Author: Aleah Chang

Aleah Chang is a second year medical student at Oakland University William Beaumont School of Medicine in Rochester, Michigan. She graduated with a B.S. in Neuroscience from the University of Michigan in 2014. She currently serves as the Vice President of the OUWB American Medical Women's Association (AMWA) chapter and is involved in the Medical Student Government at OUWB. She plans to pursue a career in family medicine, pediatrics or OB/GYN.

Categories
Emotion General Reflection

What We Carry

I recently stumbled upon an entry on another blogging site I follow, featuring a piece by Pamela Wible, MD. She’s a family physician who recently published Physician Suicide Letters — Answered. She also gave a moving TEDx Talk last year where she spoke about the four hundred physicians (and medical students) who commit suicide each year. She discussed some of the stressors physicians face, like losing income to hospital overhead or working incredibly long hours. Her unhappiness in the field motivated her to start what she calls an Ideal Medical Care practice.

After listening to this talk and looking into ordering her book, ironically, I felt kind of depressed. As a pre-med student, I was always so excited to become a doctor. I think I glorified this career choice for a long time, which isn’t necessarily a bad thing. As I’ve made my way through my first two years of medical school, I’ve experienced some of the heavy burdens that we can endure by choosing this career path. Long hours of studying, high-stakes exams and, ultimately, the responsibility of another human’s life.

These same stressors can be applied to many other rigorous fields. I’m sure law students spend countless hours reading up on cases. Engineers might make a decision that has a lasting impact on whether someone lives or dies in a car accident. So why does the medical field have such an epidemic of suicide on its hands?

One of the main differences I see between professional fields is the proximity medical providers have to death. I’ve become quite confused on how exactly we are supposed to grieve. Many medical students have heard that in the past you weren’t supposed to show emotion and to separate yourself from death when a patient passes. Obviously, the sentiment has changed and the values we instill in future physicians are different, but I don’t think our coping skills have drastically improved.

As early as the pre-medical years, students in this field encounter death. I worked in a cadaver lab in college where I was intimately exposed to death in a way I had never dealt with before. As first-year medical students, it becomes easy to forget our cadavers are human bodies, and in the clinical years, in the hospital, death is everywhere.

When will we stop to cope? Can we take a week off to grieve when we experience death? Will our superiors understand why we seem “off”? When you deal with death on a frequent basis, it’s easier to forget. We bury the emotions that we carry. However, keeping things in and not going through a proper grieving process can be detrimental to our health and well-being. It’s important for medical providers to understand the weight of death that we carry and its effect on our own mental health.

In my opinion, teaching proper grieving and allowing medical students time to cope would be a useful addition to the medical school curriculum. This might even lower the suicide rates in our field. The things that lead someone to commit suicide are ultimately multi-factorial, but I think this is one way we can try to improve these numbers.

Featured image:
sunrise and silence by x1klima

Categories
General Lifestyle Reflection

On Professionalism

I solemnly pledge to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude that is their due;
I will practice my profession with conscience and dignity;
The health of my patient will be my first consideration;
I will respect the secrets that are confided in me, even after the patient has died;
I will maintain by all the means in my power, the honor and the noble traditions of the medical profession;
My colleagues will be my sisters and brothers;
I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I will maintain the utmost respect for human life;
I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
I make these promises solemnly, freely and upon my honor.

-The Declaration of Geneva

My white coat ceremony changed many things for me, most notably the responsibilities I would have moving forward. I recited the Declaration of Geneva, along with my fellow colleagues. The weight of the term “colleague” laid heavily on me; those who were once classmates were now colleagues. Classmates to colleagues, such a drastic, but intentional elevation in word choice. Many things are expected of me as a medical student, but one of the top priorities is the demand to carry myself as a professional.

Professionalism can mean treating others with respect, upholding a certain academic standard, or leaving personal issues in a personal space. Cultivating a professional attitude isn’t always easy. I have screwed this up several times, like disrupting class through meaningless chatter or allowing my personal dilemmas seep into my professional work. Regardless of the mistake, I always try to learn from my shortcomings. I believe that the majority of medical students strive to act as a professional when encountering difficulty in medical school.

