I Hate Medicine!

Last week Ella the Med Student wrote brilliant and thoughtful advice on how to be happy in medical school: You need to love medicine.

Now Doctor D has a confession to make:

I hate medicine! Medical school was the worst 4 years of my life.

There, I said it! It felt good to let it out.

But before all of Dr. D’s medstudent fans rush to unfriend him on facebook they should know this: Doctor D not just a good doctor. He is a frickin’ amazing doctor!

How is this possible?

They look so pleased just to be in a hospital!
Doctor D isn't in any photos like this.

How I Learned to Stop Worrying and Hate Medicine:

Ella classified medical students based on their love for medicine with the “miserablites” at the bottom. They are the ones in medicine with ulterior motives. Therefore they hate school from the first cut on the cadaver. They don’t fit in with other medical folks. They don’t like studying diseases or treatments. They can’t wait for medical school to be over.

Yup, that pretty much describes D in medical school!

Young D took one of those aptitude tests administered by the college career counselor. It said that his personality was an awful fit for doctoring. He was warned.

So why did he do it?

Medical School With Ulterior Motives

Doctor D’s ulterior motive for studying medicine was that pesky humanitarian impulse. D loves people. As a student young D worked in homeless shelters and volunteered in 3rd World countries—not to pad a resume for med school, but because he actually liked doing those things. Young D asked himself, “Self, what work should you choose that allows you to help suffering people?” Since D had the book smarts everybody suggested medicine.

On day one of medical school D realized he wasn’t in Kansas anymore. He was surrounded by highly driven people who absolutely loved spending 18 hours a day studying pathophysiology and pharmacokinetics. Ella enjoys kicking back with Robbins Pathology while sipping her coffee in the morning. God bless her crazy ass! Doctor D’s trudge through Robbins was about as enjoyable as the Bataan Death March.

D’s secret fantasy in medical school was that one day he’d go in and give everyone the middle finger and drop out. This thought was the only real pleasure he had for most of med school. It kept him going when times got rough. Every miserable day D told himself, “I’ll quit tomorrow.” He came close to doing this about a hundred times, but never pulled the trigger.

Doctoring with Love and Hate

So D became Doctor D, and lo and behold he was right: All this dull medical science he forced himself to learn is useful—it helps sick people get well, and D really enjoys his job!

The actual practice of medicine allows for amazing connection with other human beings. A caring doctor during the worst and most painful day of your life is really useful. Doctor D always gets along well with patients. One reason Dr. D connects so well with patients is that he never really did connect with other medical folks.

Some doctors love studying diseases and reading the latest medical trials—quite a few retired docs do this years after they’ve seen their last patient. That’s cool and all, but it ain’t me. If Doctor D lost his medical license tomorrow you can bet he wouldn’t read another sentence of medical literature again!

"Yeah, I don't like school either, but some things are worth the misery."

But Doctor D does keep up with all the info on the escalating arms race between diseases and medicine and he'll treat you with just as much skill as the next doctor. In some ways D sees himself as the purest form of doctor:

Some doctors battle illness because they are fascinated with the weapons or with the battle strategy. Doctor D fights because he believes in the cause.

So take courage you med school miserablites—you sad souls who don’t like biochemistry or fit in with your anal classmates—here is hope for you yet! You may yet become a fine MD who loves this crazy job in a way those medical types could never imagine.

PS: If any of you med students do decide to go out in a blaze of glory by telling "the man" to stick it up his rectum and burning your student ID please email Dr. D your story because he would love to live that moment vicariously!

An informal AskAnMD poll:

How many of you medical people actually like medicine vs. those who use medicine for ulterior motives like Dr. D?

How many of you patients would care if you doctor wasn’t actually fascinated with your disease and your medicines?

Will Medical School Make Me Miserable?

Part II of ongoing series: Should I Become A Doctor?

Great question from a potential medical student:

"I got accepted to med school for 2011, but I am scared to commit to this decision. Will medical school suck all life out of me, leaving me passionless, tired and with no ambitions?"

For this question Doctor D called in a consult! Doctor D recruited a real live medical student! Ella the Med Student is a brilliant blogger and a winner of the coveted Big D Award!

Ella's Advice:

Medical school is difficult. It takes tons of time. It's stressful. It is a huge commitment. It's competitive. It is also a million other wonderful things.

