The Short Coat Podcast Visits the Premed Years

Introduction

Dr. Ryan Gray: The Premed Years is part of the Med Ed Media network at www.MedEdMedia.com.

This is The Premed Years, session number 199.

Hello and welcome to The Premed Years where we believe that collaboration, not competition, is key to your premed success. I am your host Dr. Ryan Gray, and in this podcast we share with you stories, encouragement, and information that you need to know to help guide you on your path to becoming a physician. Oh, and we’re two-time Academy Award nominated.

Welcome back to The Premed Years. I am Dr. Ryan Gray, the host of The Premed Years Podcast as well as all of the other podcasts, at least for now, over at www.MedEdMedia.com. Maybe in the future there will be other podcasts that I’m not hosting. Hey, if you’re interested in hosting one, let me know.

This week’s podcast is a fun one. This one is with a podcast that is hosted at a medical school. And I’ve known about this podcast for a while, and at a podcast conference in July of 2016 I got to meet the man behind the podcast, Dave Etler, and it was an awesome time. We met, we talked, we had fun, and we decided to be on each other’s podcasts. So a couple weeks ago as I’m recording this, I was on his podcast, The Short Coat Podcast, and now he and the students at Iowa’s Carver College of Medicine get to be on The Premed Years.

If you haven’t checked out The Short Coat Podcast, I highly recommend you do. They’re at www.TheShortCoat.com. Again, that’s www.TheShortCoat.com. A great podcast, it’s usually Dave who works at the college and for medical students who are obviously students at the medical school there, and they have very interesting discussions about anything and everything, and sometimes they’re doing weird things like trying different flavored toothpastes, and they do lots of funny things. I don’t know what goes on in Dave’s head sometimes, but that’s a different story. Go check out their podcast, again www.TheShortCoat.com. Let’s jump into this podcast.

Dave, welcome to The Premed Years, thanks for joining me.

Meeting the Short Coat Podcast

Dave Etler: I’m so happy to be here.

Dr. Ryan Gray: Finally.

Dave Etler: Yeah, it’s about time.

Dr. Ryan Gray: I know, it is, I’m sorry I didn’t-

Dave Etler: It’s about time I was asked to be on the show.

Dr. Ryan Gray: I know, it took me a while to get the courage to ask you because you’ve been so famous, such an inspiration for me as I’ve gone on this journey.

Dave Etler: Yeah I can see that, I can see how that might be true, but I am a human being. You know, I put my pants on one leg at a time just like everybody else.

Dr. Ryan Gray: That’s good, that’s awesome.

Dave Etler: Try to temper your amazement at my presence.

Dr. Ryan Gray: I will, I will.

Dave Etler: Okay.

Dr. Ryan Gray: So Dave I want to talk a little bit about The Short Coat Podcast, and why The Short Coat Podcast was started.

Dave Etler: Well so in 2010- there’s a couple of reasons why it started, but what it came down to was professional boredom in the beginning. And in 2010 I was- my title was Clerk at the Carver College of Medicine, and my job was- it was a good job, it is a good job, but at the same time I had been doing it already for ten years, or approaching ten years, and I was kind of- it was old hat. And at the same time my previous boss had left the college, and there was a new boss coming in, and I knew that he was into technology, and things like that. And so one of the first things I said was, ‘Hey I’ve been wanting to do a podcast for a little while.’ I didn’t really quite understand what that meant, but I wanted to do a podcast. And about medical students. So he’s like, ‘Yeah sure, let’s do that.’ And so that’s really how it began, was a way to sort of alleviate my professional- my own professional boredom. But I kind of knew that there were stories. I mean in the years that I had been working here, I knew about the intensity of the medical school experience, and I knew about the triumphs and the difficulties that med students experience, and I felt like it was a good idea to tell that story.

Dr. Ryan Gray: How have the medical students received being on the podcast?

Dave Etler: Well I guess I would toss that over maybe to these guys. I mean I will say that it’s always difficult to get people to get past the idea that they’re going to have microphones shoved in their face. But what I like to say is that in the end, once you get used to it, it becomes like a- just sitting down and having a conversation between friends. I mean the only difference is we don’t have beer.

