How Smart are Medical Doctors?

OK, I know that’s a slightly contentious phrasing of the question 😉

I mean, is being a medical doctor an intellectually demanding job?

Traditionally this is obviously true. Doctors have had to spend years learning a lot of information (about the body and its symptoms) and spent those years in education surrounded by other clever and ambitious people.

Now that more of this information can be looked up in databases, more diagnoses rely on automated equipment (driven by radiographers etc.) and more treatments depend on prescribing a course of drugs designed elsewhere (by pharmaceutical researchers) does doctoring still have the same profile? Or is it more about interpersonal skills (bedside manner, reassurance). Is being a good doctor becoming more like being a good nurse?

This question was posted on Quora  and answered by Liang-Hai Sie 

Let me answer as a retired doc who had had 40 years of experience with clinical (not research) work as a doc, for decades also working with a lot of young bright eyed docs who were part of our house staff.

Those who have graduated as a MD at least have a IQ of 120 to 130, so you need some intelligence, but need not be a genius.

As for the junior doctors, those having graduated with honors are often so occupied doing everything so perfect that they lose sight of the practical way of running things, so aren’t finished until late in the evening often 10pm which can’t be good, the less brilliant colleagues usually finish between 5 and 7 pm, so are better able at not spending lots of time by trying to be perfect.
I would gladly take a smart enough but not brilliant practical doc to work with me or be my partner.
EDIT:
having a lot of information on the web doesn’t mean a doctor needs no knowledge at all.  To look something up (where can one find useful information, what information does one need etc.) one will need basic knowledge, a lot of information at your fingertip, imagine having to look up everything on every patient, won’t work, and won’t inspire any confidence either.  The art of practicing medicine fortunately is not just following a recipe.

and by Emily Altman

In order to order all those tests that supposedly tell doctors all the answers, you have to have at least a differential diagnosis of what possible illness or condition the patient may have.  That means you have to know how to examine the patient and know what factors are important in the medical history/family history and review of systems.  Then having ordered tests (if necessary, because a doctor may know what the problem is without needing tests or equipment) you have to put the information together to come up with a diagnosis, determine what treatments would benefit the patient and then administer those treatments.

The ability to learn and synthesize learned information (if we can define smart by those terms) is tested many times along the way from high school to post-residency/fellowship MD.  So, yes, we do have objective proof that doctors (and I am proud to be one) are smart.

Doctors are the proverbial sight for the three blind men and an elephant that you are proposing with pharmaceutical researchers and automated programs and devices. That’s because they know how to put information together and not base their judgments and decisions only from the standpoint of a pharmaceutical researcher or an MRI machine.

Nurses do know a lot about diseases and how to take care of patients, but their education and training is not geared towards diagnosis and proposing a treatment as much as patient observation and administering the treatments.  And I might add I learned tons from nurses, especially as an intern in the ICU with experienced, smart nurses who knew exactly what they were doing and were a tremendous asset.

As for programs and devices, just remember the GIGO Law.  It’s truly garbage in garbage out.  If you give a program random facts about a patient, it will come up with a list of possibilities, but it cannot decide what the problem is.

Photo credits Technology image created by Creativeart – Freepik.com

What is it like for a non-doctor to marry a doctor?

This question was posted on Quora and answered by Carla Kayani:

I just married a doctor about three weeks ago but we have been together 8 years. She was at medical school when we met.

The downsides are that you can feel starved of attention sometimes. My wife has just finished an 80 hour week. Even when they are home, they must constantly study, prepare presentations and do compulsory online portfolio work. These responsibilities will only increase as they get promoted.

They can often struggle to understand your problems especially when it comes to difficulties in your own job. They deal in life and death as a job where you don’t. My wife resuscitates babies and such so they can invalidate your feelings when you’re upset about something you experienced at work. This can be extremely distressing on a lot of levels.

You will always feel inferior in the relationship. Sometimes in anger, they will remind you of your lack of worth for being ‘just a chef’ or ‘just a performing arts student’ or ‘just a now and then actor’.

