Sunday, March 29, 2009


"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 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.


Dr Benway said...

Psychiatry is a lot of fun. For the most part, people are warm-hearted and make good company.

The down side: the friggin' book reports.

Back in elementary school, I hated writing book reports. I decided, when I'm older I'll get a job that doesn't make me write stupid reports.


Three on my desk to finish tonight: case summary of girl who just turned 18 and may need a public guardian, summary of a TBI youth in an RTF who's started biting other patients and so needs to go ASAP, and a new admit to the RTF.

I don't see the point of Symbyax, personally. Some sort of marketing strategy, I guess.

Oh the other down side: Scientologists. One of the reasons I'm a pseudonym on the webs.

Meredith said...

LoL, social isolation can actually be a positive for Aspies like me :-)

BTW, I've seen psychiatry "from the other side" and I wonder, is it just because of this lousy country I live in, or the people who examined me were incompetent, or what is going on, because before I had my AS dx, I had dozens of other misidentifications and had to run away from forced treatment. (For the record, I now lead a fully independent and happy life of a college student without any meds except vitamins and energy drinks, but I'm always perceived as a bit "different" - but why is it bad to be different anyway?) I consider myself healthy and my friends (both AS and NT alike) say I'm right on that one. Yet at each stage of my development (transition from kindergarten to primary school, then to high school, then coming out, etc. until I turned 16 and found AS in the library, recognized myself and had undergone the proper dx procedure) I've been sent to psych professionals with the instruction that I should be somehow fixed. But as soon as the people around me get used to me and recognize how intelligent I actually am, they start treating me as a person rather than a "lunatic". It is very interesting :-) I've been called borderline (that one was handed to me after a ten-minute conversation - no kidding! and I was already under stress because I was about to lose my accommodations due to an obnoxious roommate - luckily, I managed to get a single room in the dorm and nobody complained about me since then, nor did I have any problems with myself or anybody else, surprise surprise), schizotypal, "normal but gifted", bipolar, even depressed (which is funny because to this day, I tend to jump up and down and squeak in delight from time to time, such as when I got my Amazon order last month). I didn't feel any of these accurate - until AS came along. And some weeks after, I got my dyscalculia dx too, which made a lot of sense of the hard years of math problems (and utter lack of navigational skills) I've been through. Also, these two "labels" actually lead me to strategies that *work*. However, I have to do most of the self-improvement alone: because of the past experiences I can't really trust any psych professional. They've been misunderstanding and abusing me and horrifying my concerned mother all over the place, so even though I think most of them had good intentions, I'd never consider being treated by them. Again, I seriously wonder why were they so clueless and harmful - is it the poor training in my country, as this is admittedly the case with our high school teachers (thank goodness, there are exceptions); or is that that AS is not well-known here at all; or there are some obsolete misconceptions about the autism spectrum that in Western places have been eroded by now; or I was simply unlucky and met people that weren't dedicated enough to their patients? Who knows...
(The country I'm speaking of is Hungary btw.)

Anyway, I just wanted to share this as a former patient and I'm curious if you have any thoughts on the matter. Or questions. Or anything. As I said, I'm quitting my current college and want to go to medicine myself (more interested in the research part as in actual practice with patients, but that's expected if you're bad with people, lol), so it would be nice to have some conversations with people who've "been there, done that".