Recently, I wondered how this professional attitude so quickly fades when we meet colleagues of different disciplines. Although my experience is mainly anecdotal, I think we have all heard of negative interactions between physicians and nurses, physicians and physician assistants, and so on. In medical school, some of us have participated in attempts to get medical and other professional students to interact at an earlier point in their training. I personally interacted with both nursing and physical therapy students during my first year of medical school. Although I thought the reasoning behind this choice was good, it didn’t work out exactly as planned. The medical students overheard a few nursing students talking negatively about the medical student cohort. Feelings got hurt and from there the overall atmosphere worsened.

Why did this happen? I believe we forget to act professionally when outside of our immediate, comfortable setting. We know a professional attitude is demanded between colleagues within our medical school, but we don’t often carry it over to other disciplines. Yes, you could argue that interacting with other disciplines at an early career stage helps break down some common stereotypes and issues, but will early interaction really solve everything? I’m skeptical.

I believe a constant effort must be maintained throughout our training; as I stated before, a professional attitude is not easily mastered. Regardless of one’s career stage, working harder at cultivating a professional demeanor among those in our field as well as among those in others will foster teamwork within medicine. If we, as medical professionals, hold ourselves to a certain standard, then catty arguments or negative comments will never be made, because we constantly demand higher of ourselves. Hopefully, by being more self-aware and practicing on a daily basis, we will create a professional attitude that won’t break down so easily when confronted with the newness of the ever-growing medical field.

Featured image:
teamwork staffetta by Luigi Mengato

Categories
General Lifestyle

Let’s do Better for our LGTBQIA Patients

A special thanks to the panelists and physician who inspired this article.

Recently, I was involved in a collaboration between the American Medical Women’s Association (AMWA) and the American Student Medical Association (AMSA) at my school to help our students learn more about the LGBTQIA population. To clarify, this community includes individuals identifying as lesbian, gay, bisexual, transgender, queer, intersex or asexual. We invited a board-certified OB/GYN and reproductive endocrinologist to our school, along with a few of his patients. The LGBTQIA patient population has its own unique set of challenges and understanding their struggle is vital.

Unfortunately, many members of this community have anecdotes of times in which they were disrespected, turned away, or not understood by medical professionals. One of the transgender panelist had difficulty finding a fertility physician who was willing to work with him and his wife to have him carry their child. Yes, you heard me correctly. This panelist was willing to go off testosterone in efforts to regain his menstrual cycle and carry his baby. Many physicians were unwilling to assist this couple. These stories have to be put to an end; we can do better. I hope we can challenge ourselves to be more open-minded and accepting of all those who seek our help. It’s not a physician’s job to deem what is right or wrong; rather, it is our job to serve our patients in whatever capacity we can.

Having a patient panel allowed us to hear some moving and emotional stories from these brave people. I hope other LGBTQIA members can share some of their stories with medical students around the nation because it is important for us to hear these first-hand. In addition to hearing about fertility challenges and life paths, we also heard of changes we as physicians can make to better serve this patient population. I felt the need to share these with others because I realize many students never get the chance to have an open conversation with someone who identifies as part of this community.

  1. On medical intake forms, leave the sex and gender fields blank so the patient can feel comfortable telling you his or her identity here, rather than only giving them two choices.
  2. Ask the patient what his or her preferred name is. Some patients are transitioning and may not prefer their given name.
  3. Ask the patient his or her preferred pronoun and make note of this. The last thing we want to do is keep referring to someone as “she” if they have never felt like a she.
  4. Connect with the LGBTQIA community. Unfortunately, many of these patients face discrimination. Even though it seems “sufficient” to just accept them when they come to our practice, we can do more. The patients on the panel expressed that it would be nice for physicians to reach out to their community and let them know you are welcoming to their group and want to serve them. If one of your patients happens to identify as part of this community, ask them if they can connect you to other people who may need care.
  5. If you have a patient who wants to transition, be sure to at least mention fertility issues. Someone transitioning may not have thought about having a family yet, but it can be very difficult to go off hormones and later become pregnant (if transitioning from female to male). In addition, the patient panelists mentioned that it would have been nice to know more about egg and sperm donation and the costs and barriers associated with those processes. Obviously we don’t need to push our patients in either direction when it comes to transitioning, because it is their choice. But it is our job to inform them and help them understand the potential issues that may arise if they do decide to transition at a younger age.

