Sex and patients

We has a lecture the other day that informed us that TEN PERCENT OF PHYSICIANS HAD HAD SEXUAL RELATIONSHIPS WITH A PATIENT.

Ten. Percent.

So, the study is from almost 20 years ago, BUT. That was an astonishing number. In my mind it is never okay to have sex with a patient... unless they are really really hot!

But seriously, unless you're a rural physician who is the only game in town so everyone in town is essentially your patient, that is not cool. And never okay if you're a psychiatrist.

I guess I should wait and see what happens when my first ridiculously good looking patient hits on me.

Personal v. Professional Life

Last night I went out with friends, as we have been quite a bit recently. As THE MATCH looms, coming up in a week and a half, we find ourselves with little to do other than begrudgingly go to class in the mornings and drink our normal quota of calories in alcohol. But as we transition from students to "real doctors," the line between our own selves and our doctor selves starts to dissolve. How would you feel if you saw your physician drinking a glass of wine? Probably the vast majority of people would be okay with that. But what if they are noticeably drunk? Or what if they only have one glass of wine and there is a very small (but very real) possibility they might get called into the hospital?

Legally, physicians need to report any law breaking (specifically salient to this conversation would be any arrest for drunk driving) when they yearly register with the licensing committee. But there is a whole range of other behaviors that don't result in legal action that reflect poorly on the profession and the individual. As much as we live in a society that celebrates and respects individual responsibility, I also believe that when we signed up to go to medical school, we also signed up to hold ourselves to a higher standard. It has been fascinating to rubberneck during Charlie Sheen's very public manic episode. There have been all kinds of discussions about what his professional obligations are as an actor... imagine what would have happened if it were a physician (other than the obvious fact that no physician is cool enough to get over 1 million twitter followers in 24 hours)?

I certainly am not innocent of behavior unbecoming a future doctor. And I will likely continue to occasionally indulge in that kind of behavior. I know many doctors do. In some ways, it is an unhealthy way of dealing with the stresses and pressures of the job. Last night I ran into a group of interns from the hospital!

But I also know that I am much more aware of the risks that I take every time I make those decisions.

Gallows Humor

This week's NYTimes "The Ethicist" article was about medical students posting pictures of patients on facebook along with "gallows" humor comments. One of the most difficult things about being a medical student is relaying to friends and family who are not in medicine that when we make jokes about our patients, it usually starts out less as a statement about the individual patient, and more about our discomfort, fear, or sadness about a particular circumstance. However, Randy Cohen is absolutely correct that what initially begins as a defense mechanism to prevent burnout can quickly turn into a systematic way of dehumanizing patients. To avoid falling into that trap, it takes a lot of consistent and conscientious evaluation of how one laughs about patients. As someone who loves to laugh and appreciate the absurdities of life, it has been a line (even as a 4th year medical student) I have sometimes struggled with. Often, the way that I see I have crossed the line is to relay a joke to a non-medical friend (or often, my brother), who's reaction is as appalled as the writer into "The Ethicist." These reactions, while at the (hopefully temporary) expense of my image in that person's eyes, help me define and redefine and redefine where my own humanity is, so I can focus on the humanity of my patient.

I am currently reading "House of God" for the second time (the first was during first year of med school), and I am struck with how much more hilarious, relatable, and tragic it is after I have had so many similar experiences of my own over the past year and a half. I would definitely recommend it to get a sense of what it can be like to be in the world of medicine... minus the frequent in-house sex parties. The acting out I see with my friends and colleagues is much more of the inappropriate facebook behavior variety.

Speed Dating and ... THE MATCH

As a fourth year medical student, there isn't really a lot that you need to do. There are a couple of months you spend at your own medical school (and sometimes other medical schools) basically auditioning for a month in your chosen field. Then you do some electives, ostensibly to help "make you a better intern" but often more to "take something really easy." Then, most of the fall and winter (and spring) is taken up with obsessive worrying about what you're going to do with the rest of your life and where you will be next year. Because, unlike any other career, doctors-to-be get matched with their employer for residency by a computer.

The Match is not quite so online-dating-esque as it just sounded. It is much more like speed dating.

In order to go to residency, medical students apply to multiple residency programs. For competitive specialties (like orthopedics or dermatology) this means applying to upwards of 90+ programs. For most people, the goal is to interview at 10-15 different programs. After all the interviews are over, you rank from #1 to #whatever the programs you interviewed at, and the programs do the same for applicants they interviewed. That's when the computer program synthesizes those two pieces of information (for every applicant and every residency spot in the country), and every medical student gets an envelope at the same time in mid-March that tells you where you are contractually obligated to spend the first year of your residency.

So, how is this like speed dating?

You spend very limited amounts of time getting to know someone (i.e. a program) before setting off to meet the new potential mate. You do this a dozen times, and by the end it's really hard to remember the first few people more than vaguely without confusing them. At the end, you make a ranked list of who would be willing to date, and everyone else does, too. Then the speed dating coordinator tells you who you are going to spend the next 5-7 years of your life is. (And that is how it is NOT like speed dating.)

Now, keep in mind my only reference point for speed dating is from movies, etc., as I have never been speed dating myself. I most often find myself thinking of "The Forty Year Old Virgin." Which program is going to be the one who just got out of prison and is reeking of desperation? Which program's nipple is going to be hanging out and not even notice? Which program is going to be the one who rejected you who you never got over?

And that is how I will get my first adult job as an M.D.

Semper Ubi Sub Ubi

Earlier this fall, I got to go shopping. Not that I haven't been shopping in the past year, but this was different. I was finally going to get some new underwear.

Sometimes being a medical student means finding joy in the little things (no pun intended). After having spent most of my time as a third year getting up at 4 or 5am, getting home at 6 or 7pm, and then getting up to do it all again 6 days per week, the few days I had off I found myself doing one of two things: sitting on the couch and watching TV, or sitting on the couch and watching streaming TV on the internet.

Seriously, though, sometimes it felt hard enough to find the time and energy to pay my bills on time that as long as I had functional underwear, it didn't seem like a priority.

I was wrong.

Now that I have underwear that actually fits properly, I feel like a new woman. It has helped my posture, overall comfort, and attitude. Try standing in an OR for 6 hours, retracting (i.e. being the person who holds/lifts everything out of the operative field), with a bra strap that keeps slipping down your shoulder, but you can't actually do anything about it because you are sterile and can't touch anything that isn't sterile, too. In retrospect, it really distracts from the whole "learning" thing.

Also in retrospect, I can't believe I am so proud for accomplishing something that most people dread as a holiday gift from their mothers.

Everybody has Secrets...

...Mine usually involve HIPAA.

I know that this is a cheesy introduction as my first blog post, but this is my first blog, so please bear with me. I decided to start this blog partly because I enjoy writing, and as a medical student (soon to be intern), I find that I don't have enough time to write regularly, and I'm hoping this will help motivate me. I also partly decided to start this blog as a way to chronicle the duty hour changes that have recently been put into place that will take place when I begin my intern year. But that makes it sound like this blog will be BORING. Mostly, I wanted to write this blog to tell some of the interesting (HIPAA protected) patient stories I have and talk about some of the lifestyle issues that medical students and residents face.


Right now my lifestyle issue is that I am a 4th year medical student with too much time on my hands.