A couple of things

1.  Sometimes people are the absolute best.

I just.. hold on.

Allergies. I just... allergies. I'M ALLERGIC TO LOVE.

2.  Sometimes I come up with multi-million dollar marketing plans in the shower.

Remember when you used to be able to just use face wash?  But now “facial care” is a 3 step process:  1. Exfoliate, 2. Clean, 3.  Moisturize.  You need 3 products.  (We’ll ignore the fact that I’m pretty sure Dermatology has taught me that exfoliating is a gigantic waste of time, money, and protective layer of stratum corneum cells.)

(Oh, also, I totally have my Dermatology test in 2 hours.  You can tell it’s real important to me.)

We could do the same thing for the haircare industry – increase profits by 33%.  After all, does anyone only buy shampoo, or only buy conditioner?  No.  We need a 3rd product everyone has to buy. (And by “we”, I mean “the haircare industry, if I was involved and got a payday out of this”.)

My ad campaign.

The Commercial:  “If you’re only using Shampoo and Conditioner, you’re missing out on a crucial 3rd step.  Take a look at any shower in France, and you’ll find a 3rd product – Pre-Conditioner.”

The actual name of the product isn’t important.  It just has to have a vaguely plausible sounding scientific gimmick like “providing a surface for conditioner to fully enter the hair shaft – because without it, conditioner only sticks to the outside and is mostly rinsed away!”  (Since 90% of the scientific stuff in hair commercials is made-up, this should be legally ok.)

If I were in charge of this ad campaign, I’d pin this “secret” on the French, because – at least in America – we seem to be willing to believe anything about the French, including that they’re all skinny and effortless.  Perfect hair goes with the territory.

If the hair-care industry successfully plant the seed of doubt in people’s mind that shampoo and conditioner are not enough, they could get $6 out of most of the women in the USA, and probably half of the men.  Millions of dollars.

No, I don’t know how tongue-in-cheek this idea is.  I hope you don’t either.  

How to be a med student with a mental illness

Someone just posted a great, yet heart-breaking comment in response to a post I wrote on another site about my anxiety – and I need to address it.

I have had “becoming a great physician” at the top of my life goals for about 4 years now. I have also been struggling with finding myself to be ‘mentally interesting.’ These mental quirks as they were have, however, really tried throttle my medical school ambitions. I am terrified of talking to a physician about my problems.

Dear commentor:  I’ve been there.  I felt incredibly alone. The feeling of “oh god, but I’m a future physician – I’m not allowed to have a psych problem” was worse than my panic disorder itself, because I had no role models – no physicians, no med students who knew how I felt.  I had nobody to look to for help.

So as much as I dread the idea of airing what was a pretty dark time in my life in a public forum, I have to write this.  I may not be the best med-student-with-a-psych-history in the world, but I’m one of the few with a blog.  So, hell – here I am.

“I have “toughed it out” as it were for years now, mostly since I started college. I am afraid I can’t do it any longer. I feel like a failure for even thinking about getting “help.” You managed to get into medical school before finding what worked for you. Does this mean I am just not up for it?”

First, I’ve given you the wrong impression by not talking about this.  I absolutely should have gotten help in undergrad.  In fact, I tried – I actually called my University’s mental health service after a horrible panic attack.  And I made an appointment.

But I never showed up. I never showed up, because I was having a panic attack about seeking treatment for my panic attacks.

… So, no, I wasn’t the best at logic.  But hey, I was the best at organic chemistry!  And physics!  And studying alone for hours!

But I was also the best at denial.  The fact that I rarely wanted to hang out with friends?  That just means I’m introverted. It’s totally normal for introverts to be too nervous to go out.  And the fact that I’d break down crying at the worst moments, over the smallest perceived slight?  Genetic. I’m just a crier. Sucks, but it’s how I am.

Neither of those rationalizations was true.  And I had absolutely no idea.  I knew I had panic attacks, but I had no idea that there was anything else wrong.  No idea until a psychiatrist asked me to examine my life, no idea until 10mg of Lexapro lifted 100 lbs of unhappiness off my back.

