In Defense of Gunners

Gunner. GUN-ner. noun: Considered by most to be the most annoying type of medical student, a gunner is a student that is "gunning" for a residency and willing to do whatever (they think) it takes to get said residency.

I am not a gunner.















If anyone would like to see that my grades bear this out--I'd gladly put my Z scores up here. You would not be impressed, which isn't to say they are abysmal, but enough about me.

Why defend the gunners, you ask. They are probably already busy defending themselves at this very moment to one of their annoyed classmates--why stand up for them?

Here's a confession: I hated gunners. I hated how anytime there was anyone with any clout who spoke to us, the gunner(s) of the classroom would be sure to ask them limitless amounts of questions just so that the would stick out from the class. I hated how I could study most of the time most of the days of the week and I was still just an average student because of the 1/4 of my class does absolutely nothing but study, sleep, and eat (while we're on the topic, I hated that people could openly mention that they studied way less than me and still did better on a test). I hated how obvious gunners would make their "networking" with doctors, other med students, etc. It got to a point that I even nicknamed one of the gunners in my class Verizon Wireless (it's the network).

Here's the one thing that I can say I respect about gunners: they know what they want, and though they probably aren't going about it the best way, they are doing what they think it takes to get what they want.

Here is the type of "gunner" that I can (almost) like: He (or she) is certain that he wants to get into a difficult residency, e.g. derm, plastics, ortho. Because of this he realizes that he definitely can't completely let grades go by the wayside, but at the same time he has friends, a life, and is seen at the medical school on non-test days. Rather than annoying everyone else by monopolizing a speaker's time, or being the first to answer all of the questions in class, he gets to know doctors on their own time, or talks to the speaker after words (although too much of this would be borderline :)

To summarize, actual outright gunning is annoying and is a great way to alienate your friends (that you won't have for long), but those that are simply pursuing what dreams they have I can respect. The difference is true gunners take satisfaction in being thought of as a gunner, while the others would just be content to be in whatever specialty they like when they finish medical school.

"People have got to know whether or not their President is a crook. Well, I'm not a crook. I've earned everything I've got." -Richard Nixon

Verie Inn Secyure MD, MBA, Ph.D, MPH, JD, FACS, CRNA, CPA

"There is nothing so stupid as the educated man if you get him off the thing he was educated in."

Will Rogers

Does anyone really need multiple graduate degrees?

I always thought it was interesting to analyze the type of people that get into medical school. A few people went to medical school because everyone in their family for the past 4 generations have been doctors. Some go becasue their parents said that they would pay for the education plus living expenses. Still others got into medical school because it was just something to do. While the vast majority of people get into medical school for the right reasons, I think it is the last group that is the most interesting.

Picture this, a smart undergraduate student, who also has considerable foresight, realizes about the end of their sophomore year of college that they are about 9 months from having to know what they want to do. Many students harness this fear to do some serious soul searching and decide upon a career choice such as going into business or becoming an accountant or teaching high school. Then there is the small but definite minority that decides to finish up their undergraduate degree and then decide on some graduate school ad hoc.

But, you might say, medical school has so many hoops that you have to jump through (MCAT, ACGME etc.) . How could someone decide to spontaneously pursue a career in medicine? I think that there are two ways that it is done. First, someone takes classes to get a Masters of Basic Medical Science (read: I couldn't get into medical school the first time I tried). Or you could have someone who takes an extra semester or two in order to squeeze in the requisite year between taking the MCAT and getting into medical school.

The long and short of it is this. A definite percentage of students in medical school are only in it for either the prestige/respect factor, or because they had nothing else to do. Which gets back to my first point: there are very few exceptions where someone could justify the need for multiple degrees.

1. MD/Ph.d: I have asked those who should know on multiple occasions why someone would want to do this. Generally, the response is some mumbled "I just don't know exactly what..." At the very least it means 10 years of combined schooling/residency, and for what? So that you'll be a better researching physician? Why not just take two years during residency and do some research, then you can develop your own goals rather than piggybacking on the work of someone else who probably isn't doing something that you're that interested in. I can almost guarantee that it would be 1000 times more valuable to do research as a resident because you would have much more freedom to do exactly what interests you and because you would have much more experience at that time. By that time you will have a much better idea of what you want to do with your medical life. I just don't get this one--maybe I'm just not smart enough to. The one benefit is that instead of paying for school you get paid ~14k for 7 years, but I wouldn't trade two less years of professional life for 28,000.

2. MD/JD: This is the only one that I can see reasonable people doing. If you want to spend the rest of your life suing doctors, you might as well get an idea as to the innerworkings of the medical machine. Seriously though, if you wanted to devote your life to the service of mankind both medically and legally, e.g. working with the poor, then this would absolutely be a noble calling.

3. MD/MPH: I'll be honest, I really know nothing about an MPH other than it stands for Masters of Public Health. But just the same, I can't imagine that you learn more about public health by sitting around in lecture halls than you would be spending the same amount of time following around those who work in public health.

4. MD/FACS I just found out that FACS stands for Fellow of the American College of Surgeons, this would actually be something I think should be strongly encouraged.

So in summary, I think that multiple graduate degrees are ridiculous and I realize that a CPA is not a graduate degree. I apologize for the rambling nature of this post--but at least I'm the only person that has to read it ;)

Free Clinic Encounter

So there is this clinic that I like to work at periodically that serves those of Detroit that cannot afford normal health care but that are still either working or trying to find work. And there is this doctor there that seems to like me as a med student, either that or they're just friendly to all med students. I say this because she is very good about making patient encounters a learning experience. But she is this petite woman. So one day this guy comes in dressed in "urban cowboy" apparrel and you just know when people with big leather boots come in that they are just looking for a prescription for some more drugs.

