Match week officially kicked off this morning with an e-mail at 10:00 am Denver time with an e-mail that told all residency applicants whether or not they matched - but not what program they actually matched to. The e-mail subject says, "Did I Match?" which would have been horribly anxiety provoking right before opening the e-mail were it not for Gmail's useful snippets feature that immediately answered that question: "Congratulations! You have matched!"
Now, we all have to wait until Friday morning for Match Day. The program that we matched to (because the result has already been determined) is written on a piece of paper inside of an envelope with our name on it. The envelopes sit on a table at a brunch hosted by the School of Medicine, and we're not allowed to open them until 10:00 am Denver time. I hear that some schools make their students open the envelopes on stage, or in public, but Colorado is a bit more humane in letting us take the envelope home, if we wish, and open it in privacy.
The wait is killing me. Though so far I have been keeping myself busy and my mind sufficiently distracted. I'm thrilled that my parents will both be visiting me in Denver to share in the excitement on Match Day!
Monday, March 11, 2013
Tuesday, January 15, 2013
South America
In less than 12 hours, I'm leaving for a South America adventure. This may very well be the last opportunity I'll have for quite a long time to do a backpacking vacation. How is it that I, a medical student, have the time to take 6 weeks off? That's just what fourth year medical students do this time of year. With interview season finished, and the National Residency Match Program open for business (I submitted my rank list today!!!), there's not much to do but wait for Match Day and graduation.
I could have taken an elective, yes, but every single resident who has weighed in on the subject has emphatically insisted that this time be used to do the kinds of things that I simply won't have time to do once I'm a resident. Like travel. Consistently, those residents have also said that everyone ends up on an even playing field by the third month of residency.
So I'm going on an adventure to forget about life for awhile and focus on living.
I could have taken an elective, yes, but every single resident who has weighed in on the subject has emphatically insisted that this time be used to do the kinds of things that I simply won't have time to do once I'm a resident. Like travel. Consistently, those residents have also said that everyone ends up on an even playing field by the third month of residency.
So I'm going on an adventure to forget about life for awhile and focus on living.
Tuesday, January 1, 2013
Reality check
It's now 2013, my graduation year. I will be a doctor (technically) in 144 days. Crazy.
Monday, December 31, 2012
When to believe my patient: Cynicism versus gullibility
During one of my medicine rotations this past year, I picked up a patient who had been admitted the previous night for abdominal pain. This was a middle-aged guy who had been in and out of the Emergency Department more than 7 times over the past few months for the same problem. A thorough chart review showed that he had the million-dollar work-up several times over, including half a dozen abdominal CT scans, and absolutely no biological cause was found to explain his symptoms.
Importantly, he also had a distant history of IV heroin abuse. On admission the night before, he said that he slipped up once a few months prior but swore he hadn't used since then. The admitting intern handed him off to me as a "drug-seeker with functional abdominal pain."
Talking briefly with my patient before rounds, I just didn't get the sense that he was drug-seeking. My resident was more cynical; he called me naive, but he also gave me leeway to do with my patient as I saw fit.
After rounds that morning, I spent a little more time with my patient. "What exactly happened a few months ago that caused you to use heroin again?" I discovered that his wife had committed a violent suicide and that he had found her. He blamed himself for her death. This was a revelation to me. Incredibly, my patient felt that he had put this traumatic event behind him, despite never going through any grieving process. He didn't draw any connection between his wife's suicide and his current abdominal pain, even though his pain began at around the same time.
I gently suggested to him that perhaps his abdominal pain was a result of that psychological trauma. He resisted that idea because, to him, it implied that he was "crazy" or making it up, and the pain felt so real to him. I asked him to just consider it and told him that I would return later in the afternoon to talk more.
During our next conversation later that afternoon, he was surprisingly receptive to the possibility of a psychogenic cause of his abdominal pain. "In all of my hospital visits, not a single doctor has suggested that, but it makes sense." He was in unbearable pain even then, so I suggested that we try a simple breathing relaxation technique. After five minutes of this, we got his pain down to a manageable level, and he seemed bolstered by the improvement. At this point, I was practically convinced that his abdominal pain was psychogenic in nature.
We were treating his abdominal pain with narcotics, which is a poor choice of medication because it can actually cause constipation and exacerbate abdominal pain. I suggested that, overnight, he first try the relaxation technique that I had taught him and only ask for oxycodone if he really needed it. This was the real test: How much pain medication would he ask for? When I came back the next morning, I found that he decreased his oxycodone from 10 mg every two hours to 5 mg every eight hours. This was objective evidence that my patient was not drug-seeking and supported a diagnosis of pain disorder.
