Medicine, The All-Consuming

Left unchecked, medicine can easily dominate all aspect of life. This hits people at all stages of training and experience in medicine, but now that I've dipped my toe into residency, I think it likely hits residents the hardest. Residency means being both a learner and an employed junior physician, which has the unfortunate consequence of piling on both the open-ended responsibilities of a medical student to learn as much as possible, along with many (though not all) of the day-to-day responsibilities of an independent physician. Add on a situation of minimal control over one's own schedule and the need to continue to fight for a job on graduation, whether a fellowship or full employment, and medicine can easily take up every minute of the day, and every thought running through the brain.

For a small number of exceedingly passionate residents, this is exactly what they signed up for. Most residents, however, have parts of their life outside of medicine they would like to maintain or even prioritize, and that can become difficult in the metaphorical tempest of residency. Particularly when ambitions come into play, where a desired career path cannot be secured by simply showing up and performing well, medicine can push out those other, valued parts of life.

I'm finding myself falling into that trap early on in residency. I'm incredibly fortunate to be in a program with lower overall hours than many, and call schedules which are generally quite favourable. Yet this still means weeks far longer than a typical work week and the added time has largely gone towards maintaining a real sleep schedule and keeping up a rather bare-bones home life. My spare time now is still largely focused around medicine, either doing things for my career or, out of anxiety of having to do them all the time, unproductively procrastinating those activities.

As I was fairly ambitious in medical school, I've essentially been running on this medicine-focused treadmill for about 3 years straight now. I've learned this doesn't work well for my health, well-being, or even my achievement levels. I was able to scale-down my commitments later into my third year of medical school and into my fourth year. My choice to go into Family Medicine was influenced by this realization, a choice I'm quite happy with thus far if only for the sake of my own health.

Yet I'm still struggling with balancing my ambitions within medicine with my ambitions outside of my career. I want to do more as a physician, as I see so many opportunities to do a better job for patients. However, I've learned from experience that you can give everything you have to the medical system and end up causing more harm - especially to yourself and your loved ones - than you see in benefits for patients.

Prioritizing medicine above the rest of life didn't work and, in retrospect, many more senior physicians told me as much. So, I've tried to play a balancing act in the past year and a half, weighing any benefits to being more active in medicine with drawbacks to life outside of medicine. Again, for my health this has been a positive change, yet it comes with one major drawback - my life is still dominated by my medical career. Even if I choose not to pursue a new opportunity within residency, or put in an additional hour in a clinical setting, or do an extra bit of studying, I'm still making that decision with medicine as the focus. Unfortunately, this is leading to a fair bit of resentment towards my own medical career, without a countervailing positive in my non-medical life.

Therefore, I'm going to try to change tacks once again. Beyond trying to maintain a balancing act, I'm going to see how things work when life comes first. Before lifting an extra finger for the sake of a medical career that seems rather indifferent to my efforts, I'm going to try to make sure I have time for the non-medical things in life I care about. Getting a real amount of exercise. Spending quality time with my spouse. Watching the hockey game. Reading the newspaper. And if I'm really lucky, pursuing some hobbies I've had on the back-burner for years. Only then will I do the non-essential work in my medical career. My hope is that I can attack those activities in medicine with the vigor they deserve and which, over the course of the past 3 years, has waned from exhaustion and over-exposure.

Part of that is this, my Medical Blarg. This blog started as my way of actively de-stressing about being a medical student. As it unexpectedly gained viewership, it felt like the one activity in medicine that was leading to something productive. The encouragement to keep going from posters was immensely appreciated. Yet, it's hard for me to deny that as a result of its viewership, this blog has, in a way, also become a part of my medical career. There reached a time when posting felt more like an obligation that the enjoyable exercise it started out as. As a result, I've pulled back a bit on my posting frequency. My hope is that doing so allows me to continue to blog, but with a bit more enthusiasm and genuineness that I have been able to in the past few months.

Medical Blarg - Where to Start

Despite my best efforts, this blog is getting a bit more readership, so I figure it's time to get some things organized around here. This post is meant to be a place to start for new readers at various points in training. My posting thus far has not been organized, so the posts don't necessarily flow into each other, but they should give you a sense of who I am and the opinions I hold.

