Jan 30, 2010

What Do I Want To Be When I Grow Up?

One of the great things about medical school is it allows you to put off the question "what do I want to be when I grow up?" Sure, you decide to become a doctor and go to medical school. But the real decision- what kind of doctor you're going to be- is put off for another four years post college graduation. While your peers are stuck in a working world trying to find their niche, you are protected in the safety catchall of "I'm in medical school."

I'm supposed to decide on a specialty soon. There is this TV show, Scrubs, that I love because it portrays the experiences of a couple young physicians. It's goofy, but really taps in to some experiences that must be essentially universal for all young doctors. One episode (that I saw while in my first year of medical school) shows the student sitting on his stuffed unicorn, asking it what his specialty should be. At the time I thought, well that's stupid. They must have put that in there just to make the audience laugh. Now that the time is near for me to choose a specialty, that actually seems like a reasonable solution. I have no better ideas for how to make the decision.

So much of the perceptions of the clinical rotations is subjective based on the experiences that the student had during that time. Do I dislike family medicine because the patient population that I worked with was noncompliant, the clinic was four degrees too warm and smelled like a bologna sandwich, and the attending didn't let me talk or touch? Or is it because I really don't like being only the sounding board for problems; for having to redirect anything too serious into the direction of a specialist? Do I love ob because I had an attending that let me do deliveries, assist in surgery, and do patient exams on my own? Will I still love deliveries when they are in the middle of the night and I've been doing this for thirty years? Is it just the novelty and excitement of the experience that I love, or is it really that I love the experience?

Someone told me once to pick the specialty that you actually want to read the journals that they send you. I think that advice actually has a lot of merit. Once I got into medical school, I seem to have automatically ended up on the mailing list of every professional organization out there. I now get more junk mail from professional medical groups than I do from the grocery store, drugstore and LL Bean combined. From the mail that lands on my coffee table, the journals for cardiology, surgery, neurology, and pediatrics get tossed in the recycle bin immediately. I'll peruse the journals of osteopathic research, oncology, and family practice, and then recycle those. The journal of obstetrics and gynecology gets read and kept for another look.

Despite these inclinations to a particular practice, its still hard to choose. It's unsettling to commit to a lifestyle of being on call. Specialties like dermatology, ophthalmology, and anesthesia offer a comfortable, rested lifestyle (which is very appealing in itself) but possess less inherent interest for me than obstetrics.

So, I'm kind of left where I started. Do I choose a practice that I declare the hours and workload, and am left with medicine that I like but don't care deeply about? Or do I match with a residency that trains me for a lifestyle of long hours but rewarding work? I'm not sure. But I'll have to figure it out pretty soon.

Now where's that damn unicorn?

Jan 17, 2010

The Great Physician

Today I accompanied my parents to the church I grew up in. Reading through the prayer requests, I was struck by how the great majority of them focused on a physical ailment. Loved ones who suddenly died of heart attacks. So-and-so with Parkinson's. A newly diagnosed breast cancer. A kid with brain tumors refractory to chemo and unhealed despite gamma knife surgery.

The church prays for God's healing hand on these people. My heart has a different prayer: "Help me become a good doctor." I believe sometimes God does miracles, and can heal people. More often, I believe that he provides medicine to do that for him.

As I thought about this, I reflected on the idea of Christ as The Great Physician. Luke recorded this phrase, probably in reverence (and some jealousy?) as he himself was a physician. Jesus was a doctor with many specialties. Some that come to mind are:
  • Dermatologist: he heals men of leprosy (Luke 5)
  • Orthopedic Specialist: crippled men are healed (Mark 2, Luke 7)
  • Otolaryngologist: he heals a deaf person (Mark 7)
  • Opthalmologist: the cure of a blind man (John 9)
  • Pediatric Intensivist: the healing of a dying child (John 4, Luke 8)
  • Hematologist: curing a woman who had been bleeding for 12 years (Luke 8)
  • Neurologist: the healing of an epileptic (Mark 9, Luke 9)
  • Pyschiatrist: healing of mental illnesses (Matthew 4)
The quality of all these encounters was caring, listening, clear directions, and effective treatment...all the aspects of a patient visit that a good physician wants to create. As I consider my career in medicine, with Medicare cuts, health care reform (?), and uncertainty in the profession, I pray that my life in medicine is modeled after the Great Physician.

Jan 8, 2010

The Cost of Medical School

At our white coat ceremony, the speaker warned us of the sacrifices we would have to make to become doctors. I was so happy to be there, I wondered what he was talking about? My whole life I wanted to be a doctor, and now I finally was going to be. It would have been more of a sacrifice not to get in than to do the work to get out. I looked down at my clean white coat, embroidered with "Anne Kennard, Student Doctor" and thought, whatever it takes, its worth it.

What does medical school really cost? Four years, eight if you count residency, but you knew that going in. $45,000 a year, plus living expenses? Somewhere along the way you realize that it costs more than that three hundred thousand dollars accruing at 6.8%. What it really takes is the focus of your life. You have kids, but hey, you've got to study. You work a long day, and come home to answer practice questions at night. It's hard on your self-esteem, because nobody likes a medical student. The attending is riding you, the nurse is resentful because she has to take orders from a student that knows less than she does, you're in the office staff's way, and you are competing with the other students to look like the star. You rotate in a different place every four weeks, packing your suitcase and stethescope and leaving your spouse.

Sometimes I wonder if someone knew, if they really really knew, what it takes to become a doctor, would anyone do it? Some days it feels like no, but the answer I came to for myself was ultimately yes. It takes more sacrifice than I ever imagined, but I'd still do it because I love medicine and feel like nothing else would be quite right for me except doctoring. You're lucky if those around you support you, because it is quite possibly more of a sacrifice for them than for you. I have classmates whose wives have put their careers on hold to focus on kids while their husbands are in school. I myself have a thoughtful husband who does the dishes while I study and who packs my suitcase when I'm leaving him to go on a rotation.

Someday, it'll be worth it. I'll be a doctor, make money, and have more time at home (or so I'm told). I'll chip away at that interest, working my way down the principle. I'll start doing the dishes. Maybe someday I'll be on a medical faculty somewhere, informing another little doctor of the costs, both monetary and otherwise, and they won't know what I'm talking about. And that's probably for the best.

My suitcase, packed for another rotation

Jan 4, 2010

For Your Entertainment

Today I saw a 90 year old man with prostate cancer. He was getting some chemo, but doing well. I asked him what he likes to do for fun, and he said that he goes to the gym for an hour four times a week. Impressed, I asked him which machines he likes to use at the gym? He said, "Oh, any old machine...I just sit on it anyway and watch the ladies."