My resident and attending were both surprised, to say the least. The management of drug-seeking patients is truly difficult, especially at a safety net hospital that predominantly serves a socioeconomically disadvantaged population with a high proportion of drug addicts. I grant that I am naive and perhaps too trusting when it comes to handling these patients. But I also see that if I hadn't at least been open to believing my patient's story, that he was in fact not drug-seeking, I would have failed to properly identify the underlying cause of this man's abdominal pain. This hospital visit would have been just as unproductive and wasteful as the previous 7 admissions. Most importantly, his abdominal pain would have persisted, with inappropriate medical treatment, and his need for counseling would have continued to go unrecognized.
Before discharging my patient, we started him on an antidepressant and gave him a list of psychiatrists who he could see on an outpatient basis. He had already made an appointment with an outpatient psychiatrist before leaving the hospital.
He was tearful when we said goodbye, thanking me for genuinely helping him after many frustrating hospital visits. Then he handed me a folded piece of paper, a letter addressed to my attending, who later shared it with me and quoted it verbatim in my evaluation:
Importantly, he also had a distant history of IV heroin abuse. On admission the night before, he said that he slipped up once a few months prior but swore he hadn't used since then. The admitting intern handed him off to me as a "drug-seeker with functional abdominal pain."
Talking briefly with my patient before rounds, I just didn't get the sense that he was drug-seeking. My resident was more cynical; he called me naive, but he also gave me leeway to do with my patient as I saw fit.
After rounds that morning, I spent a little more time with my patient. "What exactly happened a few months ago that caused you to use heroin again?" I discovered that his wife had committed a violent suicide and that he had found her. He blamed himself for her death. This was a revelation to me. Incredibly, my patient felt that he had put this traumatic event behind him, despite never going through any grieving process. He didn't draw any connection between his wife's suicide and his current abdominal pain, even though his pain began at around the same time.
I gently suggested to him that perhaps his abdominal pain was a result of that psychological trauma. He resisted that idea because, to him, it implied that he was "crazy" or making it up, and the pain felt so real to him. I asked him to just consider it and told him that I would return later in the afternoon to talk more.
During our next conversation later that afternoon, he was surprisingly receptive to the possibility of a psychogenic cause of his abdominal pain. "In all of my hospital visits, not a single doctor has suggested that, but it makes sense." He was in unbearable pain even then, so I suggested that we try a simple breathing relaxation technique. After five minutes of this, we got his pain down to a manageable level, and he seemed bolstered by the improvement. At this point, I was practically convinced that his abdominal pain was psychogenic in nature.
We were treating his abdominal pain with narcotics, which is a poor choice of medication because it can actually cause constipation and exacerbate abdominal pain. I suggested that, overnight, he first try the relaxation technique that I had taught him and only ask for oxycodone if he really needed it. This was the real test: How much pain medication would he ask for? When I came back the next morning, I found that he decreased his oxycodone from 10 mg every two hours to 5 mg every eight hours. This was objective evidence that my patient was not drug-seeking and supported a diagnosis of pain disorder.
My resident and attending were both surprised, to say the least. The management of drug-seeking patients is truly difficult, especially at a safety net hospital that predominantly serves a socioeconomically disadvantaged population with a high proportion of drug addicts. I grant that I am naive and perhaps too trusting when it comes to handling these patients. But I also see that if I hadn't at least been open to believing my patient's story, that he was in fact not drug-seeking, I would have failed to properly identify the underlying cause of this man's abdominal pain. This hospital visit would have been just as unproductive and wasteful as the previous 7 admissions. Most importantly, his abdominal pain would have persisted, with inappropriate medical treatment, and his need for counseling would have continued to go unrecognized.
Before discharging my patient, we started him on an antidepressant and gave him a list of psychiatrists who he could see on an outpatient basis. He had already made an appointment with an outpatient psychiatrist before leaving the hospital.
He was tearful when we said goodbye, thanking me for genuinely helping him after many frustrating hospital visits. Then he handed me a folded piece of paper, a letter addressed to my attending, who later shared it with me and quoted it verbatim in my evaluation:
I have been in and out of the hospital the last few months. No reasons were found for my problem until I was assigned Mr. O. He was able to help me in such a way that I am able to function again. He spent a good deal of time talking to me about my medical and personal life. He personally has brought back faith and recovery for me. He spent his personal time explaining ways to help with pain. I wanted to tell you that I am grateful for all his council, medical advice and help.