This is also my opportunity to encourage those lurking around to comment on posts. I never really intended this blog to get much readership, but there's a reason it's a publicly-accessible blog and not a private journal. I want feedback on the things I write! Especially for those who might disagree or have a contrasting opinion to offer, I'd love to hear it.

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For Those Considering Medicine
Back Up Plans
You Should Study Something You Enjoy

For Those Applying to Medical School
On Giving Advice About Medical School Admissions
Should You Study Medicine Abroad?
If I Don't Study Medicine Abroad, What Are My Options?

For Those Trying to Choose a Specialty
How To Pick A Specialty
Preparing to Match in CaRMS (Before Knowing What To Match Into)
How To Pick A Specialty - A Follow-up

My Likes and Dislikes in...
     OB/GYN
     Pediatrics
     Emergency Medicine
     Oncology
     Internal Medicine
     Psychiatry
     Family Medicine
     Radiology
     Surgery
     Anesthesiology

My Thoughts on Medical Education
Fairness in Medical School Admissions
What Should Medical School Admissions Look Like? (Part I)
What Should Medical School Admissions Look Like? (Part II)
Med School Curriculums Across Ontario
Underpants Gnome Theory of Medical Education

Miscellaneous
Reading About Healthcare
It's Alright to Hate Medical School

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Ultimately this is a personal blog, more like an open diary than anything else, so I post about whatever comes to mind. This is how I express and reflect on my random thoughts.

I find in medicine it's too easy to get stuck on autopilot, or to feel caught on whatever treadmill I've put myself on. This blog is my effort to turn off the autopilot, to step off the treadmill if only for a few minutes.

What I hope for those who stumble across this blog is that you'll leave with something to think about, even if that thought is "wow, that guy was totally wrong!"

Happy reading!

Reading About Healthcare

I like to read. A lot. About all different things, but being in medical school, I like to keep up with what's going on in healthcare. Knowing that I get a lot of traffic from pre-meds and other medical students, I thought I'd share the resources I use to stay up-to-date on what's going on in healthcare outside of my local bubble.

Blogs

The Incidental Economist (link)

Focusing on healthcare policy, particularly from an economic perspective, TIE does a great job of contextualizing system-level concepts in medicine. Their posts are well-written and provide non-technical explanations for technical subjects. There is a fair bit of medicine in there too - most of the contributors are policy experts rather than physicians, but Aaron Carroll is a pediatrician who does a great job of using an evidenced-based approach to common medical or quasi-medical questions. He also makes very helpful short videos! It's a bit American-centric, so not every topic applies well to the Canadian healthcare system, but being concept-focused, even the American topics provide some useful means of understanding healthcare in Canada too. Overall, I find this site to be my highest-yield resource. Check it out if you've got a real interest in healthcare policy.

Healthy Debate (link)

Canadian content, which is great, and there are some articles with some really unique insights into the Canadian system. It doesn't have too many contributors however, and I find some of the articles to be a bit fluffy, so I don't check the site often. In typical Canadian fashion, it also tends to play things fairly safe, with many articles taking rather non-controversial or vague stands on issues. In some ways, it's more a news site than a blog or opinion site. Where Healthy Debate does shine is in the comments, which are generally high-quality and provide for reasonably insightful discussions. Posters are more willing to take hard stands - and to defend their viewpoints - which also gives a good look into prevailing opinions in Canada's healthcare system, including those of physicians. It's worth checking out every month or so.

KevinMD (link)

In many ways the grand-daddy of healthcare blogs, KevinMD is now mostly an aggregator of blog posts from other blogs, some better than others. It's an American site with a distinctly American focus, so a lot of what's on there has minimal value for Canadians. There's also a fair number of fluff pieces. Still, it updates so regularly that even if only one in four posts catch your interest, there's still plenty of content to go through. The comment section provides some interesting viewpoints from our American colleagues, but don't get too absorbed in them - unlike Healthy Debate, this is not a place for measured discussion. Opinions get thrown around with little or poor justification and seem permanently unresponsive to counter-points. It's also a rather commercial enterprise, with Kevin Pho, the site's founder, talking a lot about how physicians can increase their online presence. It's a great resource for bloggers if your primary goal is to be seen/heard by more people, but being a content-focused person, I find the emphasis on wide exposure rather than quality content a bit off-putting at times.