It is difficult to learn about this population because each member is different and unique. In a struggle to find medically relevant information for health care providers, I found two good resources I found for more information are from American Medical Association (AMA) and AMSA. Click the links below to find out more about the LGBTQIA population in the medical context:

http://www.ama-assn.org/ama/pub/about-ama/our-people/member-groups-sections/glbt-advisory-committee/glbt-resources.page?http://www.amsa.org/advocacy/action-committees/gender-sexuality/

Featured image:
Pride Flag 1 by Ant Smith

Categories
General Reflection

Medical Conferences: Are they worth it?

Each year there are many medical conferences held around the world. These could be conferences about new research, medical education or, perhaps, a gathering of those in a specific specialty. Last year I was lucky enough to attend the American Medical Women’s Association (AMWA) Centennial Conference in Chicago, IL. After attending my first medical conference, I have made it a personal goal to attend at least one each year.

So, was it worth it? In my opinion, it is a definitive yes. I’ll break down some of the pros and cons based on my experience so you can decide for yourself if you’ll be attending a conference (or two) within your medical school years.

Pros

  1. Connections. I can’t go on long enough about how many new connections I made. I met physicians from around the nation in different specialties. I heard from speakers who had written books, gotten double board certified while raising a family of four, and even travelled to the moon (I’m not kidding, Mae Jemison was in attendance). An easy way to stay in touch with the new colleagues you’ve met is LinkedIn. After hearing from them at the conference I connected with them on LinkedIn, which allows me to see what they are doing professionally and keep them in my network for any future communications.
  2. Relationship growth within my organization. The AMWA chapter at my medical school has always been a tight-knit group, but this trip made many of us even closer. It was a great way to get the entire group motivated for an awesome upcoming year. We were able to bond over our favorite speakers and chat about some of the important issues being discussed on the women’s rights front.
  3. Stepping outside of your comfort zone. In advance, the conference paired student attendees with physicians and asked students to meet with and interview the physician. I ended up getting paired with an internal medicine physician coming from the renowned Tuft’s University. I was intimidated at first because she came from such a prestigious university, but she turned out to be incredibly down to earth and friendly. I had the opportunity to talk to her about her personal journey and how being a woman in a once male-dominated field affected her.  She told me a story of when she was involved in a patient’s care when they began coding. As if this weren’t stressful enough, she was seven and a half months pregnant and started having contractions. Womanhood presents unique obstacles, but this physician was able to overcome them with flying colors.
  4. Exploring a city! The conference allowed me to experience Chicago in a new way. We stayed right in the heart of downtown and went on quite a few sight-seeing adventures. Next year the AMWA conference is in Miami, which would be so much fun to visit! Heading out of town for a conference can feel like a mini vacation from the hectic life of a medical student.
  5. Intellectual growth. The AMWA conference placed a strong emphasis on the advancement of women in medicine. We heard from numerous female physicians about their experiences within the field and how they got onto their current path. It was empowering to listen to women who had written numerous books, founded various organizations and impacted society so greatly. Additionally, I was able to hear from numerous female physicians about raising a family and having their dream career. It gave me hope that the life I want is doable. I think this conference truly revitalized my energy after a long first year in medical school. It allowed me to see past the current grueling coursework to what my career could potentially blossom into.
Cons
  1. Money. Okay, to be honest, this AMWA conference was actually affordable, but I know many are super pricey. My advice is to seek funding from various sources. This year I’d really like to go to the conference again, so I plan to set up a Go Fund Me account that will allow my relatives to donate some money to help me attend. Last year, I was fortunate enough to get some money to support my travel. Most student organizations can get some funding from their school, which is what our AMWA group was able to do. In addition, many conferences have grants or scholarships to help students attend. I recommend looking at a few different conferences you find interesting and pick one that is the most economical. Another option is to create a poster (or research) to present and most likely you can get a grant from your school to present it at a conference.
  2. Time. The conference I went to was an entire weekend event, so I wasn’t able to study at all. In the little down time we did get, I wanted to explore the city or just relax for a few minutes. Plan ahead and study during the car (or plane) ride. Check your schedule and make sure the conference falls during a time that isn’t incredibly hectic for you. Even though conferences are a large commitment, the time “lost” I think ends up being an overall gain when you consider the benefits.
I think medical students should look further into the idea of attending a conference. Many of us are hesitant because we think it will just cost extra money we don’t have. I urge each of you to look deeper than the price tag and make a plan to go to a conference at least once during your four years of medical school. To find out more information about the AMWA Centennial conference click here.

