Discovery Health

(And the medical school of your choice!) I make no promises, but it worked for me, so I hereby provide my path and advice to those pre-meds out there:

Undergrad
Undergrad is the time for you to explore your interests. Okay–to have fun, and explore your interests. Figure out what you love. And then do that. To some it might be graphic design; for others it might be math. Or volunteering. Or lab research. Or foreign languages. Or acting. Do. What. You. Love.

You’ll notice that I didn’t say “majoring in math,” or “majoring in Biology.” If what you love happens to be a major–great! If it doesn’t–don’t stop doing it! Figure out what it is that keeps you up at night, so excited with thoughts racing that you can’t fall asleep. Figure out what lights up that fire in your eyes: when you’re talking with friends, when is it that you get that thrill in your chest? Talking about religion? Sports? Cooking?

Undergrad should give you a depth of knowledge in one area (your major) and pique your interest in others. Medical schools are looking for the well-rounded applicant who has shown significant commitment and passion to a particular love of his or hers. Medical school is similar–you have to love learning medicine so much that you’re willing to put up with a bunch of crap for 4 years and delay gratification for many more. If you can show someone that you’re passionate and committed to something–you’re already ahead of the curve.

This all being said, of course, you also have to let medical schools know that you know you’ll like medicine. There’s nothing worse than a medical school spending their precious time and resources to figure out who they’d like to admit, and then have one of their students end up hating the practice of medicine. So find some clinical setting in which you can shadow, volunteer, or something where you get to see doctors working. I did a summer internship with a local hospital where half the time I did data entry and half the time I got to shadow doctors in different parts of the hospital.

I think one of the smartest things I did–and best for my application–was drop medicine completely from my potential career list for a time. Sophomore year sucked academically: organic chemistry and physics together for three straight quarters–and it really made me question everything. “Do I really want medicine that bad? Isn’t there something else I could do with my talents?” So I took lots of different courses, to see if I could find anything I liked more. But I always came back to medicine. I figured I could do graphic design as a hobby, program as a hobby, take foreign languages as a hobby–but never medicine as a hobby. How did this strengthen my application? I could honestly say to interviewers that I’d really challenged the idea of becoming a doctor, and that I still wanted it badly. I knew I would love medicine. (And if you find that you don’t love medicine, that’s okay. But you should really find something else to do. Better to find this out now than after you’ve taken out $50,000 a year in loans!)

Try new things in undergrad. While in some ways you want to fit in with other applicants (good scores, good grades, good letters), you want to stand out. What did every single interviewer ask me about during my interviews? Not my research, not the student groups I helped lead–it was the current events radio show I hosted with my two friends. Stand. Out. (More on this later.)

And, not totally related, but it gave me a great deal of perspective and truly changed my life: if your school offers it, do an Alternative Spring Break trip! And if your school doesn’t offer it, look into starting an Alternative Spring Break group at your school!

The MCAT
Sorry to say it, but it’s important. Because schools have thousands of applications to go through, they’ve got to use some method to reject people right off the bat, and it’s usually some funky formula including one’s MCAT score. Doing very well on the MCAT will certainly help your chances at getting into your top school, but just doing well is important, too. In my experience, there’s some vague hazy cut-off below which you won’t get a secondary application or interview at school X, but that cut-off is fairly low. (I wish I could talk numbers, but I don’t know any!) If you do well but not stellar, and this is just how you test, no matter what you do–an otherwise strong application may pull you through. (And a word to you brainiacs out there–if you’re scoring 40s on your MCATs but have no personality or can’t interview or talk to someone for 20 minutes, you in some ways have a tougher time. I’d much rather have a classmate with good MCAT scores who I can interact with that someone with a 42 who can’t express him or herself.)

What to use to study? I took the Kaplan course, which was hella expensive. It certainly kept me on track with my studying, ’cause I didn’t want to get to class and not have reviewed anything yet, but if I could do it over again I would have just tried to buy the study books on eBay or something. I also did craaaazy amounts of practice tests, which my school had on reserve in its library. (Go, U Northwestern!)

