Tuesday, March 17, 2015

Dear Dawn: How do you decide on a specialty?

(Image courtesy freedigitalphotos.net)

I got this comment on one of my blog posts and decided to turn it into a "Dear Dawn" post:

"Thank you for your wonderful weblog and wise words! Sorry if I'm commenting where I shouldn't be, but I wasn't sure where to ask this question. I'm just a med student but I noticed you're an anesthesiologist. That's really awesome! :) I'm interested in anesthesiology too. Have you by any chance written on anesthesiology and why you chose it? I'd love to read a post about this if you've written about it as I value what you've written here and I'm sure your thoughts would be amazing on this as I'm having a hard time deciding on a specialty? I know I'm probably dreaming as this might not be possible in medicine (so disillusioned sigh), but I'm hoping for a specialty where I can have somewhat of a life outside of medicine. That's my main goal, which I hate to say is the case as I feel guilty as maybe I'm not as devoted as others, but I'm just so burned out already, and want to focus on my family more who I have been missing a lot. I know I definitely don't like surgery as I don't like the work. I don't really like the wards (e.g., social issues, writing admission or discharge notes), but ironically I really love general IM a lot. I also like the ICU. I feel they're the doctors I imagine I've always wanted to be, but the big negative is I don't like the lifestyle of general IM or the ICU. I also like the ED a lot, and maybe that's another option, but I have heard night shifts are hard later in life. Family medicine is ok too but FM is maybe too slow-paced for me. I really like anesthesiology, as again I love the limited patient interaction but also I feel like the general medicine is amazing and I love "doing" things, but I keep hearing about the gloom and doom with CRNAs taking over and practices not hiring partners anymore, but maybe it's not true? I'd love to hear your thoughts if you might have written about this somewhere (sorry I can't seem to find any past posts but maybe I'm not looking in the right place or I missed it)? Thanks so much! :) Kate"

You're right, Kate. I have not written much about why I personally chose anesthesiology or how I recommend choosing a specialty. Based on your comments above, it sounds like you are already on a good path of asking about and observing the positives and negatives of various medical fields. Of course, it goes without saying that ideally you should be somewhat interested in the science behind the specialty you choose. But that is by no means a required factor and only a small part of the picture. With so many choices that have such broad range of everyday job duties, you can make yourself crazy trying to find the "perfect" situation. There is no way to accurately predict the future of the politics and business of medicine, so trying to base your decision on specialty demand or salary brackets is futile.

The truth is this: there is likely not going to be a specialty that has exactly everything that you want and nothing that you don't (and that holds true for any job or profession). Instead, I think the best way to approach the medical specialties (or any particular career path, for that matter) is to spend time learning about yourself. Focus on your own likes/dislikes and strengths/weaknesses:
  • What types of work environments and tasks do you prefer (hospital or clinic, cerebral or procedural)?
  • Do you like to work in a team, on your own, or a blend of both (the most likely situation, but certain jobs sway more one way than the other)?
  • What types of patients do you find that you are most excited to see? Describe your ideal patient (not that such a patient exists, but think about the age, gender, medical issues, etc. of patients that you enjoy seeing).
  • Do you do well in situations that are unpredictable, or are you most comfortable when you have a schedule and know what is coming?
  • How do you fare in emergency circumstances? Do you shut down or engage in "go mode"?
  • Do you have any particular disabilities that might make the practice of a particular specialty very difficult?
  • Lastly, think about your personal life and career goals. What are your values? How do you measure success? (More about this question in a future post!)
This may not be a clean answer to the question of how to choose a specialty or career path, but not many of our paths in life will manifest a clear, well-marked trajectory. There will probably be a few specialties that mesh with each person, and some of the decision will be based on temporal circumstances (such as the presence of a specific mentor, demand or competitiveness of a given specialty, etc. at the time of decision.)

Regarding my own decision, I started medical school with a specific interest in anesthesiology, given my background as a chemical engineer and some parallels behind the research science of the specialty. However, I was open to many other areas of medicine. I paid attention to my likes/dislikes in the basic science classes and approached each clinical rotation as if I would potentially pursue the particular specialty at hand. I observed the patient populations, the team interactions, the personality types and the lifestyles/happiness levels of the practitioners that I worked with. I thought about the every-day activities of each field and pictured myself doing them as an attending someday.

