Countdown to July 1: Attending

The last July 1st with any significance is after the last year of residency. At that point, a resident (AKA house officer, physician in training, indentured servant, scut monkey, etc.) completes his training and is board eligible. If you ever wondered what BCBE stands for, it's 'board certified / board eligible.'

Uniformly, residents discover that they have a limit to the amount of residency they can take. After a certain point in time, residency becomes intolerable. It is a continual nightmare having your judgment questioned continuously, and having your clinical decision making process derailed by someone who potentially knows less than you. In fact, most residents in their final year may know as much if not more factual medical knowledge than their superiors.

But practicing on your own is a different beast. There's no one questioning what you're doing, but there's also no one to offer advice or reassurance. There's no superior to appeal to.

It is an intensely isolating experience, and all those years of medical school and residency suddenly feel very empty. I thought that I was ready to be an attending when I was done with residency, but what I discovered was that there is no preparation for being your own doctor. At some point, you have to trust that you are right, and that can be hard to come by.

Advice to the new attending:
-Sometimes making any decision is more important than being right.
-Never let them see you sweat.
-Do not pull the 'Who's the doctor? You or me?' card unless you really mean it.
-Most importantly, trust no one.

Countdown to July 1: PGY1

It is somewhat common knowledge that if you're going to pick a day to avoid the hospital, July 1 is the day. The hospital is awash with not only new interns but also senior residents still green with inexperience. And if you are a PGY1, welcome to Hell.

I remember the day after I graduated medical school, I was driving down the highway and saw a car run off the road and crash. As I drove by, I thought to myself, 'That person could really use a doctor...' Then it occurred to me: OH FUCK, that doctor is me!

The nightmare of intern year has been immortalized in the book, 'House of God' by Sam Shem, and I am sad to say that for the most part it still holds true after 30+ years. Intern year is still the singular worst one year period of medical education.

It is dehumanizing. It is humiliating. It is frustrating. And it wipes away any confidence or boldness carried over from medical school. MS3's complain that they've never felt so stupid as during third year, but that pales in comparison to intern year. At least during third year, your ignorance didn't hurt anyone but yourself. Now, what you don't know kills people.

The training goals of intern year are to learn patient care and disease management. However, what I walked away with was this: I learned what kind of doctor I am. The intern will learn what kind of doctor he is. Is he someone who fudges records? Does he take shortcuts? Does he stay late every day to tie up loose ends? Is he overly confident? Is he gun shy? By the end of PGY 1, an intern will know what kind of doctor he is, and he will spend the rest of his career either accepting that fate or fighting against it.

Some advice for new PGY1's
-If you can, wear scrubs all the time.
-Making friends with the nurses will improve your Rounding-Fu*.
-When you go home, leave the patients at the hospital.
-Make yourself a 'Laws of the House of God' checklist.
-Finally, but most importantly, the most valuable thing I learned during intern year was: sleeping is more important than eating.

*Rounding-Fu: How badass you are during rounds

Practical advice for the new MS1

It's time for the brand new medical students to embark on a long and treacherous path towards being a doctor, and I think of this time as amazing. It is both scary and exciting. It is mysterious but beautiful. It is also one of the first times in your life when you are finally among equals. I thought I might provide a little advice to any MS1's out there on my thoughts about the first year.

On first draft, I wrote about principles and value and being a better human being, and you know what, I don't think you'll need that. You will get it from everyone, and tons has been written about it already. Just google "Advice for new medical students." Instead, I will give some very practical advice.

Unless you have a PhD or were a financial analyst, the first year of med school will be one of the hardest things you've ever done. If you want to do well, you have to ensure that your time is productive.

(1) Figure out how you study best (smarter, not harder). Some need to write it out. Some need to hear it. Some need to read it over and over again. Whatever works best.

(2) If you like to study in the library, you gotta get there early to camp out in a good spot. You have to get a good spot, not only to help you study, but by getting a good spot, your academic cred will go up, and smart people will want to study with you.

(3) Have a study buddy. Not someone you study WITH, but a person you study NEAR. So you can take study breaks together, chit chat. Also, with two people, more chances of getting the good studying spots.

(4) Work hard, play hard. After every test, we'd go to the bar. In med school, that whole waiting till noon thing goes out the window.

(5) Get a study group together. Meet regularly. Our study sessions were great fun, and are some of my best memories from med school.

Enough about studying. Let's talk about life for a minute. You will not have one. So you should take some steps to ensure that your life will not be completely joyless and pathetic.

(6) When you hear about this party or that party, go. Go to every single party. Party hard. Enjoy. You'll need to get all your fun in now, to make up for later.

(7) If you're not studying, you'd better be having fun. First year is all about gas pedal or brake. No neutral.

(8) Have some friends who are just friends, and you don't need to worry about a study session breaking out. I had a group of friends who met every week. It was fantastic fun.

(9) Join a million clubs. It'll help to fill up your non-productive time.

(10) Your med school colleagues will form their entire opinion about you for the next 2 years based on the months of August and September. If you have to be an asshole, don't do it the first two months, huh?

Your expectations of med school have to be a little realistic, and you will find that med school is nothing like any academic activity you've ever done, because it is the best of the best. It's like you've joined the academic equivalent of the Navy SEAL's.

(11) Don't try to show off. No one cares about your MCAT score, because we all know that the MCAT doesn't mean shit anymore. In my class, I was in the top ten for MCAT scores, but I was never again in the top ten for anything throughout the rest of med school. No one cares about the MCAT.

