The International Aspect

International education: what gives?

Though I'm hopelessly poor in international experiences, I do hold the belief that they can be vital to a person's resume, no matter what career they go into. I went to a college that stressed international education. In fact, its study-abroad program was basically its selling point, as it is one of the nation's better-known schools for having a large proportion of its student body study abroad (about 50%). That said, I was in the 50% that did not study abroad, and do I regret it? Not really.

My Mother came to the United States in the 70s from Indonesia along with her immediate family. Some other 1st-generation immigrants from her family are here in the States as well. I grew up around both my father's "American" culture and my mother's "South-East Asian" culture, being exposed to the practices, customs, and languages of both. However, I've been largely assimilated into U.S. culture, as I hardly know more than 3 words of my Mom's native language, and can only barely point the country itself out on a map (yeah, it's the one that shares an Island with Papua/New Guinea).

Anyway, other than being a hybrid of Chinese and White by blood, I'm a very American guy. I've had many friends/acquaintances go abroad for 3 months during college to...Dominican Republic, Ethiopia, China, Germany, even Peru. Their experiences have changed them and have been very valuable. I envy the clinical experiences they've had and the languages they've learned. But strangely, I feel right at home with the path I've taken. I've spent my summers doing research and my semesters loading up on the science courses I've needed.

Ultimately, I used my extensive research experience as my pitch to the admissions committee. Not every single person needs to boast working an AIDS clinic in Sub-Saharan Africa, right? It's a plus, but (at least not yet) it isn't an un-written rule like hospital volunteering is.

But just how important is the international experience? While shadowing the ophthalmologist last Thursday (who graduated from my college as well, albeit awhile ago), he asked me the dreaded question, mid-operation mind you: "So where did you go for your Study Service Term?"

"...Actually, I didn't do it. I took the alternatives instead."

"[Just about jabbed the sedated patient's eye with his scalpel] Are you kidding me? Yuki, Yuki, Yuki!"

The usual question, usual response, usual shocked answer. He wasn't actually upset, I mean it's my life, but he made his speech about how his time in Central America was so pivotal to his identity as a doctor.

"Down there...you practice real medicine. No bureaucratic systems or endless paperwork to get in your way; you do medicine on needy people and get to the heart of what it is all about. Only there are you a real doctor."

Yes, yes, I know. Things are different out there, outside the high-gates of this magical country stained with power-politics and malpractice suits. He kept telling the other docs that I was going to become a "missionary doctor", as if to poke fun at the fact that I've done nothing outside of the U.S. I didn't take offense then, and don't now, but he was just another person laying into me for not going abroad during college.

Is it that important? I don't doubt for a second that the experience is valuable...to understand another place, another culture, another people. Places where 911 doesn't get you to the nearest ER within 10 minutes, places where insurance is a foreign concept and places where germ-theory hasn't yet permeated common knowledge. I'm aware of this, and while brute knowledge/awareness is no substitute for experience, I'd say I'm more culturally sensitive than a lot of other pre-MDs I know. Unless driving the 2007 BMW your Dad bought you to school, and complaining about how "hard" life is at your $850/month 1 bedroom apartment on the Canal constitutes cultural sensitivity. Not every medical student is like this, but they do tend to come from higher tiers of society and these attitudes have been seen again and again.

But again, being an American citizen going to an American medical school to practice medicine in America for your entire life, will having visited or not visited a foreign country prior to medical training affect your skill at practicing medicine? America does have a great amount of immigrants living in it from every conceivable location; no matter what kind of doc you are, you are going to work directly with patients and patients come from everywhere. Just as with many other careers, inter-cultural awareness/sensitivity is important ("Diversity Training" on that show, The Office). Yes. I know this. Perhaps it is even more important in medicine because of the relationship you establish with your patients and the diversity of beliefs as they pertain to medicine found around the world.

