And… Switch.

It is switch it up day again.

I still hate changeover days.  I don’t like the unknown of going to a new rotation.  I dislike finding new offices, sorting out times to go to new clinics and all that stuff.  The unknown kind of sucks.

I was really sad to leave Peds Onc.  Minus my episode of semi-depression after the first week and a half, it has been a fabulous rotation.  Kids and Oncology… Not much else more to love!  At least to me as an Oncology resident who not-so-secretly sometimes wonders if Peds is the place for her.

Seriously, it was a great rotation.  I learned how to do cool things like lumbar punctures (poking needles in spines… and administering chemo) and bone marrow biopsies.  And I don’t even like procedures, but those are similar to taking blood and I do get strange kicks out of taking blood.  I learned a ton about kids cancer and chemo drugs and such.  But the bigger piece is that I got to know some super awesome families and play with some fabulous kids.  I actually followed some kids almost weekly in clinic, and a few of them I followed from diagnosis as an inpatient.  In the world of a resident where you are forever darting in and out of services, that kind of consistency is pretty exciting.

Now, I am off to Family Medicine.

My Dad that I should get a by and not have to do it given the med school I went to.  Not so much.  But it is true, I have already done over 12 weeks of Family Med and another 4 of general community Internal Medicine (which in some contexts is still a lot of primary care).  That makes me feel prepared for the rotation, at least.

Family as a med student was one of my best and one of my more liked rotations, but part of that was the doc I worked with was a person I got along with famously.  It helps.

My orientation was good.  The clinic is nice.  I am fascinated by the electronic medical record.  It will be my first time using one in a non-hospital setting.  I am intrigued because I am very pro-EMR (seriously, I wrote a whole health systems paper on them during undergrad).

I start with my first patients tomorrow in clinic.  Whoo.  I find the hardest part is figuring out what people want and what things I need to review and what things I need supervision for.  It seems everyone is different, so it is always a process.

The thing I am most angsty about is that the service also covers their own obstetrics.  Although this isn’t the main thing I am supposed to be doing, I may have to go to a few deliveries (so not my thing), although I will be thrilled to do some prenatal visits (my favourite thing after seniors and babies).

Such is the adventure of new rotation.  You take the good with the bad and figure the rest out as it goes.

This is rotation number 12 of residency.  Our physics exam is at the end of the month, then we are done that for the “year.”  I will no longer be a PGY 1 in just two months (eep).  It is crazy how this stuff flies by.

Five misconceptions you probably have about your friendly medical resident

I think sometimes people have gross misinterpretations of what being in medicine is like.

It frustrates me immensely sometimes, but I think we all have preconceived notions or expectations of certain people and certain professions.

Take teachers, for example.  I am married to one and several of my friends teach.  But, everyone assumes they just work when kids are in school and that they get so much time off.  But, they have homework too.  Prep time goes way beyond school hours.  And they invest a lot of their own money in classroom supplies.  So, it kind of cancels out.  Plus, kids are exhausting.

Medicine is a bit of a unique culture.  Everyone tends to picture a stereotypical male, white coat wearing, paternalistic doctor who works endless hours and is yet mysteriously always available for whatever they have to do (minus, perhaps, family life).  And I think there are still some influences from that generation of doctor. But, medicine has changed significantly over the past number of years from the stereotypes.  And on the other side, there are many aspects of medicine that most people may not realize or think of.

And thus, I bring you five assumptions I have been confronted with of late.

  1. All physicians are old, male and wear a white coat.  Not true.  I am a resident, which means I am a doctor doing additional training in a specialty.  I am female.  I am “you look young for a doctor” kind of young.  I only wear a white coat when I am cold, things could get messy or I am on a busy floor rotation.  I have written a white coat rant previously.  But, these days, there are equal volumes of males and females in medicine (although my field is still somewhat male predominant).  And I am not Dougie Houser, I just did things in a progression that had me graduating at 25.
  2. I get time of in lieu of call days.  No.  I get paid to be on call.  A lump sum per night.  It is not overwhelmingly lucrative at my level of training, but it is required.  Just because I work all weekend does not mean I will be off half the next week.  Just because I carry a pager all day and night does not equate my being available for a social event the following day.  In fact, I have to work and will probably be sleepy.  And sometimes I am a bit cranky or slow at work because I was up part of the night or in really early to help someone who was really sick.
  3. My hours are flexible.  Actually, quite the opposite.  I sometimes get to choose my call shifts, and when I can go in to work or leave beyond the confines of 8-5 working hours, but really, flexibility ends there.  I can’t take a few hours off of call to attend your event (though I can come if you are within 30 minutes of the hospital and my pager doesn’t go off).  I work every day that is not a stat holiday (and some of those too).  Although I carry my phone, I cannot always answer it.  And I really should not answer most of the time.  Please stop asking if I am working on day x.  If it is a work day and I didn’t announce vacation time, then I am working.
  4. Not every resident is going to be a family doctor.  I am asked all the time if I am going to be a GP.  I get it.  There is a very severe doctor shortage locally.  People are desperate.  But I just told you I am training in oncology.  But further to that, people who become specialists do not have spare time on the side to have a family practice.  I can’t take those imaginary afternoons off to see patients in a clinic or work in an evening clinic regularly.  My job is a full time (plus) job too.  I can’t be a family doctor in my spare time and still see my family.  Besides, I am actually not and will not be licensed as a GP.  Unlike what TV shows like Everwood portray, one can’t just quite neurosurgery and take up rural family practice without a hitch.
  5. Residents and doctors do have lives and families outside of medicine.  I would think this is obvious.  But, I have had people who were shocked that I go to church and have friends and a husband.  I have also had people who know I have a life who were shocked that I did so well in medical school.  I have also had a number of people (both medical and not) who have commented that I probably should never have children or it would be a waste of my training.  Nowhere does it say physicians can’t have children.  I have worked with many people who balance motherhood and medicine.  In the same breath, it is not easy, but they do it.   Medicine is not the be all end all.  There are things outside of it.  And I want children.  I would regardless of my career choice.  It is discrimination to say that one can’t have kids because they happened to choose a particular career.  In the same breath, you have to find replacements and such, but it can be done without severely damaging patient care.
  6. Bonus: We know everything and should be perfect.  I don’t know about you, but I am nowhere near perfect.  I make mistakes all the time.  I am not an expert in my field.  I am here to learn.  I know enough to not kill people, but I will be honest and say when I am not sure.  And sometimes I have bad days and good days and in between days.  I try not to let it affect people around me, but sometimes it does.

