Monday, May 28, 2012

Things I Wish I Knew - Fourth Year

Once again, with my fourth year of medical school completed, it is time for me to break out the inner nerd and share the pictograph of my numerical note-taking. The chart above representing my fourth year of school with obvious end points when interviews finished and graduation approached.


The next chart is a culmination of first, second, third and fourth years combined. Initial observation would suggest that second year was almost twice as difficult as first year if not more so.The deep troughs usually representing times of vacation after exams or between years. The steady third year was a result of various preceptors and the work loads with each specialty. Obviously this would look different for every student depending on their scheduling. Things picked up again in fourth year with interviews, audition clerkships and the match process. Once matched, the intensity levels dropped significantly until the end of school all together.

Thoughts in Retrospection

Attempting to look back and decide on the few things that helped me along the way this last year is proving difficult, but as time passed, I have been looking forward to this post and mentally banking ideas along the way. Below are the top five things I wish I knew before my fourth year of medical school and probably could have been useful before school started.
  1. Stand Tall - It can be difficult to show courage on rotations. Many times preceptors will "pimp" students or question our thinking to the point of making us feel smaller than ever before. Standing tall, using direct answers and showing interest made the difference on more than one occasion. Confidence, even if simulated, lets others know you have what it takes when challenges come.
  2. Read regularly - Medicine is a profession of lifelong learning. Getting into the habit now of seeking the latest research in your field will serve you well when it comes time to managing your own patients. Obviously, there is more to know than can possibly be memorized, but taking an active roll in consistent reading can set you apart from your peers who only read to cram for exams. Make reading a regular part of your study routine.
  3. Follow the rules - While this might seem like a no-brainer, it is surprising how many do not. Whether an assignment to study for the next day, a sterile field you are not to touch or paperwork your school needs, abiding by given instruction will only serve to help make your life easier. You will have a lifelong career where you get to be your own boss. Save your rule breaking and adventure seeking for then. Being a student means you are still governed by the rules of those who decide the receipt of your degree
  4. Be proactive - Set up clerkships early, arrive on time ready to start everyday and actively look for opportunities to participate in patient care. Having my interview application submitted early allowed me to be on my eighth interview when some students were just starting their first. Procrastination means you may be eating crumbs
  5. Have fun - This is what you came to medical school to do. You are paying good money to make the most of a four year education, even if long hours of studying depress you. The least you can do is make some friends along the way and have a good time in the process. There are some great memories to be had in medical school, don't miss out.
Medical school is honestly the hardest thing I have ever done in my life. The journey has been amazing to say the least. To be done is not only a dream come true, but a gift only I could have given to myself. I am grateful for all the support my family, friends and readers from around the world have given me along the way. While I do not know what awaits me over the next four years of residency, I am excited to be moving in the right direction. Now to start working on that quarter million dollar student loan.

Question of the Week
A 30 year old male medical student blogger has just graduated and is moving on to residency. If he continues to blog in the little free time he will have, where can his writings be found?

A. www.lifeasamedicalstudent.blogspot.com
B. www.lifeasaresident.blogspot.com
C. www.lifeasamedicalresident.blogspot.com
D. All of the above

Answer: It will not likely be all of the above, but all those are all good places to check. I will try my best to keep this site updated with changes or news.

Sunday, May 20, 2012

Doctors at Last

From the bowels of the LVH (Las Vegas Hotel) at the head of the ballroom, my classmates and I have gathered to be hooded doctors of osteopathic medicine. Its official, we are now doctors!!!

Congratulations to all my TUN classmates and peers at other universities on a job well done!

Graduation Day Is Here!

This post comes as another milestone arrives. I wasn't certain if I wanted this to be my last post as a medical student or the first as a physician. In the end, I think this entire day is in limbo between those two phases. Today is graduation day and like many of my colleagues, I am excited to leave the last four years of medical school behind and move on to the next adventure.

THE Biggest Milestone

While trying to figure out how to wear the graduation regalia can be quite the confusing task, it is exciting to be the one donning the apparel. For years I have admired those dressed in the robes of a doctoral graduate and patiently awaited my turn. In a few hours I will be joining the ranks of those who have gone before to commemorate years of education, sacrifice and desire. All this fanfare for a little pomp and circumstance, that's worth a photograph or two.

It is likely that one of the orators today comments on the ceremony being the "commencement" of our careers as opposed to the kneel of our educational experience. As more time passes, I come closer to understanding the weighted responsibility of what it means to carry the title of a doctor. For once this really does feel like a commencement wherein there is more ahead than what the past has known. How this is possible and how I am going to make it is beyond me, but it's a new leaf in life. Today closes one book and opens another. I couldn't be happier that this day has come!

