Sunday, July 18, 2010

Looking Through The Mirror

What does it take to be a good surgeon?  I've spent a lot of time thinking about this question over the years.  Raw skill?  Steady hands?  An exquisite knowledge of the involved anatomy?  A respect and understanding for how to handle the tissue layers?  Sure, being a good surgeon involves all of these things, but I've come to realize that it takes much more than this to be a great surgeon.

A great surgeon understands that s/he plays as important a roll outside of the operating room (talking to the patient and with families) as inside the O.R.

Back when I was studying to be a doctor, my medical school really placed a priority on what they called, "humanism in medicine," an ability to demonstrate a good bedside manner, recognizing that being a physician involved more than just the basic diagnosis and treatment of disease.

Coming out of medical school, I naturally felt as though I had a good foundation in this area.  I would sit down with my patients and their families and discuss their medical condition in great detail, making sure that they would fully understand what they were facing.  Even during a busy operative morning, I would make sure that I met all of the family members before the surgery, and then talk to them again upon completion of the operation, enduring that all questions were answered and all concerns were addressed.

But then again, there were a few questions that would grate on my patience, and usually it would usually involve the question, when? "When will we have the results of the pathology?" I don't know - I just sent it. "When will you come by to talk to my husband?" I don't know -- I have to go do a 13 hour case, so it will have to be some time after that. "When will I get my surgery done? You said 10 o'clock, but it's now 12 o'clock."

To most of these questions, I recall thinking to myself, "Why can't people just learn to be patient?  We're a hospital, not a hotel.  We're physicians, not concierges!"

But then I experienced an epiphany through the most unlikely of circumstances.  Just recently, I went through a very horrific and terrifying experience.  Someone in my family was very sick, and was hospitalized in critical care.  Things were touch-and-go for a while, and when I discovered how critical her situation was, I immediately flew out to be with her.  After all, my critical care expertise would undoubtedly be of benefit.  My entire family descended upon the hospital.

Now I'll pause here to disclose that my family is a little unusual in we all have a medical background.  My father has been a physician and surgeon for over 34 years, and of course as a physician myself, we certainly had no trouble in understanding all of the particular intricacies of the situation.

So as we sat there in the hospital while the person we loved went from one surgical procedure to the next, I could not help to still wonder, "When are we going to get some information?"  "When is the doctor going to come out here and talk to us about the results of the latest test?"  "When will we know whether she's out of the woods, or not?"  

It suddenly hit me like a load of bricks ... I was "guilty" of the same thing that I attributed to my patients and their families.  And so I realized a legitimacy to the very thing that had previously annoyed me.

The fact that we were physicians made no difference whatsoever, for on that day, we were simply an anxious family sitting there, pensively awaiting word regarding our loved one.  Looking through the mirror, I was able to realize this from the other side of things.  It became apparent just how important the physician's words were, for when she finally came out and sat down with us, answered all of our questions, and eventually told us that everything would ultimately be fine, an incredible weight was instantly lifted.

This is an incredible lesson that all of us who are physicians, surgeons, and aspiring doctors, should do well to remember.

My field, Neurosurgery, is a tough field, and working at a level-1 trauma center, I deliver bad news almost every day.  "I'm sorry, but your loved one did not survive the accident."  "I'm sorry, but your loved one's injuries are not compatible with survival."  "I don't want to alarm you right now, but if your tumor turns out to be glioblastoma, you may only have as much as 15 months left."  There are many different ways to say the same thing.  As physicians we must keep in mind that during these times, we are ministering to the family.  On these occasions, medicine becomes a priesthood, for the patients and their families need for us to provide a high level of truth, compassion, and comfort.  For us, it's just another day -- for them, it's a life-altering day.

I rediscovered this when I looked through the mirror on my own life-altering day.  As physicians, we must answer the "when" question.  We must find the time necessary to sit down and answer all of the questions.  We must place our hands on the patient, and reach out and touch the shoulder of that family member as we are talking to them.  In so doing, we will impart to them a sense of comfort and peace during their difficult moment.

