Thursday, May 21, 2015

How Much Do You Share With Your Patients?

Genmedmom here.

In my practice, there are two kinds of doctors. There are those who don't display even one personal photo in their exam rooms, and then, there are those that do. Me? I proudly display a collage of recent kids' photos. Occasionally, a photo will include me and/or Hubby, or our cats.

I've found that the photos can "break the ice", meaning serve as benign fodder for a softer, friendlier discussion in an otherwise sterile, somewhat scary environment.

Let's face it: a bleachy-smelling standard-hospital-grade exam room, where the cold speculum and bristly Pap brushes are laid right out on the chux, is not a fun place to be sitting twiddling your thumbs. No People magazine can change that.

How do I know this? Hey, I have a doctor, too.

What I've personally experienced is that decorations or photos can help to create a warmer, more inviting environment. I'll immediately feel like this provider is confident enough to share of themselves; that they're open to connect with me as a fellow human being.

The exam rooms that don't feature any kind of personal touch may as well be alien spaceship exam rooms: What part of me is going to get probed?

The worst exam rooms I've encountered are at my GYN's office: almost completely tiled without any objects left out in view whatsoever. I feel like a lobster in a pound. They may get high marks from OSHA and The Joint Commission, but I sit there increasingly uneasy, freezing in my flimsy paper gown. Even our dentist does better job with environmental emotional regulation.

Our pediatrician wins the prize for personal adornments. He's got family photos, his kids' artwork, obviously his choice of decorations (all sports-themed), and entertaining items like books and toys strewn all about. Not only am I made to feel more at ease, but my kids are, as well.

Of course, items and photos invite questions and conversation. I think this is good, and I tend to be very open and honest with my patients. Hey, I'm querying them deeply about their relationships, jobs, bad habits, fertility plans, and private parts. These are all topics that are socially prohibited in usual, out-of-the-doctor's-office conversation. I can at least share that my kids are in preschool and my husband works for the Patriots.

Some patients ask more, and I have real conversations with these folks. My general rules of thumb are: no personal chit-chat until the patient's issues and concerns are addressed. No shooting the breeze when I'm running behind. No sharing of my own medical issues. (Well, I'll sometimes share that I used to smoke cigarettes and that it was hard for me to quit, too.)

In seven years of practicing in this style, I haven't had anyone complain that I waste their time or overshare. My colleagues can tell you that I run on time, more or less. (More than most.) At this point, my regular patients excitedly ask for updates as soon as I walk in the door. How are the kids, how old are they now? Still have those huge cats? What does your husband thank about Deflategate?

Obviously, I'm all for sharing. heck, I blog.

What do other docs think?


Wednesday, May 20, 2015

MiM intro: X-ray Vision

Hello MiM!

I am so excited to contribute to a community that has been my lifeline during residency and motherhood. I figured my introduction should include how I got to know MiM.

Rewind to approximately 3 years and 1 month ago, I was at the end of my surgical intern year. (I know. I'm a radiology resident. Why did I do a surgical intern year? Long story short. My husband, big C, was already an orthopedic resident at the institution of my medical school before I matched. I was pretty set on staying on for internship and residency at the same institution. There is only 1 transitional program in a 2 hour radius of where we are from and that particularly 1 was heavily medicine and ICU. I don't like long rounds. So surgery it was!) At that point in my life, I was pretty darn happy to be at the end of my surgical intern year and ready to start my radiology training.

My husband and I just returned from vacation and I was feeling unusually tired. More tired than I usually do. Hard to figure out what my baseline was given that I was a surgical intern! I joked around with him that maybe I was pregnant. I had forgotten my birth control pills during our 2 week vacation but thought nothing of it at the time. I remember distinctly finishing rounds on a Saturday morning and settling into my day of call. I remember texting my poor husband who was post call that I hope he didn't "knock me up." It was a particularly slow morning. I was bored. I walked over to the nursing station and asked for some pregnancy tests. I took 5! I peed on one and I saw 2 stripes. I freaked out! I got some gatorade from the hospital cafeteria and peed on the remaining 4! 2 negative pregnancy tests followed by 2 more positive pregnancy tests! I remember as a medical student on OB thinking how could people NOT know how to read a pregnancy test. Now I knew why.

