Ask Me One More Time

Originally posted April 8, 2014

“There is no such thing as the perfect score.” “But the average MCAT score at my dream school is a 38.”

“If you have more than one C in pre-med requirements…well…” “GPA is important, but it’s your volunteer hours that get you in.”

“I’ve heard you can’t go without research.” “I know a kid who killed the MCAT and didn’t even set foot in a lab.”

“These days med schools only want non-science majors.” “If you don’t have a science major, your schedule won’t look rigorous enough.”

That, in summary, accounts for about half of my thought process at any given time of day. Whether I’m studying for a physics midterm or trying to enjoy my usual mid-day comfort cupcake at ABP, some portion of my mind is fixated on the fear of what comes after Duke.

Will I cram fast enough to take the old MCAT? Or will I do poorly and find myself needing to take the new one anyway?

Will I find myself sitting in front of pre-health deans advising me to take the oh-so-ominous gap year—in other words, implying that I simply don’t have what it takes to get into a med school?

It didn’t seem like sophomore year was supposed to be much more than a transition to life off of East. But somewhere between Beyoncé’s secret album release and a second-semester snowpocalypse, I found myself entering into a constant state of panic.

If we’re studying for a bio test, the conversation veers back into average acceptance statistics. If we fail a quiz, suddenly it’s a sign that the gates to the heavenly medical school of our dreams are being slammed shut. If we’re deviating from the pre-med path, we’re deviating from the end goal. (So, in case you were wondering, take that English seminar because it fulfills a T-req and NOT because you might like something other than organic chemistry.)

When I explain this panic to most of my family and friends, it turns into a discussion of whether or not I actually want to be pre-med. Is all of the stress and concern actually going to get me where I want in life?

It wasn’t until a couple of weeks ago that I finally had an answer to their qualms. I was at volunteer training for Duke Hospice and Home Care, a volunteer program that is not only recommended by pre-health deans but also a great way to start logging all of those hours I need (I think it’s around 1,000?).

When I walked into training, I was caught off guard to see both Duke students and people who were non-pre-med, non-college kids just looking to lend a helping hand to someone in need.

I didn’t want to admit that I was caught off guard, because I didn’t want to ask myself if I would actually be giving up time to catch up on work and volunteer if it didn’t mean checking off another box on the list of the perfect pre-med candidate.

A few hours into the training, I found myself discussing issues of empathy, how to approach the holistic needs of patients at end-of-life care and all of the possible emotional and physical issues that arise with caring for patients in hospice. In a nutshell, it was the first time since I’ve become pre-med that I was reminded of the end goal of four years of constant self-doubt, panic and a rather unhealthy addiction to 5-Hour Energy. Hopefully, at the end of the day, I will be equipped with the comforting voice and knowledge of a doctor. The person who can administer the medication or advice that puts people at ease when they can’t turn to anyone else. The person who will be able to help the helpless. Idealistic, yes. Optimistic? Oh, for sure. But that end-goal is how I get myself through the series of things that seem unrelated to becoming a good doctor.

The pre-med path is inherently structured to force us into a cycle of testing ourselves, both academically and emotionally. Should I have picked a school I knew I would excel in? Should I have waited to take calculus? Is trying to study over the semester as opposed to the summer going to hurt my MCAT score?

But I can honestly say the reason I’m sticking this out is because I’m finally starting to appreciate my struggles. Yes, I did poorly on my first organic chemistry midterm. Very poorly. But it taught me to seek help when needed (thank you Tessia, you are an amazing tutor), understand that studying meant more than just half-heartedly reading my textbook and that ultimately I don’t hate the classes I’m taking…I just hate it when I don’t know what’s going on. I didn’t have to struggle to learn in high school, and now that I do, I am a harder worker and hopefully a more humble student. Working in a lab has taught me to appreciate how far I still have to go to become truly detail-oriented and patient. My peers have taught me to be supportive of each other and doubt myself a little less. My parents have taught me to never quit.

And so as to whether or not I actually want to be pre-med, the answer is no.

But if you ask me if I want to be a doctor, I’ll have a different answer.

Nandita Singh is a Trinity sophomore.

