Wednesday, July 29, 2009

Kansas City

This weekend is the American Academy of Family Physicians (AAFP) National Conference for Students and Residents. It's a mouthful to say. At this conference there will be many seminars and lectures given by some well-known family physicians around the country. There will also be some informative sessions dealing with "The Road to Residency" - tips on applying and interviewing, etc. The most exciting part for me is that there will be residency programs from all over the United States there. I will be able to speak with residents at residency programs from California, Oregon, etc and learn about their programs. Interacting with the residents will also help give me an idea as to whether or not I could see myself working with them and people like them in the future. This is my trip to narrow down my list of places that I will be applying for residency.


In the upcoming weeks, I am going to try and explain somewhat about the applying to residency process, the match, etc. I hope it's not too boring, but it's a confusing process and this way maybe when I'm home at Thanksgiving or I mention something in an email while talking about what I'm up to that having read some of it first will make it less confusing.

First - as many of you know I am in my 4th and final year of medical school! woohoo!!!!! I have made my decision that I want to be a family physician. The next step in my training process is to apply to a residency in family medicine. This residency will last for 3 years and my training will be specific to family medicine (even though family medicine truly is a little bit of everything). But let's say I wanted to do surgery instead - I would apply to a surgical residency and start my training in surgery next year. That residency lasts 5 years.


A resident is a doctor, but they are still "in training." Residents work under attendings (doctors who have completed residency), so all of the steps a resident takes are overseen by another doctor. But...as a resident I finally will be able to admit people to the hospital, write prescriptions, and actually start to have my own patients. Slowly as a resident you build up your independence and are actually useful. The other big perk of being a resident is that you get paid...finally! Definitely not the type of salary people think of when they hear the word doctor - try about $40,000-45,000 for working up to 80 hours per week, with close to a quarter million dollars in loans with interest to pay off. Ahhh...the life of luxury.


So right now I'm starting the process of looking into where I want to apply to residency. I'm working on my Curriculum Vitae (very similar to a resume), personal statement (which is excrutiatingly painful, because all creativity I once had has been slowly sucked out of me over the last 3 yrs), and filling out the online application. I'm just at the start of the process, but am already feeling overwhelmed with the amount of work that needs to be accomplished in the next few months.

I'm off tomorrow morning! Wish me luck & I will fill you in once I'm back in Hershey :)

Friday, July 24, 2009

Yummy quick easy recipe

Creamy Spinach Ravioli

ingredients
2 pkgs (9oz) refrigerated cheese ravioli (i used some fresh chicken, mozzerella or something ravioli's from costco)
1/2 c. philadelphia chive & onion cream cheese spread (low fat) - i used the whipped kind. (also good on carrots & cucumbers)
1 c. milk
1/4 c. Parmesan cheese
4 c. baby spinach leaves
grated peel from1 lemon
6 cherry tomatoes

cook pasta as directed

meanwhile
place cream cheese in lg skilled. add milk; cook on med heat 1-2min or until cream cheese is melted & mixture is well blended, stirring frequently,
add 1/4 c. parmesean cheese w/ spinach, dill & lemon peel, mix well

drain pasta - add to cream cheese sauce; toss to coat, serve w/ topped tomatoes & some parm

I squirted 1/2 the lemon juice into mine

Goes well with a glass of wine and a girly movie (i watched bride wars)

Wednesday, July 22, 2009

Still Learning Bedside Manner

A doctor or student's bedside manner is something that develops overtime. I like to think that I have a decent bedside manner most of the time. This is the type of thing where I watch others to see what I can pick up in terms of things I would like to emulate myself and also habits that I hope to not mimic. It is part of the art of medicine and also I believe has a lot to do with one's natural personality. Bedside manner is something that is constantly growing and changing. I am changing as a person, my patients are changing, and so is the situation. The key is learning to try and gauge your patients, the situation, and knowing yourself make yourself be as appropriate, comforting, and compassionate as the situation allows. A doctor has to be adaptable and know when to be a hardass about certain things in order to get across the importance of stopping smoking, for example. It's a hit or miss type of thing and I'm learning as I go along. And let me tell you sometimes it can be funny...



A lesson learned tonight in the ED.

I was checking the function of cranial nerves on a patient. Often times to check the facial nerve (cranial nerve 7) which is in charge of the facial muscles by asking the patient to either smile or show you their teeth.

Here's how the conversation went this evening:
Jen: "show me your teeth"
Patient: "I don't have any"

Tuesday, July 21, 2009

ocean view

I feel as if I'm standing atop a cliff with the ocean waves crashing far far below. It has taken me the past 3 years to hike up to the top of this cliff and finally I can see the beautiful horizon. This year I get to stand here, atop the cliff and enjoy the feel of the ocean breeze upon my face and the gorgeous view. I have to enjoy it, because at the end of the year I must jump. Jump into the cool blue ocean below. I can land with a crisp clean dive enveloped by the welcoming water to start a new adventure or I could belly flop...ouch.

