Psych!

"Third year sucks," an intern once told me in the middle of third year.

"Really? Why?" I said (wow, way to go, Stephanie).

"Because you're constantly changing into different clinics and doing different roles and working with new people with no idea how to think or what to expect until you get the hang of it after a few days and then you're shoved into a totally new setting with a different set of practices. And the whole time that you're struggling, everyone around you is critically judging you."

Never really considered that, but it's a good synopsis of why third year can be challenging. The other aspect not really mentioned is that third year can be hard because there is a huge lack of personal free time and a sense of social isolation compared to the first two years of medical school. But it's not all bad news, ladies and gents.

Once you get the hang of third year, however, it can be exciting and fun! Imagine going to a chocolate salon and sampling every bite of chocolate. That was fun last week, until I got really nauseous.

Third year is like a cultural safari where you can study different tribes, adopt their customs, and learn how they think and what their values are. For someone who is adventurous and flexible, resourceful and resilient, third year is like a grueling backpacking trip through the Amazon where the locals are concurrently evaluating whether or not you should be allowed to go traveling. But the best part is that you don't have to travel very far at all...in fact, you tend to stay in one building for 13 hours per day.

Another interesting group that you get enormous exposure to is your patients. I have always suspected this before, but the strength of any medical training (and thus medical school) is heavily based upon both the skills of the residents AND the diversity of your patient population. Pick a medical school based on geography and the patient population that you get exposure to, because that will shape your training as a doctor. At UCSF, we are enormously privileged to have several settings (VA, Moffitt, SFGH, CPMC, Fresno) that gives us a wide range of patients from all walks of life....young/old, rich/poor, urban/rural, etc/etc. Working at SFGH has been an amazing experience, because it is the only hospital in the city that serves the uninsured, the only trauma center in SF, and the cradle of HIV/AIDS healthcare. It is estimated that up to 25% of the patients at SFGH are HIV+ and SFGH is home to Ward 86, one of the most renowned HIV clinics in the country. Going to medical school in SF allows you the unbelievable privilege of working with a large HIV+ population in SF and gives you insight and medical training that cannot be replicated, and I never TRULY appreciated this until third year.

Okay, I've totally digressed again. All of this was a prelude to a short reflection on my time on inpatient psychiatry at SFGH. It was an excellent experience, and I learned so much about how to interview psychiatric patients (be nonjudgmental, ask questions like Columbo) and how to think/adminster psychiatric medications. In fact, the inspiration for this posting was a recent UCSF news tidbit on how the drug company Eli Lilly is trying to market a new combo drug (olanzapine and prozac) for treatment-resistant depression. Psych is so incredibly interesting, and I predict big advances in the next 50-100 years as we learn more about the pathophysiology of schizophrenia, bipolar, depression.

Oops, gotta go.