‘Perfect’ is the LOWEST standard

because you’ll never meet it. It’s a way of copping out.

Aim for better than ‘perfect’: aim for ‘pretty darned good’.

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The nerve of drinking coffee during morning rounds

Most med students are quick to catch onto the fact that “sipping coffee” is synonymous with “standing there, doing nothing” (or even – god forbid! – “taking it easy“). It’s one of the many little rules you’re expected to absorb from thin air on your first day of third year.

Sure, it depends a lot on your hospital and team – but broadly speaking, having a cup of coffee in one hand during rounds gives off a certain “devil may care” attitude that doesn’t bode well for your med student reputation.

(That said – I did it on surgery rounds because 1) I already knew I wasn’t getting honors, 2) there were no old-school attendings, 3) I deeply suspected the residents were too sleep-deprived to register the sight of me, let alone notice a small coffee mug, and 4) it was freaking surgery; I needed coffee.  I mean, screw it, I’m not a machine.)

But this is SUCH a good example of why medicine is insane: there is nothing intrinsically lazy, unethical, or dangerous about simply holding a cup of coffee outside a patient care area.

But dude, if you’re on the bottom of the totem-pole of medicine, it makes you look like you’ve forgotten your place, and we can’t have that now can we.

So, right: Reddit’s medicine section has been having a discussion about it:

meddit coffee 3

I cannot believe how many non-medical people responded to this topic by raising hell about how inconsiderate it would be to drink coffee in the patient rooms.  YES, WE KNOW.

But honestly – even if the medical team taking care of you does dare to flout JCAHO rules by bringing closed containers of coffee into the room for the whopping 3 minutes they spend with you – unless you are NPO or on chemo, I can’t help but feel detecting a slight whiff of coffee in your room at Crack of Dawn O’Clock is not unreasonable.

But, right, the point here is that we are talking about drinking coffee in the hallway, not a patient care area.

meddit coffee 4

… Yep, pretty much.

It’s such a dead-on example of why students leave med school hating medicine: “don’t drink coffee within sight of your superior” is – for better or worse – the sort of thing we end up internalizing as “professionalism”.

What You Should Read This Week

I waste enough time on the internet that I should get something out of it.  I’m thinking I’ll start a feature where I list the awesome links I find each week so you guys can ignore them.  Or bookmark them, and pretend you read them!  And then have fun and glamorous conversations about them at holiday cocktail parties!

Paradocs Blog: The (Dis)Organization of Med School:  This is a must-read if you’re currently applying to med school.  I think there’s a moment where we all think “med school” = “going to be a doctor”, so “med school + other mandatory classes” = “going to be a BETTER doctor”.

… when really, it just as likely means “going to be a doctor who doesn’t necessarily know what an ‘agonist’ is.” (And, side note!  If you’re even considering a school that requires mandatory volunteer work, I want you to take a good long think about 1) oxymorons, and 2) the differences between this med school and jail.)

PhD Comics:  The Claus Hypothesis:  Well, I laughed.

Thought Broadcast:  Is The Criticism Of The DSM-5 Misguided?:  The best post I’ve read so far about the controversy over the DSM-5.

The Best Research Paper Abstract Ever:  If you could get away with this in medicine, maybe I’d be more interested in research.

And now I should get back to studying for tomorrow’s Rheumatology final: a plan which, at some point, probably involves me no longer lying in bed.  GOD MY LIFE IS HARD.

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.

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.

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?