Do I know you?

Well we meet again. It has been a long time, I have been busy, but I haven't forgotten you. I think about you often, every time I shake my head after a comment/action/experience one can only have in med school. For instance, just last week someone in a class said "Concierge medicine is unethical." I laugh, roll my eyes and shake it off. Is not cleaning up someone else's trash on the street unethical too? How about eating at a higher-end restaurant while people starve all over the world? Should I just roll over and give up on the hope that I can actually make a decent living in medicine and just go into primary care, lose money by taking only medicare and medicaid patients and feel good about myself because I am not being "unethical"? (I am not implying that you can't make a "decent" living in primary care, just saying it is much harder.) It's ok, because you are one of the youngest people in our class, have never had a job and probably have never payed taxes unless you claimed the birthday money from grandma. Oh, what's that, you didn't? Isn't that unethical?

Oh, and I have a new "guy" similar to this one and this one that I will share with you soon. Hope to see you again really soon. For now, chew on the rest of my list of things to know before med school:

1) Military med students are like Mormons. They are uniformed, polite, and can make a great case for their cause. Medical schools constantly warn you about your mounting debt and the military men and women can see the fear in your eyes. Like an injured succulent bison, you will be picked off from the herd. You will be invited to informational meetings, asked to attend jogs, and even offered to be put in touch with someone. Be careful though, because they know how to keep you interested for years and each carrot they dangle in front of you implores you to stay on the train another stop. You make one nibble on Uncle Sam's teet and pretty soon you are ironing your Temple Garments fatigues and you are monetarily debt free yet you owe Uncle Sam some serious time. It works for some people, but just understand what is going on and think through the temptation.

2) Be prepared for words and phrases to become so hackneyed that they will begin to make you ill. Phrases like "gunner", "boards", "patients don't come in with a multiple choice question", "patients don't come in with a power point", "you learn by doing", "high-yield", "I don't study much", "I am soooo worried about THIS test", the list goes on and on and on. Just know that people will use these phrases with smug superiority masquerading as professionalism in front of others to put you or others down. It is like the guy who waits all night for the perfect set-up to let loose the one-line zinger he learned that day. It is old material that keeps being regurgitated as if it is new material. Kind of like the whole "I'm Rick James!!" skit done by Dave Chappelle before he went crazy. I can't count the number of times I had to listen to someone go through the skit as if they were the writer behind it and I was the first person to hear it. Yeah, I got it, the fingers said slap, you're Rick James, and you need to watch something else.

3) Don't be afraid to defer your admissions another year to do something fun. Really, it's ok to get some life experience if you are fresh out of undergrad. I planned at least one year off of school. Trust me, it will help take the edge off a little bit. Plus it gives you a chance to earn some money and save some money for med school all while getting life experiences. I am amazed at the amount of people in my class who have never had a job. Must be nice.

4) Correlation does not = causation. If this hard to grasp, take this example. Suppose I told you that sleeping with shoes on is strongly correlated with waking up with a headache? It would be easy to say, "well then, sleeping with your shoes on causes you to wake up with a headache." Not so. There is a lurking factor in the form of body shots and Jager Bombs that cause one to wake up with a headache. The fact that they sleep with their shoes on is secondary to being intoxicated. One of my favorite things to do is find the hidden agenda in a speakers talk. Trust me, everyone has an opinion they want you to know in their presentation (especially when you are in medical school) and when you get facts like there are "40 million uninsured people in the U.S." are shoved down your throat, don't trust it just because someone said it. There are lies, damn lies and statistics. Stats thrown at you from some study do no good unless you know how the number was derived which, most of the time, is derived by someone wanting a certain outcome. Be careful. Very careful. If something said is going to make you change your views, do some of your own research. Nothing is worse than uneducated (in terms of life experiences) people forming opinions based on biased or false information who then become too close-minded to change their views when presented with facts. Don't swallow any pill that is handed to you in class. In fact, just the other day I had a speaker tell me that "a majority of doctors believe health care is a right." I have my doubts about whether that is true or not, but either way she was stating an opinion and trying to hide it behind something that slightly resembled a statistic. If you didn't know any better you might fall for it.

5) Do not have a anything on your stethoscope in class. Nothing says "I need attention" more than that. So you worked with children. Great. Take the pink Giraffe off your stethoscope before you shove it in my face. You aren't a children's photographer. It is annoying and awkward, plain and simple.