Long story short, the guy was in an accident a few years back (in his defense he did nearly die), but he grossly exaggerates his pain (10 out of 10--everywhere in my body!) in order to try to convince her to give him another prescription for some opiods. And to try to be even more convincing he tried to act completely out of it, I guess because he thought that by acting like he had no mental faculties he would be a better candidate. For instance, even though he had to write his name and the date at the top of the mental coherence test (which he got right), he suddenly thought that it actually was "November" not "February."

But thank goodness the doctor wasn't buying any of it, and before we went back into the room to give him the "bad news" she told me to be ready incase he got hostile in response to what we were about to tell him. So I ran through a few scenarios in my mind in case I (being the only one of us within 70 pounds of this guy) had to defend the both of us. Luckily he took the news pretty well inasmuch as he didn't get violent.

So I sat down on the stool while the doctor explained in detail why he wasn't going to get what he wanted, while he did his best to roll out some answer like, "Well, I just think that when I was on the Oxycontin I was in a good place, a place were I wanted to be." But when she asked him where he wanted to go from here, e.g. pain free or working etc, he didn't have an answer. Even more troubling, his medical records showed that he had tried to kill himself on a couple of occasions by overdosing on pain medication.

As this was going on, I noticed that the doctor kept trying to get my attention for some reason. When we finally made eye contact she motioned towards the door with a look.
So I got up and moved towards the door. When I talked to her later, she said, "I was trying to get your attention forever but you were just sitting there on that stool!" She didn't say it in an angry way, but rather she was more just pretending to ream me out. To conclude she told me, "Never let a potentially angry patient get between you and the door."

Oh and the guy also made some vague references to feeling "homicidal" without his pain medication, his one thinly veiled threat from the encounter.

Medical Records

Medical records are a funny thing. Search google for "Hospital X Medical Records" and you can very easily get a fax number by which to request the medical records of a patient, with the only requirement being that you send over a faxed copy of the request for the records including the signature of the patient. And if you put something like "the patient is in the office" on the request you can even get them in a matter of a few minutes.

How fun would it be to send a request over to Henry Ford and say that you've got Joel Zumaya in your office and would like to see the MRI of his shoulder; then take a look to see if the injury was really consistent with a "box falling" or a dirt bike accident (assuming I actually knew something about shoulders, MRIs, or medicine in general).

Shakespeare once said that the guilty "protesteth too much," and Zoom-Zoom's preemptive strike with his vehement denials seemed a bit suspicious when not to many people were questioning the validity of his story.

Obviously this would have serious legal and ethical ramifications, so I would never actually even consider it. But it would be interesting none the less.

Morbidity and Mortality

M&M conferences are one of the more unique things in medicine. I know that I'm not the first person to think this, but when I went to my first one this morning I was struck by the layout.

Not that it was an earthshattering experience, or something that forever changed my life, but rather it was an interesting experience. In what other profession do professionals lay out for all to see--in vivid detail--the mistakes that were made.

Since they have M&M every week, chances are that if you picked a random week you would not hear about someone who accidentaly gave someone 10x the normal dose, instead the most common thing that you hear about is situations where very subtle warning signs were missed, or where a patient died for no clearly defineable reason.

The only people to talk during the M&M conference is the nervous resident who is presenting and the attending physicians who ask the questions. It's not at all like the TV version where people are shouting contentious questions at the presenter, but rather it is a very quiet environment where residents and students can learn from the mistakes and missed signs of those who have proceeded them.

Solitaire

The difference between perseverance and obstinacy is that one comes from a strong will,

and the other from a strong won't.

~Henry Ward Beecher

I was playing solitaire the other night (to take my mind off of studying for the biochemistry test that I have to take in a couple of hours) when I noticed that I wasn't really playing solitare anymore.

In the solitare game that I have, you don't need to click and drag the cards in order to place them on the stack. In other words, if I wanted to take a 3 of hearts from the deck and place it on one of my piles all I had to do was click on it--which is great inasmuch as it is easier, but it can make it so that you don't actually have to know where you want the card to go, the computer will place it on the correct pile if any moves are available. Pretty soon, rather than actually thinking, I was just clicking on each of the cards to see if any moves were possible.


Which got me thinking. How much of my life and the lives of those around me been shaped by the mentality that all that matters is "winning." Not everyone is motivated to come in first, but I think there are alot of people who have fallen into the trap of just trying to get through things. What I mean is that, for many medical students, all they want to do is survive medical school.

It is an easy trap to fall into--and one that I must say I fell into of late. I have subconsciously made many decisions that directed me down the path of "just getting through." Because I thought it would be easier to get up later and stream the lectures (the lectures are recorded on video) I convinced myself that it was "more efficient" because I could watch the lectures at 2x speed. Yet, instead I found that I was doing less studying than I had been doing when I came to lectures everyday. The time that I was saving I wasted because I had adopted the mentality that medical school = passing grades for 4 years.

So to conclude this rambling post, I think it's important to constantly evaluate the motives we have. Are we just trying to "win" at our solitaire games or are we actually taking the time to experience what we are going through and live our lives to the full--no matter how difficult a situation may be.