medical school

(i kid, obv)

man now I wanna become a doctor

this is so exciting!

ERAS goes, it goes

need to gently prod at least one letter writer, tho

personal statement is....not complete

i think you just wrote your personal statement

behavior ("behavior") sits at an intersection of actual, real science-y science (BRANES!), sociocultural stuff, and hugging that i find v appealing

me too kinda but i think that's only because I've got no idea what I'm doing with my life right now. I'd probably get all As in a postbacc premed thing but I'd likely faint 30 minutes into med school due to weak constitution (7)

xp to dayo

xpost
It's all paperwork. Soooooo maaaaaaany people go to med school an no one tells them that they are primarily going to be administrators, and they have no aptitude for it.

haha my friend is straight killing a post bacc premed thingy right now, hopefully that translates into med school success

let us just be real that lots of thinking in a job sounds awesome. or is that the caricature of psychiatrists? either way, it sounds awesome.

― horseshoe, Tuesday, September 4, 2012 5:38 PM (7 minutes ago) Bookmark Flag Post Permalink

honestly, this is sorta what i had to face up and admit to -- psych seems like the 'easy way out' for someone with my, uh, personal sensibilities? like ok i will talk to people with problems all day, ok, fine, why are you paying me so much? i mean, ultimately, choosing psych sorta means choosing what plays to my strengths (and interests, obv) over what i think i ~should~ do with all this crazy training. i got honors in psych (BRAGGING) and was not even intending to (like, for real, i barely studied). but i know that some other students really struggled with it and/or hated HATED psych patients (sorry folks, but it's true). ...and i'm guessing the reason a lot of them didn't really like psych was because it was just a little ~too~ squishy; accurate diagnoses are hard and their criteria change all the time (that can't possibly be science!), treatment is rarely definitive (anti-depressants don't work basically half the time), and ewwww gross i don't want to hear about your icky relationship with food/sex/your dad/cutting/self-image/etc, just gimme something to TREAT, LIKE A BOSS.

english-lit-major-instincts die hard

yeah, but the psych rotation is, I think, the most important one for MDs, RNs, etc, because crazy people are everywhere. They're having babies and heart attacks and getting diabetes. Ya gotta know how to deal with them when they eventually make their way to you.

i was also just recently working with a 4th year med student who wants to go into psych. it takes a certain kind of person to want to do that kind of work. mental health is so criminally neglected as a part of health are and public health, i'm glad a good guy like you is going into it. plus, think of all the looooong notes you are gonna get to write :) congrats!

when in my next life i'm a doctor i'd probably choose to be an internist but psych seems like a great field with some great people

gbx you are a 4th year right?

yeah, but the psych rotation is, I think, the most important one for MDs, RNs, etc, because crazy people are everywhere. They're having babies and heart attacks and getting diabetes. Ya gotta know how to deal with them when they eventually make their way to you.

― kate78, Tuesday, September 4, 2012 5:58 PM (2 minutes ago) Bookmark Flag Post Permalink

this is otm imo. it's crazy how neglected it is by most students---right in the frontmatter of First Aid for Psychiatry (FA is a series of med student textbooks) it says something to the effect "hey we know all of you gunners are going to blow of your psych rotation because i mean c'mon, but fyi for most of you these six weeks are going to be the ONLY psychiatric/psychological training you get in your ENTIRE CAREERS and there is just no way to avoid people with mental health issues because a) they're everywhere (YOU'RE ONE OF THEM) and b) they look just like people, so at least pretend to give a shit ok"

xp 5th year, but yeah: residency app season opened up a few days ago

now I imagine a psych rotation as staring into the abyss and the abyss staring right back

english-lit-major-instincts die hard

― horseshoe, Tuesday, September 4, 2012 5:58 PM (7 minutes ago) Bookmark Flag Post Permalink

p much. some of my favorite classmates went into psych last year, and they were almost all "non-traditional" students: older, degrees in the humanities, not v gunnery, med school was more like a job than College Part II (ie - didn't socialize with the 'class' much, had more friends outside med school than within it, etc).