In the 1957 Annual Meeting of The New York Academy of Medicine, Charles Garside first wrote of the Priesthood Of Medicine. We'll all do well to look through the mirror from time to time, and remember that this key principle that is central to our profession.

Thursday, June 17, 2010

Factors To Consider When Choosing A Medical Specialty

I see many students entering their 3rd and 4th year of medical school with a seemingly daunting question hanging over their heads -- "How do I decide on the specialty that's right for me?"

On the surface of it, the question should not seem that difficult. Just choose the specialty that you enjoy the most! Right? Well, in the past, it may have been that way, but these days things are much more complicated.

In the days of the past, when people like my father were entering medicine, there seemed to be an overall superlative sense of dedication to the profession. People at that time largely entered medicine knowing that it was more than a job - it was who they were. They recognized that they would continually forego a lot of life's flexibilities in order to be there for their patients and their practices.

In those days, residency training had no "80-hour" work restriction, and young residents literally lived at the hospital. And when they would eventually complete their residency, they would classically go into a single practice by themselves and literally be on-call for their patients 24 hours a day, 7 days a week.

My father is one of those individuals. He has been in ObGYN single private practice for 30 years, and has taken all of his own call for that entire time.

Slowly over the last twenty years; however, things have started to change. Something called "lifestyle" started creeping into the mix. In the 80s and 90s, some of the physicians coming into practice would still choose a specialty based largely on what they enjoyed the most, but they would also then choose a practice modality that would allow them to have a better lifestyle. They entered group-practices and hospital-based practices. This allowed more time for family and friends, relaxation, and pursuit of things outside of medicine.

And now most recently, I have noticed a trend further toward this direction. Medical students today have such a concern for lifestyle autonomy that they are now starting to choose medical specialties that would allow them to first and foremost achieve a lifestyle outside of medicine that they desire!

In our culture, the freedom to have full discretion over one's time appears to be one of the single most important factors that affect what specialty someone chooses.

Take my specialty, for example. Neurosurgery is a field of high stakes and long hours. Our surgeries with special skull-based approaches can last as long as 17 hours. The core neurosurgical residency is 7 years. Many go on to obtain a fellowship, which is an additional year. When my father heard that I was entering neurosurgery residency, he told me, "Wow, seven years is a lifetime." He's right -- it’s definitely is a long haul!

Unfortunately, I do not see a lot of students opting-in for this type of rigorous training. Time and time again, I have had students contact me when they are eager 1st year med students, wanting to know what they can do to get into neurosurgery, only to have them change their minds when they are in their 3rd and 4th years of medical school. When I ask them to tell me why they've changed, the answer is always some version of the same thing. They love neurosurgery, but resist entering the field out of concern of for the free time that they won't have.

Now let's pause for a moment and recognize an important fact -- lifestyle IS important, and having freedom and ample discretion over one's time is definitely a key part of life happiness.

Yet the worry is that the best and brightest individuals who should be entering rigorous fields, such as neurosurgery, ENT, or cardiothoracic surgery, are leaving to enter other fields that require less time and less training. Over time, this may be something that the overall medical community can ill afford.

Just this past year, key medical students of whom I had full confidence would be well dispositioned for the field of neurosurgery ended up changing course in the last moment to choose another specialty. What did they choose? Radiology. Nothing's wrong with radiology as a medical specialty, but they chose it largely because it offered better a better lifestyle, fewer years of training, and less hours invested a week.

I'll admit it. During the last 6 years, I've noticed that life has continued without me. My parents have gotten older, my sisters are both married, and I have new nieces, and cousin, many of whom I have yet to meet. But I'm willing to forego all of this for the training that neurosurgery provides. In the end, I'll be able to provide a valuable service to individuals who are in dire need of my help. That is a wonderful feeling, and a legitimate calling.

We all have one life to live, and it is important to choose the right specialty. All of us who are physicians, or aspiring physicians are doing this largely because we have a sense of dedication and responsibility to be a positive impact on others in our community. Young physicians-in-training would do well to remember that residency training does not last forever, and when it is done, you can still reconcile your lifestyle aspirations with your chosen specialty by choosing the practice paradigm that's right for you.