There you go… My rant.

I find it amazing the assumptions people have.  Even those closest to me.

But, when you get down to it, we all have assumptions.  From what the sketchy guy on the street is about to do to how sweet that little old man must be.  Sometimes we are right, but sometimes we are wrong.

I just wish we would assume less and just ask honest questions and give honest answers.  Some misconceptions could be corrected if people just entered with blank slates.

The White Coat

The white coat.

The thing that induces hypertension in millions.  The signature of medicine so strong that there are entire ceremonies dedicated to strapping them onto first year medical students as a symbol of things to come.  The harbinger of all things infectious.

I don’t like white coats.  Sure, the look professional, but outside of a lab, they are just not good ideas.  I have my reasons.  We will get to those.

My medical school has a policy that clerks are to wear lab coats on all rotations with the exception of psychiatry and pediatrics (family is preceptor dependent)… Don’t scare the p-patients.  By the end of one rotation, most people have ceased to wear them… Or at least they try not to except when lectured by administration or other senior staff.

To be honest, I am a rule-follower, so I wore it fairly religiously through the required core rotations.  But, for my electives and selectives… Not so much.  Except lab medicine… Because playing with formaldehyde and human tissue should not occur without a thin layer of protection of the lab coat I take home and wash with our towels (yum).

Why, might you ask, would I hate something that represents such a noble profession.  Well, I will tell you.  In organized bullet form.

  • They are gross.  White coats are worn in hospital.  Hospitals are places where sick people are.  Sick people have germs.  Germs get on white coats.  White coats go from person to person and drop the germs behind them.  Delicious.
  • White coats are white.  Therefore, they get dirty, well, visibly dirty faster than most other colors.  Big pain in the neck.  Mine has pen stains and coffee stains generally by day 2 of wear.  Nothing coffee loves to fall on more than a fresh white coat.
  • They are not temperature friendly.  White coats are convenient if you are cold.  They can make you warmer.  But not warm enough that you stop being cold.  The reverse, however is untrue.  A white coat is not cool enough to keep you from broiling to death.
  • They are yet another thing to bring places.  As a clerk at my school, we are required to travel a fair bit.  Packing your white coat is not at the top of your priority list.  It usually gets jammed into the top of a bag or forgotten.
  • White coats scare people.  I don’t want to scare people.  I want to help them.
  • White coats represent a lot of what I don’t like about medicine.  The paternalistic old boys’ club past.  The elitism.  Ugh.
  • They make you stick out.  Everyone not medical assumes because you are wearing a white coat, you are clearly a doctor and therefore know what you are doing… WRONG.  A proportion of people who are medical sorts assume that you are a clerk.  This is good because they then know your appropriate knowledge level.  But then, they ask you questions excessively in rounds.  And you get volunteered for the not-so-fun jobs.  And then you get grilled more.
  • They have pockets… And the pockets get filled and then they get heavy.  And you develop this weird shoulder pain… That is bilateral.  And you can’t figure out why.  Until, at the end of the day, you remove your white coat.  And suddenly even your giant winter coat doesn’t seem all that heavy.
  • They get caught on things.  Stair rails, bed rails, door knobs… You get the picture.  I am a klutz.  The white coat does not help the situation.

As you can see, the white coat can cause a whole whack of trouble.

It has a good point, though.  The only redeeming quality of the white coat aside from statistical significance are the pockets.  Ah, the pockets.  You can keep a lot of stuff in a white coat.  Papers, notebooks, iPods, pocket guides to everything, little pen lights, pens, post-its, lists, a snack for when you get hypoglycemic after rounding for hours… The list can go on and on. Heck, you might look ridiculous, but a water bottle could fit in one of those pockets.  I may or may not have tried it once.

