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Lactic Folly

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  1. Like
    Lactic Folly got a reaction from Mustang92 in Myers-Briggs Personality Type and Medical Specialities   
    Of course, no system is perfect, and there is a book by Annie Murphy Paul that makes an argument for discrediting the use of such tests. But a brief online test may not convey enough of the nuances - that there is no value judgment in any of the modes. Both Thinking and Feeling preferences can be equally "caring" - it is not about intentions, but rather the preferred method in which decisions are made.
    I attended a leadership session in which two groups, one of T participants and the other of F participants, were each asked to solve the same problem. It brought to light the very different approaches the two groups had, and offered insight into how an emphasis on people's personal situations could be misconstrued as favoritism/unfairness by others, while a lack of attention to those personal factors could be seen as less caring/accommodating. Yet each group was trying to find the optimal solution to the problem in their own way. 
    This then, is what I see as the main utility to learning about these theories - not in a deterministic "this is the career for you" sort of way, but to know that these dimensions can exist and lead people to see the world in different, but equally valid, ways.
  2. Like
    Lactic Folly got a reaction from premed2232 in Lessons from 1st year   
    Start early. Like applying to medical school, knowing what you want to do for residency early is an advantage. It doesn't mean you can't match to a competitive specialty if you decide at the end of 3rd year, but it will save you a lot of headaches trying to arrange electives and secure letters of reference at the last minute.
     
    You can do this by reading up on all the different fields and shadowing in the most likely possibilities when you start medical school. You don't need to wait for a formal elective - you can approach the departmental education coordinator or your lecturers/student advisors. Often upper years will have specialty interest groups which set things up for you as well.
     
    Ask career-related questions when you shadow. How did they choose this field? What else did they consider? What were they not interested in? What do they see as the most important differences between the field they chose and those other fields - in terms of most rewarding aspects, difficulties, type of work, skills required, average day?
     
    If you can narrow down your most suitable fields of interest, this will help you with planning your longer-length electives and summers. If you're looking at something competitive, it may be helpful to spend some time in research during one summer (letters of reference from those known within the field are most helpful). If you are seriously thinking of going to the US, consider writing Step 1 between 2nd and 3rd year.
  3. Like
    Lactic Folly got a reaction from hijkl in Things you wish you knew before you started med   
    Our medical school class was told the same thing by the residents ahead of us - it's residency that trains you to become a physician. Medical school is but an introduction to the breadth of the field - the role of the student is too dissimilar from that of the resident or attending to serve as direct job training. ralk posted on this previously:
    https://medicalblarg.blogspot.com/2016/01/underpants-gnome-theory-of-medical.html
  4. Like
    Lactic Folly got a reaction from ChemPetE in Career satisfaction in family medicine   
    How about restoring people's sight and significantly improving their quality of life with a single procedure?
    Is that such a far fetched possibility?
  5. Like
    Lactic Folly reacted to Wachaa in Career satisfaction in family medicine   
    From my interpretation, @Arztin was just pointing out that a lot of things are repetitive, not exclusive to family medicine. I agree.
    The need to have "variety" every single day in your daily practice is grossly overrated and I would go as far as arguing that most people, whether they are doctors or any other profession, do a ton of repetitive work because that's where they are the most efficient. In the case of ophthalmology, if they don't perform those surgeries, then the waiting lists continue to grow. Plus, surgery is just one of the days of the week and I don't see a problem where they try to maximize their efficiency on that given day. The rest of the time they can do other things. It just so happens that surgeries in general, are lucrative if they don't take a lot of time.
    By the way, since I've been out in practice, I realize the reason ophthalmologists make more is not simply because of a certain procedure they can do over and over. But rather the sheer volume of EVERYTHING, including 60-100 of new referrals a day in the office. Similarly for other specialists like ortho, where they round on 20+ people in the AM, see 40-50 in cast clinic, and then be paid for being on call. People are working hard for the money and they deserve to get paid. This is, after all, "work". i.e. we do it to make a living, and compensation is part of that.