I'm not sure what the general consensus is out there, but in the bubble that I've grown up in, people seem to think that your ability to practice medicine is directly proportional to how much international service you have done. I'm sure there are many great docs out there who have never left their state! I'm sure there are radiologists and pathologists out there who do impeccable work, never having spent a second serving in a foreign country. I'm also sure there are docs from this same pool who have spent time abroad and feel that it has helped them become who they are.

I think it is just a personal choice and that everyone has a different path. Sure, if I had spent time in Peru volunteering at a Peruvian hospital, I'm sure that my perspective on the human condition and patient care would be more broad today. But, won't I get the same training as the guy next to me who spends every other week in Haiti? I'll do schooling and residency and develop the skills needed to become an excellent physician. It all comes from within. Anyone reasonable enough to get into medical school has to have enough reason to acquire cultural sensitivity throughout their training and practice.

Bottom line? I agree that international experience can really help a physician have a wider perspective. But not having that experience can't hurt you if you work hard and do your part to become a great doctor. There's enough work to do in American health-care. This is where I ultimately want to practice. Can't I just focus here and not be hassled?

Light Shed

Well, since my post on Anesthesiology, I have had some light shed on the subject!

First, through an unexpected (but greatly appreciated) comment from an actual anesthesiologist, I got feedback on my post and then read her extremely informative post. The post is the result of her frustrations with the general misconception (even by other physicians) about her profession/specialty. Really informative and insightful stuff; just what I was looking for! Read it here.

The other aspect of this is when I shadowed an oculo-plastics ophthalmologist the other day. He is a friend of my friend, so I guess I'm connected to him by two points. Anyway, there was an anesthesiologist present during some of his cases, so I had the chance to talk to the gas man himself! It wasn't a very long interaction, but it was useful in any case. I also got to talk with a pathologist, who seemed quite happy tucked away in his nice office, far from the buzzing, meat-moving flow of the rest of the hospital. A few histology slides later, and I was on my way back to the O.R. to watch more eye-lids get slashed open.

Anyway, it goes to show. You must mature a lot during medical school; the exposure you receive, the blood and sweat you suffer, the time you spend, and the experiences you have probably all act to guide you into your own little niche. And as I've discovered elsewhere in life, things always change, and if you're up to it, they'll change for the better. I think the best I can do now is focus on the two years ahead...or perhaps just the month or two ahead.

Overwhelmed, but excited.

Countdown until day 1 of school: ~51 days

Skeptic

I'd have to side with Uncle Panda on the Chiropractic issue: Its junk science at best, and most likely just a quack/hoax to get gullible "patients" to cough up money for perceived symptom relief.

The very (shaky) foundation upon which this (undeserved and isolated) "branch" of medicine rests is itself laughable. Daniel D Palmer, back in 1895, created some theory that states that there is an innate life force which flows through all of your organs/tissues/cells via the spinal column. He said that 95% of ailments are the result of mis-aligned vertebrae, because the vertebrae "pinch" nerves. By performing physical manipulations on these vertebrae (vertebral subluxations), one can (supposedly) correct the nerve-pinching culprit and restore "flow" to the affected organ(s), relieving symptoms.

With over 60,000 licensed chiropractors "practicing" in the U.S., I'm sorry to see so much money being thrown at quacks. But aren't palm-reading, fortune-telling, and herbal-medicine shops still in business? Yeah, and that's the category that I toss Chiropractic in as well. The very nebulous nature of their catch-phrases (no two Chiropractors could agree on or tell you the exact pathology of subluxations and their supposed corrections) and reliance on high-frequency-return visits proves their illegitimacy as health-care providers. Food for thought:

There is plenty of room for the passage of spinal nerves and blood vessels through the fat-padded foraminal openings between the vertebrae. It cannot be imagined that slight displacement of a normal vertebra will place pressure on a spinal nerve. This was proven conclusively 25 years ago by experiments performed by Edmund S. Crelin, PhD, a prominent anatomist at Yale University. Using dissected spines with ligaments attached and the spinal nerves exposed, he used a drill press to bend and twist the spine. Using an ohm meter to record any contact between wired spinal nerves and the foraminal openings, he found that vertebrae could not be displaced enough to stretch or impinge a spinal nerve unless the force was great enough to break the spine [1].

