ten great truths Though I don't know exactly what percentage of my readership consists of current or future medical students, as I look back on my third year of medical school, I feel like giving out some advice. Because deep inside, I am your grandmother. And even if no one takes this advice, at least by writing it out, I'll feel as though I've learned something over the past twelve months. MICHELLE'S TEN GREAT TRUTHS ABOUT THIRD YEAR (or: What I wish I had known last July) 1.) Get yourself a comfortable pair of shoes. I'm not kidding. It's worth the investment. You're paying $50,000 a year for school already, what's another $50-$100? Sneakers work for some people, but let me tell you, after being on your feet for 16 hours straight, those Nikes are going to feel awfully tight. I would suggest these, but it's just personal preference. I don't own stock in Dansko or anything like that. 2.) Never, ever lie. This may seem obvious now, but just repeat it to yourself over and over again throughout the year. NEVER LIE. Nothing, absolutely nothing, could look worse. If you haven't had time to see a patient before rounds, don't say that they're afebrile, vital signs stable, with no complaints. If you haven't drawn a set of bloods yet, don't say that you did but that the lab lost them. If you're not sure about a patient's med list, don't just make some shit up and hope that no one finds out. In the short run, you might avoid getting yelled at on rounds, but in the long run, people could get sick and die. NEVER LIE. Seriously. It's not about you. (As an addendum to the Don't Lie rule: it's also not necessary to pretend that you want to pursue a career in whatever your current attendings or residents are practicing, just to get Honors. Honestly, these doctors are smart people, and they understand that statistically, most med students will choose one of the other 14 fields of medicine rather than the one that they happened to have chosen. Be honest with them about your interests, and they might even be able to hook you up with stuff that's more your speed. I mean, you know, don't profess your hatred for their field either, like, "How can you be a urologist, that stuff's fuckin' nasty!"--but that's just common courtesy.) 3.) The most important way that you can make a good impression is to present well on rounds. And by well, I mean concise, organized, and essential. Present professionally and with confidence and you will be perceived as confident professional. Present haphazardly and you will be perceived as a stupid third-year fumbling through a presentation. It's all kind of selling an image more than anything, but you'll be surprised at how often it works, and how often a half-assed history can be glossed over by a strong presentation. Practice your presentations if you have to. Rehearse in front of a mirror. But nine times out of ten, your presentations are all that your attendings see, so you want to be ready to look good. 4.) The patient always comes first. You're working in a hospital. This is a place where, in general, very sick people come so that people can help them feel better. This is not your own personal training academy. The first priority of neither doctors nor patients lies in teaching you how to practice placing IVs or drawings bloods. You'll pick it up along the way, but wait for the right time, be respectful. 5.) Take the time. Third and fourth year of medical school may be the last time in your medical career that you have quite this much time to spend with patients. Your internship year? Probably not so much. Right now, you do have time now to talk to the lonely widow in room 53 about her childhood in the Bronx. You do have time to spend with the family of the asthmatic kid in the ER. Your patient down the hall dying of metastatic lung cancer and with no family or friends? Why not spend 25 minutes of your day with him? From my observation, it's the act of taking the time to talk to patients that distinguishes from good doctors the truly great ones. And since I idolize the great doctors to an unhealthy degree, I'm going to try and emulate them as much as I possibly can. And hey, if you're tired from running around all day? Then sit down when you go in to talk. Not only does it take a real load off the old knees, it really makes a huge difference in how the patients perceive the time they're spending with you. 6.) Don't be too cocky. Humility is key. Sure, you're a real smart cookie, you're an overachieving medical student with a paper trail a mile long of good grades and nifty awards. But you are here to learn. Always remember that. And as much as you feel you may know everything, you really, really don't. Act too cocky and two things will happen. One, you will stop learning, because hey, you're the motherfucking man, and you know it all anyway, right? Two, you will stop seeing your own mistakes and the patient will ultimately suffer for it. Oh, and while we're at it, there is no one that you will encounter in the hospital that you will not learn from. Even if you're working with the biggest fucking moron you ever met, you'll learn something from watching him, even if the lesson is the way not to do something. Don't be too dismissive of people, even if they don't have the towering font of mental fortitude that you feel you possess. 