Dr. Ryan Gray: Well you could.

Rachel: Unfortunately.

Dave Etler: I don’t know if we could. But what do you guys think? Was there an initial barrier? I mean Levi, you’re here for the first time so I’m going to put you on the spot. Is there a barrier for you? Is there something that you have to get past?

Levi: I mean not really for me because I just- my first experience with the podcast was coming here on a tour day, and my tour guide saying, “Hey let’s go watch a taping of the podcast,” and I didn’t think it was going to be interesting at all to be honest. And I came here, and I was hooked, and I wanted to get involved with this as soon as I got to medical school, so I’m just at the end of my first week, and here I am. So there really wasn’t a lot of barrier for me to overcome, and I feel comfortable speaking in front of small groups, large groups, so I guess personally I didn’t have a lot of things to overcome.

Corbin: I think one thing that’s hard about being a med student on a podcast is the idea that you’re being recorded, and professionally you don’t want that to come back to bite you ever. You know because like in medicine you never know what’s going to come back, and you can’t- I’ve kind of gotten over just- I kind of just say what I want at this point, but you kind of have to be careful about what you’re saying, and who you’re saying it about. So I think that’s the biggest one.

Dr. Ryan Gray: So Corban, what year are you?

Corbin: I’m an M3.

Dr. Ryan Gray: Okay which explains the short coat and the stethoscope I’m seeing. So as we’re recording this for you listening, we’re on Skype and I can see everybody sitting around the table. So I’m talking here to Levi, Corban, Mark and Rachel, as well as the Dave Etler. Corban, talk about that for one second. I think you’re too early in your training to have that philosophy of, ‘I’ve got to be careful what I say.’ Where did that come from?

Corbin: I don’t know. I think it comes partly from worrying about your resume a lot just in your life, or when you’re a premed, and like when you’re in school. Also you always want to be- think about like okay you don’t want to violate some patient’s HIPAA privacy, that’s always a concern. But I don’t know, maybe it’s just like undue anxiety about getting evaluations. One thing I’ve actually struggled with since starting rotations in medical school is the fact that you get evaluated from someone, and like basically their personal opinion of you becomes your grade. So it’s like- I have a big issue with it but I think it partially stems from systems like that within med school.

Rachel: I definitely don’t think it’s too early for like people in like M1, M2, M3- I don’t think it’s too early for us to be worried about our professional appearance. Even just in like our more personal areas of life, I feel like sometimes that can still reflect onto our profession, and I feel like it’s more common that people I know are like a little more cautious about that. I follow a lot of med school bloggers and a lot of them are like, ‘Got to maintain an appearance here. Don’t want to like get crazy.’

Corbin: I think what part of it is too, is like so being young in our career you have an image of what a doctor is, but you haven’t- you haven’t figured out what it means for you to be a doctor yet. You’re like kind of trying that out. And so maybe you are the doctor that swears.

Dr. Ryan Gray: Why not?

Corbin: But like right now it’s scary to be the doctor who swears. So it’s kind of trying on this what does it look like for me to be a doctor, and what does a doctor say, and how do they conduct themselves?

Rachel: I know a girl who before she started med school, she took out her tragus piercing because she thought it was unprofessional, and then she came here and saw like people with like gauges in and she was like, ‘What,’ because her piercing had healed up already.

Professionalism in Medical School

Dr. Ryan Gray: So talk about that professionalism that you were just talking about, Rachel, and talk about what happened in the news this past year with the resident who was fired from her neurology residency because of her unprofessionalism being video-recorded beating up an Uber driver, or attacking an Uber driver. Was that something that was discussed at your school, and discussions around maintaining professionalism outside of school, outside of medicine?

Rachel: This is actually the first time I’ve ever heard of that, so no we never discussed that.

Dr. Ryan Gray: Really?