Featured image:
Conférence NWX2012 by Frédéric BISSON


Categories
Lifestyle Opinion

Invest in Knowledge

One of the biggest lessons I learned during my first year of medical school is that there simply isn’t enough time. Not enough time to lead the same life I once did. Not enough time to study every last origin and insertion. And definitely not enough time for faculty to cover all the essential information. Some of the information that is inevitably left out is what happens after medical school.

How can we as residents and physicians manage both our newfound salary and our mounting pile of debt? What is a 401k? Roth? How do I save money for retirement without living like I am in college? These questions are incredibly important to answer sooner rather than later, because gaps in financial knowledge can have monumental consequences later in life. My suggestion to all medical students is to learn the basics of investing and budgeting now, so you won’t regret it later.

After realizing that this knowledge needed to be acquired on my own outside of medical school, I purchased a book called The White Coat Investor, which was published in 2014 and written by James Dahle, MD. This book is an easy read about financial information specific to future and current physicians. The bulleted information below has been paraphrased from Dr. Dahle’s text. All of the statements are his personal findings.

Pertaining to pre-med students

  • Be cautious when considering taking a gap year or more. Each year you take off is one year less of earning potential as a physician you may have. Take time off if it is to do something you are truly passionate about.
  • Apply to medical schools you can actually get into, and apply to many. It would be a large inconvenience to have to reapply because you did not apply to enough schools to begin with.
  • Go to the cheapest school at which you will be happy. There isn’t a huge difference in education from school to school.

Pertaining to med students

  • Choose a specialty wisely. Consider income and lifestyle, while still keeping yourself happy with the work you want to do (i.e. if Emergency Medicine and OB/GYN both make you happy, but Emergency has a better lifestyle and pay, go with that choice).
  • “Be a poor medical student.” Dr. Dahle states it’s a lot easier to be poor when all your friends are too. This will pay off later.

Pertaining to residents

  • Try not to buy a house. Likely you don’t have the down payment and it takes about three years to break even on this investment. Once you are at the end of residency or a physician, chances are you will want a different house (i.e. space for an incoming family).
  • Invest in a Roth 401(k) or traditional 401(k) if the Roth isn’t available, and do this up to the match by your employer. (Roth 401(k): You contribute money to this fund after taxes have been taken out and your employer will match the amount you put in, up to a set amount. This money accrues interest and can be taken out during retirement post age 55 ½ with no penalty. Dr. Dahle explains the Roth option is the way to go during residency because you are in a lower tax bracket than what you will be in the future. Traditional 401(k): You contribute pretax money to the account and your employer matches up to a predetermined amount. When you withdraw the money in retirement, you pay taxes then on the money. This is still a great option if the Roth isn’t available, because your employer is basically giving you free money).
  • Establish an emergency fund for up to 3-6 months of living cost.
  • Purchase disability, life, and liability insurance.
  • Pay down high interest debt (i.e. credit cards) and student loan debt.