Everyone in medical school has essentially the same experience, the same course load, the same time schedule, etc. Yet, you will hear very different opinion from students about their medical school experience... ranging from "it was the worst time in my life" to "this is so much fun!"

The MAJOR factor that contributes to the differences in student's experiences in medical school is why they are there.

"Why am I here?"

Let me describe a pattern I have noticed among medical student. I think there are three main groups of student attitudes about medical school. I'll describe them here...

Ella’s Taxonomy of Medical Students:

The Good

The happiest students are those who are enjoying the journey. They actually love medicine, love the material they are studying, love the lifestyle of continued learning and a high-paced academic environment. Of course, many have other interests and families, but to them medical school is not an obstacle in the way of those things. Med school is an awesome part of their life.

"I'm happier than a pig in mud! Medical school is Awesome!"

Personally, I love reading my huge Robbins pathology book with a cup of coffee in the early morning. I love going to lecture and participating in clinical problem solving. I feel a rush every time I am in the hospital, I talk to my patients for too long, and my brain is always coming up with ideas for projects and research. I look forward to residency and my future career, but I am in no way miserable in school. I absolutely could NOT imagine being anything other than a physician... it took me so much work to get here that I am actually in bliss all the time. I know this sounds weird... but I know a lot of other people like this. If you ask them about medical school, they will describe it just like I have.

The (sort of) Bad

The second group of people are those that like medicine just fine, and it came to it as a reasonable choice. They worked hard in undergrad, and are all around strong academic students. To them, medicine is more of "a good field to be in" but not "the most amazing and only possible career on the planet." They could have been attorneys or engineers or business entrepreneurs or stock brokers and would have been just as happy. They do well academically, but are a bit blase about medicine... often eager to get home, eager to skip extra discussion about a disease or patient, and tend to be a bit frustrated with the rigmarole that comes with medicine. This doesn't make them less of a physician, but they do not enjoy the ride of med school as much as the first group. They are "putting up" with med school... and looking forward to getting out so they can have a family, a paycheck and a steady schedule.

The Ugly

The third group are the Miserablites. They hate medical school. They are barely hanging on by a thread academically, and they are socially and academically absent. They are caught up in the idea that that are in the wrong spot. They've realized that medicine is a lifestyle that doesn't end after medical school... and they expect that stress and academic/hospital nonsense will be a theme in their lives forever.

Some miserablites ended up in medical school because of outside influences. They felt pressured to do something "worthwhile.” Their heart wasn't in it... but they either didn't have another readily identifiable passion, or they felt their other passion didn't hold enough weight.

Other miserablites came to medical school for the money or lifestyle, and quickly figured out that those reasons are not sufficient to motivate you through the insanity of medical school. And they also figured out too late that being a doctor usually doesn't make you rich. 90% of doctors are not free of financial obligations. Student loans, malpractice insurance, etc. make the life less than glamorous.

The miserablites are those who, as you say regard medical school as "sucking all life out of me, leaving me absolutely passionless, tired and with no ambitions." I can tell you I have NEVER even one day felt this way about medical school.

Search Your Soul!

So, you have a lot of thinking to do. I would really consider what this commitment means, and how it will effect your goals. You have already identified some gut feelings about whether this career is a good match for you. I really think you owe yourself, your wallet, your future family, your happiness and your overall sanity some real hard soul-searching.

If you decide not to go into medicine, there is NO SHAME in that!

There are a million other things you can do which are just as rewarding. And if you do choose medicine as a career, choose it because it is best for you. It is indeed a wonderful life, but only if it is the life you really want.

Good luck!

What do you think? Doctor D always loves hearing your thoughts in the comments.

Patients: Would you care if your doctor enjoyed learning medicine?

Medical Students: Where do you fit in Ella's Taxonomy? Any of your Miserablites want to explain themselves?

Go on over to Ella's blog and admire how awesome she is!

So You Want An Online Diagnosis?

Last week Doctor D sternly rebuked those who wanted him to answer illegal (diagnose-me-over-the-internet) questions.

Several commenters replied it was D's own fault for naming his blog "Ask An MD." I mean seriously, what answers could an MD possibly have worth reading if he can't discuss your bowel problems?

Oh, so THIS is what you wanted?