Sunday, December 23, 2012
Silence
A few months ago, near the beginning of the interview season, I started feeling self-conscious about what I was writing in my blog. Knowing that this is a public space, and that it is entirely possible that residency program directors may find this blog and associate it with me, I felt constrained in describing my thoughts, feelings, and opinions about the residency application process and specific programs. So I stopped writing entirely. This reaction may have been extreme, but it was also the safest and easiest. As a result, though, my family, friends, and other regular readers have missed out on a significant segment of my medical school experience. For this I apologize. I continue to write, without publishing to this blog. After Match Day on March 15th, I will start publishing back-dated posts about my residency application and interview experiences. Until then, I may write on topics that will not directly impact the Match process.
Thursday, October 4, 2012
Med/psych externship at Tulane
I arranged a second med/psych externship at Tulane University and started this past Monday. My main goal for this externship is to experience med/psych in a completely new environment. I want a broader perspective of med/psych, something with which to compare my experiences at UC Davis. I also obviously want to learn as much as possible about Tulane in general and its med/psych program in particular.
I've never been to New Orleans (N'Awlins) before now, so this externship promised to be an adventure for me. Finding acceptable housing was an issue because Tulane didn't officially confirm my externship until a week and a half before my start date. Life moves at a different pace in this city. I got lucky, though, and found a great housing situation through craigslist. It is a historic landmark built in 1845, located in the Garden District, which is a fancy-schmancy part of town with beautiful mansions in ornate French New Orleans style. I am staying in a flat on the second floor of the house, rented out to me by a real estate professional in his 30's. He is a proper Southern gentleman who offers all the hospitality that comes along with that background. So far, the living situation has worked out very well.
The first two days of the externship, I worked directly with the med/psych program director at her psychiatry clinic. Then I started working at Tulane Hospital with the consult & liason (CL) team. This is basically an in-house psychiatry consult service. For example, doctors in the emergency department may consult the CL service to determine whether a patient meets criteria for placing a 72-hour mental health hold (here in Louisiana called a physician emergency certification, or PEC for short). The CL service is also commonly called in to evaluate delirium and psychosis.
I will likely be spending the majority of my remaining time at Tulane working with the CL team, along with several weekly afternoon med/psych clinics. I will also be attending "Friday School," which is basically required lectures for internal medicine interns. I'm glad to be getting a taste of the didactic training that I would be experiencing myself as a Tulane intern.
I've never been to New Orleans (N'Awlins) before now, so this externship promised to be an adventure for me. Finding acceptable housing was an issue because Tulane didn't officially confirm my externship until a week and a half before my start date. Life moves at a different pace in this city. I got lucky, though, and found a great housing situation through craigslist. It is a historic landmark built in 1845, located in the Garden District, which is a fancy-schmancy part of town with beautiful mansions in ornate French New Orleans style. I am staying in a flat on the second floor of the house, rented out to me by a real estate professional in his 30's. He is a proper Southern gentleman who offers all the hospitality that comes along with that background. So far, the living situation has worked out very well.
The first two days of the externship, I worked directly with the med/psych program director at her psychiatry clinic. Then I started working at Tulane Hospital with the consult & liason (CL) team. This is basically an in-house psychiatry consult service. For example, doctors in the emergency department may consult the CL service to determine whether a patient meets criteria for placing a 72-hour mental health hold (here in Louisiana called a physician emergency certification, or PEC for short). The CL service is also commonly called in to evaluate delirium and psychosis.
I will likely be spending the majority of my remaining time at Tulane working with the CL team, along with several weekly afternoon med/psych clinics. I will also be attending "Friday School," which is basically required lectures for internal medicine interns. I'm glad to be getting a taste of the didactic training that I would be experiencing myself as a Tulane intern.
Thursday, September 27, 2012
Priorities
The annual meeting of the Association of Medicine and Psychiatry (AMP) is being held in Chicago this weekend. This meeting is an excellent opportunity for medical students to network with dually-trained physicians and program directors, current med/psych residents, as well as the handful of other medical students applying to combined training programs. I had been looking forward to this meeting ever since I discovered med/psych earlier this year, but it unfortunately falls on the same weekend as my grandmother's 91st birthday.