7.) Don't be too cocky, but don't be too shy, either. You're learning how to be a doctor here. Life and death kind of stuff. As a third year, you're not so much directly responsible for what happens to the patient (a relief most of the time, though you'll occasionally long for more responsibility and recognition). For now, you're still a student, so you're going to have backup. You have your interns, and your residents, and even your attendings if things get sticky. But one of these days, those patients will be yours. And you're going to be making those decisions on your own. So practice doing it now. Speak up. Suggest what you think the team should be doing. Read up on the current literature, and if you think there might be a newer or better way to approach a patient than the status quo, then say something. Don't be confrontational or pushy, just say something like, "Being a third-year, I'm obviously not as experienced as you all in handling [insert nature of medical problem], but I think I read in the latest issue of NEJM that [insert new therapeutic intervention] has been shown to be 50% more efficacious than [insert current therapy]. Do you think we might try that?" (And incidentally, that "I'm just a third year, but..." works great on the floor when you disagree with something that someone higher up has said. Instead of pushing them into some confrontational pissing match with you, as might happen if you dove right into the, "I think you're wrong, because I read this journal article that disproves what you just said!", it turns it into more of a teaching point, which people are more often than not likely to listen and respond, because at the very least, they get the chance to school you, the stupid, silly medical student with all your newfangled ideas.) 8.) Nutrition. Now it comes back to you. It might be difficult, since the motto is to eat, sleep, and shit when you can, but it would do you good to try and eat a balanced meal once in a while. I've had too many vending-machine-animal-cracker dinners. It makes you feel bad. And when you don't eat right, you can't think right. Bring food from home if you have to, and try to get a chance to eat it. (Note: stealing food off of patients' trays is not a suitable proxy.) 9.) Have a good sense of humor. A good sense of humor will carry you through this year, and taking things too seriously will sink you. And you know what? It's OK to laugh at patients, as long as you're not doing so maliciously or to their face. That guy with the IV pole walking down the hallway completely naked? That's funny! It's OK to laugh! Just make sure to run down the hall with a gown to cover him up after you're done. The patient who always calls you "Elvis," no matter how many times you've corrected her and told her your real name? That's funny! Laugh! The attending who pimps everyone on every conceivable subject, ranging from medical knowledge to Bible trivia to Opera, and then gets all mad when you can't name the Queen of the Night's aria from Mozart's "The Magic Flute" when he sings it for you on rounds...badly? That shit's funny! And that's why they have shows like Scrubs. Don't forget to laugh. 10.) The Big Question. When it comes to the decision of What You Should Do For The Rest of Your Life, I don't know that I'm the best person to give advice on the subject, as I was writhing with angst for a good portion of the Spring wrestling with that very question for myself. And even now that I've decided, I still don't know if it's "right." But I guess in the end, there is no Absolute Right. Just look at your life. Look at what you've done up until now. Look at the kind of life you want to have in the future. Think about what you enjoy--not just in medicine, but in your outside life too. Think about what kind of patients you want to work with. Think about what you want your day-in-day-out work week to be. And maybe most importantly, think about what it is that you could really see yourself still being interested in 30, 40, 50 years down the line. See what field of medicine most closely fits your answers to these questions, and then do that. Will your answers change over time? Sure. Will those fields of medicine change over the next half a century? Undoubtedly. But as big decisions go, it's a good place to start. I start my fourth year next week with my Pediatrics Sub-I. Big rotation, a lot more responsibility than I'm used to, but the same rules probably still apply. And while I talk a big game with my "Ten Big Truths," let's just see if I can manage to remember them Monday morning when I'm back on the floors. xo Michelle Countdown to the Boards: 4 days |