  6. Like
    Lactic Folly reacted to F508 in Ask questions about family medicine here   
    Family medicine is not comprised solely of incremental adjustments of HbA1c and BP...... patients present to you with a multitude of complaints, literally anything and everything. Career satisfaction comes from being a generalist and knowing a little about everything. Throughout my residency, I have counselled parents about newborn problems, delivered babies, inserted IUDs, counselled about diabetes, counselled for depression, performed a multitude of intraarticular injections, accompanied families when their loved ones were losing their autonomy / facing a cancer diagnosis, helped someone quit smoking, diagnosed skin ailments, removed foreign bodies, given patients the knowledge/tools to better their health / to prevent ER visits / reduce their health anxiety, etc. My patients trust me to tell me their secrets and fears. My staff have diagnosed malaria in walk-in, performed abortions, worked in rural Northern Canada, worked for Doctor's Without Borders, worked as hospitalists/in obstetrics/in EM. As a family doctor, you are the first line of contact. You have the flexibility to transform your practice throughout your career.
    Throughout my residency, I saw the value of my generalist training. The staff that performs scopes doesn't remember how to treat HTA, defers to the patient's family doctor, delaying care. The IM subspecialist didn't remember how to treat hyperkalemia. The pediatric subspecialist doesn't remember what is a normal adult HR. The medical team doesn't think of fracture to explain the patient's sudden decrease in mobility. Of course for a lot of these specialties, they don't need to know these particular things to function within their domain. I am a specialist of common diseases in the general population. I don't want to only know one organ system. I don't want to only treat one small subspeciality of medicine. I don't want to know how many different ways we can resect a certain body part. I love working with people of all ages. I derive career satisfaction knowing that I have the knowledge to guide my friends and family through a large range of health issues.
     
  7. Like
    Lactic Folly got a reaction from JohnGrisham in Career satisfaction in family medicine   
    There is absolutely zero implication of that in my post. I am very surprised to see such a response and have no idea why you would say that.
    Did you see my post in the other thread here?
     
  8. Like
    Lactic Folly got a reaction from JohnGrisham in Career satisfaction in family medicine   
    How about restoring people's sight and significantly improving their quality of life with a single procedure?
    Is that such a far fetched possibility?
  9. Like
    Lactic Folly got a reaction from medisforme in Ask questions about family medicine here   
    Traditional family medicine is more about the patient than the disease. Check out the writings of family doctors who share their patients' stories, and how they have built relationships with entire families and cared for them over a lifetime.
  10. Thanks
    Lactic Folly got a reaction from gogogo in Ask questions about family medicine here   
    I'm not sure that such a distinction can actually be made. But I do envision dedicated family physicians working to facilitate positive lifestyle changes, help their patients obtain necessary resources and supports (especially those who are underprivileged), detect early signs of disease, and coordinate multiple aspects of a patient's care, and that these are important aspects of medical care and prevention that help patients navigate the often fragmented healthcare system and reduce the burden of disease.
  11. Like
    Lactic Folly got a reaction from medicallyricalmiracle in Do you tell your premed friends everything you do?   
    Depends on the context. Sometimes insecure people might perceive someone else as bragging about their experiences if they hadn't been asked to share - I wonder if that is what OP is hesitant about. 
  12. Like
    Lactic Folly reacted to shikimate in How hard is residency?   
    What's frustrating with residency is that your time is very precious, therefore everything you do, from seeing cases to studying after work must be high yield because you can't afford to waste time. Your attending and co-residents can make or break it. For example, as PGY2 attending tell you to read 1500+ page textbook and know the stuff in there. That is a completely useless advice, perhaps done with somewhat of a good intention. If you have a good senior resident they'll tell you what resources are most high yield, what's most commonly asked by attending vs on exam, etc. 99% of attendings does not know how to teach, or have any idea what good resources are out there for junior vs senior residents, not someone who's been practicing for 20+ years. Telling someone to just "read this textbook" is the most useless advice I've heard but it is given day in and day out. You can watch Youtube videos and get more out of them for your Royal College exam studying.
