Originally posted on The Differential on September 3, 2008

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I’m sitting here in my room on the island of Kauai. It’s the week before classes resume and my second year begins. Coincidentally, I’ve met two of my classmates on Kauai within two days of arriving on the island.

Being this close to the start of a new school year, I can’t help but remember the feelings I felt before starting first year. I also can’t help but think about what I’ve learned during the first school year.

My cousin, who is now an OB/GYN, told me to just study like I did in college. Unfortunately for me, I hardly studied at all in college. I was in an undergraduate program that was heavily math-based. I used to cram and be alright for tests because all I needed to know were theorems and/or concepts. The rest could be figured out or derived during an exam. Medical school was a big shift for me because now the majority of my studying consists of rote memorization.

So, from the perspective of someone who has had his share of first-year struggles, here are some of the lessons I learned from first year.

1. Figure out your learning style and figure it out fast. This one seems like it’d be common sense. But sometimes students find out that their way of studying isn’t working and instead of changing their approach, they go at it harder. Personally, I felt that going to lectures helped me. But I know many of my classmates hardly ever showed up. If you thrive in a good group study, seek out some classmates and make a group. If not, then don’t be forced into one. However, even lone “study-ers” can benefit from the occasional discussion with classmates.

2. Seek help. Students who make it into medical school are used to being near, if not at, the top of their respective classes. It might be hard to ask for help. If you need help, put aside your pride and ask for it. At my school there are tutors available for the first and second year students. I think that if I had sought out a tutor, I could have had some better scores. Don’t wait until it’s too late to get help.

3. Make time to do other things. It’s really easy to get caught up with studying when the pressure starts piling up. But it’s important to remember to make time to do things outside of schoolwork. Volunteer to tutor high school students. Take up a new hobby. Continue an old hobby. Go to the gym. Or even go and volunteer at a free clinic so you can get patient interaction. Don’t let studying define who you are.

4. Study hard. Push yourself — at least through the first semester. Then, you can decide how much you can afford to pull back while still attaining acceptable (in your eyes) scores. It’s easier to “ease off the throttle” because you’re studying more than you need to, than to “floor the pedal” trying to catch up at the end of the school year.

5. Finally, visualize. Remember the reason you wanted to go into medicine. Don’t forget it. Then, picture yourself done with medical school and residency, and practicing medicine. Aim for that goal. Try not to let the stuff in between — the grueling hours of studying in medical school or running around in residency — get you down. They might be necessary parts of the journey, but they sure aren’t the destinations.

Good luck!

Originally posted on The Differential on August 25, 2008

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I’ve been obsessed with these Olympics. It’s been so inspiring watching the athletes compete. The last event I saw was the Women’s Beam Final where America, led by Shawn Johnson and Nastia Liukin, won the gold and silver medals. After Shawn Johnson won the Gold Medal, the commentator talked about her background.

Ten years ago she bounced into Chow’s (her coach) gymnasium and began training at the age of six. During those years of training her coach asked her an important question: How good do you want to be?

That is a question every athlete must answer for himself or herself. The top athletes in the world only want to be the best. And they put their whole soul into achieving their goals, putting in hours and hours of training every day. The answer to that question determined what kind of training Shawn Johnson would need; it dictated the course of her childhood, finally culminating in an Olympic Gold Medal.

A couple of weeks ago I asked why we, as medical students, should bother learning something we’ll eventually forget. A number of people commented and left what they felt was the reason for learning such things. And I think they are all very useful answers to this question.

For me, the answer is best phrased in the question I heard while watching the U.S. Women’s Gymnastics competition -– the same question Shawn’s coach asked her: How good do you want to be?

At the end of my first year I spent almost two weeks on the General Surgery service. On the last day I was there I spoke with the chief resident who was less than a week from completing his general surgery residency. He spoke about his training and how he felt it was very well rounded. Because he had to rotate through many services, he felt comfortable speaking to internists, neurosurgeons, orthopedic surgeons, radiologists, etc. Even though those areas were not his specialty, he knew enough to communicate intelligently about a patient. These days, with multiple teams caring for a single patient, effective communication between healthcare providers is crucial.

Someone commented that a doctor with a broad base of medical knowledge is a well-rounded doctor.

A well rounded doctor means better care for patients. And it’s all about the patients, right?

So… How good do you want to be?

I spoke with the one of the deans in charge of the School of Medicine’s graduate programs. We spoke about the program and I asked about the PhD and MS in physiology.

She said there are positives and negatives to science and a job as a scientist. One big positive is the feeling one gets when making a big discovery. There is nothing like it. Unfortunately, those times are rare and one must cherish and hold on to those special moments.

Then she asked me how I deal with uncertainty because, in her mind, there is quite a bit of uncertainty when doing research.

