doc w/ Pen

journalist + medical student + artist

ADCOM Q&A (working under pressure)

Being a doctor is, quite often, about working well under pressure. If someone stops breathing, for example, you better figure out how to get them breathing again, and quick! There is no time for consulting the Internet, a textbook, or (very often) other doctors. You must act. Now. Or someone might die.

That’s why ADCOMS often ask pre-medical students a variation on this question (which I found on the Internet on a list of practice questions):

How do you work under pressure? Give an example. What, in hindsight, were you most dissatisfied with about your performance? What did you learn from your experience?

“I’m no stranger to working under pressure,” I thought when I read that question.

And that is the truth. For the year and a half that I worked at the Forest Park Review, a local weekly newspaper in the Chicago suburbs, “pressure” was my constant companion. (And this was my first job out of college, so I learned it early.)

It was especially intense, though, on Tuesday mornings. That was deadline day, when the paper was sent to the printer. I would wake up at 2 or 3 a.m. in order to write a half-dozen or so stories and an editorial by 7 or 7:30 a.m. And then I would go to the office. What for? For another three hours of deadline drama: writing headlines, creating captions, approving page layouts, and so on. It was grueling.

But through it all, I had to be at peak performance. Exhaustion was no excuse. I had to get the facts right, get the dates right, and get people’s names right. And do it all in captivating prose. Oh, right — make that captivating prose in less than 700 words per story.

But I didn’t need any excuses. In fact, I kicked things up a notch on deadline day. I was intense, driven, focused. When I have a goal, and time constraints for completing that goal, I find myself subdividing time into estimated allotments for each portion of the task I have to complete. This helps me stay on track so that I don’t spend too much time doing any one thing. On deadline day, that might mean 30 minutes for one story, and one hour for another. (I prioritized as well as subdivided.)

The process was intense, and I was intense during the process. It was hard to turn that intensity off right away. So when I’d leave the newsroom at around 11:30 a.m. or noon, snippets of stories would float through my mind. And I would question myself: Did I do X right? Did I change Y like I told myself I needed to? Maybe I should have opened that one story with another lede …

Then when I saw the newspaper the next day, I saw the in most cases, yes, I did do X right, I did change Y, and in actuality the lede I opened on that one story with was fantastic.

I gradually learned to trust myself, not to second-guess myself in those high-pressure situations. Because I knew what I was doing, I really did, I just needed to BELIEVE that I knew what I was doing, and go with that. Because it was often the second-guessing that led to the mistakes.

This is an essential skill for a physician to have. There is often no time for second-guessing. Making a second guess might mean your first act is one moment too late. So trusting yourself, your skills, and also your intuition, is something that a physician must do … is something that hopefully I will one day do.

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ADCOM Q&A … (an introduction)

ADCOM (ăd´kəm) n. An abbreviation that refers to a member of a medical school admissions committee. Can also refer to the medical school admissions committtee as an aggregate. ADCOMS are, essentially, the gatekeepers to medical school. It is their decision–based on a student’s application, GPA, MCAT score, and interview–whether the student will be offered a slot at that medical school. Thus pre-medical students refer to ADCOMS with, alternately, fear, derision, and respect.

The above definition (my own) is the way most people think about the ADCOMS: cold and impersonal. And in a sense, they are. They have to make dozens of decisions, based on established criteria, in a limited amount of time. To do that effectively, you have to be a bit calculating and unemotional. (That is not meant as an insult, rather as a compliment.)

On the other hand … ADCOMS are people. In fact, I know a handful of them personally. They smile, laugh, eat, sleep, do all the things we “normal” humans do. I have even found them to be helpful, if you can believe that. No, they are not the enemy. In fact, it would behoove more pre-med students to make ADCOMS their friends. But that is a topic for another day.

Right … ADCOMS are people. Which means that, essentially, they respond as people, at least on some level. They possess curiosity and emotions, for example, which no amount of established criteria can completely wipe away. (That’s my belief at least, however naive.)

Why do I care about all of this? The reason is simple: in a couple of years, the ADCOMS will hold my fate in their hands. So I need to understand what that means. And what that means is that I need to affect them — to stand out above my peers — in some way that says “Look at me! Choose me! I’m different! I’m the ONE!” I need to do this both on my application and during my interview. (Um … in a slightly more subtle, professional way, of course.) Because there will be, literally, thousands of people just as qualified, on paper, as I am. And not all of them will get in. I want to be one of the ones who gets in.

So how do I do that? Well, there’s no sure way, of course. The best way I can figure (other than do well in school, do well on the MCAT, volunteer, and get clinical experience, which are givens) is to get into the right mindset. No, I haven’t gone all New Age-y. What I mean is to think about what the ADCOMS will likely want to know beyond my statistics, what types of things they are likely to question me about during my interview, and have my answers ready. And no, I’m not trying to predict the future and conjure up a list of questions that I will be asked.

