Its NOT Hard

From being quite sure that my age would be a negative determinant of medical school success, to being willing to take any acceptance I could get, then moving to an intentional choice of which school is right for me – this has been an amazing journey. Through all the ups and downs I’d say the most powerful realization has been this: ITS NOT HARD!

As I write those three words, I’m well aware that there are students right now in classrooms, study cubicles, huddled in apartments and bleary-eyed in libraries – who are feeling the overwhelm of what’s been aptly called “drinking from a fire hose”. With the sheer volume of information presented during medical school, how the heck do I keep stating ITS NOT HARD?

Here’s the thing.

You have to completely  change the way you study. If you use the same study strategies you used to be very successful as an undergrad, you will fail in medical school.

That’s a pretty hefty statement to make, but I believe it with every brain cell I’ve used to “decode” medical school study strategies that actually work. With the sheer volume of information presented in medical school, its easy to get stuck in thinking that your primary ‘job’ is to memorize all those facts. To become a walking, talking encyclopedia of information.

Bottom line is that if you do that, you’ll absolutely fail to synthesize information in a way you can use to pass the med school exams and boards. The tests you’ll see in medical school are different than anything you’ve seen before, and that long list of facts you spend hours storing in your tired brain is just the beginning. In med school, its all about the story, the experience, using those facts as the foundation but going so much beyond facts to what they call “secondary and tertiary questions”.

If you spend your time simply memorizing facts, you’ll be shocked when you get to exams and realize you have no idea how to answer the questions – even though you’ve spent every waking moment studying.

Here’s what works.

  • Listen to the lectures – that’s just a recitation of facts. You do need those facts as a foundation.
  • Immediately begin composing “stories” – how might these facts come together with an actual clinical scenario.
  • Spend the bulk of your time studying clinical vignettes – ‘stories’ that present a case, then ask you to pull together those disparate facts into a cohesive whole. Use q-banks as your bible, read the questions aloud, and talk your way to a solution before you ever glance at solutions.
  • Judiciously make use of study aids such as flashcards and flowcharts.
  • Another absolutely priceless way to use the q-banks is to review why other answer choices are incorrect. Regardless of which software you’re using for review, they all provide an explanation of why a particular answer choice is correct or incorrect. Don’t simply scroll on by if you chose correctly – review why the other choices were not the best answer.

I’m daily blown away by how simple this really is, so long as I first get the factual foundation then spend time practicing incorporating all those facts into clinical scenarios. By faithfully putting in the time to study this way, you’ll find that medical school is not hard  – it simply requires you to learn a completely new way of studying!

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When Grief Hits Home

The medical profession is all about giving – serving those who are hurting and helping find medical solutions.

We’re not so good at receiving.

Yesterday morning I got a text message from my sister. My big sister is a doc herself and has been part of my ‘cheering section’ as I’ve pursued my own medical career. But this message hit me hard.

“I’m writing to tell you that Al passed away this morning.”

There’s nothing that can prepare you for such news. And while I feel like my sister holds half of my heart, I know that the sadness I feel is minuscule compared to hers. She found her true soul-mate late in life, and Al was one of those priceless men who treated my sister like a queen. Their life together was a beautiful testament to how wonderful a marriage is supposed to be. And my only thought was, I need to get to her. I need to help get our mother to her. We need to be together and wrap her up in our love and support.

As messages of condolences roll in, I’m watching how different folks deal with grief in another’s life. Some don’t say much but their “I’m with you” message is clear. Some offer prayers, some share a similar situation in their own lives. And some ask what they can do to help. With the help of friends, we set up a gofundme account to help us siblings and our mother travel so we can just be with. 

The most priceless messages we’ve received are those who say something like this:

Its okay to be sad. Its okay to cry. You don’t need to pretend you’re alright. I understand.

I hope I always remember this, as I continue to reach out to suffering patients. While there is a limit to medicine’s ability to ‘fix’ things, there is no limit to the power of compassion.

And often, just saying, “we’re with you” is enough.

