How Medical Residency Changes Your Personality Forever. #450

you know how , when your eyes kind of like the hoodie .

Everyone who's listening who , um , in some form or fashion , like we talk on a like often , like , like , often , like don't take none of this personally All right , like people be listening , they'd be coming up to me . Seriously , I've worked . People come up to me . Oh , why are you talking about it ? Ain't nobody talking about you ?

Guys , stop taking things so personal and mind your business and give me a thumbs up , as well as subscribe on YouTube .

So anybody who has walked up to you I really appreciate that .

So let's go to really serious news really quick , um so I'm not sure exactly when this show is coming out , but we we were recording this on the 25th , but this past week not too far from me . Not too far from me , there was a shooting at UPMC Memorial hospital . Um , long story short . Um , uh , a guy , uh , he lost his wife and was very upset .

Came to the hospital the day before .

Rest in peace to the officer . Um , but yeah , there were um folks in the icu that were held hostage and there was a gunfight and um , you know the the shooter was or the person who was accosting people . He was killed . Um , and this is crazy cause it's been all over social media .

You know there's the PA who actually gave the bad news to the person who was shooting . You know he put out a Facebook post saying that .

You know , when he gave that information to the person , you know he just saw , you know , a patient's family member who just was hearing the worst news of their life , and then to see that and then to see that person in the next , you know , in another 24 , 48 hours it's crazy and you know . You know he's saying that the healthcare system is broken .

You know , I don't know if that's necessarily the reason why I'm going to chime in . I don't know if that's necessarily the reason why someone would come up and shoot up or zip tie people . I can't see that as a reason . But I look at it more of yo .

Right For various different things , to the point where it affects how I even interact with my family . Like I understand certain things . Right For various different things , to the point where it affects how I even interact with my family . Like I , I understand certain things .

Right , Like I handle things with my parents differently or handle things with different people , because I'm always it's , I'm it's , I'm not a skeptic . You know there's a skeptic versus cynic , right ? I don't know where I fit in there , but you know I just understand life and the cycle of life and how life is can just be snuffed out , just like that .

I think the rest of the public doesn't understand that , particularly people who don't do exactly what we do , and you know I can't , I don't know to respond in a way where then you go after the people you know who are providing news and then just say that the healthcare system is broken . I just , I feel like that's .

I feel like there needs to be more of a investigation , Like there needs to be more of an explanation as to what's going on , Right , Because if you're someone who's getting zip tied and you know someone is coming in with a semi-automatic , I don't know if you want to hear the answer of , like yo , the healthcare system is broken , Right ? Um , I don't know .

Know , it's just , it's crazy . It's crazy if you're a family member , if you're a family member of the police officer who died . It's like I don't know what are your thoughts .

But I'm thinking that maybe there's a little more context that we just don't know , that we just don't understand as to why he or she would say that the health care system is broken . He or she would say that the healthcare system is broken . You know , there may be a little more context there that we were just not privy to .

But either way , it does not excuse .

Let's , let's right , rewind back two years , four years before , six months before , and what is that context ? That's that's kind of the question that I'm asking . You know , I would just need more context as to why the person would pin this on the healthcare system . And that's not to say that the healthcare system is not broken , because we know that it is .

And as physicians , you know , there's just so much that we can do . We don't run the healthcare system . Literally nobody in the hospital who is seeing patients runs the healthcare system . Literally nobody in the hospital who is seeing patients runs the healthcare system .

We are part of the healthcare system , but we don't make the larger decisions as to , you know , how the actual system is going to work .

So , basically , what I mean is this the policy is the policy , yeah , but bedside manner , how you approach people , what you decide that you can do what you decide you're not going to do , even though you can do it Right . We see that all the time .

You know , if you go to the airport , if somebody wants to bump you up to first class , they can do it , they can do it Right . But if they don't feel like doing it , they're not going to do it .

That has become the culture , you know of this country , that essentially , there's not a period in time where there has not been violence as the soup of the day . This cultural tradition that you know , violence is essentially the way to deal with things .

