Go-To Questions

And now, what you’ve all been waiting for: a post about the most important part of shadowing—asking questions! Starting right now, ask as many questions as you can. All the time. Forever. (Just make sure the doctor doesn’t need time to chart before blurting out 100 questions.)

Original artwork by Dalya Munves

For those times when a patient visit was really boring, or you couldn’t understand the patient’s accent, or you just go completely blank, here are some go-to questions to ask:

• “How prevalent is [that disease/anomaly]?”
• The ultimate go-to question. This can even be used for very common diseases. Just ask in a way that sounds like you want a statistic, like 52.3% of U.S. population has lower back pain (not a real stat, FYI).
• “If that medication doesn’t work, what would you try next?"
• To be used: if you just heard the doctor prescribe a drug.
• “How often do you personally see [that disease/anomaly] in your practice?”
• To be used: for less common diseases. Do not use for anything as common as Diabetes or you will sound stupid.
• “What is the differential diagnosis for that patient?”
• Warning: do not ask if the doctor already listed the Ddx for the patient during the visit. (So if you zoned out, don’t use this one.)
• “What tests will you use to determine the diagnosis?”
• Warning: same as above.
• If the doctor gave the patient a list of labs that will be ordered, ask how the specific labs will rule diagnoses in or out.
• “How did you rule out [XYZ Disease], since it also causes [symptom patient just complained of]?”
• To be used: for symptoms with many etiologies, but use with caution.
• Don’t ask, for example, “How did you rule out migraine in that patient with an axe in his skull?”
• “How do you determine the starting dose of [XYZ Drug that you just prescribed]?”
• To be used: ONLY if you already know a little about the drug or if it’s fairly common: a statin, Metformin, an anti-depressant, etc.
• If this is the first question you ask, 1 of 2 bad things will happen: 1) the doctor will think you’re trying to sound smart, or 2) the doctor will think your clinical knowledge is much greater than it is and he/she will start pimping you on all kinds of questions. Neither of these feels good.
• “Are there any major contraindications for [XYZ Drug that you just prescribed]?”
• To be used: same as above (if you already know a little about the drug or if it’s fairly common).
• “When you palpated her [body part], how did it feel different from a healthy person’s?”
• To be used: if the doctor found something important during the physical exam (enlarged liver or spleen, for example).

This list is by NO MEANS all-inclusive. I’m sure I’ll think of some other good questions in about 5 minutes. But it’s a start!

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As always, please contact me with any comments or questions. :)

Why I Needed an iPad (and You Might, Too)

First: I am not receiving any form of payment or incentive from Apple and I have no conflicts of interest to report.

If you're about to start med school, I encourage you to think about getting an iPad now, before class starts. I waited until a week or two into school, but I could have just bought one right away. I pretty much knew I needed one on the first day, but I was afraid it would be a waste of money (more thoughts on the expense to come). My undergrad routine of using ~6 highlighters was waaaaaay too slow for med school lectures. But I still needed to be able to highlight, take notes, etc. 

If you learn better when you can physically take notes, I highly recommend a tablet. 

If you have a photographic memory, stop reading my blog because you make me mad.

What about the cost? Okay, so at our school (and most) we can get our syllabi as free PDFs or we can pay to print/buy printed copies. The syllabi start to get pretty expensive to print. (I'm pretty sure we calculated that the ROI on an iPad was less than 1 semester.) 

[In case you don't already know about syllabi, in med school the syllabus is the textbook. Your lecturers actually write their lectures for the syllabus and it (usually) includes all testable material. For classes like Biochemistry & Gross Anatomy, we had one syllabus per block (about 150-200 pages) for three blocks.]

I also got the wifi-only iPad (not 3G), because I knew I'd mostly use it at home or school. Plus you can still use Dropbox, iAnnotate, etc. without Internet access; it just syncs the next time you're online. So with wifi-only, plus the Apple student discount, it really wasn't too bad.

One other reason my iPad saved my life: you always have your books with you. (This may be good or bad, depending how much of a psycho you are about studying.) But I love that I always have my iPad and therefore always have my syllabi. This means I can study while I wait at the doctor, sit on the bus, when my friend is late for dinner, etc. It's impossible to carry around 3+ syllabi everywhere. (I also walked home from school fairly often and an iPad is much more portable than 800 sheets of paper, in case you didn't know.)

So, think about it. You will not die if you "wait and see" like I did, but it would have saved me a little stress to have decided in advance. 

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Please feel free to ask questions, as always: thehealthscout@gmail.com.

Thinking About 2nd Year

I went through this 3-minute mini-breakdown a few days ago... And last night... And again this morning.

Hmm... I'm starting to perceive a pattern.

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How to Shadow... Like a Boss... Part 3

How do I find a doctor to shadow? And once I find one, how should I ask them?

Ok, so I found both of my preceptors/mentors in fortuitous ways, and that's probably how it will happen for you, too. My first preceptor happens to be my personal ob/gyn--and she offered to let me shadow her while she was performing my Pap! (True story--I even used that as the opening for my admissions essay.) My second preceptor was my friend's doctor, and she introduced me to him. 

In my experience, there is no point in sending out resumes or trying to call offices of doctors you've never met. I tried both of these, and I got ONE shadowing experience out of it. And it was a bad one (see arrogant neurosurgeon in my previous post). 

So, the rule of thumb is: ask doctors you already know. Don't worry about it being awkward--if I can shadow my ob/gyn and then go back for my annual, you can shadow your old pediatrician! 

If it doesn't work out with any doctors you know, or you've managed to go through life until now without encountering a doctor (??) move onto the next steps.

