Friday, September 9, 2016

Is medicine the right career for me?

I'm writing to reflect on my own career decisions and what I knew and didn't know when I was considering a career in medicine.


What I Thought:
I thought that medicine was hard work (which it truly is).  I didn't know how hard it would be though.  I was thinking it'd be more manageable than it is and I thought the future sacrifice would be bearable and constantly fulfilling, leaving me always energized with high morale.  Working long hours without a day off for 2-3 weeks at a time every month is exhausting, especially when the work is stressful. As a med student your schedule is pretty nice and you have much more time off than you ever will as a resident or attending.  Medical school is basically an illusion.

I'm mostly buoyed by some slivers of remaining self-esteem and optimism and the feeling that I'm making a difference in the world.  I also survive by handling criticism well even though it's mostly condescending (a lot of people act like they were born knowing everything and having 50 years of experience).

A lot of us are idealistic when we consider a career in medicine and we're convinced that everyone respects doctors and that everyone truly masters every aspect in patient care on graduating from medical school.  Even to some extent in medical school we're also shielded from all the administrative burdens and having our hands tied because "treatment X is too expensive so use this cheaper, less effective method."

What I Experienced:

Almost intolerable amounts of stress from college to residency.  I never had panic attacks, I never dropped out of anything, but I did have a good deal of stress and anxiety.  Every chemistry exam in college, worrying about whether my GPA was high enough, to always feeling like I could've done something better in residency.  Since residency I've been in these situations that I've never been in before and my supervisors knew that.  So I would be guided by them but then be hit with "well why didn't you do X?"  And my thinking was "Because I didn't think it was safe and you weren't there to help me." That's kind of the worst criticism: when you're guided only partially in a new situation and then belittled because you couldn't gain 20 years of experience instantly or read minds and you did what you thought was safest (and it was) and it didn't injure anyone.

 And then there are times you ask questions about what to do because you're interested in the patient's safety and outcome but then you get criticized for asking questions and made to feel like you're an idiot when you're just a beginner.  Medicine is a very discouraging profession.  A lot of med students in particular think they know everything about patient care..until they start intern year, so a lot of my advice to them often gets ignored.  They think because they're familiar with some concepts that they don't need to pay attention to my advice about patient management or my pointers on various topics, and then they start intern year and are completely lost when it's their turn to make decisions.

 I'm also consistently tired.  My friends outside of medicine know me as someone who is just tired all the time and not always up to go out.  "Tired" is a personality trait for me and will be one until I retire.

I've seen belittling and bullying in medicine as well and have been belittled and criticized a lot myself, for all kinds of things.  I stopped asking questions as a medical student because while asking questions demonstrates interest and curiosity, it apparently also means you're an incompetent idiot for not knowing as much medicine as someone who graduated residency 10 years ago.  At least that's how I've been treated.  I almost felt like I was perceived as "smarter" for not asking questions on rounds or questions about patient management (none of my questions were first order, but rather more thought-out questions on patient care).  It erodes whatever morale and self-esteem you might have.

Then you grind through a few years and finish with medical training and life supposedly gets better.

too tired to continue writing

Tuesday, September 6, 2016

Residency Blues - Burnout, anxiety, unhappiness

I only have a few minutes to write but I feel like I have so much to get out.

I'm not sure if it's just being a "beginner" in residency mainly or factors like being on call twice a week almost every week and being away from family and loved ones so much with little time to study that is starting to make me feel a little depressed and not very satisfied with what I'm doing.

It sounds crazy, not being satisfied as a doctor who saves lives and takes care of patients.  On a daily basis there are times when I think what I do is pretty awesome, I feel empowered at times.  Other times I'm exhausted by my work hours, I struggle to make my loved ones feel loved because I'm too tired or have to study, I struggle having enough energy and focus after work to study, and I have so many evaluations to do, work hours to log, cases to log, and emails to respond to.  Also how "good" a day or call I have is determined by my attending as well as senior resident.  There are times I have anxiety because I know what my work day will be like because one of those people might be very mean, condescending, stress-inducing, and so on.  My self-esteem is really at the mercy of those people even though I try very hard to be resilient.

Sometimes I wonder if everything psychologically is starting to manifest physically with nausea, feeling excessively tired on my rare day off, and a general feeling of malaise and true lack of excitement when I get ready for work.

Sometimes I think I should've chosen another field in medicine.

The way I'm coping with things is really just keeping it inside and writing in this blog.  Which is not optimal but I don't really want to get anyone of my loved ones down and I don't want to seem like a "problem resident" among my peers or faculty.  I really need this job.

Another way I'm coping with residency is my goal of moving to somewhere nice after I graduate, and looking forward to having more control over my own schedule.  Having said that, I plan on going into private practice since it seems like I'll have more control over my schedule.  What I am nervous about is the private practice environment.  But who knows, I'm sure I'll learn more from contacts in different cities.

I'm not really religious so I don't have that going for me as a coping mechanism, nor do I think I'm a special chosen one who is amazing all the time and should be worshiped by everyone one.

Monday, August 22, 2016

What Medicine Is Really Like - Part 1



I didn't really know what medicine really was like until my clinical rotations in med school.  I generally thought all doctors were nice, that everyone respected doctors, and that everyone collaborated really well in the hospital.   I thought people who could get better got better, and I didn't know there were so many administrative things to do, and I didn't know insurance companies could be so hard to deal with.  I didn't know I could nearly vomit from anxiety in certain situations as a doctor.