Then , yeah , even on an individual level , right , we're not even talking about going to war or , you know , moving Native Americans , you know , off their lands and annihilating them . We're not talking about hosing people you know Black people down in the street . We're not even talking about those things . We're just talking about on an individual level .

Right , we have whole shows dedicated . Right , you ever think about what we get used to ?

Now we have to start getting used to having violence at a hospital . Right , and that's crazy . I'm not saying it's crazy crazy , but it's just like , like it's crazy . Imagine you going through and realizing that yo , like this could be your last day , or like I find myself like going to the ICU . I'm like , is there another way to get out of here ?

No , I'm serious , you know . Is there another way to get out of this ICU ? Is there another way to get out of this thing ? Because , like I said , no-transcript .

Whereas with most things in medicine , you know , like if someone is going to pass away , you know it's kind of like , like it's a long process , there's a spiral right and if you're a hospitalist , more than likely outside of a heart attack , you know there's this like spiral of things that you know someone is going to pass with .

But in trauma it's like you wake up , that's it . You don't . You know it's crazy . Consistently so it's like man people come in like people come in like yo . I am not like what are you talking about ? Like they , you just told me to come to the hospital , now you're telling me that my loved one is gone .

That is nuts and someone can flip out Like I remember when I was in Chicago and I was at Cook County , like there was a couple of times where I was like yo like giving bad news to people . It's like yo , let me get out of this , like this room , because these people going crazy .

death Right . Like just walking to church and all of a sudden you know something happened and you're in the family members like wait , what you know . And for me it's potentially knock on wood , all kinds of wood that you have . What should be a very glorious event turn into tragedy . You know , and it's just , and it's just .

I just think that the hospitals now have to kind of think about what they can do in order to mitigate these circumstances before they turn into these ultimate tragedies , because you put a lot of people at risk . You put a lot of people , not just the healthcare workers . You have other patients there , you have other patients , families there .

Like I can't even imagine if someone came onto our floor and did that . You understand what I'm saying . I'm like you come to the labor and delivery floor and do something like that . That is , I can't even imagine what the headlines would be .

But again , if it's acceptable at schools taking out kindergartners , then why wouldn't it be acceptable at a labor and delivery floor ? She's extremely sad .

So , basically , what they're saying , in order to make the budget . There's a bunch of budget cuts that they want to make , the GOP wants to make , and one of them is okay , in order for us to save money in one place and be able to spend money in other places . Whatever it may be , we should consider making tax cuts .

Or we should make sure that maybe we get rid of the PSLF program , which is a big deal , right ? This is how the majority of folks , or majority of doctors who you know , finance their way through medical school . This is how they plan on paying it back . A majority of them , right ? They ?

say okay , well you know I'm going to graduate $300,000 , $400,000 alone . But as soon as I start residency , you know I'm going to make those things , that the changes that I need to make , and I'll jump into the PSLF .

I'll go through my three or four years of making my payments and then , when I become an attending , I'll make an additional seven years right Cause you got to make 10 years of consecutive payments and not miss . And then I'll be out of student loan debt and I got to be at a nonprofit hospital .

So not only is PSLF possibly on the chopping block , but also they're talking about taking out the nonprofit status of all hospitals also .

$662,000 of student loan debt in three years ? We paid it off for a variety of reasons , but the biggest one is we don't want to be in debt anymore . It made too many changes to our lifestyle . It almost literally didn't allow us to start having children for various reasons . One of them is trying to afford IVF , look .

But when we paid off the debt , we went so hardcore at it

and then , when PSLF became a thing , I was slowly thinking . I was like , hmm , could we have kept a lot more of our principal , a lot of that money that we went to pay off debt ? Could we have , like , said , okay , we're going to do pay our minimums that we have to , and then use the rest of the money to kind of just put towards other things .

Right , invest it in the stock market , get some more homes , you know , do some very interesting things with that money , as opposed to take all of that cash and put it towards student loan debt . It had me thinking .