“I really want to go to medical school, but my thoughts are “How can you possibly survive medical school when you have these anxiety problems NOW?”

Here’s the thing:  No matter who you are, med school forces you to confront your anxiety.

I know an extremely competent, high-achieving med student who has been in 4-times-a-week psychotherapy for the past 12 years.  You’d never guess it.  Some of the most socially outgoing and fun people at my school see psychiatrists.  And a couple of the most outrageously anxious people I know have never set foot in a therapist’s office.

But you don’t have to wait until you’re overwhelmed.  Sure, I waited until med school – but I also wasted a lot of time in undergrad locked in my room or crying in a corner. You can survive by seeking help, doing the work, confronting your anxiety now.  I promise, you wouldn’t be alone.

So there’s no rule, no pattern to “who can handle it and who can’t”.  In the end, the only important thing is this: are you willing to learn how to handle the anxiety?  Therapy can teach you.  It won’t happen overnight, and it’ll take work.  But it can happen.

Just know this:  There’s no First Place Award for “toughing it out”.  There’s no medal, no praise, nothing you get to add to your CV for being 100%-certified Therapy-Free.

And that’s why you should seek help.  Life can be so much easier.  When you’re anxious or depressed, you don’t even know how hard life is for you – and it doesn’t have to be that way.

It doesn’t.

• Choosing A Psychiatrist
• Choosing The Right Mental Health Therapist
• Find A Psychiatrist
• Find A Therapist.
• Depression Screening Test.
• Crazy Meds: Forum for the Mentally Interesting

How to Have A Class Meeting About 3rd Year

Welcome!  Good morning!  Take your seats!

I’m so glad you could all be here for this mandatory meeting.  Now, you may have heard some rumors about 3rd year – rumors that it’s filled with soul-crushing paperwork, vague directions, and a surgeon who has driven at least 2 students to suicide.  We hope to set the record straight that those rumors are all absolutely true.

… Just kidding!  Haha, jeez, lighten up everyone.  No, those bodies were in too many pieces to be legally identified.

Let’s get right to it:  How to schedule your rotations.  It’s a simple process, really:

While we don’t have time to go through it in detail, if you’d like a closer look, this chart is on our website.

Oh, the young woman in the back – a question?  Yes?

… Where on the website?  It’s not, uh… well, I’m not quite.. Hmm.

Okay, look, it’s not there right this instant, per se.  The IT guys are redesigning the site because “it’s impossible to navigate”, and I guess we’ll get it back online when they’re done?  It should be soon, though – maybe a few weeks.  One year, tops.

Still,  I want to let you know that my entire office is here for you during the transition period. I know it’s difficult to schedule your life and med school at the same time.

So if you’re planning on having an important family event – such as a graduation, marriage, or tragic death – just give me a call!  I can easily sit down with you and discuss how best to schedule this event so that it coincides with your vacation week.

But most importantly, remember:

Meeting dismissed.

Memorizing Cyp450 Inducers & Inhibitors

One of my favorite new apps on my Android phone is made by Pendragon Entertainment: USMLE Pharmacology.  Definitely recommend it – while I was setting it up yesterday, it asked me about cytochrome p450 inhibitors and inducers so many times that I accidentally learned them.

(I know, right?  Technology!)

It seems like the first step was being able to recognize that a drug is a cytochrome p450 something.  The commonly tested ones, at least on that app, were these:  Erythromycin, quinidine, rifampin, isoniazid, griseofulvin, cimetidine, carbamazepine, phenytoin, and phenobarbital.

And that’s basically the hard part, because I realized the names themselves are simply divided into “quick” names (inducers) and “slow” names (inhibitors).

Of course, you don’t need pictures to recognize that QUICKidine, GRIZZLYofulvin, CARbamazepine, RifAMPin, and PHENPHEN (Phenytoin & Phenobarbital) are “fast” names.

No, I don’t know where the grizzly bear got the illegal drugs. I suspect his dealer was in the car, and the mosquito’s all “Dude, Phenphen isn’t legal. LET ME TAKE CARE OF THAT FOR YOU.”

