Medicine From The Trenches

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

Getting Into Routine

Since the nature of medicine (and life) is change, getting into the best routine to greet and excel in a changing environment is being in the best mental and physical condition possible. It’s very easy with study, long hours of duty and other demands, to gravitate towards anything that bring rest and relaxation/lack of stress. My challenge for those who are starting school, getting ready to start school, starting a new year of clinical duties or any changes; is to have a routine with good stress that allows for optimal performance within the context of changes and challenges.

For many in medicine, stress is the bane of our existence. We are stressed with long hours that often demand the good performance in early morning hours, as most of the population sleeps. We are stressed with keeping up with our academics and studies that mark our ever-changing profession. We are stressed with keeping a sound balance in life that will enable us to enjoy our personal lives in addition to our professional lives. This sound balance is as vital to having a great career and general well-being but finding that balance is not easy or quick.

As the summer has always been the time that I try to improve on my routines and make changes, I will invite you to consider making small changes that will help you deal with the mental and physical challenges to come as your careers change. These challenges need not derail your health and mental resilience but might enhance the enjoyment of your career at any stage.

Good Nutrition

When one is tired physically, mental acumen wanes and one becomes both mentally and physically exhausted. This mental and physical exhaustion can lead to choosing foods that are high in sugar or fat which might lead to a quick energy fix but weight gain in the long run. Trust me, carrying extra weight around doesn’t help with mental or physical exhaustion, often leading to more of both.

Eating a well-balanced diet that has more fresh fruits and vegetables with less fat and refined sugars helps keep your weight under control in addition to keeping you healthier. You can make small changes in terms of grabbing a piece of fresh fruit for a snack rather than relying on the high fat alternatives of the vending machine. Also cooking a week’s worth of healthier food that you pack rather than eating the burger and fries in the hospital/school cafe can help make small changes.

Small changes can lead to larger changes or that routine that becomes more comfortable for you. While I love an occasional burger and sharing fries/chips with my friend (the only way I indulge in these), I keep these occasions as special and not routine. Not only does eating a healthier diet help my immune system, my healthier diet helps me avoid long term chronic disease such as obesity, atherosclerosis and diabetes.

Regular exercise

Exercise tends to be one of those activities that suffers when one enters a demanding profession. It is easy post call, to come home, drop on the sofa and rest. This was my routine in medical school where I gained significant weight after being robustly active during my graduate school years. It took years of work to rid my body of the excess weight but once regular exercise became my routine, I found that I had more energy and more time rather less.

Today, I am a distance runner, using that time on the running trail to work out problems, meditate and simply enjoy myself. I have strength and energy for my work and for recreation. I also have a greater capacity for dealing with stress and the physical stress of a 10-mile run helps everything in my life. Running is quite solitary which appeals to me but anything that gets your heart rate up at least 30 minutes 5 times per week is better than nothing.

My workout time is as precious as my work time. I have mapped out running routes around my hospital, in my neighborhood and when I travel. I keep running gear in my locker (running shoes and shorts) so that I have no excuse not to move. I also try to get my workout done in the early morning before I start my day.

You don’t need to block hours of time for a bit of an aerobic challenge as you can run up a flight of stairs several times per day; park the auto further away and walk briskly to your workplace; take a brisk walk for 10 minutes as a time over lunch with a friend. Distance running isn’t for everyone but most of us can do something as simple as walking. Incorporate small changes which can become a habit that becomes part of your life.

Avoiding excuses (reasons)

As one becomes mentally stressed and physically exhausted, reasons for not adhering to healthy habits abound. For each of us, there will always be challenges that take us out of our routines. Take a moment to reflect on what reasons/excuses become commonplace and how you might meet or avoid them. For me, I looked at every hour of my day and examined where I could make small changes. Those small changes became my routines.

For example, I wanted to have more time for journal reading thus I looked for where I could set aside 30 minutes daily for my journals. I ended up finding at least an hour for my journal reading which became a welcome habit. I looked at where I could “sneak in” a workout even on my busiest day. I also left time for complete relaxation when I needed that too.