The decision wasn't difficult, to skip the meeting and celebrate my grandmother's birthday. How many birthdays and other big family events have I already missed because of medical school, and how many more will I miss during residency? I am still disappointed to forgo all the networking opportunities, especially heading into interview season. But the program director at Davis offered me some reassurance when I told him why I couldn't attend: "There will be meetings every year. Go spend time with your family."
The decision wasn't difficult, to skip the meeting and celebrate my grandmother's birthday. How many birthdays and other big family events have I already missed because of medical school, and how many more will I miss during residency? I am still disappointed to forgo all the networking opportunities, especially heading into interview season. But the program director at Davis offered me some reassurance when I told him why I couldn't attend: "There will be meetings every year. Go spend time with your family."
Monday, September 24, 2012
Well-deserved vacation
I finished the Davis externship, and now I'm on my first real vacation since Winter break in December 2011. The two weeks I spent at home last month don't count because I was studying for Step 2. So here I am back at home: nothing to study, no patients to care for, no responsibilities except to relax. It feels great.
Friday, September 21, 2012
Davis: End of the externship
My externship with the Davis combined medicine/psychiatry program ended today. I left the clinic this afternoon with a sense of satisfaction that the experience was all-around positive and that I received encouraging feedback from everyone. I'm sad to be leaving, and I'm eager to return to Davis for the interview; this speaks volumes about my gut-level feeling about the program.
I had two goals when I started this externship. First, I wanted to figure out whether combined medicine/psychiatry is right for me, or whether I might be better served by a pure medicine or pure psychiatry program. Second, I wanted to get a better feel for the UC Davis program, in particular: the leadership, the residents, the strength of the training, and the general environment of Sacramento.
On the first goal:
I am much more certain now than when I started this rotation that I want combined training. I could only feel comfortable coming to this conclusion after gaining first-hand experience in an environment that combines medicine and psychiatry to provide integrated patient care. This rotation leaned heavily toward the psychiatry end of the spectrum, much to my initial disappointment. But this limitation to my experience here at UC Davis provided a contrast that helped me appreciate the satisfaction I feel from treating patients' medical and psychiatric needs together.
Over these past four weeks, I learned why much of my clinic experience was straight psychiatry: MediCal reimbursement rules prevent billing for medical and psychiatric services in one visit. In fact, one of my last patients of this rotation lamented that she would soon have to find a new primary care provider for her medical needs because her insurance was switching over to MediCal. This is a woman with COPD, congestive heart failure, diabetes, and bipolar disorder, all of which my dually-trained attending has been managing well. She would be ill-served being forced to find a new primary care provider who just treats her medical needs. My attending says that changes to MediCal reimbursement rules are in the works to address this problem. This is a poignant lesson, though, of the types of struggles that I will likely face in choosing the combined medicine/psychiatry path.
On the second goal:
Over and over again, I was struck by how friendly and happy people are here at UC Davis. I'm left with the feeling that I would enjoy working with these residents and attendings, an extremely important feeling considering that these would be my colleagues for the next five years. Both the medicine and psychiatry programs, as well as the combined training program, are very strong. And Sacramento itself was a pleasant surprise. It's a small city with not too much going on, which suits my purposes just fine for residency. The heat was not unbearable as I was expecting. And it's close by to many attractions (e.g. San Francisco, Lake Tahoe, the Redwoods). My attending says that Sacramento is a better place to live than visit. I agree.
So, with everything said and done, my mind wanders back to about four years ago when I was visiting different medical schools. I remember walking around Colorado's medical school campus, taking everything in, thinking, "I could see myself happy here." And it turns out that I was. I get that same feeling from Davis. This is a nice starting point to have heading into interview season.
I had two goals when I started this externship. First, I wanted to figure out whether combined medicine/psychiatry is right for me, or whether I might be better served by a pure medicine or pure psychiatry program. Second, I wanted to get a better feel for the UC Davis program, in particular: the leadership, the residents, the strength of the training, and the general environment of Sacramento.
On the first goal:
I am much more certain now than when I started this rotation that I want combined training. I could only feel comfortable coming to this conclusion after gaining first-hand experience in an environment that combines medicine and psychiatry to provide integrated patient care. This rotation leaned heavily toward the psychiatry end of the spectrum, much to my initial disappointment. But this limitation to my experience here at UC Davis provided a contrast that helped me appreciate the satisfaction I feel from treating patients' medical and psychiatric needs together.
