Category Archives: Medical School

There Is No Team In Medicine

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Teams pull together. They’ve got your back. They work together towards a common goal. The term “team” is used very loosely in the medical world. The fact is there is no team in medicine — it’s just a term used to foster some semblance of cohesiveness within dysfunctional rotations. Don’t let them try and tell you otherwise.

Medical school rotations are typically made up of an attending, one or more residents, and one or more medical students. This is what is collectively called the “team” on ward medicine. If you look deeper you’ll soon realize that an accumulation of more than one body isn’t adequate to truly define a team.

The common goal on ward medicine is typically to care for patients. This is really where the teamwork both begins and ends. Unlike a football or basketball team, there is a lot going on behind the scenes in medicine to ensure that teamwork does not truly exist.

  • Other students will go behind your back and attempt to show you up. This can include answering questions about your patients or bringing in journal articles when other students aren’t prepared.
  • Some residents will not tell you where you need to be and then fault you for not being wherever it is that they (supposedly) wanted you to be.
  • Attendings are malignant about “pimping” and some verbally abuse students and/or residents for not knowing the answers.
  • You are overworked and very rarely will another person put in some extra effort to make sure you’re out on time.
  • Attendings waste tremendous amounts of time. They’ll tell you that they want to round at 5 PM and then not show up until 6:30 PM. No phone calls are made to let the residents know that he is going to be late. You sit around for an hour and a half with your thumb up your ass.
  • Nurses, who are sometimes considered part of the “team,” are incredibly slow about getting things done.
  • As a student, you are made to complete meaningless extraneous tasks such as coming up with a presentation about some topic you’ll never use ever again. This time could be spent studying for your shelf exam.
  • Most residents and attendings don’t care that you have an exam at the end of the rotation to study for. Instead, they’d rather you follow them around and waste 4 hours every day.

With just a few examples, you can see that there really is no teamwork in academic ward medicine. Here is what you actually have:

  • The attending is getting paid a monthly bonus on top of his regular clinical (or academic) duties and salary to participate on the wards. Thus by nature of the situation his ward duties come second.
  • The residents are there to please the attending and to do the daily “scut” work. They just want to make sure that everything is in order before rounds.
  • The students are there because they were told to do so. At best they want to learn something useful to apply to their career. At worst they just want to pass the rotation and could care less if they remember anything 1 day after the shelf exam.
  • In order to impress the attending, cut-throat measures on the part of students and residents will sometimes be employed. After all, they want good letters for that competitive fellowship or residency.

So in reality, you have three different individuals: Attending, resident, and student. Each wants something different. This in itself defeats the “team” in medicine.

Contrast this with a football or basketball team. The coach wants to win. The players want to win. They pull together to make it happen.

There is no team in medicine. What once might have been a team has transformed into a cut-throat competitive atmosphere where each participant has their own individual goals. Without well-defined universal objectives that apply to each participant as a whole, teamwork cannot and will not exist.

When Did I Realize Medicine Wasn’t For Me?

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First and second year was pretty decent. I got to make my own schedules and really only went to class for exams. I had my daily studying completed by the time my classmates got out of class by not attending classes each day.

At some point during the beginning of second year, we had to begin doing H&Ps on real patients in the hospital. We were assigned a preceptor, and we met with him or her once per week for a few hours while we saw our patients, wrote up an H&P, and then presented.

If I had to mark one single point during my medical school career that I started having second thoughts, it was during this time. From the first day I stepped into a “real” patient room and starting asking questions to get more information, and then finally going into the physical exam, I started to realize this wasn’t what I had signed up for.

But, most of my time was spent studying with my own schedule so life was pretty good. The fake H&Ps eventually ended and then we all moved to third year.

This is basically where my initial thoughts during second year were solidified. I started third year on pediatrics in the outpatient clinic. The hours were good, but I didn’t particularly care about dealing with lots of kids or the parents. Still, looking back pediatrics was probably the lesser of the evils in terms of clinical rotations.

After pediatrics was OB/GYN. Now, this is where it really got shitty. I hated OB/GYN. I mean I really, really hated it. It was at this point that I had second thoughts about quitting.

Why didn’t I just go ahead and bite the bullet then? I tended to always talk myself out of it. The thoughts in my head were something like “I’ve already done two years of medical school, what’s two years more?” Each rotation that I had completed (and hated) was only one step closer to finishing school — and one step farther away from me getting out.

