Tag: Medical School

5 Things I Learned in Business School I Wish I’d Learned in Medical School

These days, many people enter medicine as a second career.  I am no different.  I was an undergraduate business major and worked in the corporate world of internet marketing for 6 years prior to medical school.  Perhaps a science major would have been more practical when I was spending 7 hours struggling to understand some fundamentals of molecular biology; however, my business background did occasionally give me a leg up. Going back to school at 30-something, surrounded by recent college grads, I realized a few lessons I picked up along the way weren’t necessarily obvious to others.

1. Everyone has a job, and they all matter

Despite modern movements away from it, medicine is an extremely hierarchical world.  Medical students pine for that long white coat.  Doctors bark orders at nurses without introducing themselves or asking nicely.  Phlebotomists, lab techs, housekeepers and others largely go unnoticed.

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Copyright: Michelle Au | theunderweardrawer.blogspot.ca

One beautiful reality of capitalism is that jobs don’t exist unless they are vital… IMPORTANT.  In medicine, we need janitors, doctors, accountants, secretaries.  Everyone with a title has responsibilities and is therefore necessary for the organization to function.  Companies with excess overhead from superfluous staff don’t stay in business very long (VA Hospitals aside). So when the surgical consultant steals a computer terminal from the ED Tech so she can finish her note, this disrupts work flow, and sends a message that somehow the doctor’s work is more important than the ED Tech’s.  It’s just not true.  Be mindful that everyone on the team has a job to do and people will want to be on your team.

2. “For-profit = evil” is not always the case

Yes, pharmaceutical companies are responsible for their reputations as greedy, evil, for-profit companies.  Just ask Martin Shkreli.  And while it would be great to provide free medications to any and all who truly have need, research and development (R&D) of new medications is risky and costs money.  A lot of money.

 

On average, a new drug takes anywhere from 11-14 years to make it to market, and that’s IF the drug makes it that far.  Of any new drug developed in a lab, there is an 8% chance that drug will actually make it to market, meaning it’s prescribed by doctors for actual patients.§ The money spent on R&D for 92% of unsuccessful drugs is a true cost, and those bills still need to be paid.  Smart R&D focuses on modular development, so that one lesson learned developing a drug that failed can be applied to new research that will hopefully help a different drug get to market.

Yes there is excess and greed.  Yes Big Pharma develops drugs based on profitability, not strictly based on need.  People with “orphaned diseases” have to create non-profits and raise funds for R&D since the pharmaceutical companies won’t do it.  It’s not ideal.  Attracting the brightest minds to develop major pharmaceutical innovation requires paying people well, and I’ve yet to hear anyone tout how well-paid they are at their non-profit organization.  In the end, it’s not as simple as saying “just lower the prices or make it free.”

3. Product perception is reality

Marketing is everything.  You can have the best product in the world, but if no one knows it exists, or if consumers don’t understand what it can do for them, they won’t buy it.  Similarly, you can get all the science right in medicine, but if results, diagnoses and plans aren’t communicated, getting it right doesn’t matter.

If anything this is even more applicable in medicine than business.  While people have some innate understanding of what makes a good vacuum cleaner, they probably need more help understanding their liver failure and what treatment they need. I never assume patients understand their disease.  Taking 5 minutes to explain the relation between the liver and ascites goes a long, long way.

4. Dress & Look the Part

Being a medical professional requires knowledge, honesty and altruism.  Most people get that part right.  But professionalism in medicine also means being on time, dressing professionally, and remembering that people are always watching.  So for the EMT: put down the cigarette, tuck in your shirt and wear your gloves when needed.  For the medical student: be the first one arriving to rounds, wash your white coat (not just once a semester either), lose the stubble and open toed shoes and ditch the piercings for the day.  Doctors: wash your hands, put down your iPhone and give patients your undivided attention. All the knowledge in the world can be quickly overshadowed by a distracting or detracting exterior.

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“The Doctor” by Luke Fildes

5. Listen to Customer Feedback

This is not “The customer is always right.” Medicine is different.  Just because a patient thinks he needs antibiotics for his cold doesn’t mean he should get them.  But your customers do know their bodies best and how they are feeling at the time.  If you are handing a patient discharge paperwork and they “still don’t feel right,” stop and listen.  In this case, the customer feedback is critical, and the price to pay may be high – both for the patient and for your wallet.  Any seasoned Paramedic will tell you, “When the patient says they are going to die, I believe them.”  We’ve all been there.  And if you haven’t yet, it’s just a matter of time.