So "Ask An MD" is running a special this week only:

Doctor D will answer every single diagnosis or treatment question you ask in the comments of this post!

(Very important small-print disclaimer: None of Doctor D's answers will be correct or sensible in any way )

What good are bullshit diagnoses, you may ask?

The Weight of Perfection

One of the greatest stresses in a doctor's life is having to be correct all the time. Of course, we aren't always correct, but people always expect us to be correct. This leads to a lot of stress in a docs life.

The avalanche of questions started early:

When Young D was a Pre-medical student in college people started asking him questions that were totally beyond his abilities. "Hey D, I get this weird feeling in my stomach, but sometimes it isn't there. What is that?"

Ah, to be young and free of the heavy responsibilities of doctoring!

D would just smile, shrug, and say, "Probably either metastatic cancer or gas."

Young D became legendary for his smart-ass diagnoses, and a good time was had by all.

But then Medical School began and the game of diagnosis became one of life and death. A wrong guess could hurt someone—badly. People kept throwing unanswerable questions at him, but the weight of his profession had crushed D's carefree attitude. He began giving evasive responses and advising people see their own doctor.

D has been practicing medicine for a while now. It is heavy stuff to talk to people every day about the ways that their own bodies can cause misery or kill them.

Doctor D actually doesn't like talking about suffering and death. He would rather open your mind and make you smile. So D started this blog answering people's questions about the odd quirks of the medical profession. For D this blog is a lighthearted way to process the hard and nasty stuff he has to see every day at work.

But work found Doctor D in his secret online hide out. He should have expected it—answering questions about doctors brought patients, and patients have questions about diseases they want to ask doctors.

Unfortunately, I can't answer diagnosis or treatment questions, no matter how desperate you are. I have to admit: I don't even want to try. I miss sleep at night over the guesses I make in my real job. Trying to do the same thing on-line would lead poor Doctor D to have a nervous breakdown.

But Doctor D won't abandon you poor folks so desperate for answers. He can't diagnose you but he can offer you the next best thing: Utter Nonsense!

"Nonsense Therapy is all-natural and involves no harsh chemicals!"

Therapeutic Misinformation

Do you doubt the healing power of ridiculous bullshit?

Doctor D learned this lesson as a young doctor. He had been working for months with a patient who was miserable from one of those frustrating mystery illnesses. She was in the office crying and listing her symptoms. Finally Doctor D shrugged and grinned, "All I have left to offer you is racehorse therapy. We take a rifle and put you out of your misery!"

At first Doctor D was petrified. He had let one of his pre-med smartass comments loose on a real person with real suffering! Then the patient smiled—the first smile he’d seen from her in months. Then she laughed, and D laughed with her. They had a good hearty laugh and the patient hugged him as she left the office.

Things were different after that. We talked and laughed a lot. We never found a diagnosis for her, but we ridiculed the disease mercilessly. It made us both feel better.

Nonsensical bullshit from a doctor can have a wonderful therapeutic effect!

Ask any middle-schooler and they will confirm it: The human body is funny! The human body is silly! The human body is gross! The human body is ridiculous! The human body is a low-down Judas that will eventually screw you over then kill you!

The only sensible thing to do is to mock our bodies on a regular basis.

So send Doctor D your symptoms and he shall mock them fiercely! He shall diagnose you with improbable and silly things! He shall loose his inner child to laugh at your bodily functions! He shall suggest ridiculous and painful treatments!

Not a single one of you shall get any useful medical information from Doctor D’s snarky replies... but you still know you want to send D your symptoms!

Therapeutic Misinformation:

Just like Chiropractics!

It feels so good,
you won’t even care that it’s total bullshit!

All questions will be personally answered by the doctor. So send in those aches, tingles, throbs, swellings, and vaginal discharges!

Now, Doctor D is a busy man, and he doesn’t check his email 8 times a day like more dedicated medbloggers. (Grumpy you're embarrassing the rest of us with your annoying dedication!)

Be patient, and the doctor will be in to misinform you and mock your symptoms shortly!

Doctor D Strikes Back!

It's time we make something very, very clear:

This is not a personal medical advice blog!

A lot of people just stumble across the "Ask An MD" name and start firing off questions before they read another word. I realize you regular D Readers are not the offenders but I have to rant at somebody, so Dr. D is going to nip this in the bud right now:

I will NEVER answer diagnosis or treatment questions online!

