Medicine From The Trenches

Experiences from undergradute, graduate school, medical school, residency and beyond.

Entering The Match 2019-style

The time has come for senior medical students in the United States to enter the Match where they will seek post-graduate residency training. This residency training is key to medical practice in that board certification, the standard of medical practice requires residency in addition to licensure for practice in the United States. All clinical medical jobs in the US require licensure and the vast majority will require speciality board certification which requires residency.

With that being said, there are more senior medical students graduating and competing for available PGY-1 positions whose numbers have remained static in the face of an increasing number of graduates. Adding to the number of competitors are graduates of foreign medical schools who want to train in the United States. With increasing competition for available slots, some graduates (both foreign and domestic) will remain unmatched.

The vast majority of unmatched graduates will re-enter the match but that means finding something to do for a year. Unfortunately, the Match only happens once per year which makes finding oneself unmatched devastating and a heavy blow after four years of diligent study and hard work. Make no mistake, if one intends to practice medicine in the United States today, one has to come to terms with the Match.

I will be the first to say that I hate this system as it exists today. With the need for good physicians dire in the United States, I want everyone who wishes to have good training for practice to find a good training program without question. I also hate that the selection process is very subjective which can favor people who have personal connections to programs. In my opinion, there has to be a better way of getting people into programs so that they may be trained to practice because we need them.

Most residency programs will look at medical school performance and performance on licensure exams as their main criteria for inviting applicants for interview. Those who have high grades and high scores on licensure exams will be at an advantage especially for programs in competitive specialities. Other things that can push an applicant forward especially during interviews would be physical attractiveness and an engaging personality which again are subjective but let’s look at those folks who may struggle to find a position.

Things that may cause struggle in the Match would be the failure of any class, rotation or licensure exam. Hundreds of applicants may have one of these items on their application which may be problematic for them. If this turns out to be the case going into the Match, I would strongly advise that the applicant make sure that the reasons for failure/less than strong performance are addressed and thoroughly explained.

If one has endured four years of medical school with some bumps or failures in the road, they must spend some time with their Deans and professors to make sure that they post the strongest application possible. Any failure and these are not personal failures because the entire medical school process has more than tested these individuals are things that have to be transparent. I cannot emphasize more that if there are major problems, don’t sit out the Match but address the problems and enter having received crucial advice and critique from the Deans and professors at your medical school.

Perhaps one might not be a star, few stars exist, but having a licensure board failure, course failure or rotation failure does not define work ethic, ability to practice medicine or ability to thrive in a post-graduate training program. Every human being will have trials but it’s been my experience in medicine/surgery that those who have been tried and succeed, are the people I want in medical practice.

As thousands of fourth-year medical students head out on those interviews, don’t apologize for not being perfect but find a way to allow those interviews to see your passion for medical practice. Make sure that you find out as much as possible, about the programs that invite you for an interview and use the day to show your magic. If you have made it through four years of medical school, you have the magic thus, let it shine.

 

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31 August, 2019 Posted by | academics, application, applying for Residency, medical school | | Leave a comment

Starting Medical School

For those who have been accepted and starting medical school, congratulations. It’s affirming to start a new journey especially one that is long-term and a step towards a goal. I certainly remember the days of sitting in orientation for my medical school with questions, anticipation, and hope. I remember the wonder of all that I would undertake in the upcoming months.

I participated in our school’s White Coat Ceremony which is always an affirming experience. I remind myself of the privilege of treating patients and the absolute magic of making a difference in the life of my fellow humans. I remind myself that every human being is in the image of our creator with feelings and hopes of getting back to good health. I remind myself that my experience and training have to continue with every patient encounter. This is never a job for me but a calling that brings joy and stress sometimes but is a gift.

My late Pop was a physician who always encouraged me to remember that I have to give my best when I am tired, frustrated, and busy. I remember the words of my professors, my teachers, and those who take the time to help me give my best for my patients. I remember that my patients do not come to my care by choice but by need. While I chose this profession, my patients do not choose to be ill.