After my call ended and thoroughly freaked out, I remember going to the pharmacy and purchasing digital pregnancy tests. The kind that said "pregnant" or "not pregnant." Same thing happened! 2 "pregnant" and 2 "not pregnant." At that point, I was still in denial. I wanted a blood test. Except I don't have a primary care physician. Who has time to go to primary care physician as a medical student or a surgical intern?

I found the family medicine department on our institution's website. It was already Sunday at this point and I was desperate. I e-mailed one of family medicine physicians, Dr. B. I never met her. But she e-mailed me back immediately. She said it was no problem and she would put in the lab order for a blood b-HCG. I got my lab drawn the following morning. After rounds that Monday, I got an email saying that new lab values were posted on my online medical chart. There it was. b-HCG 79. Reference Value: >10 pregnant.

I remember taking a screen shot of my labs and texting it to my husband. First and only time he would actually excuse himself out of rounds to call me. We were both in shock. I was an intern! He was a PGY 3 but basically a PGY 2 as his orthopedic program requires a research year as a PGY 2. We were babies in the world of medicine and somehow now we were going to be responsible for a real baby in less than 9 months?

I remember Dr. B calling me with the results herself. She said "Your intuition was right! You are definitely pregnant and very early pregnant, which explains the equivocal urine pregnancy tests." I sat there and tried to calculate my due date. I was going to be mom half way through my first year of radiology training. Once baby comes, I will still have another 3.5 years of residency and 1 year of fellowship. How am I going to do this? I will forever be grateful to Dr. B. I wasn't her patient. I was just some resident that found her e-mail and she was just nice enough to respond. It was then she asked, "Have you ever heard of the website Mothers in Medicine? I think it will be good for you."

I've been hooked ever since! So here I am today. 3 weeks away from taking radiology boards. My little love bug, little C, is now almost 2.5 years old. I'll be starting my last year of radiology residency come July. (We take part 1 of our boards a year before we graduate. Part 2 comes 15 months after graduation.) Big C will be graduating from his orthopedic residency this June and leaving to the east coast for his spine fellowship.

This year will be an adventure for me and little C. I will have to figure out what it's like to be a "single parent" while doing residency among other things. I am very lucky. I have a wonderful support system that mostly involves my mom, which is the reason I even survived up until this point. All topics for future posts! (most likely after boards!) Thanks in advance to everyone in this community for being a part of this journey :)

Sincerely, X-ray vision

Tuesday, May 19, 2015

MiM Intro: Juggler

Hello! I'm so pleased to be joining the MiM community as a new poster. I'm a rising fourth-year medical student with a fifteen-month-old daughter. I'm currently wrapping up a year of research and will soon be starting my final clinical rotations before the residency interview season commences.

Just shy of two years ago, I took Step 1. I was 8 weeks pregnant at the time and came to the testing center armed with acupressure bands, ginger and saltines in the hopes of keeping my first trimester nausea at bay. Adrenaline turned out to be a more effective remedy, containing my queasiness all the way through the final question. I left the testing center wondering if I'd passed, but mostly feeling relieved to be done. Before long, however, tendrils of uncertainty began to creep into my consciousness. I felt suddenly overwhelmed by all that lay ahead - pregnancy, labor, an infant to care for...all while on my 3rd year clerkships. I was still learning to survive as a medical student - why on earth had I decided to add learning to be a mother on top of that?

Fast forward to today, when I sat for Step 2 CK. This time I came to the testing center armed with tissues and lemon tea (because if I've learned anything since being a parent in medical school, it's that the week of a board exam your kid will get you sick). I made my way through the sections, feeling only marginally more knowledgeable than I did two years ago. As I was signing myself out at the end of the day, the ladies staffing the testing center kept commenting on the cute little girl who'd been popping in. My test-addled brain didn't quite make the obvious connection ("Who's just letting their kid wander around the building?" I wondered vaguely as I waited for the biometric scanner to register my fingerprint).

