The List

Compiling a medical school list is as much of a strategy as studying for the MCAT. After months of research, studying, and comparing requirements, I have a tentative list of medical schools to apply to for the upcoming cycle. The AAMC application opens on May 1, 2019. Though I don’t have my MCAT score, I have a general idea of my personal stats.

Applying to these schools is expensive, so I’m limiting myself to 13-15 schools for this cycle. I’m still debating on whether I want to apply to the Texas Application System.

Factors I Considered:

  • Location
  • Accept All Types of Credits (online, AP, community college)
  • Global Health Component
  • School’s Preference for In-state/Out-of-State Students
  • Team-Based Care
  • Problem-Based Learning

Factors I Did Not Consider:

  • School Rankings
  • Residency Matching
  • Underprivileged Students Programs (I don’t qualify)

I looked for schools where I have support systems and where I felt I could live without too much “culture shock”, if you will. This means many of my schools are located around the Southwest. Being located in the Southwest does not guarantee admission of course. A school in Utah stated that they basically left only 8 slots for out-of-state students. I’m not applying there with such slim chances.

Being a non-trad also changes my profile. My classes come from a variety of backgrounds, which some schools do not accept as pre-requisites. I took time going through MSAR (AAMC’s cheap service with all of the AAMC school statistics) eliminating schools that didn’t accept my credits. For example, Johns Hopkins expresses a strong preference for traditional applicants (in addition to high GPA and MCAT preferences). They do not accept online courses, so I can’t apply there. (Their admissions team was rude to me anyway.)

Here’s the List:

  1. University of Arizona Phoenix
  2. University of Arizona Tucson
  3. Chicago Med- Rosalind Franklin College of Medicine
  4. University of Colorado
  5. University of Southern California
  6. University of California San Diego
  7. Baylor University
  8. University of Kentucky
  9. Wake Forest University
  10. Tufts University
  11. Thomas Jefferson University
  12. Albert Einstein College of Medicine
  13. Duke University

Schools 10-13 might be considered “reach” schools, but I have reasons for choosing them. There’s always a chance that I score high enough on my MCAT to make it past the admissions filters.

I’ve got 2 Texas schools as well, which I don’t think makes it worth it to apply to the separate Texas application service… Of course, the list might change once I get my MCAT scores, but we’ll have to wait until June before I know anything.

What do you think of my school list? Are you applying to any of the same schools? Share your lists with me!!

Happy Holidays, You Might Have Cancer

It was the day before Thanksgiving. The menu was planned, the shopping done. I planned on baking pies and chopping vegetables once I got home. Only a few patients to see that day, one a new patient. Usually my NP doesn’t see new patients, as initial evaluation is left to the physician.

She was flustered about seeing this patient she’s never met. Rushing into clinic to see the NP usually means something is urgent. This particular patient was highly symptomatic following a procedure by another provider. Unable to provide an explanation for her sudden shortness of breath, that provider referred her to our clinic.

The sudden onset and change in her symptoms frightened the patient and her husband. A young woman who enjoyed exercising was panting after walking less than 10 feet. Looking over the results from labwork, procedures, and imaging didn’t reveal a clear picture. She looked at us, pleading for answers with big, round eyes. She held her hand tight as her husband helped answer questions so she could catch her breath.

Imaging showed an abnormality, not explained by the most common diagnosis. The suspicion arose for cancer, though more testing would be needed. By the way her face fell, she had obviously not considered such a disastrous possibility. Her procedure was supposed to be simple and easy. From a cardiac perspective, it had been successful. Now she and her healthcare providers were forced to contemplate more malignant causes.

Despite working in a medical clinic, I’m not accustomed to seeing my patients die. We primarily see patients with atrial fibrillation, a treatable and manageable disease not likely to be the sole cause of death. The interventional team has to worry about death from heart attacks, while the heart failure team deals with high risk transplant candidates or LVAD patients. Cancer is usually handled by outside physicians specializing in other bodily systems and/or oncologists.

Right before the holidays, even the most remote possibility of cancer seemed devastating. It was difficult to hold myself together for the patient’s sake.

One of the research physicians suggested that I begin hospice volunteering. Despite all my research and reading book after book about death, I have little experience with confronting the ultimate partner to medicine. Perhaps it’s best I heed his advice.

Confronting “Bad Faith” in Medicine

 

Image result for bad faith when religious belief undermines modern medicine

This month’s reading focused on a sensitive topic – religion. When people mention religion and medicine, most people jump to abortion; however, there’s a frightening array of issues that involve religion in the setting of modern medicine. Bad Faith: When Religious Belief Undermines Modern Medicine covers these topics in depth. The preventable deaths caused by “faith healings” is the main focus of this book.