So that’s it, 5 small things.  What lessons have you borrowed from an earlier career and applied to medicine?

~Steph

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§ http://www.fdareview.org/03_drug_development.php

Celebrate the Small Stuff: Surviving the Marathon of Medical Training

In just two short months, thousands of newly minted young physicians will be walking into new hospitals, new jobs, and new responsibility. They’ll notice something unfamiliar tickling their calves on that first day – a long white coat having replaced the short one, which in our case went up in flames just days earlier. They’ll be excited and terrified, nervous and naïve.

A doctor’s “intern year” has become something of a legend in pop-culture, portrayed as twelve months of rude awakenings, sleep deprivation and verbal abuse, +/- a love triangle or two. Having been there, done that and proudly owning the t-shirt, I can say the reality couldn’t be further from the truth – at least it doesn’t have to be.*

To all the newbies out there – yes, there will be long hours and sleepless nights. You’ll occasionally go a full week without seeing your loved ones and eat whatever/whenever you can. Med school will seem a lifetime ago when you’re being asked at 3am what to do for a dying person, and you’ll wonder why they never taught you all the things that matter. But Steph and I have stumbled across the solution to all of that.

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Champagne celebration for med school graduation | Photo credit: Amy McClure

We celebrate the small stuff.

Sure we popped champagne like we’d just won a Grand Prix on graduation day, but we’ve also raised a glass to finishing tough rotations, making a clutch diagnosis and running our first double cardiac arrest. We’ve made a ritual of rare Sunday mornings off together with a supply of cinnamon buns always available, just in case. Sometimes we just celebrate because it’s Tuesday and we can. By making a big deal of small victories, the roadblocks become surmountable.

 

Don’t get me wrong – residency is tough. In the past month, three of my patients have died, and I’ve told four others they have cancer. But for every bad day I have had there have been a dozen that left me thinking, “I have the best job in the world.”

I encourage all the newbies out there to approach this next chapter the same way. And remember: when the champagne runs out, there’s always more coffee.

 

*Note: does not apply to general surgery residents. Your life will suck.


How do you like to celebrate the small stuff?

~Amir

 

Advice on Switching Careers: How I made my decision to move from Marketing to Medicine

I’ve had a few people ask me to write about this, so here goes.  First off, my story is just that – mine and potentially not entirely applicable to others looking to change careers, but nonetheless I’m going to attempt to pull out the pearls and advice that I can.  Here’s the step by step process I took to a total career and life change, from President of a boutique Interactive Advertising Agency, to Emergency Medicine Physician, in the span of 7.5 years.

STEP 1: Recognize you need a change

Sometimes the need for change is obvious – if you find yourself counting down the clock to the end of your workday, then something is likely wrong.  What’s harder is recognizing the need for a career change when it’s less obvious – when you like the job you have, but you have more passion for something else.  That was the case with me.  I’d been fortunate enough to have great success in my last career.  I was well-paid for doing interesting work with cool people.  But, I had been volunteering with the rescue squad for 3 years and had gone back to school to get my Advanced Life Support (ALS) certification.  I felt alive and intellectually stimulated in the course. I was finally getting to learn the deeper pathophysiology behind what I’d been seeing in my patients for the last 3 years.  And, instead of volunteering the required 48 hours per month with my rescue squad, I was logging somewhere just over 100 hours per month.  I was about to cross a threshold where I was spending just as much time pursuing my passion for Emergency Medicine as I was in my professional field of Interactive Marketing.  That’s when I first had the idea of a career switch.  That was October 2007.

STEP 2: Mull it over

A career change isn’t the kind of thing you should decide on a whim.  So, do yourself and those around you a favor and take some time to digest the idea.  One of the smartest things I did was asked my friends what they thought, “Could you see me as a doctor?” “Do you think I’d miss marketing & technology?” “When do I seem most happy?”  If you have great friends & family like I do, they’ll have noticed this and be willing to share.  For the record, my parents did ask me the night of my EMT-B graduation (December 2004), “Are you sure you don’t want to go to medical school?”