I remember every long day of rushing around for class and studying late into the evening. I remember the magic of understanding and finding structure in my Gross Anatomy dissections. I remember the joy of every slide examined in my Pathology class and I remember final mastery of the skills for a sound physical exam in my Physical Diagnosis class.

I didn’t become a higher life form by acceptance into medical school or the study of medicine. I became a person of service to my fellow human beings. Even today, I work to be a keeper of their trust and a better servant to those who come into my care. Even today, I read journals, study consistently in order to be the best professor that I can be.

I learn from my students and I teach my students as best I can. The best of what keeps me going after many years of practice is that I surround myself with those who see the wonder of all humans, who love what they do, and who continue to hone the skills that make them good educators.

If you are starting this journey of medical school, remember that this education is going to open the door to a lifetime of service to others. Remember that you have to give everything even when you believe you can’t give any more. Remember that your fellow classmates are going to be people you will refer and consult for your future patients; be cooperative and not competitive as you won’t practice alone; appreciate and nurture those who study with you. Always have to courage to ask for help early and often but enjoy this new journey.

17 August, 2019 Posted by | medical school | Leave a comment

Medical School Application Time in Coming Up Fast.

You have studied diligently and completed/are completing your coursework as best you can. Now, is the time to get all of your information and materials organized and keep them organized. Things to do right now:

  • Make a complete list of all of your Letter of Recommendation writers that includes the date the letter was requested, the full contact information for your letter writer- you need this for completing thank-you’s for them doing this.
  • Make a complete timeline of the Application process so that you meet and exceed any deadlines. Look at your timeline daily, sync it with your calendar so that you know when those deadlines are coming up (set reminders).
  • Be thoroughly familiar with your undergraduate institution’s pre-med protocol process. You don’t want to find out that you need to do something at the last minute. Your pre-med advisor’s office is your best resource for this. Follow the protocol and know everything about it far in advance.
  • Make a folder for each school that you apply to. In that folder place a copy of every piece of correspondence and every person who helps you in any way (again, letters of thanks are needed here too if someone does something significant for you). Add dates of interviews etc., to your calendar when you receive them.
  • Keep copies of everything that goes into your application. This includes your personal statement when completed, all of your transcripts (unofficial copies will do). You want to be thoroughly familiar with every word on your application.

In terms of your mental state, force yourself to stop comparing yourself to others or even listening to the woes or brags of others. You are you and the best you can do is be a better version of yourself today than you were yesterday.

If you have never interviewed for anything in your life, get some help from the career center at your institution. Interviewing for any professional school is quite similar to interviewing for your first job. Let them guide you and give you tips, hints and information. Be sure to practice in front of a mirror in the clothing that you anticipate wearing to your interview. Be sure to break in any new shoes or clothes so that you are relaxed and comfortable.

Along the line of clothing and appearance, this is not a time that you want to try a new look or an extreme look that you might not be comfortable with. Comfort and relaxation are the keys to performing well in any new situation. Spend some time now, experimenting with any new looks that you anticipate trying out. Again, the career center at your college/university is a great resource if you need a bit of buffing in this area.

Make a travel budget and stick to it. You don’t want to have to purchase an expensive ticket at the last minute. Plan to arrive the night before and scout out where you need to be, how long it will take for you to get there and be prepared for flight cancellations/delays thus arrive as early as you can.

If you don’t know the cities that your prospective schools are located in, this is a great time to research them. The New York Times “36-Hours In” Series is a great place to start. You can’t do too much research in this area so that you are not stressed needlessly. You can also get an idea of where you might live and what transportation will be like. For example, traffic in some urban area such as LA or San Francisco can be brutal. Are you prepared to deal with that on a daily basis and keep your sanity?

Look at the application process as the next step in your career. You have come this far with excellence, now take this next step with the same excellence. It’s going to be stressful but handle that stress as best you can. As I have written in other posts, being in good physical condition is key to stress management. I am a distance runner which helps my stress level greatly but anything physical such as swimming, basketball, biking or even regular brisk walks can reduce your natural stress level an add to your health.

