This is Water - David Foster Wallace

Herein lies some amazing insight.  Please watch.

Hey followers!

Here is a brief update.

I am done with my M1 year!  

It is surreal.  I will write a lot about that soon. However I have some things I need to catch up on… such as sleep, exercise and personal relationships.  I also have some personal issues I need to take care of right now.  I may not be posting regularly in the next couple weeks because I will be doing some traveling, clearing my head and eventually bike riding out in the wilderness.  My askbox is currently overflowing and I hope that you all will understand if I am a little slow in responding.  Hopefully I will find some hours here and there to get caught up.

Thanks for all your support.  

TNQD

Hi, Do medical schools only look at the GPA from science courses/pre-reqs? Or do they look at the overall GPA too?

On your application it will have you report overall GPA and science only GPA (which, if I remember right, is technically math and science).  For science majors like me, these GPAs are often the same.  However for non-traditional majors (e.g. art, history, etc.) these GPAs may be dramatically different.  Which one has more weight?  I am sure that depends on the school and application.  Admissions committees won’t just look at one aspect of your application, they view it all together as one package.

I hope that answers your question.  All the best,

TNQD

If I fail my first general chemistry class (I’m a freshman) and I get a C in another class for math, do you think I should give up on pre-med? This semester was terrible compared to my first semester in which I got a 3.79. I feel as if repeating any class will look horrible. I feel horrible about myself.
There is no reason to feel horrible.  Things happen.  Life happens.
Maybe this post will help you out: What to do if you get a bad grade.
Everyone stumbles.  The question you have to ask yourself is: what are you going to do next?  Read that post, reflect and come back stronger.  You can do this.
All the best,
TNQD

Hi! Do you have any advice for a high school freshman who desires one day to be a doctor? I know I’m still VERY young and I probably don’t know what I am talking about, but I’ve always had this dream of one day going to med school and getting an MD. My grades right now, are not the greatest :( I’m struggling with A minuses/B pluses. What would you recommend I do in terms of extra curriculars? What should I focus on? hahaha there is so much to think about!

I think this post should help!  I wrote it awhile back for all my high school followers.

Best advice?  Slow down.  You have years to figure out all of this stuff.  Enjoy high school and the experience of growing up.

All the best,

TNQD 

Go for it!

I’m 34 and I’ve always wanted to be a doctor. It didn’t go as planned since my father got sick and I had to work immediately after my undergrad. I plan to quit my current job and go back to being a pre-med. I feel that that move is essential since, well, in all honesty I need to polish my Sciences up (especially Organic Chemistry). Should I still go for it? Being a doctor has always been my dream. I would very much appreciate your response.

Yes!

Why would you ever knowingly deprive yourself of something you wanted your whole life?  In fact a classmate, and good friend of mine, has a similar story.  34 is not too old to go to medical school.  We have some people in their 30s, 40s and one in her 50s.

It’s not going to be easy, and you have to be realistic with yourself.  But I truly believe if they are willing to put in the work almost anyone can go to medical school (I say “almost” because some things, like a felony, unfortunately can’t be overcome with work).  You can do this, I promise.  I went back to school to be a doctor and now I am well on my way.

Lao Tzu is reported to have said: At the center of your being you have the answer; you know who you are and you know what you want.

You know what you must do and I imagine you already made up your mind.  You just want some confirmation.  So if that’s what you need, here it is:  do what make you happy.  If that is being a doctor then that’s what you should do.

All the best,

TNQD

First semester classes

Hello First I’d like to thank you for this blog. It’s wonderful :) I’m going to be a college freshman this upcoming fall (Bio major premed track, the usual) I had to pick my fall semester classes yesterday, which was stressful. I mainly chose biology, chemistry, and the english/writing class the university forces all freshmen to take. I wanted to also take calculus, but I was told that it’d be too much. My question to you is: what were your first semester classes? what do you think I should do?

Oh jeez, that was so long ago.  Remember, I didn’t start out as a pre-med so the time I got into taking science classes I had a few years of college under my belt.  

I agree with the advice you were given.  There are a lot of things that will be happening all at once for you.  Your new classes that are likely to be dramatically different that high school.  You will be in a new environment full of new people.  If you move out that will be a stressful event all on its own, not to mention you may be leaving behind your past support systems (family and friends).  That is a lot of stress.  I wouldn’t couple that with an overwhelming semester.  If you fail classes that is hard to come back from.  Better to start light and then make your semesters harder than start hard and regret that decision.

Not to mention you are a freshman!  This is your time to have fun!  Explore the world, take fun classes and make sure medicine is what you want to do.  Don’t get on the pre-med train to early.  Sometimes if you get swept up in it you never figure out how to get off.  Plenty of people end up in med school and realize it wasn’t for them.