Sunday, June 13, 2010

Today's A New Day! Yesterday Can't Help Me Today

The road to becoming a doctor is a long road, and one that is filled with many pitfalls and traps. Along my way, my experience has taught me that fortunes can change quickly, without scarcely a warning. It's like the weather in Oklahoma. They say, "If you don't like the weather, just wait a minute -- it'll change!" Undergrad, medical school, and residency, is much like this. You can easily go from the penthouse to the outhouse, from the so-called golden-boy to the red-headed stepchild, from being at the top of everyones adoration, to being an after-thought. How do I know? Because I've been there. In fact, anyone who's walked this long road into medical school and residency has undoubtedly had this happen to them at some point in their training.

I remember getting my acceptance letter to medical school, scarcely finding the words to convey my happiness. Little did I know that it was the start of a huge journey, where I've experienced some very high "highs", and some very low moments.

A key high point for me in medical school was my research that I presented at a neuroscience research symposium. At that point in my life, I felt intellectually invincible, and thought that there was nothing that I couldn't accomplish if I put my mind to it. Much of the faculty were patting me on the back for a job well done. Then along came an exam in which I did poorly, and many of the same people lavished me with accolades, now were muttering that I would not amount to much. The good news is that I persisted when others would have given up, and now I've been able to get to this particular point in my life. There's still much work to be done, but I've come a long way.

It's important to remember that throughout your experience, you'll be continually buffeted by storm clouds - by the naysayers that will always question your abilities on one day, even as they lavish you with praise on days that you perform well.

Here are things that I remember to get me through those times.

  1. No one wants you to do well, more than YOU want yourself to do well! Therefore, don't listen to people who aren't positive and uplifting. YOU are your own best judge of whether you can do something or not. A very high percentage of success is believing that you can do it, and then very diligently with an unwavering devotion in order to make it happen.
  2.  Don't get outworked! I remember one day, I went to the library early in the morning to study for a difficult exam. I ran into one of my colleagues who was already there studying, his books opened up elaborately on his table. I studied diligently all day long, and after an exhaustive study session, prepared to go home. Gathering up my books after the long day, I walked by my colleague's study area. He was STILL there studying. What's more - he always scored better. This is when I realized that even though I was studying hard, I was still being outworked by my colleague. In order to make it, you must work harder than anyone else. It's the only way to ensure success!
  3. Don't become to satisfied with your successes that you may enjoy along the way. It's tempting to settle in after enjoying a good result, and say, "Now that I've accomplished this goal, I can now take it easy." There is NO SUCH THING as taking it easy, for it is perilous to do so. All it takes is one mediocre result to de-mast all that you've worked hard to achieve. One slip is all that is required to go from the penthouse to the out-house.

One of my favorite allegories for this is the gazelle and the lion. When the lion wakes up, he knows that he's at the top of the food chain. All the same, he knows that he must successfully hunt the speedy gazelle in order to maintain enough food to survive. When the gazelle wakes up, it knows that it's at the bottom of the food chain, and must continually be "on-the-run" in order to survive. The concept is this -- in the morning, it doesn't matter whether you're the lion or the gazelle, you'd better be running!

I always tell myself, "Today's a new day. Yesterday can help me today!" Keep working!

Sunday, June 6, 2010

How Did This All Start?

Successfully navigating your way into medical school, and then successfully completing medical school takes a lot of grit, resolve, and determination, and also a little bit of good luck. One of my best friends used to tell me, "Good luck favors the well prepared." That statement really sums up the plan and approach to applying to -- and succeeding in medical school.

One of the key things I quickly realized throughout the entire process for me was that other people had a tendency to be very insincere and disingenuous. This appeared to be true at every phase of the process. When applying to medical school, I would engage many of my fellow applicants in conversation. They would say that their MCAT scores were higher than what they actually were, or that they were just applying to only a few schools, when they had in fact widely applied to many schools. Once I was in medical school, my fellow students would downplay how much they studied. They would see me studying and then say, "Oh, what are you doing that for? The exam's still three weeks away." Meanwhile, while they were convincing you to let down your guard, lulling you into a false sense of comfort, they were studying diligently the entire time. When the exam would roll around, they would get their high score, and then shrug their shoulders as if to say, "Aah shucks. I must've just gotten lucky."