You have to listen to some quite boring work stories that you can’t possibly understand because your highest scientific qualification is an O-Level in Biology as you took linguistic and theatrical subjects.

Their parents may resent that they married you instead of another doctor.

You feel embarrassed by being around their doctor friends because you feel like a mere mortal especially if you don’t have a degree. You find yourself overcompensating by exuding wit, vivacity, loquacity, self-taught knowledge and then hate yourself.

The upsides include feeling very safe in medical emergencies or during sickness unless it’s mental health problems where you’ll often get no understanding at all. They have a profession which is not actually as well paid as people think but the pay steadily rises over the years. You can survive off one income comfortably providing neither of you are particularly materialistic. Also, their doctor friends tend to be interesting, intelligent, friendly and have impeccable manners. They would never make you feel excluded or inferior. Largely, it probably wouldn’t cross their mind to think of you in that way.

You might feel validated in your intelligence and attractiveness. You must be those things if an attractive doctor genius married you.

If you have a fetish for doctors like me, you feel you’ve won the jackpot.

You get to play sexy doctor games with a real doctor. This is sexual heaven.

Sometimes they come home wearing scrubs looking all heroic and important.

You get to hear some really juicy stories about strange doctors, nurses, patients, crazy baby names, funny interactions, general gossip.


The Upside:

1. No threat or ego issues: Ever saw your friends resenting their spouses who are in the same line of work, and have become more successful? Here, I know that eventually doctors tend to earn more, and hence am fully prepared for it mentally. There is no scope of jealousy or resentment, and we both can be as successful as we can without hurting each other’s feelings. Further, we both get equal opportunities to appear more intelligent in front of each other.
2. Interesting conversations: She tells me about the curious cases that come to her, I tell her about the new marketing campaign I am working on. We exchange work talk, not really expecting expert opinions, but interesting ones nevertheless.
3. Network: I know I can count on a dentist, a pediatrician, a surgeon and many others whenever I need them because of her. She knows who to call if her computer crashes or she needs life hacks or she needs to find good pubs around 😛 . Also, typically medical students are too engrossed in their studies to really get to know outside life, so my circle of friends prove to be a good break from that for her . 😛
4. Understanding: She understands when I get really busy, or not able to take her call, or get to work at wee hours, cause that’s what she expects from me.
5. Min level of intelligence expected: Think about it. Doctors are anyway intelligent. Intelligent enough not to fall in love with idiots. Hence both parties get the benefit of no-stupidity-no-frustration factor.

The Downside:

1. Patience: Chances are, your doctor spouse was standing non-stop 6 hours assisting surgeries, hasn’t had anything since morning and has slept only 6 hours in last 48 hours. In such cases in whatever you speak or breathe, please tread carefully, very carefully. Be patient and considerate, and remember, ‘This too shall pass’.
2. Doctor Ego: Fact is, doctors had to study more and grill themselves for longer hours doing harder work than any engineer will ever do. This might lead them to think that doctors are better than engineers or anyone else. Again, a delicate topic to stir up.
3. Family awkwardness: You might end up feeling a bit ignored in case your family members get more interested in discussing their minute health issues to get free consultation than pampering you like you were used to. I, however, enjoy the peace. Then there is also the pressure of standing up to the expectation of ‘how can a doctor and non-doctor work it out together?’
4. The doctor vs the spouse: Often when you will hold her hand, she will suddenly observe some weirdness in the bone structure of your hand and start cautioning you against medical conditions you have never heard that affect body parts you never knew existed.

Bottom Line:
Be Understanding, Kill the ego, understand that your backgrounds are different and you both will never ever understand each other’s career completely. Enjoy the diversity, and make what time you get together count.

Useful History taking format in medicine

History Taking Format

Hello, Mr/Mrs/Miss.         . I am Dr.         , one of the doctors in this department. I am here to ask you some questions about your condition. Is that OK? I assure you whatever we talk will be strictly confidential.

Present Illness

What brought you to the hospital today?  (Could you tell me what happened?)

Can you describe more about your symptom?

Has this happened before?

O (nset)           = When did it start? What were you doing when it started?

D (uration)      = How long did it last?