Finally, speak with folks who have gone through this process the year before. Listen to their experiences and get the best information that you can obtain. Try to speak with people who are first-year medical students at the schools that you anticipate applying to. They are happy to tell their stories so that you can learn from them. Be sure to speak with people who are reapplying too because they can let you know great information. Enjoy this next step as best you can but be as prepared as you can.

28 March, 2019 Posted by | application, medical school, medical school admission, medical school interview | | Leave a comment

Patience

At last, I learn patience, calmness and quietness in my practice. I consciously take time on my morning run and meditation to remind myself to listen to those around me before I speak and before I act. For many years, I let my brain move by instinct, honed by training but now, I temper with mindfulness of the moment with more connection and patience. It hasn’t been an easy road but it has been more fulfilling.

As a physician/surgeon/scientist, I have trained to observe with my experience and training guiding those observations. Today, I attempt to slow the process, a tiny bit, to allow myself more connection with my observations. Rather than slow my overall practice down, I have become efficient-another gift from my daily early morning running and meditation sessions.

I recently moved from a house that was too big for the simple life I seek. I had found myself going for weeks and not entering may of the rooms of my former house. With a smaller house, I moved things I didn’t need or use out of my life. With a smaller space, high up in the trees, I live uncluttered and unfettered.

I now enjoy the simple order and beauty of living and using everything in my presence. With my newly found simplification and declutter, I find that I must declutter my brain as well. Thus, I listen, I slow down and I have become sleekly patient in all things.

9 February, 2019 Posted by | medical school | 2 Comments

Doing Your Best with Honesty

As the semester winds down for those who are in school, the temptation to cheat or cut corners becomes problematic. I understand that you are just busy and want to do anything that will lessen the load but cheating carries risks beyond getting caught.  Sure, being questioned is stressful but consider other problems with cheating.

Most people will attempt to justify their cheating by saying that, “Everyone does it”, which is not accurate. Most students diligently attempt to complete their exams, papers, and other scholarly activities as honestly as they can. If you copy another person’s work, you are cheating. If you share answers on an exam, you are cheating. If you stash “crib notes” in the loo for consultation, you are cheating.

The other risk with cheating is that once you cheat, you are never honest again. There is no remediation for dishonest, especially in medicine. When a patient is in distress, as others look to you for solutions to that distress, the cheating won’t help you. You can’t “cheat death” and you can’t have a do-over in these matters.

All of us face subjects that challenge us which is part of being a human. When faced with challenges, I try to solve problems so that I can master what needs to be done. I study regularly and constantly making appointments with myself to keep my work covered. Reading and study are my constant companions as a physician which is why I enjoy my work immensely.

I also know that when I do my work as honestly as possible, I figure out where I fall short and make sure that I put extra time on those things that require more intensive study for me. In short, just as I give my sickest patients more time, I give my worst subjects more time. If my mind doesn’t want to focus on the study tasks in front of me, I take a  brisk walk or short run to get my focus back. I hate procrastination in myself and have found that my daily, discipline of running has eliminated procrastination.

As the semester winds down, do the best that you can with honesty and reverence. Resolve to increase your focus on those subjects that require more focus; do them first if you have a choice. Force yourself to do the hard stuff because getting past the hard stuff is most rewarding.

10 December, 2018 Posted by | academics, medical school | , | Leave a comment

Voyage to the Bottom of the Sea

Living With Adventure

My mind went back to my first “crush” when I was a kid growing up on an East Coast Horse Farm. While my sisters had photos and dreams of Robert Redford and The Beatles on their walls and in their hearts, I had a single snapshot of Richard Basehart in his role of Admiral Nelson of the telly series “Voyage to the Bottom of the Sea”. My crush was Admiral Nelson, not so much Richard Basehart. I wanted to be a scientist who explored the oceans discovering new truths and making observations; figuring out the world with science.