Here are the 2 questions I ask any new patient to determine if they are crazy or not. It is sure-fire:

1. Do you have any allergies? (if they report they are allergic to more than 3 things or "every antibiotic", they are crazy)

2. Is there a history of mental illness in your family? (if no, IT'S THEM)

now I imagine a psych rotation as staring into the abyss and the abyss staring right back

― USADA Bin Dopen (dayo), Tuesday, September 4, 2012 6:06 PM (1 minute ago) Bookmark Flag Post Permalink

well it could be if you're on the psychosis ward

BOOM

(just a bit of fun, etc)

xp ha, i like that kate78, and am totally stealing it, my EM attending will eat it up.

what's the earning potential like in psychiatry

depends entirely on beard length & style

I think Psych tends to be on the lower end of avg salary (which still means a median of like $150,000) because talking in general is really poorly reimbursed (which is why so much of talk therapy is done by Psy.Ds or paid privately, because otherwise it is sort of fiscally difficult to make your margins on 60 minute visits without procedures). But really the right answer is to do the thing you would do for a crappy salary (if your ginormo student loans were not an issue).

Also I am at a VA right now and it is my dream of dreams to set up a Med-Psych unit, because there are way too many dudes with significant comorbidities in one who come in with some acute problem of the other (e.g. schizophrenics with AKIs, people with metabolic syndrome issues that are prob associated with their atypical antipsychotics), and they go to medicine because Psych floors aren't equipped to do a lot of basic medical floor stuff, but the medical floor staff is also poorly equipped to deal with crazy dudes being all crazy, so they just snow them or restrain them or whatevs until their medical issue resolves. I basically babysat a dude for four days with an AKI he got because he wasn't eating because his medication was super-overkill and he just slept all day, and only after his Creatinine was acceptable could he go up to Psych for proper medication management. I just want a place where Psych people can manage the Psych issues and medicine people can manage the medicine issues and ideally they both learn from each other.

totally and this sort of speaks to the need to actually teach non-specialist HCPs to be confident with these disease states so these management/handoff problems aren't so pronounced - as i sort of alluded to earlier, mental health is too often seen as separate from ~health~; and as gbx and kate said, the relatively little enthusiasm w/ which practitioners-in-training approach their psych month (and the fact that most get ONLY a month; for us pharmacists it's not even a requirement during clinical year) leads to the fragmenting of care for these people who are often complicated, both mentally and physically. leads to wasting of time (and $$) and isn't best for patients

i know you are kind of joking but i know non-crazy people who are legit allergic, like throat-closing-up allergic, to more than 3 things
xp

tbh i have little sense of humour when it comes to the issue of mental illness/"crazy" as considered by the mainstream medical profession let alone general society. but i know doctors gotta joke... often morbidly...

:-/

gbx psych seems p awesome to me

Hey, good choice.

I like psych a lot, that's what I was leaning toward at first. Read a lot of psychology / Freud / etc in undergrad, loved it. Eventually opted for neuro b/c I like the anatomy and (potential) precision. Also I found the worst-affected psych patients were too crazy to have much of a conversation with (this was no doubt influenced by the fact that my clerkship rotation was on a locked inpatient ward). In the other non-procedural and talky parts of medicine (neuro, geriatrics, GIM...) you meet all sorts of people with mental health issues (as you well know) but more of them are more normal, and more reachable in conversation, which gives me a chance to connect/persuade in the clinical half hour.

Have you read Tanya Luhrmann's "Of Two Minds"? She's an anthropologist, spent a couple of years training as a psych resident ca. the late 90s, at the cusp of the SSRI / atypicals sweeping in and marginalizing psychotherapy. My main interest was psychotherapy, and I saw the same trend, which was another strike against psych for me.

I still love psych cases. My main interest in neuro is non-neurological neurology: pseudoseizures, psychogenic movement disorders, functional weakness, and subjective symptoms without underlying pathology (this is a huge category, includes migraine and all its many branches). My most involving cases almost all have a psych flavour. They're often very frustrating, because the psych situation presents with neuro phenomenology and usually resists treatment from either end, but I love them nonetheless.

The point about multiple allergies is that they often correlate with a general sensitivity in the patient, who may be more likely to notice/report symptoms of any sort.