I think you are doing the right thing.  Make sure this year is about adjusting to college.  Hard semesters can come later.

Best of luck!

TNQD

P.S. check out my pre-med timeline for more detailed info on what to be doing your freshman year. 

Q:WhatShouldWeCallDentistSchool is a thing :)

clapsforgoalie

Really?  Who knew?  Check this out dental fans!

Here are two other recommendations:

Hi! I’m pre-dent and I follow: sayyestodds and substanceandsoul both are dental students at UCSF. Hope this helps!

Hey! Are there any tumblr blogs by current Dentists or predent student you can suggest? Thanks!

I don’t follow any.  However, I do have some amazing followers and if anyone has the answer it will be them.

Followers assemble!  

Are there any great dental blogs out there?

P.S. If I had a dental blog I think I would name it “Cavity Search.”

P.S.S. I really love that I got to say “Followers Assemble” in a post.  I think that will be my new thing.

Med School Ebooks

hiya! i’m starting med this june and i was wondering where i can get medical ebooks? i’m hoping you know some free ones out there but if not, i hope ones that are affordable. i’ll definitely buy actual textbooks but it would help to have them in my ipad as well.

So here is the skinny on books.

Right now, most medical ebooks are not great.  Some have no search features.  Some don’t let you jump directly to indexed topics.  Some are literally just .pdfs of the book.  That said, it is nice to have digital copies of books so you don’t have to lug around lots of textbooks.

Before you go out and buy anything I would wait for two things.  First, see what you school offers as resources.  I literally have dozens of electronic books that my school subscribes to.  I didn’t have to buy them (well, my student fees paid for it).  I just log in and get access.  Most of them are searchable and indexed well.  These are books like Harrison’s, Robbin’s, Cecil’s, Guyton & Hall and many other exceptional medical texts.  This is done through services like Access Med and MDConsult.  I would get ahold of your school and see if they have these resources before buying anything.

Second, I would talk to upperclassman.  Many will have books they want to sell.  They will also tell you what books you need.  You will soon find that the best book for you and the recommended book by the school are probably not the same.  Upperclassman will be better able to advise you about that.  If you do decide to buy a book, many now come with digital content.  For example, most of my classmates used Costanzo Physiology, which came with an online version.

Finally, yes I have lots of digital texts that I got, *ahem, less than legally.  I don’t plan to advertise that on my blog though.  Generally what happens is that books will trickle through the class.  Upperclassman will pass down digital text books and classmates will send around their finds.  Eventually you will have more resources than you could ever need.

Bottom line?  Hold off and buying anything just yet.  Find some upperclassman and get advice from them.  Personally I wish I had done that, I ended up buying lots of books I never touched.

Congrats on getting in and good luck with med school,

TNQD

Crazy? A little…

Hi! I’m a non-biology major currently in my junior year; I haven’t been able to complete all of my prereqs (1 year Chem w/ lab and OChem) and I was wondering—when would I take the MCAT if I were to take a gap year? Also, would it be realistic to fit Chem and OChem into that gap year—Chem 1 over the summer, Chem 2 Fall, OChem 1 Spring, OChem 2 Summer. Or is that just crazy?

Question 1:  If you were going to take a gap year I would advise taking the MCAT your senior year, or basically the spring before you plan to apply.  Generally the timeline goes: MCAT in the spring -> apply in the summer -> interview in fall -> celebrate getting in the following spring.

Question 2:  Yes.  That would be abnormal (crazy) and probably not advisable.  If you did that it would mean you would take the MCAT prior to having any chemistry whatsoever.  Gen chem is tested pretty hard on the MCAT. O-chem is giving way to biochem, but you will still see it.  I just fear that if you have no chemistry experience prior to studying for the MCAT it might affect your score.

That may not have been what you wanted to hear.  I wish you the best of luck though.

TNQD

the AMCAS opened and I’ve started filling it up and let me just say: AAAAAAAAAAAAAH! stuff’s getting real!

I remember that day!  Actually here is a reenactment of the first time I looked at the AMCAS.

I wanted to say: thank you for the work you put into this blog. It gives other students, pre-meds like me, or those on the path towards medicine who are sure of their passion, but unsure of the future, insight to what is part of the next step. I can feel your passion for medicine as well from each and every post that you put up, and am glad that I am joining a force who never forgets to put their patients first. Thank you again, and good luck in all endeavors.

im proud of you for you “the least of my people” post. you are going to be a phenomenal doctor

Awww, you guys.  I want to hug you all!

