Why MD/PhD?

Med school is SO long - why spend another few years getting a PhD?  I've gotten this question a lot since I started med school.  Like applying to straight MD programs - there are plenty of good BS reasons to apply to MD PhD programs.  [The REAL reason I want to go to med school]

MD/PhD - the rough outline by year

Sidenote - if you're wondering what MD/PhD programs are - see image on right - they are essentially med school (MD) and school for scientists (PhD) so we combine medical and scientist training.  We exchange spending a few extra years in school with free tuition.  

Here on sidenote, we give the people what they want.  Once we pare away all the BS of med school admissions, there are 3 reasons why I chose to pursue two doctorates, when I would have been equally as useful with an MD.  

1- The incredible tution bill of med school.  The average 2010 med school graduate left with $160,000 in debt.  15% of all med school graduates left with a quarter million dollars of loan money.  And when you graduate med school you're still a resident which means you make in the neighborhood of $50,000, not quite doctor money.  And don't forget that loan money is definitely not interest protected.  It keeps growing and growing and..  

As an MD/PhD student, the government pays my medical school tuition bill.  Thanks tax dollars!  

running gels gets a bad rap.. but I love science

During my admissions year I kept hearing that the financial incentive to pursue an MD/PhD wasn't worth it, but it still seems smart to me.  Spend 3-4 years working in a lab, which I love, and come out with a free MD, which my wife loves.  Everyone wins.

2- I needed a backup plan.  One day, I really want to be a scientist and run a mega lab to the tune of 20+ scientists, Cell papers by the month, and grant money flowing in like Brandon Roy's bank account.  The point is - I only want to be a scientist if I can be a good one.  

If you've ever worked in a lab you know the 40 year old burned out postdoc that's bitter at the research world for screwing over his opportunities to publish in Science/Nature/Cell and get independent grants.  You also know that guy questions his life on a daily basis - should he quit and go into advertising?  teaching?  

great book

I didn't want that to be me, but frankly it's only so much in my hands.  Science is a volatile career, and a high impact publication is usually the result of right-place-right-time phenomenon.  (See Malcolm Gladwell's Outliers).  

I really want to have a family some day - preferably sooner rather than later - so I wanted to make sure I had a viable backup plan before I tried to launch a risky career in science/academia.  At the end of the day I want to do science so I can use my brain to help people, so I figured being a doctor would be a good alternative - still intellectual and still helps people.

3- I believe I do things right and other people don't.  Don't hate me for it. I despise med school because all we're doing right now is learning the status quo and how medicine has been done for years.  I know we have to learn this because we need to pass boards.. but it is BORING.  Sidenote - when I run academic medicine we will be done with standardized tests and memorizing rote BS. Instead med students will learn, you know, actual medicine.  

I'm a cynical med student, and I know in 6 yrs I won't be the kind of intern that's going to see the medical world and accept it at face value.  I know I'll be a pissed off resident, and a pissed off attending.  There's a lot to be cynical about in science, but at least science is trying to come up with new solutions.  I wanted to be part of a world that asked, what if we could come up with a better way to do this?

Overall conclusions.. perks to the MD/PhD - it saves $ and you get to do science.

See you on the other side,

from ken

Relationships in med school pt 4: When doing less is doing more.

700 pg behemoth

"The secret of basketball

is that it's not about basketball."

- Isaiah Thomas

One of my favorite all-time books is Bill Simmons' The Book of Basketball.  BS endlessly analyzes and ranks the top basketball players.  My favorite idea is that the secret of basketball is about a conscious choice a player has to make everyday - he has to fight off the pressures of the world and avoid thinking the world revolves around him. It's about LeBron James deciding that it might be better to pass to a wide open Shane Battier than trying to take on another double team for the highlight reel. It's about Chris Bosh deciding he'd rather be a glorified role player in Miami than being the man in Toronto.  

--

Like all med students - I'm a born and bred overachiever.  In third grade I got in trouble once for bad handwriting - so I had to write a cursive f twenty times.  I sat in a corner and filled three double sided pieces of paper with a cursive f.  It was a third grade version of eff-you mode.  

Similarly, in my marraige I'm the kind of guy that wants to be a super husband. Washes the dishes.  Makes the bed. Does sweet things. Listens to all the logical complaints my wife has. Cleans the bathroom. I want all the gold stars.  

