Why Do Physicians Have to Be Leaders?

“Why can’t I just work here?” is a question that many physicians may ask at the end of a long day. There are many tasks to be completed. There is a never-ending supply of work to be done. On top of that, no matter how much work we get done, it seems like there is always the demand to do more. It eventually becomes exhausting.

To be even more practical, there are patients who are depending on us. These are people who WANT and NEED to get better so that they can go about their daily lives. They need to go to the operating room so that they can recover from their injury. They need their medications to lower their blood pressure or better control their diabetes before something terrible and irreversible happens to them. They need their cancer treatments to prevent metastatic spread and an irreversible outcome.

Similar to what I discussed here, it isn’t hard to get ‘stuck in the suck.’

If we want to make things better. If we want to help our colleagues and our patients, it isn’t enough to just work here. We have to be willing to look critically at what we do on a daily basis. We have to be willing to look for solutions to make it better. We have to be willing to come to the table and discuss these issues with the people in charge. Sometimes, we have to be willing to drag the leaders to the table to explain to them why things aren’t going well.

And….

We have to be willing to do it the right way. Attitude matters, much as we don’t want it to. We can be disappointed. We can even be angry when things don’t go as we would expect them to. BUT, you have to be angry and disappointed in the right way. You have to attack the correct enemy. It isn’t the administrators. It isn’t the patient. It isn’t the charge nurse. It isn’t the scrub tech. It isn’t a student or a resident or a fellow. It isn’t even YOU! Be mad at situations, at the inequalities that our patients face. Understand and point out the fact that we’re all in this together, and, sometimes, despite everyone’s best efforts, we all miss the mark.

Here’s the most important thing that we all need to be reminded of. We’re humans taking care of humans. There aren’t any robots involved. There aren’t any gods involved. Everyone is fallible. Perfection is the goal, but it will rarely, if ever, be obtained.

So, control what you can control. Own what you are an expert in. Don’t settle for doing it wrong or something that harms patient care.

HOWEVER, and this is important….

You can’t be a jerk and then claim doing so in the name of better patient care! You still need to be respectful.

Say “hello” to your colleagues in the hallways. Learn who you work with. Who are they when they leave the hospital or the clinic? Fostering these relationships will help to create the psychological safety necessary to allow everyone to speak up. You’d be surprised where the solutions to problems will come from. Give everyone a voice. If a person’s voice isn’t being heard, take them with you to the forum where people can listen.

Ask for help. Find the experts in whatever the problem might be. Just like we are supposed to seek out disease, seek out solutions! If you try something and it doesn’t work, regroup and try something different.

I saw something bemoaning QI work and calling it worthless. If you do the right QI work, it isn’t worthless. We should be working on QI every single day. If we want to help our patients, we have to lead the way.

10 Commandments of Orthopaedic Surgery

According to Ryan K Harrison….

(In no particular order)

-Don’t ignore pain out of proportion to your exam

-Don’t varus.

-When you can’t see the skin, you’ve applied enough padding.

-When the nurse asks you to come and see the patient, just go.

-Touch every bone and move every joint, you’ll never miss anything.

-Don’t get fooled by X-rays

-Never Discharge a prisoner or homeless patient with an injury that needs surgery.

-Just because you’re having a bad day doesn’t mean everyone else has to.

-If you’re wondering if it’s sterile, it isn’t. Redo it.

-The amount of time you spend preparing before you walk into the operating room will be inversely proportion to the amount of time you waste inside the operating room.

Welcome to the first day of the rest of your life!

You spent 13 years in K-12, four years as an undergraduate student, and four years in medical school, plus/minus whatever other education or sidequests you may have been on.  You survived writing a personal statement and going through interviews, creating a rank list, and the age-old ritual of opening that envelope to find out where you will undergo residency training. 

It’s July 1. It’s the first day of residency training. 

The first day is overwhelming. There is no way to soften the blow. It doesn’t matter how prepared you are, what medical school you went to, what specialty you chose. The first order will trigger the imposter syndrome everyone worries about.