And part of the reason that , for me , the PSLF program was you know , because we've been asked that before like , oh well , if you know , if you had known that PSLF was coming down the pike right , because it was very shortly after we paid off our debt that they were like , hey , everybody , you know , you can get your student loans paid off if you have 10

years of X , y and Z , years of X , y and Z . But for me it was never going to be an option , because in order for me to have benefited from PSLF , that meant that I had to have been employed , and that is the price that you pay for getting , but we was employed though . We were employed for three years .

Correct right we were employed for three years , correct , right , we were employed for three years . That means that we would have had to have been um employed for at least for me , that was what that would have been residency , and then three years of employment would have been a total of seven years .

That means three more years I would have had to be employed . I didn't want to be employed at the point at which I decided to quit my job . That's why I quit I didn't want to be employed anymore , right ? So for me , you know , doing those three extra years would not have been worth it .

You have to work for a qualifying employer , which for the most part is a nonprofit hospital right . You have to submit the employment certification form you can find that on any of the student loan websites and you have to make 120 qualifying payments . You cannot miss these payments and if you do that , you'll get your student loans forgiven .

So let's say , for example , like you have $400,000 loans , you know , at the time you was , uh , how much were you making as a resident ? Like 40 , 50 , you know , or maybe like 50 , 60 .

You know , every month they bring it down to I don't know , like a G , two Gs , whatever it may be , maybe even less than that , and then you do that for several years from residency and then it may change once you become an attending , and then you have to make consecutive payments . It might be worth it , but you don't think so .

I was also in the hospital doing planned surgeries in the ER all those kinds of things Right , doing consults on the floor Right . And I just wanted to be able to do the things that I liked to do best . And for me , I liked being in the hospital .

I liked being able to choose my own schedule Right , because you could say , well , become a laborist , you know , or become a hospitalist .

You didn't want to have to wait until the end of the month to find out . Yeah , I couldn't do that . Um , being employed , um , and you know , finding your name on a schedule on days that you're like damn , I really wanted this day off . Um , I just didn't . I just don't want to have to deal with that anymore . I just didn't .

I didn't know that , like no , like you only work , you only work when you can work or when you want to work .

That was one of the biggest things of not controlling my schedule .

And then there was just some other things that I just didn't like and I felt like , once I signed on that on a dotted line , you know , I lost like the ability to make certain decisions , like clinically , that if I stayed as a locums I could be like well , just don't invite me to come back anymore .

They just say we don't want you to come back , but you getting fired because maybe , like , you disagree with like hospital policy or you disagree with like you know , you're , um , the head of your department or something like that . Those are two separate things . And um , I just I get .

I guess , even going through residency and going through fellowship , I learned enough to know that I didn't like nobody telling me what to do and I just felt like , once I became an attending , I should be able to call the shots .

And I think I was just like it was too much smack in my face Like , yeah , you're never going to call the shots , you're never going to do this . It was like I felt like it was this and I was like , yeah , I don't like this , like get out of my face . You know I'm John Cena , you know like yo , get out of my face , like yo .

I was like , yeah , I don't like that , I don't like that , but I feel what you're saying . I feel what you're saying . But listen , elections have consequences , y'all Elections have consequences . And look , they got it . At this point right now , they got it .

I'm not saying I agree with it , I'm not saying that we shouldn't say anything , but I'm just saying , yeah , they got it . And this is a time over these next four years that y'all gonna have to just tighten the belts and just kind of pick out a way so that you not Go ahead .

And if you think that something that you can't control is the thing that you're going to peg your life on , you need a plan B , Because you cannot control the PSLF and we've talked about this on this show before where we're like okay , well , PSLF , you know , it didn't exist when we were paying off our loans , but now it exists , which means but it was a

problem early on .

He didn't , he never thought about what retirement would look like , which is why he essentially lost his well , I can't say that's why , but he essentially lost his entire family right at the point at which he was supposed to retire , right . And so it's like , well , what does this look like for you ?