Similarly, no one should need a poorly-drawn picture to recognize that ICEoniazid, ERRORythromicin, and CEMENTidine are “slow” names.

Why is there a block of cement in the middle of the ice rink? I don’t know. Maybe someone just hates that poor robot.

But then, where would be the fun in that?

How to Get Financial Aid for Med School

There are 8 easy steps to getting financial aid for med school.  

And because those 8 easy steps are forbidden by the laws of most nations and at least two major religions, I am instead offering you these 8 really sucky ones.  Because that’s the kind of reliable blogger I am.

1.  Print out all necessary forms and tax info, grab pen, sit down purposefully at desk.

Yes, your college financial aid was always filled out by your parents – but now that you’re in med school, you are going to fill out these forms yourself.  Because you are an adult. An adult who knows exactly what your – let’s see here – “parent’s J509b form categorization” is.

2.  …Call Parent

You:  Hey, can you, um… tell me what your J509b form categorization is?  Also the original and adjusted-current worth of your car, house, all savings accounts, major electronics, and SSN?

After several incredulous phone conversations (“I thought graduate schools weren’t allowed to require our info for financial aid.”  ”Right. They don’t require it as long as you don’t need the financial aid.”) they will end up filling out almost all the forms themselves.

3.  And now you can fill out the rest of the forms

Like an adult!  An adult who knows things like your “total income from part-time employment”!  And the total amount of Stafford loans you’ve taken out over the… past 4 years…

… Hmm. Okay, but you can still be an adult who knows things like “where you put the tax info from your last job” and “what your FAFSA account and PIN number are”.

4.  Repeat Step 2 with “former employer” and “US Department of Education”

DAMNIT.

5.  Submit all seventy pages of it.  Be proud of yourself.

You did it!  Like.. okay, not like an adult at all.  That’s okay.  Whatever.  It’s over.

6.  Receive financial aid award letter

YES!  … Wait a minute.  That.. can’t be right.

7.  Inform parents what your school thinks their “Expected Family Contribution” should be

Mom:  Ahaahahahaha, this is hilarious.
You:  It’s not a joke. After considering your assets and salaries, my school thinks you’ve put aside this much money for m-
Mom:  HAHAHA, wait until I tell your dad.
Dad:  Tell me what, dear?
Mom:  Look!  The med school – hahaha – thinks we can -hahaha – pay -haha, oh I can’t breathe..
Dad:  HAHAHAHAHAHA-.
You: Please stop laughing.
Dad:  Ahaha, I’ll stop laughing as soon as it stops being funny.  Hey, check out this line – they think you have an “expected individual contribution”!
Mom:  Oh, that’s adorable.  Look at all those zeros!
You:  *abject horror*

8.  Inform school that you would like to take out additional federal loans. Repeat steps 1-7.

College Courses That Will Prepare You For Med School

ETOH766 – Advanced Techniques in Binge Drinking:  Students undertaking this tutorial section should be prepared to decrease their binge drinking from “every weekend” to “after every major med school test”. Please note that this is a graduate-level course, and thus the intensity of drinking will be greater than at the undergraduate level. Appropriate dress required.

BUS115 – Introduction to E-mail:  ”Reply-all” and how it is rarely your friend.  Required for all students.

BUS427- Advanced E-mail Etiquette:  A discussion examining the ethics of BCC’ing, the politics of quick replies, and the point at which a lengthy email signature goes from “informative” to “douchetastic”. Final grading will be determined by attendance and one 40 page essay on the merits of various e-mail sign-offs.

FASH109 – Survey of Professional Dress:  This is the “pre-health” version of the upper-level “Principles of Professional Dress”. Topics covered will only include basic color coordination and evaluating the “attractive” vs “professional” balance of various ruffled blouses. (Due to limited time, the topic of “how to come up with the $300 to build a post-college wardrobe” will no longer be covered.) It is suggested that FASH207 – Introduction to Ironing be taken concurrently.