Monday . June 24 . 2002 . 9:40pm |
ten great truths Though I don't know exactly what percentage of my readership consists of current or future medical students, as I look back on my third year of medical school, I feel like giving out some advice. Because deep inside, I am your grandmother. And even if no one takes this advice, at least by writing it out, I'll feel as though I've learned something over the past twelve months. MICHELLE'S TEN GREAT TRUTHS ABOUT THIRD YEAR (or: What I wish I had known last July) 1.) Get yourself a comfortable pair of shoes. I'm not kidding. It's worth the investment. You're paying $50,000 a year for school already, what's another $50-$100? Sneakers work for some people, but let me tell you, after being on your feet for 16 hours straight, those Nikes are going to feel awfully tight. I would suggest these, but it's just personal preference. I don't own stock in Dansko or anything like that. 2.) Never, ever lie. This may seem obvious now, but just repeat it to yourself over and over again throughout the year. NEVER LIE. Nothing, absolutely nothing, could look worse. If you haven't had time to see a patient before rounds, don't say that they're afebrile, vital signs stable, with no complaints. If you haven't drawn a set of bloods yet, don't say that you did but that the lab lost them. If you're not sure about a patient's med list, don't just make some shit up and hope that no one finds out. In the short run, you might avoid getting yelled at on rounds, but in the long run, people could get sick and die. NEVER LIE. Seriously. It's not about you. (As an addendum to the Don't Lie rule: it's also not necessary to pretend that you want to pursue a career in whatever your current attendings or residents are practicing, just to get Honors. Honestly, these doctors are smart people, and they understand that statistically, most med students will choose one of the other 14 fields of medicine rather than the one that they happened to have chosen. Be honest with them about your interests, and they might even be able to hook you up with stuff that's more your speed. I mean, you know, don't profess your hatred for their field either, like, "How can you be a urologist, that stuff's fuckin' nasty!"--but that's just common courtesy.) 3.) The most important way that you can make a good impression is to present well on rounds. And by well, I mean concise, organized, and essential. Present professionally and with confidence and you will be perceived as confident professional. Present haphazardly and you will be perceived as a stupid third-year fumbling through a presentation. It's all kind of selling an image more than anything, but you'll be surprised at how often it works, and how often a half-assed history can be glossed over by a strong presentation. Practice your presentations if you have to. Rehearse in front of a mirror. But nine times out of ten, your presentations are all that your attendings see, so you want to be ready to look good. 4.) The patient always comes first. You're working in a hospital. This is a place where, in general, very sick people come so that people can help them feel better. This is not your own personal training academy. The first priority of neither doctors nor patients lies in teaching you how to practice placing IVs or drawings bloods. You'll pick it up along the way, but wait for the right time, be respectful. 5.) Take the time. Third and fourth year of medical school may be the last time in your medical career that you have quite this much time to spend with patients. Your internship year? Probably not so much. Right now, you do have time now to talk to the lonely widow in room 53 about her childhood in the Bronx. You do have time to spend with the family of the asthmatic kid in the ER. Your patient down the hall dying of metastatic lung cancer and with no family or friends? Why not spend 25 minutes of your day with him? From my observation, it's the act of taking the time to talk to patients that distinguishes from good doctors the truly great ones. And since I idolize the great doctors to an unhealthy degree, I'm going to try and emulate them as much as I possibly can. And hey, if you're tired from running around all day? Then sit down when you go in to talk. Not only does it take a real load off the old knees, it really makes a huge difference in how the patients perceive the time they're spending with you. 6.) Don't be too cocky. Humility is key. Sure, you're a real smart cookie, you're an overachieving medical student with a paper trail a mile long of good grades and nifty awards. But you are here to learn. Always remember that. And as much as you feel you may know everything, you really, really don't. Act too cocky and two things will happen. One, you will stop learning, because hey, you're the motherfucking man, and you know it all anyway, right? Two, you will stop seeing your own mistakes and the patient will ultimately suffer for it. Oh, and while we're at it, there is no one that you will encounter in the hospital that you will not learn from. Even if you're working with the biggest fucking moron you ever met, you'll learn something from watching him, even if the lesson is the way not to do something. Don't be too dismissive of people, even if they don't have the towering font of mental fortitude that you feel you possess. 