Very few of the allergies listed on medical charts are anaphylactic or otherwise medically significant. Most are intolerances or typical side effects (many people list allergies to morphine and other opioids because of sediation or delirium or even nausea/vomiting). Some are seemingly offered for secondary gain (patients who report anaphylactic reactions to all non-narcotic pain medications when presenting to ER with severe pain). A few suggest the patient's understanding of their health is not going to be easily mapped with my usual compass (the many people who tell me they are "allergic to toxins" or "sensitive to all medications").

(As a side note, a major goal of the move to electronic medical records and other forms of safety-conscious checklist medicine is to make sure that all allergies are recorded and reviewed at every encounter. This is a huge investment of time and energy in information that is usually dubious at best and of little or no clinical relevance in almost all cases.)

It's fairly well understood that there are neurological correlates for a state of central hypersensitization, which can apply to sensory symptoms of all sorts. Hypersensitive patients are more likely to experience and/or report severe headaches, chronic/recurring indigestion and abdominal pain, painful menstrual periods, aching muscles, tingling numbness, motion sickness or chronic dizziness, and allergies of all sorts. Most (but not all!) of those symptoms are not associated with significant underlying pathology, and therefore are given syndromic diagnoses like migraine, irritable bowel syndrome and fibromyalgia. As a neurologist I tend to think of all of this as being in the broadest sense migrainous -- related to dysfunction of otherwise intact neurological structures.

A patient with multiple allergies is more likely to present with (often, multiple) symptoms that will not be easily explained by objective tests. It is usually harder, in medicine, to prove that nothing serious is going on than to figure why something serious has gone wrong. Ambiguous symptoms can be time consuming and frustrating to assess in detail, especially if the (sometimes unfair!) expectation heading into the encounter is that there likely will be nothing to find. Many doctors/etc are impatient types and have a low tolerance for ambiguity. Thus the mordant (not morbid) humor.

Rules of thumb I have personally found useful:
-- A patient wearing sunglasses indoors will have a normal exam
-- A (non-pediatric) patient with a stuffed animal on the bed will have reassuring test results
-- A patient who comes to ER with a suitcase (one of mine last week brought 2 cardboard boxes of stuff, like she was moving into a dorm room!) may not necessarily need to be admitted after all

ah, what i was saying is that *i find* that sense of humour morbid (dark, disturbing, unhealthy) in that "crazy" is so often used as a dismissal rather than a window into further inquiry - sarcasm is one thing, but it's disturbing in that even if doctors in this thread (jokes are jokes i realize that) don't necessarily dismiss people's health concerns due to "crazy," many people do, doctors or otherwise. psych ward patients are one thing, of course, but it's worrying to me that docs would and do jump to "crazy" with people who have a referral to a specialist, who happen to present a few markers of mental instability or simply don't express themselves well in speech or can't focus their thoughts in a situation where an authority figure has (what the patient perceives to be) most of the power. or etc. I just think it's unfair that some doctors do at least initially paint people as normal or crazy, easy to deal with or overly sensitive/reactive, when there is such a broad spectrum in between. I would assume that psychiatry is more about examining that spectrum and breaking down the stigmatizing normal/crazy dichotomy.

It's definitely a spectrum / continuum, not a dichotomy. Didn't mean to imply otherwise. And certainly patients who seem difficult to doctors deserve the same high standard of care as everyone else. I don't dismiss their concerns, I spend a long time listening and document everything they tell me in detail.

It is a fact that doing so is tiring and more difficult than dealing with people who are more straightforward. That's one of the challenges of the job, I don't mean to whine about it. A major part of my job is seeing patients that other doctors find difficult to figure out for one reason or another.

I would guess that most other service industries make jokes and tell stories about demanding and difficult customers/clientele. Medical workers are not unique in this regard, but the fact that they're dealing with the health of their patients makes inappropriate joking that much more offensive, I agree.

sooo....surgery is awesome

(nb - we have a very strange 3/4 yrs here, where it is common not to get core rotations until your 4th year. like, i'm doing surgery now, and still have OB and the second half of internal medicine. its stupid.)