Over these past four weeks, I learned why much of my clinic experience was straight psychiatry: MediCal reimbursement rules prevent billing for medical and psychiatric services in one visit. In fact, one of my last patients of this rotation lamented that she would soon have to find a new primary care provider for her medical needs because her insurance was switching over to MediCal. This is a woman with COPD, congestive heart failure, diabetes, and bipolar disorder, all of which my dually-trained attending has been managing well. She would be ill-served being forced to find a new primary care provider who just treats her medical needs. My attending says that changes to MediCal reimbursement rules are in the works to address this problem. This is a poignant lesson, though, of the types of struggles that I will likely face in choosing the combined medicine/psychiatry path.
On the second goal:
Over and over again, I was struck by how friendly and happy people are here at UC Davis. I'm left with the feeling that I would enjoy working with these residents and attendings, an extremely important feeling considering that these would be my colleagues for the next five years. Both the medicine and psychiatry programs, as well as the combined training program, are very strong. And Sacramento itself was a pleasant surprise. It's a small city with not too much going on, which suits my purposes just fine for residency. The heat was not unbearable as I was expecting. And it's close by to many attractions (e.g. San Francisco, Lake Tahoe, the Redwoods). My attending says that Sacramento is a better place to live than visit. I agree.
So, with everything said and done, my mind wanders back to about four years ago when I was visiting different medical schools. I remember walking around Colorado's medical school campus, taking everything in, thinking, "I could see myself happy here." And it turns out that I was. I get that same feeling from Davis. This is a nice starting point to have heading into interview season.
First residency interview offer!
I got my first residency interview invitation this morning! So exciting! The whole thing feels a lot more real, now.
Late Update: My first interview offer was to Iowa's combined medicine/psychiatry program. Exciting!
Late Update: My first interview offer was to Iowa's combined medicine/psychiatry program. Exciting!
Saturday, September 15, 2012
Residency application: Submitted!
Today is a big day for fourth-year medical students all over the country, the day when we can finally apply for residency programs. This is done through ERAS, the Electronic Residency Application System that aggregates all application materials. The whole process is much simpler than applying for medical school. There are only three parts to ERAS that medical students have any control over: 1) the personal statement, 2) the curriculum vitae, and 3) letters of recommendation.
I did my fair share of freaking out about the personal statement. My perfectionist traits shine brightly when writing an essay that's meant to convey most of who I am and the kind of doctor I want to become, all in less than a page. But beyond that, I've had a surprisingly zen attitude about this new round of applications. It doesn't do to obsess about something that can't be changed. For all the nit-picking over my application this last week, the substance of my application has been settled for quite some time.
Perhaps that's why clicking the "Submit" button this afternoon felt anticlimactic. I celebrated, regardless. How exciting to think about all those program directors out there reading through my application! Nerve-wracking to wait for the interview offers? Yes. But I'm confident in my application and am looking forward to this next step in the long slog of becoming a doctor.
I did my fair share of freaking out about the personal statement. My perfectionist traits shine brightly when writing an essay that's meant to convey most of who I am and the kind of doctor I want to become, all in less than a page. But beyond that, I've had a surprisingly zen attitude about this new round of applications. It doesn't do to obsess about something that can't be changed. For all the nit-picking over my application this last week, the substance of my application has been settled for quite some time.
Perhaps that's why clicking the "Submit" button this afternoon felt anticlimactic. I celebrated, regardless. How exciting to think about all those program directors out there reading through my application! Nerve-wracking to wait for the interview offers? Yes. But I'm confident in my application and am looking forward to this next step in the long slog of becoming a doctor.
Wednesday, September 12, 2012
Be a sponge
I had lunch with the med/psych program director for my midpoint evaluation. His feedback was different than any of the feedback I have gotten during other midpoint evaluations, which more often than not are formalities and not all that helpful. "I want you to take a step back," he said. "I want you to absorb everything that's going on around you. Be a sponge."
This advice was especially interesting to me because it echoes something that a close friend told me as I headed off to medical school: "Be a medical anthropologist. Look at what works and what doesn't work in the medical system and think about how you would do it differently." So, throughout medical school, I have been purposefully doing just that. Here at UC Davis, taking a step back and observing as much as possible of my surroundings and the people around me, that is all the more important as I am trying to figure out whether this is the right residency program for me.