That's sort of how I feel. I look forward to this next year excited, but truthfully I'm scared. I have none to very little control over the next stage in my life. It's very scary that next year at this point in time I can honestly tell you I have no idea where I will be. From the places I currently have on my list of residencies to apply to - I could be anywhere from as far west as San Francisco, California to as far east as Chicago, Illinois! And the only control I have is to make a list of the places that interview me and hope that it all works out.

I keep telling myself that if I end up somewhere not as close to home as I would like - it's just another 3 years and it's another new city to explore. I'm ready to be back home, though. I'm tired of living my life in 4 year chapters.

Even though I'm scared, this is the year for me to live it up! I actually get my life back this year before I become a slave to the system once again.

Saturday, July 18, 2009

Family medicine

I have not been writing as much as I had hoped to recently, because I have A LOT on my plate right now in terms of things that need to be accomplished in the near future.
I have a personal statement to write, a CV to compile, a list of residency programs to narrow down where I will apply, and then fill out the application. So lets just say even though I am enjoying 4th year and relaxing some - I'm also still running around like a crazy person.
Starting my personal statement is what I have dreaded the most...and today is the day I am making myself start to write it.

I went back in my journal from when I had my family medicine rotation last July and thought I would share that entry with you now.

"So after 4 weeks in a family practice setting - could I see myself doing that for the rest of my life? I would say it is still a definite possibility. The reasons I enjoy it so much are the personal interactions, the extended relationship of knowing your patients for years, and the variety. When walking into a patient's room you truly never know what you are going to end up discussing. For example a young man came in the other day for an infected thumb wound, well before the visit was over we had a discussion about his pregnant wife and the fact that their baby failed the nuchal fold test (one of the possible tests for Down's) and the chorionic villi test came back normal. They are unsure if the nuchal test was a false positive or something else. Anyway - NOT what you would be expecting when walking into the room.

It's the trust & bond between the patient and the doc. The chance to make a difference throughout the patient's life. To be there during times of grief & there to share in their celebrations. To counsel, console, and educate your patients. Help them change behaviors for a more healthy lifestyle for the rest of their lives. I will learn from my patient's and their unique lives & backgrounds.

What do I worry about or the not so great aspects of family medicine? There is variety, but...will I get tired of hypertension, diabetes, COPD, etc? Will I be able to have a younger patient population in my practice? or do deliveries if I want to? Learning to and performing procedures is possible, but how hard is it to learn? Will I get bored? I hope & thing not, but it's possible.
Underserved, preventative, & women's health are where my interests currently lie. So much to learn & experience this next year. another exciting time is approaching - where & what will I be doing in 3 years? who knows? Anything is possible."


Well it seems it as all come full circle. Final decision is family medicine and right now I still would like to focus on women's health and preventative medicine. Lucky for me family medicine in the West is much more amenable to family docs delivering babies. :)

Wednesday, July 15, 2009

A summary of 3rd year!

Below I've copied & pasted an article from the magazine "The New Physician" put out by AMSA, a medical student association.
This article describes the experience of 3rd year almost perfectly. It's not as long as it looks.

"WORD FOR THE WARDS

An open letter to third-years
The New Physician, July-August 2009

by Jessica Yeatermeyer, M.D. Volume 58, Issue 5

Dear Rising Third-year,

You deserve a pat on the back. You’ve maneuvered through your first two years and you’re well on your way to doctorhood. Nicely done. But before you’re jettisoned into the clinic, it’s only fair that you take a minute to reflect on the incredible (read: insane) things you’ve accomplished thus far. You played “Where in the World Is Carmen San Trochanter?” with every tiny groove and bump on every bone in the body. You went spelunking through every hole—excuse me, foramen—in the skull. I mean cranium. Or is it the calvarium? One’s anatomical prowess wanes as the years go by. You carried the stench of formaldehyde home to your loved ones and talked about interesting lab dissections over pot roast and mashed potatoes. And you grew to think there’s nothing abnormal about that kind of dinner conversation.

You sat through hundreds of hours of lectures given by immunologists contorting themselves into fairly convincing antibodies, and pharmacologists cracking beer jokes. You worked your way through cleverly crafted cases about Diabetic Dan, Lead-Poisoned Lilly and Atherosclerotic Alan and all the other alliterative characters intended to keep your humanity intact. You became well-versed in the hypers and hypos and pneumos and hemos and -itides and -oses and -emias. You learned to refer to red bumps as erythematous maculopapular lesions. And you valiantly battled the boards and came out unscathed, thanks to a little First Aid and maybe some under-the-table methylphenidate. In short, you ducked and covered and summoned the will to push through.

Now you get to don your freshly pressed white coat and march into the clinical world armed with an inflated vocabulary and the admirable desire to make a difference. If you’re feeling both excited and on the verge of throwing up, then you’re right on track.

The third year of medical school is at once exhilarating and exhausting, fantastic and frustrating, and there are a number of other oxymoronically paired adjectives describing how it feels to be both overwhelmed with glee and flat-out scared shitless. Lodged in your brain you have a wealth of information, but there will be quite a few days when you will feel like you’ve been denied access to your own mind.

