One of the big pieces of advise you always hear when trying to figure out what specialty you want to go into or what residency to apply to is “see what the residents are like.” And all the residents, and even the attendings I’ve worked with so far I vibe with. It’s refreshing to be around people who make it part of their job to be genuinely interested in patients’ lives outside of the clinic/ hospital. Not to say other specialties don’t care, just often times they aren’t as interested because it’s not pertinent to their role/ objective.
Today I got to tell a patient she was pregnant (she was hoping to be). I got to work with some babies and diagnose some rashes. Did some motivational interviewing and worked up some chest pain (clinically). I still need to work on being a bit more thorough/ systematic in my history taking. I just sometimes just get caught up in the conversation, or I ask things a bit spur of the moment so I rush, or I don’t want to fatigue the patient. We will adjust.
Again a lot of things I missed from primary care that popped up again today. I like talking about lifestyle and I do feel like a have an approach that many patients have responded well to (at least in the moment). I also did a HEADSS assessment (basically a very thorough social history) with a 12-year-old (usually at this age this is the first appointment where we ask their parent to step outside the room) which is something I enjoy and feel like I am good at. Throughout the day I also got good feedback from the residents and attendings, as well as from patients.
Still learning a lot and definitely have pick up a lot of good technique from my seniors, but overall its been a super good learning environment. The days also feel like they go by quickly and aren’t arduous.
We still in the honeymoon phase of the rotation though, we’ll see where I’m at by week 3.
Today was my first day back in a primary care clinic. There was a lot of things I missed about working in this setting. I missed all the good conversations. I missed the motivation interview. I missed the counseling and consoling and supporting. I missed seeing pediatric patients and babies. I missed the personalities of primary care providers. I think this experience so far has me thinking a couple things: (1) I definitely want to have some component of outpatient, longitudinal, primary care and (2) I definitely want to work with both kids and adults. But I kinda already knew both these things going into this rotation, this has just reinforced that (so far).
Also maybe for the first time ever I was told, “Wow you are fast.” Which probably was not a good thing and a result of being trained to have short and very focused patient encounters in my past few rotations.
Right now I’m kinda in the process of really trying to figure out where in medicine I want to end up. We just wrapped up 3rd year this past Friday and tomorrow is the start of 4th year. I completed all my core rotations and at no point in the last 10 months did have that “aha” moment that people always talk about. I feel like my problem is that I have an tendency to tolerate, or dare I say enjoy, whatever I am doing. There was nothing I absolutely hated (that doesn’t mean I didn’t rule anything out), but also there wasn’t anything that I 100% fell in love with, and I’m not sure such a thing exists.
I’ve spoken to a few advisers in the specialties I’m interested in which has been helpful. I have also spoken to family members and friends, and while I’ve very much appreciated everyone’s input, it’s hard to know who to trust. I feel like no one I’ve talked to fully understands me as person nor due that fully understand my my values or my philosophy towards medicine. Many of the doctors I’ve spoken to, including those within my family, seem to have come to medicine from a slightly (or more than slightly) different angle from me with their own set of values. The metrics are different, but often in conversation we speak as if they are the same. What is a downside of a particular specialty for one person, may actually be a bonus to me and visa versa. Then to make it even worse, just because a particular thing matters to me now, doesn’t mean it will matter to me 10+ years down the road.
At the end of the day, I will eventually have to make a decision based on whatever information I’ve obtained by that time and then live with that decision. I just have to remember that regardless of what happens, my satisfaction and contentment with life is based on so much more than the outcome of what currently feels like the biggest decision of my life.
In 2023 we have the solution to boredom. We’ve actually had it for a while now and it comes in the form of these tiny rectangles we keep in our pocket. The moment boredom rears its ugly head we have the perfect weapon to ward it off. Not a single minute of our time need be wasted sitting idle when we can fill it with videos of people dancing at work or of people showing the silly things they did at Disneyland or of 5 tips for making yourself rich TODAY.