I  (ntensity)     = Was it severe or mild?

P (rogression) = Is it getting worse, better or same since onset?

AR (aggrevating and relieving factor) 

                        = Have you noticed anything to make it worse or better?

Associated Symptom = Did you notice any other symptoms?

(Were there any other symptoms before or after this episode?)

Anything else             =  Do you have anything else you would like to tell me about?

 

SOCRATES

(Site, Onset, Character, Radiation, Associated symptoms, Timing, Exacerbating/relieving factor, Scale)

Consider DDx and ask relevent questions

Did you notice any change in – Sleep Appetite, Diet, BW, Bowel habit, Waterworks

Past                 = Have you had any medical problem or surgery before?

HT, DM, Heart, Blood clot, Asthma

Personal         = Smoking, Alcohol

Sex- Are you sexually active, Are you in a stable relationship?

I’m sorry to ask you this but do you have any other partners?

More than one partner?

M        =  Are you on any medication including over-the-counter medications?

A         =  Are you allergic to any medications?

F          =  Is there anybody in your family with the same problem?

T         =  Did you travel abroad recently?

O         =  What do you do for a living?

S          =  Do you live alone or with others? Was anyone with you when it happened?

A         =  Do you have anything else you want to talk about?

(P3 MAFTOSA). In present illness we have to ask ODIPARAA or SOCRATES (is suitable when there is a pian symptom)

However, I would like to take more detailed history, do relevant clinical examination and discuss with my seniors.

Thank you very much for answering my questions. You have been very cooperative.

OBGY

P          = Period 

               When was your LMP?

How many days do they last?

Are they regular?

How many weeks between each period?

Do you get pain? Any bleeding between your period? Or after intercourse?

P          = Pregnancy 

                Have you ever been pregnant? How many children do you have?

Any miscarriage? Duration of pregnancy?

Mode of delivery? Any complication before, during or after pregnancy?

P          = Pills (Are you taking pill?  Are you on any contraception?)

P          = Pap smear (When did you take Pap smear?)

(P7 MAFTOSA)

PAEDIATRICS (BIRD MAFA)

Birth               = Was everything fine at the time of birth and just after that?

Immunisation = Is your child up-to-date with jabs?

Red book        = Are you happy with the red book of your child?

Development  = How do you see development of your child?

Cover picture by lovleahyayimages.com

Funny Moments of Doctors during their shift

1. A man comes into the ER and yells, “My wife’s going to have her baby in the cab!” I grabbed my stuff, rushed out to the cab, lifted the lady’s dress, and began to take off her underwear. Suddenly I noticed that there were several cabs -and I was in the wrong one.
Submitted by Dr. Mark MacDonald

2. At the beginning of my shift I placed a stethoscope on an elderly and slightly deaf female patient’s anterior chest wall. “Big breaths,” I instructed. “Yes, they used to be,” replied the patient.
Submitted by Dr. Richard Byrnes

3. One day I had to be the bearer of bad news when I told a wife that her husband had died of a massive myocardial infarct. Not more than five minutes later, I heard her reporting to the rest of the family that he had died of a “massive internal fart.”
Submitted by Dr. Susan Steinberg

4. During a patient’s two week follow-up appointment with his cardiologist, he informed me, his doctor, that he was having trouble with one of his medications. “Which one? ” I asked. “The patch. The nurse told me to put on a new one every six ours and now I’m running out of places to put It!” I had him quickly undress and discovered what I hoped I wouldn’t see. Yes, the man had over fifty patches on his body! Now, the instructions include removal of the old patch before applying a new one.
Submitted by Dr. Rebecca St. Clair

5. While acquainting myself with a new elderly patient, I asked, “How long have you been bedridden?” After a look of complete confusion She answered…”Why, not for about twenty years – when my husband was alive.”
Submitted by Dr. Steven Swanson

6. I was caring for a woman and asked, “So how’s your breakfast this morning?” “It’s very good, except for the Kentucky Jelly. I can’t seem to get used to the taste,” the patient replied. I then asked to see the jelly and the woman produced a foil packet labeled “KY Jelly.”
Submitted by Dr. Leonard Kransdorf