"Luke, I am NOT your doctor!"

This isn't that I don't love you guys. It just can't happen. I challenge you to find any MD giving personal medical advice to strangers online. Nope it isn't there!

Doctor D put this info on the "Email Dr. D" page but still a majority the letters to Doctor D basically ask: "Here are my symptoms. What should I do?"

Doctor D used to write polite replies explaining that the blog is here to answer general questions about doctors and the medical system, but I really cannot diagnose you... etc.

..but as the popularity and google rank of this blog has grown Doctor D's inbox has become congested with please-treat-me-over-the-Internet emails. Abandoning all bedside manners, Dr D has begun sending snarky rebukes to the worst offenders: "Did you read the f*cking disclaimer!?!"

But that pesky medical compassion keeps D feeling sorry for all these people sending hopeless requests for help to some random medical blog!

Could These Emails Be The Symptom Of A Real Problem?

This deluge of unanswerable questions got Doctor D thinking. These people begging for answers reveal some real issues with the medical system:

1. Sick people are desperate for answers.
2. It is way too hard to get a doctor to talk to you. It costs too much money to get in, and even then the doc is in and out in like 5 minutes!
3. Doctors are terrible at addressing what is really bothering patients.

"Houston, we have a problem."

Unfortunately, turning to some anonymous doc on a blog is not the solution to these problems.

Do you really want to risk getting an answer from an anonymous doc who can't examine you—some dude who may sleep under a bridge and just plays doctor online to meet chicks? Trust me: you don't want to do that!

And Doctor D won't risk his medical license making random guesses over email for people he's never laid eyes on. Giving you a harmful misdiagnosis over the internet would make Dr. D feel terrible, and it could be the blood in the water that sparks a feeding frenzy of lawyers and disciplinary boards.

Perhaps someday doctors will be more accessible, better communicators, and be able to treat you over the Internet, but this just isn't a reality right now.

Now you have to deal with regular screwed-up doctors working in a bizarre healthcare system. Yes, it sucks, but you really don't have many other options.

This is why Doctor D runs this blog: To help you navigate the tricky world of real doctors.

If He Can't Be My Doctor, What Use Is Doctor D?

Well, if you would even consider writing some anonymous blog for help then your doctor-patient relationship is probably on life support.

It may not be your fault (doctors suck at relationships—just ask Lady D), but you will be the one who gets hurt.

Instead of desperately emailing random bloggers on the internet for answers which will likely be wrong, why don't you learn to work on with the doctors you have in your life?

Doctor D volunteers his time as a relationship counselor for your doctor-patient relationships. D isn't going be your doctor (although, he blogs anonymously so, who knows, he might actually be your doctor?), but he just might teach you how to make your own doctor useful!

So respect D's boundaries! ...And send me some questions I can work with!

What do you think?

Currently there is no way to get answers direct from a doctor online. Getting diagnosed by a doctor miles away who can't examine you is a recipe for mistakes, BUT it would be convenient.

Would you be willing to take a risk with an online doctor? Would you forgo the ability to sue if the advice harmed you? Should the standards of doctor-patient relationships change to adopt to the wired world?

By the way, if you ever sent Dr. D a forbidden e-mail now is your chance to grovel and beg for his forgiveness!

Dr. D's Guide to Killing Your Loved Ones

A very different question this week:

"What can I put in someone's IV that will kill them fast?"

Now don't start judging yet...

This person was writing out of compassion not hate. Someone they love has a terminal illness and asked them to do this if the pain got too bad. (Think: Clint Eastwood in Million Dollar Baby)

It is a hard question. I feel for the person who wrote because I have been in this situation many times.

The Moment of Truth

There is the moment when doctors say, "I'm sorry, but there is nothing we have that will stop your illness. The disease will win shortly and you will die."

We are all going to die one day—many of us from illnesses that are long and painful. Everyone mentally acknowledges this as a concept, but when you are on the receiving end of such news it still hits you like a ton of bricks.

It is not uncommon for people to get in a very dark place after this news. Despair, fear, and hopelessness are understandable emotions given the circumstances.

Doctor D is by no means the final word on such a heavy topic, but perhaps I can offer some perspective from a doctor who has accompanied many patients on that difficult final path...