I told her that I wasn’t quite sure. “I guess I’m uncertain about uncertainty,” I answered with a chuckle.

By the look on her face, I don’t think she was too amused…

Originally posted on The differential on August 17, 2008.

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Like many Americans and non-Americans alike, I have been following the 2008 Summer Olympics. It’s been fun watching Michael Phelps grab a record 8 gold medals, Misty May-Treanor and Kerri Walsh dominate on the sand, and the “Redeem Team” (I’m not sure who came up with that nickname) led by Kobe Bryant and Lebron James handle business in the early preliminary rounds.

But it’s also been amusing to read the news about how Beijing has focused on putting on the perfect show. First there was news that some of the fireworks outside of the Olympic stadium were faked using the wonders of modern technology. Then I read that the cute little singing girl dressed in red was, well, just cute and little. She wasn’t actually singing. The real singer wasn’t “cute enough” and so the red-dressed girl was told to lip-synch.

It looks like China has been doing a whole lot to convince the world that all is well and perfect in their country behind that bamboo curtain. And maybe it is. But most likely it isn’t. Of course, I have yet to find any place on earth that is perfect.

The whole idea of projecting perfection, though, reminded me of some of the things we discussed in class. One professor noted that doctors have this strong desire to stick together. They want to give a colleague the benefit of the doubt. As a result most doctors are very slow to offer any criticism, often exercising their right to remain silent because they weren’t present during the procedure.

I think that giving the benefit of the doubt is great. False accusations can lead to devastating consequences. But there have been instances when certain doctors no longer deserved the benefit of the doubt. An extreme situation is described in the book Blind Eye by James Stewart. In that book, Stewart writes about a doctor that got away with murder.

Would transparency in the medical field be beneficial to both doctors and patients? I’d like to think so. But sadly, with our current litigious environment, complete transparency would be a nightmare.

And so, doctors may very well have to continue painting that picture perfect image of medicine.

This week during clinic I walked into an exam room behind my attending. She introduced herself and then she introduced me as a medical student. The fifth grader in the room exclaimed, “You look familiar!”

I just laughed and asked, “Oh?”

“You look like that guy on MythBusters,” the kid told me.

I just laughed again. The guy on Mythbusters? I assume he was referring to the Asian guy named Grant Imahara and not the girl or one of the white guys (because I am an Asian male, if that wasn’t already obvious)…

Oh and a few minutes later the kid asked me if I did anything extreme… like blowing things up (like the guys on mythbusters.) I think he was disappointed when I told him the most extreme thing I’ve been involved in is medical school…

Patients make me laugh…

And what am I supposed to say to this? Thanks?

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I was also put on the spot this week in clinic. A patient came in with a complaint of a bump on her hand. The attending looked at it, then looked to me and asked for my “spot diagnosis.”

Tentatively I replied, “Uh… wart?”

Fortunately I was correct. But my satisfaction with myself lasted only until we saw our next patient who had Otitis Media.

The attending decided to quiz me. “What’s the most common causes of Otitis Media?”

She told me number one was Streptococcus Pneumonia and waited for me to give causes two and three.

Brain went totally blank there. She finally told me two and three are Haemophilus Influenzae and Moraxella, respectively.

Originally posted on The Differential on August 13, 2008

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This week I was driving home from Target with my mom. I casually mentioned something about going back to Loma Linda for an autopsy.

“What?!?” she asked. I looked at her, while safely driving down the street, and laughed. The way I said it, it sounded like I was going in for my own autopsy. And for a few seconds she doubted whether she remembered what an autopsy was.

But I cleared it up. I wasn’t going in for an autopsy. It wasn’t a back-to-school thing like getting a physical. I had to view an autopsy being performed — not have one done on me.

The whole situation reminded me about the importance of clear communication. Communication is important in daily life; it can be vital in the medical arena.

Last year I had a class called “Understanding Your Patient.” During one lecture we discussed giving patients bad news. We watched a video clip of an oncologist demonstrating how he gives bad news, using actors as patients. The actors didn’t know what he was going to say and so their reactions were genuine.

He, the oncologist, discussed breaking things down and repeating often. It’s not easy to take bad news. It’s also easy to jump to conclusions at certain trigger words.

My mom battled cancer a couple years back. To this day, she remembers the moment she heard the word “cancer” from her doctor. I haven’t asked her too much about that conversation, but sometimes patients will shut down and come to their own bleak conclusions once they hear a word like that. So it’s important to slow down, repeat, and get feedback from the patient to make sure they understand.

I also heard an orthopedic surgeon, Doctor A, talk about one of his experiences with a patient. A patient came to see him and told him what Doctor B had done. In passing, he made some comment like “Why would he do that?”

