Tuesday, September 24, 2013

A pre-med student asks some probing questions

Here are some questions from Lionel, a pre-med student.

What is something you wish you had known before entering medical school?

It would have been nice to have known what changes were going to occur over the 40+ years since I graduated.

If you had the opportunity to choose a specialty all over again, would you do surgery again?

Yes. While I have often envied the controlled lifestyles and flexibility of radiologists and anesthesiologists, I don't think I could have stood the sitting in the dark all day (radiology) or utter boredom 95% of the time (anesthesia).

If not medicine, what other healthcare occupation would you consider to be more rewarding?

It depends on how you define rewarding. It seems to me that being CEO of a hospital is more rewarding financially these days. I have blogged about that. Is it more satisfying on any other level? I don't think so.

Is it possible to carry a healthy relationship where the significant other is not a medical student? Would it be more/less difficult in residency compared to medical school? [this is one I'm mostly interested in especially since you are a surgeon]

I am living proof that it is possible to have a healthy relationship with someone who is not a med student or physician. I met my wife, who is a nurse, when I was an intern. We were married when I was a third-year resident and still going strong at 39 years.

What implications have enduring medical school/residency had on your personality?

I was always kind of a pessimist, but med school and beyond amplified that trait a lot. As some people have written about lately, med school and residency can induce cynicism, and I'm afraid I am a classic example of that.

Does every single day of the year feel stressful or are there days where you feel in control and free to relax?

Since I retired late last year, the days are not particularly stressful right now. When I was an active surgeon, just about every day was very stressful. It took at least the first five days of every vacation to unwind, longer if I had gone away and left a sick patient to be managed by someone else. Here's a link to a post I wrote about "collateral damage," which is about how complications affect surgeons.

I have always dreamed that being a physician would help me feel more connected spiritually to god/universe by seeing all the unfortunate people and being able to lend compassion. However, does being under constant stress distract a physicians focus from that feeling and does it make you just want to finish the job and go home?

There were many days when I just wanted to finish the job and go home. I would like to think though that I was able to get past that and offer my patients the compassion and support they needed.

What do you like/dislike the most about your journey thus far?

I liked the challenge of figuring out what was wrong with a patient and having the ability to fix it. I liked the feeling of satisfaction after helping someone who was really sick get better. Today I got an email from a former patient who is 10 years postop from breast cancer surgery and disease free. Hearing that is hard to beat.

I took every complication, whether it was my fault or not, very personally. That can wear you down. I didn't like the empty feeling that I got when I operated on a patient and found something like incurable cancer. It was frustrating not to be able to do anything about it. It is very hard to look someone in the eye and tell him that the surgery did not solve the problem.


  1. As I prepare to go out this morning and teach our first class of first year medical students, I find myself profoundly disappointed in the limited scope of ideas and possibilities in this commentary. My advice to pre-meds and early-meds is quite different. I will check in again after class and elaborate, but one thing that strikes me early and often, and again in this piece, is the notion that it's even desirable for doctors to marry doctors. My med school boyfriend became a surgeon and I did not and could not have married him. My husband is a Renaissance man--his background is philology, linguistics, computational linguistics, and artificial intelligence. (We met at a Medical AI Panel Discussion planning meeting at Apple Computer.) For, as that irreverent classic, "House of God" by Samuel Shem says, with regard to two residents' ROR (relationship on the rocks), "What erectile tissue can support two residencies?"

    Beverley Kane, MD ... whose road not taken is CGI for Industrial Light & Magic
    Program Director, Medicine and Horsemanship
    and Somatic Horsemanship
    Stanford School of Medicine

    1. I am puzzled..

      The student asked if it was possible to have a relationship with someone who is not a medical student.

      I replied, "I am living proof that it is possible to have a healthy relationship with someone who is not a med student or physician.

      No one said it is "desirable for doctors to marry doctors."

      I hope you will return to clarify your comment.

    2. Seriously? Medicine and Horsemanship and Somatic Horsemanship? Please tell me my tax dollars are not in play here.

  2. This article is mostly misleading. Personally, I found the comment about other specialities, specifically radiology and anaesthesiology, most tasteless. According to the writer, radiologists are just "sitting all day in the dark" and anaesthesia is "utter boredom 90% of the time". No surgeon with a holistic professional experience would have written thus. It shows complete ignorance of modern medical practice, and no awareness of the roles of these two specialities and, probably, the other ones as well.
    Confining myself to anaesthesia, I can assert that current anaesthetic practice covers not only surgical operations, but ranges from trauma management to intensive medical care to pain management. For a competent and involved anaesthetist, the career is a fascinating and rewarding one.
    Boring? Anyone who interacts with an anaesthetist will soon be disabused of such a notion. I have never regretted for a single day my choice of specialisation as an anaesthetist. On the other hand, I am grateful for what this career choice has given me in life as a professional and as a person.
    Foundation housemen I have worked with have always been much impressed and attracted by this speciality.
    I earnestly hope the erroneous comments in the article do not lead astray prospective medical students and those planning post-graduation.
    Dr Sriram Gurumoorti,
    Nottingham University Hospital,
    Nottingham, UK

    1. I appreciate your comments. I'm not sure what it's like in Nottingham, but here in the US, we tend to tease each other about our respective specialty choices. Most people don't take it seriously.