First and foremost, you must remember that YOU ARE NOT ALONE. Medicine is a team sport. Even ten years into practice, I regularly discuss patients and cases with my colleagues and mentors. There is never any reason to try and impress people by proving you can figure it out without help. The balance of medical knowledge and the rate with which we learn new things is too outstanding for any human to know everything there is to know about medicine. Knowing what you don’t know is infinitely more important than any fact you can learn.

For proceduralists, there is more to it than knowing the limits of your knowledge. You must also understand the limits of your skills. At first, all of the procedures are new. You read about the steps. You learn the relevant anatomy. Then, you watch. Then, you perform while supervised. Finally, you will be able to perform a procedure independently. 

Remember, a patient is on the other end of whatever procedure needs to be performed. Procedures almost always have the capacity to cause the patient pain. There are potential complications. Treat pain. Be honest with patients about what you need to do to help them get better and what can possibly go wrong. Use words the patient can understand. Patients appreciate doctors who communicate with them and are humans instead of robots.

Take a little time to learn something about your patients beyond what is written in their H&P or daily progress notes. Get to know who makes up their family, what they do for work, and where they go to school. What hobbies or sports do they enjoy? Do they enjoy traveling or seeking out good food? Again, a human connection will go a million miles when you reach a difficult point in a patient’s care or encounter a complication that needs to be managed.

The patients are important, but to take great care of them, you need to be organized. There are many different methods. Perhaps you learned some while a student. Someone may have explained a good method during orientation or shadowing before the beginning of residency. Maybe you don’t have a suitable method. Make this a priority. Find a system before you finish reading this blog post. 

Are you all ready to make a list and check it twice? Now, it’s time to evaluate patients, determine a diagnosis, and develop a plan. You’ll come back later to ensure we implemented the proper plan and look for the results of your actions. 

This won’t always go as smoothly as you might think. Hospitals are complex places. There are many different hands involved in patient care. Tests require a patient (or perhaps some specimen collected from that patient) travel around the hospital. Orders have to be written and then acknowledged to be completed. A well-thought-out system is required to ensure the sometimes not-so-well-oiled machine does what it is supposed to.

Organization is not the only thing required to get this done. A bit (or maybe a lot) of tenacity is essential. Write an order and make sure it’s in. Connect with a nurse or a pharmacist to ensure the order was acknowledged. Double-check with a scheduling clerk that the procedure has a time. If the transporters can’t get the patient somewhere, sometimes you have to wheel the patient there yourself to make sure they are on time. In an emergency, you might have to insist someone get out of bed and drive to the hospital to provide the patient’s required care.

Again, these are times when you must remember that you are not alone. Taking care of patients will come with conflict. It is unavoidable. Responding to and mitigating conflict is a skill that takes time to learn. You will be right sometimes. You will probably be wrong more than you are correct at the beginning. Take a deep breath, listen to the other person, consider their knowledge and experiences, and react accordingly.  Assume the best of intentions. If you aren’t sure of the source of the conflict, ask some clarifying questions. Perhaps there is just a misunderstanding. Remember, everyone is there to make patients better. If you need to talk something out, don’t do it in front of patients!

If you aren’t sure of the best response, run the scenario past someone more senior. Discuss the issue and a strategy to respond. Don’t respond to scenarios when you are mad. If the conflict is being discussed over email, write your response and sleep on it. Have someone read over your response, and then send it. One of the best ways to defuse conflict is just simply to let time work its magic!

One final thought. (Yes, there could be so many more in a blog post like this!) You can’t take great care of patients unless you take care of yourself. You may hear people talk about spending a long day caring for patients and not taking time to eat, drink, or use the restroom. Do these essential functions. If you need five minutes to walk outside and get some air, TAKE IT! If you have an important phone call or need to talk with your significant other or a best friiend at an important moment, DO IT! 

There is always going to be work. There are always going to be patients. It is a never-ending stream. We all want to be great teammates and avoid passing work on to others. The reality is, you are probably never going to be able to hand off a clean slate. Look for the best transition points, and choose moments when you must stay until a task is completed wisely. There are some times when the extra time is important to you and your patient. You’ll figure those out as you go.

Remember, we call it practice for a reason. We’re all trying to be perfect.  Very few of us, if any of us, have made it there!

Good luck!