Even in the series, Captain Crane played by David Hedison was the “heartthrob” but for me, it was always the Admiral and his “flying sub” an amphibious sort of a vehicle that captured my heart. Well, I loved Basehart’s voice too. Even as a kid, I was a young woman who appreciated words…

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29 November, 2018 Posted by | medical school | Leave a comment

Welcome to the New Norm!

This past week I attended a wonderful trauma conference in my city. One of the outstanding presentations at this conference highlighted issues that all of us must consider when treating patients who are morbidly obese. A morbidly obese trauma patient can have increased mortality and morbidity from issues surrounding the EMS to the treating institution not being able to accommodate their size. This is the new reality of the patient population that is increasingly entering our trauma bays injured.

Consider that many morbidly obese patients can’t lie flat because of respiratory compromise caused by their size. Consider that sounds such as lung sounds, heart sounds, and bowel sounds are simply harder to appreciate fully in patients who have large amounts of body fat. Consider that CT Scans generally will not accommodate patients who are more than 350 lbs (certainly we see a fair percentage of people who are over 350 lbs). Consider that stretchers, wheelchairs and even chairs in waiting rooms cannot accommodate patients who weigh more than 350 lbs.

Treating a trauma patient is not the time when one has to worry about whether or not their facility can take care of a patient of size. One has to know the weight limits of their resources before that patient arrives in the trauma bay. One additionally needs to be aware of the chronic physiological demands of this patient population in addition to the added stress of a major traumatic injury. One also has to be aware of the demands of staff who may be in short supply when a patient of size winds up in your trauma bay.

I recall taking care of a 5’4″ trauma patient who weighed 644 lbs who presented to my hospital (a bariatric facility).  Even turning this patient for a thorough examination took more than eight people and was problematic. We had beds that would accommodate this individual for vascular access was difficult; determining the extent of the injury was difficult along with safe positioning for prevention of respiratory compromise was difficult. For our trauma team, it was a complete challenge but not an impossible one.

This extremely large patient was taken care of in the initial stages (without CT scan or any of the usual diagnostic tools) but the patient ended up with significantly more morbidity issues because of their size.  Even contributing to this patient’s injuries and recovery were the staff attitudes toward this patient which was the most difficult issue in caring for this patient.

Consider that when one treats morbidly obese patients, these patients didn’t gain their weight overnight. They likely are depressed and have been ridiculed by our society that devalues them based on their appearance. Obesity is a chronic nutritional disorder that often comes with mental health concerns along with physical issues. As physicians, we can’t “punish” this patient population or refuse to treat them because we don’t like the way they look or because they are difficult.

Obese trauma patients are part of the new norm because obesity (two-thirds of our population is overweight or obese) is our population. We can’t badger them to “just lose some weight” because weight loss has probably not been successful for our patients. We are fatter and in many cases less healthy even though diets and nutritional information is readily available for most people. We know the problem but the solution is complex.

Our trauma conference was great to begin to address the issues of these patients. We, as physicians will see more and more patients who are obese and morbidly obese. We owe our patients the best care possible. Often the solution for delivery of proper care is to begin to know our facility capability, discuss how we will handle bariatric patients and put devices and accommodations in place that allow safe care of these patients under all circumstances.

17 October, 2018 Posted by | emergency, medical school, trauma | , | Leave a comment

Staying in Good Physical Condition

Physical conditioning is crucial to keeping your body strong and healthy for meeting your long-term goals. While sound study habits are important for successful navigation of academics but keeping healthy keeps one on track to master a large amount of information and concepts that come with preparation for medical practice. I can’t emphasize the importance of striking a balance between mental and physical conditioning.

Most mornings, I begin the day with a minimum of 30 minutes of running (goal is always 90-120 minutes) as running is my favorite cardiovascular activity for conditioning. As a surgeon, my runs are at 3:00 AM, a time when many are sleeping. I enjoy running the streets of my little suburban village in the dark because I don’t have to dodge traffic, dogs or people on bicycles. If I make my 2-hour goal, I get a very nice distance run to start my day off great. If I can’t get a single run, I do a few runs over the course of the day.