    2. Yes and it's due to arrogance. MDs and particularly surgeons have been some of the most narrow minded, arrogant people I have ever met in my 53 yrs. The advice I give my A&P students is to avoid becoming a self important jerk while going to med school. Dr Skeptical, you are a good example of what I am talking about.

    3. Interesting that your comment is the same type of sweeping generalization that others have accused me of making. I suggest you lighten up a bit.

      Another way of registering your displeasure would be to stop reading my blog.

    4. Peter J Stanton, DC may only have a subluxation to blame for his attitude. Nothing a good old adjustment will cure. It's certainly much more broad-minded to consider the spine the root of all disease.

  3. I my rush to get out to class, I extrapolated the question about med students pairing up with med students, or non med students, to the predictable dating sequelae of doctors marrying doctors. Revisiting the question as originally posed, the same principle applies: med school often being a stressful, artificial environment, it might be -preferable- to date someone with a different lifestyle.

    Taking a broader, out-of-the-box approach to the initial question, "What are some of the things that you wish you had known before entering medical school," here are a few things we said to our students this morning in Medicine and Horsemanship (a class that teaches dr-pt communication, teamwork, and leadership with liberty horses):

    1. Your career choices may change radically during your years in training and beyond. Don't feel that you are locked in to one decision or one speciality, in or out of medicine, for life.
    2. As a physician, one of your chief duties to your patients is making yourself an example of body awareness, self-awareness, and self-care.
    3. While many profs, attendings, and colleagues will try to make you "wrong" or looking foolish during your career, you have to develop the courage of your convictions, the positive self image, and the inner strength to make your relationships with patients primary, not the pimping or put downs.

    (#2 and #3 are what the students learn from the horses and what they might not hear any where else in med schoo--I didn't.)

    I also missed the keyword on "If not medicine, what other ***healthcare*** occupation would you consider to be more rewarding?" In any case, the question invites the broader inquiry and response in consideration of rewarding occupations outside of medicine, as chosen by William Carlos Williams, Anton Chekhov, and Senator Tom Coburn.

    1. Thank you for stopping back in. I am trying to be the Anton Chekhov of the early 21st century. Even Anton had to start somewhere. If he was just starting today, no doubt he would be a blogger.

    2. I entirely agree with Dr Gurumoorti.
      As a simple measure, Anaesthesiology is the biggest department in most hospitals, ample evidence of its essentiality.
      Humour? Well hidden, I should say. Sounds more like a pathetic excuse for a joke that backfired.
      In my speciality, it is well known that insulting jokes are made only to insult.
      Even if I wish to joke about surgeons, I would hardly call them butchers.
      Nasty jokes are just that- nasty.
      Dr T R Suresh, Psychiatrist, Chennai, India

    3. T R, where did I say that anesthesiology was not essential? I know of no hospital in which the anesthesiology department is larger than the departments of internal medicine or surgery. I challenge you to name even one.

      I am sure you realize you insulted all surgeons by calling us butchers while cleverly saying you would not do such a thing.

      I invite you to join Mr. Stanton (above).

  4. Ah, it does hurt when it strikes closer to home, doesn't it! Good to see you are more sensitive when it concerns your speciality. You should rather lead where you suggest to join.
    I meant anaesthesia vis a vis specific departments, not the combined medicine or surgery.

    1. It doesn't hurt at all because I can take a joke, even a bad one. I was merely pointing out your inconsistency.

      General internal medicine is a specific specialty.

  5. I am a med student and would like to thank Sceptical for an honest review of things that med students wonder about. Arrogance is not confined to a speciality, but apparently humour is. It is kind of sad that the doctors we as students look up to seem so small minded that they cannot take a jest in good humour. Seriously - grow up, sirs. As for anaesthesia being the biggest dept - I call BS and I am just a student...

  6. Anon med student, what can I say? You "get it." Thanks for commenting..

  7. I was procrastinating in my usual way, Twitter, and discovered this blog. I'm glad to see that comments are just as misguided here as they are on any other blog. Good reading and I'm glad someone in the profession is taking the time to do a good blog.

    1. Ryan, thank you. I hope you'll keep reading the blog.

  8. Easily the most entertaining blog-commenter exchange/squabble I've seen for some time.

    1. Thank you. I do try to be entertaining.

    2. It is interesting how "Skeptical Scalpel" is blasted by people who take offense to his humor. I recently went to a pain conference where a radiologist gave great self-deprepacating humor on radiologist which did hold a grain of truth like SS has stated. She was willing to laugh at herself with us. When I sat on tumor boards one of the phrases that the ENT surgeon would always use with the chemotherapist was "What poisons are your guys wanting to use?" It was all taken with good humor. Medicine has to relax a little. Of course I am not a doctor, but being a nurse has given me a lot of insight into the field.

    3. Thanks for the kind comments. I think we all shouldn't take ourselves so seriously.