12 Things That Aren't in Medical Texts (But Should Be)

by Ryan Winter on June 2, 2010

“The most common apologetic phrase I hear is ‘I’m not good at antibiotics,’ says EM-blog poster Michael Heller MD, of medical interns. “This is like calling a plumber for a clogged toilet who then says, ‘I’m not good at bathrooms.'”

There’s little enough time to absorb all the informational details from four-years-plus of med school. So it’s no wonder a great deal of crucial practical information is left out between graduation and rotations.

When it comes to patient health, there’s more than text book study and making-the-grade to becoming an effective physician. Check out our picks for the dozen things that we think should at least show-up as a sidebar in modern medical textbooks:

Interacting with people (including yourself)

The doctor-nurse relationship

Few situations are as telling of a doctor straight-out-of-med-school as a personality conflict with a seasoned nurse. Though no one will explain in medical school that qualified nurses are valuable assets, such staff can be a doctor’s greatest ally (or worst enemy, depending on how these two professionals conduct themselves.) A new doctor’s theoretical knowledge fresh from med school may be considerable, though short on practical experience. While a facility’s existing nursing staff can have tremendous specialized knowledge of treatment practices. A doctor’s relationship with nursing staff can increase efficiency, keep patients happy, and make or break a career.

(There actually is a textbook – of-sorts – on such issues: the British volume What They Didn’t Teach You at Medical School by Alan Parbhoo. Though there are some differences between bureaucracy and terminology between the UK and U.S. most of the advice translates usefully.)

Handling children

“Never work with animals or children,” Hollywood producers are often advised. Though some medical professionals have his luxury, others don’t. Either due to time-crunches, uneasiness with kids, or lack of training, first-time doctors often find the relationship with young patients and their parents challenging under the best circumstances. Bnet author Mary Jane Kitchens offers frank, useful advice for doctors, from listening to parents and kids to fostering a sense of calm and safety during exams:

Dealing with red tape

“It was in the first year of residency, during my first call, that I learned about prior authorizations,” says Omar Fattal in the May 2005 edition of Behavioral Health Management. “I was soon calling insurance company reviewers’ answering machines at 3 a.m., yelling at them to accept the cost for treatment and then calling them back again the next morning to see what the answer was, and fighting with the social worker as to whose job it was to get further authorization.” Check out this excerpt of the article in which Fattal goes on to talk about a patient who needed an MRI of the brain who told him, “I already have an MRI of the back scheduled for this year. I am allowed only one MRI a year.” Honest, useful insights into how to effectively work the system, rather than rail against it in vain: http://www.allbusiness.com/government/health-regulations/467896-1.html

Taking leave

Believe it or not, you can and should take a break, beyond yearly vacation. Don’t try and get on leave after your first year at a facility (unless there is a good/extenuating reason.) Even worse, don’t put-off such a move once you’ve considered it. The fact is, doctors who take leaves of absence come back refreshed, more focused and more energetic, benefiting their careers and the institutions for which they work. What They Didn’t Teach You at Medical School by Alan Parbhoo also has a particularly useful exploration of how, when, and why to do this.

Knowing your way around

Referring patients and preventing referrals being ‘bounced back’

At different stages in your career, you will be required to refer patients and accept referrals from other doctors. Because no one doctor can know everything, this process is critical to getting patients the best care possible. This task often falls to the newest member on a team. Ironic, since this is usually the least equipped person to handle such a task. One way to help inform and streamline this process is to use referral management software, such as OmniMD http://www.omnimd.com/html/referrals.html

Non-medication-based ways to keep patients healthy

We’re not talking acupuncture or chiro…We’re talking about the need to keep up-to-date on medical science studies and new ways of seeing health that might be useful alternatives to medication: Eat more antioxidant-packed berries, cut out abdominal fat (now known as a good indicator of upcoming heart problems) at all costs, laugh (a recent study holds that this benefits your health even if you’re laughing insincerely.) This study out of the Netherlands looks at “Vitamin G” – the extent to which spending time in green spaces can boost your health. In short, new doctors would be well-served to choose lifestyle-modification over drugs if they can (and they can’t always.)

Getting to know the Operating Room

Even those planning on becoming general practitioners may enjoy their time in the OR immensely, if only briefly on the way to becoming a licensed doctor. On the other hand, even some aspiring surgeons may hate their first time in the operating room. One of the keys to success here is gaining a little background on how an OR works and why. Again, this is a great opportunity to get to know and learn from the nurses and surgical assistants trained to run a typical OR.

Further training

Constant learning is more important in medicine than perhaps any other profession. Many sites exist that list meetings for specific aspects of every medical specialty. One of the most useful is doctorsreview.com Even cooler – we think – is our own recent post on medical conferences in exotic locales

Business and leadership

Get a job…and a career path

It’s a foregone conclusion for most doctors-in-training that a high-paying full-time job awaits them after countless years of dedicated study. For getting a job, this is true. But the road to finding your ideal job will likely see many competing applicants in your path. For some choice tips on how to score in a medical job interview, check out our very own post on the matter, in handy infographic form.

Opening a practice

This is an exciting, rewarding, and complicated endeavour. Doing so involves a great deal of business knowledge and savvy. If you’re undertaking this straight out of residency, you may be opening a practice with a group of doctors or joining an existing private practice team. Here’s a great resource for those thinking of making the move.

How to lead and manage

Planning, organizing, working with others: All of these are skills will serve any physician well. They are also prerequisites for anyone looking to become an attending or administrator. The British Medical Journal has a great article on planning and strategic planning as it pertains to leadership in medical environments.

Time management

The same article also deals wonderfully with time management as well. Though medical students dream about ways to keep from becoming like so many time-crunched physicians, the reality is that this can only be accomplished with excellent time management skills. Only then can a new doctor hope to “keep” enough time for each exam, diagnosis, and treatment.

Getting up to speed on all of the above isn’t mandatory and it certainly isn’t required reading in med school. But most of these items show up on one advice blog or another, as well as throughout the speaking circuit, when it comes to dispensing advice to new physicians.

The above insights are all things they won’t teach you in medical school (at least most of the time) but they are all things many physicians will end up learning eventually, whether the hard way or not.

Surely there must be two or three other real-life scenarios we’ve neglected…Are there any ideas, concepts, subject matters, or techniques not listed above that you wish they taught in med school?  Dispense an education to us in the space below…


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