7.) Don't be too cocky, but don't be too shy, either. You're learning how to be a doctor here. Life and death kind of stuff. As a third year, you're not so much directly responsible for what happens to the patient (a relief most of the time, though you'll occasionally long for more responsibility and recognition). For now, you're still a student, so you're going to have backup. You have your interns, and your residents, and even your attendings if things get sticky. But one of these days, those patients will be yours. And you're going to be making those decisions on your own. So practice doing it now. Speak up. Suggest what you think the team should be doing. Read up on the current literature, and if you think there might be a newer or better way to approach a patient than the status quo, then say something. Don't be confrontational or pushy, just say something like, "Being a third-year, I'm obviously not as experienced as you all in handling [insert nature of medical problem], but I think I read in the latest issue of NEJM that [insert new therapeutic intervention] has been shown to be 50% more efficacious than [insert current therapy]. Do you think we might try that?" (And incidentally, that "I'm just a third year, but..." works great on the floor when you disagree with something that someone higher up has said. Instead of pushing them into some confrontational pissing match with you, as might happen if you dove right into the, "I think you're wrong, because I read this journal article that disproves what you just said!", it turns it into more of a teaching point, which people are more often than not likely to listen and respond, because at the very least, they get the chance to school you, the stupid, silly medical student with all your newfangled ideas.) 8.) Nutrition. Now it comes back to you. It might be difficult, since the motto is to eat, sleep, and shit when you can, but it would do you good to try and eat a balanced meal once in a while. I've had too many vending-machine-animal-cracker dinners. It makes you feel bad. And when you don't eat right, you can't think right. Bring food from home if you have to, and try to get a chance to eat it. (Note: stealing food off of patients' trays is not a suitable proxy.) 9.) Have a good sense of humor. A good sense of humor will carry you through this year, and taking things too seriously will sink you. And you know what? It's OK to laugh at patients, as long as you're not doing so maliciously or to their face. That guy with the IV pole walking down the hallway completely naked? That's funny! It's OK to laugh! Just make sure to run down the hall with a gown to cover him up after you're done. The patient who always calls you "Elvis," no matter how many times you've corrected her and told her your real name? That's funny! Laugh! The attending who pimps everyone on every conceivable subject, ranging from medical knowledge to Bible trivia to Opera, and then gets all mad when you can't name the Queen of the Night's aria from Mozart's "The Magic Flute" when he sings it for you on rounds...badly? That shit's funny! And that's why they have shows like Scrubs. Don't forget to laugh. 10.) The Big Question. When it comes to the decision of What You Should Do For The Rest of Your Life, I don't know that I'm the best person to give advice on the subject, as I was writhing with angst for a good portion of the Spring wrestling with that very question for myself. And even now that I've decided, I still don't know if it's "right." But I guess in the end, there is no Absolute Right. Just look at your life. Look at what you've done up until now. Look at the kind of life you want to have in the future. Think about what you enjoy--not just in medicine, but in your outside life too. Think about what kind of patients you want to work with. Think about what you want your day-in-day-out work week to be. And maybe most importantly, think about what it is that you could really see yourself still being interested in 30, 40, 50 years down the line. See what field of medicine most closely fits your answers to these questions, and then do that. Will your answers change over time? Sure. Will those fields of medicine change over the next half a century? Undoubtedly. But as big decisions go, it's a good place to start. I start my fourth year next week with my Pediatrics Sub-I. Big rotation, a lot more responsibility than I'm used to, but the same rules probably still apply. And while I talk a big game with my "Ten Big Truths," let's just see if I can manage to remember them Monday morning when I'm back on the floors. xo Michelle Countdown to the Boards: 4 days |