Pertaining to physicians

  • Live like you are on a resident’s income (for three to five years, or as long as you can manage).
  • Live somewhere affordable, unless your dream is to live in California. Understand that higher living costs don’t necessarily correlate with higher wages.
  • Educate your family and make sure they are on the same page as you financially.
  • Don’t buy a house that has a price tag more than double your gross income. Try to put 20% down on the house.
  • A few things to consider if you want to hire a financial advisor: make sure they are fee-only, have gray hair, don’t mix insurance and investing, and offer physician specific help.
  • The biggest risk to your financial wellness is divorce. Spend time with your significant other and consider a prenuptial agreement.
  • The book contains much more on investing in stocks and real estate, plus additional info on protecting assets, taxes and how to make sure money goes to the right people in the event of your death.
If any of this information confuses (or empowers) you, be sure to read The White Coat Investor. Dr. Dahle does an excellent job of explaining financial material in an understandable way. He backs up all of his recommendations with solid arguments and life experience.
The advice given to medical students consists of common sense factoids, like “try not to rack up credit card debt and try to spend loan money wisely.” When we begin to earn an income in residency, the advice becomes more tangible, hence the difference in the amount of advice under medical students vs. residents in the bulleted list above. There isn’t a ton we can do right now while we are in medical school to be financially savvy, but we can invest. Not money (yet!), of course. Rather, we can invest in our own future by putting time and effort into learning the foundation of the financial world.
Featured image:
Tom Gores: Investing by Tom Gores
Categories
Lifestyle Narrative Reflection

Lonely in a Room Full of People

Stock phrases:

“Hey mon, you alright?”
“You have a blessed day.”
“How is your morning walk pretty ladies?”
“Yeah mon, no worries. Everything alright.”

These ‘stock phrases’ are just a few of the things I heard each and every day while staying in Negril, Jamaica. I travelled to the island to take a short vacation and attend a destination wedding this past month. While on the island, I was pleasantly greeted by the local Jamaicans any time I left the bed and breakfast I stayed at. I was surprised at first at how friendly the locals were – I had heard from friends to be cautious of the crime in Jamaica. Nevertheless, I always responded to the locals, asking them how they were.

A few days into my trip I was with a Jamaican driver named Patcha, headed to another part of the island. I chatted with Patcha for quite a while. I asked him about his culture – his views on marriage, money, economy, etc. He was open and never held anything back. I mentioned to him how friendly I thought the Jamaicans all were. He kind of chuckled and asked if that was out of the ordinary for me. I told him America was different.

I went on to tell him that I am guilty of being unfriendly at times; not intentionally, but just by habit. He didn’t quite understand. I told him how common it is in America to be walking in a hallway or down a street with one other person and for neither of them to say hello to one another. Some people even say they feel lonely in a room full of people. He burst out laughing.

I started laughing too. Why do we do this? What stops us from just initiating a conversation with others? He asked why this is so. I started thinking and said, “Maybe it is because Americans are too stressed. We forget about other people because we are kind of on a mission each day.” Patcha responded, “Us Jamaicans are stressed too, we need to have food on the table every night.” I bit my tongue remembering Patcha had told me earlier that many Jamaicans live in poverty. He told me workers at some of the larger all-inclusive resorts on the island make only about ten US dollars a day and smaller establishments tend not to pay their workers on time or abuse their power over their employees in other ways.

Clearly, stress is a problem in Jamaica just as it is in America. So why is it only in the US where we insist on emotionally walling ourselves off? Why do we stray away from human contact when it is so easy to make a connection with another human? I couldn’t give Patcha an answer. I have been a shy person for the majority of my life, but by no means am I scared to strike up a conversation with anyone. When I returned to the United States I noticed myself falling into old habits, just politely smiling at the person next to me in line for coffee, but never saying hi or asking the how their day is going.

I wanted to write this blog post to hold myself accountable and also challenge my readers to break the silence. Say hello to strangers. Dare yourself to give someone a compliment. Make yourself more human.

As future medical professionals, part of our responsibility is to make our patients comfortable. I will count this challenge as daily practice for my career. I’ve seen many doctors put on a positive attitude for their patients, only to find them miserable when engaging in other social interactions. What makes a stranger in the grocery store any different from a patient in the hospital?

I hope this short story will help readers see that sometimes we all need a reality check. Whatever the reason is, our culture is heading down a path of loneliness, instead of solidarity. Let’s all take responsibility for this and make changes to unite one another.