I am not a fan of the white coat, except for the pockets (until they cause strange shoulder injuries).  It represents much of medical history, but in an age when we are so well educated about infection control and patient centered care, it is ridiculous to strap them on outside of a special ceremony.

**This post reflects my views only and not the views of my peers (okay, well most of the people I talk to agree, but not the others) and definitely not of my medical school (which outside of the white coat thing is lovely).

Related posts:  White Coat Problems (sugarandscrubs.wordpress.com), Doctors Should Stop Wearing White Coats (getaheadwithdrg.wordpress.com), Why Doctors Wear White Coats (numberneededtotreat.wordpress.com), Why do Doctors Wear White Coats? (slate.com), Considering the Significance of a Doctor’s White Coat (medicallessons.net).

On Rural Medicine

I am leaving my beautiful rural community.  I am excited to be back with Patrick and company, to have a car again, to have options beyond deep fried food when eating out and to not have to pack and drive an hour and a half back and forth every weekend.    I however will miss the really nice apartment we have here and the gorgeous scenery that God produced in this little space.

The view from the living room window, where I sit to write.

In the past four weeks, I matched to my program of choice, learned that I didn’t forget all of Internal Medicine, discovered that rural hospitals (at least this one) run surprisingly smoothly and learned that, as they say, in a small town, everyone knows everyone.  I also discovered the cardiac disease capital of Canada (at least, it looks that way).  And despite not going to the gym for four weeks, I got epic workouts climbing “The Biggest Hill of All” on a daily basis.

Evidence of the abundance of fried food and the source of many of the heart attacks I see in emerg... "We sell fried food." Oh wow.

So, as much as I sometimes become frustrated with my school’s obsession passion for rural medicine, I must say I am glad that I have had the chance to work in rural communities for 12 weeks (technically 16, but the first four were epic fails in the rural department and turned out to be suburbs of my hometown).  The whole small community, everyone knows everyone and fewer resources really do make a difference, but there are definite benefits.

And thus, I have concocted a list of the great things about rural medicine, even though I will likely never practice in a rural community (unless God rearranges my plans, career choice and such… And to be honest, I would not be impressed if He did at this point).

  1. You get to live in a small town… Cheaper cost of living (in general until you go really north), less traffic, less pollution, and fewer distractions.
  2. Many rural communities I have been are beautiful (at least in Atlantic Canada).   Waking up every day to the view of the ocean or forest is something that is priceless.
  3. You can often walk places (and because there is no public transportation, you don’t really have a choice).
  4. You can learn a new activity… For instance, the community I did family medicine in was very big into canoeing and kayaking.  I had a few chance to go, but they didn’t work out.  Here, I had an impromptu skiing lesion when I had to navigate my way down “the Biggest Hill of All” in the middle of a freak storm.  At one point, I did a full-on split, and then fell over.  Thankfully no cars were coming (or I may not have been able to type this).
  5. The practices are often less busy and somewhat smaller.  This is not always true.  But, I have noticed on medicine, especially, the pace is so much more relaxed.  Going home at lunch on medicine would never happen in a bigger centre.  Unless you were post-call.  And even then, it is unlikely.
  6. Home call.  Never underestimate the value of sleeping in your own bed.
  7. You have a broader scope of practice.  The GP I did family with covered the local “emergency” (I used quotes because only 25% of the patients were legitimate emergencies), did minor procedures and had his traditional office practice.  The Internal Medicine doctors here cover the ICU and also their own subspecialty.  The Hospitalists here can do some emerg shifts, some deliver babies and still have a community practice.  The variety is fascinating to me.  I can see why people would prefer a community like this, especially if they like that kind of autonomy and those opportunities that are often lost in giant cities.
  8. People are more grateful.  Again, this is a stereotype.  But, people are glad they don’t have to go to town for care.  So, whatever you can do here is often just amazing.  Not always, but sometimes.
  9. You get a lot more follow-up, even as a specialist.  In a small town, people just happen to run into each other, so as you can imagine, people who wind up back in the hospital are likely to be on your service, or their family member is, or there is time enough to actually see them in clinic to make sure they are doing okay.  In big centres, people leave and sometimes you wonder what happened, but they go to a GP on the other side of town who is too busy to give an update.  We had a guy go home one week and get readmitted under us the next for two unrelated problems.  Another person came in to visit someone else and told us that she was feeling much better.
  10. You just plain have more time.  Most physicians out in the periphery are salaried, which means they don’t get paid for volume, they get paid for designated amounts of time.  Thus, people don’t feel obligated to book patients one on top of the other.  You get more time with people.  You can give better care.
  11. As a learner, you get more experience.  Now, volume is an issue.  I could have seen as many people in a week in a city, but because for the first three weeks, I was the only medical student on the service, I had free reign.  I managed the patients on my own, did my own consults and reported back to the doctor.  So much better than clamoring over five other people who wanted to do the same thing.

The peninsula as seen from my bedroom window.

So, rural medicine isn’t all bad… In fact it is really good for many, especially those people who live in those communities.