Don’t Drown in the Suck

When talking to students considering medicine as a career, I talk about all of the advantages or taking care of patients. I also say to everyone –

“Remember, it is still a JOB.“

Physicians are stuck in the middle these days. The expectations are high, and rightfully so. Our patients’ lives and livelihoods are on the line.

So, where is the suck? We have many bosses: our patients, our physician leaders, and our administrative leaders, not to mention the insurers. The insurers want to do everything but pay medical bills. The first goal of every insurance company is to maximize their profit – the complete opposite of the first goal of every physician.

Primum non Nocere!

It’s easy to want to give up. “I don’t get paid enough to deal with this,” may be a tempting out. In many ways, that is fair. Fighting everyone around us against the stream to provide appropriate care is not what we ever agreed to. Physicians are taught to say “yes,” and “how can we help.” If you want to be a successful physician, you HAVE to be available, able, AND affable. No one likes a cranky doctor, but it’s so hard to put on a fake smile when you leave the patient room and run into roadblocks and brick walls.

First and foremost. Take care of yourself. Ensure you have a solid plan to take care of your mind, body, and family. Use your paid vacation days – EVERY SINGLE ONE OF THEM – throughout the course of a year. We don’t get paid to work 365 days a year. Read something that isn’t a textbook or a journal. Take some time out of every day for a workout or some meditation. Spend some time every day with your family and friends or your pets.

What can we do at work to prevent drowning in the suck?

Get right in the middle of it! Get involved in the decision-making. Join committees. Volunteer for strategic leadership opportunities. Notice, I said strategic. You can’t say yes to everyone and do everything. Be as picky as you can. Look for places where you can make a difference or where you have experience that will benefit you and your patients. At the beginning, start small. As you gain more experiences and the leadership get to know you better, you will be asked to do other things. Edit as you go. As you get overextended, pass along responsibilities to others that may be looking to get acquainted with your institution. It is expected that your interests and availability will change over time.

Go to the places where decisions are made so that you can be a part of the solution, not the problem. Engage with all of the bosses. When you spot a problem, point it out AND SUGGEST A SOLUTION. If the decision-makers see that you are thinking beyond the problem, they will ask you to participate.

At the end of the day, remind yourself why you show up at work every day. It isn’t to save the insurance company’s profit margin. You show up at work to take excellent care of patients, to change the lives of people in need.

Paralyzation or Triumph in Difficulty

We’ve all been there. We’ve been at the difficult junction in a case or found surgical progress stalled. We’ve planned for all possible paths a procedure might lead us down, but we operate on the human body, and not everything is predictable in every case. Perhaps something irreplaceable has fallen onto the floor or is broken. Maybe every step we take seems to lead to something worse.

When we find ourselves in this predicament, what is the most appropriate next step? How do we restart progress and complete the procedure? Do we find calm in chaos, or do we allow the difficulties to paralyze our decision-making abilities? In dire circumstances, when a life or limb is on the line, we can find ourselves in a fight or flight scenario, but with another human’s outcome on the line.

There are rare times when pausing for contemplating and conversation is not possible. Rapid hemorrhage, spreading infection, or hemodynamic instability are all examples where decisive action must occur instantly. However, in a lot of scenarios, finding some zen in confusion is essential.

We have to learn when trying less is the right move. In the field of orthopaedic surgery, hammering harder or choosing a larger screw is rarely what brings us to the finish line. Multiple brute force attempts to get a screw into the right place or the implant out at all costs may lead to an unsavory outcome.

My approach to these scenarios has been to take a second. Irrigate the wound. Step away from the table for a few minutes. Scrub out and walk out into the hallway for 5 minutes, if necessary. Take a second to review images and ensure there are not any unrecognized details missed during pre-operative planning.

If you are genuinely stuck, don’t forget that you are not there alone. Ask an assistant or trainee what they are thinking. Involve the entire team. Bring other personnel in the room into the conversation. If you have a partner next door, ask their thoughts.

Maybe you are operating alone and need another set of hands for better exposure. Perhaps the incision is too small. Inadequate exposure is often a cause for difficulties. Remember, incisions heal from side to side. A 3-inch incision will heal just as well as a 6-inch incision if that is required to complete the case safely; never hesitate to be more invasive. For example, in a hardware removal, extending the incision might make an otherwise 1-hour surgery a 10-minute procedure.