Monday, May 14, 2012

There's No Homework Like No Homework

Rotations are finished. Residency is on the horizon. I am basking in the space between...vacation-land. Although there is plenty to do in preparation for the next steps, this time is just as precious as it sounds. Letting go of the time schedule, burdens of major responsibility and trivial concerns is more relieving than I imagined it would be.

Recapturing Lost Time

While I could have been intently studying for my next board exam, reviewing the pharmacokinetics of anti-microbials or rehashing the Kreb's cycle, I chose to rest the organ I've exercised intensely for the last four years. Traveling here and there, sometimes without a phone or computer to really dive into the organic "R and R" so badly needed. Mother's Day was no exception. With no prior commitments and time to spare, I made the trek to surprise my mother even though it was the week before graduation where I would see her again. Why would I do it? Because I could. Time allowed and it makes for a better story than going to the arcade for a day.

With only one week remaining before graduation the obvious excitement has somewhat worn off since starting vacation. As it stands now, only time is between me and a degree. No more exams, interviews or documents need my attention. My vacation time seems more valuable at this point than a 4 hour meeting of name-calling and black robes. Yet we are required to attend the event, perhaps for the school to maintain its public appeal of graduating x number of doctors this year. Attending graduation will be the public culmination of all this hard work put to rest. An opportunity for close friends and relatives to say, "I know that guy, how on earth did he become a doctor?" I suppose deep down inside I want to be there too, because it is a proof-giving ceremony validating the last 25 years of my life. Something few events can do.

Here is to a lifetime of dreams, four years of hard work, relationships made and kept, mothers and fathers who support, being a medical student who experiences bipolar highs and lows, and most importantly to the years ahead. The next time I post here will be as a doctor, not that far removed from the student, but across the line a marathon winner.

Question of the Week
Was it hard?

Answer & Explanation

Sunday, May 6, 2012

Fighting for Good Health

While it seems that doctors are making buckets of money, lawyers have found a way to change this in concert with the political movers and shakers who are following suit. Many veteran physicians are encouraging young students to stay away from medicine for fear of endless paperwork, insurance battles and lawsuits. The face of medicine is changing.

Medicine Is A Business

What once used to be a profession geared towards healing the disabled and sick has now become a battle for safeguarding ones career. Often referred to as "CYA" (cover your a__) medicine, doctors are ordering more tests so not to miss pathology and treating minor ailments in vain. They put forth great efforts to serve their patients, but must protect their practice from suing patients, money-hunting lawyers and non-paying insurers. Some discussion with physicians about the subject often brings up ideas for reform with what sounds like logical plans to solve the issues at hand. In some markets doctors are paid almost 50% for their services as a result of under-insured patients or insurers who just won't foot the bill claiming there were non-qualified expenses. Since when can people utilize a service provider, demand services and pay nothing? When I go to the supermarket looking for home goods, they are certainly going to laugh when I ask them to put it on my tab.

In some places the "fee-for-service" model has done well. Patients want their health care provided and pay the provider an agreed upon fee. Both parties are satisfied and treatment is given. There is talk of requiring all citizens to have health insurance. I am still trying to understand why this would be a bad thing. I choose to drive a car; I get insured. I choose to receive health care; I get insured. Seems simple. Research has shown that people value things more when they have to "pay" a nominal fee for it. Even if there was a required co-pay, at least it would show sincerity of the purchaser to the provider that they have a significant concern needing to be addressed. It becomes taxing on the medical systems to provide free or discounted care more often than not. Perhaps that is why one third of hospital emergency departments have closed across the country in the last few years. Uncompensated services cannot last forever.

Whether paying in cash, through an insurer, Medicaid or Medicare, it seems fair to be offering remuneration to physicians for their hard work rather than trying to scheme ways to leave them empty handed. While each insurance organization has various offerings to their clients, some may come up incomplete, requiring users to seek for additive options. Medigap insurance plans for example, offer to fill in the gaps that Medicare Part A and B do not cover. It brings peace of mind to patients that experience a wider coverage of care and allows providers to give comprehensive services.

As I move into medical practice it is hard to know what medicine will be in the future. Policies are being written into law and health care reform is happening at the national level. Medicine as it is known today may be inside out and backwards years from now. Hopefully, parties on both sides of the fence find will be able to latch onto something positive so the face of medicine is tainted no more than it already has been.

Question of the Week
What are the issues, past and present including the proposed efforts of health care reform?

Answer & Explanation

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