This advice was especially interesting to me because it echoes something that a close friend told me as I headed off to medical school: "Be a medical anthropologist. Look at what works and what doesn't work in the medical system and think about how you would do it differently." So, throughout medical school, I have been purposefully doing just that. Here at UC Davis, taking a step back and observing as much as possible of my surroundings and the people around me, that is all the more important as I am trying to figure out whether this is the right residency program for me.
Monday, September 10, 2012
Face time with med/psych residents
Last week, the chief resident took me and a few other med/psych residents out for my first recruitment dinner of the interview season. It's a great opportunity to get to know the people who I may be working with closely over the next five years. Do I like them? Would they be easy to work with? No doubt they are asking those same questions about me. This dinner was all the more important, for all of us. Because I have mostly been working with dually-trained attendings and psychiatry interns, I haven't had the opportunity to get to know my potential future colleagues.
Recruitment dinners in general have an interesting dynamic. On the one hand, it's a social event, and everyone should be having fun. I don't want to come across as boring or rigid or anything else negative, but I also don't want to have too much fun. I've heard many stories from current interns about applicants who drink too much alcohol during these recruitment dinners and end up making asses of themselves. Why anyone would do such a thing with so much in the balance is beyond me. Regardless, I did genuinely enjoy dinner and chatting with the med/psych residents.
Then, this weekend, I took a day trip to San Francisco with one of the med/psych interns and a couple of her friends. The whole day was very relaxed and a ton of fun, a showcase of what my days off could be like if I end up at UC Davis.
Recruitment dinners in general have an interesting dynamic. On the one hand, it's a social event, and everyone should be having fun. I don't want to come across as boring or rigid or anything else negative, but I also don't want to have too much fun. I've heard many stories from current interns about applicants who drink too much alcohol during these recruitment dinners and end up making asses of themselves. Why anyone would do such a thing with so much in the balance is beyond me. Regardless, I did genuinely enjoy dinner and chatting with the med/psych residents.
Then, this weekend, I took a day trip to San Francisco with one of the med/psych interns and a couple of her friends. The whole day was very relaxed and a ton of fun, a showcase of what my days off could be like if I end up at UC Davis.
Friday, September 7, 2012
Answering personal questions from patients
I was interviewing a depressed patient with my attending in the room, watching. I asked my patient if she had any thoughts of death or dying, and she said yes. "Well what of it? Haven't you had those thoughts?" This direct personal question took me aback. I faltered, then I answered her question. I knew right away that she was trying to rationalize her own morbid thoughts by normalizing them. See, you think about death, too, so my thoughts of death are normal.
Then she turned to my attending and asked him the same question, but he handled it completely differently. He sat back relaxed in his chair, looked down at the floor briefly then right back up at the patient meeting her eyes, he smirked slightly, then he said, "You know, I think it's really interesting you asked me that." His voice was saturated with sincere curiosity. "Why is it do you think you asked me that?"
I was in awe. How deftly he had flipped her question right back to her and incorporated the very fact that she had asked that question into an exploration of her depressive symptoms! The patient went right along with the flow of the conversation. My attending never did end up answering her question.
I talked with my attending about it afterward. "You're going to be asked a lot of personal questions throughout your career: Are you single? Do you have children? How much money do you make? There's always something behind the question, and it's your job to figure out what it is." He went on to say that a very real power differential exists in the clinical interview. It's not unfair; that's just the way it is. If I ever feel like a patient is interviewing me, that should give me reason to pause and wonder, Why? From there, I should let my own curiosity guide my response.
This lesson made quite an impression on me, and it gave me an important tool to use in future clinical interviews.
Then she turned to my attending and asked him the same question, but he handled it completely differently. He sat back relaxed in his chair, looked down at the floor briefly then right back up at the patient meeting her eyes, he smirked slightly, then he said, "You know, I think it's really interesting you asked me that." His voice was saturated with sincere curiosity. "Why is it do you think you asked me that?"
I was in awe. How deftly he had flipped her question right back to her and incorporated the very fact that she had asked that question into an exploration of her depressive symptoms! The patient went right along with the flow of the conversation. My attending never did end up answering her question.
I talked with my attending about it afterward. "You're going to be asked a lot of personal questions throughout your career: Are you single? Do you have children? How much money do you make? There's always something behind the question, and it's your job to figure out what it is." He went on to say that a very real power differential exists in the clinical interview. It's not unfair; that's just the way it is. If I ever feel like a patient is interviewing me, that should give me reason to pause and wonder, Why? From there, I should let my own curiosity guide my response.
This lesson made quite an impression on me, and it gave me an important tool to use in future clinical interviews.