Rachel: We actually haven’t really had any like formal discussions with like personal behavior effecting-

Mark: The only one was during orientation. At the end of the week our dean, Dean Cooper, he did give a very good kind of presentation about professionalism and how we’re ambassadors for the university and the college of medicine. So there was that big one. I know socially going back to what you were talking about with the neurology resident, it did bring up a discussion I remember with some friends just the idea of online presence, and that’s a culture that we’ve been brought up in, is your online presence is something that may not go away if you want it to, even if you actively try. And I don’t know, Levi when you were applying, and I know there are some schools, I can think of Michigan State University that will ask for your Facebook. They will ask for the link to it, and they’re looking around, they’re seeing what type of individual you are. So that’s something that is in the back of my mind constantly. I don’t know if it’s too early or too late, but it was one thing that made me pause for a second.

Dave Etler: In your case it’s too late.

Mark: When I saw that I was like, ‘Well, hm.’

Dr. Ryan Gray: Facebook? What’s Facebook?

Mark: I need to go around and see what kind of image am I presenting?

Dr. Ryan Gray: Yeah, no that’s good to know. So I’m interested to know, Levi you’re an M1, Corban you’re an M3, Mark what are you?

Mark: M2.

Dr. Ryan Gray: M2, and Rachel I’m assuming M2 as well. As you guys were applying to school or applying elsewhere and were premeds, did you listen to The Short Coat Podcast?

Dave Etler: Say yes.

Rachel: I actually didn’t know about The Short Coat Podcast until I came here and was like, ‘What’s that weird spider-y looking thing with the microphones on it?’ So like I kind of found out about it afterwards, but I like it now, so that’s good right?

Corbin: I actually did listen to it before I came to med school. I don’t know, I listened to it a whole lot more before I came to med school than I do now, mainly because I don’t like to listen to my own voice. But I liked it because it was like somewhere you wanted to be, and you’re listening to people who were where you wanted to be. So it was a good time.

Levi: I guess I can say I didn’t listen to it before I came but I wish that I had.

Dr. Ryan Gray: Yeah.

Dave Etler: Oh, good one.

Dr. Ryan Gray: Regret.

Mark: Post interview I used it as a way of like feeling the culture of Carver College. So you know, this was an area- I’d never even been to Iowa prior to interviewing so once I saw this was an option it was my way of saying, ‘How do people talk and interact?’ It was refreshing to see that there wasn’t this fear of constant-

Dr. Ryan Gray: Yeah, people were normal in medical school. They didn’t change too much. That’s awesome.

Dave Etler: Well you know the way I think of it is, I also am not from Iowa, I’m from the east coast and you know we’re kind of snoody out there on the east coast about the fly-over states. And my wife got a job here out of grad school and she said, “Let’s go to Iowa,” and I said, “Let’s go where?” And so at some point in this process we started looking at apartments, and I wasn’t able to come out here and look at apartments; and keep in mind this was 2000, the web wasn’t new but it was certainly not something that apartment complexes were big into but we found one where they had pictures and floor plans online. And what I noticed is that this particular apartment complex, their apartments all had the same floor plan as my grandmother’s house- or my grandmother’s apartment. And I remember feeling like the sense of, ‘Okay I can live there.’ And I think that’s sort of what the show does for the College of Medicine, is it gives listeners a window into the culture of the Carver College of Medicine, and what medical students are like in general which sort of allows them to see themselves in that role.

Dr. Ryan Gray: Yeah.

Dave Etler: So, yeah.

Culture of Carver College of Medicine

Dr. Ryan Gray: So talk about that culture a little bit more. Mark, when you were applying you said you weren’t from Iowa. Why did you apply here- or there?

Mark: The first thing that pulled me in- so there was at UC Davis, they do those big fairs and there’s tons of schools from everywhere. Somebody had mentioned the humanities program. So I had majored in philosophy originally and that kind of pulled me in. It was kind of just a swing, just swinging for the fences, I thought why not? It sounds like a cool program, I was super excited about it, but I thought my chances were extremely low being an out-of-state resident. And so I got an interview, I was stoked. I fell in love with the school when I came, and just this kind of pulled me deeper and deeper into the culture of hearing how people think, the discussions that were coming up since it’s kind of a free form, not agenda-driven podcast. So seeing that certain themes kept coming up which was work / life balance, talking about these individuals and students that it sounded like they were self-directing where they wanted to go. And I actually ended up canceling several interviews because I knew what else am I looking for?

