a pre-med journey

dear [potential] future colleagues,

i am serious about medicine, i want you to be serious about medicine too, and that’s really why i’ve decided to take the time to write this and make all this information available to you. i want to challenge you guys to think about why you’re doing what you’re doing and i want to help you prepare yourself (read: not freak out about) for the long admissions process.

love,

gph

matthewdipaolamd:

baseln:

hjluks:

Rule 1: They don’t want to be at your office.

It may seem odd to patients, but most doctors forget that going to the doctor is generally unnerving. We work there, and being in a doctor’s office is normal to us. Not so with most patients. The spotlight is on them and their health. They stand on the scale, undress, tell intimate things about their lives, confess errors, are poked, prodded, shot with needles, lectured at, and then billed for the whole thing….There is always an underlying fear and self-consciousness that pervades when a person is sitting on the exam table. The best thing to do in response to that is to show compassion.

Rule 2: They have a reason to be at your office.

They don’t come to the office to waste the doctor’s time. Yet early in my training I was incredulous at the reasons some of my patients were coming to see the doctor. Why come in for a headache? Why come in for a cold?…It took me being in my own practice (and trying to keep my business going) to realize that there is (almost) always an underlying reason for a patient to come in. Sometimes that reason is simple: they have terrible pain that needs to be treated. Other times, however, the reason is more subtle. When a person comes to my office with enlarged lymph nodes, for example, the real reason they are coming in is that they are afraid it is cancer. If a person has chest pains, they are afraid it is their heart. On every visit I try to identify the real reason (or the real fear) that brings them to see me. I don’t end the visit until I have addressed that reason.

Rule 3: They feel what they feel.

Patients will often tell me their symptoms in a very apologetic tone. They seem to think that they have to come to me with the “right” set of symptoms, and not having those symptoms is their fault. Sometimes those symptoms make no sense to me at all, and I am tempted to dismiss or ignore them. But as a physician, you have to trust your patient….Yes, some may exaggerate what they feel out of anxiety or out of fear that you won’t hear them for lesser symptoms, but then your job is to uncover the anxiety, not ignore the complaint. I have heard from many patients that their doctor “did not believe” their complaints because they did not make sense. If you don’t trust them, why should they trust you?

Rule 4: They don’t want to look stupid.

People are often worried that they are over-reacting. They wonder what I must think for a person to come to the office with that symptom. This is especially true of parents bringing their children in. Nobody wants to be “that mother that over-reacts to everything.” In response to this, I try to specifically say, “I am glad you came to the office for this because…” or “Yeah, I can see how that worried you because it could be….”

Rule 5: They pay for a plan.

What do people pay for when they come to the medical office? They pay for opinion, yes. They pay for knowledge as well. But what they really pay for is a plan of action….They want to know what is going to be done to help. I try and give a plan, either verbal or written, to each patient that walks out of the exam room. What medications are given and why? What medications are to be stopped? What tests are ordered and what will the results mean? When is the next appointment? What should they call for if they have problems? The better I can answer these questions, the more confidently the patient will walk out of the exam room. The days of paternalistic medicine are over - no handing a prescription and just saying “take it.” Patients should know why they are putting things in their body.

Rule 6: The visit is about them.

With all of the stresses in a doctor’s office, I get tempted to complain about things. Who better to complain to than someone who feels much the same way? But patients are paying for you to take care of their problems, not the reverse. I keep my personal gripes or frustrations to myself as much as possible.

via well.blogs.nytimes.com

Dr. Robs’ rules, initially published in NYT and on his blog in 2008 deserve to resurface in the blogoshpere every now and then.

rejections: university of washington, vanderbilt bringing my interview:rejection list equal. i think. i actually forget already. wow.

i’ve been reading complicatons by atul gawanade. good book. giving me some ideas of what to write for the professionalism duke essay…

ch1 - the dilemma: “as patients, we want both expertise and progress. what nobody wants to face is that these are contradictory desires” — how steep the learning curve is for medicine, but how high the stakes are

ch2 - what is the role of doctors when machines may outperform us in diagnoses and so forth

ch3 - mistakes are unpreventable, but we need  to aim for perfection anyway

ch4 - why doctors go to conventions even though they are a glitzy mess. also known as the lonely & isolating life of a doctor.

more news: interview invites by mayo and einstein!!!! i’m so excited - both of these schools are in my top 10 :) :) i feel kind of bad that i am more excited about these than pitt when pitt is actually an amazing school and the more i learn about it, the more i like it. i think i have just been guarding myself against being rejected from pitt since deep down i think that the school is too good for me. but honestly, i really feel like God is with me. i remember after getting my mcat scores back i was like “at which step was i supposed to trust you?” but God you just show me again and again - i can’t do this without you, and neither would i want to, philippian 3:14 wowww

just had a bit of a freak out moment. the national median for mcat is 32 (even though i think the mean is 27), which means that i am an even riskier candidate than i realized. sigh, most of the schools that i want to go i am THE bottom range of the candidates they accept. i never realized how much i have been screwing up my chances in these past 3 years.

jayparkinsonmd:

How American Health Care Killed My Father by David Goldhill in The Atlantic

and

The Cost Conundrum by Atul Gawande in The New Yorker

These are the two most important articles of the past year on health care. Please take the time to read and digest them…

It’s an unfixable mess that will only be solved by complete restructuring from the ground up— the top down bureaucracy that satisfies the main players of the entrenched industry will only let you down.

Stop arguing or even thinking about “reform” and contribute as best you can, as collective individuals, to something totally different and new.

Now get to readin’…

on monday, i got my first rejection from boston university. i was very disappointed because i am really interested in attending medical school in the boston area because my sister and her husband live there. additionally, bu is actually one of the lower ranked schools that i was applying to, so it kind of makes me doubt my abilities. i am currently considering applying to tufts so that i can still have a shot at interviewing in the boston area.

today, i submitted wake forest, meaning that i have officially completed 10 secondaries! i probably should be more worried than excited about this statistic.

I have been really anxious about interviews, not only because 2/3 of my secondaries are not in, but also because a bunch of the schools that I have already submitted to have not invited me to an interview (especially Einstein). However, today, I was ECSTATIC to find my first interview invite from UPitt, which is a school that Dean Wahl flat out told me was a reach school for me! Hooray!!!