Your contributions will be used to help us travel to be with my sis, and anything beyond travel costs will go to help with all those ‘little’ things for my sister. May blessings continue to flow into your life as you give, and receive, compassion.

The Others

I’m convinced that its never too early to begin establishing habits of acknowledging those “others” – the ones who so heavily contribute to student doctors and physicians being able to effectively do their jobs.

Last night, I spent late hours at my local hospital Emergency Department. It wasn’t exactly a busy night, but there was a steady stream of patients. The little boy with a croupy cough – not bad enough for admission, but I spent quite awhile reassuring his exhausted parents. The dad in the middle of a custody fight concerned about possible abuse to his 2 year old daughter. The confused young man high on ‘something’ and his mom who tried to cope…

As I watched the night play out, I paid attention to those “others”. Here’s a few of the lessons I learned.

  • Take time. In a busy setting like an emergency room, everyone is focused on doing their job. But I’m finding it so important to create time to interact with those “others”, even if just for a moment. The nurse who seemed relieved to share how her own son is doing with his medical challenges. The front desk folks who’s faces light up when I stop to ask them how their night is going. Don’t be so busy “doing your job” that you forget to take time.
  • Make eye contact. Its not enough to throw out a fast “how the heck are ya?” as you dash past the tech, or housekeeper, or student nurse. Stop walking for just a moment and make eye contact. Its important.
  • Say thank you. Last night I watched as patients were collected by Radiology for a fast CT scan, blood draws and X-rays quietly just “happened” after the doc checked that box in the EMR… Saying Thank You is huge. It doesn’t happen often enough. Its important.
  • Intentionally acknowledge people. Sure, often those “others” are just doing their jobs. And they’ll most often brush off your acknowledgement. Do it anyway.

It was after midnight when I finally said good bye to a mostly empty ER and walked out the door. I said good night to security and walked out into the drizzle – after all, I was parked close, under a light, and I didn’t feel any need of an escort. As I started up my car I looked out my rear view mirror and saw the security guy standing on the sidewalk. I hadn’t asked him to, but he had followed me out and was watching. Just to be sure.

I jumped out of my car and jogged back to where he was standing.

“Thank you,” I said, reaching out to shake his hand. “I didn’t think to ask you to watch, but I feel safer having you here.”

He acted a bit embarrassed actually as he dropped his eyes. “Just doing my job ma’am”. But I saw the smile lifting the corners of his mouth as I turned around to leave again.

Acknowledge people. Everyone. ALL are important.

The Pendulum Swings

I’m daily reminded of the gaping chasm between academic medicine and actual medical practice. I don’t have a solution (yet), but I notice it. Mostly on days when I’m in clinic or making housecalls or working in the ER with my clinical mentor.

I went into this grand adventure hearing for at least the last decade how more than half the information I learn in medical school would be obsolete by the time I graduated. That’s a theoretical and interesting fact until one is experiencing the whiplash going back and forth between clinical experience and memorizing seemingly endless facts.

Things like: if the evidence is incontrovertible that antibiotics simply don’t benefit patients with acute bronchitis, why are we taught to prescribe it?

If evidence indicates no net benefit for Tamiflu, why are we taught to use it?

Why are we taught to use thrombolytics for acute ischemic stroke when evidence shows they don’t help a single patient?

If there’s no advantage to using PSA to screen for prostate cancer

Well, you get the picture.

I spend hours every day learning, memorizing, absorbing all the details of development, anatomy and physiology of different body systems, what can go wrong, and how to treat it when that ‘wrong’ becomes reality. I enjoy (truly) every moment of this learning experience. But then there’s the whiplash of seeing patients with bronchitis, grossly enlarged prostate, or pharyngitis and watching docs cite the latest research and say something like, “The evidence shows that we could actually cause more harm than good by treating this with antibiotics …. With very few exceptions, your body really will take care of the infection.”

What’s even worse is watching docs prescribe treatments that they know have no benefit, because their employer has published the protocol, or because they’re afraid of litigation.

