10. Electronic devices will OWN you.
No matter where you look, medical technology will rule your world. From pagers to iPhones, doctors are accessible 24/7 with Electronic Medical Records, messaging, Skype and Zoom. With the click of a mouse, you can plot data from heartbeats to brainwaves. You’ll grieve the physical exam skills you worked hard to master, as you witness Legal Medicine take over your universe. You’ll see doctors flippantly order MRIs and CT scans for the same patient (with the initials “CYA”) and wonder why we are so aggressively defensive in our practice of medicine.
Be firm in your resolve to protect that which brought you to medicine: the awe of human physiology and healing. Palpate the edge of that liver! Find that asymmetrical thyroid nodule! Feel the oxytocin in a hug. Human touch still matters. Even though we are walking meat skeletons...we have energetic souls that yearn for the connection that happens only with physical touch.
9. Get a summer job selling Used Cars.
Wasting a summer at Blockbuster Video was not worth the five free rentals per week. 90’s video rental skills aren’t transferable (unless you’re looking to try and get someone admitted to the hospital under 23 hour observation status...in that case, BE KIND, REWIND and PLEASE RETURN GRANDMA BY MIDNIGHT). Instead, every pre-med student should learn to sell used cars. Walk that dirty lot and try to convince a reasonable, well-educated person that this sturdy car will outlast the next decade of Midwest winters.
Once you acquire the skills to motivate and convince them, you will be ready for the throes of patients who automatically assume you are trying to kill them. Any Google search or personal blog will supply your patients with infinite powers to deny, accuse, or thwart your best intentions. You will need to embolden your powers to withstand this exhausting force. If you can sell a Used Car, you might have a chance at convincing Karen that drinking lemonade with cayanne pepper won't solve her dry mouth, restless sleep, hot flashes and extra 20 pounds (but perhaps stopping her nightly benadryl washed down with a double gin and tonic could help).
8. Be prepared to defend the ridiculous and superficial.
Telling people to get naked and put on a hospital gown will IMMEDIATELY spark nervousness. Excpect that they will mindlessly leak out chatter as a byproduct of brain anxiety. If you’ve got a sweet babyface or you are at least 2 decades younger than the patient sitting on the table, you’ll need to learn how to graciously side-step comments about being “too young to be a real doctor.” Start practicing scripts in response to quips about age, birthdays, politics, or celebrity lookalikes. Look in the mirror and rehearse your poker face as you try the following:
“That’s interesting! No one has ever told me that I look like 'a human version of Elmo' before.”
“No, I didn’t donate blood today. I’m always this pale.”
"Yes, as a matter of fact....I am tired."
Beware: there are no physical characteristics off limits, especially if you were born with anatomically female tidbits, so be prepared with quick and assertive replies like: “I’m not the nurse; I’m the doctor. ...Yes, I’m sure. I’ll go get her for you.” or “Please don’t call me ‘honey’.”
7. It never gets better, it only gets different.
Admit it, when you’re up at 2am, diligently studying and your college roommates are sleeping off their beer hangover, you’ll think: “It will get better…...once I get into medical school.” Nope. Fast forward to medical school, and you’re up at 2am again, cramming every last bit of the Kreb’s cycle into your short-term memory to pass Step 1 (of a Gazillion Steps) boards, you’ll think, “It will get better …..once I’m done with all these tests.” Wrongo.
Wait a few years, and you’ll be walking the hospital halls like a zombie with a belt of pagers, waiting for a catastrophe to happen during your on-call shift. Still not better. Then, they’ll promise you it gets better once you’re out in the “real world” with extra staff, a new EMR rollout, hospital re-build, RVU incentives….. Nope. Nope. Nope. It doesn’t get better. The landscape of medicine changes underfoot and NOTHING makes this “easy” or “better.” (except hiring a scribe, which has been statistically shown to alleviate burnout in doctors!). Nonetheless, if you want to become a physician, you better start doing some deadlifts and sumo squats to work your quads, because this is a relentless uphill climb. The view may never get better, but your life grows more interesting. It’s a gloriously fascinating journey, so enjoy every step.
6. Being a doctor is still not as hard as motherhood.
No one is judged as harshly as moms. Motherhood is an on-call 24/7 agreement for the rest of your life. Sure, physicians provide a “medical home” for patients and promise to adopt “meaningful use” of electronic health records to help steer community health in a better direction. But peek into any home and you’ll see it’s impossible to coax a child under 5 to swallow a single bite of a green vegetable. There’s no such thing as “meaningful use” of a laundry hamper. Cleaning up vomit or urine is easy; it’s the psychological warfare of motherhood that is traumatic.
Without measurement or feedback on your job skills, you will live with an undercurrent of worry that you missed something, that someone else has it all figured out, or that you are damaging your children by having them take the bus home. The best advice for both situations: Stop Googling. Start breathing. And know that no matter what, your presence in that room, at that moment, is better than nothing. (Also: where else--other than a bus ride---is a kid gonna get this ripe stash of alternative words for “feces”?)