7. A nurse was on duty in the Emergency Room, when a young woman with purple hair styled into a punk rocker Mohawk, sporting a variety of tattoos, and wearing strange clothing, entered. It was quickly determined that the patient had acute appendicitis, so she was scheduled for immediate surgery. When she was completely disrobed on the operating table, the staff noticed that her pubic hair had been dyed green, and above it there was a tattoo that read, “Keep off the grass.” Once the surgery was completed, the surgeon wrote a short note on the patient’s dressing, which said, “Sorry, had to mow the lawn.”
Submitted by RN no name

8. As a new, young MD doing his residency in OB, I was quite embarrassed when performing female pelvic exams To cover my embarrassment I had unconsciously formed a habit of whistling softly. The middle-aged lady upon whom I was performing this exam suddenly burst out laughing and further embarrassing me. I looked up from my work and sheepishly said, “I’m sorry. Was I tickling you?”
She replied, “No doctor, but the song you were whistling was, ‘I wish I was an Oscar MeyerWiener’!”.
Dr. wouldn’t submit his name

Why Doctors Are Unhappy

As a medical student, I was often unhappy. I would be stressed about the next exam, downtrodden after a surgeon just yelled at me in the OR, or worried that I may not match into the residency of my choice. These are just some of the feelings that doctors-in-training experience every day.

Becoming a physician is no easy task. In the United States, it often takes 11-15 years of education after high school: 4 years of college, 4 years of medical school, and 3-7 years of residency. Along the way, you are faced with competitive admission committees, difficult exams, and uncertainty of whether you will make it all the way through.

Why put up with all of this stress and anxiety? Because young doctors are often looking forward to a “good life” later on. Not only are doctors viewed as financially well-off, but they are also among the highest respected professions in society. Therefore, we deal with what we have to in order to become physicians.

The promise of future salvation keeps us going. However, now that I’ve taken a leave of absence from medical school for two years to pursue an MBA, I’ve had the chance to reflect on the past three years of my medical school career. I recently read the book The Power of Now by Eckhart Tolle. In it, is the secret to why so many future doctors (and doctors) are unhappy.

There is no such thing as future salvation.

Eckhart Tolle stresses that if you are always looking forward to happiness in the future, then you will never be happy at all. You can only be happy in the now. If you are not happy now, then don’t expect to be happy later. Be happy now or be miserable forever.

But searching for future salvation is exactly what medical students, residents, and even physicians do. We are willing to put in the time and energy to become physicians because of the idea of delayed gratification. We’ll work our tails off now so that later we can live a life in which we can provide great care to our patients, get paid well for doing it, and live a more balanced life.

But that is a flawed mentality. I realize now that I was always looking forward to getting something over with in medical school: the next block of curriculum, the next United States Medical Licensing Exam, the next clinical rotation, etc. Once I got done with that one thing, I would hope that my life would be a little better. But it wasn’t.

And that is what we, as future physicians, do. We expect that life will be better once we are done with premed, medical school, and residency. But it doesn’t get better. It will stay the same…unless you change your mentality.

Enjoy the now. Enjoy studying for the organic chemistry test as a premedical student. Enjoy rotating through internal medicine as a medical student. Enjoy working 80-hour weeks as a resident. If you do not enjoy your current situation, you will not enjoy your future one. As Eckhart Tolle states, “Nothing has happened in the past; it happened in the Now. Nothing will ever happen in the future; it will happen in the Now.”

Be happy now. It is the only way to be happy ever.

Shaan Patel is the founder of 2400 Expert Test Prep, a #1 bestselling author, and MD/MBA student at Yale and USC. He raised his own SAT score from average to perfect and teaches students his methods in an online SAT prep class.

Why I chose medical career?

Well, I chose Medicine for various reasons.

  • First of all, I love studying our body; it’s wonderful to know how your body really works.

It’s amazing to discover, that there are a lot of cells that we can’t see with our own eyes, which have to work daily to keep us alive (Thanks guys!)

Our heart keeps beating day by day, many organs function without our influenceWhat can you say to that, rather than Wow?