    Also if your co-residents slack off then good luck because as PGY2 and 3 you'll be the ones doing the cleaning up. If you're in a small program and someone switch out or they reduce your residency spot then you're screwed because the work and responsibility will always be there and most likely junior residents will bear the brunt of the new workload. Never match to a program with a high drop out rate. Also pay attention to what happens with the senior residents in that program, because if they're desperate with job search or whatever then you can sense the PD/admin people don't care about what happens to their residents and in a few years it'll be your turn. Ask if the senior residents are happy with what they are doing  after residency, there are lots of fellows who are in fellowship because they can't find jobs or their training was poor and they're afraid of going into a job. Also never ask any admin or PD how their residents are doing because that's like asking a wolf if they eat tofu, always ask the residents in an informal setting outside the hospital. Also pay attention don't just ask the most keen star resident because most likely you won't be the star resident and sometimes they have moral hazards like they were promised to be hired back to the program or have some academic aspirations so now they can't speak poorly of the program or chair or PD etc, so also ask the mediocre and even poor residents what they think. 
    Don't dwell on bad people around you, know your goal is to complete residency and find a job. Don't dwell on bad patients, bad admin, bad attending, etc. Let them putrefact and always write down your long term, 5, 10 or even 20 year goals so you don't get distracted by short term. Academic physicians are often stuck in academic because they are too specialized. I've seen those that want to transition to community practice but have forgotten what they learned in residency and don't have the skill anymore so they are basically hostage to the department. So I ask why don't they just retire or do something outside the medicine? Like they've been in practice for 15 years you think they'd save and invest enough money they're financially independent now? Or maybe they're the HENRY makes lots of money but never rich because spent it all on trillion dollar HGTV house and have to pay alimony or something.
    I always tell people explore the world outside your center, do lots of electives at other hospitals and see how others do their work. Academic hospital runs very differently from community hospital or outpatient clinic etc. Academic center the cases are always harder, more complex, more layers of bureaucracy etc, and your mind get stuck thinking this is how the earth rotates. Sometimes people get sucked into being academic and look up to people with encyclopedic knowledge etc because that's all academic centers teach you. But once you go in community you see people with vibrant lives outside of medical practice who is doing fine even though they don't have some title of endowed chair in useless research studies. They might even teach you a thing or two about incorporation, work less and make more money, or something else you never get taught in academic centers. Also academic center cares too much who's assistant prof, associate prof, full prof and all that, it's all useless titles like the medieval era when you have to be Marquise or Baron of some plot of land or something. If I donate $5Mil to a department I guarantee you I create my own endowed chair then name myself the endowed professor and maybe even have a hospital wing named after me.
  13. Like
    Lactic Folly got a reaction from frenchpress in How to get exposure to medicine to know if it’s for me?   
    This is a good suggestion. There are tons of bloggers and authors out there whose writings will provide much more insight into a medical career than your typical hospital volunteer placement.
  14. Like
    Lactic Folly got a reaction from hbmed in How to get exposure to medicine to know if it’s for me?   
    This is a good suggestion. There are tons of bloggers and authors out there whose writings will provide much more insight into a medical career than your typical hospital volunteer placement.
  15. Like
    Lactic Folly got a reaction from winston87 in Realignment of Doctor's Income 2   
    It is important to note that the numbers are *not* salaries... they are fee-for-service, so the volume of work must be very high to reach those numbers, and do not represent the average according to the ophtho's I've spoken to. I think that the competitiveness also has to do with the limited number of spots for ophthalmology. At the end of the day, my sense is that students will continue to gravitate towards the fields that suit their interests and fit their personal situations, and those who are drawn to a field for extrinsic reasons will eventually get filtered out by the realities and demands of training and work.
  16. Like
    Lactic Folly got a reaction from Starburst in Is the amount of money dentists make misleading?   
    COVID-19 Updates
    The College has recommended that all non-emergency dental services should be postponed to help prevent the spread of COVID-19.
    https://www.rcdso.org/en-ca/home
  17. Like
    Lactic Folly got a reaction from RadHopeful in Does having a negative comment on your MSPR ruin your chances of matching?   
    I would appeal. MSPR comments should be summative. You could say that you evidently took the feedback to heart and improved significantly by the end of the rotation, so that a formative comment from the start of the rotation should not be taken as reflective of your overall performance.
  18. Like
    Lactic Folly got a reaction from ChemPetE in So, how’s the job hunt going for other specialties?   