CHEM527 – Chemistry of Caffeine (Lab):  During the first quarter of the course, students will be expected to investigate kinetics of caffeine metabolism via oral administration. In the second quarter students will continue on to the study of calibrating levels of caffeine dependence to personal metabolism and study schedule.

LANG407 – Latin I & II:  This course sequence will prepare students for scientific terminology that wilhahahaha just kidding. Listen, I’m no expert – I just write the course catalog – but spending $2000 and untold hours of your life on a dead language, just to maybe recognize some prefixes of medical words later is like using a jackhammer to pop a zit.  I mean, hey, if your goal is to legitimately read Aegil – well, more power to you – but otherwise you’ll be better off spending 30 minutes with a pamphlet on medical terminology. True facts. (Prerequisite: LANG405 or permission of instructor.)

How to study for med school

Congratulations!  It’s your first day of med school!  Your most immediate tasks are to get your ID badge and to avoid having a panic attack.

You are nervously watching a bored second-year student sift through the box of IDs.  He is looking for your name.  Now, it may seem like he’s taking a long time to find it, that he’s close to frowning and saying “Uh, I don’t see your name here.. so..”:  But relax: he will not say this.  (If he does he is either a]. looking in the wrong box, or b]. not nearly as funny as he thinks.)

Do you have your ID badge now?  Fantastic.  This should remove all doubt in your mind that you are not supposed to be here.  (It won’t.  But it should.)  You’re now ready to learn how to study for med school.

1.  Gather school supplies.  You will spare no expense, because if med school isn’t important enough to justify the $20 highlighter pack, what the hell is?

For example, I... may have bought said pack multiple time.

2.  Listen to advice of sage second-year students:

“Keep your priorities straight,” one will tell you.  ”Remember, you’re here to learn to be a good doctor.  So don’t waste your time on the dumb stuff.”

“What’s the dumb stuff?” you’ll ask.

“Oh, biochem, molecular bio, embryology, genetics – stuff like that.”

“… That’s the entire 1st semester.”

“Oh, is it?  I forgot.”

“Dude, just chill and enjoy the ride,” another will reassure you.  ”The most important thing is to get a schedule.  Like me: I always start my day with a couple hours in the gym, coffee, racquetball, a run, a shower, research at the lab, and 4 hours of Halo.  Then I study til’ 3am and wake up two hours later.  No prob.”

3.  Disregard advice of sage second-year students.

Hmph.

4.  Try random study techniques in rapid succession

You will experiment with the highly technical “write things until you get tired of writing things” method, the Cornell Method, OneNote, and flashcards.  You will write these flashcards in impeccable hand-writing, with your new med school pens, and then set them aside.  You will find them 5 months later, shoved in a desk drawer.

Hey.  Cheer up.  You tried.

While you're at it, weigh the pros and cons of different study locations! ... Some pros will mean more than others.

5.  Your First Test Day

Wow, that really crept up out of nowhere, didn’t it?  You will ignore the advice of your professors, the Student Health people, and the second years – all of whom are constantly assuring your class that failing the first test is no big deal.

You know the truth:  If you fail, you will be all alone in the world, fail the retake too, and then be fed to lions.  (Or even worse: summoned to the Dean’s office, where you will be subjected to a disappointed gaze.)

As you open the test and realize you don’t know the first question, you reflect on your options.  You decide that, if offered the choice, you’ll take the lions.

At the post-test party, a 2nd year will congratulate you on finding your med school groove.  ”Now you know how to study!” they will say, clapping you on the back.

“But I don’t know how to study,” you’ll protest.  ”I just did a bunch of random things and then freaked out at the end.”

“… Well, yeah,” the 2nd year will say.  ”Like I said.  Now grab a beer.”

And now you know.

How to give a lecture that will break your students’ spirits

First, you’re gonna want to check your subject matter: is it difficult?  Brachial plexus difficult?  If so, fantastic – you’re done.

But if it’s not, just remember: God invented Powerpoint for the express purpose of making lectures harder than necessary. (Pretty sure there’s a bible verse about it and everything). You’ve got this.

