MYTHBUSTERS: RESIDENCY INTERVIEWS

MYTH: Interviewing for medical school, you have to sell yourself to them.  Interviewing for residency programs, they're selling themselves to you.

Generally, the big picture is fairly accurate. There are a LOT more candidates for med school than residency, and the further up the ladder, the stronger the application's correlation with good performance and success. Imagine looking at MCAT scores, college grades, and extracurriculars to decide if someone will be a good doctor one day.  "Lab assistant" could mean anything from washing pyrex beakers (me) or being first author on a publication (not me). Residency applications, on the other hand, are a slightly better representation of one's ability, focusing on medical board scores, clinical rotation grades and recommendation letters from other physicians. 

First, you have to understand the idea of cutoffs....

CHANGE OF PACE

Awhile back, my mom mentioned to me that changing my blog title to “No ifs, ands or buts” demonstrated how much I’d changed over the past few years. I was finally able to appreciate the humor in those trivial but frustrating situations that used to nearly drive me over the edge.

As I rapidly approach another big milestone in life (graduating from medical school!), I feel like it’s time for another change of pace (a pacemaker pun).  Also, I have one more week of vacation and I’m going crazy from boredom. My bizarre penchant for blank slates has now leached into other parts of my life- every few months I’ll buy a new calendar/planner just to start fresh, with one ink color. (I did that last week but only got about halfway through transcribing before I got bored, so now I’ll probably redo the blog.)

So, back to this coming year being full of exciting changes.

REFLECTION ON MORTALITY

People often comment about how close we are to death, as healthcare professionals. When I first started into medicine, I assumed that that constant exposure would make death easier to deal with- whether myself or those close to me. I thought it would be like exposure therapy in psychology, overcoming fear by incremental, gradual introduction.

Instead, it has done the opposite. My experience in medicine has made me feel infinitely more removed from death; paradoxically, because it is so routine. The problem is that I've been conditioned to assume that it's never me or my family. Death is always in the controlled environment of a hospital, and it's usually not unexpected or sudden.  I guess my mind has developed this corollary that if my family isn't in a hospital, then they are immune to death (but when I hear someone close to me has been taken to the hospital, I am immediately overcome with anxiety).

I'm always surprised to hear from others that a death was unexpected (of course there are exceptions, like a car accident)....

ZEBRA HUNTER

One of the first pieces of advice I remember was that the difference between a new doctor and experienced one is the approach to a clinical question. The new doctor starts with a wide differential, gathering information to narrow it down, whereas the intuitive, experienced doctor immediately has a general sense of the answer and gathers information to justify the suspected diagnosis.

I have been keenly aware of my changing perspective over the years, noticing every so often that I've shifted a tiny bit more toward the latter (not only did I not truly understand the true meaning of the statement initially, I didn't understand the timeline- it's not an overnight change of perspective, unfortunately).  My ignorant, egocentric first thoughts were that I, of course, was exempt- I knew it all already....

DON'T BUY ALL THE BOOKS!

Now that I'm 7/8 of the way done with med school, I'm starting to compile some of my better advice, and hopefully one day can publish it.  Here's an excerpt; not that anyone ever comments, but if anyone has suggestions or requests, let me know!

Like college textbooks, medical texts can be outrageously pricey. Embarrassingly, I was “that person” who purchased every single book on the “required book” list.  I think it was probably around $2000. (Yes, I bought them new from Amazon.)  Sitting in orientation surrounded by people complaining about said booklist and realizing that I was literally the only one who had purchased any books at all, I vowed to pass on the word.

PAIN, PART 2

Facts about narcotics that doctors assume patients know (and therefore don't address):

• Narcotic medications are addictive. Period. Even if you really need them, you can still be addicted. There was a big scandal recently which revealed that some drug companies had mislead doctors and patients about the dangers and addictive qualities of narcotics, so everyone needs to be aware.
• "Narcotics" aren't just illegal drugs like heroin. Narcotics are also those "pain pills" you get as a prescription. Sometimes the doctor asks if you've ever been dependent or addicted to drugs- THESE COUNT, and doctors assume you've never had a problem if you say no.
• TOLERANCE: The more narcotics you take, the more your tolerance builds up. Then when you experience even more pain, you need more medication. It's excruciating to watch people who are dependent on narcotics after surgery or an injury experience excruciating pain that we can't control because your body has such a high tolerance....

PAIN, PART 1

Being in a surgeon's office this week has really made me reflect about the wide variation of pain perception. Clearly, assessing and treating pain presents major quandary for physicians- who is really in pain? Whose pain are we missing? Are we killing people by over-managing pain?

I've heard the surgeon discuss narcotic pain medications multiple times with patients this week, and the bottom line is evident: doctors often do a horrible job of screening for pain (I'll place most of the blame on a lack of tools, because there's no magic lab test or xray) but also explaining the proper use of narcotics and the risks of inappropriate or long-term use.

Narcotics are a big pet peeve of mine (not when used "correctly" of course, but even that's not well-defined). Volumes of books could be written on this subject (and have been) so ill try to be brief (and also divide this up into multiple posts).

This is a bit like discussing politics around election time, so I'll try to be as objective as possible (which is impossible)....

TAKE A HIKE, SAVE YOUR BRAIN

Doing crossword puzzles was my "morning coffee" during college- the absolute only thing that kept my forehead off the desk in 8am classes. I justified it by convincing myself that word puzzles were just as important to keeping my neurons happy and healthy as the chemistry I was unable to concentrate on.

Well, it turns out that might not be true....