Dr. Ryan Gray: You’re from California originally?

Mark: Yeah, Long Beach, California.

Dr. Ryan Gray: The word ‘stoked’ just gave it away. So that’s awesome. I’m from Redondo Beach, so not too far away, yeah. Levi, what about you? Being the first year student in the room, why did you choose Iowa to apply to?

Levi: Well I’m initially an Iowa resident. I’ve lived here all 22 years of my life. I did my undergrad here in Iowa, and I’ve heard a lot of good things about the University of Iowa, there are a lot of people from my college here, and I’ve kept in good contact with them. They’ve all said good things about the school and when I came here, and I actually had the chance to interview and talk to some of the other students that I met on my interview day, and some of the current medical students, I fell in love with the culture here and sort of the mindset of collaboration versus competition. That was one thing I was really looking for in a medical school, and Iowa had that, and it just happened to be a very good school academically primary care research-wise too, and I was sold on the school as soon as I saw just how warm, welcoming and collaborative the environment was here.

Dr. Ryan Gray: So it’s interesting you say that. In my opening for the podcast I specifically say ‘collaboration, not competition is key to premed success.’

Levi: I promise I haven’t watched your podcast before.

Dave Etler: But do you find that this is something that still exists at other schools, Ryan?

Dr. Ryan Gray: Competition?

Dave Etler: I mean the competition thing.

Dr. Ryan Gray: Yeah, definitely. Unfortunately. I think once you hit medical school it’s a lot less than premed because everybody’s fighting to get into medical school, but even in medical school there are gunners, and they are dangerous, and you can pick them out very easily.

Dave Etler: It’s interesting because I feel like- and you guys can either disagree with me or not, I’m going to give you that option.

Dr. Ryan Gray: For once.

Dave Etler: Yeah it doesn’t always come up, and you guys should cherish it when it does. But I feel like the definition of gunners here is maybe a little different than it is elsewhere. And you know, it’s more of a somebody who just buckles down and does nothing else maybe than study medicine. It’s not necessarily the people who sabotage other people.

Rachel: I actually don’t think I like really know gunner gunners at all here.

Mark: So I think that’s why that this definition is a little different at Carver. So I got in this big discussion with a couple other people because they were joking about, ‘So-and-so is such a gunner,’ and I was like, ‘No, they’re great.’ ‘Nah they’re gunners,’ and this and that, and I was like, ‘They’re not,’ and we realized after a couple minutes of arguing that my definition of a gunner is someone that will succeed at the expense of others. I will do whatever I can to elevate myself even if that means pushing you down. Versus here, yeah and maybe it’s the Iowan work ethic, I don’t know, but the idea of a gunner here is just someone that says, “I will do what it takes, I will work very hard,” and it’s a very centralized kind of inward looking.

Dr. Ryan Gray: Yeah, that’s awesome.

Corbin: Yeah I mean I think that now that we’re on clerkships too, where sometimes it does even behoove you to look better than your classmate, but that doesn’t really happen on rotations here. It’s always like if I know something, and one of my colleagues is being pimped you kind of like try to whisper the answer below your breath. You know?

Dave Etler: There’s an elaborate system of hand signals that you use.

Corbin: Right? Say, ‘I think you’re supposed to do this. Maybe you should go do this quick just in case.’ Or we share a lot of study guides.

Rachel: I was actually a little apprehensive before starting medical school. So I was an engineering major and the college of engineering here is like really collaborative, and like my premed classes were not like that. There were gunners there and I like I was kind of intimidated that like med school would be kind of moving more into that crowd of people, and that has not been the case at all. Like it’s just like I was like, ‘Oh all of you guys are so cool and nice.’ Like it was really just not what I feared at all.

Mark: Yeah kind of the same here. I mean our class already has like a class Facebook page going, and I’ve just seen resource after resource. People are going, ‘Hey this is useful for anatomy, this might help you review biochem,’ and it’s just a laundry list of Google docs, and spreadsheets people have been creating and sharing, adding to just kind of as a class to try to get everybody ready for that next exam.