No more wasting our time with useless mind wandering and daydreaming when our attention can be continuously captivated by an endless stream of catchy and misleading headlines, targeted ads, and controversial content. We can check our emails, be entertained, catch up on the news, connect with friends, make business connections, or love connections (or both?) all without taking our eyes off our screens. It’s called productivity and productivity how we keep up in this world lest we fall behind into cultural irrelevance.
There’s no need to reflect, there’s no time to pause because we already have notifications piling up that we need to attend to and trends we need to participate in. Boredom and idleness are problems of the past, and in this day and age we finally have the space and the tools to be focused on what’s really important.
We’ve all been there. After hearing the phone buzz after that risky text; after being told the results for the exam you didn’t feel great about have been released; after lifting the cup from over a cockroach you think you trapped, there’s a fear of finding out what the outcome is. Our minds have a tendency to perseverate on the worst possible outcome (or at least mine does), regardless of the true likelihood of that outcome. And as they say ignorance is bliss.
I feel like I used to be really good at combatting that fear; at telling myself and believing that knowing is better than living in that dark, but as I’ve become less confident in myself I’ve found that fear starting to win more battles (even though in most cases I end of needing to confront reality at some point, and usually it being fine). I’ve been slipping. I want to go back to that mindset, and part of that involves taking back control of my competence and identity.
I came across this term, FOFO somewhere but I can’t remember where so I apologize to whoever inspired this thought, and thank you, and I definitely do not take credit for coming up with it.
I started to get into rock climbing about 5 months ago and recently it has been the only physical activity I’ve been engaged on a consistent basis recently. I been taking it pretty slow, trying to nail down easier climbs, improve my strength and endurance, and develop my climbing IQ before jumping into higher level climbs. What I’ve enjoyed about climbing is that each one is a puzzle, and as you move to more difficult climbs it doesn’t just get more physically demanding, but it also requires you to think more critically and creatively, and just like with mental puzzles, even when you get it wrong the first time something about it has you coming back to try it again to figure it out. There is not just one way to do any particular climb, but there usually is a “best” or “lowest effort” way. The freedom to fail and to try things out and work slowly is something I’ve missed since being back in school, so it’s been nice to have this as an outlet.
Drug reps coming to the office for lunch is so awkward. My attending clearly doesn’t want to talk to them, but obviously they are there to try and do their job and talk up their medication. I know it’s all about getting free lunch or whatever, and I don’t think anyone should feel bad about taking resources from pharmaceutical companies, but also I can’t help but feel bad for these folks who are being given a hard time just trying to do their job.
There’s going to be a lot of advancements in neurology in the coming decades I feel, and so maybe it is a could be a good place to be, I just need to find the kind of practice that matches what I’m looking for.
I’m learning. Each day I come in, I (we the students collectively) are answering more questions correctly. Today I impressed the attending by adding Lesch-Nyhan syndrome to the differential of a hypothetical patient. It was the first time I saw him say, “That’s a good thought,” non-sarcastically.
Being back in this community setting I think I am getting a better idea of what my ideal practice would look like in the future. Right now I feel like one of my biggest concerns is not having the bandwidth to do all the things I want to do in both my personal and professional life.
When talking about seizures, we often talk about a postictal state – a period of altered consciousness or fatigue after seizure stops. I only recently made the connection between that term ictal and something I learned about back in high school marching band. Ictus refers to an inciting event and is often synonymous with the onset of a seizure. In music, the ictus is like a recurrent beat and in the case of conducting, I was taught that the ictus was the bottom of my arm strokes, which indicates the exact moment of the beat (can also think of it as the apex of the stroke). I’ve known both these terms, at least since I was in high school but didn’t realize the connection/ similarity until my attending said the word ictus in clinic the other day (usually when talking about seizures we always hear -ictal).
I don’t have a deep life-lesson or reflection to glean from this realization, I just thought it was interesting.