That said, be prepared that this is the stage where the naysayers also come out.  I can’t tell you how many people said to me something along the lines of, “So I guess you don’t want marriage and kids then, huh?”  To which I wanted to reply, “No, I’m pretty sure I didn’t say that.”  The implication is reasonable though, and certainly something I took into consideration.  At the time I was 27 and single with no kids.  If I was accepted to medical school, would I ever have time to date?  Even if I met the right person, would I be able to balance marriage, babies and a life as a Med Student/Resident?

But at the same time, was I going to put my dreams and my life on hold waiting for a theoretical knight on a white horse that might never arrive?  I saw myself 10 years later without my knight or my dream career in medicine.  I most certainly didn’t want to come up empty handed on both counts.

What about the financial implications?  Here’s where it helped that I was single with no kids.  Supporting just myself, I’d been able to save a decent lump of money while working.  I was in a position to quit working and go back to school full-time (more on that in a bit).  And if it meant going back to eating Ramen Noodles, it was just me who would have to suffer.

STEP 3: Gather Information

Having not been a pre-med major, I had no idea what the rules were for medical school.  For example, would they even accept someone over the age of 30?  What prerequisite courses are required?  Does it matter that I majored in Computer Science, Marketing & Spanish and not Chemistry or Biology?  What’s on this MCAT thing? Every career field will have some of these rules, written and unwritten.  You need to know what you’re up against.

Do yourself a favor and do what I did.  Make some appointments to meet with the people that matter.  I had two major challenges: 1) identify and take all of the prerequisite courses and 2) understand admission requirements for medical school and assess my competitiveness.  So, I knew I needed to talk to someone at an undergraduate university and at a medical school.  Because I wanted to stay local, I set up appointments with the Dean of Sciences at Old Dominion University (ODU) and the Dean of Admissions at Eastern Virginia Medical School (EVMS).  Getting the appointments was much easier than I had anticipated.  I simply filled out contact forms on the websites for each school; they emailed me back within 48 hours.  That was November 2007.

Also, this is a great time to network.  On a side note, coming out of undergrad I was very hesitant to play the Networking game.  I naively wanted to feel like I achieved everything I had on my own, without “cheating.”  After working for a few years, I learned that success is actually a combination of three things: hard work, luck and help from those around you.  Your neighbor may have gone to college with the Hiring Manager for the job you have your eyes on.  Ask your Facebook friends if they know the people in charge at the place you want to go.  Did you know you can search Facebook for people who work at specific companies?  Simply type in “Friends who work at ________” and you might be surprised to find that someone you know works at the company or school where you need an “in.”  Here’s an example from my page of “Friends who work at Google.”

Facebook example

The last thing I did as a part of my information gathering was organize what I had learned about the situation.  A pro and con list if you will.  It looked something like this:

PROCONlist

STEP 4: Pull the trigger

This was actually the easiest step for me.  By the time I reached the end of my Information Gathering stage, my decision was essentially made for me.  So many people have barriers to making a big career change – no money for classes, family commitments, you name it – I had none of those things.  I knew and still know so many people that would kill to be able to pursue a new life dream but can’t. Most of my CONS were just related to money.  I couldn’t NOT do it.

STEP 5: Enjoy the ride

While med school was downright miserable at sometimes, ok many times, one thing I can say about this whole journey is that it’s been an amazing experience to help me grow as a person.  I’ve learned a ton about myself, what motivates me, what I can survive.  And, I feel true to my soul having pursued what at many points felt like an impossible dream.  Oh, and the icing on the cake, I met and married my best friend.

~Steph

5 Things I learned in Medical School I wish I’d learned in EMT School

Granted, it’s been 10+ years since I went through EMT school, but I still remember the gist of it. I remember often thinking the course was being dumbed down – taught to the lowest common educational denominator, which at least in the State of VA can be a GED. I actually think that’s fine – someone with a GED can do a great H&P, start CPR when needed and fashion a pretty good sling out of cravats. But EMT class is often the entry point for many folks with capability and ambitions to continue well-beyond the EMT level. I’m a firm believer in setting expectations high – assume your students want to learn as much as possible, and believe that they can. Don’t assume that they can’t understand why. Looking back on medical school and a year of Emergency Medicine Residency, I’ve complied a few things I wish I had known earlier.

