a somewhat stable GI bleed: I say send him home, even though he’s bleeding.
C: Let him bleed at home! Women do it all the time!
Intern: The patient asked me if she could take Midol while she’s on coumadin. I had to look it up to find out what’s in it. Turns out, Midol is a hundred different things. You got Midol PM which is acetominophen and diphenhydramine, Midol teen which is acetominophen and pamabrom, whatever that is…Midol Liquigels, which is ibuprofen, and Midol Extended Relief, which is Naproxen. So basically Midol is Tylenol, Motrin, or Aleve, depending on which kind you get.
Me: I think there’s another form that has caffeine in it and is essentially the same as Excedrin migraine.
3rd Year: They should make Midol with Haldol.
Attending: AHA! Yes! For when that time of the month coincides with full moons. Or for when your uterus starts talking to you.
Any ideas about interview wear for ladies? I’ve seen your post lamenting the downfalls of heels, but what about the rest of the ensemble? And the shoes: heels? flats? depends on what you’re pairing them with? thanks! -aconn51
Again, I’m not the foremost authority on med student / resident fashion out there. Not. At. All. But I offer my observations.
In the med school or residency interview, suits are always encouraged and accepted. I didn’t wear a suit to my med school interview because I couldn’t afford one at the time, but I can’t really say I recommend that option too highly. I wore a nice tailored, belted blouse with dress pants and heels. It was professional, and it made me stand out, but it probably wouldn’t be appropriate for every school or program. Fortunately, I was applying to a place that was pretty laid back and already sort of knew me.
any advice for a teen who wants info on sex & birth control but doesn’t know how to ask at an appointment because mom or dad is always in the room? -anonymous
When I see kids 12 and up, I always ask the parent to leave the room briefly for this very reason. I’ve found that even teenagers who aren’t doing anything their parents would disapprove of are still embarrassed to ask questions to their parents or in front of them. I’ve had teenagers ask about bullying, cutting, sex, birth control, STDs, drugs, etc in these brief private encounters.
If your doctor is not one who regularly does 1-on-1 interviewing with teenagers, maybe ask your parents if they will wait in the waiting room and allow you to go in alone to show them that you are mature enough to go it alone at the doctor’s.
Another option would be to call ahead to your doctor’s office, explain the situation, and request that the doctor ask your parents to step out so that you don’t have to ask them yourself.
Depending on your state and your age, you may be allowed to make an appointment on your own anyway and go without your parents. I assume that you don’t drive, though, anon, because you state that your parents are always with you at visits. A driver’s license does afford you a bit more freedom.
In the meantime, here are some good resources about sex and types of birth control.
I have an old That Girly Stuff post about name changes. But I’ll add that I don’t know many people who use the professional/social name system. I know maybe 3. I haven’t found it to be super common, but again, I’m in the South, where most women change their names anyway. It could be confusing for your patients if you practice in a small town where people are likely to know you in a medical and social context, but if you are in a big city where you can separate the two, it might go smoother.
I hear from my friends that it’s kind of a hassle to get your “professional name” changed on your medical license, DEA number, NPI number, etc, but if it’s what you really want, you’ll do it. I think it’d be just as hard to keep up with 2 names as it would to bite the bullet and do some one-time paperwork.
Hey there I know you mentioned previously you wanted to go abroad for a mission trip whenever you have the time/resources. I wanted to join the peace corps once I’m done with my NP program but ill be in my late twenties and I’m just freaking out like will I ever have time to do that and find a husband and have kids at a reasonable age and I guess I’m just freaking out/ranting but wondering if you had your mission trip planned/figured out? -anon
Well hey there yourself gray-face, and welcome to WayfaringMD’s life struggles.
Here is a post dealing with your question. In short though, you can do it all. Life may not follow the timeline you wanted it to follow when you were 14, but if these things are meant to happen for you, they will in due time.
These worries hit me from time to time too. I very much want the husband + babies + mission work ideal situation, but I’m learning to be content with where I am. I’m learning to take advantage of my singleness, which I hope is just on loan to me but is possibly a permanent gift, and use it in a way that glorifies God.
I am in the process of planning a trip for August of this year. I had plans in place (two or three times, actually), but they keep falling through for various reasons, which is why I haven’t announced travel plans yet. I’m down to 2 options left, so I’m hoping one will work out soon, otherwise I’ll have to rearrange my whole schedule for the coming academic/residency year. When plane tickets are in hand, I’ll make a more formal post about it all.
nainokibullet asked: wowza! i wonder…do they get time off during the first few months when the baby is born?
Descantforhope replied: I don’t know anybody that gets time off, in response to your comment. I was taking finals 6 days later. I did get a week of excused absence, since I was in labor the first 3 days and then recovering from a c section the next 3.