Not only that, but time after time, investigators go to multiple Chiropractors and receive different results/treatments each and every time. One time I'm told my left leg is longer, another time vice-versa, and another time I'm told my bladder is going to be distended because my x, y, z nerve is pinched. You get the idea.

Baloney, baloney, baloney. You might get immediate relief, but that whole theory makes me annoyed.

And so, I'm quite a skeptic. Not to say that I refuse to believe in things that are not directly observable, but things like Chiropractic, acupuncture, ghosts, chi-manipulation...how can the masses fall under the opium so easily?

Anesthesiology: It Doesn't Fit!

I'd like to think that the universe is fundamentally based on order. The physicists have already tackled this question, from Einstein's relativity ("God does not play dice") to more modern quantum mechanics and its uncertainty.

Still, things tend to fit into a sensible world-view, right? Those who work hard get rewarded and those who are lazy end up on the bottom.

We all know that life isn't by any stretch of the imagination fair, and that the world often works in chaos-mode. Kids starve in Africa, bad things happen to good people, the hard-working go unrewarded and the hero goes unsung.

In medical specialties, I came to the realization that things do have an internal order. The specialties with a better lifestyle/income are predictably harder to match into because of competition resulting from too many students vying for few coveted spots.

"Better/Lifestyle" specialties equal harder to get while "Not-so-fun/lower-income" specialties *cough* Family Medicine *cough* are easy to match into because "nobody" wants them. It makes sense...work hard to match into dermatology, get the 9-5, Monday-Friday hours, no call, and (extremely) high pay. Screw around, mess up your USMLE Step I score, and get matched into FM with long hours, call, and lower pay.

But someone has messed up my lofty world-view!

Anesthesiology! You dastardly creature! I do not get you...

From what I hear, you are (relatively) easy to match into, pay well, have super hours, are definitely a "lifestyle" specialty, and don't even have many litigation issues. Wait...easy to match into? How does that work? One of my EM-bloggers, EM Physician, puts it so eloquently:

For one, [anesthesiology] was a very easy specialty to get into. Not a whole lot of butt kissing involved. The salary was great. The job market, wide-open. It was known as a ‘life-style’ specialty, which allowed time to enjoy life outside of medicine, and that appealed to me. Anesthesiologists only deal with one patient at a time, and they sit all day (and read magazines) behind the curtain. What a life!!

So that's what I hear...the 90% boredom, 10% super-crazy life of the anesthesiologist. And medical students don't know anything about the specialty unless they do a rotation on it during medical school. Is it a closely-guarded secret? Is it a conspiracy? Is there a hidden evil in the specialty that nobody knows about?

*shakes head* I just can't accept this. A lifestyle specialty like that, so easy to match into. What ails it? An uncertain future (all of medicine faces this, though)? Encroachment from mid-levels?

Anesthesiology, you puzzle me with your defiance of logic. At the least, you make me very curious. I do not know what I want to specialize in, but I hope to unlock your secrets one day. That's for sure.

Waiting

So I've been around the "blogosphere" lately, reading blogs from medical student to attending. I even ran across the blog of a girl who is a pre-med, detailing her daily life as a health-sciences student shooting for a spot at Medical School. For now, I am the only "MS0" blogger that I know of (that's MS-Zero; Medical Student, year zero, a denomination for those accepted but not yet started). There aren't too many MS0 bloggers, simply because it is a very temporary status that kids only ever have for perhaps 3-9 months.

I am finishing up my very last class for college, and I have to say it is a nice, refreshing break from everything else. One week from this moment, Wednesday, May 16th, 2007, I'll be officially in summer vacation at last! I plan on working only part-time at my research lab, then shadowing a few docs in (hopefully) some different specialties. Kids on Student-Doctor Network give the advice of shadowing while you can because, unlike rotations, you get a unique glimpse into physician life at a private/community hospital as opposed to a gigantic teaching hospital. Even as such, they make the important point that you can never truly step into someone else's job even for a moment. Think about watching a grandmaster play chess; you see him/her move pieces every once in awhile...easy job, right? The mental aspect of being a physician is probably far more than half of the job and its stresses. Watching an anesthesiologist sit in the OR might lead me to believe, "what an easy and boring specialty!" but I must remember that the anesthesiologist is (hopefully) running through 100s of scenarios in his/her head, utilizing the years of training they've received.