i'm in my first week at the Top Secret surgery-is-fun site (only 2 students, doesn't host a residency). first assist in pretty much anything you can get into (which is basically anything you want cuz, you know, only two students at a tertiary care hospital), all the attendings are ~really nice~ (friendly pimping, esp since there's no fellows or residents to embarrass you in front of), you only have to pre-round on patients you've scrubbed in for (and there's a lot of outpatient procedures...so, often it's zero to three ppl you have to see), formal rounding with students happens ONCE A WEEK (but it happens randomly, so you still need to be on the ball), call ONCE A WEEK (and you can choose the night...and call ends at 10pm!). we have also been assured that, by next week, we'll be "cutting," and that by the end of six weeks we'll be "doing surgery." i did a skin closure (sub-cuticular) on a open inguinal herniorrhaphy this morning (my third procedure of the clerkship), and i got to drive the camera during this afternoon's lap chole

oh and no weekends

http://gifsoup.com/webroot/animatedgifs4/1324222_o.gif

do you get to ride unicorns on yr lunchbreak y/n

no but the hospital IS connected by SKYWAY to a place that has a "global market" food court with a bunch of independently run shacks or w/e where you can get basically anything from african to vietnamese to middle eastern food.

also the hospital has a 24hr mcdonald's

in it, physically

if you're hi rn and making all of this up I'm going to be upset

I am intrigued to hear how it stands up to psych! I guess quite differently...

if you're hi rn and making all of this up I'm going to be upset

no way lady, real talk

then u are living the dream, my friend

I am intrigued to hear how it stands up to psych! I guess quite differently...

― obliquity of the ecliptic (rrrobyn), Thursday, September 27, 2012 7:04 PM (1 hour ago) Bookmark Flag Post Permalink

romulus and remus imo

i decided today that they are very similar in at least one respect: both have, at some point, and in some way, relied on tautological criteria for intervention. according to my psych attending, the diagnostic criteria for depression include (or included at one point, either in the DSM or by convention) the stipulation that the patient "responds to anti-depressants." whatever you say, doc.

similarly, some surgical procedures are diagnostic in and of themselves, and only justify the intervention retrospectively. "hmmm this guy sure seems like he has appendicitis, let's do an appy." *nope* "welp (~watches the Days Without Unnecessary Surgery counter roll back to 000~." *yup* "i knew it!"

i like to think of it this way: a guy's in clinic and an x-ray (let's say for lower back pain) turns up a square intra-abdominal object as an incidental finding. he is referred to a surgeon ("cmon the dude's got a thing in his belly!"). he evinces zero abdominal symptoms, per se, but the surgeon thinks, maybe, that he could have cats syndrome ("i mean, i know it doesn't seem like the ~classical~ presentation of cats syndrome, but what if it's an aberrant presentation?").

a procedure is performed.

the surgeon locates the object---a clasped metal box---and removes it from where it was seated under the liver. down in the path lab, the box is opened. the lab decides to adopt the kitten, naming it goljan. the surgeon receives a text page, "you were right: cats", and pumps his fist out the window of his sedan.

"i knew it!"

nb all doctors everywhere do "diagnostic interventions" a lot, it isn't limited to those two (nor are they Bad For Your Health). but for some reason i feel like "...holy shit it worked" is very slightly more endemic to surg and psych than other specialties. whereas in neurology they tell you EXACTLY and in great detail what is wrong with you and then shrug and go write a paper about it (BOOM!)

nb nb i'm not really this flip about people's health, btw, but this thread and a handful of friends are where i feel comfortable with some levity

Your search - "evinces zero abdominal symptoms" - did not match any documents.

Everyone has symptoms, there's always going to be symptoms in cats syndrome, that's the diagnostic hallmark. Wouldn't be much of a syndrome if there were no symptoms or signs.

In neuro we can sometimes say exactly what's wrong, but a lot of the time I'm more like, "yep, that kind of thing can happen in a normal brain, it's just changing up tricks on you, nbd, hang in there champ".

I like the idea of cats syndrome

Patients suffer terrible disfigurement, sometimes permanent.

http://the-void.co.uk/wp-content/uploads/2008/06/CatsTOP.jpg

hey geebs and others: can i ask a semi obscure health/surgical question here and get directed toward answers? i've tried the vast array of med website symptom porn out there, trust.

I figure it is reasonable to provide a forum for that and for me to be all bitchy about residency (I had to do a random night float yesterday u guyz, I was very sleepy and had to do a wad of admissions): The thread where we are physicians (and/or surgeons)

Also really maybe I just want to have this thread to hear stories of ERASing and interviews and such