At my school it depended on when you had the baby as to whether time off was possible. Those that had kids during the first 2 years didn’t get time off (well, maybe a week like descant). I remember a girl in the class ahead of me taking an end-of-phase test just a day or two before delivering. But those who had them third and fourth year could take up to 6 weeks off. The 6 weeks was taken out of the total 8 weeks vacation time given during 4th year, so any missed rotation as a third year would be made up then.
Do you know any females who have gone through med school or residency while pregnant? I’ve read your posts on relationships and marriage while training to become a doctor, but given the limited window of peak fertility, it’s naturally something that concerns me as a single woman hoping to enter the medical profession. Pregnancy doesn’t seem like an easy undertaking with the stress and time demands, but I was just wondering if anyone in your experience has successfully done it. Thanks! - efxaristo
Absolutely, I know quite a few ladies who have had babies during medical school. A great one to ask more specific questions to would be descantforhope, who had her first baby a few months ago.
In my class there was only 1 girl who had a baby during med school, and she had hers toward the end of our third year.I remember looking at her being 8 months pregnant, holding a retractor in the OR for hours and thinking “she is hardcore”. I would have been all over the one stool in the OR being like “my feets hurt”. People would offer to let her sit out on things, but for the most part, she did everything everyone else did (plus manage to find time to pee 12 times a day). She actually refused when an attending told her to go home one morning because she looked sick. She was like “I’ll be fine once I throw up. Just give me a few minutes.”
as a woman have you ever hesitated med school with the whole “when will i have time to get married have kids, raise the kids, etc” b/c im just scared I won’t have time for that. By the time I get out of med school I’ll be old. I just have this fear of not being able to enjoy my “youth” or just be normal… - anon
I think most of my readers by now are aware of the fact that I have no husbandly prospects. Since that has always been the case in my life, it has actually been a little difficult for me to imagine life being any different than it currently is (though I definitely want the whole husband/litter of children thing, don’t get me wrong). So when it came time to apply for med school, I really didn’t take family life into account. I sort of figured, “well, if it happens, it happens, and I’ll make it work”.
I certainly wasn’t going to put off school and go on a hunt for a fella, because at the time I was starting school, I knew I wasn’t ready for marriage anyway. If I had put school off, I’d likely still be single and working a job I less than enjoyed right now.
For the most part, I’ve seen the “make it work” mentality with most of my peers. Sure, you can try to plan marriages and babies at times that could be slightly easier, but it’s not always possible. As I’ve said before, you’ll make time for things you deem important, so it is possible to still be a good wife and mother and be in medical school or residency.
Now the fear of not being “normal” or not enjoying your youth is legit. We all have issues relating to our non-medical peers because our lives literally revolve around medicine all day every day for so many years. It can be very hard to relate to your friends, which is why it’s important to be involved in things that put you in contact with so-called “normal” people. This is why church involvement was so huge for me. It gave me an outlet besides medicine.
So cheer up, anon. It is possible to have it all.
Yes, it is harder, and if you examine yourself and find that you would rather focus on one thing or the other at a time, that’s totally fine too. Though it’s hard to have a baby during medical school or residency, it’s equally hard or even moreso (financially, emotionally) to go back to school when you have a family at home. My best advice: seek out female physicians and ask them how they did it. Get different perspectives and then think about what would work best for you.
2. What are my boobs supposed to feel like/not feel like? <—- that is the most embarrassing sentence I’ve ever written. Thanks. -anonymous
Don’t be embarrassed anon! I get this question quite frequently in the clinic.
Boobs. They come in many shapes and sizes and often are lumpy. The best way to know if your boobs are normal lumpy or abnormal lumpy is to have them examined by your doctor. Have your annual breast exam and then go home and do a self exam so that you will know what normal feels like on your body.
Many women, especially teens and young women, will find that their breasts feel lumpier around the time of their period or the few days prior to starting. Thus, this is not the greatest time to do self breast exams because it will be hard to differentiate benign lumps from sketchy ones. They may also have breast engorgement or tenderness during that time, which may make exams uncomfortable. More often than not, these lumps during the womantimes are fibrocystic in nature (benign lumps), but are still worth having checked out.
Now what kind of lumps should you be worried about? Lumps located in the armpit or the area between the breast and the armpit, ones that are very hard, aren’t freely moveable or feel like they’re stuck to the chest wall, or ones that cause skin changes like puckering or an orange-peel appearance. Those kind of lumps need a doctor’s appointment fer sure.
Educational pictures after the jump.
