medlyfe

[medlyfe]

Intern update

Going into my 8th week, including orientation.

2 weeks of pure orientation was too much information and not enough at the same time. I really like my group of coresidents! And I feel settled into my new home, which is nice. I have experienced several aspects of curriculum and using this to mark my first thoughts.

Clinic: I feel lost in the sauce. I like patient interactions and feel a lot of reward helping people with their problems but the time crunch to see patients, precept and figure out the EMR is stressful.

Palliative 2 week rotation. I liked it. Good first 2 weeks to build confidence and learned how to approach difficult conversations.

Inpatient service: Not a fan. Very exhausting mornings with boring afternoons. The medicine is fun, but politics are disheartening. I didn't feel reward at all.

Nursing home rounds: 2 so far. I really like these mornings. We go as a resident team with attending, round on anyone who needs to be seen at a local nursing home. I like the complexity without pressure of the hospital.

Prenatal clinic: Only one so far. I liked my time. I realized I don't know the timeline for when testing is needed very well. But I enjoyed working with pregnant individuals and using the ultrasound.

Overall ok, I struggle with imposter syndrome and feelings of inadequacy. Still enjoying the process tho.

[medlyfe]

The cost of post match day

I know the Match process can be quite pricey. It's very well known and an estimate of cost is available on the ERAS and NRMP websites, how many in person interviews you take is variable between people and there are some fees like board score reporting that you can't avoid.

HOWEVER

No one warned me about post match expenses. So here is your warning. Your state license, background checks, drug screen, and lab work for most people are refundable but up front fees. Plan on buying a house? Need to apply for loans asap after match, pay application and realtor (and all other buying home fees ) before your first pay check. Need to do something at your program or want to check out apartments? Travel costs add up quickly (flight, car rental, airbnb, food). Graduation celebration and travel if you did rotations away from your school. And finally moving costs... some programs don't give moving stipends, make sure to ask in interviews! Also, many people take vacation right before residency as a break.

It's a lot... and after shelling out all that money, you have to organize loans and pick a repayment plan 🫠

[medlyfe]

Post Match Update

I matched my number 1 program in family medicine 😁

Time has not existed since then. The days simultaneously feel like they're dragging and flying by. Match day was a big celebration and weight off my back. However all the on boarding has been a little overwhelming.

Since I matched in a different state than my home address, moving plans and pre hire obligations are extra expensive. And since I did rotations in a different state than my school, I have to travel for graduation. This has left little room for a vacation.

Super excited to start and trying to relax a bit before then! I have an apartment and have been planning my decorations :). It has also been nice with rotations lightened up I can go to the gym more which has helped deal with some excitement and dread.

[medlyfe]

I know this was written last year but I think about this every year with the milk and cookies for Santa. Why are Americans encouraged to drink milk/eat cheese? why is it mandated in schools??? 

Is it because the USDA is paid by the dairy industry? Is big pharma pushing it because more antibiotics are sold to use on cows than humans? I don’t know. decide for yourself but it just doesn’t sit right with me. 

[medlyfe]

Rotation and interviews update

Residency interviews: I have completed 14/16 family medicine interviews. I think I took too many but I took interviews for some of my less preferred programs early on and couldn't cancel them. Oh well... I have had the same top 2 throughout the process but the rest of my list has changed dramatically. The things I care about are: unopposed, rural training focus in their mission statement, # of months on in patient medicine, call obligations, community program involvement. Some other things like benefits also play a role but not as important.

Notice location is not on the list. My top 3 are all in different time zones. That is stressing me out a bit. I have an advisor meeting after the new year to allow me to think out loud.

Rotation: finished my rural requirement rotation at home. My favorite part was coming home to my mom and the cats. It also confirmed I want to work rural after residency! Very excited to feel confident about that decision. I saw so many procedures, different pathologies and patients of all backgrounds.

