So you want to get into med school...

I often get asked how med school and residency works.  It's not really clear or intuitive and most people get their information from extremely accurate TV shows like Grey's Anatomy and Scrubs.  As someone who finally understands it, and I can assure you I did not until probably this year, let me do a bit of explaining.

For pre-med, I've given a decent explanation here, so I'll leave it alone.  I'll move on to first year.  This year is all about minutia.  It has been said that you spend the first year learning a language, and that is more or less accurate.  Particularly first year, your life is to learn basic science, basic science related to medicine.  This is like getting hired as a lawyer and then being asked to spend a year learning how books get made.  You learn new fancy words, with no idea how to use them or what they really mean.  You hear about things that sound important, but don't really exist.  The kind of thing where your attending* sees primary syphilis and is like, "It does exist!", and he's been doing it since the pre-antibiotic era. You definitely learn a lot, but it's mostly useless or won't stick. The major utility of this year is to drink and hook up with your classmates.

The summer between 1st and 2nd year is the only summer med students get.  This is a hard concept to understand for the rest of the working world, who assumes school is school and schooooooooool's out.for.summa! It's not.  And most people work this summer, doing research.  Lawyers get paid around 30,000 for the summer.  We get paid around 3,000.  If you have a good grant.  Again, a good time to drink and sit by a pool and regret hooking up with your classmates.

Year 2.  This is pretty much the same, but they get your ready for the wards**.  You do things like see standardized patients; paid actors who pretend to be sick and then give you feedback afterward that is always the same, one good thing, one bad thing, and "how do you think it went?"  "I think it went about as well as it could go considering you aren't sick and I've seen you tending bar at The Back Saloon.  We were both there last night.  Didn't have a bum knee then, did you?".  We learn physical exam, interviewing skills, basically all of the stuff that teaches you how to diagnose the fact that you need to order a cat scan.

At the end of this year, you take Step 1. This is the MCAT for residencies and is a super painful test.  More about it here.

More on year 3 and 4.

*Note: An attending is the head doctor (Dr. Cox, if you will) who runs the show, makes final decisions, and pimps the shit out of you.
**Note: The wards is the name for actually being in the hospital.  Clinics is a synonym.

I'm like a super hero but without being super or a hero

In response to my recent post, truthfully, I've had to pull back on everything.  I'm basically hiding from the internet right now.  I have to apply for residencies which is, for all its other bullshit, still a job.  So posting poop jokes on twitter and the pictures of me in cat-face for the month of July are not cool, bro, not cool.

Privatize this, anonymize that, stop making up words like anonymize; life in the real world blows.  I realize the problem, you can't have doctors going around writing shit like I write, saying the shit I say, using the word "shit" so often.  It's unprofessional and makes people lose faith in doctors.  So I keep it anonymous.

Although in reality, I'm a work hard, play hard kind of person and I never mean anything but a joke.

I can complain about med school and make jokes about rectal exams being uncomfortable, but I don't dislike my patients and I don't dislike my work.  I'm ecstatic to be doing what I'm doing and take it very seriously.  That's why I write this.  It's an outlet for me to get all of the jokes out of my system before I walk into a manic patient's room, because when they start telling my team a 25 minute rambling story about a cat, going into exquisite detail about the cat, never letting focus get off the cat for more than a sentence, when they finally finish talking about the cat, if I don't have an outlet, then I feel it necessary to blurt out, "Sorry, you said you had a cat? Can you tell me more about that?".  That tends to make me unpopular with my colleagues (although super popular with the manic patients).  So I get the jokes out now.

A question that gets asked on interviews with a frequency high enough that I'm pretty sure it's  JCAHO* required interview question is, "how do you deal with stress? how do you relax?".  You have to say things like, "exercise" and "playing with underprivileged minority children", but even a legit real outlet, like writing a blog, is a huge no-no.  I took certain things off my application that were actually impressive and show me to be a well-rounded individual because you can google them.  Since this is just a job and they don't care how well-rounded I am, I'd rather them think I'm boring than think that I write the word "shit" so frequently.

I guess this is the duel-life I have signed up for, by day, mild mannered doctor, by night, slightly annoyed doctor, every month or so, when I have a free hour or so, dude who writes a shitty blog.

*note: JCAHO is the Joint Commission on Accreditation of Healthcare Organizations.  They are the standards committee that comes by once a year "without warning" and makes sure that people aren't like tossing needles into patients from a distance or letting patients just wee where they want.  They are sticklers for things like washing hands and not weeing wherever you want.  A real drag.  They would never sanction a question about the well-being of doctors because they would never care about the well-being of doctors.

Pimp my expensive education

There is a thing in medicine called, "pimping". Basically, pimping is when a higher up doctor puts a lower down doctor or medical student on the spot in front of the group and makes them answer a question about medicine.  The idea is to see what a young doctor knows about a subject that comes up on patient rounds regarding their disease.  Although sometimes it's about history.  Or trivia. Sports sometimes.  I once saw an attending pimp a patient.  No joke, the patient was a PhD in physics and he started asking him who discovered some string theory equation.  The guy was like, uh I don't know, but my ankle reallyl hurts.  He was then told to read more. Pimping is as old as medicine* (there is a story in the bible where Jesus, right before healing a sick man, asks one of his disciples to name the 4 kinds of gastric ulcers, then smotes him and tells him to read more.  I think it's in John somewhere) and has a lot of surrounding controversy.

The controversy exists because it sort of sucks to be made to look like an idiot in front of a bunch of people.  Generally, the term "unnecessary humiliation" gets thrown around in sensitivity meetings.  On the other side of the coin is that fact that frankly, you learn a lot from being pimped.  Once you get over the shear terror that is being asked a factual question in front of a bunch of people you don't really know who will judge and grade you based on your answer, you swallow your fear, take a small poop in your pants, and give an answer.  You will either surprise yourself with what you know, or get the answer wrong and be told the correct answer.  I know some of the most obscure facts in medicine because the emotion associated with the question burned the answer into my brain parts (but let's be clear, that emotion is fear).

A good pimper, one who asks relevant and useful questions (see this post about the difference) without adding too much visible weight to the answer, will teach you more than you can imagine.  In fact, once med students get over the sharp pain of being pimped, many will agree that a rotation without pimping is a decidedly dull one.  A lot of being a med student is scut work; a term that means "shit" work.  "Call this nursing home", "make sure that CT got done", "walk this patient down the hall"; those are things I am asked to do on a daily basis.  Only paying 70 grand a year, NBD.  So getting a little extra teaching in the form of a jeopardy (because you are in actual danger) style learn-a-thon is not that unpleasant.

*Note: I once looked up the origin to the use of the word, "pimping" in medicine.  It doesn't seem novel now, since MTV pimps everything that can be bejeweled, but it is listed in books and articles in the 70's.

If I wrote textbooks

"Enhancers increase transcription rates of specific genetic loci and also increase the zoom on a freeze frame image in action/thrillers when they catch an important clue on tape"  Enhance.  Enhance....ENHANCE.  There! What's that?  A transcription factor dropping off a brief case for that promoter gene.  You're mine Tyrosine Kinase, you're mine.