But then I’ve always believed that sticking it out was the most ideal situation. Fall-back plans are great, as you never know what is going to happen in the future. The desire inside of me to always have a fall-back plan — all bases covered — is what kept me in for the long haul.

Knowing how things worked out, I am very satisfied with my decision and I feel that I made the best one for me. But making that decision with an unknown future was certainly scary. Now, the company is doing extremely well and I am completely happy. I could technically go back into medicine if I ever needed to. But, I don’t think this will ever be necessary.

A Primer for Applying

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The following guest contribution was written by Locus Potus, who writes for the blog Hybrid Vigor.

Dear Friend/Family/Colleague:

You are receiving this letter because someone you know is about to apply to medical school. The entire lengthy process is riddled with intricacies, misperceptions, variables, and unknowns that make it unlikely you realize the full extent of what this person is about to do. I’m sure that you will try to empathize over the next year, but some things in life must be lived to be understood. Even my own knowledge base, seasoned over a long application cycle and qualified enough to enter medical school this fall has already become outdated with changes to the MCAT and the application process. Nonetheless, I will try to inform you as best I can.

A pre-medical student is born the instant they make the decision to apply to medical school. For most, this happens years before they ever start filling out application forms and taking tests. Making good grades is an obvious undertaking, but they must also be significantly involved in extracurricular activities, all while befriending busy professors to write raving letters of recommendation. All this extra work makes them an “average” applicant. Thus, for the pre-med you know, the application process began long ago.

The initial step in applying to medical school is the Medical College Admissions Test (MCAT, pronounced “em-cat”, not “em-cats”). For most people, this test is prepared for months beforehand, often utilizing expensive test-prep classes (>$1000), and on top of a full work/school/life load. Like most standardized tests that can be studied for, it does little to measure actual intelligence, but does reflect baseline knowledge in the sciences and reading comprehension needed for medical school, particularly in the first year. There is a weak correlation between MCAT score and USMLE scores (the licensing exam for MD’s) and even less predictability with being a good doctor. The full details of this 8-hour monstrosity could fill pages, but suffice it to say that the test itself is needlessly long (one quarter of the test, the writing portion, is generally not considered by medical schools), expensive (>$250), and just another “weed out” step in narrowing down the applicant pool into only the most studious and determined applicants. In my day, the exam was only held twice a year, leading to a great amount of anxiety on test day, but thankfully it is now being offered multiple times per annum.

Assuming your acquaintance has made it this far in the process and taken the test, next up comes the actual application mediated through the American Medical College Application Service (AMCAS) beginning in June, the year before they are to start med school. This is the pre-med’s first official foray into the needless bureaucracy that is the American medical system and a continuation of the expensive journey into medical school. All coursework and activities must be meticulously detailed in the AMCAS application. As this information will be sent to schools in a standardized format, pre-meds will strive to polish their resumes as best they can. More importantly, however, the AMCAS also collects a personal statement, also known as the application essay, which asks the question “why are you interested in medicine.” Herein lies one of the greatest challenges facing any aspiring physician – to put into words a lifetime of experiences that led them to pursue their career path. The personal statement can make or break an application, especially for the “average” applicant since there are thousands of others who likely have the same exceptional grades and activities. Using the cliche “I’ve always wanted to be a doctor since my parents bought me a Playskool doctor set” might as well be asking for a rejection because the admissions committee sees hundreds of these essays every year. No, this essay must be special. It must reflect who they are as a person. It must grab the reader’s attention and compel them to offer the writer an interview. Not surprisingly, finding a unique way to say “I want to help people” can be difficult. It will take a long time to write, with multiple revisions and criticisms. If your applicant is on the ball, it will be completed before AMCAS even begins to accept applications in June. Whatever you do, don’t question why they are spending so much time/stressing on an application because this step weighs heavily on the rest of their careers and lives. Applying early is a crucial advantage in a cutthroat process, where any edge should be employed.

Before hitting the Submit button on their internet browser, pre-meds must select their list of medical schools. Unlike college, where everywhere basically teaches the same material in the same way, each medical school has a distinct personality and should really only be chosen after some consideration. US News and World Report rankings is not the best of guides, as they are based mostly on revenue from research grants, not necessarily educational practice. Different schools will appeal to different applicants based on their interests. It is difficult to say one school is “better” than another, especially given that all Allopathic medical schools require national certification. In this regard, there are only varying degrees of good.