Monday, September 3, 2012
UC Davis: Summary of the first week
My first week on medicine/psychiatry was a good one.
I am spending most of my time at the Sacramento County Primary Care Center (PCC), which mostly caters to an indigent patient population. There is a separate Integrated Behavioral Health clinic with a set of three dually trained physicians who supervise me and another fourth year student. She attends UC Davis and is applying for internal medicine residency. I am also spending a few mornings per week at a pain clinic staffed by the Medicine/Psychiatry program director.
Everyone with whom I have interacted is very nice and welcoming... and just as important, they all seem happy.
But so far, I haven't met any Medicine/Psychiatry residents. The one resident at PCC is a psychiatry intern and so is not a good person to talk with about dual training. The Medicine/Psychiatry chief resident, though, has been in close contact with me to make sure that I am having a good experience. I am looking forward to interacting more with the Medicine/Psychiatry residents. Beyond just asking them questions, I want to get a better feel for how happy they are in the program, with their training experience.
Regarding what I have discovered about the actual practice of combined medicine and psychiatry, I was surprised that the vast majority of patients who I saw at PCC were there only for management of chronic psychiatric conditions without addressing any of their medical problems. My attending says that this is mostly due to insurance reasons, because neither Medi-Cal nor Medicaid reimburse fully for office visits that address both psychiatric and medical problems. That is concerning to me but not altogether unexpected given some of the criticisms I have heard from various people about combined training programs.
I have been exposed to a lot more of mixed medicine and psychiatry in the pain clinic, where patients' chronic pain issues often stem from both physical and mental causes.
There is still so much to experience during this externship. Next week I will also see patients on the psychosomatic medicine inpatient unit.
I am spending most of my time at the Sacramento County Primary Care Center (PCC), which mostly caters to an indigent patient population. There is a separate Integrated Behavioral Health clinic with a set of three dually trained physicians who supervise me and another fourth year student. She attends UC Davis and is applying for internal medicine residency. I am also spending a few mornings per week at a pain clinic staffed by the Medicine/Psychiatry program director.
Everyone with whom I have interacted is very nice and welcoming... and just as important, they all seem happy.
But so far, I haven't met any Medicine/Psychiatry residents. The one resident at PCC is a psychiatry intern and so is not a good person to talk with about dual training. The Medicine/Psychiatry chief resident, though, has been in close contact with me to make sure that I am having a good experience. I am looking forward to interacting more with the Medicine/Psychiatry residents. Beyond just asking them questions, I want to get a better feel for how happy they are in the program, with their training experience.
Regarding what I have discovered about the actual practice of combined medicine and psychiatry, I was surprised that the vast majority of patients who I saw at PCC were there only for management of chronic psychiatric conditions without addressing any of their medical problems. My attending says that this is mostly due to insurance reasons, because neither Medi-Cal nor Medicaid reimburse fully for office visits that address both psychiatric and medical problems. That is concerning to me but not altogether unexpected given some of the criticisms I have heard from various people about combined training programs.
I have been exposed to a lot more of mixed medicine and psychiatry in the pain clinic, where patients' chronic pain issues often stem from both physical and mental causes.
There is still so much to experience during this externship. Next week I will also see patients on the psychosomatic medicine inpatient unit.
Wednesday, August 29, 2012
Studying for Step 2: A thank-you to my parents
I want to say a special thank you to Mom and Dad.
Before driving up to UC Davis for my externship, I spent a couple weeks studying for the USMLE Step 2 at their house. I'm pretty sure that I wasn't the most pleasant person to be around during those two weeks, but they put up with me anyways, and they did so much to help me get through all the studying.
They set aside a designated study area and respected my need for a quiet study environment. My dad found an empty room at his office that served as an alternate place to study when I got tired of studying at home. My mom was home most of the time, and we chatted or played a quick game of Parcheesi in between question sets or when I needed a short break. We went to the movies together and played pool together in the evenings when it was time to relax. Plus, my mom fed me! Except for all the studying, I had a wonderful time visiting with my parents.
They have already done so much to support me in medical school, and I want them (and everyone else, apparently) to know how much I appreciate everything they do to help me.
In short, my parents are wonderful. Thanks, Mom and Dad!
Before driving up to UC Davis for my externship, I spent a couple weeks studying for the USMLE Step 2 at their house. I'm pretty sure that I wasn't the most pleasant person to be around during those two weeks, but they put up with me anyways, and they did so much to help me get through all the studying.