Staying in good physical condition is the best way to stay in good mental condition. As I look around me, those friends who are physically fit are the most mentally resilient too. In my life, my good physical condition has been a key to many successes in my career. As my physical capacity increased, with a combination of endurance and strength training, the greater my capacity to work and play with my pleasures coming from enjoyment of craft beer, good food and fellowship with friends and colleagues.

Final Thoughts

Take a moment and look for the following:

  • Where you might incorporate small changes that will increase your physical conditioning.
  • Where you might substitute better food choices in terms of avoiding high fat and high refined sugary foods for foods that are whole grain, fresh fruits and vegetables with leaner meats.
  • Where you might take time for small tasks that enhance your professional development.
  • Where you can find some time for pure recreation and enjoyment of life.

Make the changes today, that will help your life and enjoyment of life in the long run. It’s easier than you imagine as you don’t have to become a spartan or fitness nut. Your studies and your mental health with be much stronger which is the key to success in today’s world of medicine.

18 July, 2017 Posted by | academics, medical school, practice of medicine | | Leave a comment

Before you shadow…

As the new school year begins, I am receiving requests from premedical students about shadowing opportunities. I am happy to honor some of these requests and I am happy to pass some of them along to my colleagues so that as many students as possible get an opportunity for a shadowing experience. What can a pre-medical applicant do to prepare for a shadowing experience? I will offer some suggestions in this post. These suggestions are based on my requirements for shadowing and on some of the requirements of my practice institutions.

Do Your Homework

When you contact a physician (or physician assistant) for a shadowing experience, be sure to ask about dress requirements, paperwork and expected times of arrival. It is a good idea to contact the person (or office of the person) that you wish to shadow a minimum of a week in advance to make sure that all arrangements are in place. You want to have the best experience possible thus you need to ask about the schedule for the day, logistics of when and where you should arrive and what you should bring. Many places like for you to bring a copy of your resume (or CV), your personal statement (write one if you don’t have one ready) and a list of questions or goals for your visit. Remember, you are not going to a party where you are expected to be entertained, you are collecting valuable information as to your future career. Shadowing opportunities are become more difficult to obtain (patient privacy and liability concerns) thus you need to make the most of any opportunities that you can.

Be sure that you know something about the profession of the person that you expect to shadow. If this person is a physician, then you need know about the practice of medicine as it relates to this particular specialty. As a surgeon, I am not interested in hearing how you don’t like surgery but are only with me to get a letter of recommendation. I am likely not to write a letter of recommendation for a person who first, has no experience in surgery, other than perhaps as a patient, and who doesn’t understand that whether or not you become a surgeon, any physician needs to know something about surgery other than just not liking it. I don’t expect everyone to want to become a surgeon but I do expect every pre-medical student to have at least an intellectual interest in the practice of all aspects of medicine.

Do come into a shadowing experience with some knowledge of the process of entering medicine. Again, the time of the person who has generously allowed you to have this experience should be respected. If you have no idea of what you need, go to the AMCAS website and check out their Aspiring Docs pages. This should be the minimum knowledge in your possession before you seek shadowing experiences.  this page also gives you some ideas of what you may want to request from your shadowing physician at the conclusion of your visit.

Arrive Early

Most physicians arrive at their offices early in the morning. It goes without saying that you don’t want to be late. Do a “recon mission” and figure out traffic, driving directions, parking and the like. If something catastrophic happens, you also need to have a number where you can contact the person that you are supposed to meet. You don’t want  to be the reason for an entire day getting off to a late start. If you are unavoidably delayed, the person you are meeting may be able to reschedule or make arrangements for another person to meet you so that both of your days are not ruined. If you know that your experience is going to involve observation in the OR, be sure to arrive early enough to change into scrubs and other operating attire. It’s always better to be early and wait rather than have a busy professional waiting for you.

