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What I Learned From My First Year As A Resident Doctor


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1. You’re only one…Google search away from coming up with a differential so long that even your staff is rolling their eyes.

2. Getting two pillows in your call-room is the universe throwing you a HUGE bone.

3. You’ll constantly be surprised by your ability to run on less and less sleep and more and more coffee.

4. You’ll start to understand why the enthusiasm of medical learners brightens up any ward.

5. Being part of a professional group is nice and so is having benefits – begin chanting – I have rights! I have rights!

6. Nothing cures the post-call blues like the comedic genius of Kevin Hart, John Mulaney, Amy Schumer, and Amy Poehler. Nothing.

7. One of the coolest moments will be being when you get called to a code and are able to manage it (#iknowstuff).

8. Be kinds to nurses.

9. Be kind to the person who hands out call room keys.

11. Drink lots of water and lots of coffee. But more water than coffee.

12. People can’t help you if you don’t let them know you’re struggling.

13. Rounds scheduled on days that end in ‘y’ typically have coffee at them.

14. Sometimes the quality of a rotation depends on the frequency of free coffees.

15. It goes faster than you think.

16. Patients love when you ask about their pets.

17. Ask how often the hospital keyboards get cleaned. I dare you.

18. Be kind to everyone…but especially the Timbit guy at Tim Horton’s.

 

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health, ideas, medicine

Physician Burnout: More Than Just an Old Battery (Part 1)


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Good evening everyone. I hope that you are all well. I’m sorry that it has been a little while since my last post. I have been having quite a time trying to balance my clinical duties with long, long hours at the hospital with my research interests with my interpersonal relationships with physical activity with the needs of my new (recently ill) kitten. Needless to say, there has been a lot on my plate. So much so, that I have been feeling like there’s not too much room left. I thought I would right about a topic which has felt a little closer to home than usual – burnout.

We use the term ‘burnout’ pretty regularly in everyday life when speaking about a variety of household objects – batteries, candles, light bulbs, etc. Typically, the word is used to describe the amount of an energy source or, rather, lack thereof. When used in the context of physician health, burnout also denotes a depletion of energy but this energy takes on a number of different forms including physical, mental, emotional, and spiritual. Different physicians may vary in how much each of the aforementioned domains is impacted; however, the outcome or end picture is fairly consistent. Physicians who are burnout are significantly less engaged and/or effective in their clinical duties. In some of the more extreme cases of burnout, physicians may feel totally disconnected from their personal and professional identities coupled with a sense of purposelessness. Now many people are at risk of experiencing burnout – it is not an affliction unique to physicians; however, I have chosen to speak from the physician perspective because of my personal experiences.

What does burnout look like? There are a few common symptoms which have been described in the literature; however, like many other illness states, burnout’looks different on different people. The rates of burnout vary between different specialties, genders, locations…you name it. The following are some commonalities which have been highlighted, although not all symptoms need to be present for one’s burnout to be clinically significant or, in non-medical jargon, “real”,

  • Exhaustion – Mentally, emotionally, physically, individuals feel that their current pace of life is not sustainable and that a “crash” is inevitable, however that crash may look.
  • Lack of purpose – You begin to question the usefulness of your work – “Why do I do this every day if people don’t listen to me?” Devoid of meaning, your work becomes something to get done, rather than something you enjoy doing. You go through the motions of your day-to-day without ever feeling like you are making a difference.
  • Depersonalization – You become mentally and emotionally disconnected from your work. You find it increasingly difficult to relate to others and the “real world” seems a lot less “real”. Deadlines – do they even matter? A complaint? It will probably just go away or maybe it won’t – it would not matter to you either way.

 

Have you ever experienced burnout? What was your experience like? What symptoms did you notice in yourself? How did you become aware of these symptoms? In future segments, I will be exploring the importance of identifying and addressing burnout as well as strategies individuals and organizations can employ to prevent its occurrence. Any other thoughts or questions? I would love to hear from you!

health, medicine

7 Things I Wish I Had Known Before Applying to Medical School


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Good afternoon everyone and welcome back! I have a few friends who are writing the MCAT over the next week. It has been a blast cheering them on from the sidelines as they wade through the med school application process and seek admission to any of Canada’s medical schools. Understandably, they’ve had a few (okay, a lot) of questions as to what to expect with the MCAT, the application process, and medical school in general. So I decided to sit down and reflect on what I wish I had known before starting my own journey. I don’t believe knowing these things would have changed my desire to go into medicine, I just feel that it would have been helpful to have a little more insight into the application, admission, and academic process (especially since I am the first person in my family to ever go into medicine).