And so that's what I would implore every single person listening to this show , doctor or not , that you need to think about what something is going to look like if it ends . If you are in something and that thing ends , what is it going to look like for you ? And to have a plan B . You know , have a plan B , now I get it .

There are things in life that you just you can't plan for , or you know they just happen . So suddenly I get it . But there are a lot of things that you actually can plan for .

And student loans has the potential to take over someone's life , right , or you know their , you know their economics and so forth . So their resources , you know like I think that , listen y'all , like y'all may have to start considering , like , what it's going to be like to put some stash away .

You know , put a stash away so that you can save money , so that you can make some student large student loan payments that may be on the table .

We already know that people a lot of times they'll choose a certain specialty or they choose specialties that have a higher amount of pay just because they help them get out of student loans quicker or help them have a perceived lifestyle .

Right , all these things , all these things have a common thread and that is something that you can control right In terms of the . You know the impact of that thing . Right , you can control , like , what happens , at least financially , or at least you know in some sort of lifestyle way , some sort of plan . You can make a plan for that thing Doesn't pan out .

Um , today it was well , I'll say quickly , I know we probably weren't going to get on this subject at all , but speaking of , you know , pop culture . So today or yesterday actually , I found out about , you know , joanne Reed being let go from MSNBC .

And if you know anything about me , I had said two years ago I was like they're going to get rid of Joanne Reed . And today I was talking or texting with a friend of mine and I was like I feel like people are shocked . I feel like people are just shocked that this happened , and particularly her .

I felt like , just , she had a clip on on I forget what show she was on , but she had a clip that played on Instagram and , you know , obviously she was very upset about , you know , having lost that spot on on MSNBC . And I was like on MSNBC and I was like , should we be leaving on a high note ? Should we be taking control of our own lives ?

Should we be realizing that a platform that isn't yours and built for you , ie a program PSLF that isn't necessarily , you know , built for you specifically , you don't control it ? Should you be planning a plan B ? I think the answer is yes .

Actually , this is a very quick topic I want to talk about in residency and stress parts about podcasting over the last nine years almost we're getting close to 10 years . Next year is being in contact with the folks who listen to the show .

They keep me young , they help me think about where I was during their time , because we have residents who listen to the show , we have med students who listen to the show , and one of the residents who listens to our show just reached out to me and said that they're taking some time off and you know I'm not going to name any names or anything like that ,

but they ended up being in a very good situation . That's very healthy for them and also healthy for the residency program and kudos to them . But it had me thinking about residency and stress and you know where I was . You know close to almost 15 years ago . And , um , I'm gonna tell you something right now .

Like I did not realize , uh , that I let residency change my personality . I didn't realize that I didn't realize how much of a different person that I became during residency and even after residency . Right and um , yo I'm gonna tell you something right now .

I remember my second year of residency which at my program you , the second year is mainly run the ICU and that , um , you know , when you have a program , when you have a program that doesn't have many residents but you still need coverage .

Yeah , that second year was , first of all , I think , a lot of the , the administrative , the way in which we policed ourselves .

We should not have been allowed to police ourselves Right , like the way in which the person starts at a certain time at seven o'clock in the morning , and then we'll go till the next morning and then that person writes the notes for the next , you know , the next day . That didn't make any sense whatsoever , was the stupidest thing .

Like I'm gonna tell you something right now . Like you know , I didn't know better , but I kind of knew I was like this doesn't make any sense I get it the person who's coming in fresh . The person who's coming in fresh should be writing the notes or there should be some responsibility split between the person leaving and the person coming on .

So , just for context sake , if you started at seven in the morning , you didn't write the notes that morning but you rounded with the attending and you rounded with the person who was finishing that night right , and then for the entire day you know you're taking care of you . Coming in fresh , you're taking care of all the issues that are going on .