When I was at university, I played varsity tennis and ran 10K. I learned to run in the off-season because I always wanted a strong cardiovascular base for my tennis. My tennis coach didn’t allow us to play contact sports even though a nice soccer or rugby game was always fun for me.  I often had to hide my love for these two sports. Keeping active was a means of keeping my weight down and keeping my muscles strong.

When I began graduate school, I stopped playing tennis and concentrated on running. I loved the middle distance generally not enjoying runs that were longer than about six miles. My graduate school was in a large urban area that offered plenty of opportunities and trails to keep me interested and content with my distances. In the mornings, I ran with a group of Marines from a nearby barracks as they did their early morning runs. I also rode my bike around the city which kept my heart strong and happy.

When I entered medical school, the stress and study demands quickly consumed me which resulted in losing my daily runs. I ended up gaining a tremendous amount of weight. The weight gain coupled with lack of activity added to my stress though, at the time, I didn’t realize this fact. I placed my emphasis on my academics only with the loss of my conditioning. When I entered residency, I gain more weight along with more stress.

I ended up with obesity as my companion in medical practice which became a burden that I knew I could sustain. I knew that I had to place physical conditioning and good eating habits or I would develop atherosclerosis, diabetes or any of the chronic conditions that plague my patients. I also hated that I didn’t want to walk up a flight of stairs of became winded when I had to rush to an emergency from a remote area of the hospital. In short, my size and lack of conditioning were becoming more stressful than my job. Certainly, as a physician, I knew what I needed to change in my life.

Three years ago, I set a goal of walking briskly for a minimum of 30 minutes per day. I walked 15 minutes out and 15 minutes back taking one day at a time. Along with my walking, I stopped eating sugary and high-fat snack foods; exchanging them for fruit or raw vegetables. I ate three meals per day with proper portions, constantly hungry at first but adjusting to my changes. I had to learn portions and choose my foods carefully. I became a critic of the hospital cafeteria foods because they offered few choices for me.

Today, I am a distance runner completing half-marathons regularly as my early morning runs are both training and mental health. On my runs, I meditate, listen to my favorite music so that I start my day with a calm mind; well-perfused brain and heart. My day is more efficient, my stamina readily more than enough to do my job and enjoy my social life. In short, stress is gone, replaced by activities I enjoy.

If you are reading this and thinking that you don’t have time for exercise because of family, academic or job demands consider that taking care of yourself has to be a priority for those demands. You have to keep yourself healthy to keep up with items in your life that are most important for your life.

The human body was made for activity as lack of activity is the single factor that causes our patients to develop conditions which lead to major health concerns. Increased activity helps humans keep their immune systems strong, their cardiovascular system strong and aids in sound mental health. It very easy to see that people who are in poor physical condition are often depressed and prone to picking up infections. Even small increases in physical activity can provide huge dividends in terms of treating conditions like obesity and hypertension.

In the United States, our population is very sedentary and far more overweight/obese than in countries where the population is more active. Our patients sit in front of computers, tellys and eat a diet that is high in fats, sugars, and sodium. We see the results of poor diet and lack of exercise across our patient population with decreased lifespan. Yes, our patients have to work long hours and take care of their families but they need our encouragement to change habits that contribute to early death and chronic disease.

As a population, we have more information and devices readily available to make our lives more efficient but as a result, we have become less healthy as a nation. We can use the drive-thru for ordering food, banking, and even dropping off our dry cleaning. We can order food for delivery to our homes eliminating even walking through the grocery stores. Along with the use of those convenience services, we have less communication with other humans (necessary for good mental health); lives spent on social media where reality is not usually present.

I encourage my students and my patients to start with something simple such as a 30-minute walk in the neighborhood after dinner or parking the car further away and taking more steps to their destination. I encourage my students to strive for a sound night’s sleep with electronic devices turned off. I encourage my students to stop comparing themselves to others on social media because any comparison is generally based on posted items that may or may not be accurate. I encourage my students to make small changes, stick with them so that they become habits especially striving to get into good physical condition.