(12) A lot of med schools are pass/fail, but I have heard stories about people not sharing notes or giving out false information to try to game their class rank. This is SO NOT COOL. You will get a reputation for shit like this, and guess what, reputations don't go away so easily any more. Eleven years later, some blogger like me will be writing about how Mousy was such an asshole because she wouldn't let me copy a lecture handout, because she didn't need anything from me, and how much satisfaction I got when she wanted to switch calls with me during 3rd year, and guess what, I didn't need anything from her.

(13) Don't start drama. I have known people who've gotten into fist fights in class, or yelled at a professor. That's just ridiculous. I mean, really.

(14) A lot of schools have a 'med school for dummies' kind of extra study session for students underperforming. Don't make fun of these people. That's just fucking rude. I had to go to one of these sessions. It is already one of the most humiliating things that can happen in med school. Your mockery is not required.

Romance in medical school is possible, and I would encourage you to pursue a love life, but there are some definite pitfalls and caveats to keep in mind.

(15) Med school is a small world, so if you end badly, expect repercussions to follow. And do me a favor. As a guy who was turned down at least twice with the line, "Oh, I'm not going to make the mistake again of dating someone in med school," when you do get into a relationship, don't take out your frustrations with med school out on the other person. Med school is a stressful time, but it's never okay to put other people down to make yourself feel better.

(16) For the guys, most girls in med school are in their early twenties (like you probably are), and are still essentially the same girl who turned you down in college. If you are striking out in the med school world, try the working world. That same 23 yr old girl has developed very different priorities after working for a living. For you ladies, c'mon. Boys never change. We hit our maturity peak at 16. He's not going to grow up and act his age, even if he's going to have MD after his name.

(17) Although most med schools are about 50/50 boy girl now, the number of single men to SINGLE women is still vastly disproportionate. In my class, it was somewhere around 5 to 1. If you like a girl, don't do what I did and wait around. Move quickly, because there are 4 other guys with the same idea.

A little advice for the ladies: dating men in medical school is like car shopping. Do a little research. Figure out what you want from a relationship, what are the deal breakers. Take a test drive. All of med school is your oyster. If you can't find anything good in your class, try one up or one down. However, keep in mind that med school selects against bad boys and heavily favors nice guys. You might want to look outside of med school if dating jerks is your thing.

I have some miscellaneous pieces of advice that don't quite fit into the categories I've set up, but are worth mentioning, because some are extremely practical.

(18) First chance you get, steal a pair of scrubs. If you have access, start wearing scrubs regularly (just not to class). You'll save money on laundry.

(19) Become the 'Go To' guy for something. I had a couple friends who invested in a kegerator. Guess who got invited to every party? Even I had my own 'thing' for med school.

(20) You will be poorer than ever before. Save your pennies. Eat ramen noodles.

(21) Whatever you may think about Drug reps and docs whoring themselves to Big Pharma, the only decent meal you're going to eat for weeks is being provided by the drug rep, free of charge. Swallow your pride and take free food whenever it is offered. You can have standards when you get paid.

That's all I can think of for now (isn't that enough?). I'd be interested to know if anyone else has practical advice for new MS1's.

Lush

So, I keep hearing from various sources that a small amount of daily alcohol (whatever the source may be) is actually good for cardiovascular health. Although we don't recommend people drink, if you're going to drink, one or two a day may help. The problem is that one or two turns into eight.

In any case, I'm drinking one or two a day now, and rediscovering my love of beer. And wine. And scotch. And gin. And cognac. And martinis. And... hmm... I'm thinking that maybe I'm in trouble.

AHA Nutrition Committee et al. Diet and Lifestyle Recommendations Revision 2006: A Scientific Statement from the American Heart Association Nutrition Committee. Circulation. 2006; 114(1):82-96.

Doesn't do anything for me

Trust me on this women. If you should meet someone who is a doctor, please avoid doing some specific things. If you don't have a steady job or aren't in school, then we have practically nothing in common, because I have been in school or in training every year of my life since preschool. At least pretend to have a job.

Most importantly though, do not tell me how cool it is to be a doctor. If you're trying to flirt with me, tell me about how wonderful a doctor I must be or some other contrived crap like that, but being a doctor is not cool. If you tell me how cool it is to be a doctor, then I will take that as implied consent to every disgusting medical story I have in my arsenal.

Because saying that being a doctor is cool is really no different from saying that it's cool to be a fireman. It's without any understanding of what it is to be a doctor.

Other people's stories

I tried once to get my mom to see "The Joy Luck Club" but she refused. She didn't want to see a movie about made up stories, when she had her own story that she'd lived. Every now and then, she'd tell us a little bit about her childhood, almost by accident. She'd tell us about her life during the war, how her family ate nothing but squash for weeks and were grateful, or how her aunt was killed by shrapnel while walking across the street holding my mother's hand. Most of these stories stay hidden, memories of a darker time best forgotten.

My father has no stories. He was telling me about his life growing up, and it's a collection of stories about uncles and cousins and grandparents and friends, but never about himself. None of it is witnessed or experienced. None of it is substantial. It's more rumor than history. And so it's hard to take my father's stories seriously, because it reads like fiction.

And I think this difference is what cuts at me sometimes, because it's advice without even experience behind it, and what is that worth?