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 

A young doctor's future plans

It might be burnout, it might be things in my subconscious, but I'm hoping to find a good balance in my life for the future.   Residency is a time to resist breaking as you're constantly pushed to your limits and a lot of your relationships suffer.  I'm already tired and have a long way to go.

One thing that stuck with me was said by a senior resident who said to think about going straight into practice after graduating and working to save and invest and eventually retire early.   I think that sounds like a good plan to me, maybe even get into real estate and find some balance in my life.  

I feel like we have such limited time on this earth and I want to make the most of it and see my loved ones be as happy as possible.   Life probably won't get easier after graduating and getting board certified and I'm learning to deal with that.

I just have to find ways to stay strong and balance the demands of my job with keeping my loved ones happy and doing things that are fulfilling.

Sunday, August 7, 2016

How to have fun during residency/medical school

Decompressing isn't only for neurosurgery.

Terrible joke aside, there's always time to rest and relax and find joy and make your free time not only free time, but meaningful.

I just finished a hard, incredibly busy week and have a few hours until going to bed and working tomorrow.

You probably know a lot of people who post everything they do on Instagram or Facebook.  It's pretty annoying.  I do take photos of what I do for fun but don't post, probably because I grew up before it was mandatory to post photos of everything you do onto social media.

It's nice to personally go through photos of the things you did for fun the day after, and the memories are nice to visit a year out.

Intern year was so busy for me and I was in a new overworked, stressed state of mind that I never really took the time to record what I did for fun, and now it seem sort of like a busy year devoid of joy.

In medicine it takes a lot of effort and time to coordinate hanging out with your friends and family because your schedule is so busy and irregular.  I recommend seeing when your friends/family are off when the monthly schedule comes out, then make Facebook events or other forms of RSVP for the day you all want to get together.  It might take some reminders.

Everyone has their own idea of what's fun, but it's often the cheap, easy, laid-back things that make my time off feel well-spent.

Usually the more people you get together, the more fun things can be, but if you're like me, a night in playing PC games or watching films is just the right about of activity and relaxation.

With such limited time I've had off, I've started doing things I ironically wouldn't when I had more time off like: day trips to the beach or another nearby city or weekend/3 day trips to somewhere I can fly to.

We're basically worked really hard as residents and there's little to no flexibility in our schedule.  In order to really enjoy life, we have to get out there and enjoy every moment possible.

Among the things I've found to be most fun during time off is getting friends together to swim and grill outside.  It's the right balance of activity and everyone bonds over good food.  I'm not much of a bar hopper or club-going person these days.

Med students are more fortunate and have more vacation time and less responsibilities than we do as residents, so I urge them to have as much fun as possible before their schedule becomes more rigid.

You learn to appreciate the small things so much in residency because you get so deprived of them on a daily basis.

Don't feel guilty or feel like you're a bad student or resident for taking time to enjoy yourself.  Take care of your studies but also take care of yourself.

Make the most of every moment.