Central to the skillset of every physician is the differential diagnosis. This is a list of possible diagnoses that helps guide clinical decision-making. By asking specific questions, performing a focused physical exam, and ordering lab tests, all through the lens of the differential, physicians are able to rule in or rule out each item on the list. The differential is not fixed, however; it is a fluid list that can be rearranged or completely changed at any time given new information. This information often comes in the form of an extra piece of history from the patient, a new finding from an imaging study, or frequently, from several lab tests coming back negative.
Residency
Sleep Deprivation and Residents: Are We on the Right Track?
The tradition of long hours on the floor is an old one in American medical training. And criticism of this tradition is of long standing too. The controversy over the grueling residency schedules is not a new one, but neither is it one that has been successfully resolved. It can still spark off strong feelings in both the proponents and opponents of cutting back on the length of residency shifts and/or the time off between shifts for professionals engaged in this important stage in their medical education. What’s more, it is a topic which has pitted respected healthcare institutions such as the Harvard School for Public Health and the American Academy of Family Physicians against one another, so much so that this issue is not likely to be resolved anytime soon.
Should Medical Students be Sued for Malpractice?
An Ongoing Dialogue Between Medicine and Law It is no wonder why medical schools across … Read more
Choosing a Residency That’s Right for You
If you are in medical school, you have been making choices for a long time now, from what to major in as an undergraduate to what volunteer work during your gap year will give you the best chances at getting a coveted med school slot. But now that you are in medical school, one of the most important decisions still lies ahead: what kind of residency should you choose? This is an incredibly important choice that will shape the rest of your career. A good decision now will make it more likely that you will be satisfied with your professional life down the road.
The choice can be a difficult one. What things should you consider before you decide? Read on to find out more about the steps you should take in order to match to a residency that will leave you both personally and professionally satisfied.
Challenges Remain for Female Medical Students
It might actually come as a surprise to many would-be medical students that gender is an issue that still affects those who are training for a career as a doctor. After all, there are more women in medicine than ever before–and certain areas of practice have become largely female-dominated. Despite this, however, gender attitudes can color nearly every aspect of medical education.
Women in Medicine: Close to Parity – at Least In Numbers
Statistically, if you just look at the numbers, the participation of women in medicine has indeed come a long way. According to the AAMC, as of 2013, of the 20,055 students who were accepted into medical schools across the country, the split between men and women was almost evenly divided: 53% male and 47% female. It is important to look at these stats in terms of their historical context in order to truly appreciate them.
Get A Better Letter: An Insider's Guide to Letters of Recommendation
By Michelle Finkel, MD Whether you are a candidate for medical school, residency, fellowship, dental … Read more
Breaking the Glass Ceiling: Students With Disabilities in Medical School
Updated December 1, 2021. The article was updated to correct minor grammatical errors and to … Read more
Q&A with Physician-Author Dr. Matt McCarthy
Dr. Matt McCarthy is an assistant professor of medicine at Weill Cornell Medical College and an assistant attending physician at New York-Presbyterian Hospital. He graduated from Harvard Medical School and went on to complete his internal medicine residency at Columbia University Medical Center. Before that, Dr. McCarthy graduated from Yale University with a degree in molecular biophysics and biochemistry, and then spent a year in Minor League Baseball. He wrote about his stint in baseball in Odd Man Out: A Year on the Mound with a Minor League Misfit. The Real Doctor Will See You Shortly: A Physician’s First Year is his most recent book, and details the trials and tribulations of internship year. Dr. McCarthy has published in USA Today, Sports Illustrated, The Atlantic, Slate, Reuters, Deadspin, and Stat. I sat down with Dr. McCarthy at an Upper East Side café to pick his brain. This interview has been edited and condensed:
Physician Employment Contracts Part II: The Story Continues
Make sure to check out Part I here!