Proper Attire

Before you select that new outfit, keep in mind that most physicians wear business attire in the office. If you are a female shadower, wear comfortable shoes that you can stand and walk fast in. Ultra high heels with slick soles that clack on floors are not acceptable. You have to be able to keep up with the person that you are shadowing. Keep makeup, jewelry and perfume to a minimum as you may be in contact with patients who are ill. I remember a young lady appearing in platform heels and ultra-short suit with large hoop earrings ready to make rounds with my surgical team. Not only was she not able to keep up with us moving from room to room, her earrings made noise as she walked and she missed a great deal of the morning rounds experience because the rest of us were going to the next room while she was applying Band-Aids to the blisters on her feet. Moral of the story: wear comfortable, well-broken in shoes and clothing that will allow you to move. She was dressed fine for a business or law office but not for medical rounds. Minimally, wear low heeled shoes, comfortable suit (slacks) with shirt and tie (men) , comfortable blouse and jacket.  You may be given a lab coat to wear for the day so pick something that will go under a lab coat.

Follow Directions

One of my hospitals will not allow pre-medical students in the operating room but offers some of the best clinical experiences for shadowing students. If I am doing surgery at that particular hospital on the day that a student is shadowing, I have to abide by the rules of that institution. If you are at an institution that does not allow you in the OR, the you wait in the surgeon’s lounge until the case is over. I do try to avoid having shadowers if I am operating at that particular hospital. If you are allowed in the operating room, make sure you introduce yourself to the circulator, ask if this person is not pointed out. The circulator will tell you where to stand. The operative word here is stand though you may be given a stool to sit as long as you are far out-of-the-way. If you are standing, keep your arms folded in front of you or at your sides and don’t touch anything.  Most of the circulating personnel that work with me will make sure that you can see as much as possible. Eat breakfast, use the rest room and get something to drink before you enter the Operating Room. You can’t afford to be dehydrated or develop a case of low blood sugar just as the incision is underway. Often the anesthesiologist will invite the pre-medical student to sit at the head of the table. If this happens, again, keep your hands close to your sides and follow any directions. Last direction, if you feel faint, notify the circulator so that this person can take care of you quickly.  Fainting happens and most people know when they are going to faint. Just say something.

When I bring a shadower into the operating room, I usually introduce them to the circulator and to the anesthesiologist (anesthetist) so that everyone knows who you are and why you are there.  I usually give the circulator a card with your name and why you are there-for their records. The circulator will help you understand what is going on and will explain things once the case gets underway. Also, be aware that the patient on the operating table is our main concern so that you understand that we are not ignoring you but are performing patient care in a very specialized manner. When the introductory procedures are completed, scrubbing, anesthesia induction and other pre-operative procedures, people are willing to explain things. (Do keep in mind that I will have already informed the patient that you are present and sought their permission for you to be present.). Every patient has the right to refuse having unlicensed personnel in the operating room or clinic when they are being seen. Most patients are happy to be part of your experience but not all patients.

Keep in mind that sometimes things become tense  in any clinical situation. If this happens, move out of the way and allow anyone and everyone to handle the situation. There is nothing personal about this but we always have to be prepared for the unexpected. You may observe some things that are not planned and may be tragic. Under patient confidentiality rules, which many institutions will have you sign, you are not allowed to speak about anything that you observe.  The unexpected and the tragic are part of medicine more often than in other professions but keep in mind that the confidentiality and safety of the patient is our first and foremost job. We will get back to you as soon as the emergency has passed.

Take names!

Bring a card so that you can write down the names of everyone who was part of your experience. It’s a nice gesture to write a short note of thanks to the office managers, operating room personnel and others who have helped to make your day as informative as possible. Most professionals who are in health care are happy to provide information to people who are cordial and interested in joining their ranks. A short note of appreciation is very welcome and let’s them know that you appreciate what they do.

Enjoy yourself!

A shadowing experience is a chance to see health care professionals do their jobs. Enjoy the experience and learn as much as possible. Actual work in medicine is not like what is on the telly or in the movies but is fairly routine for us who are there every day. While things are never routine for the patient, they are our main focus. We are all happy to have you learn and join our ranks but keep in mind that we enjoy our routine days. The best surgical experiences for me are those where everything goes according to procedure and the patient’s outcome is excellent. Take in everything and don’t take any comments personally as that is never the case. Some people are stressed on any given day and may not be a cheerful as you would like but are capable of teaching you something new and exciting. Make sure that you are in a position to learn which is why you are there in the first place.

9 August, 2013 Posted by | application, medical school preparation | | 2 Comments