Holding both treat, or don’t treat, in my head at the same time sometimes makes me a little twitchy. I’ll admit, as a baby-boomer I’m thoroughly immersed in the belief that there’s a pill for just about everything, and its been tough to let that go. So in some ways, I’m much more comfortable memorizing lists of medications to treat various disease states. Yet I keep coming back to what I experience out there in the real world of patient care, learning from docs who are providing the very best care possible to their patients.

Perhaps by the time I’m a practicing physician, the pendulum will have swung back the other way. But I find myself hoping not. I dream of being part of a medical profession that intervenes rarely, that prescribes only when the evidence is incontrovertible that the benefits outweigh the risks, and that truly has the overall best interests of the patient in mind at every moment. I’m idealistic enough to believe I can help make that happen.

 

 

 

 

Pessimism

I consider myself pretty dang tough. Over the last couple of decades, I’ve honed skills of determination, introspection, and time management. I’ve learned which goals are super important to me and what I’m willing to do to achieve them. And I’ve told myself for years that I’m not swayed much by circumstance especially when it comes to issues that are important to me.

Then last night happened.

Working at the hospital as a medical student gives me the almost indescribably wonderful advantage of learning all about emergency medical care, with few of the stresses I’ll experience as a 3rd or 4th year during rotations. Since I’m a first year student, I get teased often when my typical answer is “I don’t know”, and my mentor and other docs seem to enjoy the prospect of having me as their captive audience to teach. I’ve been exposed to several different styles of practicing emergency medicine, and many different doctor personalities.

Last night was an eye-opening experience. As the typical non-emergent patients began their journey through our Emergency Department, I found myself surrounded by frustrated physicians. Maybe it was just an ‘off-day’ for them. Maybe last night was the end of a long week of shifts. Maybe this patient was the 47th who had come in with nebulous pain complaints and no definable injury or illness. Maybe frustrations over endless bureaucratic paperwork and pointless busywork were spilling over onto the patients who didn’t know where else to go.

I don’t know why. And bottom line it doesn’t matter. All I know is that as the evening wore on, I found myself joining in with eye-rolls and jokes about the intelligence levels of those allowed to procreate. I felt a growing internal battle over my drive to always deliver compassionate care, and a sarcastic almost jaded attitude toward those asking for that care. And I watched as I laughed at the jokes, added a few of my own, and mentally excused times when caregivers ignored requests or talked over a patient trying to find a way to express themselves.

And today, thinking about last night makes me uncomfortable. Not that there were jokes and sarcasm – lord knows there needs to be an element of humor in medical care to help balance out all the seriousness. But what bothers me in hindsight is how quickly I allowed myself to be drawn in to an attitude of jaded pessimism.

That’s not me.

Not only am I not a “follower”, but I have some bottom-line standards that I hold myself to. Always before I’ve been able to simply observe when I saw behavior that nudged close to the invisible line, reminding myself that I could learn from each encounter even if the person I was observing was practicing medicine differently than I would choose to.

So now… now, I get to raise the bar. For myself. I get to remind myself that I can be swayed by those around me, even against my own internal standards, if I’m not careful.

From my life experience I know that only so long as I remain conscious of potential pitfalls can I guard against waking up one day only to discover that I’ve become one of “those” docs who seems to genuinely dislike their job.

I’m grateful for the lesson this early in my medical school journey.

All-Or-Nothing Hell

I’m writing this on a Sunday morning. Feet up and cozy in my fuzzy slippers, steaming coffee in hand. I’ve got my clear plan for studying this morning, but first I need to address an issue I keep hearing about from those who have asked me to help them on this journey.

One of my student mentees emailed me this morning: Please help. I feel like I’m floundering. I don’t want to study all the time. I’m in ‘all-or-nothing’ hell and don’t know how to get out of it, and right now its stuck in ‘nothing’. Help!

Can I ever relate to that feeling! As a super intense and driven person absolutely intent on achieving goals that some say are “unrealistic” (whatever that means), it took me awhile to find ways to keep myself going, keep the study schedule even on boring days or overwhelmed days or just blah days. There’s some switch in my brain that turns to the OFF position sometimes, and it used to make me absolutely twitchy until I figured out what was going on and a few effective work-arounds.