    Fellowships lined up
  19. Like
    Lactic Folly reacted to hero147 in Post-match depression   
    Residency goes by quickly. Faster than undergrad, faster than medical school. You'll be so busy most of the time you won't have time to mope. If you are really invested in your relationship with your girlfriend, there are ways to make it work. You have 4 weeks of vacation to spend with each other as well as taking a couple of personal days to see each other on weekends sounds nice even if short lived. Plus there's things like skype/facebook messenger/whatsapp for the times you need her through the week. You will slowly adapt to a new life in your new city and make new lifelong friends. I would know because I was in your situation at the beginning of residency as well. I was homesick every day and it only hit when I started living here but slowly but surely I got used to it, made new friends and started a new life. I still am not happy being far from home, but it's a lot better than when I arrived.
  20. Like
    Lactic Folly got a reaction from apple94 in Question About Reference Letters   
    1) Ask the supervisor about this at the start of the elective. If they know in advance, they could put together feedback from everyone into a letter, as presumably they would be doing this for the elective evaluation as well.
    2) If the letter writer is equally supportive of you entering either specialty, it would be preferable to have two versions of their letter tailored for each field. If you have many potential letter writers, then you could choose to have your family medicine preceptor only write for family medicine, assuming you don't want to give the impression that FM is your backup. In general, you'd probably want letters from specialists in the 5-year field for those applications, or at least from core rotations such as surgery or IM, but if you had space to submit more letters, a glowing FM letter wouldn't hurt.
  21. Like
    Lactic Folly got a reaction from BoardManGetsPaid in No ECs in Med School?   
    What are you doing for self-care? Any activities that might count as ECs? They don't have to be within the medical school (many of those clubs and positions often have a significant social component and function).
  22. Like
    Lactic Folly got a reaction from confusedmedstudent in Is it a red flag if you don't get a LOR from an elective?   
    Sorry! Did not mean to make any such implication. I don't know too much about your situation, but could it be that performance anxiety is interfering with your ability to recall information and your confidence in presenting it? Could you put down some of your DDx and plan in writing if that would be an easier way to help you communicate it? I think that preceptors would rather decline to write a letter rather than agree to write a good letter if they know they cannot be supportive.
  23. Like
    Lactic Folly got a reaction from confusedmedstudent in Is it a red flag if you don't get a LOR from an elective?   
    Regarding the top x% -- many letter writers do not use this notation. I have also heard tales of a chairperson who was known to place students in the top 1-2% more often than should have been mathematically possible.
    Unfortunately, letters of reference can be extremely variable in the style and degree of generosity in which they are written. The composite of many letters and evaluations does give a better impression as to the overall strength of the student.
    However, this is why, particularly in the smaller fields, direct exposure (i.e. electives) as well as letters from people known to the committee (where it's easier to decode info on where the student lies along the continuum) are more influential.
  24. Like
    Lactic Folly reacted to bearded frog in Is it a red flag if you don't get a LOR from an elective?   
    It doesn't matter if you don't know specific facts about conditions diagnoses, etc. that you can easily look up, with the expectation that you do so when you need to. Obviously once you see a case of X you should read about it "read around cases" so that the next day you can demonstrate that you can appropriately source info. The knowledge that we are looking for is how to appropriately act and assess patients, how to interact with nurses and allied health and colleagues, when and where to find accurate and appropriate information to guide your practice, stuff you can't just google or look up on pubmed/uptodate. When I have med students or even elective students I will ask them a question about a specific question or disease with the assumption that they don't know the answer, and that is 100% ok and you are not expected to know unless we already discussed it, but then I work backwards through the question and try to get them to come up with the answer on their own, based on the basic physiology/anatomy, etc. Stuff like "should we order a NPS on this child with likely viral triggered asthma". The answer is usually no, but its a difficult question to answer, so my next question is what is a nasopharyngeal swab, and if i don't know that I explain it, then I ask how the result would affect their management, if it was negative, vs flu, vs other virus, etc. And usually they can work through it and the point is to demonstrate their problem solving/reasoning skills.
    I can't answer this as I haven't been involved with reviewing LORs.
    Ask about their program? At some point you will have to make a rank order list and decide which programs you will prioritize, so you should ask questions that would help you make that ranking. Don't ask specifically about ranking, but you can ask things like "What kind of applicants does the program look for" or "what kind of applicant would excel in this program" etc.
