Tag Archives: medical education

It’s a man’s world?

When I was a medical student, now over a decade ago, we had a fairly active “women in medicine” chapter, despite the fact that our class was at least 50%female. Understandably, the whole work-life balance debate was a main topic of discussion, although thanks to the recent uproar over part-time docs, that issue is forefront again. At any rate, one thing I remember from these gatherings is a statement made by an upper level resident offering her worldly advice to us impressionable young medical students.

“I watch Sports Center with my boyfriend every night,” she said. “That way I have something to contribute to conversations with the guys while we’re in the OR.”

Consider the opposite scenario – a group of male medical students getting together for support, being told to read In Style magazine or watch a reality TV dating show so they’d have something to talk to their female colleagues about (I know, gender stereotypes abound).

The question arose back then – do we, as female medical students and residents have to play in a man’s world to get ahead? And is it over when we’re attendings?Are we still excluded from the clubhouse?

A few months ago I attended a local medical society women’s group where we explored the very same questions. We discussed how women tend to emphasize group collaboration over individual achievement. When given a compliment, many women will deflect or minimize the praise. Does this partially explain the reason women physicians are paid less than their male counterparts? Through role playing exercises, we learned how to craft PAR (problem, action, results) statements and borrowed other concepts from the business world, such as having a ready-to-go elevator speech about your accomplishments in the event you meet an important contact. I have to admit, I do like knowing that I have a way to communicate my current projects to the CEO or a colleague from another institution when I run into him or her at a meeting.

However, a lot of these changes are conversation styles or body language typically attributed to men. Someone raised the point I had been wondering years ago, “Do we really need to try to act more like men to get ahead?”

Sorry, new medical students and residents, I have no conclusions for you today. Concentrate on learning as much as you can and caring for your patients. Be confident. Be assertive when you need to. Respect each and every member of the healthcare team. The vast majority of your patients won’t care if you’re a male doctor or a female doctor. They just want a good doctor. Happy July 1st – happy medical new year – and good luck!

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The Post-Conference High

What do you call a gathering of 15,000 Rheumatologists and Rheumatology health professionals? There’s got to be a good punch line to that opening question. Having recently spent 5 days in Atlanta in the company of this nerd fest geekdom medical brilliance, for me it was a walk down memory lane. Imagine a giant convention center, people streaming from building to building, Starbucks lines snaking down the hall, massive ballrooms with projection screens displaying video of the scientific talks like a rock concert. With thousands of doctors, nurses, research scientists, industry and press milling about, would I see anyone I know?

Strolling through the maze of poster presentations, I turned around and ran smack into my mentor from medical school and residency, or THE REASON I became a Rheumatologist. Memories of events, people and places long since forgotten instantly flooded my mind. Saying goodbye to him with a promise to email more often, I grabbed a coffee and almost dumped it on the person behind me – a mentor from fellowship. Over the next few hours on convention day one, I saw another attending from residency, a former co-resident, a current Rheum fellow who had been one of my residents here in MA and another few attendings from fellowship. Each was greeted with a hug and a smile and a “Remember when . . . ?” Later that day during a quick snack and rest break, I overheard some valuable advice during a mentor/mentee discussion. As we go through our careers, there is a constant interplay between being the one giving and the one getting the advice, and maybe both at the same time.

As important as these conferences are for our CME and learning the most up to date practice and research information, the opportunity to form and renew relationships is equally important. I’m sure my colleagues across all specialties will agree. What this really illustrates is the often repeated phrase, “Medicine is an art and a science.” While the art lies in the nuances of treatment and the doctor/patient relationship, it also lies in the interpersonal mentorship we cultivate all the way back from those early pre-med days to the present. Remember picking the brain of any doctor you met? “Should I go to medical school?” During school, “What type of doctor should I be?” And as careers progress there is, “What should I look for in a job?”

As a group, I’ve noticed doctors are less apt to network than, say, business types. Friends and family members in other fields are constantly going to networking events, coffees and the like to meet and greet. Events like this conference remind me how valuable it can be to get out there. Say hello. Give advice. Get advice. Mentor a student. Thank your mentors. And since we can’t all traipse around the globe attending conferences and meetings each month, get connected through social media. Both in person and online, the relationships help make it all worthwhile.

Grand Rounds

I’m proud to be included in this week’s education edition of Grand Rounds. Thanks to Spice Island!

http://notesfromspiceisland.blogspot.com/2010/10/grand-rounds-volume-7-no5-lessons.html

A Love Letter to Primary Care

Faneuil Hall, Boston

Living in a major metropolitan area means taking a lot of things for granted. Especially here in the Boston area, with its many renowned hospitals and universities, one can find physicians practicing and conducting research in specialties within specialties. Nothing seems too far out of reach. However, this city mouse recently traveled down the Blue Ridge Parkway for some R&R and to learn how the country mice work and play.

My FP friend's happy old horse

I was thrilled to meet up with a medical school friend who practices family medicine in a rural area a bit further south. We spent a lot of time catching up and reminiscing, of course, but we also did a fair amount of “shop talk.” Touring her office space, she shared with me some examples of what her typical day might be like. The pride in her voice was evident as she talked about what it means to be a family doctor. I was surprised to hear about all the office procedures done on site, as I think locally a lot of procedures here in the city are referred out to specialists. We hear so much about how medical students these days don’t want to go into primary care. Maybe they need to spend more time seeing what it truly means to be someone’s family doctor. Through blogging I’ve been touched by the words of some fantastic doctors who are living and sharing this life, but it was also wonderful to hear about the struggles and inspirations from my friend over lunch. “You know what I wish,” she said, “That people didn’t think you only go into primary care if you’re not smart enough to specialize.”