Well, one year later the patient comes back –- this time with a lawyer. The patient wants to file a lawsuit against Doctor B. And the patient wanted to use Doctor A as an expert witness because Doctor A had made a single comment wondering why Doctor B did what he did.

It turned out that the patient had misunderstood what Doctor B told her. And the patient had given Doctor A the wrong information. And Doctor A realized he shouldn’t have made that comment to the patient.

Twisted, I know… but it reminds me that I have to be careful with what I say –- especially when I am around patients and still have no idea what I am looking at. They see a white coat and assume I have some body of knowledge. Well, I do have some body of knowledge, but at this point in my training, it isn’t the kind the patient needs.

Originally posted on The Differential on July 30, 2008

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During high school I took three years of Spanish. I thoroughly enjoyed it and really wanted to spend a year abroad to become fluent with the language. Unfortunately, when I got to college, I desperately wanted to finish in four years. My year abroad ended being sacrificed. In my final year, I did take Spanish 101 and 102, more for the fact I knew they would be easy A’s.

Two years removed from graduation, I’m sad to say that I feel I wasted all that time studying Spanish. I haven’t used it at all. Sure, I might remember some words and phrases here and there. I can probably still conjugate the present tense of most regular verbs. But I can’t remember the vocabulary. I turn on Spanish television and I get nothing. Well, the actors are pretty dramatic, so I suppose I can get something.

The other day I was standing in line at the Argentinean Consulate when the lady behind me started talking to me in Spanish. I looked at her, puzzled. She repeated her question. I tried to piece together what she was saying but the only thing I got was “Koreano.” I assumed she was asking if I was Korean. Well, I finally apologized and told her I couldn’t speak Spanish after which the conversation ensued in English. But I couldn’t help feeling frustrated that I couldn’t even understand a simple question after more than 3 years of Spanish classes.

Language is just one of the things that you have to use, or else you lose it. And this got me thinking about medical training. This year, as with most first year medical students across this country, I took General Anatomy. As far as I know, I won’t have any anatomy classes during second year. But Step 1 of the USMLE exam will cover General Anatomy. It worries me that I will go through an entire year without ever having an Anatomy lecture. I guess I am going to have to continually review myself whenever I find myself with that elusive “free time.”

I also thought about the practice of medicine. This year, I heard a talk by a cardiology resident. He said that while he was tempted to go into surgery, he found the clinical skills of surgeons to be lacking. Most wouldn’t be able to properly auscultate a patient. He had chosen cardiology because the cardiologists he had witnessed all impressed him with their clinical abilities.

One could debate the merits of having surgeons equally competent in wielding a stethoscope as they are with scalpels. It is probably not really important for surgeons to retain this skill. After all, they are called in to do their specific job — to cut open a patient and fix an immediate problem. If a patient requires auscultation, then his or her internist should be able to do this or refer the patient to a cardiologist.

But doesn’t it seem like a waste of time, money, and — well — medical training to just let a skill atrophy? Would time in medical school be better spent training students in the specific specialties they are interested in? Why bother teaching a student proper auscultation skills if the student is heading into Ophthalmology? I wonder, is there a better way to train our doctors of tomorrow?

In his book, Complications: A Surgeon’s Notes on an Imperfect Science, Dr. Atul Gawande writes of Shouldice Hospital in Ontario, Canada. The surgeons there are experts at hernia repairs. That is all they do. Day in and day out, the doctors do nothing else but repair hernias. What may be surprising to most American medical students is the backgrounds of those who operate at this clinic. A few of them have never even completed a surgical residency. But they have trained extensively at repairing hernias. This clinic, Dr. Gawande writes, has a far higher success rate for their operations than any other place in the world. Why? Because they only do one thing, and they do it amazingly. Can this be applied to medical school to cut down on the massive amounts of information that medical students are force-fed each day?

Source: Army doc, 74, ready to deploy to Afghanistan – Military- msnbc.com

Dr. John Burson

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I just read this story over at MSNBC. It seems pretty crazy. Seventy-four year old ENT surgeon is getting ready to ship off to Afghanistan for a deployment with the Army.

I wonder what I’ll be doing when I’m 74 — of course, that’s assuming I do live that long. It’s hard to say these days. I’m not trying to sound suicidal. I just mean that there are so many unknowns. Nobody can really know how long they are going to live for.

But this whole story got me wondering about the Military Medicine system. I’m just wondering: Don’t they have any younger doctors? Is the situation that bad?

I suppose this could just be because the guy really loves deploying. I mean, it sounds like he does have fun with the excitement. I just hope it isn’t because our military is so desperately thinned out by this ongoing war that we have to resort to sending senior citizens into war zones when they should be enjoying retirement.