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Rice Students Refine Their Design Solutions to Health Care Problems

Second in a series

By Jennifer J. Salopek

Last month, I reported on an innovative undergraduate English course at Rice University that introduces medical students to design thinking and inspires them to apply its principles to health care problems. I introduced you to Michael Fisch, MD, chair of the Department of General Oncology at the University of Texas MD Anderson Cancer Center and “problem owner”; and to Erich, Veronica, and Aaron, the students who are working to solve the problem. The course is taught by Kirsten Ostherr, PhD, and Bryan Vartabedian, MD.

Much has happened in the past few weeks. Continue reading

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NephMadness: An Experiment in #MedEd and #HCSM

By Joel Topf, MD

Social media is proliferating. More and more of our real-life experiences are being enhanced by social apps. We tweet about sports and entertainment; Instagram our meals; and announce our relationships, births, and deaths on Facebook.

Social media wound its way into medical education in a bottom-up fashion: Med students created private Facebook pages for their classmates, where students participate in a spirited back channel for classroom snark. Students share educational resources while complaining about droning professors using Power Points dripping in Comic Sans.

Moving up the food chain in social media in medicine, emergency medicine docs created FOAMed (Free Open Access Medical Education), a loosely bound community making rigorously evidence-based medical education freely available. The social media angle of FOAMed is in the wide adoption of the hashtag #FOAMed, tying the educational resources together.

Conferences have also taken to social media in a big way. The Twitter analytics coming out of the American College of Cardiology meeting are astounding.

Internet chats are finding new life on Twitter. Some are synchronous, like Ryan Madanick’s fascinating MedEd chat, and some are asynchronous, like the one urologists are using for their journal club, #UroJC, where a twitter conversation revolves around an article for 48 hours, allowing people from time zones around the world to participate. Continue reading

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Physician Accounts from the Front Lines of the Syrian Conflict

By Coleen Kivlahan, MD

Physician colleagues and their hospitals have been the targets of direct attacks during the past three years in Syria. According to UN war crimes investigators, Syrian forces have deliberately targeted hospitals, attacked field hospitals, and prevented patients from receiving medical care.

A United Nations Commission of Inquiry independent panel published its findings to draw attention to what it called “an enduring and underreported trend” in the conflict. The report cited attacks on hospitals shelled by artillery or bombed by jets or helicopters. The attacks have injured and killed both civilians and medical personnel, damaged hospitals’ infrastructure, and impeded their ability to treat patients. Most of us cannot imagine working in such circumstances.

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How to Build a Health Care System from Scratch: Revisiting New Orleans Ten Years Post-Katrina

By Ulfat Shaikh, MD

Originally posted March 24, 2013 on Pulse.

“My friend was a neurologist at a hospital in New Orleans”, my daughter’s art teacher told me when we were chatting at pick-up time about my upcoming trip to New Orleans. “She lost her home in Katrina”, she continued. “The stories she told me about how they cared for all these patients in the hospital with no electricity and water and barely any resources were just plain scary”.

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Posted in Population Health, Quality Reporting | 2 Comments

Medical–Legal Partnership Builds a Culture of Upstream Advocacy

Originally posted on March 13, 2014

By Elizabeth Tobin Tyler, JD and Edward Paul, MD

Sometimes the screening questions a doctor most needs to ask her patients are not the ones she has traditionally been taught to use.

During a recent visit, Dr. Jordan, a family physician, asked Maria if she had any concerns about her housing or her family’s safety. Maria, a married, young mother of three, burst into tears. She told Dr. Jordan that the utility company was threatening to shut off the electricity and gas in their home because they were behind in their payments. Maria’s husband was disabled on the job several months earlier and had been unable to work. His application for disability insurance was denied, leaving the family with limited income.

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Posted in Care Delivery Innovations, Patient Access, Patient Engagement, Workforce | 1 Comment

Of Billionaires, Jellyfish, and Pond Scum: What Really Matters in the Debate Over the Future of Research

By Ann Bonham, PhD

On March 15, 2014, The New York Times Sunday edition published a front page story by William J. Broad,“Billionaires with Big Ideas Are Privatizing American Science.”The piece drew nearly 500 comments on the Times’ website in 24 hours, debating the pros and cons of philanthropic support for research.

Philanthropic investment in research is most welcome, but I was struck that this story made the front page, over a much less flashy yet far more important story: that the nation’s entire biomedical research enterprise may be in peril from a lack of federal investment. However generous, philanthropy cannot begin to substitute for a national commitment to medical research.