I can only say that having a strong body contributes to having a strong, resilient mind. I can say that my running/biking helps my mental health so that meeting the demands of my chosen career are easier and enjoyable. I can say that my running/biking allows me to be a kinder and nicer person overall, adding spirit and positive energy to my day. I can also say that running allows my mind as much recreation as in my childhood days of playing allowed; something that all of us could use. It’s hard to take oneself too seriously when one is sweating like a farm animal running down the street at 3:00 AM but it’s great fun.

31 August, 2018 Posted by | life in medicine, medical school, medicine, success in medical school | | Leave a comment

Read, read and read some more!

As a practicing physician (and research scientist), I am a regular journal reader. I read about 30 journals per week as part of my regular reading. Early in my medical career, as a medical student, I learned to evaluate medical and basic science literature. This is more important for practice today than ever before.

Many of my colleagues do not regularly read many journals, especially research, because they just don’t have the time. Practice today is very demanding with the push to see more patients and do more procedures. They rely on the industry, pharmaceutical, and medical device, within their specialty to keep them updated on the latest science out there. This is problematic for many reasons.

The pharmaceutical and medical device industries want to have you sell their products. They go to great lengths and expense to make sure that you get the most positive information on what they are selling or presenting. They are not as closely regulated these days by government agencies (FDA) as in previous times. A clear understanding of how many people who were formerly heads of pharmaceutical and medical device industries are now in charge of the FDA is a huge warning signal for me.

I am forced to evaluate all research on any device or pharmaceutical that is used in my patients. I look at all studies, not just the studies that the industry reps present with their products. Yes, there are new innovations coming at quantum speed but I have to make sure that I have all sides of the equation before using (or implanting) something in a patient.

I made sure that I thoroughly learned to evaluate studies and that I agree or disagree with the conclusions of the studies. I ask for alternatives; doesn’t make me popular with the reps who are often not medical professionals but salespeople with little clinical knowledge. It’s cool to look at displays at conventions but I take the literature, do my own research and call colleagues who might be using the devices.

We owe our patients our best knowledge and good faith. Their trust is in us which is part of the magic of medicine. This is also why medicine is the toughest and greatest profession that anyone can practice. In today’s world of instant access to scientific literature (from a remote computer), it’s overwhelming but we have to learn to take the time to do our own research rather than rely on the industry.

Much of what makes medicine difficult for me these days has to do with the profit margin that my hospital and healthcare system administration pushes in my direction. I am pressured to do cases faster than ever and get patients home as fast as possible. My social workers are burdened with making sure a patient has adequate care at home or in a non-acute facility for recovery as hospital stays are shorter and shorter with sicker patients.

Medical device innovation and development are expensive for companies with millions and millions done in research before the device gets into clinical practice. I am charged with making sure that the studies cover all of the bases and that I am thoroughly aware of the consequences (side-effects) and safe uses of devices and pharmaceuticals. Often my patients will have seen an advertisement for a new product and want the latest done or prescribed for them.

I have to have good information and explain all the risks and benefits of anything that I prescribe or use in my patients. This takes time, diligence and reading the literature. I am happy to do this and even happier if a new device/pharmaceutical helps my patients. Thus, at any stage in your practice, read, read and then READ more. There is much at stake for all of us.

2 August, 2018 Posted by | academics, medical school, practice of medicine | | 3 Comments

Human Sexuality/Well-Being Part One

2017-07-07 10.56.37

In working with my medical students in the Physical Diagnosis course of the past semester, I discovered that there was more than the usual amount of discomfort with the discussion of human sexuality and sexual history-taking. Certainly, my students have studied anatomy, behavioral aspects, and physiology of the genital organs. They are quite comfortable with what is there but having conversations, connecting and explaining human sexuality is something novel for them.

In the past, I was prone to explain my students’ reluctance of sexual conversations with patients as a product of their lack of personal understanding but there are far more aspects than pure lack of understanding. The first item that I needed to introduce is that one does not have to have had a particular sexual experience in order to understand what a patient is attempting to communicate. One simply has to have an open, non-judgemental attitude with conveyed willingness to listen and hear what is said. If one does not understand, then one has to be willing to make the attempt to understand what the patient is saying.