Although your pre-med may be very smart and accomplished, applying to the very top schools is not always a wise investment. Most applicants to every school will come from the top of their classes nationwide. No, Harvard will not accept them just because everyone says, “she’d make such a great doctor and she’s SOOO smart!” Even a 4.0 GPA and a high MCAT score is no guarantee to any medical school, many such applicants find themselves applying again in the next year (especially if their personalities are unappealing during the interview). The list of schools must also be chosen prudently because each additional school costs $30. I applied to an average number of schools, fifteen, which cost me approximately $500. In return for this exorbitant fee, which you must pay, AMCAS will check your transcript for accuracy (that applicants enter themselves) and send all the information in a nice, neat electronic file to each medical school. That’s right, for about an hour’s worth of work on their part and minimal production time/cost, they take what most student’s can save over an entire summer – but I digress and this fee pales in comparison to the next step in the application process. Did I mention that AMCAS processing takes about a month (if you’re early)? If your pre-med’s spirit and bank accounts are not exhausted by now, they soon will be.

Once AMCAS finishes their part, medical schools will begin collecting the primary applications and processing them in what amounts to another month of waiting. Mind you, each school will do things differently (see above about researching schools), but most will be willing to offer you their own, secondary application, for an additional fee of course. For each school selected in the AMCAS, pre-meds can expect to pay anywhere between $50-$120 for the pleasure of writing additional essays on exciting topics like “Why do you want to be a physician?(yes, they ask it again and heaven forbid you put the same answer as your primary application)”, “What makes you special?” or “Why do you want to come to School X?”. If they’re lucky, they’ll be able to recycle essays between schools, but expect lots of long nights and stress while they come up with answers that must not only be well-written, but sound original and fresh. If they applied to 15 schools like I did, it becomes very time consuming and expensive for this step alone (~$2000).

In another long pause after the frenzy to return secondary applications – remember, early is better – pre-meds will try to recover some lost money and time. Soon, interview season will be upon them. Don’t expect any particular reason why or when school’s schedule interviews. As I mentioned before, even excellent applicants don’t get interviews everywhere. An application may sit at a school from July to January the next year, presumed as a rejection, only to be called up for an interview. The logic behind each medical school’s admissions decision to interview (and accept) is a well-guarded secret. If you haven’t noticed odd behavior already, your pre-med will likely to obsessively check their email accounts every couple of hours/minutes for any word from schools. Small letters in the mail are generally rejection letters, get used to the sight of them arriving even if they’re a “better-than average” applicant. (Note: sometimes schools will offer interviews via snail-mail, but they will usually accompany an email).

A brief commentary on chances of admission: It is important for you to remain realistic during the application process. Making it any step beyond the secondary application is an achievement. A few exceptional students will be very fortunate in the process and garner numerous invitations and eventual acceptances. This is not the norm. Almost half of all applicants nationally will not be accepted anywhere and more applicants are applying every year. Many applicants get only a few, if any, interview invitations. At any medical school, expect only 1 in 5 applications on average to get an interview. Of these, only 1 in 3 or 4 will be accepted, for an overall acceptance rate between 3-10%. It may be tempting to stop worrying after receiving interview invitations, its not over until you see an acceptance letter in hand. In each of the waiting periods, be patient and supportive, but don’t assume that an acceptance is coming, chances are against them.

Assuming your pre-med is lucky enough to get an interview invitation so begins another round of expensive and time consuming preparation. Interviews are usually done on the pre-med’s own (you stay at home) and in proper business attire (more $$$). The cost of tickets and hotel can cost hundreds per trip. In these nerve-wracking situations, they can be expected to answer questions like “Why do you want to be a doctor (yes, they ask it again)” or “Tell me about yourself.” Unfortunately, there is a high degree of variability in interviews – some interviewers are nice, while others can put on a full-out grilling session, even at the same school. This is another reason why applying is often called a “crapshoot.” Applicants must prepare themselves to answer questions about medicine in general and also weaknesses in their application without sounded too rehearsed, although they are likely to have answered the same questions everywhere they interviewed. The day can be long or short, depending on the school, but almost always awkward formal – it’s a face to face meeting with the competition. However, they can be fun as pre-meds are usually Type A personalities with interesting backgrounds or else they wouldn’t have made it this far. Interviews are generally extended from September to February, don’t read too much into the timing.