A Cry for Help

Depression is miserable. Anyone who has depression can attest that the mental anguish of hopelessness can be just as terrible as the worst physical pain. Often depression is triggered by traumatic life events.

The good news is that depression is not the end. Most people recover from depression, especially depression that is due to horrible news.

We all work very hard to convince a suicidal but otherwise healthy 20 year old that life can be better and their depression can be treated. Why should we not similarly address the depression of terminally ill patients? Whether someone's life will be decades or days they can live to the fullest when supported by people who love them.

Often when a dying person asks someone to kill them it is a cry for help. In their despair they are asking, "Am I worth anything anymore?"

The answer they need to hear is, "Yes, you are still worth everything to me! I may not be able to save your life, but I will cherish and honor you to the very end."

Every terminal patient that ever asked me to die, they later expressed to me their joy in life and how much they value their time once they had made peace with what was happening. Depression can be treated allowing people to pass with a peaceful heart.

Do not doubt the value of a human spirit, even during the final hours! Doctor D once watched a dying woman do more good during her last day of life in a hospital bed than he has done in all his years of practice.

Fear of Pain

Hurting sucks. We all hate pain and want to avoid it. The thought of dying in pain is intolerable even to consider. And a lot of fatal conditions are also very painful. Many people who otherwise are at peace with dying might contemplate suicide to avoid the pain at the end.

I believe that the field of Hospice is perhaps the finest breakthrough medicine has made in recent decades. Hospice is care for those with terminal illnesses.

Hospice is the art and science of comfort, and as a discipline they have made amazing discoveries in the treatment of people in the dying process.

There is no reason that anyone with terminal illness needs to die alone and in pain these days.

It is sad, but many people still don't know about Hospice. (I guess it's because they don't have their own TV dramas like every other field of medicine. I suppose the ratings wouldn't be good for a medical drama when the patient dies every episode.) Many patients seem shocked when I tell them there are teams of medical professionals that are skilled at managing every aspect of care at the end of life.

Not only do they insure you don't physically suffer, but they address the emotional and spiritual pain of facing death as well. Hospice patients are able to pass in peaceful environments or even in their home. There is support for the family as well. And yes, insurance does cover it.

Many patients are skeptical if Hospice can really deliver.

People figure that if fighting an illness was miserable, then loosing to it must be torture. Back in the old days that may have been the case, however, hospice has an advantage: they aren't trying to cure you. The very thing that seems like the problem they use to create solutions. Without needing to cure anything they can avoid any procedure that causes pain, and they don't have to avoid treatments that might not be good for your illness because fixing your illness is no longer the goal. Your comfort becomes the ultimate goal.

I have never seen a hospice patient die in pain.

Some patients wonder if they can trust the doctors and nurses involved with Hospice to really care about their pain. "Aren't a lot of doctors jerks who enjoy hurting patients who complain too much?" I admit, there are some callous doctors, but I have yet to see a single one involved in the hospice system that wasn't about as kind as a human can be.

Please don't touch the IV!

So in response to the question: Your loved one is asking for your help, but it is important to recognize help they need. Putting down your loved one like a dog is not the solution—despite what Clint Eastwood says.

Love, support, respect, and connecting them to resources that can help them through this difficult time is the right and humane approach.

Doctor D always loves to hear your thoughts. Have you ever had someone you care about feel this way? Have medical professionals ever wanted to help someone die?

Anyone have any experiences with Hospice?

I realize that suicide is a difficult topic with lots of emotion on all sides. Please share opinions and discuss with respect.

Should Fear of Patients Keep You From Medicine?

The first of the series: Should I Become A Doctor?

A confused premed writes Doctor D for advice:

"I really want to be a doctor, but I have a fear of sick people. I don't mind needles or blood and guts, it's just people being physically sick that I am horrified by. It's the only thing holding me back from applying to Medical School. Is this something you think I can overcome?"

Excellent question my young friend!

The good news is that you aren't the only person who feels discomfort in the company of ill people. Many people feel this way to some extent or another. Ask any chronically ill person and they'll tell you how often people squirm in their presence. If you want to be a doctor you will eventually need to work comfortably around sick folks, but first lets examine why people feel this unease...

Why would you be horrified by sick people?

1) You're afraid you will catch their disease.

I suppose this is an understandable concern. But many illnesses aren't contagious and most of the others can be easily prevented with proper hand washing and immunizations. Doctor D has caught more things from his preschooler than he ever caught from patients!