Today’s article takes a closer look at several key terms in employment contracts that can have a significant impact on a new physician – compensation methods, incentive compensation and outside work or “moonlighting”. Building on our first article that examined termination provisions, non-compete clauses, professional liability insurance and indemnification, we will identify key issues in evaluating compensation models and moonlighting and outline some of the questions to consider before signing on the dotted line.
Dr. Sandeep Jauhar, Author of Doctored
What made you decide to write your new book, Doctored? What were you hoping to accomplish?
When I was growing up, my mother wanted me to become a doctor. She told me, “I want people to stand when you walk into a room.” When I started my first job as a cardiologist, I realized I had been isolated from the changes occurring in medicine. I was a fellow in cardiology; I was learning about the human body, the heart, the physiology, and the therapeutics, but not about the culture of practice. I was shocked to see how unhappy many of my colleagues were. The unhappiness wasn’t just about paperwork, patients going on the Internet, malpractice, the usual things you hear about – it was a deeper, more existential problem. The problem was the systems of medicine didn’t allow them to be the kind of doctor they wanted to be – the same kind I wanted to be. When I entered medical school, I had this fantasy that I was going to reform the profession somehow. I didn’t know how, but I thought I would, somehow. When I got out, I started seeing physicians who were unhappy. I think their unhappiness was a response to this loss of ideals. I think a lot of physicians have had to compromise their ideals because of a diseased system. That’s why I wrote the book. I wanted to write about it and put it out there.
Junior Doctor Stress and What Can be Done about It
Junior doctors [and residents in the US] do a valuable and sometimes life-saving job for patients. They are the future in medicine and can bring enthusiasm and fresh ideas into the profession. Despite the importance of their role to society, junior doctors have sky rocketing stress levels and many have an appalling state of mental health.
The Shocking Suicide Rate Among Doctors
It is totally shocking that in the 21st century, so many bright young doctors fall prey to depression and around 400 US physicians intentionally end their own lives annually. This means that every year in America, a million patients lose their doctor to suicide. The chance of dying by suicide is greatly increased for those in the medical profession compared with ‘lay’ people. For instance, male doctors have a 70% increased risk of dying as a result of suicide, when comparing the death rates with men from the general population. One of the reasons there are more completed suicides – ironically – may be as a result of doctor training. Doctors know the human body intimately. They know about drug dosages, they know more about the effects of drugs on the body. They know how to save a life and because of this, how to take one. A determined doctor can calculate a fatal drug dose expertly or know where to cut that would be catastrophic. They also have access to powerful, death dealing drugs that are only available on prescription to the rest of the population. This may be why there are so many successful doctor suicides each year.
Increasing Access to Healthcare in America
The advent of the Affordable Care Act was meant, in part, to help to increase the access that all Americans have to healthcare providers. However, while this has meant that a larger number of families now have health insurance, there is still a long ways to go before equitable access to healthcare is achieved.For medical students who will be coming into practice in the near future, an understanding of this issue and why it is important is a critical beginning to producing new physicians that are aware of the problem and are willing to be both proactive and creative when it comes to finding solutions to it. This article covers health care disparity and why it is important, as well as practical solutions to help close the gap of access to medical care in America.
Love and Happiness… And Medicine? Our Experience in the Couples Match
We were in the same class in medical school. It was your typical story. Boy meets girl, girl doesn’t like boy’s buzz cut, they waste a year, eventually end up as anatomy TAs working on the same dissection together, and fall in love. Standard. I knew that I was going to be a surgeon, he was thinking about ER. We moved in together. We talked about getting married. Then he went out for third year rotations and I started the Anatomy Fellowship at our school. He did Surgery mid-way through the year. To my concern, though not to my surprise, he loved it. He loved it the way I loved it. We talked seriously about what this would mean for us, both for our relationship and for our careers. We had always assumed that when the Match rolled around that we would participate in the Couples Match. Couples matching into Surgery seemed like a long shot, but we both knew we couldn’t be satisfied in another field, that we were surgeons at heart. So we decided we had to try.