  25. Like
    Lactic Folly reacted to MSWschnoodle in Psychosis (Schizophrenia) and Low Overall Average   
    Hey AstrocyteKM!
    So first off, congratulations on being so proactive in managing your mental health. Regardless of the field you wind up in that will serve you very well!
    In terms of medicine specifically, I would never tell someone to give up entirely on something that mattered so much to them, but because of the structural issues in medicine there are a few things I would strongly caution you to explore BEFORE heading down the road to medical training. Some of these are considerations for you personally (how to manage call and maintain stability of your health, for instance) but others are very much out of your control (will the college of physician and surgeons in your province of residency refuse your license). Unfortunately many of these issues will not come up until later in your medical training - after you have already invested many many tens of thousands (or even hundreds of thousands) of dollars into your training. This is incredibly unfair to learners who make the (very understandable) assumption that if they make it in to medical school and pass medical school that there should not be a problem licensing them as a doctor and that if they received accommodations in medical school that can receive the same accommodations in residency (which is not the case). Medicine has multiple points where you can get derailed or suddenly be denied entry (medical school admission, graduation, residency matching, licensing etc.). Every year there are people who get stuck at these barriers, unable to move forward, and face huge financial, emotional and psychological consequences. 
    Here are some things I would suggest if you are considering going for medicine (some of these have already been suggested above):
    1. Contact the admissions office and/or wellness office at your local medical school and find out if there is anyone at the school who would be willing to meet with you and discuss the realities of medical training, the potential challenges that could arise for you and what schools/residency programs can (and cannot) do to accommodate you. Some specific things to discuss would include: 26+ hour call shifts, overall work hours, any mental health monitoring policies in place, additional resources the school can offer, accommodations for exams etc if needed and what the school would do in the event that you had something arise with your health (mental or physical) requiring an extended leave (particularly what would happen if you needed multiple leaves because some schools have limits on this). Talk to them about the grade issue as well to find out what the best options are.
    2. Contact your provincial college of physicians and surgeons and ask to talk to someone about any barriers you might face in getting a license to practice medicine for residency or beyond. The college will have monitoring requirements and those can be intrusive and/or costly depending on the province you are in. I would ask specifically how they would manage your licensing if you were to have a relapse during medical training or once you are licensed. If you get wind that they might refuse to license you then I would very much caution you about heading down the path of medical training because without a license you cannot enter residency or practice medicine and you don't want to be 200K in debt and get a letter stating they won't license you. 
    3. If available in your area, consider shadowing some physicians in fields you might be interested in. Talk to them about what the job is like and what the demands are. Talk to them about the challenges they have in maintaining their mental and physical health. Talk about work-life balance and what you need in your life to maintain balance and stability and ask if this is something attainable in X specialty or not.
    4. Talk to your psychiatrist and your family doctor about your goals. They have completed medical training at some point and they (hopefully) know you well (strengths, challenges, talents etc). Explain how important this is to you and ask for their help in seeing if there are ways to problem-solve around the barriers. If you have a therapist it would be worth it to talk to them as well! The road to medicine has a lot of stress and disappointment along with the excitement and rewarding experiences so making a plan and building your skills to manage the emotional experiences you will encounter along the way is an important part of maintaining your health (honestly everybody applying to medicine, regardless of their mental or physical health history, should invest the time to build these skills).
    5. Consider your plan B. Anyone and everyone who is interested in medicine should have a solid Plan B that will also make them happy. There are so many truly wonderful and meaningful careers both in healthcare and outside of it. Think about the things that most draw you to medicine (what is it about medicine that aligns with your values or makes you excited about it) and break those things down into components. For me, the opportunity to interact with people every day, the privilege of being trusted with their story, being able to support people in some of the best and worst moments of their lives and helping people achieve their goals are some of the things that make medicine worth it. They are also the things that made me love the career I had prior to medicine. I would have been VERY happy continuing down my previous path if I hadn't gotten in to medicine because both of them align well with my values. Find the alternate careers that align with your values and explore them. You could find something that is more appealing than medicine or if you discover barriers to medicine that make it too risky for you to pursue (only you can decide how much risk you are willing to tolerate) you will have another pathway to explore. 

    I hope the suggestions above are helpful. All the best as you continue to explore your career options going forward!
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