In fracture care, reduction and 3D visualization are a couple of pitfalls. In closed reduction attempts, it is never wrong to try. If closed reduction attempts aren’t successful, there is NOTHING wrong with using open techniques that respect soft tissues to get it right. For example, in intramedullary nailing, a small incision at the fracture site for manual assistance with the passage of the guidewire is a soft tissue friendly technique that can save a significant amount of time and facilitate appropriate length and alignment rotation and a successful procedure.

3D visualization is a complex skill to master for some. One of the things I discuss with learners is utilizing every surgical procedure to understand anatomy better. For example, visualize the starting point for an intramedullary tibia nail when doing a total knee arthroplasty. Pay attention to the cruciate ligaments for potential arthroscopy during the same procedure. There is something pertinent to your future surgical practice in every case you participate in for residents and fellows!

A part of planning is expecting things might go wrong. When preparing for surgery, understand how to respond when everything seems to be going wrong. Don’t let yourself get stuck in the quicksand. Slow and smooth are often the most appropriate way out of the worst situations.

What thoughts do you have? Fell free to continue the conversation at https://twitter.com/rkh_md.

The Patient, A Doctor and Their Shadow

The doctor-patient relationship is a truly remarkable bond.  On regular days, patients come into clinics and hospitals and tell a relative stranger about their life, sometimes details they do not tell their closest friends and family. On their worst days, patients are transported to emergency departments and trauma centers in extreme duress, with life and limb-threatening emergencies, expecting to arrive at a place where their injuries will get the full attention of the medical staff without prejudice.  

Unfortunately, the system is not setup to work equally for all.  We have been taught to be biased as physicians[1]. We were told (incorrectly) as students that physiology and pathology is different for people of different races[2, 3].  Our teachers have insisted that age and gender are important when many times they are not.  The books that have been written and updated for edition after edition have led us to believe that discriminating against our patients is practicing good medicine.

How can a physician start a new patient-physician relationship without bias?  This is where our “shadows” come into play.  As physicians, we need to train ourselves to evaluate encounters with patients from the bystander’s point of view – as our shadow might.  As we listen to patients and gather data, either in an effort to establish a diagnosis or to assess the success of our treatment course, we need to look for the clues that tell us the relationship is broken.  We need to be able to evaluate the phrases that our patients will use to tell us we are not having success.  When the patient says, “something is wrong,” or “I am concerned,” it is the physician’s duty to “seek out disease,” to search high and low for what is wrong and address the problem or reassure the patient that everything is OK.

Likewise, if these concerns are coming from the patient’s advocate, we must respect their relationship with the patient and their observations.  Assume the pure intentions of everyone involved and go above and beyond to make sure the fears of all concerned are alleviated.  This is hard work, to be certain.  It is not even work that may be compensated fairly when it comes to the time spent at the bedside.  It is, however, work that can potentially save lives.  We need to actively explore concerns.  We need to ask clarifying questions and address our patients’ concerns head-on.  

As physicians, remember we do not practice in a vacuum.  Medicine is a team sport.  In academic and teaching settings, it is important to seek out the observations of learners and other members of the team.  Talk to the least experienced people in the room.  Ask for their thoughts.  Ask what they observed about the encounter.  In all settings, listen to nursing and ancillary staff.  Seek out their opinions and respect their expertise.  Discuss what is said when you are not in the room.  Ask social workers, discharge planners and therapists to give you their opinions of the patient’s course.  Setup the environment so that they understand why the questions are being asked.  It is important to make sure everyone on the team understands that we are not looking for affirmation.  We are looking for problems and solutions before bad outcomes occur.

We, as a profession, need to rethink our practices.  We need to reprogram our brains to listen to our patients and not just attempt to recreate debunked statistical norms.  We need to listen to our colleagues that have sounded the alarm and pointed out the inaccuracies in our textbooks and teaching practices.  This should be especially true when we might not have the same life experiences as our patients or come from a different socioeconomic background.  If we truly listen to our patients, they will tell us what is wrong.  They might even present us with the solution.  

