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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Posts tagged "that girly stuff"

lactosefreeninja:

Of obvious and grave importance: how do folks dress in medical school?

On class days during the first 2 years, most folks are jeans and t-shirt types. We even had some PJ bottom folks in our class. Occasionally (like when everything else is dirty), folks get fancy. Some schools mandate business casual, but that’s rare. Our school only required us to dress up on days where we interacted with standardized patients or real ones. Since we were a PBL school, we had mandatory attendance, so we didn’t have the pantsless-at-home option on group days. 

In the second half of medYes, I am taking scar stories. I had to turn off submissions a while ago because of pr0n blogs, but I can turn it back on tonight when I’m home. school, folks go with business casual at the hospital. That usually implies dress pants and nice shirt, +/- tie for the guys, and dress pants + blouse/skirt/dress for girls. Some places are even more casual, like my current workplace, and allow jeans on Fridays. 

Asker Anonymous Asks:
Will my boobs shrink if I lose weight?
wayfaringmd wayfaringmd Said:

'Tis possible. If the girls are the area you generally gain weight in first, then you'll probably lose some weight from them. If your boobs are primarily glandular breast tissue (and not fat), then you probably won't lose much from them. 

Also - I feel your pain when it comes to trying to lose weight with a large chest. Apparently after you reach a certain cup size, sports manufacturers just assume that you won’t be exercising. 

In nursing home rounds with 6 guys

K: Mr. H is bothered by his testicles again. He says they hurt and that they shrunk. He’s always concerned about his testicles. But I mean, who isn’t concerned with their testicles?

Me and the female intern:  image

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I’d like to start off with that I love your blog! I’m an ER scribe, and I’ll be attending medical school next year. Your blog is really awesome! I noticed you said you see a lot of minor OB patients. I was wondering if you give them any kind of sex education to prevent further pregnancy. We see a lot of young people with multiple children in my community ER and very rarely does a doctor try and give then information about preventing further pregnancy (understandably I suppose because it gets quite busy). I was wondering how you approach these young parents, or even if it’s an appropriate conversation to have?

Yes, it is definitely an appropriate conversation to have. Our clinic policy is to address contraception plans in every pregnant woman prior to delivery and then again while in the hospital. About 90% of our patients leave the hospital either A) already on birth control, B) with prescriptions for birth control, C) with plans for IUD or Nexplanon implantation, or D) with a tubal ligation.
When I’m discussing birth control types with patients (regardless of age), I cover the effectiveness of them, major side effects, and their individual advantages and disadvantages. As with any medication, if a patient experiences a side effect they haven’t been warned about and stop taking it, or if they use the medication improperly, it doesn’t work. I also remind them to use condoms to prevent transmission or spread of STDs. 
With my teenage patients, I generally involve their parents in this discussion so they can all come to a decision about what would be ideal for the patient. The parents are usually pretty concerned about contraception because the care of the new grandchild often falls to them. I tend to push longer term contraceptive options that don’t require remembering daily dosing. I encourage Depo shots, IUDs, or Nexplanon for teenagers or anyone not looking to get pregnant for several years.
Unfortunately, most teenagers don’t take me up on those types. My patients tend to be more concerned about the weight gain side effect of some birth control options than the getting pregnant side effect of not using contraception. Many of them end up using pills and inevitably do not use them properly, despite education about proper use, so it’s important to discuss contraception every so often in follow up visits. I tend to preach consistency to my patients. Regardless of their contraception method, they have to use it consistently and correctly for it to work. 

Additionally, I refer teenage patients to a state program we have that partners nurses with first time moms. The nurses go to the patient’s house during their pregnancy and up to 2 years after delivery to teach them about healthy pregnancy, contraception, care of a newborn, etc. Moms in the program have higher high school graduation rates, healthier babies, and longer intervals between first and second pregnancies. 
Ultimately, the best way to prevent repeat teenage pregnancies is to prevent first teenage pregnancies.
Every well child visit I do with a teenaged girl involves a discussion about safe sex and birth control. I can’t force patients to take medicines or to use condoms, but I do try to do what I can to educate them so they can make wise choices. 
Hi, you're a female right? I have a question regarding female medical students and the doctors they become. Is there actually a stigma against still attempting to do your makeup and hair while attending medical school, and then while actually practicing medicine? i've heard different things, and it was a popular theme on Scrubs to slam the female doctor for trying to look attractive still, and I just have to ask if this is a real issue to people. Thanks for anything you can add (:
wayfaringmd wayfaringmd Said:

I do indeed have a uterus

So you’re talking about scenes like this, yes? 

image

No, there’s not really a stigma about dressing up. At least where I work, in the warm fuzzy environment of family medicine where we love everyone and everything is rainbows and unicorns, it is okay for ladies to dress nicely. Except I wore a new scarf last week on casual Friday (with jeans though) and 2 different people asked me why I was all dressed up, so that was weird.

But honestly, image

Girl, get yo hair did. Get yo nails did. Wear those uncomfortable high heels (but don’t look to residents like me who only wear flats to pity you at the end of the day). Wear that adorable chevron monogrammed scarf that you love. Also enjoy waking up super early to do that stuff. 

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Things may be a little different in more traditionally male-dominated specialties like surgery, but in primary care, we are ok with dressing nicely. Regardless of what you go into though, don’t worry about it. Dress in a way that is respectful to your patients and attendings, and don’t look like a total slob (I mean unless you’re on call or night float, then scrub PJs all day long!) and you’ll be fine. 

Asker Anonymous Asks:
How do you deal with that "time of the month" while on call? Advice please!
wayfaringmd wayfaringmd Said:

image

I made a semi-serious post about that a while back in my That Girly Stuff series. 

But on a completely serious note…

You can always sneak away for 2 minutes to, um… refresh your supplies…even when you’re on call. That is, if you’re prepared. Always have supplies, whether in your car, your white coat pocket (sew in INSIDE pockets…they’re amazing), your call room, or your locker (if you’re lucky and your hospital has these). image 

Being a med student or a resident is a lot like being a boy scout. You should always be prepared. Because no one who works 80 hours a week should be expected to keep up with a monthly calendar. 

You could even go in with fellow students or residents to keep the call room bathroom stocked for emergencies. Cuz hey, surely you’re not the only student who has run into this problem, right?

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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. 

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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. 

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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. 

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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.

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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. 

Asker spontiferous Asks:
What are your thoughts about having a professional (ex: Dr. MaidenName) and social name (ex: Mrs./Ms./Mr. SOLastName)? How common is it in the medical field, or does it just get really confusing?
wayfaringmd wayfaringmd Said:

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.”

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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.