The Unmatched Student’s Guide to Successfully Dealing with Failure
I was in the middle of a fairly busy day on the palliative care ward, … Read more
5 Soft Skills Every Pre-Med Student Needs
Though the emphasis of the medical school application process lies on academic achievement, there are a number of personal qualities that pre-medical students should strive to develop if they wish to become superior physicians. The development of these soft skills may also make students more competitive medical school applicants when they are evident in interviews and letters of recommendation. Such soft skills include:
1. The ability to work effectively in a team
Modern medicine requires immense coordination between various clinicians and providers. Doctors must collaborate with nurses, social workers, specialists, therapists, and others in order to adequately care for their patients in today’s complex medical and social climate. The ability to lead and to collaborate with team members is a necessity for today’s medical trainees. Pre-medical students can develop this skill while working in a team setting in their college coursework (e.g. group projects and presentations), extracurricular activities (e.g. student government and student interest groups), and other major experiences (e.g. philanthropic organizations and research laboratories). Students should actively strive to lead, but they should also work to see the perspectives of all team members, and to incorporate effective strategies to help their team meet common goals.
How To Overcome Adversity in Professional School
After coming home from a long day at the library studying for my cardiology exam, I get a phone call from my sister. “Hey,” she said. “Grandmother is in the hospital. Can you come home this weekend?” Great, I thought. Not this again.
I was barely beginning to cope with the loss of my dad over eight years ago, and barely staying afloat in medical school because of it. I had failed my first medical course, anatomy, during my first year and just spent a tough summer trying to remediate it, as my other friends went off traveling or spending time at home with their families. Now, my grandmother was a piece of my childhood that I was about to lose and I had no idea how to prepare for it.
Top Tips for Sub-Internship Success
The sub-internship is a crucial rotation for all medical students, no matter which specialty they plan to pursue. During this transitional phase in their clinical training, students begin to assume more independent responsibility for patient care. A sub-internship introduces students to life as residents, and it is often a source of recommendation letters for the residency application process. Below are my top tips for success during your sub-internship.
Student Loan Forgiveness for Medical Students
Many medical students cheerfully expect to be earning a generous income as they begin their medical practice. But while it is true that that, according to the Medical Economics website that in 2014, 7 of the 10 top-paying jobs were in the medical profession, the issue of course is far more complicated than that. The American Association of Medical Colleges estimates that a four-year medical education at a private school today will cost around $278,455 dollars while a public one runs only slightly below that at $208,868. And the average medical student will be around $180,000 in debt at the time of their graduation. Around 20% will have debt in excess of $250,000.
These numbers can seem staggering. Fortunately, there are programs available to medical students which not only get them out from this monumental debt, but help underserved communities across the country and improve access to quality medical care for some very vulnerable patient populations.
What You Should Know: Lies in the Patient-Doctor Relationship
What You Should Know is an ongoing series covering a range of informational topics relevant to current and future healthcare professionals.
It happens to every medical student sooner or later – the realization that their patient has lied to them. Especially for students, who are just beginning to gain clinical experience, this realization can come as a shock. A sense of betrayal, anger or even the desire for retribution can set in, all of which can be damaging to the doctor-patient relationship.
These emotions aside, it might help student doctors dealing with the nature of this reality to understand where deception enters into the therapeutic relationship – as well as how and why people lie in a clinical setting and what the doctor can do about it.
The Million Dollar Question
Interview season. The time of year that roads and skies swarm with the best and brightest medical students to all corners of the country taking aim at the next step in their training – residency. Believe it or not, behind the shiny brochures, extravagant dinners and polished powerpoint slides, residency programs are just as nervous about attracting top talent as you are about getting your top choice.
The interview trail is usually a blur of dry cleaning bills, rental cars, and the smell of breath mints masking cheap coffee mixed with nervous sweat. The broken record of the obligatory “strengths and weaknesses” question loops in your head. One of the more terrifying moments in the day comes when an interviewer asks: “What questions do you have for me?” Regardless of who asks it–the intern only four months above you in training or the gatekeeping program director–you know you have to ask something. So why not make it count?