The Application
#1: Have your application ready by the day you’re allowed to start submitting. Have your letters in, your transcript sent, your personal statement ready. Medical schools work on a rolling admissions basis, so the earlier you submit, the faster you get the secondaries. The faster you submit the secondaries, the faster they can review your application and offer you an interview. And once your interview is over, if you’ve done it early, your application will be discussed in more rounds of deciding whether to offer you a spot. (Compare that to the person who submits in October, and your application gets two months’ more of time in committee.) For some of the faster schools (UChicago!), I had interviewed and been accepted by early September–before I’d even received secondaries from some slower schools. (And that first acceptance is the best, ’cause you know you get to be a doctor somewhere.)

The obvious: while you’re doing all this exploring and “doing what you love” stuff that I rambled on about, you’ve also got to be studying. Not just to get good MCATs, but also get good grades. This is likely something to make you learn how to find balance in your life–between your academic life and your social one (I still struggle at this, as most of us probably do).

Extracurriculars: It’s great to see someone with a ton of interests, but try to pare it down as you become an upperclassmen. Again–find what you love, and make a significant contribution to it. Take on a leadership role. Advance the field, or activity, or whatever.

Letters of Recommendation: I can’t remember the recommendations on how many science and non-science letters to get anymore, but follow them. If you fall in love with a class and a professor, and think, “Wow, I really love this topic, the professor seems great, I would really like a letter from this person,” make sure the professor gets a chance to know you. Does that mean kissing up and going to office hours for no reason? No. It means participating in class, making your voice heard, letting the professor know you’re thinking and processing the information in his or her class. When I knew I wanted to ask my Physiology professor for a letter, I made sure to start asking questions that I had during class, or going up after class to ask.

Next, ask and ye shall receive. Don’t just ask someone “for a letter of recommendation.” Ask the person, “Would you feel comfortable writing me a strong letter of recommendation?” or “Do you feel comfortable writing me an excellent letter for my medical school application?” People will tell you if they don’t know you well enough, or if they just don’t think they’d honestly be able to write you a strong one!

Finally, meet with the person if they don’t already know you extensively. A 20 minute private face-to-face, you with resume in hand, where they can get to know you and ask you some questions will make their letter much more personal, warm, and true.

The Personal Statement: The most important thing on your application. I read applications as a 2nd year at Stanford, and it was usually the Personal Statement that either impressed me or bored me the most, and weighed the heaviest on my voting. My tips:

Get the reader’s attention. In the first sentence. I do this with a lot of my non-blogging writing. Picture this scenario when you’re writing: the person reading your application is tired (true). This is either the first or last thing I’m going to do during the day. It’s late at night, I’ve just spent a long night studying, and now I’ve got 5 applications to get through. I’m in bed, with my laptop, my eyes are starting to drift as my parasympathetic (rest’n'digest) system is slowing me down. I’ve only got a reading light on, I’m so sleepy…. but I must… keep… reading… BOOM.

Hit me with your best shot by sentence one. Make me want to know more. Wake! Me! Up!

Have a theme; relate your life and your experiences back to medicine.

Next tip: Every word must matter. I went through a ton of revisions (see left) until I got it tightened up. I asked friends who are good writers to read it and give me their honest feedback until I got to something I liked.

Here’s my own personal statement for your viewing pleasure. (Update: I’ve included my final draft, as well as two other drafts if anyone cares to see how the thing changed over successive drafts.)

Next time: Secondaries (again with a few samples of my own), the interview, and acceptance! Good luck to all!

Maggie Mahar has some great history on the origins of the “good cholesterol” vs “bad cholesterol” stuff, and how we got to our thinking about cholesterol to begin with. I don’t know how the woman has time to write and research all this for her blog, but she’s absolutely amazing. When residency starts, I’m going to seriously be cutting back on my blog reading, but Maggie’s won’t be leaving my Feed Reader anytime soon. If you’re not reading it, I’ll say it again: you’re missing out on some of the best of the web.

Google has now announced their Google Health product, now with a screenshot.

As I’ve said before, patients should not control their own medical records. If this Google Health product is an addition to the medical record for patients to use, fine. But if you think a physician is going to trust a patient’s listing of his or her weight over the scale in his or her office, you’ve got another thing coming, Google. (I’m also looking forward to a three page Google Health printout of a patient’s “allergies.”) It would, however, be nice to be able to get results of colonoscopies and stress tests, which it looks like Google may be able to do.