1. It costs a lot of money. Even more than you think.

Sure, you’ve done your reading online and probably had to scrape your jaw off the floor after seeing how much tuition would cost. The schools provide lofty estimates of how much you’ll spend on books, medical equipment, and other learning resources. What’s not listed online are some of the miscellaneous costs – for example, the amount you will spend booking and attending electives. Electives are your opportunity to network and explore programs outside of your home school. If your electives go well, they can help your residency applications. Electives typically last from 2-4 weeks. Once you begin to factor in flights, (maybe) car rentals, accommodation, food…it adds up pretty quick. Then there is the cost of applying to residency programs. In Canada, you pay a baseline rate to register with CaRMs and then an additional amount for every program you apply to. The list goes on and on and on. I won’t belabour the point – medical school is very expensive.

2. You might not get the residency spot you want where you want.

You have finally been accepted into medical school – Huzah! You’ve made it, the competition  is over…ish. In most parts of the world (although I can only speak to my experience in Canada), there are a finite number of residency spots with regards to discipline and location. Historically, some disciplines (ex. family, internal medicine, psychiatry) have significantly more spots than others (ex. dermatology, vascular surgery). There are a number of factors considered in the determination and allocation of residency spots including population demands, market trends, and funding availability. For example, if you are interested in providing primary care in rural areas, you’re chances of securing a spot are pretty good because there is an incredible need for more rural primary care physicians. On the other hand, if you want to be a neurosurgeon in downtown Vancouver, it might be more challenging to secure a residency spot. Why? Because there is a finite amount of OR time with a sufficient amount of neurosurgeons already battling for it. The government wants to train doctors to work in fields and regions where they are needed. Overloading the market when there is already an adequate number of specialists is not the best return on their investment. Does this mean you should give up on your “dream specialty” in your perfect location? Absolutely not. If you were born to be a cardiac surgeon in Toronto, go for it! What I’m suggesting is that you familiarize yourself with the current healthcare system trends and understand your professional goals in the context of what opportunities are available. Depending on your preferences, you might need to make some sacrifices along the way.

3. You are not expected to know everything. Actually, you are expected to know very little at all.

After writing the MCAT and fighting for your spot in the class, there can feel like a lot of pressure to measure up against your peers – but there’s really no need. Sure, you will be applying with your cohort in a few years for residency spots; however, residency programs are looking for people who are skilled learners, not individuals who feel they know it all. The reason why we complete residency training is to grow and mature our knowledge. If you knew everything going into residency there would be no point! So, how can you be a skilled learner? Try maintaining a sense of humility when identifying and addressing gaps in your knowledge base. You may have read all of Harrison’s, that does not mean you understand all the embodied concepts and are ready to incorporate them into practice. Recognize your limitations and honour them. Furthermore, understand the value in working with others and take advantage of how many learning opportunities are embedded in team-based environments. Most members of the team have been practicing for a lot longer than you have – be open to their perspective and ask their advice. Challenge yourself to test your knowledge. If you sit back and let others answer all the questions, how can you be sure that you know the answers? Take a stab at solving clinical problems, it may be more challenging than you think!

4. It can be hard to predict what time your clinical duties will finish at.

If you are someone who likes to know that they will be done at a certain time so they can be home for dinner, children, significant other, sports activities, hockey games – kudos for having a good level of insight into what is important for you. You will not always have that luxury in medicine. As a trainee, you are expected to stay until you are dismissed by your staff or they go home. As an attending, you are responsible for the care of your patients. If someone’s blood pressure starts tanking or one of your patient’s is in significant psychological distress, you don’t have the luxury of clocking out and dealing with it the next morning. This can make scheduling appointments, social engagements, child care, etc. challenging and, at times, pretty frustrating.

5. “Pimping” is not something that happens on the streets or in hip-hop songs.

Throughout the first few weeks of medical school, I heard several students discussing how much they were being “pimped”. I was confused and frankly a little disturbed by the thought until one of my roommates clarified what was going on. “Pimping” is a rapid series of questioning posed by one of your seniors to reinforce the traditional medical hierarchy. There is some debate as to how the term originated – one of my colleagues referred to it as the act of being “Put IMPlace”. Some physicians will debate and defend the educational merits of “pimping” suggesting that their questioning facilitates clinical reasoning. In my mind, questioning and “pimping” are two separate entities. I believe that questioning can be an effective teaching tool when it is used in a goal-oriented, supportive manner. Many of my favourite physician-teachers regularly use questioning to determine the knowledge level of the learner so they can use whatever foundation they have to learn new concepts. Questioning can help create a respectful dialogue between learner and teacher that builds on student’s strengths while addressing knowledge deficits. “Pimping” on the other hand feels as dirty and demeaning as it sounds. Instead of empowering and supporting the learner, it leaves students feeling demoralized, incompetent, and isolated. Still not sure what “pimping” looks like? Watch an episode of ‘Scrubs’ and pay close attention to how Dr. Cox asks his interns questions.