As I turned to leave, I saw that it was me (or, rather, my husband), who'd been doing just that. My daughter stood in the waiting room, her face breaking out into a huge grin as she ran to meet me. I swept her up into my arms and covered her with kisses. In that moment, everything in the past two years - the weeks of dragging my pregnant body through ORs and wards, the hurried pumping sessions in call rooms and restrooms, the 3 am diaper changes when I had to be at the hospital to pre-round only hours later - everything felt worth it.

Today, with the hardest parts of medical school behind me, and only residency interviews and a handful of electives (plus one pesky Acting Internship) ahead, I'm feeling excited about what the future holds. I'm looking forward to welcoming all of you along as I hit the interview trail, agonize over my rank list, and wait impatiently for Match Day. I hope that I can offer encouragement to other women who are parenting or contemplating parenting in medical school, or maybe just a sense of solidarity during those moments when none of it seems worth it (or even possible). I'll be posting here under the name "Juggler" - a role I'm sure all of you are intimately familiar with.

Thanks for reading and for making MiM such a vibrant, dynamic community for women at all stages of motherhood and medicine!

-Juggler

Monday, May 18, 2015

The Do-it-Again Equation

Cutter’s excellent post and the comments to follow really got me thinking. What factors go into our thoughts about whether we would do it again (become a doctor)? Can this change?

This is just my way of thinking about the question (one way of potentially many), but I think the simplified, general equation may look like this:

Outcome - Sacrifice    =    DiA
                    time

If DiA = positive, you would do it again. If negative, you would not.

And where Sacrifice = time, money, family relationships, moves, etc , thus far

Outcome = present level of satisfaction with career, may include work-life balance (or work*life product), income, career-related meaning, work-related aggravation

And time, because I do think time is a factor because time attenuates sacrifice/hardship. For instance, if you asked me whether I wanted to have another child while I was sleep-deprived and breastfeeding my newborn Q2 hours during those awesome early weeks of being a new mother, occasionally crying in the shower if I was fortunate to have a shower, my answer may not have been a resounding Absolutely! Not that I didn’t think my child was a magical gift, but wow. My pregnancy/labor/post-partum period were not easy. Fast forward a couple of years and that hardship didn’t seem quite as insurmountable relative to the outcome.  That was kind of a terrible analogy (along with math, not my forte), but I think in general, distance makes the heart grow fonder and the memories fuzzier.  Alternatively, maybe the Sacrifice was way too much and no time in the world would make that value small enough.

For me, my Sacrifice to become a doctor was relatively small and feels smaller with time. I met my husband during medical school. I was really fortunate to finish training with minimal debt, and besides being very tired and on-call during multiple holidays (Thanksgiving dinner with my co-residents in the physicians’ dining room; watching fireworks on July 4 through the 8th floor hospital windows), it wasn’t so bad. My Outcome, on the other hand, has increased over time. I now have more control over my schedule (compared to being junior staff right out of residency), higher income, more clinical knowledge, have engaged in new areas that keep me excited (teaching, research, mentorship, leadership) and after working with all different members of the healthcare team, value the role of physician as leader more than ever. Don't get me wrong- there are parts of my job that are the mental equivalents of how I imagine a root-canal would feel, but on the whole, my career is rewarding beyond what I could have imagined right after my pre-duty hours residency. My DiA started out positive from the start and only has grown more positive with time.

It goes without saying that this equation and its variables are individual, and there could be a fatal flaw that I have not considered in forming this equation. But, it’s not an easy path to take, no matter how you compute it.

Thursday, May 14, 2015

MiM Intro: PracticeBalance

Full disclosure: I am not a mother... yet. But I will hopefully (finally) be one soon!

Like many women in the medical profession, I delayed my plans for starting a family until late in my residency training. I initially worked as a chemical engineer, and I also traveled extensively to rock climb prior to deciding on medicine. In addition to entering the medical field a bit later than average, I frankly wasn't ready to be a mom when I was a medical student. I found the amount of work ahead of me to be exciting but also overwhelming in the face of a potential pregnancy/childbirth/parenting etc.