Several church groups and religious organizations shun the advancements of modern medicine on the basis of faith. Most notably, “Christian Scientists” refuse all medical treatments except those to set broken bones and a few other necessary treatments. Vaccinations, surgeries, antibiotics, and most medications are strictly forbidden by the Church. Instead, they seek “treatment” in the form of prayer.

Religious belief is a touchy subject. Many providers have difficulty understanding why people would refuse life-saving care in favor of prayer. There is little debate in how adults can choose to treat themselves. If a Jehovah’s Witness refuses a much-needed blood transfusion, that is their choice to make. This is the same for any patient, whether or not they choose this for religious reasons. Legal adults of sound mind are able to sign AMA (against medical advice) forms.

The greater problem lies in the children of these “faith-healers.” On the basis of their religious belief, parents deny their children medical care – which lawmakers refer to as “medical neglect. In the state of Arizona, there are multiple religious protections in place, including protections to avoid vaccinating school-age children. Although anti-vaxxers (religious or otherwise) have been refuted repeatedly due to overwhelming evidence in support of vaccinations, many continue to refuse to vaccinate their children against potentially deadly diseases.

It is my strong opinion that every adult person should be able to dictate their care. They have the right to refuse medical treatment and care. That belief, however, should not automatically apply to their children. An infant or a child cannot consent to medical care. In the medical community, we rely on the patient’s parents or guardians to provide that consent. The issue is that children cannot refuse medical care either, which unfortunately falls to the responsibility of the parents. The default practice should be, then, to provide care when children are sick and in emergencies, regardless of parental consent. The type of care provided may be subject to religious relief (such as avoiding blood transfusions), but parents should not be able to refuse care completely. Naturally that creates the issue of where the boundary lies. Providers and medical staff often end up court-ordering care for pediatric patients, which depends on the decision of a judge.

“Faith healers” can specifically refer to Christian Scientist “practitioners” who provide “care” in the form of prayers. The quotations are there because these people in no way provide actual medical care. Under Arizona law, these people are exempt from medical licensing. They can provide “care” yet they are not liable for the outcome of their “patients,” nor are they regulated in any way. This lack of accountability is something a physician would never dream of, a point made in Paul Offit’s book.

Doctors can be part of the problem as well. Per Arizona law, doctors and medical personnel can refuse to provide services based on their religious beliefs. This means refusing to prescribe birth control, perform abortions, collect umbilical cord blood (for stem cells), and end-of-life care. Notice that most of these cases are related to women’s health. (If you have the time, read Justice Ruth Bader Ginsburg’s scathing dissent of the Hobby Lobby ruling and the importance of reproductive rights). One pharmacist made headlines for refusing to provide a patient with abortion-inducing medication (even though the fetus had already died inside her.) Physicians and other healthcare providers should be required to perform and provide the services needed of them.

In the same way that providers would have to respect a patient’s religious belief, providers should respect their lack of religious belief.  Jehovah’s Witnesses do not believe in blood transfusions. I disagree with this, but I would respect that adult patient’s wishes. By the same logic, a patient requesting an abortion (for any reason) should be able to receive that procedure safely from a doctor, regardless of whether the doctor personally objects. A doctor’s personal conflicts, political leanings, or religious beliefs have no place in patient care. The physician is not a god, is not a judge of people’s moral actions. The physician’s duty is to provide the care needed.

I don’t have anything against religion in particular. In fact, Mr Offit’s book makes several points about the importance of faith. He even uses the New Testament and Jesus’ treatment of children to support medical care and protection for children. I would also like to note that some of the cases mentioned in the book involved religions and religious leaders who explicitly recommended medical care for the sick and dying, which individuals chose to ignore. The issue isn’t religion, but how religious belief becomes warped and causes harm in the realm of medicine.

American Heart Association Scientific Sessions

I’ll be in Chicago this weekend for the AHA Scientific Sessions. You can contact me on Instagram at futuredoctorfoodie. If you’ll be in attendance, I’ll be presenting my research on a poster on Sunday around 10:30 AM!

For those of you who are unable to attend, I’ll be posting about it once I get back!

The Dreaded MCAT

The MCAT is the standardized test required for entrance to medical school. After major revisions a few years back, the test is now an anxiety-inducing 8 hour trial, testing the major sciences, psychology/sociology, and reading comprehension. Pre-meds dread this test. If your score is “too low” you might start to worry about your “stats”.

I’ve never struggled with standardized tests, but after a recent experience I’m starting to understand their concern. The other day I signed up for the free Next Step MCAT bundle, which provides diagnostic testing. (Prior to diagnostic testing, I recommend you do your research about the test, your learning style, and the resources available). Without doing much studying, I scored a 493.

I should definitely mention that I haven’t actually started studying for the MCAT. I took the diagnostic exam without a proper review. This is definitely not going to be close to my score once I actually start studying. I wanted to know which subjects to focus on. My CARS is quite strong. My psych/sociology needs a bit of review, but I’m comfortable with that area as well. Unfortunately, my biological and chemical systems section scores were dismal.