As a “not that difficult” example, let’s use “hypertension and the kidneys”.  It’s perfect for our discussion because I remember enough highlights to BS this entry without the effort of reaching for my Robbins – which happens to be across the room, propping up a wobbly nightstand.

And, hey, if my fact-checking laziness isn’t enough to get you all fired up about seeing med students suffer, I don’t know what is. Maybe if I tell you that my class will be rounding on your patients in 6 months, despite the fact that most of us are younger than the Olsen twins? Or that I’m 24, but my dad still does my taxes? This is just me trying to help you not help me.

1.  Ask yourself “What’s the absolute minimum I want my students to remember?”  Condense it to 3 points.

2.  Good.  Those 3 points are now blacklisted, and at no point during your lecture can you use any of them.  So let’s make those bullet-points into paragraphs!

Fantastic, with just one problem:  That’s just a big wall of boring text – it kills the slide. You need less boring text and more blank space.

FIXED IT.

3.  Recent Studies in the Field:  So what are the best, most up-to-date conclusions about this topic?

4.  Hahaha, no, don’t say that.  In fact, don’t say anything.  Dig up the original paper, find the graphs that look most likely to induce cataclysmic seizures, and go to town.  There’s no need to actually spell out the study’s conclusion.

While you’re at it, add 5+ slides explaining the study’s methodology. (BONUS POINTS for confusing us by explaining the proposed mechanism of the old, debunked theory first.)

"Clearly, the incredible conclusion of their study speaks for itself."

5.  Oh, come on.  You can totally fit one more graph on that sucker.

"Like this?"

NAILED IT.

Guest-post: What I’ve Learned as a Humanities Major in Medicine

This guide to what med school is like without a previous science degree is written by Sarah in the UK.  Thanks, Sarah!

I’m on a course for graduates with about half non-scientists and half some level of science (from A-Level to PhDs), with one year in lectures then three on the wards to take you from completely ignorant to an actual doctor.

In the UK medicine has loosened the system of science heavy medical undergraduate degrees, towards a system including a minority of graduate courses. Until very recently mature medical students were very rare. Around 10 courses in the UK will take graduates in arts subjects who haven’t done a drop of science since 16. That includes me…

Here are some of the things I’ve learnt during my first year cramming everything pre-med:

Some of this stuff is unbelievable!

DNA transcription! Complement cascades! RNA tweezers made of light! You are kidding me right? Massive leaps of imagination are suddenly required between levels (unlike anatomy, but is a ton of material, but relatively straightforward). Last time I did any biology, upwards of a decade ago, the cell was the tiniest thing we studied, drawn as a squre in 2D and it basically had five bits. Now they are telling me it is a massive fairground, with complex machinery, thousands of different chemicals running around, discreet entertainments, and endless variations. Cells seem to have such *purpose* my mind is boggled on a daily basis.

It’s hard for those who have been immersed in science for a long time to know what lay people understand

So, in one of the very first lectures, they explained what a protein was, but skipped over what dimer or ligand meant. The quality of the lecturer is the key factor – talk to us like ignorant but not stupid adults, give us pace and useful diagrams. Also, the relative dullness of the subject does not translate in the lecture, if the speaker is talented enough to make the dry stuff accessible. Personally, I can remember anything with a disgusting anecdote attached. One immunology lecturer got us to understand complement by making us remove our shoes and chuck them in the middle of the room in different piles. Unlikely as it sounds, it worked a treat!

Everything can kill you. Or you will kill everyone.

It is amazing anyone is born and lives once you start looking at all the chances, dangers and diseases. But, in addition to that, we are told at least one a week that failing to remember a particular fact will lead us to KILL ALL OUR PATIENTS. Miss x symptom and EVERYONE WILL DEFINITELY DIE. Way to keep us calm.