Nonetheless, I look forward to sitting around the local ED overnight or on a busy Sunday, seeing once again all the crap that Dr. Emergency has to deal with. I hope to see some oncology-related docs, as we have a very good cancer center in my town.

But you know what? At this point, you kind of sit down and breathe slowly, relieved, having passed the toughest part: getting in. I believe that those of you out there who really understand what you are getting into will be happy from that point on. Medicine's future is uncertain, bureaucratic systems and legalities creep in on all sides, but those of us with the fortitude to take the beatings and belief that this is what we are meant to do no matter what, will keep marching. Just read Hoover's article posted on medschoolhell.com to get an idea of how much you trudge through just to get in (and that's just the beginning of the floggings you'll take).

I think the best thing you can do as an MS0 is to mentally prepare yourself. And I do not mean studying Grey's Anatomy all summer. I mean:

-look into the field of medicine in general
-ask questions
-read through medschoolhell to learn about all the bad stuff in medicine
-search yourself
-meditate
-vacation
-see friends and family
-read the blog of the depressed ER doc who suffers multiple law-suits and burn-out
-search yourself again and ask, "am I ready?"

The idea is to realize that medicine is exactly what you want to do, and all you want to do. This is how I have arrived at the point where I am. I am, on some level, the doe-eyed, idealistic, hopelessly optimistic pre-med that everyone starts out as. At the same time, I am doing my best to keep informed, get different perspectives, and make sure that there is nothing else I want to do. Is there? Not a thing (besides "Lead Game Programmer" and "Rock Star"). These soul-searching questions are certainly things to ask yourself before you even apply; I did those things then. But just as much after acceptance and through the training process, these are things to always be aware of. If you can take it, warts and all, then you're one of the few who will lovingly shoulder the burden of medicine and commit yourself to a lifetime of its practice.

I got my class schedule...I start a week and a half earlier than I anticipated. I'm game, are you?

Con "grad" ulations

Graduation: I graduated from college yesterday (April 29th, 2007). A time for celebration, reflective thoughts, family, friends, and accomplishment! Yeah, OK. It was all that, but now it is over and I'm relieved because I can go back to sitting around and not doing anything while I await August. The count-down to when I move is at exactly 3 months now, putting the 2007-2008 school year well under 4 months. Scary to think about, seeing as I was a freshman here just yesterday.

I graduated from High School in the class of 2003, college in the class of 2007, and here I am entering the graduating medical class of 2011. I should really aim for a four-year residency so I can graduate from that in 2015 and call it good. Life comes in segments until you get to your career, at which point you have (assuming a stable one) an approximately 35-50 year block of time before retirement. Whatever, I'm going to totally do everything I can before mid-August. There's lots to see and do! And so, I am off. And no, that picture is not of me, and has nothing to do with my college.

Ignorant

I am ignorant and naive.

I do not have any first-hand experience in medical education yet, and therefore my blog is not even a real blog because I have no experiences to share.

Part of being prepared is to be unprepared and aware of this: thinking that you know what is coming is realizing that you know nothing.

I preach on and on about how "certain" I am that I'll go into Emergency Medicine. After thinking and meditating at length on the whole issue, I digress. I clear my plate. I still have a marked interest in that specialty, but I could not possibly have the knowledge to truly sway one way or another.

I am open again to anything and everything, to changing times, changing minds, and new experiences. I can safely say that certain things are ruled out, such as:

General Surgery
Psychiatry
OB/GYN
Ophthalmology
Dermatology

That's a start, right? But I'm going to go into this fresh, focusing on the pre-clinical years with USMLE Step I in mind and no further. I do not know myself just yet.