1. Appendicitis pain presents around the belly button for a reason

As an EMT, I never understood why appendicitis often presented as periumbillical pain. Understanding things helps me remember better than mere memorization – that’s true for many people.  The classic presentation (50-60% of patients) for appendicitis is pain that starts near the belly button and migrates to the right lower quadrant. To understand this migration, you just need to know a bit about how the abdomen is innervated. When the appendix first gets inflamed, it’s still small and isn’t pushing against other structures. The pain one feels is deep, visceral pain (think “gut”), which happens to follow a course along the midline of the abdomen, known as the splanchnic nerves. This is why patients perceive pain in the middle of their abdomen even though the appendix is located in the right lower quadrant.  As the inflammation and infection worsen, the appendix swells and begins to irritate the muscle and tissues of the abdominal wall, producing pain in the right lower quadrant.

2. Vitals really are as important as everyone says they are

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Abby Hoobler, EMT-E auscultates to determine heart rate

I will concede that my EMT instructors definitely tried to tell us this. Often though, vitals are taught in the second lesson in EMT class, just after the chapter on consent and other medical-legal issues. It’s taught up front in a focused lesson, but really should be a longitudinal study. We spend much more time up front focusing on how to take those vitals, and less time as we go along learning how to interpret and act on those vitals.  Ask yourself – how long is your differential diagnosis for hypotension?  Bradycardia?

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Vital Sign DDx Carry Cards

If you’re struggling for more than 5, try this: at the top of an index card, write “hypotension.”  List all the diagnoses you can.  Now make similar cards for hypertension, bradycardia, tachycardia, respiratory depression, tachypnea, hypothermia and hyperthermia.  Carry the cards with you on shift.  Ask colleagues to help expand your list.  Pay attention to which conditions appear on multiple cards.  You’ll be surprised how much you can learn.  And next time you feel like you are doing EMT-B&%$# work by taking vitals, you’ll realize you’re probably the most important person on scene.

3. If you communicate well, doctors and nurses WILL listen to your turnover

We want to hear your turnover, if nothing else because you’ve probably asked 70% of what we will, and that will save us time. Being assertive, confident and organized in your presentations is 99% of the battle. Believe it or not, we also really really wish we could have access to the patient care report you wrote. Those initial vital signs and early medication administrations can affect medical decision-making downstream, especially if your patient gets admitted.

4. Stomas, Fistulas, Ports & Other Medical Devices

The EMT curriculum fails to educate providers about common medical procedures and indwelling devices. I never learned about the pieces and parts of a foley, colostomy, mediport or dialysis fistula, yet in any given day, 40-50% of EMS calls can be to Specialized Nursing Facilities (SNFs) where patients have problems with any or all of these devices. We do an ok job with complex devices like LVADs, but there are tremendous gaps otherwise.  Here’s one to start:

Stoma – Any man-made hole through skin or tissue that connects a normally internal structure to the outside world. So, the hole in someone with a trach is a “tracheostomy;” the bag attached to the hole coming out of someone’s abdomen and intestines is a “colostomy,” just like the drain in the head of a kid with hydrocephalus is a “ventriculostomy.” If you want to know the grossest thing on the planet regarding stomas, look up “Philadelphia Sidecar” on UrbanDictionary.  Yes, it’s a thing.

5. Normal Values for Basic Labs

Along the same lines as above, many patients are sent to the ED by a doctor due to an abnormal lab value.  Arguably, if the lab is concerning enough that the doctor wants the patient seen emergently in the ED, then you should probably know the normal range for that value, and what to expect if it’s high or low.  If you responded to an urgent care center for a potassium of 8.2, would you think to call a Paramedic?  I know I wouldn’t have 5 years ago.  Turns out hyperkalemia can kill you, but you don’t get to learn that until Paramedic School.  Whenever I need something complex explained eloquently, I always turn to my friends at KahnAcademy.

Familiarize yourself with the components of a Basic metabolic Panel (BMP) and a Complete Blood Count (CBC) and you’ll be 95% of the way there.

Check out the follow-up to this post, written by my husband, Amir: “5 things I learned in EMT School that I wish I learned in Medical School.”

~Steph

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Oceanfront Sunrise, Virginia Beach, VA