Resilience #illumedati


Hey everyone, it’s Medicine Mondays again. This is going to be a short post on the culture of Medicine, especially the concept of “resilience“.

Resiliency

Stock Photo from: Pexels

So every year, a fresh group of bright-eyed 1st year medical students start medical school. The vast majority of them start the year with ambitions to be the best doctor they can be and for most of them I think there is a feeling of “I can’t believe I’m going to be a doctor” and “I can’t wait until I’m a doctor.”

The White Coat Ceremony happens, where medical students don the traditional white coat to symbolize their journey to become physicians.

So then what?

You clean your white coat and hang it up in your closet for the next 2 years. Then, you study like a crazy person for 2 years. I think everyone underestimates just how difficult medical school is. Yes, there will be the “rock stars” who seem to already know everything. However, for the majority of the student body, you will study harder than you ever had before.

Something I’ve promised myself to never do is to say “Well, it wasn’t that bad” – that’s because I’d be lying. Medical school for me, was the single most difficult thing I had ever done (at that time). I have never studied harder than I did back then. Even as hard as I studied, there was always more to know, and things I felt I was missing.

Also, there are others who have finished other professional schools, such as dental, pharmacy, or law school and say that “medical school can’t be that hard”. Now, I can’t compare the two because I haven’t finished dental, pharmacy, or law school. However, I do have colleagues who went to dental, pharmacy, or law school before medical school and they tell me there is no comparison. Medical school is the most difficult by far, it’s really only a matter of how many times more difficult.

So for those two years, that will be the hardest you ever study in your life.

And then what?

You finish 2nd year and pass your USMLE. Hopefully you got the score you wanted.

Now you try to find your dusty white coat in the back of your closet to start your clinical rotations. It may or may not fit anymore because you may have gained (or lost) some weight during the last 2 years. Hopefully it still does.

3rd year of medical school you get blocks of rotations usually in 4 week, 8 week or 12 week blocks. For these weeks you start every rotation essentially knowing absolutely nothing. Over the rotation you pick up tidbits of information from osmosis/diffusion from smarter or more experience people around you, like the 4th years, interns, residents, and attendings. Then by the end of the rotation you start to feel a little comfortable maybe, you know what to do and you fit in with the team. That’s exactly when you’re supposed to change rotations.

3rd year is basically testing your ability to adapt quickly to new situations and learn on the fly. However, the type of learning is radically different from that of sitting in the library with a book. Medicine moves slowly. By the time a book comes out, a good amount of the information is already slightly different. This makes studying for Step 2 CK and CS difficult because you will be told things like this: “So actually in real practice we do [A]. However, for the Steps, the answer is [B].”

Another real difference between 3rd year and the first two years is that you will likely be taking call with your intern or maybe you will be doing shift work in the ER and working “off hours”. This will be your first experience with “real medicine”. 3rd year is more physically demanding than the prior two years.

Then what?

Then comes 4th year, which is kind of a “vacation” from medical training. Most of your rotations are electives, and a good amount of your time will be devoted to interviewing for The Match. You still have your more difficult rotations doing your sub-internship or some away rotations where you try to impress. However, I think overall that the majority of medical students (and doctors) would say that 4th year was a pretty good time. I’d advise all 4th years to make use of that time.

Moving on…

Now you start your internship. You may be in a new area and may be by yourself. However, you can’t worry about any of that because intern year is pretty brutal. It’s nothing like being a sub-I. It’s the equivalent to throwing a kid in a pool and telling them to move their arms to stay above water — for a year.

There is a saying I’ve heard and I’m not sure if it’s just in the context of medicine or not, but basically it goes like this: “I can do anything for a year.” That’s kind of how internship is.

Residency is more of the same as you build your experience and knowledge base to be the expert in your field. You finish residency +/- fellowship and go take your boards to become board-certified.

After reading the above, I think it’s pretty evident that doctors are probably the most resilient people on the planet.


Resilience

So, after receiving my iPhone X, it immediately went into a case with a screen protector.

Now then, I’m going to say the iPhone symbolizes all the education, training, and debt that goes into become a doctor. By itself, it’s pretty fragile and will break if you drop it as we’ve already discussed. There is a ton of different iPhone X drop tests which prove this point.

However, over the course of your medical training you’ve become resilient as discussed above meaning you have your own case and screen protector. Also, you’re IP67 certified so you can even be under water for a full 30 minutes. You would think that with that much resiliency, you’d be able to handle anything… right?

No.

For some reason, certain hospitals and organizations seem to want to squeeze the life out of their doctors:

  • If the doctor is able to handle seeing 20 patients a day…. why not 25 patients? why not 50?
  • If the doctor can be on call for a week straight… why not 2 weeks? why not a month?
  • If the doctor can do notes from home, after seeing patients all day, why not do all your notes from home?
  • If the doctor can only take 3 weeks of vacation… why not only 2 weeks? why not 1?

This is basically like taking the iPhone X in its strong case and screen protector and pushing it past its physical limits.

For example, with a case the iPhone can survive a drop from standing height no problem… and it could probably even survive a drop off a building… but do you really want to throw it out of an airplane? or drop it from 1000 ft? or cut it with a katana? or freeze it for 10 days? or burn it with a laser?

Do you see my point? It doesn’t matter how much protection (resilience) you have, if you keep getting pushed, you will eventually break.


The problem is not resilience. 

(this has been said many times before) here and here

The problem is greed.

People and places trying to squeeze every last drop of productivity out of their doctors under the guise of patient care. I’ve seen it happen to many friends and many friends of friends.

It’s hard to stop this because of termination clauses and the lead time to get new doctors credentialed. It’s a revolving door of doctors into these situations, and doctors don’t like to change jobs in general.

By the time a new doctor starts the job and figures it out it’s not what he/she wanted or was promised, it can takes months or even years to find another job. Also, doctors don’t want to leave their patients and colleagues “high and dry” by moving to a new job unexpectedly. We have a responsibility to our patients.

I think it deserves to be said explicitly. It’s not about money. More money does not increase resilience. However, someone, somewhere thinks that by giving doctors a few extra $ that they are able to survive harsher working conditions. That may work up to a certain extent… but as you can see from the iPhone X tests, if you push hard enough, it breaks.

Unfortunately, I don’t know how to fix all this. All I can say is be careful when choosing your first job and every job after. Don’t just chase the highest salary. The money has to come from somewhere. Talk to whoever you are replacing… why are they leaving? or talk to someone who recently left, why did they leave? 

Protect yourself. All the resiliency training in the world can’t make a bad job into a good one.

Facebook is full of groups of doctors desperately trying to get out of clinical medicine, willing to take significant cuts in salary… and this is probably why.


Sorry guys, I kind of rambled today. My stream of consciousness writing kind of just decided to write whatever it wanted.

TL;DR

After medical school, internship, and residency, doctors are basically the prototype for resilience.

We don’t need more resilience training.

We need less greed in the world.

Choose your job wisely. Protect yourself.

Medicine Mondays Sensei

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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About Sensei

A young attending physician trying to navigate the mine field that is life after medical school…

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