I soon realized that good luck does indeed favor the well prepared. For those of you with aspirations of medical school, you must prepare diligently, and there are in fact things that you can do to drastically increase your chances of getting into medical school.

My path to becoming a physician was not a direct pathway. My parents taught me at home until the completion of high school. I then attended Oklahoma City University, a small liberal arts university, where I majored in Biology and Piano Performance. I eventually obtained my B.S. in Biology, and then found my way to Saint Louis University School Of Medicine.

Things at Saint Louis University were very interesting, to say the least. I strongly believe that the best thing about the medical school was the quality of the students that they selected to attend. Many of them remain friends to this day. Nonetheless, medical school was demanding and it was quite an adjustment from my undergraduate days.

I still remember participating in my first surgery on the neurosurgical service. Seeing that alive brain, pulsating in the operative field, made an indelible impact upon me, so much so that I resolved even more that neurosurgery was the field for me.

Today, I'm a 6th year neurosurgery resident at the University Of Texas Health Science Center in San Antonio, Texas. And what's more, I have no regrets about the choice I made.

With this blog, I want to use the benefit of my experience to help you achieve your dreams of attending medical school. I will be posting surveys with possible blog topics, and you can then vote on which topic you would like for me to blog.

Pick up a hardcover copy of my book. It has a lot of valuable information, including a lot of funny stories. It is a very entertaining read. Then you can interface with me through this site and ask questions to which you have always desired real and honest answers. To how many schools should you apply? Is your list of schools appropriate to your MCAT score? Which residency should you choose? Are you competitive enough for a particular residency? What should you do if you don't think that you are competitive enough? These are all questions to which obtaining true and honest answers is difficult. I'll give you the honest answers.

This site is a forum for readers to discuss my book, as well as share your own experiences in applying and traveling through medical school.

Stephen E. Griffith, M.D.

Medical School Applications

Applying to medical school can be tough. I reminisce back to those days with a grimmace. What difficult times those days were!

Back in freshman biology class, my professor asked, "How many of you want to become a physician?" All of us raised our hands.

Shaking her head sadly, she said, "Only one in four of you poor souls will make it."

This was very troubling, because I realized that the competition would be very stiff indeed. What could I do to assure myself the best chance at succeeding through the application process?

As my fellow undergraduate colleagues and I progressed through the college experience, many people starting dropping like flies. A few people scored poorly in freshman biology and then dropped out of the pre-med program. Others bit-the-dust during inorganic and organic chemistry. Still others dropped out during physics. In the end, there were not that many people left in my class who had completed their MCATs and going through the application process.

As I talked with my fellow classmate applicants, I discovered that many of them with marginal scores had only decided to apply to in-state schools. Their rational was, "Well if I can't get in to in-state medical schools, then there's no way that I'm competitive enough to get in at other medical schools."

Many people think that this is true, and this advise is widely disseminated to applying students from their college advisors. I always questioned the validity of this game-plan, and my experience would certainly suggest that this advice should be disgarded.

When you apply to medical school, you must apply widely to many medical school programs. You have to throw as much money at it as you can. When I was going through all of this, I did not have the greatest scores, but applied to 20 medical schools. Out of those 20 schools, I was invited to send out secondary applications to 12 of those 20 schools. 8 schools then invited me to interview with them, and out of those 8 schools, I was accepted to 4 schools.

And interestingly, my first acceptance was to Saint Louis University Medical School -- I eventually attended this school for medical school. As one of the oldest medical schools in the nation, it has a rich history and a sound legacy of turning out leading physicians in every specialty. Noteably, I did not receive an acceptance to my in-state school until much later in the interview season, and it was ONLY after they realized that I was already accepted to an out-of-state school!

So when you're applying to medical school, you'd better do it right! Work hard in undergrad. Do the best you can on the MCATs. Then throw as much money into the application process as you can, applying to as many schools as possible. You'll likely achieve a good outcome.

Read more about this and other topics in my book, Just Trying To Be A Doctor. You can leave feedback to this page.