About half-way through my anesthesiology residency (coinciding with my 35th birthday), my husband and I decided it was time to start trying. Only one thing stood in the way: I hadn't had a period in several months. I had always been irregular, but those irregular intervals had increased during internship to an eventual standstill of menstruation. After ignoring this warning sign for a while, I finally sought the help of a reproductive endocrinologist. This initiated a long journey with many blood draws, tests, and time off which finally revealed that I had a large pituitary tumor causing severe hormonal disregulation. My experiences managing both physical and psychological stresses during medical training prompted me to start my own blog, PracticeBalance.com, in 2011. I continue to write regular posts there about stress management, being a patient, and self-care issues.

After my tumor removal, I have suffered from continued hormone deficiencies, which means that I need to use assisted reproductive techniques to get pregnant. I started following Mothers in Medicine a few years ago, around the same time that we actively began trying to conceive. I work three days per week as a purely clinical anesthesiologist (no research or teaching responsibilities) in a large academic hospital - what I'm hoping will be the perfect setup for balancing a career and motherhood!

So now here I am, currently expecting my first child - three years, one miscarriage, and thousands of dollars later. I hope to bring a perspective to the MiM community about what it's like to be an expectant mom (and then eventually a new mom) while working in the operating room. I could also write about what it's like to be an IVF patient (who happens to be a medical professional), if there is any interest in that. Currently I am experiencing a lot of apocalyptic worry regarding all that could go wrong in my pregnancy - feelings born out of both having had a miscarriage in the past and having work-related experience with all the "bad things" that can happen.

Please let me know what you'd like me to write about by leaving a comment below. I'm excited to be here and look forward to hearing from you!

Wednesday, May 13, 2015

MiM Intro: EMMomma

I am an Emergency Physician and Medical Toxicologist practicing in a large academic center in the only tertiary care and level one trauma center in my region. My path here was not typical: undergraduate degree in bioengineering, did not get into medical school the first time around because GPA was "too low" (thanks, bioengineering!), worked for a year using my bioengineering degree clinically, got into medical school, did not match in EM and spent a year as a surgical preliminary resident, got into my first choice the second match go-around, and then did a med tox fellowship. I am at my first real, non-moonlighting job. I prefer evening and overnights shifts and take call for toxicology about 10 days a month. I have academic duties and I love teaching, especially in the classroom or small group setting. My research is focused in toxicology but not a very large part of what I do. I will likely never be tenured and I'm okay with that.

I never wanted to be a mother the way most women seem to want to; I wanted a career in Medicine since always. I decided to become one when I realized Hubby was The One and for him, it was an unspoken deal-breaker. Now I have two adorable boys, Blur1 who is 5 and Blur2 who is 2. Blur1 was born during the first year of my fellowship and was a relatively easy pregnancy. Blur2 was within 18 months of my first real (and current) job and while I was never at actual death's door, I had a hard second pregnancy. I had to tell two relatively new bosses that I was pregnant and I've never taken a written board exam not pregnant.

I would not be where I am without Hubby. He is very much not medical and blanches as some of my stories from work. He has an unusual job that requires early morning hours but unlike EM, they are generally Monday-Friday. We split the household stuff and kid stuff along our strengths and who's available but truth be told, he does more because my shifts are often when the kids are awake and not in school. Currently, we are focusing on my career so we are here, in The South, as transplanted Northerners. We are hundreds of miles away from family so we use a combination of daycare, school, camps, and a small army of babysitters who have to come to our house some days at 4 am (yes, 4 am). We have four Google calendars to coordinate Hubby's, my work, my personal, and our family's schedule; I imagine the kids will each get their own calendar in the future. We do most things as a family, including grocery shop, and we're a bit sports obsessed.