If you’re stuck in all-or-nothing hell, here’s some ideas to help.

  1. STOP COMPARING. Stop comparing your insides to someone else’s outsides. We all know students who appear to never struggle with study motivation. But those who seem the most confident are sometimes the ones who struggle the most – silently.
  2. USE TIME AS YOUR BEST FRIEND. I’ve learned that what works best is to study every day for a set amount of time, taking regular timed breaks so my brain is more efficient. This will help you avoid procrastination and those frantic last minute cram sessions (that really don’t work anyway).
  3. DON’T CHECK IN SO OFTEN WITH HOW YOU FEEL. While it is vital to do what you need to do to stay emotionally healthy, you can waste tons of time asking yourself if you feel up to the next study marathon required. Just DO IT. Just pick up the books, grab the q-bank, review the Powerpoints, run through some flash cards as if you absolutely felt like it.
  4. TRICK YOUR BRAIN. Everyone’s experience is unique. Some people need to find ways to push themselves, others need to find ways to justify taking breaks or finding balance. Try setting up rewards for consistent daily studying – like a favorite snack after an hour of intense study, or checking in on social media at the end of a productive study day, or imagining you’ve got a reality-show camera documenting your good study habits. It may sound hokey, but these mental exercises do actually work!
  5. GIVE YOURSELF PERMISSION. To have a blah day. To feel unmotivated. To even feel like you’ve just spent four hours studying and can’t remember a single thing. Just like the weather, your feelings will change. Clouds are replaced with clear blue skies. Sunshine follows rain. Snow melts. Blah days end and brain-fog lifts. Rather than feeling frantic when those down-days happen, remind yourself that the feelings will pass.
  6. SCHEDULE JOY. Medical school is intense. There’s an enormous never-ending volume of information to learn and retain. Since this is a life-long learning journey, start NOW to schedule JOY into your life. For the rest of your life, you’ll be busy. For the rest of your life, you’ll be learning. Don’t put off joy.

I promise you, every single human being experiences blah days, days when the motivation runs dry and the “off” switch seems stuck. Stop comparing, use time as your friend, ignore the unmotivated feelings and just study anyway, trick your brain, give yourself permission (to be human!), and make sure you intentionally incorporate JOY into your daily life.

This path we’ve chosen is exciting. And boring. And overwhelming. And worth it. You can do this!

The Myth of Multitasking

Its not real you know.

Whether you’re a man or a woman, there truly is no such thing as actual multitasking – literally doing more than one thing simultaneously. Researchers have proven time and again that what happens is a fast switch between multiple activities or mental exercises instead of actual simultaneous action.

But I’ve got to tell you, I come as close as humanly possible to that illusion. And one of the most frequent questions I get is some version of: “How in the world can you do everything you do and still be successful in medical school?!”

Well, consider this. There are about 18 hours of productive time in every day (while I may not like the interruption of productivity, I do need my six hours of sleep every night in order to keep up with all my super cool activities the rest of the time). I routinely study 12 hours daily, this includes lecture hours, seven days a week.

So what about the rest of the time?

Aha! This is where some folks fall down on the job. They’ll feel exhausted from their major tasks and think that what will serve them best is to just “veg” for awhile. Those six hours, usually in the evenings, are typically filled with mindless tv watching and socializing. And weekends are usually filled with many hours of “rest” that accomplish little.

Now please don’t misunderstand. I’m not one to advocate activity just for activity’s sake. I’m perfectly content to be still, to rest, and to connect with friends. I’m a human being, not a human doing.

Yet I’m also super creative.

Along with being in med school, I’m also a business and parenting coach, a social media marketing manager for a doc’s practice, and a ghost writer for various other businesses. I’m working on setting up an independent lab research project for a potential PhD program in Biology (because, well, I want that degree too). And I’ve always got several home-improvement projects going.

I guess the best advice given to me on this subject was one I heard back a few years when a friend was encouraging me not to give up on my dream. He said this: “Just make sure that you don’t put the rest of your life on hold while you’re pursuing your education. Education is a big deal, and you’ll get there. But its not the only deal.”