[medlyfe]

Audition #4 Recap

The good: it was very DO friendly environment. I really connected with the PD and could definitely hangout with the residents. They get to do a lot of procedures and I was able to assist with colposcopy which is the first one I have seen. They use MAT, have a street med truck. Their schedule is balanced out so you only do 4 days a week while on in patient and whole day in clinic. Very flexible in interest. Rotation on Mackinaw Island possible 3rd year. The area is surrounded by nature parks, easy weekend adventures, good food, amazing views. Only 2 hours from family.

The bad: Kind of a lot of weekend call where you cover weekend and Monday. The traffic was super annoying. And it's stupid expensive to live there. Would probably live 10-20 mins outside of town for money reasons. And they don't pay near as much as you would expect for the area.

What I learned: 4 auditions is too much. Osteopathic recognition really does matter. Compared to the last place, the environment was way more holistic. Being close to friends is nice but not as big of a deal as I thought it would be. Being in a town with better food options didn't really change what I ate lol. I thought I'd take advantage but ended up eating taco bell 😅 I stayed with a lady connected to the program as a roommate and had a great experience so I got airbnbs lined up for the next two months.

Overall: amazing experience and would be closer to #1 if it wasn't so expensive to live their and has one of the lower value benefit packages.

[medlyfe]

Audition #3 Recap

What I liked: The options of different clinics is nice. The housing is walking distance from the hospital and not too expensive. The PD is a DO and the program is very DO friendly, welcoming and nice. The residents joke around.

What I didn’t like: The clinics are all 20+ minutes away from the hospital, gas money and car wear and tear. The medical hierarchy is strong, meaning PGY 1s were expected to max out before seniors helped, many jokes about the PGY1s. There is morning (7:30) report every day. driving around was annoying because of the road infrastructure and SO MANY stop signs, which seems like a dumb thing to talk about here but thinking about living there does not sound fun. They are not osteopathic recognized which I didn’t know if I cared about until rotating here. 

What I Learned: Having a close clinic is important. I should probably get a new car in residency. Osteopathic recognition is a must for me. Even when they say “you can take call from home” you probably won’t do that.

Sidebar: I think 3 auditions was all I should have done. I have 1 more and this one tired me out. I have traveled 3 different states and I like the travel but the pressure to impress and “be on” all the time is a bit much. It’s not as bad now that I have interviews so I feel a bit more relaxed but I think scheduling 12 weeks of auditions is the most I would recommend. 

[medlyfe]

Second audition recap

What I did not like: the rural office was 30 mins from the hospital. The food was very bland. The streets are very hilly and I probably need to upgrade my car to live there. Getting training in abortion would be a difficult.

What I liked: everything else. I really vibed with the people. I felt like the curriculum would prepare me for what I want to do. The residents seem happy and supportive of each other. The hikes were great, food in the area was good, lots of local secrets to explore and the best boba I've ever had.

Things I didn't expect; student housing was very fun. Decided I don't really care what level trauma center the hospital is. Days away from submitting ERAS and I think I have a #1 in mind :) very exciting time.

[medlyfe]

First Audition recap

What I liked : the supportive atmosphere. OMT clinic and lab sessions. The amount of medical students to residents was manageable. The residents hungout outside of work making the communication on the job noticeably better than my core site. There was structure to each day including didactics, skills labs and curriculum meetings. I presented and was given constructive feedback which was helpful.

What I didn't like: less autonomy. The residents needed more supervision in clinic. Less procedures than anticipated. Probably due to the multiple residencies.

Something I learned about myself: I asked to do time on labor and delivery with the residents. I liked it. However I think I liked learning so much and not necessarily the work. I did not have overwhelming joy with deliveries. A lot of anxiety when they had problems and kind of bored when they went well. So I will not be looking to go FM-OB.

Overall very positive experience, I will be applying here and probably ranking it higher than I would have without the audition.

[medlyfe]

In the last year update!

I finished on Internal medicine which is what I started on. I took my level 2 a little more than a week ago and started preparing my ERAS application this week!

It feels a little surreal.

Less than a year until I am a doctor! The past year has flown by and I can only assume this year will feel even shorter.