Some schools will start accepting students soon after they start interviewing and are known as “rolling admissions schools.” Others, like many of the top schools, will make their applicants wait until March 15th to hear if they are accepted, waitlisted, or rejected, known as “non-rolling admissions.” Some schools will not even send any kind of notification at all, leaving many pre-meds to wonder indefinitely. In perhaps the worst kind of torture this process can put you through, a pre-med can be put on the waiting list of the school they want to attend and held in limbo until the first day of school. At any given moment, even well into next July or August and after plans have been made to attend another school, a student may be accepted off the waitlist. Therefore, a pre-med applicant may never really know where they are going to school up until the day they actually attend somewhere – often over a year after they initially submitted their primary AMCAS application. Don’t expect definitive answers from your pre-med since there are many things to consider like cost (including financial aid with its own application process), location, and teaching style. I hope at this point you are beginning to understand my initial statement above regarding the complexity and strain involved in the application process.

If your pre-med does get accepted to medical school – any medical school – they are to be thoroughly congratulated. They beat the odds and the thousands of people clawing for a spot. A common trend these days is for applicants to take a few years off before school to add another dimension to their application. I highly recommend this approach for students because it gives them a chance to live life and get a break from school before the onslaught of med school itself.

After all this expense, effort, and drama, the “pre-med student” evolves into a “med-student.” Keep in mind that most pre-meds and med-students have a marginal knowledge of actual medicine. Even after medical school, we’re not very qualified to practice medicine on our own until after years of residency. So, hold off on your impulse to start asking questions about that burning sensation you’ve been meaning to see a real doctor about. Also keep in mind that the progression to medical student and eventual doctor is not a guarantee of financial success. Medicine is not what it used to be. The bureaucracy and hoops to jump through only continue during a physician’s career, which is probably why they make us do it when we enter the profession – they want to see if we are willing to put up with it. Many doctors will graduate with six-figure debts, live modestly, and lead stressful lives well into their 30’s and 40’s – something to consider before advocating a hand in marriage to any future doctor. Many experts agree that our healthcare system is in disrepair. Due to absurd insurance rates and frivolous lawsuits, physicians are leaving their practices in droves, resulting in a deepening healthcare crisis. Physician’s wages are determined by a pencil pusher at an HMO and may decrease with a change in US policy. Despite this bleak market outlook, pre-meds will still strive at great lengths to enter into medical school.

My strongest advice is to not assume too many things and to be patient with your pre-med during the application process. Ask questions and be prepared for uncertain answers. They will need your support through it all and even beyond. The stresses of becoming a doctor are great. Medical students have some of the highest depression rates among any profession. After all the drudgery, conformity, and expense, the original, bright-eyed, and optimistic person you know may be gone. I can only hope that I don’t go that way myself.

This letter is by no means comprehensive and maybe a little dated, but I doubt that much as changed in a year. I hope it serves as a primer for one of the most difficult years of anyone’s life – many people would agree that the hardest part about medical school is getting in. As a further resource, I recommend the Student Doctor Network forums as a place to ask for more information. Many applicants, including myself, have relied on this site while applying, especially when most of the people around me didn’t fully understand what was going on.

Good luck to you and your pre-med.

Sincerely,

Locus Potus
Nom de plum

Medicine Is Simply Repetition

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If you’ve been in medical school for any length of time, you’ve most likely seen those docs who think they’re Gods gift to Humanity. They flaunt the fact they have have two letters after their name and even go as far as to beat down other specialties of medicine. After all, their specialty is supreme. It is those physicians that I’m calling out: Medicine is simply repetition.

Medicine Is Simply Repetition

Do something enough, and it becomes part of you. For example, before starting medical school I had no idea what a normal white blood cell count was. After just a month of internal medicine and seeing WBCs every day, I quickly picked it up. No, I didn’t go home and commit to memory the normal value. Rather, it came to me just from working with WBCs every day.

The same can be said for just about anything in medicine. Do a procedure enough times, and you know it cold. Work up a diagnosis enough times, and you’ve got it down. With that being said, there’s really nothing magical or special about medicine. Well, nothing more than being able to memorize and regurgitate large amounts of information during medical school to make it to residency training where you eventually repeat things enough that they become second nature.

Medicine Is Simply Repetition

Medicine is algorithmic. Each major clinical diagnosis or surgical procedure follows some type of pattern. Here, let’s take a look at an example:

Evaluation of Palpable Breast Masses
Evaluation of Palpable Breast Masses
AAFP

Let’s say you’re on a family medicine rotation. Your attending physician might find it enlightening to pimp you on the diagnostic evaluation of palpable breast masses one day. So, as the studious student you go home and commit the above algorithm to memory. The next day, the attending pimps you on the evaluation of palpable breast masses, you answer the question correctly, and then move onto your psychiatry rotation next month.