My plan is two-fold: to prepare for common questions (i.e., “Why do you want to be a doctor?”) and for common categories (i.e., medical current events), using sample questions to jump-start — but not contain — my thinking. Because the sample questions I have found online (and believe me, there are hundreds) are only a small slice of what could potentially pop up. I then plan to use this blog as a sounding board for some of my potential (but certainly not final) answers.

You might be wondering why I am giving away my strategy, and why I plan to give away some of my answers. After all, couldn’t the ADCOMS, then, just ask me different questions than the ones I’ve prepared for?

To address the first issue: My strategy is not brilliant. It is common sense. So why hide it? In fact, I’d kind of like the ADCOMS to know that I can analytically approach something and realize it has a real-life, common-sense solution (as opposed to a nebulous theoretical one). There are plenty of pre-meds I’ve met — very smart people, to be sure — who have exactly zero common sense. I understand theory; I also understand real-world application. To be a doctor, you need to be able to understand both. So read on, ADCOMS!

To address the second issue: I don’t plan to write a blog post about every single question or question type that I prepare for. That would take for frickin’ ever. So I am not worried about showing my whole hand. Showing part of it, though, I don’t think is such a bad thing. The medical school interviews I will (hopefully) have will be short, and there will be no way for me to communicate to the ADCOMS everything I want them to know about me. If they stumble upon my blog and discover some more pertinent information that puts me in a good light, even if it means they throw in a few more difficult questions during the interview, it is worth it to me.

As I see it, the ADCOMS and the interview are not what keep you OUT of medical school (which is how a lot of people seem to look at it), they’re what get you IN. So best to embrace them, early and often.

Managing the seagulls’ sh** (and other messes)

In my last post, I explained how I think that I might have a decent start when it comes to developing a good bedside manner–i.e., working well with patients. What I didn’t take into account in that post, however, is that you don’t only work with the patient. You also work with the patient’s family. And that can create its own set of problems, dilemmas, and conundrums, as a hospice nurse I know explained to me this week.

Take the case of Mr. Martinez,* a terminal lung cancer patient. Most hospice patients have a DNR–a “do not resuscitate” order, which directs hospital and emergency personnel to NOT use life-saving techniques such as CPR or a ventilator, but to let the patient die naturally. Mr. Martinez, a native of Argentina, does not have a DNR, although he would like to have one. Why? Because his son, who still lives in Argentina, wants the father’s life prolonged until he can make it to the United States to say goodbye to his father. The father doesn’t have the heart to disagree. While this seems like a natural desire in a way, it really is very selfish, the nurse explained–it would mean keeping the father alive, perhaps in pain, just so the son can meet his own emotional needs. And it’s not like the son never sees the father; he visits every couple of months, and has had plenty of opportunity to say a meaningful goodbye. Because what do you really gain from seeing an empty, non-communicative shell that’s kept alive by a machine?

The nurse I know said this is a common situation–family members simply can’t let go, even when the end is imminent. So it has become her job to try and convince the son–via e-mail, since he is in Argentina–to encourage the father to have a DNR. Not a task I envy, that’s for sure. It’s one that requires great finesse, compassion, and understanding. And a thick skin, to boot. All done in a one-way conversation, without facial expressions, body language, or vocal inflection–all tools that can be extremely helpful when trying to talk about something so serious and traumatic.

Mr. Martinez’s son, an out-of-town family member, is what one of the nurse’s co-workers calls a “seagull”–someone who flies in, sh**s on everyone and then flies out. They want to help, and they (usually) have the best of intentions, but they don’t really know the day-to-day situation or the intricacies of their family member’s care (or health condition). So they rather muck things up. Often, they step in so aggressively and vehemently because they feel guilty for not being there on a more regular basis, the nurse told me, so they feel they must “fix” what seems “broken” to make up for that absence. When really, the opinionated assistance often does more harm than good.

But it’s not just the “seagulls” who can cause a wrinkle in a patient-care situation. Nearby relatives, even daily caregivers, can create serious problems, the nurse told me. She related the story of one family where two sisters were, in her words, “at each other’s throats.” Just about literally, it seems. One of the sisters actually called 911 on the other sister because she felt that sister wasn’t appropriately administering the patient’s medication.

The kicker? The patient’s problem was agitation. I doubt if sirens, police, EMTs, and whoever else showed up helped alleviate the symptoms the sisters *claimed* they were so concerned about.

This is another situation that, as a health care worker, would be a sticky one to resolve (if a resolution was even possible–a temporary cease fire might be your best bet).

This is not to say that family members are always a source of trouble and ire. As the nurse told me, “Family can also be the greatest resource.” When that happens, it makes the health care worker’s job infinitely easier and richer. So you hope and pray for this scenario.

But for those times when the family members seem to be working against you rather than with you, I imagine you must tap deep into yourself for strength, composure, patience, and endurance. And still, even though it seems undeserved, compassion. Because while the family members may be making your life hell, you have to realize that their life is hell right now, too.

Come alongside. Understand. Empathize. And then maybe you stand a chance not of changing the family, but of helping them to decide to change themselves.

* Names and details have been changed to protect patient anonymity.