Posts tagged advice

We treat patients, not diseases.
All healthcare flows through the relationships between the healthcare provider and patient.
The spoken language is the most important tool in medicine.
Eric Cassell, Talking with Patients, 1985.
I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear.
Nelson Mandela, 1918-2013.
It is the duty of a doctor to prolong life. It is not his duty to prolong the act of dying.
Lord Thomas Horder, 1936.
First off, I love your blog and how you are passing your knowledge to others in this way, it really helps someone like me who is completely nervous & confused on the process of becoming a doctor. My question is: If you could go back and give your freshman self any advice as to how to better prepare yourself for applying to medical schools & building your resume what would it be? Would you do anything differently so that you might have had more confidence in your application? — Asked by Anonymous

Firstly, to you and everyone else who have been submitting questions, I am sorry for the late reply. 

The circumstances surrounding my plans to pursue medicine are complicated. However, if I could go back and give myself advice in a different life, I would advise taking my time. One of my biggest regrets has always been coming into medicine young. I feel that I could have benefitted from a year or two of life experience: working, volunteering, exploring, travelling etc.

The secret to being a great candidate is not how much time you invested in research, how many doctors you shadowed, or how stellar your grades were. The secret to being a great candidate doctor is being a well-rounded, honest, dependable, and kind person. Where medical knowledge can always be taught in school, these qualities that ultimately define you as a candidate are developed through the experiences you have gained in your life.

Without Mistakes How Would You Lern?
Even now, I have to always remind myself that it is alright if I make a mistake, it is alright if I cannot answer my attending’s question, it is alright if I missed something. In the end, what matters is that I learned something to make sure those mistakes do not happen again.

Without Mistakes How Would You Lern?

Even now, I have to always remind myself that it is alright if I make a mistake, it is alright if I cannot answer my attending’s question, it is alright if I missed something. In the end, what matters is that I learned something to make sure those mistakes do not happen again.

Trust no one.
Internist on verifying any information given to us rather than elicited ourselves.
Knowing yourself is the beginning of all wisdom.
Aristotle.

Neil deGrasse Tyson speaks about learning mathematics from the Great Debate: the Storytelling of Science.

I watched this last night and I think it is advice that applies to many of the readers who have asked through the years what to do about their struggles with math, chemistry, physics etc. Certainly, I feel that it applies to those who question if medicine is too hard for their passion to stay alive.

With practice, you can become better at your craft, no matter what discipline you pursue. It takes time, it takes work, and it takes practice. But you do eventually get there.

Watch the full Q & A session linked above for other responses by Dr. Lawrence Krauss and Bill Nye to this question.

On Stage Off Stage.
Dr. Cranquis recently broached a very interesting topic that warranted discussion: that of personal address. Is it Dr. Smith? Or do I call him James like everyone else? What should I be called? It is never really discussed and it is something you feel out as the year goes on. However, there are some unspoken rules that always apply.
Imagine the hospital setting as a theatre, with both the stage - in front of the patient - and back stage - with your team. As long as the stage is set, and the patient or their family is involved, we play our roles, our characters in the hospital: Doctors are addressed as doctors; nurses are called by their first name etc. Back stage however is where the distinctions begin to blur.
Generally speaking, it is always a safe bet to address physicians as Dr. So-and-so until they give you permission to address them by their first name. The same can be said about resident doctors, who generally prefer their first name address backstage; often times they will make it clear when you first meet.
Nurses on the other hand always go by their first name for safety purposes and that makes it easy. They do not typically give out their last name in case patients become attached. Even if you do know their last name, avoid calling them Ms. or Mrs. So-and-so in front of a patient. 
For yourself, you can choose to be addressed any way you so choose as long as it fits your role. I typically will go by my first name off stage, and go by the title medical student on stage. Just make it clear you are not a doctor as that revelation after the fact can break your patient’s trust in you and your team.
The more challenging issue comes with seniors whom you knew before medicine or when work must be done off stage. What then? In the former case, the importance is to preserve your roles on stage in front of the patient. Everything else should be played by ear. In the latter case, when orders must be given and plans are being set in motion, regardless of how equalized the playing field was before off stage, “John the resident would like to order these tests,” becomes “Dr. Doe would like to order these tests.”
Remember that in order for us to do our jobs well in the medical system, the role we take on stage and off stage must be clear. There can be no ambiguity when work must be achieved. In the intervening times, the address becomes a grey area where no clear rules are given. Unfortunately, some of these moments you will need to take one at a time.
Next pearl: Digital Confidentiality…Previous pearl: Humanity…

On Stage Off Stage.

Dr. Cranquis recently broached a very interesting topic that warranted discussion: that of personal address. Is it Dr. Smith? Or do I call him James like everyone else? What should I be called? It is never really discussed and it is something you feel out as the year goes on. However, there are some unspoken rules that always apply.

Imagine the hospital setting as a theatre, with both the stage - in front of the patient - and back stage - with your team. As long as the stage is set, and the patient or their family is involved, we play our roles, our characters in the hospital: Doctors are addressed as doctors; nurses are called by their first name etc. Back stage however is where the distinctions begin to blur.

Generally speaking, it is always a safe bet to address physicians as Dr. So-and-so until they give you permission to address them by their first name. The same can be said about resident doctors, who generally prefer their first name address backstage; often times they will make it clear when you first meet.