So how about you? Besides your ‘main thing’, what are you multitasking about? What other projects do you have going? How do you fill your time and days and weeks and weekends? I don’t know about you, but I am reveling in the soul-enriching process of multitasking, being more than the educational process!

Four Upsides To Being a Non-Traditional Med Student

“Non-traditional” is the word most often used to describe medical students who took a different route besides going straight from highschool to college to med school. Those of us determined to pursue this dream when over the age of about 25 are lumped together as “outlyers”. Admission committees juggle our commitment against the economic reality of the expense of our medical education and our life expectancy. If we do achieve acceptance, our colleagues don’t quite know how to relate. Often we’re older than our professors, and the less secure among them may (subconsciously?) lash out in their need to maintain the upper hand. Residency programs aren’t sure if the time they’ll put into training us will pay off in the long run – after all, someone like me will begin actual practice at about the age many docs are looking at retirement.

But even with the jaded eyes of one who fought long and hard against prejudice and sometimes outright discrimination, I maintain that there are huge upsides to being an older student in medical training. Here are my top four.

  1. We’ve lived. We’ve lived long enough to find balance, know self motivation, and have proven commitment in real-life experiences. We don’t need to be taught compassion. We understand at a visceral level what it takes to keep going when things get tough. We don’t need hand-holding. All those “real life” lessons not yet learned by someone spending their first 25 years of life in an academic setting have already been experienced and assimilated. We’ve lived.
  2. We don’t take abuse. This is a biggie. With much focus these days on creating a medical education experience less dominated by an autocratic mentality,  I confidently say that I don’t take abuse. Its not an entitlement thing. Its a real life emotionally healthy thing. And the icing on this particular cake is that this all happens in reality – you can try to bully me. But it will have absolutely no affect on my psyche.
  3. We can relate. Having lived, having carved out our own emotionally healthy well-grounded life in the real world, we can relate deeply and authentically with our patients. We understand the fatigue of a new parent. We never forget the ending of a marriage or the time we couldn’t pay the light bill. We know the fear of a medical mystery, teenagers in trouble, and aging parents. All that life stuff our patients live with every day, we can relate with having lived rather than from reading a textbook or listening to a continuing ed guru. All that relating makes us much more effective physicians.
  4. We’re in touch. There’s a pretty good chance that we’re in touch with our weaknesses as well as our strengths. We know where our biases are and how to work around them. We know how and where to reach out for help when we get stuck. And having lived just a little longer, we’re a whole heap less swayed by the latest push to fulfill someone else’s idea of our dream. We’re in touch with our insides, our outsides, and stay fairly well in balance even when life stuff kicks our backsides.

If you’re a person with the dream of being a doctor one day, never feel like you’re “too old”, or that its “too late”.

If you’re a “non-traditional” medical student, embrace who you are and keep going. The medical profession needs you!

If you’re sitting on a medical school admissions committee, mentoring a potential med student, a med school professor or clinical director or attending, please remember that we will learn from you whether you make the process easy or hard. We will pursue our dream whether you support it or throw up every possible roadblock. And we will bring compassion and competence to our practice of medicine whether or not you see our value.

No matter what path you’ve followed in your pursuit of medicine, if you’re a “non-traditional student”, we need you. Medicine needs you. Patients need you. You’re in the right place.

This Funny Foreign Language…

I love learning.

Truly, there is some hole in my soul that is filled best by the process of learning all things medical and scientific.

However, please forgive me while I have a mini-rant moment.

After spending a few hours studying Autonomic Pharmacology, I’m convinced of just one thing: Whoever named these various processes was hallucinating, was hopelessly psychotic, or just had a sick sense of humor knowing future med students could quite easily feel their brains explode simply by having five words that meant the exact same thing.

Here’s just one example.

Muscarinic antagonists

aka antimuscarinics

aka muscarinic blockers

aka parasympatholytics

To say nothing of the adrenoceptor antagonists and sympathoplegics…

Here’s the super cool thing (realized after I went through the material four times and it actually makes sense)…

Just a few days ago I was with a patient in the ER who needed Metoprolol. Now I understand better why it was needed, how it works, and why that was the right drug choice in this case.