Obviously, you can’t bullshit

Having got through my first degree majoring in sleeping largely by luck and general knowledge, medicine is not something you can smart-talk your way through. But this is cultural, as well as the factiness of the subject. In fact, humanities degrees often reward contary positions for the sake of it. Now, the tool arguing the point with prof is just wasting everyone’s time, and embarrassing themselves. And that note…

…some people need to prove themselves, but there are also helpful people too

I expected a certain amount of toolery on the course, but was maybe surprised by how obviously insecure and competative some of the other students are. I think, in part, this is because most of us have gone from fully-fledged careers to being at the bottom of the ladder again. Some, though, are stars who will generously and modestly unstick you when you get stuck. I’m pretty sure they will be the doctors the patients love the most.

Thank you Youtube

There is an absolute wealth of resources for idiots like me. Don’t waste time on the hardest textbook, spend extra time on the securing the simplest bits BUT make sure the level of abstraction is the same (i.e. don’t bother of the simplest version of the cell I described above if your lectures have completely scrapped that notion). There are hundreds of helpful animations and demonstrations available across the web, especially for biochemistry and pharmacology. Although, you might start dreaming about damned metabolism.

Your teachers may give you leeway – but clinicians won’t.

I might scrape through this year, but I’m dreading being on the wards getting crushed by grumpy consultants (attendings?)… During the first term I suddenly had the not-very-original revelation that medicine is a degree about everything human, from the smallest chemical upwards. Perhaps you could be a relatively good doctor without a lot of the scientific basics, but you certainly wouldn’t be helping your patients.

Why medicine?

First, there are some easy, boring, true answers – I like science.  I like helping people.  I want to work in a fast-paced environment.  But all of these answers only actually address “Why a career in the health sciences?”

Things get much more interesting, and more uncomfortable, when you start considering “Why medicine, specifically?”  The best interview question I’ve ever heard was this: “You say you want to help people.  Why not nursing? There’s a nation-wide nursing shortage, but a surplus of people who want to be doctors – wouldn’t you be helping more people if you became a nurse?”

To his credit, the person who told me this story was only panicked for a minute.  He answered honestly:  ”Because, sir, I respect nurses, but I’d rather be trained to call the shots.”

This guy knew why he wanted to go into medicine.  He also had the guts to answer honestly, even when his reason for going into medicine is something that, taken alone, would be a bad reason.

That said, I believe that every possible answer – when taken alone – is a bad reason.  Because you want to help people?  There’s a million careers where you can do that better, and in some cases with a much better lifestyle.  Because you want to make loads of money?  Well, good luck with that.  Because you want to impress your friends?  You can’t really impress them when you’re so busy that you lose touch with them completely.

But I believe that a couple of “bad reasons” can be okay.  The key is to make sure they’re outnumbered by the “good” ones, and to know exactly what it is you’ll be sacrificing.

1.  Write down a brutally honest answer to “Why medicine?”  Brutal is the key word here.  A lot of the time we know something’s a bad reason to go into medicine, so we don’t even acknowledge it ourselves.  For example:  if I’m being completely honest, I like how hard it is to become a doctor.  I’m stupid ambitious, I know.  I also like that it guarantees a modicum of financial security if you play your cards right.  These reasons aren’t anything I’d write in a personal statement, but I’m glad I acknowledged that they existed before I decided on medicine.

2.  Bombard yourself with reasons to NOT go into medicine. Read The House of God.  Read the Anonymous Doctor blog (try this entry, or this one, or this other one).  Read SDN (start here, then here).  Invite your surgical resident friend out to dinner, liquor them up, and ask them if they’d still choose medicine if they had to do life over again. Know the worst of what you may be getting yourself into.

3.  Then go back to your brutally honest reasons for going into medicine.  Is there another career that could satisfy those reasons?

I think often it’s the dumbest reasons that narrow the choice down to medicine.  It doesn’t stop these reasons from being dumb – it’s stupid for me to want to do something just because it’s hard – but at the same time, 1) when you think about it, with all the sacrifices you have to make?  You kind of need at least one dumb reason, and 2) I can’t change that aspect of my personality.

The real question is:  if you take all of your reasons together – good, dumb, and altruistic – do they outweigh the sacrifices?