I recently realized I do not do anything for me, as a person, on a regular basis. I enjoy Social Media but primarily use my accounts for education (FOAMed supporter) or keeping in touch with friends and family. I love to read but with The Blurs, that is hard. I bake and cook but there is only so much food we can eat. I started working out more but I view exercise as a necessary form of torture. I was looking for a hobby or something to call my own that is not work, Hubby, or Blur related when this offer from MiM came along, which means the thing I call my own will be my thoughts on work, Hubby, and the Blurs (thanks universe). I have been reading MiM since the near beginning. During my first maternity leave, I had a hard time alone with Blur1. I found momblogs and medical blogs. I found MiM through one of Fizzy's cross-posts. I don't follow many of those blogs from those early days anymore but they got me through maternity leave(s) and early motherhood and career and made me realize many of the things I felt and thought were normal. Now I hope I impart this feeling of normalness to my residents, colleagues, and MiM readers.

And in response to Cutter, I would do it all again. Definitely the medicine. And Hubby. And the Blurs.

Tuesday, May 12, 2015

Baby City

There are only three things in this world that are certain: death, taxes, and babies.

Nobody knows this truth better than Emily McCoy, a third year resident working in Baby City, the affectionate nickname for the busy Labor and Delivery unit at a New York City hospital. On a typical day in Baby City, Emily delivers more babies than the number of hours of sleep she manages to squeeze in that night. And definitely more than the number of dates she's been on since she started her training in OB/GYN two years earlier.

As Emily works tirelessly to safely herald baby after baby after baby (after baby) into the world, she becomes well acquainted with the three hard facts of Baby City:

1) Babies never come when you want them to.

2) Babies always come when you don't want them to.

3) You don't know who your true friends are until your baby is sliding down the birth canal.



Baby City was a joint effort, written by myself and Dr. Whoo of OB/GYN Kenobi. Do you remember the wonderful Dr. Whoo, who used to blog here? Well, now she's back… in book form! This book is all about the real events that take place on a labor and delivery unit, based on true stories.

This book is the ultimate book for mothers and medicine. Because it's about mothers (duh), both new and old, and it's written by two female physicians who are also mothers. It's light reading, but it deals with a lot of issues that are important to women and mothers and physicians.

Buy it today on the Kindle or in paperback!

Side note: We are donating 25% of the profits from the book to the fistula foundation, a nonprofit organization that does great things for women in Third World countries.

Saturday, May 9, 2015

Hello from CaliMed

Hello MiM!
I'm excited to be joining this fantastic community that has helped me tremendously from the time I started thinking about medicine to now, 12 weeks shy of starting my first year of medical school. A little bit more about me, my background is in finance, but after a few years on Wall Street I knew I was going down the wrong career path. After having my first daughter in 2011, I realized if I really wanted to go for medicine, I had to get on it. I am extremely lucky to have a supportive husband and thus started my post-bac when my daughter, SK, was 1. Because I was a finance major in college I had to take all the pre-reqs and although I've always loved school, I learned that studying with a toddler in tow was a completely different experience than my undergrad years. (Like that time SK accidentally locked me in the garage like a prisoner before my organic midterm...)

Now said princess is turning 4 in June and we are expecting another in a matter of weeks. It was my plan all along to squeeze another child in before the start of school, but the window was limited and tricky. At one point I was clearly delusional and considered being a "little bit" pregnant for the MCAT, but thankfully came to my senses. I am sad that baby #2 will still be tiny when school begins, but I know I am luckier than most to have the flexibility that comes with being a student.

I am really looking forward to sharing my journey through school with you all. I have to confess, I feel like quite a newbie - I've done the mom thing for a while now, but I've just started the medicine part. And with so many wonderful members in this community who are much more advanced in their careers than I, I am curious what others would like to see from me. Please let me know!

And now I will leave you with my brilliant plan for the next 12 weeks before I take the plunge into medicine:
1. Pack up house and move most of our stuff to new city.
2. Rent out current place.
3. Host fantastically awesome Rapunzel birthday party for SK at 38 weeks pregnant.
4. Pop out baby #2.
5. Move the rest of our stuff and drive down to med school.
6. Get situated (make sure SK likes school, find nanny (!), get to know area, figure out transition from life with 1 kid to life with 2, oh and unpack)
7. Start school and balance marriage, 2 kids and student-life like a boss*

* TBD. May need help with this one, but absolutely thrilled to be pursuing my dream.