Featured Image:
Humanity by Kevin Dooley

Categories
Clinical Opinion

Does this make you uncomfortable?

“Homo sapiens is one of the few species on earth that care if they’re seen having sex. The impala is unconcerned. The dingo roundly flaunts it. A masturbating chimpanzee will stare straight at you. To any creature other than you and I and 6 billion other privacy-needing H. sapiens, sex is like peeling a mango or scratching your ear. It’s just something you do sometimes.”
– Mary Roach, Bonk: The Curious Coupling of Science and Sex

Mary Roach is one of my all-time favorite writers because she delves into topics that make the average person squeamish. I’ll admit, as I read Bonk: The Curious Coupling of Science and Sex, I found myself peering over the top of the pages at the pool, carefully checking that no one realized I was reading about sex. After finishing this text I wondered, why was I trying to hide? Why is our society so confined (in comparison to, for example, Europe) when it comes to our sexual well-being?

Even though many medical students will boast that very little makes them uncomfortable (they get excited to dissect cadavers or watch an open heart surgery), it is clear from the literature reviews that a large number of medical students are not comfortable, nor prepared to take accurate sexual histories from their patients. A study published in the Journal of Sexual Medicine reported that, “The majority of medical students (75.2%) feels that taking a sexual history will be an important part of their future careers, yet only 57.6% feel adequately trained to do so. Furthermore, 68.8% feel that addressing and treating sexual concerns will be an important part of their future careers, and only 37.6% feel adequately trained to do so.”1

This data is pretty alarming seeing that many Americans, young and old, struggle with sexual disorders and diseases. In my opinion, there is one main reason that underlies these statistics – lack of education (don’t scold me for saying this, I know our training is already quite lengthy, but, hey, we are lifelong learners).

In the 2008 article “Medical school sexual health curriculum and training in the United States,” researchers reported that a whopping 44% of US medical schools lacked formal sexual health curricula.2 Although a few years have gone by, it is clear that this percentage is way too high. Similar results were reflected in a study done in Malaysia by Arrifin et al.; researchers reported that only half of research participants (final-year medical students) reported feeling comfortable taking a sexual history and only 46% felt that they had received adequate training to take the sexual history.3 This level of inadequate training reflects in the demeanor of medical students when they are asked to take a sexual history.

Although I can’t speak for medical students at other institutions, many of my classmates, including myself, have expressed a certain level of unease when asked to question patients about their sexual history. What is the proper way to ask a person about his or her sexual identity and orientation? How can I make patients comfortable enough to tell me about the rash they are panicking about, but too embarrassed to bring up casually in conversation? What if the patient identifies as a transgender individual, how am I supposed to know what his or her needs are from me as a health care provider?

All medical students should know it’s okay to struggle through these questions and mess up, possibly offending a patient (future patients please be kind to the students who are still learning!). These are all questions that I don’t have the answer to, but I want to learn more so I can give my patients what they need from me. These are essential questions for medical students to ask and explore, but more importantly these discussions really require an individual with years of experience and education to be present. Although many US medical schools may be working towards providing a more solid education on sexual health, it is urgent that this be done swiftly and accurately, because our patients are the ones who are suffering as a result of our inadequate training on this aspect of health.

To the medical school officials, please answer our desire to learn more about these topics. To medical students and other health care providers, don’t be afraid to bring up sexual health with your patients. Our minds and the overthinking we do are the only things that hold us back.

  1. Wittenberg A, Gerber J. Recommendations for improving sexual health curricula in medical schools: results from a two-arm study collecting data from patients and medical students. J Sex Med. 2009 Feb;6(2):362-8.
  2. Malhotra S, Khurshid A, Hendricks KA, Mann JR. Medical school sexual health curriculum and training in the United States. J Natl Med Assoc. 2008 Sep;100(9): 1097-106.
  3. Ariffin et al. BMC Res Notes (2015) 8:248

Featured image:
sex and love (because when love meets sex, bodies and souls become one and time, colours and place are on ecstasy…) by dim.gkatz