Evidence Network (link)

A University of Manitoba-based collaboration project between healthcare policy experts from a variety of backgrounds, the Evidence Network provides easy-to-understand position pieces and commentary on the Canadian healthcare system. It's not exactly a blog, so it doesn't seem to update too often, but the quality of the pieces is exceptional - as the name suggests, they really draw off the evidence in a comprehensive manner. Most of their positions are nothing I haven't heard before, but their circle of experts have expressed them in such a clear, concise, Canada-specific manner that they're worth a thorough read. Anyone looking for an introduction or refresher on Canadian healthcare policy, particularly from an economics perspective, could do a lot worse than reading the Evidence Network's articles.

Doctor Grumpy in the House (link)

Uses examples from Doctor Grumpy's practice to highlight the absurdities present in medicine. American practice, but the instances are generally quite applicable to Canada. Always hilarious, usually not too serious. Good for a laugh every now and then for stress relief.

Forums

Premed101 (link)

Needs no introduction - if you're on my blog, you probably got here from Premed101. Good resource for Canadians looking to navigate getting into medical school or residency, arguably the only free, reliable, online resource for some important questions. Canadian-focused, so a bit of a smaller community which goes through periods of relative inactivity. Also a bit dominated by a small group of posters - which I'll fully admit includes me - so what gets posted isn't exactly representative of the broader community in undergrad, medical school, or residency, but I do find there's at least a range of opinion and room for different ideas. I've had some excellent discussions on Premed101, which is why I generally keep coming back to it.

Student Doctor Network (link)

The American Premed101 (ok, it's probably the other way around), it's a great resource if you're looking at doing anything in the US. Bigger community, so it's a decent place to get a variety of perspectives on medicine. Chock-full of useful or funny anecdotes if you search around enough. Not the greatest forum for discussion - threads seem to get pretty non-constructive fairly quickly - but still good for simple data-gathering about viewpoints about medicine, particularly from an American perspective.

News Sites

Medicine is a social occupation. Healthcare is very much society-dependent, and society is changing all the time. I find it very useful to keep up with the world outside of medicine, or at least to see what non-medical people read about healthcare. I meander between different news organizations when trying to get general information about the state of the world, including the CBC, the Globe and Mail, Maclean's, the Guardian, CNN, the New York Times, the Washington Post... it's changed a lot. My go-to at the moment is...

Vox (link)

Started by a bunch of younger, established, left-leaning journalists a few years ago, Vox is an online-only news organization. It tends to go a bit beyond reporting the immediate story of current events, instead trying to inject some fact-checking, context, or counter-points to common media narratives. This raises the level of reporting substantially and avoids some common journalistic pitfalls. The problem with trying to inject context into news, however, is a higher potential for bias. It's a left-leaning site (for an American organization at least) and sometimes misses or ignores contextualizing information that goes against established viewpoints of their main staff. These tend not to be egregious errors and because their articles actually make concrete conclusions, they're pretty transparent about their viewpoints, so at least it's easy to clue into where their bias lies. It's not a uniquely good news site, but I'd say it's a cut above most.

Raw Data Sources

Canada has a large number of organizations that collect information on the state of healthcare, so no one site is going to have all the necessary information. Government departments (local, provincial, and federal), physician organizations (CMA, OMA), and accrediting bodies (CFPC, RCPSC) all have good data. Here are the sites I visit most often for raw data.

CaRMS (link)

Everyone involved in Canadian medical education knows about CaRMS. It's the organization that handles our residency matching process, the most important post-medical school admissions event, so it's kind of a big deal. It's also a fantastic source of data on the Canadian medical education system. They've got reports on residency matches stretching back decades, as well as program information for the current match cycle. I pull a lot of raw data from them when looking at the medical education pipeline.

CIHI (link) 

The Canadian Institute for Health Information is not a site I visit often, but if you're looking for an obscure data point on healthcare in Canada, if you find it anywhere, chances are you'll find it there.

Health Force Ontario (link)

The most comprehensive job posting sites for physicians. Far from complete - a good number of positions for doctors aren't posted anywhere - but it's a large and searchable database, which puts it a good cut above anything else I've found. I like it for the purposes of contextualizing future career opportunities. Finding even one job that is appealing in a specialty is a great motivator to go into it, to see what's at the end of the tunnel. Many other provinces have similar sites (British Columbia's is notably excellent).