Today as I was walking through campus I noticed a banner hanging on a wall announcing that it was Parent Day for the School of Medicine. This is a day that the Freshman medical students get to bring their parents to class and basically show off. I wrote about my Family Day experience here.

As I walked by I felt like I just had my Family Day. I almost wish that I could go back in time and be a first year again. At least I know (now) that I could do it. I’m struggling right now. Going through one of the lows of medical school. And I can’t help but think about doing something else.

There are times when I wonder whether or not it’s all worth it. I hear it all the time. But most of the time it’s from people who have no idea (i.e. they’ve never attended medical school nor do they have any desire to do so).

I wrote a post about it for The Differential. It’s a post about the taboo we seem to have — admitting doubts about ourselves. (Here’s the link.) It’s on the new Differential platform so you will need a Medscape account if you don’t have one already. If you don’t care to sign up for it, I’ll probably repost it here in about six months (minimum time before I can post it elsewhere).

This morning I also heard a classmate say, “If this doesn’t work out, at least I can go to law school.”

I have no idea what context that was in. But I couldn’t help but wonder about law school myself…

Ok, well I realize this is a somewhat scattered post — even for me. But oh well. My brain is scattered. I just got home from the last test of the week and I think I averaged only a couple hours of sleep a night. I don’t like giving excuses.. so call this an explanation.

Originally posted on The Differential on July 23, 2008

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My little sister has been on a classic film spree. She announced to me that she wanted to see all the movies that had won an Oscar for best film. She also bought an Audrey Hepburn 3-Pack DVD that contained Breakfast at Tiffany’s, Roman Holiday, and Sabrina.

Okay, I’ll admit that I too am a fan of Audrey Hepburn, Julie Andrews, and other great actresses of Hollywood’s golden era. They seem to convey so much in the subtle facial expressions or tone of voice -– something that I fail to notice with so much CGI/special effects these days. Well, being the awesome big brother that I am, I used my Netflix subscription to order another one of Audrey’s famous films: My Fair Lady.

At almost three hours in length, My Fair Lady is a pretty long movie that traces the journey of a poor flower girl as she is transformed under the instruction of Professor Higgins into a genuine Lady. The process is long and arduous. It’s filled with frustration as well as comical moments. The audience watches as Eliza Doolittle sheds tears and then as she recites phrases like “The rain in Spain falls mainly in the plain” or some other nonsense about hurricanes in Hereford and Hampshire trying to properly emphasize each syllable to the professor’s satisfaction.

It’s sort of like the transformation that is required of medical students. They say medical school changes you. It changes the way you think, speak, and act. It changes who you are. And it’s supposed to do exactly that. It takes the raw material in the form of an eager, optimistic, and sometimes-naive college graduate and transforms it into a newly minted MD who is probably more than just a little nervous about starting internship.

During orientation and registration our school administrators told us that by the end of just the first year we would notice things differently. We would see and hear things through different lenses.

I am kind of surprised at how true that statement turned out to be. There are words and phrases now floating around in my noggin that I never knew existed.

Mnemonics wander idly through my mind. Sometimes I don’t even remember what they are for. There are words like “LARP” (describing the path of the Vagus nerve) and phrases like “army over, navy under” (suprascapular artery over and nerve under) and “To Zanzibar By Motor Car” (branches of the Facial Nerve).

Prior to the first year, I had never heard of the phrase “differential diagnosis.” Well, on second thought, I did often hear Dr. House ask his team what the differential was. But it kind of flew over my head at the time.

Evidence-based medicine now means something. Before, it just sounded cool. I was a science major. I knew that evidence was good. Now, I still think it’s good. But I’m not too fond of searching through the literature for the latest studies trying to determine a link between statins and preventing Alzheimer’s disease.

Whenever I go to a restaurant I watch the waiters. Why? Because in Anatomy class I kept hearing about a waiter’s tip that can present with injury to the upper roots of the brachial plexus. I still have yet to see a waiter walking around with the so-called “waiter’s tip.” But it hasn’t stopped me from trying to find one.

Wal-mart is no longer just a convenient place to pick up supplies. It’s also a great place to pay close attention to customers’ faces and gaits. I might be able to identify a walking example of some neurological deficit I learned about in lecture.

As far as medical education goes, I’m just a baby. Or, to tie in with my intro, I’m just starting my training with the good professor. I’m still raw and crude. But even after MS1, I’m glad to report that there’s progress.

In about a month, right after Labor Day, my second year will officially begin. I’ll try to enjoy my last “free” summer. In the meantime, like Eliza Doolittle, I’ll try to faithfully recite the precious tidbits of information that the dear professors have imparted. However, it’s probably a little bit harder than talking about rain falling on Spanish plains in that oh-so-elegant British accent.