Don’t be alarmed. This is the nature of third year. You will get mixed up on rounds. You will mistakenly refer to potassium as vitamin K and then spend the rest of the day wondering if your attending thinks you bought your way into med school. You will know the answer to every question pimped at your colleagues and then come up short when the doc turns to you and asks where heparin comes from (hint: don’t say eBay).

You will try to present the case of John Smith, a 78-year-old man who complains of shortness of breath, and you will be cut off by your attending who tells you that you should open by saying, “He’s a 78-year-old man with a history of COPD who complains of shortness of breath.” Then a few days later you’ll present the case of Janet Jones, a 78-year-old woman with a history of COPD who presents with shortness of breath, and another attending will chastise you for giving the past medical history before the chief complaint. You will be asked if your patient is on Zosyn, and you will say, “No, he’s on piperacillin-tazobactam,” and then the whole team will stare at you while you pull out your Pharmacopeia and blush at your mistake. And you will most certainly contaminate yourself in the OR. And even if you think you didn’t, even if you know you didn’t, you won’t argue with the scrub nurse because you will never win. These things will happen.

But there will be good days, too. You will find mentors in the physicians who lead your teams, and you will find reassurance in the residents who are just a few years ahead of you and remember what it’s like to feel superfluous. You will meet nurses and ancillary staff with years of experience and invaluable tricks-of-the-trade to impart, if you’re smart enough to listen. You will get better with your hands and sharper with your mind, and you will learn how to sleep when you can and chug the caffeine when you can’t. And, if you really make yourself present and available every day, you will find that you’re not superfluous at all, that for at least one of your patients, you have been the difference between a loathsome hospital stay and a patient-centered health care experience. These things will happen. This is the nature of third year.

But it should be more than all of that, too. For the first time, you will get a glimpse of your future life, what it really means to be responsible for another person’s well-being, and perhaps for the first time you will question whether or not the practice of medicine is a responsibility you want to take on, or whether you’ll ever feel worthy of the challenge. Don’t ignore these thoughts: They’re just as important as the rest of it.

The clerkship year is as much about self-discovery as it is about intellectual advancement. It’s 12 months, six blocks, five hospitals, 40 nights on call, dozens of mentors, a handful of sympathetic classmates and innumerable encounters with patients. The common denominator is you. You have 52 weeks to decide what you want to do with your life and, more importantly, how you want to do it. Learn the medicine, but take a shot at imagining your future in the world of medicine. Talk to residents and attendings, soak up the culture of academia and venture outside of it, and try to remember why you came here in the first place. What you’ll find when it comes time to trade in your short white coat for a long one is that your medical acumen is absolutely dependent on your personal growth; one can’t evolve without the other.

So embrace your third year—all of it. It doesn’t have to be perfect. It won’t be perfect. The goal is to come out feeling that it was worthwhile and that you, in at least some small way, are better for having gone through it. This is the nature of third year. This is the nature of medicine in general. Welcome to the inside."

Saturday, July 4, 2009

Exciting things!

First Happy 4th of July! I hope everyone has a wonderful 4th, celebrating with family & friends. I will be celebrating in Philly and no I will not be going to see the Liberty Bell, but will be sure to see fireworks!

There is more for me to celebrate, because this is my 1 weekend of summer! Yesterday marked the end of my 3rd year of medical school (assuming I passed the test I took yesterday). It's kind of scary that this time next year I will probably in a hospital on call, wearing a long coat, taking care of patients, with an M.D. behind my name and have some actual responsibility! Ahhh....
Until then 4th year shall be amazing. I will write more about the amazingness of 4th year later.

The other excitement in my life is .... I have a new roommate! We've only lived together for a week and so far, so good. I'm super excited for my new roommate who is Arabic and can cook and bake like a 5 star pastry chef. Seriously he (yes I said he) makes the most AMAZING chocolate cake with caramel filling and chocolate ganache that I have ever had. Of course he makes everything from scratch. I'm still trying to convince him that in the future he needs to make my wedding cake (which he has done before). I've had one cake baking lesson from him last year and there are many more in my future. Below are pics from the my first lesson (it tasted much better than it looks)

1st layer of chocolate...


action shot of my roomie spinning the cake & cutting it so the edges are all even!


ta da! Afterwards I practiced my writing skills to finish the decorating.


I actually have a list on the fridge of all the things he needs to teach me how to bake. I'll blog about them as it happens. He brought with him the greatest kitchen tool of all time...




And of course since he is a guy that automatically equals a TV larger than anyone truly needs & lots of speakers. Apparently my house now has surround sound and a playstation 3 on which I can watch Blue Ray DVDs assuming I can figure out how to work all of the remotes! The new roomie also told me he almost died when he saw the number of channels I have...14. Hey, it's basic cable what do you expect!



So there is the excitment that is happening in my neck of the woods. Anything exciting happening with any of you? I'm sure there is...fill me in :)