Disparities and systemic racism in healthcare are real[3, 4].  They lead to outcomes that, at their best, are disappointing and, at their worst, are deadly.  Not even the most knowledgeable people, our physician colleagues, are immune from these biases.  We do not have to look very far to find examples of these lapses in treatment.  They occur every day.  

1.         Amutah, C., et al., Misrepresenting Race – The Role of Medical Schools in Propagating Physician Bias.N Engl J Med, 2021.

2.         Inker, L.A., et al., Effects of Race and Sex on Measured GFR: The Multi-Ethnic Study of Atherosclerosis. Am J Kidney Dis, 2016. 68(5): p. 743-751.

3.         Hoffman, K.M., et al., Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proc Natl Acad Sci U S A, 2016. 113(16): p. 4296-301.

4.         Ellis, L., et al., Racial and Ethnic Disparities in Cancer Survival: The Contribution of Tumor, Sociodemographic, Institutional, and Neighborhood Characteristics. J Clin Oncol, 2018. 36(1): p. 25-33.

Choosing Where to Go To Medical School

When it was time to choose where to go to medical school, I didn’t think all that hard. Indiana is unique. There is only one medical school in Indiana, at least there was when I was applying. (There is now IU, offering an MD degree and an osteopathic program affiliated with Marian University in Indianapolis.) Indianapolis serves as the hub, and there are eight satellite campuses spread throughout the state. The first two years can be done at any of the nine campuses. Some aspects of the third and fourth year can also be completed at satellite campuses, each with a different focus.

In-state tuition compared to going to an out-of-state or private school was a no-brainer. We’re talking double the price of tuition and fees, and I didn’t see the benefits as being worth the price.

Of course, we’re talking about getting into medical school here. You have to apply to more than one place. We’ll talk about this more when we get down the road to the residency match, but a large portion of this is a numbers game. Nothing is guaranteed in medical school admissions. There are more qualified applicants than there are spots. You have to position yourself to be within the pool of qualified people and hope something you do during the process sticks out enough to get you accepted.

The process isn’t simple, and it should begin as soon as possible. Check out this post for more on my thoughts regarding the application process.

Planning for and Navigating the Medical School Application

If you live in a state where more than one medical school is available to you, do some research. Different medical schools have different focuses. There may be small nuances in the curriculum that are preferable to your learning style or career goals. You may find a school focusing on primary care and a program that offers a fast-track to residency. Maybe the school has a focus in public health.

I wanted to go to one of the small IU campuses because I wanted more one-on-one time with professors and a focus on in-person classes. I wanted to be able to focus with a small group of people on my first two years. This was quite the opposite of my reasoning when it came to choosing an undergraduate school. Bloomington also had full-year classes for the first two years. More time in courses like anatomy and physiology allowed for more time to focus on details.

I’m not trying to say out-of-state or private schools are bad. You can earn the same medical degree at the end of the day. It’s also important to note that I’ve never been involved in a discussion regarding residency applicants where a degree from Harvard or Yale was considered more important than a degree from a state medical school. A medical degree and the appropriate requisite credentials are more than enough to get you into almost any residency, anywhere.

Excelling During an Orthopaedic Surgery Rotation

Trying to get a job in the middle of a pandemic is less than ideal. Given that, when you get an opportunity to work with residents and faculty one-on-one, it is crucial not to waste that time. Don’t get black-balled before you’ve ever even walked into the hospital!

It’s essential to understand who is usually on a residency selection committee. The committee is composed of representative faculty as well as residents. (If a program doesn’t have residents on their selection committee, you don’t want to go there.) It’s important to remember that you aren’t just doing an audition rotation to impress a faculty member and get a recommendation letter. The residents have a significant say in who they want to work with when a new class joins. A program may altogether remove a student from their rank list after resident feedback.

Don’t underestimate other people in the program. The residency program coordinator and the medical student coordinator (if a program has one) are essential. Same for PAs and NPs, nurses (in the office and on the floors), secretaries, and assistants. Be nice to the janitors! Treat everyone like they are your grandmother. If you are rude to them or don’t complete a task on time, that is likely to get communicated back to the program selection committee, and the result can be not being included on a rank list when the time comes. I know it seems like something that shouldn’t have to be said, but it happens way more than it should.