But being in med school where the top resource is time, it's been a challenge. I feel like I'm always scrambling for time, or walking around ragged tired.  

ironing the shit out of that shirt

As I got busier Katie started being really helpful and willing to take care of more stuff around the house. I help out with the chores a little bit on Sunday, when I take a day off from studying to focus on my more important pursuits of blogging and watching basketball.  But other than that one day Katie wants to be super domestic - making home made christmas presents, home made cookies on a weekly basis, and making sure my stock of ironed shirts is always ready to go. 

Since then, there's been a lot more sitting around and watching league pass in my life.  Time that used to be filled with doing the dishes, cleaning the bathroom, and other fun chores.  But by giving up my need to be super husband - it's kept me a lot more sane and more pleasant to be around, so the time katie and I do have to spend together ends up being high quality.  We have a lot more fun.  

We make a good team.  ..Or at least I make a lazy husband.

See you on the other side,

from ken

House of God Book Review and thoughts on burnout

The House of God is a pseudo fictional memoir that takes a cynical look at the training of young doctors. The protagonist Roy Basch is a naive grad of BMS (best medical school) working as a first year intern at a hospital called the House of God.  The story chronicles Basch's year as his mental health spirals down due to poor working conditions, brutal superiors, long hours, and a severe lack of time to spend with friends and family outside the hospital.  

Shem drives home the point that internship takes up so much time and mental energy that doctors lose their humanity. They slowly get isolated from friends, family and even fellow interns- and when that isolation happens, they move from thinking this is crazy to I am crazy. One intern in the House of God commits suicide because he bottles up the madness of the hospital within himself, he eventually can't handle it, and has no other ways to release that stress.  

So the moral of the story - everyone needs to deconstruct all the craziness going on around them. Cope or perish.  

According to some quick some studies I pulled up on pubmed - 45% of physicians experience at least one form of burnout: emotional exhaustion, feeling unaccomplished, and losing empathy for humanity. Half of all doctors are feeling burned out!  That has to be terrible for healthcare?  On top of that, male physicians are 50% more likely to commit suicide than the general public, and female physicians are 200% more likely!  

Sidenote - Residency training may be when the stress of dealing with patients peaks, but what if the real root of the problem is earlier?  What if interns are arriving at their residencies already so burned out from med school that they're already on the highway to that depressed, burned out, suicidal hell?

white coat ceremony - the bright eyed days

Before I started med school someone told me to enjoy the first few weeks - everyone is bright eyed and happy to be there, still friendly, and tan from the summer.  Now, almost three months into school - no one's that tan, you can start to pick out the gunners, and the bright eyes are slowly fading to zzz.  

I've been getting a lot of that frustration and burnout myself. I drafted out an entire post complaining about being burned out, then I decided it sucked and wasn't up to public consumption.  Then I hated myself for being terrible at writing, and then I hated myself again for procrastinating instead of studying.  Self-hate has to be one of the top signs of burnout.  

The last block definitely burned me out.  I was talking with my similarly overwhelmed and burned out classmates - and we literally couldn't figure out what to do to unburn out.  I try to study all day and fail - I watch recorded lectures in the corner while checking gmail, MUSC email, facebook, grantland, the NYTimes, really I'd rather look at anything than the syllabus. 

Last block we had a lecture on physiatry - the cushiest specialty in medicine, you play volleyball every weekend, and you get tons of $$. Physiatry is looking better and better everyday.  

I need to come up with some half-baked ideas to fix physician burnout.  

See you on the other side, 

from ken

physiatry life

1st Annual NBA bold predictions

After my brutal MLB predictions - Adrian Gonzalez wins MVP, Red Sox win the WS - I decided to stop making predictions, and just start going for bold predictions.  That way when I'm wrong I don't feel as bad about myself, and if any of them are right I look like a prophet.  So here's the first annual NBA bold predictions:

James Harden leads the league in scoring.  The Thunder basically told him they'd rather have Ibaka.  In his first game since then, he scored 37 and had 12 assists playing with a bunch of guys he's never met.  Arguably Andrew Bynum should be in more F U mode, but he's probably chilling on his couch already getting ready for his guaranteed max offer next summer.  Harden in eff you mode all season could be a sight to see.  Plus - he'll shave the beard to increase the hype. 

so much more aerodynamic

Spurs win the west.  Maybe it's not bold to some people, but out of 32 espn analysts only 1 picked the Spurs.  The Thunder took a step back losing Harden.  Ibaka is good, but he doesn't have that same edge Harden has.  When push comes to a shove in a big playoff game, it just doesn't feel like you could rely on Ibaka to come through - offensively OR defensively.  At the same time, Harden HAS come through at those moments already.  At age 23.  I feel like they should've gone with Durant-Westbrook-Harden core than Ibaka.  The Lakers - could easily be the most dominant team in the west, but they need a healthy point guard.  They need to keep that core 4 healthy and they need to destroy the other team whenever they're on because it doesn't look like Antawn or Steve Blake are going to provide much help.  So who else could win?  Maybe the team that won 21 games in a row? 