6) You remember back when you started undergrad? Not day one, but like month three when everyone went home for Thanksgiving, saw some old friends and realized they had gained 15 pounds and then you took a look at yourself and realized you too had gained 15 pounds from all the cafeteria food? If you thought that was bad just wait. Every club on my campus serves pizza for their meetings. Sweets become lunch and a nutritious meal is considered taco bell because they serve rice in their burritos. 8 hours of studying is accompanied by 8 hours of snacks, soda and pizza. The med school 30 beats the pants off of the freshman 15. Trust me, if there is anything you can take from this it needs to be this point. EXERCISE. REGULARLY. Stress relief is so important in med school as is staying healthy. Make a time each day to exercise. No matter what. Just an hour is fine. It is so easy to say "well finals are coming up, I can't spend one minute doing something else other than studying." Bad decision. Excuses are abundant in med school. One hour of exercising isn't going to fail you. Neither will not exercising for that matter. I know that control of my own time only gets worse as the years go by. Pretty soon I will be in rotations and residency and if I don't have the habit of exercising it will be nearly impossible to start. I try to remember that one day I may have to lecture a patient about losing weight. I know they wont think twice about judging me by my appearance and lifestyle. You don't have to be perfect, no one is, just make an effort. Walking up stairs to go to class isn't an effort.

Bonus: Do not take your books into the cadaver lab. Your classmates wont think twice before grabbing your book with their greasy hands. They don't care. Let someone else be the sucker.

Bonus number two: If you have a habit of chewing on your pens, you better stop it. Nothing will elicit a gag reflex faster than when your pen tastes funny, and you then realize it is the same one you had in anatomy lab....except maybe people who update their facebook every ten minutes. Status Update...that spells H-i-s-t-r-i-o-n-i-c P-e-r-s-o-n-a-l-i-t-y D-i-s-o-r-d-e-r. (Let it be known that I made this)

Don't Say I Didn't Warn You Part II

Back again. Sorry for the delay in posts, but I have been too busy hazing the first-years. You know, telling them that all the test questions are from the assigned readings (500+ pages a week) or telling them the library and study halls are for second-year students only. Got to get them freaking out. In all seriousness though, the only hazing going on is the selling of those books WE were foolish enough to buy but never use to this year's incoming class. "Come on, I have reduced the prices on these babies 20%, but disregard the lack of creases in the spine, you NEED this book to survive." This year's incoming class is far worse than mine. I am glad I didn't defer my acceptance a year because this class would have tickled my area postrema more than my class. People were studying BEFORE classes began. Seriously. But to make this short, I have a couple more nuggets for you.

3) Do not have relations with med school classmates. Friendship is fine, but in a world where Paul Revere rides a horse called Texting, you can start one class pure as snow, and by the first break you are on the verge of prostitution. And gentleman, do not be "that guy" who goes after all the first-year females. Just because your own class knows what a tool you are doesn't mean you can fool the first-years for more than a week. Trust me, keep your sexuality outside your medical school. And off craigslist for that matter.

4) Do not go to class. I learned this the hard way. Think about it. Why sit in class hearing something for the first time when you can go over the info twice as fast, picking out concepts you don't understand and have the time to go over those concepts? Plus, when you can then go listen to the lectures at twice the speed, what's there to lose? Seriously, you don't know how much time is wasted with jokes, pauses, and side-stories. I don't pay teachers to tell me where her 4 year old thinks his liver is. The key to med school from the start is time management. Your time is so valuable because of the deluge of information, that to spend too much time on one idea or concept is academic suicide.


5) You have a right to express discontent. Don't let the administration keep you down. Damn the man! No, seriously, don't be afraid to tell someone how upset you are by certain things. You have a right to having power points posted online in the right format, recordings to be done, teachers to be clear about what to expect, etc. You are paying a pretty penny for the education and yes, I believe the school should cater to everyone as best as possible. This is a little different for a state school where uncle sam helps out a bit, but either way, you are paying money for a service, if it isn't what you want, speak up.