Then there was the patient who came in with an overdose – after today’s study session, I better understand anticholinergic toxicity, inhibition of cholinergic neurotransmission at muscarinic receptors, and why certain treatments are and are not appropriate.

Here’s the thing.

I make jokes about the sometimes ridiculous and convoluted new language I’m learning – just because its actually rather funny to me that there’s so many very long nearly unpronounceable words (and goofy awesome when I can say and spell them and describe what they mean). But far more incredibly cool for me are those moments of putting it all together – the academic details with the clinical application.

I look up and six hours have passed. I know far more than I did six hours ago (even if the way-too-long words are ridiculous), and there’s still so much more to learn. Now on to the indirectly acting cholinomimetics (AChEIs)!

I Don’t Know

Working the ER last night, I had one of those realizations. You know the kind – that moment that rocks you back on your heals and makes the breath catch in your throat. The moment when you realize that some of your basic assumptions about medicine are simply false.

I can’t begin to tell you the times I’ve said I don’t know over the last few months. Working alongside my clinical mentor gives me the opportunity to observe diseases and treatments that I haven’t studied yet, and frequently my mentor will ask simple questions that I just don’t know the answer to.

Take last night for instance.

A patient came in complaining of “just feeling ‘off'”. She was tachycardic (124), had elevated blood pressure (181/110), and her face was flushed. Afebrile, no diaphoresis, no nausea, no chest pain or difficulty breathing. In fact, her physical exam was completely unremarkable. This patient exercised regularly, drank no caffeine at all, and pretty much thought she was healthy. After blood work we still had no better idea of why… cardiac enzymes were normal, d-dimer normal, TSH levels normal, nothing helpful on the EKG… Still, after two hours in a quiet darkened room, her symptoms remained precisely as they presented initially. Metoprolol magically lowered her heart rate and blood pressure back within normal ranges, and my mentor and I went to see how she was doing.

And then I had that moment.

Dr. J looked at me from the other side of the patient’s bed and asked, What are we worried about?

MI, blood clots, PE or other pulmonary issue, perhaps metabolic disorders….. my voice trailed off as I realized I simply didn’t know anything beyond that, and I looked forward to hearing his explanation to the patient. Possible causes of her symptoms. Treatment options. A concrete plan going forward.

But what happened was much different than what I was expecting.

We just don’t know what caused your symptoms. Three months ago you were here with similar presentation, and at that time the doc who saw you thought it might be that you were drinking too much caffeine. But you’re saying you cut caffeine completely out of your diet so it can’t be that. All your tests came back normal so we’ve ruled out the life-threatening issues, which is a good thing. We’ll provide you with a prescription of a beta blocker to help prevent your heart rate and blood pressure from spiking, then get you in to see a cardiologist asap.  

Whoa. So me not knowing wasn’t only about my clinical inexperience or being in an early stage of my education…. Even my mentor didn’t know.

Que huge shift in my thinking.

Medicine isn’t necessarily about absolutes. Even highly educated and experienced physicians will often not know what’s causing a particular set of symptoms.

And that’s okay.

I write that’s okay as if it is. I’m surprised at how uncomfortable those two words make me. I want medicine to be an exact science – enter in symptoms, spit out a diagnosis and concrete treatment plan. But that’s not reality.

And in those times of not knowing, I’m learning how vital it is to treat the patient with compassion and competence. Regardless of the storm of discomfort aroused by that I don’t know conclusion, our task as physicians is to provide as much reassurance as possible to the person actually experiencing whatever it is that has us baffled.

I’m well aware that it is impossible for me to ever know everything about everything in the medical realm. But moments like I had last night hugely motivate me to learn more, know more, understand more, minimize as much as possible the times I must say, I don’t know. And with that, its back to the books for me, oh so grateful that this upcoming block of lectures covers cardiac issues and I’ll gain a little more knowledge to help minimize those I don’t know moments.