They set aside a designated study area and respected my need for a quiet study environment. My dad found an empty room at his office that served as an alternate place to study when I got tired of studying at home. My mom was home most of the time, and we chatted or played a quick game of Parcheesi in between question sets or when I needed a short break. We went to the movies together and played pool together in the evenings when it was time to relax. Plus, my mom fed me! Except for all the studying, I had a wonderful time visiting with my parents.
They have already done so much to support me in medical school, and I want them (and everyone else, apparently) to know how much I appreciate everything they do to help me.
In short, my parents are wonderful. Thanks, Mom and Dad!
Monday, August 27, 2012
Externship at Davis
I have neglected to mention on this blog a major development in my medical education. During fourth year, it is common for students to do clinical rotations at different medical schools. These away rotations are called externships; they serve as a sort of month-long interview for residency, allowing both the student and the program to check each other out before or during the interview season.
I applied for an externship at the University of California Davis in their combined medicine/psychiatry department, and that's where I am right now. In fact, today was my first day! I am looking forward to this coming month to gain first-hand experience in this combined field.
How are medicine and psychiatry combined in practice? What do my attendings' careers look like? What sorts of careers do the medicine/psychiatry residents hope to forge for themselves? Do I want to spend the extra time and money for this dual training, or can I achieve my career goals through another training route?
This coming month promises to be very informative.
I applied for an externship at the University of California Davis in their combined medicine/psychiatry department, and that's where I am right now. In fact, today was my first day! I am looking forward to this coming month to gain first-hand experience in this combined field.
How are medicine and psychiatry combined in practice? What do my attendings' careers look like? What sorts of careers do the medicine/psychiatry residents hope to forge for themselves? Do I want to spend the extra time and money for this dual training, or can I achieve my career goals through another training route?
This coming month promises to be very informative.
Friday, August 24, 2012
Escape
After taking the MCAT, I escaped to China. After taking the USMLE Step 1, I escaped to the Utah National Parks. Now that I just finished taking the USMLE Step 2, both Clinical Knowledge and Clinical Skills, I am escaping up the California coast. I love California!
Monday, July 30, 2012
Half-mast
I'm on campus today studying for Step 2, the first time I've been on campus since the Aurora shooting 10 days ago. It was a bit of a shock to me seeing the heightened security and having to show my ID badge to get into the building in which I took all my classes during the first two years of medical school.
I set up shop in a corner room on the second floor, quiet with lots of natural light. It also has a view of the main flagpole standing over the main entrance to campus. The flag was still at half-mast when I arrived this morning, but sometime during my first or second problem sets, the flag was raised back to the top. A sign of this community trying to move on.
I set up shop in a corner room on the second floor, quiet with lots of natural light. It also has a view of the main flagpole standing over the main entrance to campus. The flag was still at half-mast when I arrived this morning, but sometime during my first or second problem sets, the flag was raised back to the top. A sign of this community trying to move on.
Tuesday, July 24, 2012
Oral presentation without notes
Today I had to present a new patient from memory. The team split up in the morning, half going to clinic and the other half rounding quickly on patients. I only had two patients to present, one of which was a new patient I had seen yesterday with an intern and still needed to be staffed with the attending. I realized after it was too late that my intern had taken the History & Physical with her to clinic.
Given my previous struggles with oral presentations, I was a little worried about how this presenting-without-notes thing would play out. To my surprise, though, I not only pulled it off but gave a thorough, concise, and conversational presentation (in my humble opinion). What's more is that the senior attending from another team happened to be at the patient's room and stayed specifically to listen to my presentation, so I had an audience.
It felt good to get it right.
Numerous attendings have told me that the best way to improve my oral presentation is to present without notes. That seemed like an impossible task a few years ago but within reach now that I have some more clinical experience under my belt. I'm going to take their advice now and try to present patients with as little help from notes as possible.
Given my previous struggles with oral presentations, I was a little worried about how this presenting-without-notes thing would play out. To my surprise, though, I not only pulled it off but gave a thorough, concise, and conversational presentation (in my humble opinion). What's more is that the senior attending from another team happened to be at the patient's room and stayed specifically to listen to my presentation, so I had an audience.
It felt good to get it right.
Numerous attendings have told me that the best way to improve my oral presentation is to present without notes. That seemed like an impossible task a few years ago but within reach now that I have some more clinical experience under my belt. I'm going to take their advice now and try to present patients with as little help from notes as possible.
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