  • A sentiment I didn’t find in any other profession other than medicine, is when you help a patientWhether  you save his/her life or do anything to improve it and the next thing you see is the smile on their face. This sensation is indescribable and it fills your heart with joy and accomplishment. It’s the best feeling in the world! To know you’ve done something to help others and to know they get to continue with their everyday life, all thanks to you.
  • Medicine is international. Being a doctor, you can work in the whole world, you can help anyone, around the globe, even without knowing local language…Medicine is universal, it speaks for itself.  One day, you may be sitting in your private practice in London, and next day someone can call you as an expert to visit Africa, or New Zealand, to help with a certain case. As a result, you may visit places you’ve only dreamed of.  Probably not the worst outcome 🙂

    Background vector created by Photoroyalty – Freepik.com

My big dream is to become a Pediatrician. I love kids so much, I think they are much better than adults (that’s my personal view for sure) as they are honest and straightforward. You cannot trick a kid, they will see right through you.

A kid’s smile is worth more than all the money of the world. When I am sad or not in the best mood, the only thing that can put a smile back on my face is a cute baby, with those chubby cheeks and giggling. After seeing this- everything is right in the world again 🙂

Medicine is not a normal course, it’s very hard and it consumes all your life. But, it also gives you a special view of life and certain path that u have to follow, if you decide to begin this journey.
If you want to be omniscient and study everything, your life will be hard. Our body’s anatomy is too much complicated for any person to memorize to the very detail… it will take you years.

With medicine, studying never really ends and you can count on many sleepless nights with book in your hands.
Ultimately, if this is your passion, I say, go for it! If you want to be the best at your job, first you have to love it. With medicine you can call it tough love 🙂

After finishing medical school, you will have to decide upon certain specialty you want to take. This is a breakthrough moment for many doctors.

Some may decide not to take a specialty at all, becoming general practitioners. Yet, others will become surgeons, gynecologists, oncologists knowing that they enrolled into medical school only to pursue that career.

Certain percent may even take into account the salary given, and as a result choose the specialty according to current market demand.

Therefore, be sure to choose what you love doing. You know the saying: ” Choose a job you love, and you will never have to work a day in your life.”

I believe this is true. And in the medical field, especially… When you love what you do, spending days at the hospital, taking care of patients, comes much easier. No one wants to be treated by a grumpy or unhappy doctor. And as a doctor, the stakes and expectations are high- you must always do your best!  But in the end, it’s also very rewarding.

So word of advice, when it comes to your specialty, choose wisely!

Cover picture by Wavebreakmediayayimages.com

Dr H.Nawatha
Founder at Meddy Bear

‘Fear Not, This Is Normal’: Advice for Young Doctors

Medscape asked some of our contributors and our community to offer advice to soon-to-be residents. The responses that poured in went far beyond the expected tips to help achieve success during residency. Most submissions included insights from years of professional experience, along with wisdom to help all young doctors, not just those in training. In fact, the scope of the advice is likely to trigger reflection in those of all ages.

Here are just a few highlights of what they had to say. Prime Directive One of the themes that emerged among the advice that was offered involved a need to prioritize. Dr Brad Spellberg suggested that times have changed. He told us, “We must engage our patients in decision-making and move away from the traditional, physician-centric paternalism of medicine, which is contrary to achieving high-quality, safe, efficient, and patient-centered care.” Dr Spellberg was not alone in suggesting a shift from “physician-centric” attitudes. An emphasis on listening to, and learning from, patients was repeated as a guiding dictum. As Dr J. Greensmith explained, “The patients are your best teachers, followed by the nurses, then your attendings.”

In fact, developing a fast appreciation for nurses was another common refrain. Dr Mark Morris was explicit, as he laid out his advice: “Please remember that the only thing between you and disaster is the nurses. Honor them; respect them; and, if you’re a DO, treat them. Don’t go to sleep when you first can; sit and talk with them, learn from them. And they will feed you and protect your sleep.” Much of the advice suggested considering those who surround young doctors as new family units.