I’m not writing this to cause fear. You shouldn’t spend too much time walking around on pins and needles. Be a normal person, and things will go well. Here are some more thoughts that I have about excelling on an orthopaedic rotation.

  1. Show up to the operating room early. Introduce yourself to everyone in the room. Write your name on the board so the nurse can put you in the computer. Write your glove sizes on the board as well. Never assume someone will get your gloves. Grab gloves and a gown for the first case and ask the scrub if they want you to flip them onto the field or give them to someone else to put them on the field. Don’t be surprised if they don’t want you to put something on their sterile field until they trust you to do it correctly.
  2. When the patient gets into the room, help the team. Don’t stand in the corner and watch. Get in on the action. You may not be invited up to the table. The focus is on the patient at that point, not other people in the room. Go and grab a warm blanket for the patient. Help move the patient to the OR table (not the feet). Get in there and do the heavy lifting. Help turn the patient. Don’t throw stuff on the floor that one of the room staff is just going to have to come behind you and pick up later. If you show you have their back, they will get yours!
  3. When it’s time to prep the patient, ask if you can help. The person prepping the patient may or may not need it. Again, make yourself part of the team. Everyone in the room is focused on getting the case started and may not be looking around to invite people to help.
  4. Prepare for cases. Ask the resident or attending that you are working with to go over cases the day before. The resident may be able to prep you for questions. Read up on the anatomy. You aren’t expected by most people to know much more than that.
  5. When you are asked a question during a case or on rounds/in the office, don’t panic. The purpose of the question may not be to see whether or not you know the answer. It may be to evaluate your thought process. Can you work your way to the solution? I worked a lot with a faculty member as a student where I ended up doing my residency. He loved to ask me questions about musical artists. I almost never knew the answer. It became a fun game. No one was keeping score as to which answers I got right or wrong. Usually, by the way, no one is.
  6. Practice knot tying and suturing at home. Be able to tie one-handed and two-handed. Practicing using your dominant and non-dominant hand. Learn to use scissors and clamps with both hands. If you have practiced when someone asks you to do something and you can do it efficiently, you will be asked to help more and more. If you aren’t sure, ask the scrub to show you how to hold an instrument or use it correctly. They will show you.
  7. Have supplies with you that will be helpful. Keep a pen (that you don’t like too much) in your pocket. Have trauma sheers available. Help with dressing changes in the mornings. If you can work ahead of the resident or attending, you will be seen as a valuable team member.
  8. Be prepared to show up early and work late. This is the same thing a person would do if they got an entry-level job in the business world and wanted to work their way up the ladder.
  9. If you are on call and slept during the night, be prepared to stay and work the next day. You only get so long to work with the residents and faculty. Please take advantage of it. If you worked all night, that’s a different story. The team should be sending you home in that scenario.

At the end of the day, just like the residents and faculty are trying to decide whether you might be a good fit for their program, you should be doing the same thing. Try to talk to as many residents as you can. Get a sense of what their life is like. Are they miserable? Is it just that they are on a particularly busy and challenging rotation, or is every rotation at a program miserable and difficult? Get a sense from the faculty whether or not they enjoy their job. If the faculty are miserable, there’s a good chance the residents aren’t going to be much happier. Talk to PAs and NPs if you are helping them close. They can give you useful information about the program.

There are more applicants than spots. Except for a few people, almost everyone is mashed up pretty close together. Applications are surprisingly similar, with similar-sounding letters of recommendation and personal statements. Everyone has good clinical grades and an acceptable test score.

The best way to distinguish one applicant from another is to see their work-ethic in person.

I Don’t Understand Guns

This post is different from what I’ve been posting so far, but I want to share my thoughts. This post is my opinion. Some people may not agree. That’s ok. We don’t all have to agree.

“A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.”

Congress ratified the second amendment to the US Constitution in 1791, eight years after the American Revolutionary War. The state of the art weapons available were muskets. It took a well-trained soldier about 20 seconds to load their gun. Musket balls were lethal at close range, but are not very accurate from too far away.