You're responding to trauma calls , you're taking care of the general surgery patients that need to go to the ICU , and then at night you're the senior in-house right , and then there's an intern there also and then if someone needs to go to the OR , you know you're calling the attending and if the patient needs to go to the OR , it's you and the attending and

you're also handling the ICU . And if the patient needs to go to the OR , it's you and the attending and you're also handling the ICU . And then you know five o'clock comes in the morning .

I'm like man , but when you're not in control see , this is the key thing , though when you're not in control , you kind of have to play the game to get through the game , so that when you go back , you can change it and look back and say , yo , this didn't make any sense .

That's where I was , and that was a lot of stress that I had during that time , and then that carried on to me , carried on with me into third year and things started to look better , into fourth year and obviously into fifth year , but I definitely felt like looking back .

The one thing that I wish I could have changed was that second year rotation , you know , because I think that it's a , it's an unnecessary stress that you put on residents to have that type of lifestyle just so you can have coverage in the ICU because nobody else wanted to in any of the other levels .

So , before I ask you , the question I was going to ask is have you ever felt like you needed to take time out during residency ?

I wouldn't let myself , I wouldn't let myself really kind of just explore it , because I felt like if I did , like I would go down this rabbit hole that I wouldn't come back from , you know , but I don't know , I wouldn't do residency again . I'll tell you that right now I wouldn't .

You were on edge all the time . There was not a time that I spoke to you in residency that I felt like you felt relaxed .

So that first year and then the second year , when you took your in-service exam I remember that because you , I don't do well on this in-service exam , they're going to make me a prelim and I don't want to do that and it was just like , oh my God , like what the hell is happening to you ? Like , yeah , you , you changed a lot in residency .

You were almost unrecognizable yeah you were , but I loved you anyway .

Like what happened , which a lot of people do , right , is you start to realize look , the only way I could survive is like you start taking on like your captors mentality . Right , you start taking on the traits of your captors because you're like yo if they're doing this and they're surviving . I got to do that also .

I don't even think you knew you were going , where you were going , because , you know , whenever I said something to you , whenever I kind of tried to bring it to your attention , your response to me was but you don't understand , you don't understand , you're not here , you don't understand , right .

And so it was like your coping mechanism to be able to essentially make it through a tough program . But I will say this I think that residency programs don't do a good job at checking in with residents and making sure that residents you know are okay . I don't know if that's the residency's job to do .

The maintenance workers are employees . Like they would have to check in on everyone .

Now I understand that we're a different category of employees and that we're employees and trainees , but at the same time it's like well , well , ultimately we're getting paid to be there , so does does the residency program have an obligation to us to check in on our mental well-being ?

Um , giving me massage , like that's what they should be doing .

I don't know if she took it as a challenge or she took it as the concern that it really was Right , because that , that's that's kind of the the conundrum , right ? Well , if I say no , I'm not all right , what does that mean ? What was that going to ?

So to this day I don't know how she took it Right , but the reason , the reason , huh , she's still practicing , yeah , okay , she's a good , huh , she's still practicing , yeah , okay , and she's a good doc , she's a good doc , but there I mean , there were points and she was a first year , but there were points at which I saw in her things that I saw in me

in my first year and other people saw it too . And it was actually other residents who asked me to speak to her , I guess cause I'm a , because I got a big mouth , but I was like it doesn't seem like you really want to be here , you know . So I don't know .

I don't know , because I think you asked a really good question how do you recognize that you actually have a problem before you even tell someone ? Or are you so competitive with yourself that you're like , nah , I can do this , I can do it . I'm in a dark place , but I can do it . I can do it , I can do it .

That's not like me , but because you know you going into depression you get to work at five in the morning and you don't leave till like eight o'clock at night . That's an exaggeration . I don't leave till , like you know , and then you , you stay up all night , you're studying .

You stay up all night , you study in and then you wake up and you're like you wake up and it's like two minutes , you know , five minutes before you're supposed to be on the highway and you're like , oh shit , you know you got to get in .