6) Some Many of your fellow classmates are socially awkward. I don't mean like middle school dance awkward, you know, guys in one corner and girls in the other. I mean like don't-know-when-to-keep-their-thoughts-to-themselves awkward. For instance they don't have the internal gauge to tell them that what they are thinking in their head isn't something they should tell other people. What sounds like common sense, or constructive criticism to them comes out like smugness or elitist to others. It also seems a lot like they will say something just to one up you. Whether they mean it to be like that, it doesn't matter because they will not be able to know any different. If they start sentences with "I would", drop any sharp objects because you will want to harm them. They are about to tell you how they would do it better than you, but hide it behind critique. Remember, you didn't ask for their feedback. I think that is where it crosses the line. You didn't ask them, yet they will open their mouth anyways. I once had someone "critique" my patient interview by saying "you were blocking the door, I know for me, I don't like when people block my exit." For one, there were two doors to the room so technically I wasn't blocking the exit, Dragnet and besides, not everyone is suffering from PTSD and thinks his doctor is armed and dangerous. Regardless of his lack of observation, he felt it was necessary to open his mouth.

BONUS: Do not call first years "fresh meat". This isn't Dazed and Confused buddy so put down the paddle. There will be no initiation. Ever.

Don't Say I Didn't Warn You Part 1

Alright, so it appears I am 1/4 doctor. Yep, passed all my tests, jumped through all my hoops and didn't kill anyone in the process. I may be able to tell you where the ductus arteriosus is (heart), what the muscles of the rotator cuff are (Supraspinatous, Infraspinatous, Teres Minor and Subscapularis), where the deep tendon reflex for L4 is (patellar tendon), what bug is gram +, coag +, cat + (Staph Aureus) and about 926 mnemonics and acronyms. (Real Texans Drink Cold Beer, Cadavers Are Dead People, MONA, MUDPILES) blah blah blah, but somehow I feel like I know nothing. In fact, if there is anything I do know its that I know nothing. I have such little medical knowledge that I am still insignificant, but I know enough to make me dangerous. Not 007 dangerous but SAW III dangerous.

Having said that, I am here to quell all your fears. Well, any of you who are wondering what to do and what not to do during your first year, or if you are beyond that and want to compare your experiences. I am here to let you know some rules to live by. These are influenced by my experiences, observations, and/or swift judgment. I am no way trying to insult anyone so don't get it twisted. I am guilty of many of these things myself and I am way cooler and better than everyone else not perfect. I am going to stretch this list into a few weeks, so deal with it.

1) Do not listen to people on your interviews, they are lying to you. Remember, they want you to go there as much as you want to be there. If no one was impressed, they wouldn't fill seats, and would be out of a job. Make sure you understand that no school is perfect. After studying for the MCAT, filling out applications and getting interviewed, an acceptance can make you put the blinders on in such a way that you overlook some important details such as how they test, how they teach, and what is expected of you. A lot of it, unfortunately, you will find out once you are there. Just be ready for it. Because your interview was perfect and the campus has a Starbucks in it and you hooked up with a second-year during your interview does not mean that it is the perfect school for you. Make a list of what is important to you (board scores, location, rotation locations, board prep, not getting herpes from that second-year, whatever, etc.) and make your decision off that. This is, of course, assuming you are fortunate enough to have multiple options to choose from. If you don't, take whatever you can get and go for it (except the herpes).

2) Wait to buy books until you absolutely need them. Right now I am looking at a shelf full of books. I can pick out 5 that I have actually used more than once. If I could do it over again I would pick maybe 3 of them to buy. Your school pays teachers to teach you information. They should give you enough in their lectures to do well on tests. It is impossible to read the "assigned reading" for four classes each day and still study without being up all night. Your library should have the books on reserve so use them from the library if you need them. Plus wikipedia is free so use it. Don't be the one who is so excited for school that they buy all the books. Waste of money. Do not show up to orientation week with all the books purchased you little eager-beaver. Pay down your interest, or better yet use it for something fun on the weekends to keep yourself sane.
2b) Don't buy your books from the campus book store. What a joke. eBay, half.com, amazon, 2nd years, etc. have books for a fraction of the cost of your campus book store. It's just another way to suck up your living expenses. Again, use the money for something fun. If you say "but reading med school books is fun" I want to punch you in the face.

Bonus: Unless you like finding flesh and melted human fat all over your stuff, do not bring your anatomy books into the lab. Let someone else ruin their book.

MORE TO COME...