Our country was new, and the Continental Army had been formed at the beginning of the war to allow for an organized defense against the British Army. Before that, the war was being fought by militias from each individual colony. We didn’t have grocery stores. People hunted for or grew their food. Guns were a necessary part of life.

Let’s fast-forward to 2020. Technology has advanced a million times over. We have electricity, refrigeration, the microwave, telephones, the internet, credit cards, grocery stores, etc., etc., etc. We have a more than sufficient military to protect us from potential threats. We don’t even need people in many circumstances to fight wars as unmanned drones can be dispatched to fire weapons that are infinitely superior to the musket.

And yet, we have automatic and semi-automatic weapons. These weapons serve one purpose – to kill people. A semi-automatic handgun can fire 40 rounds per minute. A fully automatic weapon can fire 600 or more rounds per minute. You can’t legally use an AR-15 or a 9mm handgun to shoot a deer or a turkey for food, nor would you want to. So, why are we so obsessed with having them. I’m no constitutional scholar, but I can’t imagine the framers could have ever even dreamed up the weaponry available to us today. They would not have ever considered this to be OK. We only promote violence from all sides with these weapons.

I’m not trying to say people shouldn’t be allowed to possess a firearm. I’m just asking, “Why do we need to allow such powerful weapons to exist?” The police argue that they need powerful weapons so that they aren’t out-gunned on the streets. So, instead of fighting fire with fire, why don’t we fight fire with water? Let’s de-escalate the situation instead of ramping up the wars that are being fought on our streets.

Again, I don’t want to collect and melt down all the guns out in the world. I do think, however, we should seriously consider getting rid of weapons whose only purpose is to kill or injure other humans. If no guns of this nature existed, we’d all be a whole lot safer than we are with them.

Academic Failure Is More Frightening

It’s one thing to fail at a goal to participate in a sports program. It’s quite another for a student interested in getting into medical school to experience academic failure. There’s no place where this is more likely to happen than in battle with every pre-medical student’s arch-nemesis: organic chemistry. I was a good general chemistry student. I enjoyed the classes, and my high school background in general chemistry was strong.

Organic chemistry was a different beast. It’s not just memorization and math. Organic chemistry requires an understanding of concepts so that they can be applied. I was able to get through the first Organic Chemistry class. I did OK. Then, I started Organic Chemistry II. Two course sections were offered that semester, and I didn’t do a good job of picking. The professor for that section had taught the honors course the year before. He had a reputation for being a tough professor. I didn’t know that.

Sitting through this man’s lectures were painful. He would use up all portions of the multiple chalkboards in the lecture hall. I would take 4-6 pages of notes during a 50-minute lecture. I tried to study. I went to the discussion sections and prepared for the first exam.

And then, I sat down in lecture one day, where he passed back the first exam.

12.

Out of 200.

6%.

The average for the exam was not high. But it wasn’t 6% either. The professor promised that our grades would stick. There wouldn’t be a curve. We had to earn the grades. He took his job as the head of a gateway course seriously. I sat through the rest of that lecture and took my pages of notes, but the decision wasn’t hard. I would need to cut bait and come back to play another day.

Lot’s of questions went through my mind. What would be the effect of a W on my transcript? In the end, however, I decided the W would look way better than an F. I would withdraw and then re-take the course during a summer session. It would allow me to focus solely on organic chemistry.

It’s pretty crazy how much fear comes with getting good grades for those who want to go to medical school. It’s important to know that good grades are important, but it’s OK to be human. Not every grade has to be an A to gain acceptance into medical school. Students are allowed to start slow, but you have to show progress along the way. We have to be learners to be competent physicians. Medicine is improving at breakneck speed, and the knowledge we gain during medical school is frequently defunct by the time we receive our diplomas.

I’m not trying to blame my first organic chemistry II professor on my lack of success in that course. I didn’t fully know how to study for organic chemistry at that point. I didn’t know how to apply the concepts, and I needed a new strategy. Luckily, the second time around, I did much better.

None the less, I made it to where I wanted to be, and I learned a valuable lesson along the way. You need the right strategy to be successful, and you need to be willing to course-correct along the way if you find yourself at risk of failure.