Interview Process

Dr. Ryan Gray: Talk about the interview process there, and looking back on it now how you think they were able to find you guys, and find students like yourself who are collaborative, and not competitive, and not that true definition of a gunner.

Levi: I have no idea how admissions does- it’s interesting because you’ll see overlap of individuals that have interviewed at the same schools. And I don’t know, it always kind of amazes me that whatever these admissions process systems are, they’re identifying the same traits. As for like answering that question, I have no clue.

Mark: It might have something to do with the CBL session they do on interview day, that might be like some type of qualitative assessment. So on our interviews we do a CBL session called Case Based Learning, where you essentially have like an M3 and an M4, a couple of upper class students, and you have a small cohort of the people who are interviewing on that particular day, and they walk you through kind of like a general from a patient presentation all the way through to diagnosis and treatment, and they kind of help you as a group try to reason through it. But they don’t just give you the answers, you all kind of have to give your own input, and they want to see if any one person kind of has sort of a dominating personality, or just sort of how you interact with peers that you’re meeting for the first time, working with for the first time, never really even met before.

Corbin: My impression of that was more like it’s just like weeding out the people who just like socially fall on their face, rather than like actually trying to select for people who really get along with each other. I feel like it’s probably more done for like the general culture rather than like the individual students, just because it’s something that I feel like would just be really hard to actually select for.

Dr. Ryan Gray: What do you mean by that, the culture?

Corbin: Well like you come in and there’s really just like- there’s really not things that you compete for each other with. They kind of split us up into like- we have the houses, like [Inaudible 00:21:35] like Hogwarts houses. They do like team building things that aren’t like lame team building things, they’re like fun team building things. And like you get to know people, and I don’t know, like I just never really like- never even got the impression that people would be like really competitive with each other here.

Dave Etler: Which is interesting because those team building exercises- maybe not during orientation week but those continue throughout medical school in the form of the community’s Olympics. So there are periodic competition between the learning communities where they sort of compete for points, and they’re all sort of centered around service activities as well. So you know, we’re going to [Inaudible 00:22:28] activity, I think it’s- well say it’s the shelter house. So they have a shelter house fundraiser and so the points are gathered based on how much donations are received. So there’s still some competition, and maybe that’s an outlet for that competitive-

Corbin: You have to have good competitive outlets for type A competitive people. Put it in the right direction so it doesn’t-

Mark: Point it where it needs to be.

Corbin: Katie’s latest philosophy is like be as competitive as possible for things that don’t matter. But like I think some of the things that actually- like grades or test scores or anything, everybody’s just like working together for that. Like people will study together, and like share resources and everything.

Transitions to Medical School

Dr. Ryan Gray: That’s great. Levi, talk about- since again you’re the M1 in the group, talk about your recent transition to medical school and how that’s been compared to undergrad.

Levi: So I had a little bit of a stark realization yesterday morning that-

Dave Etler: Too late.

Levi: As of the end of today for one of our classes, Foundations it’s called, I will have had nine lectures by this point this morning compared to my undergrad experience which some classes were like at the most three lectures a week. So I’ve covered for one class about three weeks’ worth of material in what would have been- or one week here would have been three weeks at my undergraduate. So it’s taken- it’s going to take a little bit for me to adjust to the pace. But so far I feel like I’m definitely up to the challenge, I just have to figure out what’s going to work for me and how I need to adjust to the adjustment of pace. But I’m starting to see a little bit where the classic fire hose analogy comes from.

Dr. Ryan Gray: And how soon is your first test for that class?

Levi: Next Friday.

Transition to Clinicals

Dr. Ryan Gray: Yeah, so as a medical student you become that professional test taker which is awesome. And Corbin as an M3 you’re now in your clinical rotations. How is that transition from the classroom to the hospital?

Corbin: I think it’s a big learning curve for sure, just using all the knowledge that was like not ever- it was there and it was in your mind, but now you actually have to apply it to a patient that you see. There’s like definitely a little bit more of an urgency in some ways when you see a patient. You’re like, ‘Oh gosh I actually need to know this because I’m going to go into that room and like ask him about why he takes this drug,’ and he’s going to be like, ‘Shouldn’t you know why I take that drug?’ I should know but can you just tell me?