Our patients come to us for problem-solving ultimately.  Patients bring their sexual experiences, which may include shame, guilt, embarrassment along with lack of knowledge. They seek reassurance that what they have experienced is “normal” or why something that they have read about or constantly seen on modern media is uncomfortable from the standpoint of behavior or physical experience. In short, we as physicians, regardless of specialty, need to explain and educate in some cases.

In this country, sexuality is intermingled with advertising, entertainment and the promise of personal achievement. How many times have we been bombarded with images (check out fragrance commercials) of young people in quasi-sexual situations that promise if you wear this fragrance, you too, will have this same situation. The same experiences are with the alcoholic beverage commercials where attractive people hint of increased attractiveness if one drinks a particular beverage.

On social media sites such as Facebook and Snapchat, we share our experiences of connection where some constantly compare our lives (sexual and non-sexual) with our friends without remembering that people only post what they want you to see. Few of us tend to post that we are depressed or confused about aspects of our lives. We tend to post what we are proud of or what we want others to see. The constant comparison with others can cause anxiety in other aspects of our lives.

Sexuality for many of our patients (and us) came from experiences as teenagers, often with or without explanation or discussion. Knowledge may have come from religion, which introduced shame when sexuality is a normal, strong behavioral aspect of the life of a human being. Experiences from youth, coupled with lack of knowledge, can often produce feelings that need to be explored and explained. There is no hesitation in explaining a fracture or diabetes but there is hesitation or even non-discussion when a patient may have a behavioral/sexual issue.

The first step in any behavioral standpoint clinically is understanding our feelings and attitudes. Our attitudes have to step aside so that the patient feels acceptance and feels free to tell us what they need for us to know. We do not have to have experienced something to listen to the experience of our patients. We need only listen, ask questions if we don’t understand and convey an atmosphere of comfort. These conversations may take place over a couple of encounters but they should take place if necessary.

An example from my experience is a 50-year-old gentleman who had symptomatic peripheral vascular disease. He was diabetic, had moderate-to-severe atherosclerosis, was a heavy smoker, and experienced erectile dysfunction. He wanted to discuss his erectile dysfunction and could not find a physician willing to listen to this important aspect of his life. As a surgeon, I made sure that I listened to what he needed to say.

My first task was to allow him to tell me why this aspect of his life was important. For him, it was more important than the pain and limitations his disease has produced in terms of walking from his car into a grocery store. He felt, understandably for a 50-year-old person, that his life was over and that there was no use in seeking treatment for his health problems. His sexuality was important to his sense of well-being and his perception of himself as a man.

My point in this little essay is to remind those who read it, that we as physicians have to allow our patients to tell us everything and anything that they need to tell us without judgment or criticism. Our patients have to feel the freedom to allow us to know all aspects of their lives that may influence future therapeutic interventions. With pressure from healthcare administration to speed clinical encounters along quickly, we have to be aware that some encounters won’t be quick but are necessary over the long-term.

If I don’t have the time to explore something that my patient needs to discuss, I make sure that I note that a sensitive conversation has taken place and schedule them for another encounter as soon as possible. I strive to allow my patients to feel that I have listened even though I am pressured to “move them along”. I listen and accept what they need to say without judgment but with openness, one human being to another.

Human sexuality and sexual behavior are important to all of us. In this country, it’s the one behavioral aspect of life that is shrouded in mystery for many people regardless of educational level or background. Over my years of life and clinical practice, I constantly inventory my feelings and knowledge. I am learning new aspects of sexuality and behavior daily, the magic of medicine for me.

Explore your feelings, seek knowledge and seek to be open to your patients for sensitive discussions. I will be writing other posts about some of my learning experiences in human sexuality as I go forward. My findings are that if I speak openly of my learning experiences, my students feel open to listening and learning, a gift for their future patients and for themselves without discomfort.

14 July, 2018 Posted by | life in medicine, medical school, practice of medicine | | Leave a comment