Cheers all!

Edit: I wrote this post before I saw Cutter's post from yesterday. After reading it and all the comments below which seemed to offer a resounding and unanimous "no" to her question, I realize my post may sound slightly manic and also maybe naive. But I am honestly very excited for this new experience that lies ahead and think it would be wrong even, to make such a drastic change in my life and not put everything into it. I have so much respect for Cutter and all the women in this community who have taken the path that I am just now embarking on. And I would be lying if I said I was not affected by some of the comments. But I was also very encouraged by the fact that many of you absolutely love what you are doing. I know I have a lot to learn and I may feel differently down the line, but for right now, I can't look back and can only look forward and say yes. 

Friday, May 8, 2015

Would I do it again?

No.

I’ve thought about this a lot over the past few weeks.  Residency is ending.  It’s been 7 yrs coming. There have been many ups and downs.  The end is exciting and stressful.  The costs at the end are nearly insurmountable - thousands upon thousands of dollars for boards, licensing and moving.  The worry that you don’t know enough.  The sadness about leaving this family and the excited anxiety about starting the next step.   As I reflect upon this journey, I recognize that it has been amazing.  It is an unbelievable honor to take care of patients. I love what I do.  I love being a surgeon.  I will be starting a fellowship next year back in my hometown and I couldn’t be happier about going home and training in a field that I love.  I’m excited about my research.  I love my future colleagues!  I don’t regret my choice and I love my field and my patients.  However, I also admit that 7 yrs has wreaked havoc on my life, my family, my husband, my child, my health, and my bank account.  The direction of medicine worries me.  I think the business of medicine is crowding out the practice of medicine.  But, I realize that no field is perfect.  I understand that.  But there are other ways to live a life. Other ways that would give me a different sense of control.  There are other ways to have challenging work that is not so hard emotionally, technically and physically EVERY DAY.  Medicine is not just challenging, it is hard.

So, as I reflect upon these years in the few moments of silence and meditation, I think to myself, would I do this again.  I think it’s important to reiterate that I actually don’t have regrets about my choice and I don’t dislike my job, I LOVE it in fact.  My husband is still here, right by my side.  My daughter is a fireball of wonderfulness who loves hearing about my day.  I’ve missed many family functions and have not been there for my siblings and parents in the way I wish I could have been all the time, but they still love me and I have found ways to still be present.  But when I really ask myself, knowing everything I know - Would I leave my job in finance and go to medical school and choose to be a physician?   I think the answer may be no.  What is your answer?

Thursday, May 7, 2015

MiM's most viewed posts 2008-2015

Just for fun, thought I would post the 10 MiM posts that have had the most pageviews to date. Mind you, our posts go back for 7 years and number of views is determined by many factors including what shows up on search engines and links from other sites. But, thought it would be fun to take a walk down MiM memory lane.

1. A day in the life of a neurosurgeon - seriously?  by GCS15. This was part of our Day in the Life Topic Week from 2009.

2. When breastmilk isn't best  by Fizzy, 2012. The title alone attracted many views and commenters, including some non-MiM breastfeeding activists who clearly did not read/get the post. Check out the great discussion on "gunk" (on pump parts) in the comments.

3. Guest post: Why it's all worthwhile (or what keeps me going) by GCS15 in 2010. A personal favorite. So inspiring.

4. Why you absolutely need to have a baby during residency by Fizzy, 2012. Another great and provocative title. Again we see Fizzy's signature use of humor to make her points and win over the audience!

5. MiM Mail: (Un)happy match day - It doesn't matter what YOU want, 2015. Our community came together in support of this MiM - we felt her struggle and all wanted to help. Any updates?

6. The opiate endemic and us by Genmedmom, 2013. Thoughtful commentary about a difficult, serious issue in patient care.

7. Why is residency so harmful? (And what can we do about it?) by Genmedmom, 2014. Another thoughtful commentary about medical training and sometimes toxic culture that comes along with it.