Okay, I guess this qualifies as a That Girly Stuff question(s). 1. I am not/never have been sexually active. Should I still see my gynecologist regularly/at all if I’m not having any lady issues? (I’m 24, so do I need a pap smear or no?) - reader asked to stay anonymous
(Second Question will be dealt with as a separate post tomorrow)
First let’s start with terminology just so everyone is on the same page: a Pap smear should not be synonymous with a pelvic exam. You have to have a pelvic exam to get a Pap, but you don’t have to have a Pap when you get a pelvic exam. A Pap is just when the doctor takes a scraping of cells from the cervix to screen for cancer. It may be necessary to have a pelvic exam done even if you don’t need a Pap if you have vaginal discharge, bleeding problems, pelvic pain, etc.
The latest recommendations from ACOG, the ASCCP, and the USPSTF say that Pap smears should be delayed until 3 years after onset of sexual activity or age 21, whichever comes first. Since almost all cervical cancers are caused by the human papillomavirus (HPV), Paps are of little value in women who have never engaged in sexual activity. That being said, no doctor will tell you it’s ok to not get a Pap because, like House, we believe that everybody lies, and therefore we can’t accept the liability of not testing people just because they say they are virgins.
From age 21-29, the bigwigs recommend pap smears every 3 years. After age 30 you can continue with Paps every 3 years OR space them out to every 5 years if they are done in conjunction with a blood test for HPV.
Also, just a reminder: you don’t have to see an OB/GYN for a pap smear. Family docs and internists do ‘em too, so if you already have a primary care doc you’re comfortable with, it’s not imperative that you see an OB/GYN.
tl;dr: if you’re over 21 and you have a cervix, then yes, you need a Pap.
Hello! This is kind of a girly question. But do you know any easy to maintain hair styles/length that you have or had in the past that looked good despite a crazy busy schedule? As a premed I know that hair would be the last thing that I would want to focus on when I have a class. Any suggestions? Thank you! -selfpermutations
Well I can’t give all my secrets away, so rather than discussing my personal hairstyle, let’s talk hair in general. Easy hairstyles that look good and don’t take all your time in the morning are hard to come by. So here are some options:
1. classic ponytail - Pros: looks good on almost anyone, as long as your head isn’t totally flat and you don’t do the messy bun. The messy bun is a no-no. Cons: gets old after a while. Honestly, this is what pretty much everyone opts for. However, I’m one of those weirdos whose head looks square when ponied up.
I’ve been eyeing this cute medical student (5th year) for 6 months. I study psychology and will probably choose neuropsychology as my major subject. Some of his friends mock me and my collegemates for being charlatans, fraud docs, mojo thieves and so on. I’m dying to get advice from you - HOW DOES ONE PICK UP A MED STUDENT WHILE BEING PSYCHIE? -universityofnowhere
I’m flattered that you’re dying to get advice from me, but you got the WRONG ONE.
I am the absolute LAST person you should ask for advice on how to pick up a fella. Why’s that? Glad you asked.
But I still thought about your question, and since I’m not one to chase after guys, I sort of turned it around.
How would I want a non-medperson to pursue me?
Is it true that Birth Control Pills can affect a woman’s biological chemistry causing her to be attracted to the “wrong guy?” -strawberryjamsandwich
I had to do a little research on this one. I’ve heard all kinds of claims about “side effects” of birth control pills, but “choosing losers” is a new one, definitely.
Quite a few studies have shown that oral contraceptives (OCPs) decrease androgen (male hormone) levels in women, which is part of why they are prescribed to women with PCOS. Other studies have suggested a correlation between women with low androgen levels and a decreased preference for men with high androgen levels. But correlation does not = causation.
Your altered hormone levels have nothing to do with what constitutes the “wrong one” for you. Think about it: if we asked 1000 women to define a “loser” mate, they would have wildly different answers. The way you pick your mate has a lot to do with your values, personality, environment, upbringing, judgment, and common sense—not just your hormones. There are lots of reasons that you might pick a dud every now and then. To illustrate it a different way, if I were to trip and fall while walking on the sidewalk, is it the fault of the company that designed my shoes, the city that laid the concrete for the sidewalk, or my own personal clumsiness? All had a part in making me fall, so you can’t really pick just one to blame.
It has long been known that OCPs can alter women’s mood and libido. However, how that translates for individual women varies widely. Sometimes they’re altered for the better—they become more emotionally stable (which is why OCPs are sometimes used to treat severe PMS, called PMDD)—but sometimes they become more volatile. But regardless of how your pills affect you, you have to realize that they’re not totally to blame for your poor life choice. Attraction is a complex biological process, involving many neurotransmitters and hormones, but who you choose to date is ultimately up to you, not your hormones.