Students, residents, and educators writing on KevinMD about how physicians are made: medical school, the match, residency, duty hours, supervision, assessment, mistreatment, and the path from student to practicing physician. Many contributors write while still in training, and many write anonymously. For a maintained record of what students and physicians have said about medical school since 2004, see Medical school: what students and physicians say, in their own words. For what residents and attendings have said about residency itself, see Residency: what residents and attendings say, in their own words.
In a recent post, I wrote about the iCOMPARE research study that is comparing the effects of increasing medical residents’ consecutive duty hours with observing the currently prescribed limits on their shifts. According to the study protocol, the primary hypothesis of the research addresses the safety of patients: that mortality under the increased residents’ duty hours will not significantly exceed patient mortality under the current mandated standard for medical residents on …
I start this article with a disclaimer: I am not here to comment on the decreasing salaries of physicians or the knowledge that I will never get paid the way the prior generation of doctors got paid. It is hard for me (and the American public) to feel bad for anybody making more than $200,000 a year when the median household income is in the mid-$40,000 range.
Medicine has a fraught relationship with money. Dealing as they do with matters of life and death, doctors are loath to assign a dollar value to human life, preferring to avoid the subject altogether and instead provide the care that they deem appropriate no matter the cost. Insurance companies, on the other hand, make their business in rationing health dollars and have no such qualms: the consensus among them is …
When you enter medical school, you have this very esteemed white coat ceremony. It’s a memorable occasion, where speakers tell newbie medical students and their families all that it means to wear such a coat: the responsibility, the ethical code, the professionalism, the compassion all intertwined to make up the very fabric of each emblemed cape.
My coat was part of my dilemma. It wasn’t that I couldn’t be all the …
Despite convincing results for many health care interventions, translating evidence from research into clinical practice is often challenging. Implementation barriers are myriad and complex, but a number may arise from core design issues. While real-world environments are clearly vital to the success of any intervention, many traditional research efforts are structured to remove them from the proverbial equation.
In studying the impact of a new medication, for instance, a group might …
Critics have been making the rounds again with a warmed-over complaint: International medical schools that offer U.S. teaching hospitals financial support for clerkship programs are unfairly buying access for their students instead of “more deserving” U.S.-based students. As the proud dean of a Caribbean medical school, I want to set the record straight yet again: This argument is hollow and based on a false dichotomy. In fact, the argument has …
“Observe, record, tabulate, communicate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert.”
– Sir William Osler, “The Father of Modern Medicine” (1849–1919)
In this modern era of oncology, the potential extent of malignant spread is staged by high-quality scans. Further, when …
How do you learn to be a good doctor? Sure, you study anatomy, and make flashcards, and memorize nerve pathways, but what makes someone a good doctor is the way they apply all that knowledge to real patients with compassion and diagnostic expertise. Strong “doctoring” skills, like listening carefully, taking a comprehensive history, explaining medication and treatment options clearly and patiently, and writing notes that colleagues can understand, are what …
His eyes were as wide open as his mouth as he slowly placed his beer on the bar without looking away from me. Making no effort to wipe the thick foam from his upper lip, the man continued to stare in disbelief, “That’s the coolest thing I’ve ever heard.”
The thirty-something C-something-O was blown away by what I did for work. By this time a small crowd had gathered, standing in …
Fidgeting in my seat, I waited nervously in one of the most crowded waiting rooms I had ever been in. Suddenly, I felt like a bucket of ice water had been dumped down my back; my legal name was being called over the dozens of waiting room sniffles. My instinct was to remain glued to my seat, not to let anyone know that I was the person attached to that …
The family medicine fellow set down her pen and inhaled deeply. “So when is it OK to cry with a patient?” she asked the senior attending across the table, a veteran internist in her mid-60s.
About a dozen of us — fellows, physicians, writers — sat hunched over a paper- and laptop-strewn table in the fellows’ shared office, talking about a poem: Sharon Olds’ “Death of Marilyn Monroe.” In it, Olds …
These are the words that inspired me to begin my journey as a medical student blogger. Four years later and I’m still at it! The time has flown since I received my acceptance letter to now, only a few weeks away from my graduation. And as graduation approaches and I make the transition from student to resident, I can’t help but ask myself, how am I doing? How is my first patient really doing?
As I get near the completion of an intense 5-year orthopedic surgery residency program, I had an interesting interaction with our hospitals sub-committee specifically tasked to address duty hour and resident fatigue issues.
As they gave examples from other departments about changes made to their programs regarding duty hours, a clear-as-mud connection was continually made. They spoke of “improvements” made as the result of residents stepping up to serve as whistleblowers …
Those were the first words Mr. O. told me as I introduced myself. As a 75-year-old stage IV lung cancer patient with brain metastasis, Mr. O knew his time on this planet was limited — the last place he wanted to be was in a hospital with a newly minted clinical student. Mr. O’s neighbor had found him unconscious on his porch earlier this morning, and …
The abandoned retractor clatters dangerously close to the other edge of the sterile field, saved only by the quick reflexes of the scrub nurse. The attending lets out a brief laugh, “I guess we’re using the Madagascar technique,” then it’s back to the operation at hand. Minutes pass as I continue to stand in my assigned place at the attending’s side, prepared to offer whatever meager contribution I can to …
At 12 noon EST, medical students all over the United States simultaneously opened envelopes which revealed the destination of their residency training. The tradition is an exhilarating and emotional event for everyone involved. For medical students, it is a milestone that symbolizes a dramatic life change and a new adventure. It marks the culmination of years of hard …
When I first seriously began discussing the possibility of applying to medical school with my family and close friends, I received mixed reactions. Although medicine seemed like a great fit for me in many ways, I also heard sad stories about relationships and even entire families that had struggled to survive the strenuous period of medical training (particularly residency). As somebody who values family and close relationships highly, I was …
My “aha” moment wouldn’t come at the signing of my leave of absence contract. Nor would it awaken me at night with the chair-gripping dizziness I had come to expect.
When the vertigo started in early December during my third block of clerkship, I chalked the symptoms up to stress.
Over the December break, I met with my family doctor and casually recounted my symptoms. The vertigo had worsened, and seemed questionably …
As health care settings become more focused on patient experience and care for the whole person, issues of culture, diversity, personal beliefs, and values have come to the forefront. Staff are expected to deliver not only high-quality clinical care but to do so with compassion and care. Neither of these elements are new, but they are gaining attention as health care is increasingly measured on a number of quality indicators, …
I’m a medical student in the UK. Though I’ve only been in med school since September, it has already taken its toll on me. Before I started, I was so in touch with my emotions, spirituality, and nature. Now I feel so empty and desensitized. I hate that when faced with the horrible circumstances of another person, I just don’t feel …