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Posted in Commentary, Research | 6 Comments

Balancing the Ethical with the Financial in Medical Research Funding

By Philip A. Cola

The United States government allocates billions of dollars annually to training physician scientists and funding medical research. But what are the ethical and motivational considerations of the scientific knowledge transfer necessary to advance the clinical practice of medicine, known as translational medicine? Naturally, when we or a family member gets sick, we want the best-trained physician scientists and the most advanced treatments available. Indeed, there is a greater need for health care services and dissemination of scientific discovery than ever before. Unfortunately, the outcomes of these studies come at an unusually heavy societal cost.

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Posted in Human Capital/Management, Leadership, Research | 1 Comment

Public Health and the Freshman Fifteen

By Christine Hunter, MD

For many young adults, the college “freshman fifteen” marks the beginning of a lifelong struggle to balance calorie intake with activity level. Long days of studying are punctuated by trips to the dining hall to socialize over well-stocked buffets. Academic commitments, along with work or community service, leave little time for recreation. Left unchecked, weight gain is inevitable, and these young adults will enter the health system as the next generation of diabetics and hypertensives.

To reverse this trend, colleges often take the important steps of serving healthy entrees, displaying nutrition information, and providing ample fresh fruit and vegetables. Standout institutions encourage every student to participate in athletics—offering inviting gym facilities and a diverse array of intramural sports. On a recent trip to Boston University, I was struck by the lean builds of the student body—nary a “beer belly” or “muffin top” in sight. University leaders shared insights into their remarkable success, agreeing on three extra steps that earned them a spot among the “Top 25 Healthiest Colleges in the United States:”

On-campus living. Because Boston real estate is expensive and parking scarce, the University president and medical campus provost led an initiative to provide more housing in attractive residence halls on campus. Without commutes from remote apartments, students get time back in their days for recreational sports or personal exercise.

Public transportation rate changes. For many years, BU students could ride Boston’s Green Line streetcars from one end of the Commonwealth Avenue campus to the other without charge. When the transit authority’s financial circumstances ended this privilege, BU turned adversity into advantage. Students literally “took to the streets,” adapting their routines to walk or bike between classes. Boston’s new Hubway rental bikes provide a handy alternative.

Going trayless. This was the crowning move. Concerned about sustainability, staff and students sought to eliminate wasted food along with the water, energy, and chemicals used for tray washing. A campus-wide initiative to “go trayless” paid unexpected dividends as students selected only what they could carry—and consumed fewer calories in the process!

Medical schools should jump on the bandwagon to encourage adoption of similar strategies to prevent untimely deaths from heart disease, stroke, and complications of diabetes. In fact, BU School of Medicine Dean Karen Antman notes that medical schools “have a responsibility to lead; promoting lifelong habits that translate into health and longevity.”  Health care and medical education have long been criticized for teaching only about disease treatment and ignoring the importance of prevention. We acknowledge that the curriculum crunch leaves little room in formal didactic training…but there is a great informal environmental training opportunity here.  We can begin the discussion about how personal health connects to population and public health.

The resources are readily available. The Practical Playbook is an online repository of tools, resources and case studies that explain what happens when primary care and public health work in concert.  State by state public health metrics that reflect nutrition and daily activity are available from the CDC.

What are we waiting for?  Small changes add up to a big impact, and the Healthy Campus 2020 Initiative offers additional tips on how to get started. Whether by embedding more physical activity into daily routines or going trayless to reduce calorie consumption, and getting serious about measuring our impact, we can all lead by example.  Let’s lay the groundwork now for a healthier class of 2015!

Hunter_ChristineChristine Hunter ( is Chief Medical Officer at the U.S. Office of Personnel Management where she oversees health care quality for Federal employees and their families.  Dr. Hunter is a retired Navy Rear Admiral with over 30 years of experience in Federal health care.   She serves on the Boston University Board of Overseers.

The views expressed in this post are those of the author and do not necessarily represent the views of the Office of Personnel Management or the United States Government.

Posted in Population Health, Primary Care | 1 Comment

Happy Match Day from Wing of Zock and The Health Scout

Match Day cartoon - Munves

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