6. Short, case-based review sessions are more helpful than hours spent memorizing arbitrary facts.

During my undergraduate degree, I prided myself on my comprehensive note taking and ability to memorize slides prior to mid-terms and exams. This study strategy lasted for my first week of medical school before I quickly abandoned it. It felt impossible to read and retain all the information I was sifting through. My Harrison’s text was quickly relegated as a makeshift TV stand. I was feeling overwhelmed so I decided to ask for guidance from one of my early mentors, a rheumatologist. He smiled in a kind, understanding way and gently suggested reading for 30-60 minutes each day around clinical cases. He explained that the added context would add meaning to I was skeptical – how the heck would that amount of reading get me to the MD?? I decided to trust my mentor and give his suggestion a shot. Not surprisingly, he was right and I continue to use this strategy to this day. My studying has become significantly more efficient, meaningful, and relevant.

7. You won’t enjoy Grey’s Anatomy as much as you did before.

You’ll cringe every time Meredith puts her stethoscope on backwards and roll your eyes when a gown’d and glove’d surgeon pulls off their face mask and then resumes operating (Has anyone heard of sterile technique? Surgical site infection?). You’ll be pretty confused as to why the surgical department at Seattle Grace seems to operate every other department. You’ll feel irrationally angry watching all the top-notch surgeons let McDreamy die with his ETT 7cm at the lip (I would have saved you Derek, even as an MS2). Actually, who am I kidding. You will love it all the same. Maybe even a little more now that you’re able to pick out some of the medical flubs and that you can answer your mom when she asks if that’s what it’s like “in real life”.

health, medicine

The 5 Stages of Losing Your First Patient


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Stage One: Panic

You answer the page with a sinking feeling. The nurse confirms what you already know – one of your patients has passed. You slowly make your way up the hospital stairs, your mind on total overdrive. What happens next? Did we miss something? Are we sure they have actually passed? Did they suffer? What room are they in again? How many family members will I have to talk to? What do I say? You pause and take a breath. You pick up your heavy feet and try to ignore the cramping in your abdomen.

Stage Two: Sadness

You arrive at the bedside. The patient has had all their loved ones – children, siblings, grandchildren – circled around them in their final hours. Or maybe they haven’t. Both scenarios leave a dull aching feeling in your chest. They look so different from yesterday morning. I wonder if they got to speak with their daughter or see a picture of their dog – I can remember them saying how much that meant to them. Were they scared? Were they lonely? What would I have wanted if I were in their place? Pause. Time for another breath. We need to focus.

Stage Three: Numbness

You walk away from the patients room and begin to accumulate the modest stack of paperwork demanding your attention. How many forms can there possibly be? Once more, you become aware of the incessant buzzing and chirping of your pager. Does this thing ever stop? Did I really need to be told that Mr. A has had two normal bowel movements today? For a short moment, you catch yourself lamenting the passing of your patient for the additional work it has created. You take another deep breath, this one fuelled by disappointment and disgust. Where has that exuberant pre-med who wanted to help others gone? In a self-compassionate move, you let that thought go and focus on what matters right now – your patient. Where are those papers again?

Stage Four: Doubt

Finally, a pause. It’s almost comical how five minutes of silences can feel like a 5 star vacation. You find yourself waiting in line for your second (okay, maybe third) coffee of the shift and begin thinking back to your patient. A macabre carnival of “what if” situations takes over your mind. What if we had found the malignancy sooner? What if we had given more fluids? What if we had tighter blood pressure control? What if…you feel dizzy. You consider going to review the patient’s chart when another page comes. You hate to admit it, but you feel rescued and soothed by the obnoxious little machine.

Stage Five: Acceptance

You don’t think about the patient for a little while – maybe a few days, maybe a few months. You are surprised when they finally percolate back into your consciousness: “Oh….right”. You have had a few more patients pass since then. Again, you start performing a mental review of the events leading up to and immediately following your first patient’s passing. The reflection process is so much safer and more productive with a clearer mind. You identify things you commit to changing in your future practice noting the importance of honestly and openly engaging in early advanced care discussions. You also start to feel more a peace with the care you provided, realizing that you did your best to honour your patient’s wishes with the skills and tools you had at that time. You examine your patient’s face, laugh, and voice in your thoughts until the shrill sound of your pager brings you back. Buzzzzzzz. Buzzzzzzz. The moment is over and you keep moving.

chai