I have over a month before I know my score which is awful. I'm not the best at suppressing score anxiety so it'll be a rough wait.

On the bright side, I have many aways and looking forward to traveling in the coming months :).

[medlyfe]

Wayfaring’s Laws* of Medical Superstition

1. Upon utterance of the “q-word,” (a word too heinous to commit to writing here, even in the disguised form of one of its many synonyms), the Emergency Dept, clinic, or medical unit in which it was uttered will become inundated with emergencies, difficult patients, and a census out of ratio to staff within the hour.

2. Cloud color dominance submits to the traditional medical educational hierarchy. Thus, a white cloud resident paired with a black cloud attending on call will suffer the effects of the attending’s stormy weather. Medical students, like weathermen, are merely present to record the day’s events for posterity. Cloud forecasts from medical students have a positive predictive value of 14% and are not to be trusted.

3. A seemingly random fleeting thought regarding a patient of particularly disdainful character or of frequent visitation to one’s facility is bound to result in producing said patient’s presence in one’s clinic or ED before the end of the shift. Pronouncement of the patient’s name in the presence of colleagues will result in contact with said patient within the hour.

4. Precipitation precipitates precipitous deliveries. Inclement weather not only brings on labor but also predicts baby booms 9-10 months into the future. The same can be said for Full moons and full ERs and psych wards or Friday the 13ths and emergencies in clinic.

5. Bringing work to be done during one’s “downtime” is a guarantee of a busy day with no downtime.

6. If the functioning of a pager is in question, all that is required to elucidate an answer is to drop one’s pants in a bathroom stall or sit down to a meal. If one is able to complete their bodily eliminations or enjoy a full meal uninterrupted, the pager is surely in need of fresh batteries.

7. The more severe the weather, the more likely all scheduled patients will show up. Conversely, the more pleasant the weather, the less likely scheduled patients will show up. See also: the pre-chart principle, in which pre-charting on a patient prior to their arrival to clinic substantially increases the likelihood that the patient will not show up.

*Laws are still in the research phase and have not yet been found to be universally true, though the frequency of their occurrence and observation by medical personnel from a wide array of specialties and locales supports their factual nature.

[medlyfe]

Psych rotation recap

What I liked: out patient psych is very rewarding, getting to see people stabilize and get through their life stresses. The medications are still being figured out and for the most part, trial and error is safe enough to do. Within reason obviously. I learned some go-to algorithms for primary care setting.

What I did not like: in patient psych was rather draining for me. Watching patients stabilize quickly was fun to see. However the acuity of most patients was very overwhelming. My experience on ED psych was disheartening:/... not as much as I hoped could be done in that setting for people.

My take away: mild anxiety/depression family medicine is ready to handle. Anything with antipsycotics is more than primary care is really made to handle.(just an opinion)The medications are very complicated and the indications for each drug seem to be changing rapidly. Huge respect for those who go into this specialty as balancing how much of yourself to give to each patient is very hard.

[medlyfe]

Surgery recap

I had an odd experience I think. I had 1 week of plastics, 1 week of urology, 2 weeks of ortho, 1 week of wound clinic, 1 week of Gen surg and 1 week of cardiothoracic. And it was during the holidays during a pandemic so the schedule was pretty lite.

Things I liked: Working with my hands. All the out patient procedures I was able to see. I learned a lot about reading imaging and rules to ordering imaging. Anesthesia medications were very interesting to me for some reason. Like why is propofol white? I can see myself doing procedures a lot. I got the hang of suturing and instrument ties. I felt like a big shot suturing lol. My favorite surgeries to be a part of were hand surgeries. Very intricate and fast paced. Also most of the time the patients are awake during it.

Things I did Not like: being in the OR period. I had an out of body experience multiple times. The procedures almost didn't seem real and I found it hard to stay focused. It feels very gruesome. Many elective surgeries just didn't make sense to me. I also didn't like the staff dynamic of the OR. Still a much bigger fan of the clinic setting which I got a lot more of than expected. The hurry up and wait format is not for me. Scrubbing in and the inconsistencies of how people did it was a frustrating process for me.