After entertaining specialties such as internal medicine and neurology, I ended up going back to anesthesiology for many reasons. The anesthesiologists where I trained seemed happy and had personalities that meshed with my own. I enjoyed the subject matter that was presented at the conferences and journal reviews. Through self-reflection, I realized that I craved diversity in my work day activities, environment, tasks, and patients. Anesthesiology is obviously performed on people of all ages, sizes, and disease states. The work tasks are a blend of manual procedures and cerebral problem-solving. It is performed in the hospital environment with a mult-disciplinary team, both of which I enjoy. The workday can be unpredictable in terms of length and caseload, but at least the call is usually infrequent (if in a large enough group, or if you get a no-call position like I have :)), and anyway most of the work is done during the day except for emergencies. There is the potential for some very stressful situations, but they are not constant. It involves no clinic work, which would allow me to travel for extended trips if I chose to. Etc etc.

I hope this helps! If you are in a medical profession or other specialized profession, how did you choose your field of practice? What factors went into your decision? Share your thoughts here!

Monday, March 2, 2015

Ode to the Deadlift

(Image courtesy www.dieselcrew.com.)

This is the picture that most people associate with the deadlift. It even has an ominous name: Dead. Lift. But we have all deadlifted, even my grandmother. Have you ever bent down to pick something up off of the floor? Then you have, too.

(This is not my grandma, but this is pretty darn cool. Image courtesy www.nerdfitness.com.)

The deadlift is one of the most revered exercises, and it is my absolute favorite. Why? It is pure function in motion. We NEED this movement in our lives, whether it's in the back yard (rogue leaves), at the big box store (40 lb bag of dog food), at work (paper wad missed the basket), or at home (furniture rearrange!). Think of the implications: if there was a fire and your loved one was out cold, could you drag him to safety? Your child breaks her leg in the park; could you swiftly get her in the car and off to the emergency room?

I revel in the capabilities that deadlifting has given me. I'm stronger in the core, grip, and latismus muscles from deadlifting with a barbell. It has helped my climbing AND my ability to carry that huge bag of dog food from the back of the Costco warehouse to the check out counter. Yes, I'm fine waiting in line. No, I don't need a basket. My balance has improved from doing one-leg bodyweight deadlift drills. When I come across that uneven terrain on the trail or that rare cobblestone street, I won't trip and fall (hopefully!).

Let me reassure you that deadlifting will not make you look like the guy above. But it will get you leaner, functionally stronger, and more confident! Here are some pictures of variations on the deadlift:

Lastly, I refer you to this article from Girls Gone Strong about benefits of the deadlift, specific variations, and how to properly do each one. What do you think? Did I convince you to incorporate this into your exercise practice? Or have you already been deadlifting (and possibly not know it)?

Wednesday, February 18, 2015

Happy Birthday: Advice I would give my 21 year old self

I turned 41 recently, which prompted me to think about how much has changed in 20 years. What would I say to that 21 year old woman, the one working away at her chemical engineering degree, falling in love with her boyfriend, trying new things like rock climbing after growing up a music nerd? Here's what I would say:

Stuff is not the answer. Even though graduation is a year away, you're already looking for that perfect engineering job, the one that will spawn envy amongst your classmates. The one with the big starting salary and cushy benefits. It will be tempting to rent that spacious apartment and use all your extra money to buy cute work outfits. But be conservative. You don't have to prove anything to anyone. It would be a better use of your work and life energy to maximize your savings and deferred income and live a little simpler. Because those nice clothes and that nice pad don't define you, and they don't matter. Success is better measured by how much freedom you have to do things you like outside of work, to pursue other interests, or to possibly change careers someday (don't think that won't happen!).