These groups include nurses and fellow residents, and beyond residency, peers who will grow to be very familiar faces. Cheerfully, Dr Brent Mothner offered, “Never pass up the opportunity for a meeting, or even a quick coffee together. Great things can happen simply by chatting along the way. Oh, and good cookies make almost any day better!” A Resident State of Mind In terms of advice specific to the residency experience, Dr Lisa Gobar offered some quality reassurance: “You are starting all over again. You will feel like you know nothing. Fear not, this is normal.” Encouragement permeated the advice provided from our contributors and users, with many sharing personal stories of doubt that gave way to experience.

The overwhelming attitude was that although young doctors are sure to face personal crises, they can be overcome. While accepting that a certain amount of fear is normal, other situations in residency can be avoided with preparation. As Dr Merius Atangcho specified, “Scan the ACGME curriculum requirements.

Probably no medical student ever looks at ACGME curriculum/resident experience requirements to graduate from a residency. Especially when deciding between different fields, however, these requirements can inform you of what your entire residency will look like.” Others recommended concrete suggestions that involved surveying the medical literature thoroughly and learning to approach the resident experience as a rebirth. The full article you can read it on medscape.

The world’s oldest doctor dies at age 105!

Shigeaki Hinohara ( 4 October 1911 – 18 July 2017) was a Japanese physician. This extraordinary man continued with his practice as a doctor even after turning 100 years old. He was highly respected in Japan and was a honorary head of St. Luke’s International Hospital in Tokyo. The cause of death was respiratory failure on July 18th, according to the hospital. He was 105. Hinohara had been suffering from medical conditions affecting his heart and other organs as a result of his age.

He was born in Yamaguchi prefecture in Japan on 4th of October 1911. He graduated from the Kyoto University School of Medicine in 1937. Dr Hinohara also studied at Emory University in the United States. In 1941., he began working at St Luke’s hospital, as a physician. At that time, World War II was in its peak, and Hinohara helped in treatment of victims of the firebombing that destroyed large parts of Tokyo. In 1992. he became the director of St. Luke’s hospital.


In 1970. Dr Hinohara was a passenger on a Japan Airlines plane hijacked by the communist militant group, the Japanese Red Army.The armed hijackers, took 129 hostages on the flight from Tokyo to Fukuoka, later releasing them at Fukuoka and the South Korea capital Seoul. After the incident, he said that the experience changed his view of life, and at that moment he decided to dedicate his whole life to helping others.

During his long career as a physician at St Luke’s hospital, he established and popularized Japan’s practice of annual medical checkups. These comprehensive medical checkups have become standard for many middle-aged Japanese. Hinohara was also an advocate for preventive medicine. He was author of 75 books, including “Living Long, Living Good,” which sold more than a million copies.

In 1995. the cult Aum Shinrikyo used sarin for subway attack in Tokyo. At the time, Dr Hinohara was the director of the hospital, and just year before, he decided to install oxygen tubes throughout the walls of the hospital building, in case of emergency. The measure proved life-saving at the moment of the attack, as the hospital was able to accommodate 640 patients in just 2 hours. All the patients survived, except one.

At the age of 88, he wrote a script for the Japanese musical entitled “The Fall of Freddie the Leaf,” in which he also performed as an actor, alongside children. The show was first performed in 2000, and later had a production off-Broadway in New York in 2010. In 2005. he received the Order of Culture from the Japanese government.

As an remarkable figure representing the active elderly, being a centenarian did not stop Hinohara. He delivered speeches across Japan, which included motivational messages as how anyone can change his/her life at any age. Hinohara’s words have inspired many people, as words of wisdom based on his century-long experience.
“My goal is still far away. I would like to become Japan’s oldest person on record without retiring, as I will keep working from now on,” Hinohara said after his lecture in October 2014. on his 103rd birthday. Until his death Dr. Hinohara remained active, traveling around the country giving lectures and seeing patients.
Dr. Hinohara’s funeral ceremony will be held at St. Luke’s hospital on Saturday afternoon, July 29.

N.Jovanovic                                                                                                                        All rights reserved – Meddy Bear 2017