5. You will feel like a TV actor when someone asks “Is there a doctor on the airplane?”
There’s trepidation to push the call light when the flight attendant announces trouble in the cabin. You will hesitate a millisecond longer than you ethically should. It’s happened three times to me, each at different stages of training. No amount of medical knowledge will keep your heart from palpitating at high altitudes. Thankfully, your well-honed reflexes will automatically engage: your brain will activate, your poker face will appear, and your calm demeanor will convince the rest of the crew that you know exactly what to do.
There will come a moment when your choking panic subsides and you glow with a tiny bit of heroic pride. Enjoy this rare opportunity of gratification. There’s very few career choices that provide this comfort and solace, just by your mere presence in the room. (Bonus points: it will be the only time your three children will acknowledge your medical degree.)
4. Your knowledge will not magically protect you from heartbreak of any kind.
Life is unfair. When you sign up for a degree in medicine, you gain a front row ticket to witness the extremes of all human conditions from the joys of birth to the tragedy of death. Though you might feel equipped to guide others through painful diagnoses and treatments, it will never prepare you for personal adversity. Being a doctor doesn’t mean you Get Out of Jail Free, nor does it mean you are saved from infertility, motor vehicle accidents, alcoholism, depression, cancer, divorce, suicide, or SIDS. A career in medicine won’t stop any emotional hemorrhage.
If that’s not bad enough, there are no financial luxuries bestowed to doctors. You can’t write off your heavy student loan debt on your taxes, you won’t get paid time off for vacations, and those conferences in tropical locations? It’s all out of your own pocket. Many doctors have succumbed to financial bankruptcy. Nothing is guaranteed--not physical or financial health, and not even tomorrow’s sunrise. So take care of yourself and find a good behavioral therapist. Budget wisely and surround yourself with people that fuel your sparkle. The happiest doctors live with abundant gratitude without expectation.
3. You will frequently question whether you made the right decision.
If you’re a decently ethical and good human being, you will still question all major decisions in your life. It’s just the price you pay for having a conscience. Albeit, a frustratingly, over analytical, high-strung conscience, indeed. Will I regret eating that raw tuna tartare in a few hours? Was the teal cocktail dress more flattering than the yellow one I bought? Should I put the snow tires on my Prius in October instead of November? Did I send my child to school in pants that are scandalously too small? Do I have this baby before I graduate residency? Should I have chosen a different career other than medicine? You will always wonder. Just because you find yourself fantasizing about running away as a barista in a quaint Italian cafe, it doesn’t mean you made the wrong decision to become a doctor. It just might mean that you need to work on cultivating your 6th vital sign, Creativity. (see #2)
2. Being a doctor should be the least interesting thing about you.
The moment you admit, “I’m a physician,” in a crowd, we know all about you. In those three words, everyone can accurately assume your work ethic, core values, and ability to delay gratification. We can predict your high school GPA. We know what you were typically doing on a Friday night in college. It’s possible to estimate your academic achievements, resilience to challenges, and ability to empathize. But is that what makes you interesting? What really keeps you ALIVE? Temperature, pulse, blood pressure and respiratory rate are vital signs. They measure your vitality. (Sadly, since 2001, pain is also a 5th ‘vital sign,’ even though it has nothing to do with keeping you alive.) It’s never too early to start cultivating your 6th vital sign: creativity. What topic really makes your eyes glow when you talk about it? What would inspire you to get up at 5am? What salacious deed would you really do for a Klondike bar? Creativity is what makes us human beings, not human doings. Make it a priority to explore what makes you curious every day.
1. Choosing a career in medicine is the first door, but not your last.
As the delivery of modern medicine tries to keep up with demand, many doctors are left feeling like factory workers, flipping patients every 10 minutes. The career they were promised is quite different than what they’re experiencing. This results in over 50% of our doctors feeling burned out (characterized by emotional exhaustion, perceived low personal achievement and depersonalization). The most important thing that no one told you about becoming a doctor: you have unlocked a treasure trove of infinite possibilities.
You might not see them at first. They’re not visible as you walk across that stage during medical school graduation. When your hand reaches out for the diploma, you won’t see it encased inside. You’ll be fixated on your first job, your first patient, your first paycheck. That’s fantastic. Be excited about putting that white coat on! You deserve it.
File this away for future use: Becoming a doctor doesn’t have to be your final destination. You can change your mind. As you grow, your needs change. Do you want to be an employed physician or change to private practice? Do you prefer predictable shift work or the spontaneity of locum tenens? Are you called to serve in a non-profit public health setting or travel the world as a cruise ship physician? If you feel stuck or burned out, use that 6th vital sign of creativity to notice other unopened doors. Your skills as a physician transfer easily as a teacher, speaker, educator, mentor, author, consultant, advisor, CEO…. The doors are endless. You just need to walk through and bravely color outside the lines.