Barn cat

Maybe this sounds strange coming from a specialist, but I couldn’t be a bigger advocate of primary care. And the further I get away from my general internal medicine training, the more I’m struck by just how hard it is to have to keep up to date with ALL the body systems! Not only do I value the teamwork and co-management of the primary care providers I work with, but I want my OWN doctor too. Everyone is a patient, and don’t we all want someone to call “my doctor?” Having gone to medical school at an institution with a strong primary care commitment, I don’t think this value has ever been far from my mind. In fact, of my group of close friends from medical school, the majority are family doctors, one is a pediatric specialist and one is an internal medicine hospitalist. Then there’s me, in rheumatology, which I do love for the multi-system nature of many of the conditions I see.

Some medical student blogs I follow occasionally talk about “specialty bashing” or how residents and attendings they encounter put down other areas of medicine. Some have said, “Oh, I could never be a XXX doctor. How boring! What torture!” (Well, more colorful language may have been used, but you get the picture). I’m GLAD we all find some things boring and some things exciting. What if every medical student in the world wanted to practice in the same field? That wouldn’t work at all. This post didn’t start out as a love letter to primary care. My original intent was just to say thanks to my good friend for the visit and share some photos. But after thinking about it, I want to also say thanks to all the primary care internists and family docs for what they do. Thanks for inspiring my friends and colleagues, who will hopefully be able to inspire today’s medical students to follow in their footsteps.

Hospital life . . . not like TV!

[picapp align=”center” wrap=”false” link=”term=emergency+room&iid=5286372″ src=”6/a/4/9/Hospital_hallway_a0e0.jpg?adImageId=9884053&imageId=5286372″ width=”380″ height=”392″ /] This month I’m “on service” at the hospital. This means, in my group, that I’m the doctor responsible for doing rounds each day and seeing any hospital patients the admitting doctors (usually hospitalists) ask us to see. There are many ways that medical groups split up this responsibility, but we go “on service” for a month at a time. In addition to seeing consults, the doctor assigned to the hospital is also the teaching attending for the month. We usually have two internal medicine residents who are taking the Rheumatology elective for the month. Part of what we do each day is formal teaching about diagnosing and treating common conditions encountered by Rheumatologists.

Perhaps we should digress for a moment and talk about what internal medicine residents do for their 3 years of training. I’m sure you can find many other places online that describe this more in detail, but here’s the quick summary. Internal medicine residency is 3 years and there are certain requirements, like months spent doing “general inpatient medicine” or “ward months” primarily caring for hospitalized patients. Other months that are usually required are ICU, ER, outpatient medicine and then a whole bunch of elective months which a resident can tailor to his or her own interests.

We have internal medicine or preliminary year residents, podiatry residents, sometimes pharmacy interns, sometimes Physician Assistant students and sometimes medical students who spend a month with us. Usually when we get asked to see a patient in consultation the resident gathers the information about the patient’s workup so far, sees the patient for a history and physical exam, then we discuss the patient and go back and see him or her as a team, make our recommendations and, when possible, discuss them with the admitting team. Each patient we are asked to see gives us a chance to talk about “real world” situations as they relate to actual patients. Sometimes there are procedures that need to be done as well. This whole scenario probably looks fairly similar to anyone who has watched “ER,” “Grey’s Anatomy” or “Scrubs,” though in the real world we’re not that attractive, evaluations and treatments move slower and there’s generally much less social drama!

So what kinds of patients do Rheumatologists see in the hospital? Probably the number one reason for consultation is a swollen joint, which could be an infected joint but is usually gout or pseudogout. Often this requires doing an arthrocentesis, which is basically inserting a needle into a joint to draw out fluid for the purpose of diagnosing the condition and also for pain relief as it relieves the pressure. We can also inject steroid into the joint (a “cortisone shot”) at the same time for pain relief and to reduce the inflammation. We also see patients who have a known Rheumatologic condition, like Rheumatoid Arthritis or Lupus, and are in the hospital for some other reason. In this situation, we might need to help manage the patient’s medications. And sometimes we’re asked if a patient might have some type of rare connective tissue disorder. Already this month we’ve been asked to see patients and help decide if they could have such conditions as Wegener’s Granulomatosis, Churg-Strauss and Erythema Nodosum. We also have a monthly journal club, I’ll be giving a noontime lecture to the residents later on in the month and we go to conferences like a radiology conference to review interesting x-rays. I am only “on service” about 3 times a year so I look forward to the change of pace and spending the mornings teaching and discussing cases. In the afternoons we are in the office as usual and the residents come over to our offices and shadow us there. That’s the month in a nutshell. We’re only 3 days in but I have a great resident this month. I actually really like our hospital’s cafeteria food and the break from packing my lunch every day and also we have a Dunkin’ Donuts in the hospital lobby which is convenient for a little pick-me-up! I also get to chat with colleagues whose offices are in the hospital and sometimes there’s a special event, like the “heart expo” they had in the lobby today. I’ll check back in at the end of the month and let you know how it all went.