You just start doing it over and over and over again and you're on edge and then you realize , oh snap , I haven't taken a shower . Or somebody else has noticed . Right . Or like I remember getting a phone , you Right . Or like I remember getting a phone , you know , my mom tried to reach me in the OR .

Nurses picked up the phone and my mom is mad apologetic because I guess I've been snapping , Didn't realize this . Right , you start to realize , yo , you got a problem , so you know , it's just .

Yeah , I think it's OK to say that sometimes residency got you acting a way that is highly abnormal and that you may need to check in and get some help , whether that's seeing a therapist , whether that's talking to a loved one , whether that's talking to a trusted one .

I don't even know if you can talk to someone in your residency , if that's possible , because that's scary , right . You think that that may be used against you . You know what I'm saying .

Yeah , you're not good at colloquialisms , no , you're not good at colloquialisms , but heed the warning , essentially right , heed the warning , take a shower . Take a shower If someone comes to you , if someone comes to you how embarrassing that is .

When someone you know says something to you that's a little off kilter , is that you have to . When you recognize that someone is off kilter , right . Or if someone says something to you that you're like , wait , what you know , there's gotta be the understanding that there is concern , more than there is anger , behind what is being said .

But you have to be more concerned about somebody than you are angry with them and I think that that's really important because that when you approach them about that thing , that they are actually more concerned about you than they are upset with you , then it might be a little bit easier for that person to recognize in themselves that hey , I'm going down a dark

path , I'm going in a deep dark place . That was your problem . Was that you never you know path . I'm going in a deep dark place . That was your problem . Was that you never . It's hard to accept when you want to see a sharks .

But you don't realize that it's changing you . So I think that definitely some malignant behavior that occurred and stuff . And I'm glad that you stuck with me because I can't front like I did change and I became mad , annoying to deal with and so forth . But on the real , I became mad , annoying to deal with and stuff , even though I was fine .

You know what I'm saying . Like in the inside , I like in the inside , I was on the what , even though I was fine look at this .

This is the part when you're trying to get , when someone is trying to give you advice in the program , like you don't even know if they're like trying to get at you , if they trying to snipe at you or if they , like you said , given the proverbial olive branch , because you feel like yo , you want to see a sharks right .

Like you feel like like I'm in the lion's den and you're not gonna knock me out . You know I'm saying so . It's it's really tough to accept those things and I just wanted to . And then we probably should end the show on this end , because I know there was other things that we wanted to talk about .

But before we go down and make the show too long , you know , to the resident who reached out to me I heard you , I appreciate you sharing that and you know , sometimes you just got to take a mental break .

Shout out to the programs that are out there , that are given the students and the residents the space to kind of say this stuff , because you know , a lot of times you're just going to have to take , you're going to have to make an uncomfortable change right , in order to see effective change in your program right .

A lot of people are going to have to get uncomfortable with .

Maybe they have to take an additional call to allow their , you know their fellow resident to take time away that they need so that when they come back they come back stronger , right , that's the type of change that people talk about and say , well , our healthcare system is broken , but then you don't have the time , you don't have the patience to deal with the

inconvenience , to deal with the healthcare system changing . Right , if you want it to change , there's going to have to be some inconvenience , there's going to have to be some pain that comes with that . I'm going to leave it at that . I don't know if you want to say anything about that .

And so you know , when you do end up giving the other residents that extra call , you might be snowballing the effect as a program , snowballing the effect as a program . So I'm hoping that those programs actually find a different solution than to pile on to , you know , the other residents who are remaining .

would you be cool with taking orders from people ? I'll take orders from people too , for a certain amount , for like $150 an hour . I'd do it ? For what ? $200 an hour ?

If you want to get in the show notes , you can send us emails . You can send us text messages . Everything is in the show notes . Everything is in the show description if you want to get in touch with us . But once again , thank you again for listening to Docs Outside the Box . Let's let Dr Renee get that sleep .

Go get your sleep on and yo , we'll catch you guys in another episode . Y'all Good night , Peace .