If you want an honest review of Google Health, feel free to contact me, Google. (I’m a trusted tester!) Until then, color me skeptical. (And Patient Sam Sample–watch your kidney function. Lisinopril plus ibuprofen is just asking to shut down your kidneys.)

So I’ve discussed being out as a blogger on residency apps, so now it’s time for the harder (but more important and wide-reaching) subject: Being Out, Coming Out–whatever you want to call it–as an LGBT person on residency applications.

I don’t really talk much about my personal life on this blog–I think mainly because where I go hiking on the weekends or who I go grab a drink with wouldn’t really interest anyone, and doesn’t have much to do with the theme of this blog: becoming a doctor, thoughts on health policy–that kind of thing. But this doesn’t get talked about a whole lot–hell, gay anything doesn’t get talked about much anywhere in the world of medicine–but it should, so here we go (sorry, it requires some history):

As a gay man man who happens to be gay, it hasn’t always been an easy road in medical school. Overall, I’ve been incredibly fortunate to be at a medical school in the San Francisco Bay Area that is overwhelmingly gay-friendly–with Out gay, lesbian, and even transgendered faculty even. My classmates have truly been amazing in their embracing of me (it probably helps that I’m kind of awesome, too). I wasn’t sure what to expect, but I’m incredibly excited for my generation of physicians, if they’re anything like my classmates.

I decided to just be “the gay classmate” from Day One–none of that “coming out” stuff that can be awkward and uncomfortable. I’ve always preferred to just drop the hint than have to come right out and say “Oh, I’m gay.” I’d much prefer to mention my ex, and then use the pronoun he, or one of many other such schemes I have previously concocted. Easier for me that way, and I find it to be less direct and confrontational. I don’t have something to prove, or some vendetta or anything. I yam what I yam.

The residents I worked with were, for the most part, great too. I wasn’t out to most of them–rarely did it come up or have any import–but when it did everyone was very accepting (as they should be). I’m not what people might call “gay-acting” (translation: what you see in the media as gay stereotypes), but I’m always surprised when someone assumes I’m straight (’cause it’s so darn obvious to me that I’m not), which a few residents did. The one incident that sticks out in my head was a surgery resident–otherwise good guy–who called his intern who felt bad for a patient “so fucking gay,” as a put-down. Lost a lot of respect for the guy right then and there. My esprit d’escalier reminds me that I should have spoken up or said something, but I didn’t.

So for the most part, I’ve always felt like I’ve just been able to be me during medical school, and I decided that’s how I was going to continue to be on my residency application. Being gay is certainly part of me, but it’s not the only part of me. I decided to include it in my application. I was the LGBT-Meds president for a year (2004-2005, baby!), so there it went on my app. (It ended up being pretty buried in my application, as achievements and extra-curriculars are listed reverse
chronologically, and I didn’t really have anything else to say about it, so that was the only place it was on my application.)

My perspective was and continues to be this: I am going to be a great doctor. I’m smart, I work hard, I’m positive and I play well with others. If a residency program wants to drop me in their rank list because the fact that I’m gay somehow overrides all those other things? Their loss.

So applied to 13 places. And got 13 interviews.

The fact that I’m gay barely came up on the interview trail–in fact, less than the blogging did. I’m not sure if this was because people were uncomfortable (didn’t seem like it), they didn’t want to get in trouble for a rules violation (possible), or just didn’t see it on my application (also possible). A gay residency director (I think the only out one in Emergency Medicine) did talk with me about it briefly, saying it was strong of me to put it on my application. I think one resident did mention that Chicago is gay-friendly, and he has a few gay friends, which was a really nice way to both a) let me know he read my application and b) let me know that he and the program were gay-friendly.

So how did things turn out? 8/10 programs where I interviewed contacted me saying I was a great candidate–whatever that’s worth–so I’d say being gay certainly didn’t hurt my application (not trying to brag to make people feel bad, just trying to give some data to future LGBT applicants). If anything, it certainly makes me stand out as a unique candidate as well.