8. Maternalism by JC (a cardiologist), 2010. A wonderful post trying to reconcile comfort, evidence-based medicine and the post-paternalistic era of medicine.

9. Guest post: The two kinds of mothers in medicine, by Jess, 2014. Generated great discussion about balance and working mothers' guilt (or lack thereof). We're lucky to have Jess as a regular contributor now.

10.MiM Mail: Anesthesiology or psychiatry? 2014. Apparently, a much-researched question!


Do you have favorites not represented here? Feel free to add in the comments.


Wednesday, May 6, 2015

MiM Mail: Feeding a family

Another long day in the life of a resident, and I find myself at home wondering what to feed myself and my family for the next week. Hubs is willing to help, but lacks creative energy in the kitchen most days and doesn't like to spend much time prepping a meal. Munchkin is young enough to be happy with basic staples pulled out night after night, though she does express boredom at times and I prefer to introduce a variety of foods.

I found an app with associated website this weekend that will let me plan a menu with recipes and create a shopping list. I'm hoping with less call in the upcoming year that we will be able to eat more intentionally.

How do you keep your family fed? Do you plan ahead and shop for your weekly menu? How often do you sit down to a freshly cooked meal, and how do you get it done?

-One Hungry Mama, aka Ladybug

Sunday, May 3, 2015

To be or not to be.....a generalist

Hello MiMers!

I'm nearing the end of my Family Medicine residency and am struggling with the age-old question: To be or not to be?....a generalist.

I've always loved the variety and scope of FM. To me, there is such great appeal of being a jack-of-all-trades kind of doctor. I love being the first point of care, collaborating with specialists, seeing new and unfamiliar problems, and flying by the seat of my pants. Growing up in Canada and being surrounded by a culture of Family Medicine has undoubtedly shaped my love for general practice.

That being said, after countless hours of studying, rotations, patient care, and hard work, I am sometimes weighed down by the questions, "What am I GOOD at? What's my area of EXPERTISE?" Sure, there are the things that I see everyday and feel pretty comfortable with: Diabetes, high blood pressure, back/shoulder/knee pain, asthma, preventive care to name a few. But this always comes with the knowledge that I'm not necessarily an EXPERT in those fields. Can I really be giving my patients the best care for their problems if I'm not an endocrinologist (diabetes)? orthopod (shoulder pain)? pulmonologist (asthma)? Could I give a thoughtful, professional-level lecture on any of those subjects?

I've been seduced many times during residency into doing a fellowship. At one point, I've seriously considered a fellowship in geriatrics, OB, EM, sports med, palliative care, dermatology and HIV/AIDS (to name a few). But I can never seem to commit myself to narrowing down to one subject. I find myself getting back to the same fear of getting pigeonholed into one area and losing my ability to be a generalist. It is quite a humorous mind-loop that I get into time and time again.

Ladies, lets discuss. What do you love about being a specialist? Or a generalist? I'd love to hear your thoughts.

Sincerely,
HulaMed

Friday, May 1, 2015

Call for new contributors

Update 05.04.15: Thanks so much for those of you who responded to this call. We are going to have an amazing cohort of MiMs joining us over the next year, from all stages of training and representing some new specialties we haven't had in recent times. For everyone else, we always welcome your guest posts and MiM Mail. Next open call: May 2016. Thanks for reading!

It's hard to believe, but Mothers in Medicine is celebrating its 7th birthday this month. We recently passed our 3 millionth pageview. Some of our contributors have written here since the beginning, and others we have welcomed along the way. Your guest posts and MiM Mail and all of the posts (over 1200 to date)  have made this a community where we can reflect, share, support, and grow.

In honor of May, the home of Mother's Day and MiM's birthday, we wanted to try something new to add to the voices that have been on this site: an annual, open call for new contributors to join as writers for a (renewable) one year term. The only requirement is the willingness to share a part of your journey as a mother in medicine with this community over the next year. No blogging experience necessary.

If you are interested, please send a note to mothersinmedicine@gmail.com with why you would like to write for MiM and a little bit about yourself. We would love to welcome some new MiMs to the roster!