The attending no doubt has the above algorithm memorized in some form or another. It might not look identical if you had him or her draw it out on paper, but it gets the job done. What the attending most likely didn’t do, however, is go home like you did and memorize the algorithm straight up. Instead, he knows it because he’s been evaluating palpable breast masses in patients for years.

You, on the other hand, who has just begun your psychiatry rotation might not see another palpable breast mass. Ever. After a week or two, you’ve completely forgotten about the evaluation of palpable breast masses and if asked about it in the future will know just a fraction more about the evaluation of said breast masses than a high school dropout on the street.

Medicine Is Simply Repetition

So you see, there’s really nothing magical and special about medicine. Sure, physicians are smart people. However, the those that go into medicine to begin with have the personality type that allows them to succeed in such a competitive and repetitive environment. This takes precedence over intellectual capability.

The next time that an attending pimps you on something, remember that he’s been doing this for years and it’s second nature for him to know the material simply due to the fact that he has repeated it much more than you have for your level of training. Some may argue that pimping then helps to reinforce the material, but I disagree. You will have ample time to repeat the material during training, so pimping is technically not necessary in order to learn the material.

If you don’t believe that the above statement is true, then think about this: Residency training programs have minimum requirements set in place for all residents. You must do procedure X Y number of times in order to complete requirements. This is where repetition comes into play, and not through pimping.

You’ll eventually learn whatever it is you need to learn through repetition. In fact, you could probably completely skip the first two years of medical school and head straight to the wards and start repeating stuff over and over. Give it 10 years and I bet you’d make a decent physician.

After all, it’s simply repetition. Oh, and it was the way it was done in the old days, too.

Learn From My Mistakes

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I was pretty much the traditional pre-med student when applying to medical school. I did the standard volunteer experiences, had the ECs, and my GPA and MCAT scores were pretty good.

As most of you know, however, I did quite a lot wrong. Let’s take a look at my thought processes when deciding to attend medical school.

Job Security
Probably the number one reason I wanted to become a physician was job security. In fact, I told each interviewer this at all schools where I was accepted. I think they appreciated the blatant honesty.

My father was laid off work after 15 years of service, and then had to deliver Domino’s Pizza to make ends meet. I saw first hand at what poor job security could do to a family, and I wasn’t going to make that mistake.

There certainly is quite a bit of job security in medicine, so I feel this was a valid reason for me wanting to become a physician. On the plus side, you can pretty much work wherever you choose to (or at least close to where you’d like to be) due to the good demand for physicians in the workplace.

Money & Prestige
Although I never straight out and told the admission committee that one of the top two reasons for me wanting to pursue medicine was money and prestige, it sure as hell was true. Yes, you have to work seemingly ungodly hours for good pay but where else can you complete a post-bac and make a guaranteed 6-figure salary?

This was my thought process regarding the money and prestige reason initially as a lowly pre-medical student. Looking back now, however, I’ve learned that (for me) medicine is simply not worth it.

Despite what the majority of pre-med students will tell you, I still think that money is a huge decision factor for students – along with the “prestige” that being a physician can offer.

Caring For The Sick
I honestly never really gave a crap about caring for sick people. I even knew back when I was doing my volunteer experiences that I didn’t particularly like working with sick people who complained all the time. Why didn’t I listen to my heart way back then? Well, honestly I chalked it up as me not liking [insert volunteer specialty here]. I thought that out of all the specialties in medicine, surely I’ll find something I like. Don’t always bet on that.

Before I started school, I actually thought I wanted to practice family medicine in some podunkville town somewhere. My, my how things change.

Pillar of the Community
We hear so much about the “community” these days. Admission committees like to hear your crap about communities too. The honest truth was that I didn’t (and still don’t) really give two shits about the community. Sure, I have lifelong friends and cool neighbors, but in general I like to be left the hell alone. I just don’t like people knowing what I’m doing all of the time. Habitat for Humanity? I’ll let someone else build the homes.

In my opinion, to be really truly happy in medicine, I think you guys need to be thinking much less about money and prestige, maybe a little bit about job security, and focused a hell of a whole lot on caring for sick people and doing stuff to better the community (or your patient population).

I was the exact opposite, and have a really bad taste in my mouth for the practice of medicine. Premeds, if you’re like me, don’t try to fake it. Get out, and get out while you can. Otherwise, you might wake up one day and realize that you’re unhappy and 65 years old.