It’s hard to say how things would have gone had I applied in another specialty or at other programs. There’s certainly a selection bias at work here: I only really applied to major urban areas (LA, SF, Chicago, New York, Boston) for my training, which are by default more open and gay-friendly. If I was applying to more rural schools, I’ll admit I don’t know if I would have put it on my application. It also helped that I knew I had a strong application, with good board scores, evaluations, research, teaching experience, extra-curriculars, and letters of recommendation–this made it easier for me to apply to these major urban areas and still feel like I’d have a chance of matching at one of them.

I don’t know what I’d say about other specialties, really. Emergency Medicine types in my experience are usually pretty laid back, fun people who’ve seen it all, and really care more about doing a good job and being efficient than much else–so I really didn’t anticipate it being much of an issue. I have no idea about other specialties, besides that fact that I know LGBT people in many specialties–including the surgical ones–but again, they’re all in the Bay Area, too. It seemed to me like the Psychiatrists, Internists, and Pediatricians were the most gay-friendly on my rotations overall, but I’ve talked with general surgeons who have told me about their gay general surgeon friends, too. There’s a pretty outdated survey on the AMSA website about LGBT-friendliness for specialties and residency programs, if that helps anyone… I’d love to hear other people’s opinions.

I hope this helps someone!

I don’t think anyone has talked about this, because I don’t think it’s really ever happened before. But when I applied for residency this year, I debated whether I should put my website or my blogging on my application. I worried that people reading my application would be scared about blogging, or wouldn’t know what it was, or had only heard bad things about it. I worried they would just think it’s a great way to violate someone’s privacy, or a great way to get in trouble with a lawsuit. (One of the reasons I haven’t decided if I’m going to blog residency is because I’d like to discuss it with my future program director first.)

But I decided to go for it and include it in my application for a couple reasons:

• I’m proud of it.
• It’s something in my life I do weekly at the least.
• It’s unique and sets me apart.
• Being able to reflect and process things makes me a better physician.
• I’ve had national news coverage of my blogging.
• I knew I was going to include my other projects, MDCalc and MedsList in my application, and those are casually linked to my blog, so they’d find them anyway.
• And speaking of finding them anyway, if you Google my name, I’m either the first or second hit (always fighting it out with this guy)

At the brilliant suggestion of a mentor of mine (Hi Michelle!), I came up with a short list of some of my favorite posts (PDF) showing what my blogging was all about, printed it out, and brought copies to give interviewers if the blog came up.

And the blog did come up. I’d say at about one-third of the programs, I talked about it with at least one interviewer. The response was overwhelmingly positive. No one mentioned any concerns about HIPAA/privacy stuff, and as far as I could tell, everyone felt like it was a Good Thing ™. People liked the fact that I was reflecting, processing, and thinking about what it means to become a physician, and also liked the informal network medbloggers have created as a community. I think having the print-out of some of my posts was really, really helpful to reference. Very few interviewers (only ones that I knew before applying) had actually visited the site (that I know about). In hindsight it was probably silly to think that an interviewer that has to get through thousands of applications would dial-up my URL on his or her PC, but you never know.

My advice to future applicants: if you’re writing a blog, first, don’t be anonymous. While there are certainly bloggers who are anonymous to protect their identities and lawsuits and blah blah blah, there are way too many bloggers (medbloggers, especially, in my opinion) that hide behind a pseudonym so they can bitch and rant and complain about these horrible, horrible people (read: patients) who waste the blogger’s time. They would never say these same things to their mothers, friends, or in polite company. Being public and open about your blogging forces you to think about what you’re going to write–”do I really want my name to be associated with this?” I certainly try to follow something I learned in church camp as “Thumper’s Mother’s Rule”: If you don’t have anything nice to say, don’t say anything at all (my addendum is this: or at least be constructive).

If you’re proud of what you’re writing, and what your blog has done for you, put it on your application (including the URL)! It won’t even come up most of the time, but it certainly gave interviewers something to ask about, and definitely made me stand out from other applicants (which, as you know, is the key to getting into med school). It sure beats the same old, “So, tell me why you chose Emergency Medicine” question that I hope to never answer again in my life.

Finally, bring a list of some of your posts. It will help interviewers immediately see the things you write about, and will also help them to see you’re passionate about medicine, care about it greatly, and you’re also passionate and interested in the field in which you’re applying.

(That all being said, if your blog is just a bitch session about how terrible med school is, no one wants to hear that. Leave it out.)