Thanks for reading!

Thank you MiM

MiM seems to call me at the strangest of times.  And everytime I go to it, a post that 'talks to me' awaits!  I've learnt many things from MiM, but the thing that stands out the most is the sense of community.  Sharing my stories and hearing others, I'm struck by how similar many challenges we face are.  Across continents and specialties, ages and stages, whether we are single, divorced, widowed, mothers of one, two, three or more, there is always a single thread that binds us all.  Sometimes it's a spider thread.  As the voices start answering (no, I'm not crazy, I mean the responses) that thread turns into a rope, and then a cable.  A skip comes back into my step, some hope into my heart and I throw myself back into the fray, strengthened and centred.

Thank you MiM.  I think you're wonderful!

What have been your lightbulb moments, things learnt, precious memories of MiM?

Wednesday, April 29, 2015

MiM Mail: Planning for baby #2

I'm a resident, wife, and mom to one, hoping to have one or two more children. My first was born during intern year, and we're planning for a second during residency. With my first, I ended up with multiple third trimester complications that eventually led to 2 weeks of bedrest and delivery a month early. I've been an avid follower of MiM since before my first pregnancy, and I'm hoping for advice and encouragement from some of you.

I'm in a field that requires a separate intern year and am now working with people unfamiliar with my first pregnancy. All they know is what I choose to tell them. I think my current PD knows I had complications, but not the specifics. Thanks in part to an amazingly supportive PD my intern year, I finished PGY1 and started PGY2 on time. From a residency timeline I'm right on track, and I have some sense of when the "best" times could be to have another baby during my program. We'd end up with about a 2.5 year spacing. Our preference would be somewhere closer to 2 years rather than 3.5+.

My spouse is great with baby #1, does a lot around the house, and picked up a ton of slack during my first pregnancy. It was hard, but we made it through, and my upcoming schedule will be easier than it was last time.

Medically, my odds for the healthiest possible second pregnancy considering my complications are higher if we choose not to wait until after residency. Besides, at that point I'll have written and oral boards and be trying to establish myself in a practice, so I'm not convinced it would be much easier.

In many ways, I feel like I'm between a rock and a hard place. When I think about attempting #2 during residency there's a part of me that wants to believe we'll make it through just fine, but the realistic side of me expects a great deal of physical, emotional, and mental strain. I wasn't deathly ill, but it wasn't fun, and both baby and I could have gotten very sick very fast. I expect to deal with some problems again, but hopefully not all, and hopefully not the one that led to bedrest. I'll be meeting soon with a new OB to talk through everything.

I don't want to sell myself short, and if I feel like having a second soon would risk compromising my training. On the flip side, ultimately we don't want to stop with one kid, and waiting would only compound my risks. Jumping to adoption is not the right answer for us.

Where we are now, we have a lot of support outside of residency. Even if we move after training, it makes sense to have another baby while we're here. I think there would be support from my program, but I don't think it could be as robust as it was with my first. My previous PD was amazing; few could measure up. My peers have verbalized a mutual intent to help cover for each other when circumstances arise including babies, but I haven't gone into details of my first with them and don't care to unless it becomes necessary. I don't see how they could understand what I was up against, or how it would help to talk about it right now. I sure hope I don't need weekly or twice weekly appointments until the last short stretch, but we might end up there again.

I guess I have an idea in my head that if I do decide to pursue a fellowship and don't finish residency on time, I can look for a job for a year, maybe a couple years, and then continue training. I may also be happy without a fellowship. I know people say it's hard to go back to a resident's salary (or worse) after being out for awhile, but we could knock out a lot of debt in a year or two and be in a better place for me to take a pay cut, even with 2 kids in daycare. I don't think the financial side would prevent fellowship down the road if I wanted it.

Anyone have advice for how, when, and what to communicate to my program and my co-residents if we do get pregnant again? Thoughts on trying during residency with high probability for some (manageable) complications vs waiting and dealing with recurrent and possibly worse complications? What else do we need to consider? Anyone else make it through a difficult pregnancy without feeling like you lost your competence as a physician?

Ladybug