But... I suppose there is always a small chance you will catch a bad illness from practicing medicine. If you aren't willing to take this risk then you should probably stay away from medical school.

2) Ill people remind you of your own frailty and mortality.

If you want to blissfully imagine you will live forever in perfect health the existence of illness in others is a painful reminder of reality. If fear of sick people is an extension of your personal dread of death then by all means stay away from medicine because every day at work will terrify you.

Believe it or not, a lot of narcissists with the this issue are drawn to medicine because they want the MD as a status symbol. They leave medical practice when they realize that the presence of suffering kills their hedonistic buzz. Good riddance!

3) Ill people make you uncomfortable because you feel their discomfort.

Human beings are social creatures. We all to some extent experience the world through the experiences of others. When we are around people who suffer—if we are at all feeling persons—we tend to feel a small amount of their pain.

This is Empathy, and empathy has motivated some truly amazing people to choose medicine as a career. Rather than avoiding the ill because of the sympathetic pain they feel, many empathic people want to help those who suffer.

If you are disturbed by ill people because you feel their pain, then you can become an understanding doctor goes the extra mile to help. We need more doctors like this.

If this is you, then you could have the makings of an excellent physician!

"Trust me kid, I'm more scared of you than you are of me!"

Disclaimer: Empathy Can Be Handicap Too!

If you feel so strongly for ill people that you turn into a puddle of ineffective mush when confronted with the suffering of another person then you aren't much use. Sick people come to doctors for help, and sympathy is an extra—a good extra, but only if it comes with professional help and skill.

Can you calm your emotions enough to think clearly and help people who are suffering greatly?

Also, empathetic doctors tend to get burned out. It's wonderful that you feel for your patients, but you have to realize that disease always wins in the end. You will lose a lot of patients. You will be unable to cure a lot of diseases. If your motivation for being in medicine is helping people's suffering you will have a lot of days you want to just give up. This is called compassion fatigue and it is the bane of kind doctors everywhere.

Can you keep doing your work with sick people and still care even when you lose again and again?

If you can maintain your empathy despite these obstacles you may just find that your initial anxiety around sick people made you into an even better doctor!

What do you think?

Patients: Would you be comfortable seeing a doctor who still sometimes feels uncomfortable around sick people? Would you go see our young premed once she graduates from medical school?

Med Students and Doctors: Have you ever overcome a dread of ill people?

PreMeds: Dr. D loves bringing premeds to the hospital and answering their questions about medicine. He always gives it to them straight about what it is really like to go through the training and then practice. So send him more questions!

32 Years

The winner of the contest to guess Doctor D's age:

Drumroll please...

Linda!

She correctly nailed it on the head at 32 years old. Although she loses points for suggesting that Mrs. D is a "teenyboppper" [D married a woman his own age, thank you!] she still wins the coveted Medical Mafia Mug!

Congrats to Old MD Girl for finishing as runner up with a guess of 31!

But apparently Doctor D doesn't look 32.

While looking younger than one's actual age may be the goal of maturing women, it doesn't always bode well for an MD.

Patients who don't know D usually refer to him as "that young doctor."

Often in the middle of an examination patients will stop and ask, "Doctor D, how old are you?" The don't care much about the age I tell them. The real question is, "Do you have enough experience to be taking care of me?"

"Hi, I'm your new doctor. No, really I am! Wait, where are you going?"

Actually D has had an MD at the end of his name for half a dozen years and knows his shit, but it doesn't matter when the babyface stirs up immediate distrust.

D would grow a long beard to radiate age and wisdom if Mrs. D could stand kissing it, but since she dislikes beards, Doctor D has to wear his face stubbly to keep the old ladies from asking if he would like to meet their granddaughter who is still in highschool.

Admit it. This is the doctor you hoped for, isn't it?

The fact is that everyone expects a really good doctor should be old.

Now D isn't hating on old doctors, since he plans to be one eventually, but it gets frustrating when patients give him that "Oh shit, a young doctor. I'm gonna die!" look when they first lay eyes on him.

What do you think? Does a doctor's age change your expectations about his or her competence? Do you prefer younger or older MD's to care for you?

D always loves to hear your thoughts!

PS: Linda, email me so I can send you your award!