I often get positive feedback, much of it anonymous.  Things like this really warm my heart and make me glad to put time into this blog.  I often don’t post these things because I feel like people probably don’t want to read this and there are only so many ways I can say thank you.  However, I did want to make sure that everyone knew how much I appreciate notes like these.  They always seem to come on the days I need them most.

I blog because it helps me process my experiences.  I also blog for other med students and premeds that have questions or need that bit of inspiration for the next test.  I know how that feels because I have been there, and needed inspiration to get me through those times.

Anyways, this post has two points: 

1. Thank you for the kind words, when ever or how ever you send them.  They mean the world to me.  Sometimes I feel like I don’t have time for the blog and have pondered blogging less.  But as long as interested people are reading I promise to find time to keep writing.

2. If you send me anonymous feedback like this I am not always likely to respond.  That doesn’t mean I didn’t get your message or value your words.  However, when people message me not on anon I am more than happy to respond with a formal thank-you through messages (especially since I know who you are!).

Bottom line, I want the blog to be full of content people want to read.  There are enough posts to navigate already (I hope to improve the navigation this summer by making some pages with FAQs) and I didn’t want to add to that with short individual responses to non-questions.

I really do love these messages though, and I wanted you amazing people to know that.  Thanks!

Sincerely,

TNQD

The least of my people

Tonight I got guilted into working clinic.  My buddy was involved in a car accident last week and has been behind in studying ever since.  Doing the good-guy thing, I agreed to cover his shift despite my own looming test and scarcity of time to study.

The clinic we work at serves the uninsured.  In other words, we often get difficult cases that have a multitude of comorbidities that may be the cause or effect of the patient’s low socioeconomic status.  On top of that, their lack of insurance means that these conditions are often unmanaged.  As an example, my first patient had a history of heart attack, hypertension, diabetes and several other conditions.  Her glucose on admission?  450.  Yowza.  And that was with three diabetes meds…

My last patient was the highlight of my night though.  He was an older gentleman presenting with foot pain.  What started as a normal history quickly turned into a torrid story of drugs, underground fights and jail time. I liked John, and I felt he was being truthful.  There was no reason to lie, and I had no indication that he was pulling my leg.  I finished my exam and presented to the attending.  As I said the words I realized how they must sound to a third party who was not involved in the interview.

“Patient with foot pain…. history of narcotics…. abuse of morphine and prescription pills…past hospitalization for OD…. pain not radicular or easily reproducible …”  Before he could respond I knew he thought John was seeking drugs.  But somehow I knew differently, and I said so.

“I know this looks bad, but I think he is being honest,” I stated.

“This doesn’t sound much like physiologic pain…” he responded.

“Let’s go look at him.  I don’t even think he wants pills.”  We went into the room and the doctor quickly interviewed and examined the patient.  His years of experience showed; he was much more efficient than I had been only moment earlier when I fumbled through the same exam.

The conclusion?  John did indeed have a neuropathy that could be explained physiologically (I don’t plan to divulge details).  I was proud, and vindicated, when John asked about exercises and stretches to do since he didn’t want any more pills (and he didn’t take any, for those that might think that was a ploy).

John left feeling better, with a follow-up and some strategies to reduce his pain in the meantime.  I honestly left clinic smiling because I felt like we had really improved some lives.

As I walked out into the cool evening air I was struck by a bible verse.  I am not a christian, however I did grow up catholic and I believe Jesus, and the bible, had some good things to say.  

“Whatsoever you do to the least of my people, you do unto me.”  

The patients we serve at the clinic are those who are down on their luck.  Some of them are criminals.  Some of them are liars.  And surely some of them are drug seekers.  But how can we know who is who?  And shouldn’t we treat the least of all people with the utmost dignity?

Was the attending wrong to have preassumptions?  I don’t know.  But I think it is easy to get jaded in medicine.  That is exactly what we have to fight against.  I have seen blogs posting about the annoying drug seekers and resource suckers.  But what happens when you misclassify someone who truly needs your help?

The best ER doctor I have ever met told me: “I would rather 10 junkies get their fix than 1 person who truly needs medicine to do without.”  

I think John would have gotten proper care had I been there or not.  But preconceptions are a dangerous thing in medicine.  No matter how many times you see a disease or symptom, never forget you are dealing with a unique individual.

I don’t know if there is a God who judges how you treat the least of His (or Her) people.  However I do know that if you fail to give each patient, the least or the best, the dignity and respect they deserve as humans you will never fulfill your potential as a doctor.  Perhaps whatsoever you do to the least of all people is the best you will ever be. 

An End to Medical-Billing Secrecy? | TIME.com

In wake of TIME’s “Bitter Pill” Special Report, Sebelius reveals hospitals’ price lists and Medicare Repayment Rates for 100 inpatient procedures

This is a huge step forward in controlling health care costs.