The Chicago Bulls repeat as #1 in the East.  They tied for the best record in the league with only 60% of Derrick Rose.  Who says they can't hang in there around the middle of the conference until January when Rose comes back?  This guy cried at a rehab update, there's no way he's sitting out a season when he could be playing.  Plus, I love every single Adidas commercial about him.  Don't try to tell me that guy is not a gamer. 

Brooklyn misses the playoffs.  If Deron Williams doesn't have this miraculous return-to-the-olden-days season, or worse - gets hurt, they're left with a core of Brook Lopez and Joe Johnson.  It's a conglomeration of guys who want the celebrity and cash of playing in Brooklyn. 

Chris Paul gets traded.  I don't know enough about NBA trades and salaries to tell you where he'd go, but if the Clippers get off to a slow start, I could see it.  They've clearly committed to Blake for the long-term, and CP3 doesn't really play a Blake-style game.  He wants to run efficient defensive minded basketball.  Some team will be willing to take a risk and get in on the CP3 sweepstakes early. 

Carmelo Anthony wins MVP.  As Lin and Stoudamire move out of the picture, this becomes the Melo show again.  They went 18-6 with Mike Woodson, don't tell me they couldn't sneak into the 2 spot in the east.  If they pull that off - who else would get more hype, and isn't that really what the MVP award is about? 

See you on the other side,

from ken

Senior Mentor Reflective Essay

We had an assignment where we had to reflect on our feeling towards providing healthcare to the elderly.  Here's my essay:

Reading the three vague questions demanded of us in the senior mentor reflective essay, I can’t help but assume the administration just wants us to ramble on about our thoughts on providing healthcare for the elderly - so I plan on doing just that.  I apologize in advance if I don’t answer all three questions.

BMS

In 1978, Samuel Shem famously wrote a pseudo fictional memoir called House of God, in which he told one of the first tell-all books of the insanity of internship.  Shem covers a wide range of the insanity - the depressing isolation, the extreme coping methods, the reality of how little medicine can actually do - but one of his favorite targets is GOMERS, which stands for Get Out of My Emergency Room.  GOMERS are elderly patients that are suffering and actively dying, but medical technology is somehow keeping them alive.  The doctors and nurse taking care of GOMERS are frustrated that they take up so much of their valuable time and attention.  The question they ask is, “Shouldn’t they be allowed to die with dignity?”

My view on healthcare towards the elderly is, unfortunately, similar to Shem’s.  It is frustrating to me whenever I see off-hand statistics that mention the surprising concentration of healthcare dollars that are spent on the last six months of life.  If there is not enough money to go around to provide healthcare for everyone, don’t we need to ration our resources, and invest the money where it’s actually going to help our society?  On a simpler level - should we even be taking care of people that can no longer control their bowels, or worse - their breathing?  I imagine I am not the only young person that sees the world through this cynical lens.

Who deserves healthcare? ...a loaded question

These frustrations over serving an aging population that is no longer able to serve society like it used to, is one of the main reasons driving me towards something bordering on a fear of the elderly and an in interest in pediatrics.  I can't help but relate to the doctors portrayed in Shem's House of God and predicting that I too will fall into the same pessimistic bunch of docs.

I understand the situation in real life is much more difficult than crunching numbers - seeing one of your loved ones passing away, it must be difficult to let go.  There must be a point when it becomes more than just being about efficiency.  To that extent, I have never had close relationships with anyone over the age of say, 60, and being so unfamiliar, it is definitely difficult for me to relate to this age group.  

On a sidenote, I want to believe in the value of every life - young, old, black, white, rich, poor - whatever.  I definitely cannot say I live a life that embodies that ideal, but it is an ideal I wish to attain.  I sincerely hope the Senior Mentor activity will change my views on serving the elderly.  They have certainly done their part to serve out society, and they deserve to be taken care of in their dying days.  I also hope the senior mentor activity will help me understand the issue of dying.  Is it possible that it's not wrong to let GOMERS die?  Don't the elderly deserve the respect of dying with grace?  

It's hard to reach any substantial conclusions in a rambling reflective essay, but here's what I've come up with: I see a lot of personal conflict in serving elderly patients, and I hope that will change in the coming years.  

See you on the other side,

from ken