Nurses on the other hand always go by their first name for safety purposes and that makes it easy. They do not typically give out their last name in case patients become attached. Even if you do know their last name, avoid calling them Ms. or Mrs. So-and-so in front of a patient. 

For yourself, you can choose to be addressed any way you so choose as long as it fits your role. I typically will go by my first name off stage, and go by the title medical student on stage. Just make it clear you are not a doctor as that revelation after the fact can break your patient’s trust in you and your team.

The more challenging issue comes with seniors whom you knew before medicine or when work must be done off stage. What then? In the former case, the importance is to preserve your roles on stage in front of the patient. Everything else should be played by ear. In the latter case, when orders must be given and plans are being set in motion, regardless of how equalized the playing field was before off stage, “John the resident would like to order these tests,” becomes “Dr. Doe would like to order these tests.”

Remember that in order for us to do our jobs well in the medical system, the role we take on stage and off stage must be clear. There can be no ambiguity when work must be achieved. In the intervening times, the address becomes a grey area where no clear rules are given. Unfortunately, some of these moments you will need to take one at a time.

Next pearl: Digital Confidentiality…
Previous pearl: Humanity…

A Word with Third Year

For the students who have finished their academic years, congratulations to you. You are now half way to your MD title. Prepare to shift gears and enter a new medical state of mind as you move away from the theoretical to the practical. Here are some words of wisdom as you begin this challenging but rewarding year of medicine.

  1. Stay healthy. This point makes a daring return yet again on this year’s list because it is such a supremely important point that I cannot emphasize this enough. Take care of yourself. The learning curve this year can be quite steep. Call shifts can be long and hard. Between your health and your work, always remember to look after your health first.
  2. Know what you are getting into. Each rotation has very different scopes of practice. With them, comes different skill sets and expectations. Make sure to read the rotation primers that are available to you. Speak with senior students or classmates who have gone through the rotation before you and get a first hand account of how to prepare for the rotation. 
    Even between preceptors, expectations can change. Do not hesitate to ask your preceptor before beginning your rotation what their expectations are for you.
  3. Make an impression. Do you need to be extremely keen, fighting tooth and nail to be on the ward for every consult? Perhaps not but you should make a strong first impression. Be punctual. Be engaged. Be curious. Of course most importantly, be professional. You not only want to develop a strong work ethic that they want to work with, but also would recommend to a colleague in the future.
  4. Read and keep reading. One of the most challenging aspects of third year medicine is finding the time to read. Not only are the days long to begin with, you can see so much in a day that you do not even know where to begin. Pick two or three interesting or common problems that you have seen that day and read around them. Read briefly around everything else if you have time. Read during short breaks on the ward or immediately when you get home. Always make time for a bit of light reading.
  5. Practical applications. As you gain more exposure to the world of clinical medicine, be sure to keep an eye out for practical situations. Watch, learn, and practice clinical skills when the opportunity present themselves. The only way to solidify clinical experience is through repetition and practice.
  6. Keep track. In the same vein as the previous point, find a way to keep clinical pearls passed down to you as you can be told many teaching points in a day. Type them into your phone, write them down in a notebook, dictate it to yourself. These are useful learning resources for the rest of your rotation, your career, and beyond.
  7. Snack. Unfortunately, your schedule in third year can fluctuate quite a lot. Remember to bring bite-sized food and a small bottle of fluids with you at all times. There is never a guarantee that lunch is going to start at noon.
  8. Thicker skin. Though not universally true, always be ready for harsh feedback, criticism, and scut work. Part of this can be alleviated by tip #2 by knowing what is expected of you, but even then sometimes the reality can catch you off guard.
  9. Medical students anonymous. Medical school in third year can be one of the most intense and gruelling experiences you face. It may not be easily relatable to your family or friends who have not been on the inside. Be sure to stay in touch with your classmates and find support in each other in difficult times. In difficult situations in the ward, never hesitate to ask to be debriefed to address any emotional toll of what you encounter.
  10. Playing doctor. At this stage, you are still under quite a bit of supervision to ensure patient safety. This absolves you a lot of the hard decisions. However, go into any situation imagining you are the doctor. Think to yourself: “What is the problem? What is important and unimportant? What do I think is going on? What can I do to fix it?” Even if you may not know how to approach a situation, if you can use those questions to dictate and guide you, your clinical acumen will flourish.
  11. Have an approach. Along the same lines of the above tip, equally important if not more important than retaining every detail of every condition you see is to develop an approach to tackling a problem. Remembering every rare condition that can cause the constellation of symptoms X, Y, and Z is an exercise in memory. However, if you can reason through a problem and how to solve it, this is a more valuable skill. When you see problems, try to distill the problem to its essence as that is the framework from which everything else can be built upon.
  12. Do not lose your sense of self. In the midst of all of your newfound responsibilities and experiences, this is the year where many medical students lose their empathy and their passion for medicine. Remember the wonder and excitement of being done with lectures to finally work in the hospital. Do not forget to be a kind person to a fellow, suffering patient. If you can find play in your work then work becomes play and your practice and your patients will benefit from that in the long run; there is no better time to start than now.

Good luck and take care.


Related post: A Word with Second Year. A Word with First Year. Clinical pearl series.