Dave Etler: There’s so many off label uses, I just want to be sure.

Corbin: Yeah I just want to make sure you’re taking- I just want to know what you know so I can verify your information. But I mean it’s a lot of fun and it’s still pretty tiring, but the change- I think the big thing is a big learning curve. You have to deal with all like the administrative stuff which I think is a good lesson to learn about like Epic, and what we can do for our patient because of their insurance, and scheduling, and referrals. I mean it adds a whole new complexity to the art of medicine for sure.

Dr. Ryan Gray: Yeah. It’s not 100% patient care all the time.

Corbin: Right, yeah.

Dave Etler: Corbin, have you embarrassed yourself at all?

Corbin: Every day. You mean today? Yeah. I mean it depends on what- I mean patients are super nice and they’re very forgiving typically- I mean not always. But and you embarrass yourself- I mean when your faculty is so much smarter than you, so you’re going to say something- you’re going to say something to them that is like so trivial, but it just is a part of learning, you just have to like put yourself out there because-

Dave Etler: In the back of their mind they’re thinking, ‘Oh that’s so cute. That answer’s cute.’

Mark: They’re nice about it- well I don’t know about in the clinics.

Corbin: Some are. Some are nice about it.

Mark: We had a big group discussion of like clinical cases, I think it’s prepping us for where Corbin is now, and I said one thing and it was wrong and he was like, “Yes does everyone agree with that?” Like that’s way of, ‘No, sit back down.’

Corbin: My favorite is when they- you know you’ll ask- you’ll say something and then they’ll be like- like, ‘This is because of this,’ and they’re like, ‘Is it because of that?’ You’re like, ‘Oh, I’m not sure now.’ Oh I fainted like four times.

Dr. Ryan Gray: Really?

Corbin: I’m a fainter, it’s a thing. I’m starting to become- I know what I need to do. See the thing about- here’s a tip for your surgery rotation; surgery is a fine balance between hydrating enough not to pass out, and not hydrating too much that you have to pee for eight hours.

Dr. Ryan Gray: That’s what catheters are for.

Corbin: Yeah I’m not very good at finding the balance apparently because I faint. But just know that fainting does not preclude you from becoming a doctor apparently.

Dr. Ryan Gray: Yeah, so do you just wear a helmet as preventive?

Corbin: Yeah I just warn everyone I’m a fainter, I’ll just step out when I need to.

Biggest Surprise Starting Medical School

Dr. Ryan Gray: So Mark, what has been the biggest surprise for you as an M2 now, transitioning from undergrad to medical school what’s been the biggest surprise that you’ve seen as a medical student?

Mark: Hm, that’s a good question. The biggest surprise, coming here something totally unexpected, I think it’s the financial side of medicine and how much business interacts with patient care. And that was something I knew, and it’s something I’m like kind of acutely aware of, but I didn’t realize that it’s not a part of the curriculum strictly, it become this extracurricular portion. And they started a healthcare science and distinction- or healthcare science delivery track here at Carver and I kind of went on it on a whim, and the first seminar that they had was a couple hours long and it blew me away of like these are just such critical pieces of knowledge, of basic relationships, and how a hospital is structured, and how individuals have access to care, that it seemed like, ‘This is- I’ve got to know it.’ And I think that was a huge profound moment where I realized that I am doing a disservice to my patients by only focusing on clinical care, that I must educate myself on the administrative side as well. And I think that’s really changed my perspective on what I’m supposed to be doing for these four years.

Dr. Ryan Gray: So much so that you think it should be part of a curriculum?

Mark: Oh absolutely. I think that was one of the greatest things they did was putting that here and adding it to our curriculum. It’s co-curricular so it’s not mandatory for every student, but there are elements that are pulled from that that become mandatory.

Dave Etler: And I should say that it was created by students, this particular distinction track, was basically put together by four students who saw a need and said this is something that we need to do.

Corbin: I would kind of echo what Mark said about since being in clinic you kind of realize how much of patient care is really just the system, if you will. It’s not- I kind of have joked with a few of my friends recently about how I wish I could like go back to the old times where it was just like me in my office in like a small town with a leather bag and like a dog by my feet, you know like the Norman Rockwell painting.