Shadowing a doctor you don't know

It's time to get over being shy. When you meet doctors, from this point forward, stick out your hand, introduce yourself (full name), and say you are planning to apply to medical school. You'll usually be able to read the doctor pretty easily at this point, in terms of wether they are the teaching type or not. They'll either get very squirmy and awkward or they'll start asking you ALL about your plans. 

If they are the latter type, come right out and say, "I'd really love to shadow you. Do you allow students to shadow?" If they say no, it's usually because of a facility rule or because they already have too many students. If that's the case, ask if they have any colleagues who enjoy teaching.

So, I know this can be awkward and it feels like begging for scraps, but you just need to start asking for help from every doctor you meet. Seriously. Every one. The thing with shadowing, and with medicine as a career, is that it's all about connections. I hated this and resisted it for a long time, but it's just a fact. The more people you know, the more resources you have. This will help you learn, get into school, get a job, and, most importantly, take better care of your patients!

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And ask ME for help! Please let me know what other questions you have. I write this for you guys! Comment below or email me: thehealthscout@gmail.com.

How to Shadow... Like a Boss... Part 2

Q: How often should I shadow & for how long each time?

First, a quick vocabulary lesson:

Preceptorship = an extended shadowing experience (consistently shadowing the same physician over some length of time)

Preceptor = the physician whom you shadow

I recommend shadowing as often and for as long as the doctor wants you to.

Many doctors will have experience letting students shadow, so they'll often have a particular way of running the show. My first preceptor was very specific: she asked me to come for a half day once a week. I did that for about 2 months during the summer.

Preceptorships are a nice warm-up for 3rd year in med school, when you're expected to be eager to be there and learn. Meaning: if a doctor offers to let you come in more often than once a week or for the entire day, I wouldn't turn it down without good reason. (Obviously, if your schedule doesn't allow, just say so.) In the same vein, if a doctor says you can only shadow one time, that's still valuable experience.

What about the length of the preceptorship? As in, should you shadow a doctor 4 times and then move on or keep going for eternity? I think that's something you have to feel out. In general, you'll start shadowing with the understanding that it's temporary. This way, you both have an out if there's a personality clash or you realize pediatrics is boring to you, for example. 

That's how it started with my second preceptor. I asked if I could shadow, and he said to show up Friday at 7am and we'd "see how it goes." He also asked me to come for the entire day, not half days.  (I ended up shadowing him weekly for about 9 months, and now I've worked with him at a healthcare consulting company for almost 2 years total, so obviously it went okay.)

However, there were plenty of other doctors I only shadowed once. One was a wound-care doctor who's extremely busy, so she made it clear that it was going to be a one-time thing. Another was a neurosurgeon who told me I should "just go to PA school" because malpractice insurance is so expensive and he wasn't making any money with his divorce anyway. (I'm sure you can see me rolling my eyes all the way from wherever you are.)

Just be as flexible as you can. The more doctors you meet and the more specialties you experience, the better. If it doesn't work out with a doctor, learn what you can and move on. 

And remember that they are not obligated to let you shadow. Be nice. Offer to get them coffee. Make sure you are respectful of the doctor, the staff, and the patients. And thank the doctor EVERY TIME before you leave! 

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Please leave comments or ask questions! Thehealthscout@gmail.com

Responses to "I'm in Medical School"

There really aren't a lot of different responses to this statement. See the top 4 below:

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Are there any doozies that I forgot about?

The Physician-Legislator: My Elected Official or My Colleague?

Image source: http://www.cato.org

I just read a New York Times blog about doctors bad-mouthing other doctors. This is a huge concern in the medical community, as it frequently causes or exacerbates malpractice suits (meaning another physician either tips off a patient or files the complaint). In the first year of medical school they’ve already started cautioning us about this and I’ve heard a malpractice lawyer speak on the topic at length. And I agree: unless patients are in danger, there are MANY other ways of correcting mistakes/bad behavior besides bad-mouthing a colleague. (Patients’ safety and well-being are always first priority though.)

This blog came to my attention at an extremely opportune time. Watching the Texas House and Senate live streams last week made it very obvious that I need to ask a few questions. In the realm of peer loyalty, where do physician-legislators fall? Am I allowed to tweet to/about physician-legislators? Am I allowed to publicly question their views? Are they exempt from my criticism?

Basically: are they my elected officials or are they my colleagues?

You may not be aware that there are currently quite a few physicians holding public office in Texas. (I’m not sure how common this is in other states, and I’d love some perspective.) In any case, the Texas Medical Association (TMA) strongly supports this movement, via TEXPAC, the Texas Medical Association Political Action Committee. And I certainly understand the logic: if lawmakers are going to legislate about healthcare and medicine anyway, we need to make sure we’re part of the debate.

But SB1/HB2 has convinced me that the concept of the physician-legislator is much better in theory than in practice.

The question is: does a physician’s oath of office take precedent over the Hippocratic oath? In my mind, the answer is clear—NO!–but I’m not sure how the physicians in the Texas legislature feel.

I was alarmed by some of the arguments doctors made on the House and Senate floors last week. I heard physicians describing anecdotes and feelings as if they constituted scientific facts. I heard providers discredit robust, high-quality research in favor of biased, unrepeatable research. And several doctors openly challenged well-respected medical organizations, such as the American College of Obstetricians and Gynecologists (ACOG) and TMA. Calling TMA’s opposition to HB2 into question seemed particularly imprudent, because, as far as I know, every Texas physician-legislator is a member of TMA.

So, here is my dilemma: I disagreed with many statements made in the legislature, in terms of substance, logic, evidence, and tactic. However, when physicians offered arguments that I disagreed with, I felt absolutely incensed. How could a doctor fail to provide evidence?! How could a physician rely on personal experience to legislate?! In other words, I judged those specific legislators more harshly because I’m inclined to expect more from medical professionals.

So I am I bad-mouthing colleagues? Or am I simply responding to the actions of my elected officials?