My concern is that I need to spend more time preparing for the exam than I expected. I was going to start my study plan in January 2019 for my May 2019 test date. Considering I got an email from the Next Step team warning me about my score… it looks like I’ll need to move up the time table. Right now I’m starting with the backlog of MCAT practice questions in my email. Hopefully I’ll be able to find more specific areas within the sciences to focus on. Then I’ll start the Khan Academy videos and prep books. Ultimately I intend on a Next Step prep class. What I need is a schedule. Does anyone have any study schedule recommendations?

Ochem Woes

Many of you saw on my Instagram that I was taking summer Ochem I. Taking it over the course of 1 month (4 hour classes 4 times per week) was really not advisable. I was looking forward to this semester’s Ochem II class, because the pace was more suited to my learning style.

My professor taught quite slow for my tastes, but the expectations were clear and the information was much easier to process. Unfortunately, my professor had to have surgery and will now be out for the remainder of the semester. A substitute teacher has been assigned to us – a physics and engineering professor with a background in chemistry. Without the syllabus, the previous professor’s powerpoints or materials, and no knowledge of what we have learned, this professor has strived to teach us.

My classmates and I have been frustrated, as the professor’s teaching method is a strong shift away from relevant materials toward seemingly hare-brained physics lectures. They take their frustration out on him, when it isn’t his fault.

Supposedly next week, we will have 2 new teachers. The first person will teach lecture. Some of my classmates have been in his class before, and there are mixed reviews. My lab professor will be the same professor who taught me over the summer. I’m not sure whether this is good or bad yet…

Regardless, I need to finish this class in order to complete my pre-requisites. They cannot cancel this class and I refuse to withdraw. Anyone have any tips on how to deal with inconsistent classes like this?

Protecting Patients from Sexual Abuse

An orthopedic surgeon and his wife recently made headlines for drugging and raping women. The NPR article makes no mention of revoking his physician’s license, though if he serves the maximum sentence (of only 30 years for possibly thousands of women!!!) it is unlikely he would be able to continue practicing. The article does make a reference to his position as a physician establishing a sense of trust in his victims.

After 2 years, prosecutors were finally able to convict Dr. Shafeeq Sheikh of raping a heavily sedated patient while she was hospitalized. He was fired from the hospital and his license was suspended. He served no jail time. Unfortunately, Texas does not require permanent revocation unless a doctor agrees or when a doctor permanently surrenders his or her license in lieu of further investigation. He could potentially re-apply in a year.

These headlines are unfortunately not uncommon. Sexual assault and rape are hot-button issues in the US right now, particularly sparking outrage when rapists and sexual predators receive little to no punishment for their actions. There should be even greater outrage against physicians who take advantage of their position and their patient’s vulnerabilities.

There are watchdog organizations focused specifically on appropriate legislation and punishment of physician-offenders. Per one website, Arizona only scored 66%, but ties Massachusetts and Ohio at number 10 best patient protection states in the country. Mississippi is the worst, and Delaware is the best.

In Delaware:

  • Duty-to-report laws require any healthcare worker aware of an offense to report the physician within 30 days, or else pay hefty fines.
  • Physicians who have committed felony sexual offenses have their licenses permanently revoked.
  • Doctors must undergo background checks with fingerprinting, updated every 6 months.

In Arizona:

  •  Incidents reported by other hospital or clinic staff do not need to be made within a specific time period, and there is no requirement to report these offenses to the medical board.
  • State law does not require revocation for any type of sexual misconduct or convictions.
  • The medical board cannot refuse to issue a license based on previous criminal acts.

In Mississippi:

  • There are no criminal laws specific to sexual misconduct for physicians.
  • State law does not require physicians to report possible violations by fellow doctors.
  • Doctors whose licenses are revoked can reapply at “reasonable intervals.”
  • State law doesn’t require revocation for any type of sexual misconduct or convictions.

Physicians are with patients at their best in worth. They establish trust with a patient, and that patient trusts their physician to provide the best care possible without taking advantage of their vulnerabilities. When a physician rapes or assaults a patient, they violate that trust and the trust future patients would have given. Those physicians guilty of such crimes have violated the fundamental vow of doctors- “Do no harm.” I cannot fathom how a felony sex offender, a rapist, would in good conscious be allowed to continue practicing.

The laws need to change. We need to make hospitals responsible for the behavior of the physicians they hire. Physicians, patients, and staff should be able to anonymously and quickly report inappropriate and unacceptable behavior. The physicians responsible for these heinous acts should be punished severely, including the loss of their right to practice medicine.

Does anyone have any suggestions on how to get Arizona laws regarding license revocation altered?