Overall not as bad as I expected. I did learn that I could really enjoy doing out patient procedures frequently but do not plan to be in the OR even again.

[medlyfe]

Family medicine rotation recap

I liked: the patient interaction, out patient environment, med management, problem solving, document diving and OMM. Loved doing OMM.

Did Not like: all the documentation.

I felt at home in family medicine. Even with residents I didn't get along with right away it felt like my place to be. I loved talking to patients all day and coming up with plans and seeing them the next visit with improvements. It's challenging but oh so rewarding. Happily choosing family med as my specialty. 😁

[medlyfe]

My elective month recap

I spent 2 weeks with a family med doc who specialized in OMM and 2 weeks with Physical medicine and rehabilitation.

Pros of PM&R: I really enjoyed the Neuro part of it and feel a lot better about my Neuro exam skills.

Cons of PM&R: very little patient interaction time and its the same exam with every patient essentially. Due to covid the patient load was very limited so I did not get the true experience.

After learning more about the field day in and day out, I am no longer interested. Mostly there isn't as much of an opportunity to use OMM as I thought there would be. It felt a bit like a glorified PT job. The hands on procedures would get repetitive and boring after a while.

OMM: I have always loved OMM and want to use it every day. I had a great experience learning some quicker techniques that can be used in a 15 minute appointment.

Proud to say that I am back on team family med. Which is my next rotation. I also had the chance to go to NYC for this past weekend with some friends. Which was a great get away 🍎

[medlyfe]

Pediatrics Recap

I liked: all the cute kiddos of course! Durring in patient, The serotonin release from newborn exams in the nursery woke me up more than my coffee. Seeing children bounce back from sickness is of course heart warming. Looking at growth charts and recognizing what stage of life each patient was in really made me appreciate my education. Parents see the child going through phases of throwing things or being shy. And you learn to recognize its their way of learning to interact with their environment and an appropriate amount of stranger anxiety. Child behavior makes way more sense now.

Did not like: seeing kids really sick. Antivaxination parents. Over worried parents -> in need of constant reassurance, calling the office multiple times a week... Its a lot of the same problems. My attending had speeches he could do in his sleep because he sees the same problems multiple times a day. The parents who didn't have the resources to take care of their child made me feel helpless. If someone can't get a ride to the office but needs an appointment, then what??? The reason I don't want to go into peds is the same reason I decided not to be a veterinarian. Kids dont have control of their wellness. The reliance on their care takers makes them very frustrating patients. You know they need a behavior change but the switch off from parent to daycare to school or whatever makes behavior very difficult to control even for the best of parents.

I was surprised: i thought it was a fairly easy rotation. I got along with most of the kids and learned how to examine them without starting a tantrum. Even in the hospital most of the plan was "give them time" .

I have experienced a chunk of primary care at this point and I must say the check ups are getting boring. PM&R has peaked my interest.

[medlyfe]

Month 2: OB/GYN recap

What I liked: you are doing different things everyday. Some days you are doing procedures in the OR, complicated deliveries or an afternoon of ultrasounds. Gyn side is very chill and you make really close connections with the women you treat. Infertility is a very intriguing feild to me. But that might be because my friends are going through it right now. I have little to no problem talking to women about their gyn complaints which I was a little nervous about. Feel fairly confident in my pap smear collection abilities.

What I don't like: birth, labor as a process, it can happen at any time. Its only handled by the doc if its complicated (at least at my site) and that really stresses me out. I not only don't want to deliver other peoples children, pretty sure I dont want to deliver my own lol. I also do not like the OR. I beleieve I could do laproscopic procedures but they're a bit boring in my opinion. I find patient prep for gynecologic operations quite demoralizing. I know what is done is needed for the safety of the patient but I felt put off by it.

Womens health offers a wide range of options and if I absolutely needed to work as an obgyn I could find a niche in the feild to be happy. But too many days this month I cramped out of empathy for the patient.