Trust your instincts. Everyone encourages you to keep on this current path, but something is nagging at you. Listen carefully. Take that trip. Consider that career change even though you're barely starting this one. Very little in this life is irreversible, and you're young and healthy, so what's to lose? [Side note: I did do these things, which eventually put me on the path to medicine, but there was a lot of second-guessing along the way.] Speaking of instinct, it will come in handy someday when you just don't feel right but aren't sure what is wrong with you. It's going to be something serious, so you best not ignore it for too long. [Side note: I did ignore it for too long, but it all worked out ok :).]

You ARE strong. You see yourself as a clutsy, uncoordinated human being who has subsisted so far on book smarts. Yes, you're intelligence will get you far in life. But you will complete much harder tasks than next month's thermodynamics test. You can't imagine it now (you say it will never happen), but you will climb a 5.12 someday. Then you'll get cancer and you'll have brain surgery and you'll survive it and you'll recover. Then you'll climb a 5.12 again. You think you're weak and squeamish, but someday you'll be sticking tubes and needles into people for a living, and eventually you'll have to stick needles into yourself on a regular basis as well. Even though you can't stand it when someone disapproves of what you're doing, you'll sometimes go against what people in authority tell you to do, and you'll sometimes forgo the advice of well-meaning loved-ones. Own your choices.
"Always in the human experience, we find that some of the most difficult things that we've ever gone through -- the biggest tests or challenges that we're ever given as human beings -- actually are doorways to a new level of growth and new possibilities." - Rainn Wilson
Live in the present. You like to have a one-year plan, a five-year plan, and a ten-year plan. Hell, you get upset if your Friday night doesn't go according to plan! Life rarely aligns perfectly with expectations. Stop living in the future and forming your ideas based on the past. Embrace the growth mindset and be flexible.

Look inward. You, as many people do, tend to look to outward cues for appreciation, approval, and accomplishment. But everything you seek is already within you. You are loved, and you are love.

What would you say to your younger self? Try this on your next birthday (or any day for that matter) and see what comes out of it!

Monday, February 9, 2015

Seeing Love

(Image courtesy freedigitalphotos.net)
I used to think of love in the typical ways that we all do: the love between a parent and child, romantic love between two individuals, love as admiration and dedication to a certain practice or cause. But I'm seeing it differently now, just as a thing that IS. Everywhere.

For the month of January, I participated in a journaling experience led by my yoga teacher, Denise Druce. She called it Miracles in Action, designed to help set your intentions for the year 2015. On one day, we were instructed to recognize love in even the mundane things. This was a non workday for me, so it wasn't as easy as noticing the love between patients, family members, caregivers, etc. as people are whisked to and from the operating room. Instead, I saw love in our kitchen as we dilligently prepared nutritious food for the day. I saw it in a neighbor's yard, where neatly piled leaves sat waiting for removal in hopes to improve the landscape for the spring. There was love in the small consignment store where I shopped, as the clerk proudly and carefully displayed the items "given up for adoption" (as opposed to being discarded) by consigners in hopes that another person would come along and love them again. I saw love for myself as I stared into the mirror that night, performing my ritual of cleaning and preparing my body for sleep.

One of the other journaling participants shared her "loves" on the Facebook page: "I am measuring my year 2015 in LOVE! In sunsets, in sunrises, in yoga practices, full moons, and friendships... Sharing my love for nature, my family, and our global connection to each other." This is the kind of love I'm talking about. With Valentine's Day coming, people feel compelled to demonstrate love, most often the romantic type, and most often through material means. But I'd argue that the important thing to remember on Valentine's Day and every day is that true love is innately within all of us. We are alive, so we are love. And if we do not show ourselves love, we cannot truly give it to others in any form. Fellow blogger Sara T MD discussed the consequences of not loving yourself here.

The late Dr. Sherwin Nuland wrote the popular medical prose How We Die and The Wisdom of the Body, so he was kind of an expert on existential questions and things that matter in life. In an interview with On Being's Krista Tippet, Nuland said:
"Everybody needs to be understood. And out of that comes every form of love. If someone truly feels that you understand them, an awful lot of neurotic behavior just disappears — disappears on your part, disappears on their part. So if you’re talking about what motivates this world to continue existing as a community, you’ve got to talk about love…."
Where are you seeing love? Happy Love Day!