The Work Environment

So everyone is overworked.  Pleasant people become sarcastic and cynical.  The rare few who aren't have fantastic coping mechanisms.  Consult teams are paged all the time and are juggling so many patients that they might brush you off or be rude to you.  You'll have to page a second time and then get yelled at on the phone or talked to in a condescending way.  A superior will make an intern call a consult that isn't exactly medically indicated but is being called as part of a defensive medicine move, causing friction between the primary team and the consult team.

Different specialties talk bad about other services, and everyone has their own idea of how the hospital should be run.  You'll hear stories about patient mismanagement and then see it yourself the longer you are in medicine.

Medicine says surgery is dumping patients on them, surgery thinks their surgical patient is more of a medical patient.  Nurses get frustrated that the July intern doesn't know everything and the intern is frustrated that he doesn't get the patient updates going to the upper level or fellow.  Ancillary staff will give you a lot of grief and won't hesitate to disrespect you for minor things that don't even matter.  Disrespect from techs is pretty unwelcome.  I know they're overworked and I often hear them complain about their job, but please, residents are learning and doing their best with unstable patients and every moment is critical.  They don't know exactly what it's like to be a resident.


Administrative Headaches
There's a lot of learning how to document in medicine that makes you feel like the administrative aspect overshadows patient care.  We have to check these boxes and prove to others that our central line in the ICU patient in shock is justified and checking boxes to show we reviewed medications on the patient who got admitted.  We have to document everything, down to our discussions with patients about bowel movements, or it never happened and we are held accountable.  I understand the impact medicine has on human lives, but we're micromamanged a lot and have to document everything little thing because of the medicolegal atmosphere.  You can verbally instruct a patient to do this or that but if you don't take the time to document that conversation in your busy backed up clinic with impatient patients and overworked staff, you're in trouble.  A lot of medicine is documentation to protect yourself. 

We spend more time doing computer related charting and administrative tasks than on actual patient care on a typical inpatient unit or outpatient clinic.  It makes you feel dissatisfied.

Patient Adherence

It used to be called compliance,but I guess that sounded too authoritative.  I've seen dozens of patients repeatedly get admitted to the hospital for exacerbations of chronic diseases because they just didn't want to take their medicine.  I've had patients with HIV tell me they stopped taking their anti retrovirals "because I felt fine and didn't feel like I needed them anymore."  Seeing a patient get admitted twice in the same month a week apart because they have terrible heart failure but chain smoke and follow a diet full of salt while not taking any medication is something that happens a lot despite how ever much counseling you do.  I can see why internists burn out.  The patient who eats healthy, runs, and takes all their medicine, and loses weight has been pretty rare in my experience.  

Monday, August 15, 2016

How I Handle Bad Days in Medicine

Get ready to have a lot of bad days in medicine for different reasons.

Usually I cope with things by:

1.  Candy.  Usually gummy bears, sometimes Smarties.  It's usually how I start coping after a rough day at work

2. Suppression.  I force myself to not think about what happened/what was said when it crosses my mind.  It'll happen to you

3.  Never hurts to have a beer or three in moderation

4.  Focusing on what I could've done better.  I've never caused an adverse outcome but there were always was I could've been more efficient and effective

5.  Talking to a friend in medicine.  They're more likely to understand you than anyone else.  

6.  Sleep.  Sometimes you nee d a break from consciousness

7.  PC games.  Mindless stuff helps sometimes

Medicine is rough and the people you work with can grind you and your self esteem down.  A good support network is key

Tuesday, August 9, 2016

Q&A - Applying for medical school and residency

I just wanted to open my blog for any questions anyone might have about applying to medical school and residency, especially last minute questions.  Good luck with your applications this year

Bloody Footprints

I'm thinking back to when I did my first stat case.   The patient came in unstable and the anesthesia team and I were busy getting the airway, arterial line, additional vascular access, hanging antibiotics and blood, sending an arterial blood gas, getting the patient to the right anesthetic depth while making sure they were stable, treating hypoxemia, and making sure that the patient was had the right amount of surgical paralysis.

Being airway man is fulfilling, especially in an emergency.  Getting the patient stable with fluids and strategic use of pressors and volatile anesthetic is rewarding too.   Cases like that make you feel like you really saved a life.

When the case is over and you're moving the patient out of the room, you see streaks of blood on the floor, and bloody smeared footprints.  Imagery like that sticks with you,especially the first time you see it.  

Being on stat and urgent cases makes me feel accomplished, though the stress and uncertainty can certainly be pronounced.  I need to get some rest now, it's going to be a long time before my next day off.

Monday, August 8, 2016

The medical school mentality

I've found the mindset that worked to help me stay sane in med school and residency so far is to think of myself as a servant.  You get walked over by different people in the hierarchy, get disrespected by consult services and patients that seeing get yourself as a humble servant makes everything sort of make sense and helps you cope.   

I'm pretty tired and feeling worn out these days but one of the things that keeps me going is believing I'm a servant and making a difference in people's lives.   Maybe someday I'll have some time to decompress and regain some energy for this marathon of residency