Dr. Ryan Gray: Getting paid in chickens?

Corbin: Yeah getting paid in chickens and eggs. But I think it’s really important actually for medical students to start being more aware of the system and the administrative side of things because you know I think in the future for us to have a really humane healthcare system, we need to have people making those decisions- the big system decisions who have taken care of patients, not just people who went and got their Master’s in Healthcare Administration. We need people who have taken care of patients, who understand what a patient’s going through, making big system changes.

Fears for Future Healthcare Systems

Dr. Ryan Gray: Interesting. Rachel, with being an M2 there as well, with Mark was just saying and Corban just saying about this big system, how scared are you for the future of what the Affordable Care Act brings, or whatever version of our healthcare system is next?

Rachel: I feel like I need a lot more like knowledge to answer this question probably. I feel like people with a ton of knowledge on this subject still can’t like really answer this question in ways that other people will agree with. I don’t know, I take the fifth on this one.

Dr. Ryan Gray: Well I’ll kind of tell you my thought on it, because it’s something we talk about a lot during mock interviews and stuff with students, is at the end of the day patient care is patient care. Whether it’s a single payer system, whether it’s a private sector like we have now, or some mix of it; at the end of the day behind closed doors you’re still taking care of a patient and that’s really the beauty of what medicine is. And so that’s why whenever I talk about it with people I’m like, ‘I don’t care what is going on legislatively. Yes I need to know it and I would love to give my input, but at the end of the day I don’t care because it’s still one-on-one patient care.’ What do you think about that?

Rachel: I think that’s important. I feel like that’s the most important part of us- our relationship with our patients, what we do for our patients is us actually seeing them, and having that relationship with them. But at the same time I feel like the system is just such a big, important part of it, and affects so many different things that we just don’t really have control over, that it’s really hard to just like separate those out.

Dr. Ryan Gray: Too naive?

Rachel: We can control- we can control [Inaudible 00:33:00] but that relationship, that like one-on-one here, you’re my patient, I’m your doctor, I’m going to help you. But there are so many things that can be done on a broader scale that it’s really hard to answer that I think.

Dr. Ryan Gray: Yeah.

Dave Etler: I wonder if I guess as a school that focuses a bunch of its attention on primary care, and things like preventative medicine, community health, all that kind of stuff; it’s hard to help a community that doesn’t have access to medicine. One of the big drivers of access to healthcare is the amount of money that you have available to spend on it, and that’s- if you’re going to be a physician in a community health setting, that’s something that you’ve always got to be mindful of. I mean especially when you talk about things like compliance. One of the things we’ve talked about on the show is how important compliance is to medicine, and how it’s also important not to judge patients based on their compliance as being good patients or bad patients. Sometimes compliance means getting to the clinic for your appointment, and if you can’t get there because you have no money, then that’s an issue.

Dr. Ryan Gray: Yeah.

Corbin: Absolutely. I mean I think it’s also- you know I think it’s kind of a middle road because to a certain extent the system can like infringe on your ability to like take care of your patient. It kind of can- so it becomes a decision of how much am I willing to give up before like I don’t want to take care- I don’t get to take care of patients the way I want to take care of patients. Especially if- I don’t know, I’m someone who has a lot of strong feelings about a lot of things, so if someone’s telling me that I can’t take care of a patient the way I want to take care of them I’m going to be pretty upset about it. Especially if we’re talking about underserved populations, if you’re restricted by finances, if you can’t give that patient what you think they deserve, or what they need because of all these restrictions that their financial resources have or your clinic’s financial resources have, or how the system is set up so that Medicaid doesn’t cover X, Y or Z even though that’s the best care for them, like I think it’s extremely frustrating. It’s just like terribly unjust, and I think if I was that provider providing that care I would feel a little- and which I’m sure I will be that provider providing this care one day where I’m just like, ‘I don’t feel great about this. I don’t feel great about the way this looks and how this all pans out.’

Rachel: You feel like it’s actively working against you, like it’s the end of me sometimes where you just can’t get patients what they need.

Mark: I can speak to it a little bit as well. Kind of a personal story, so my father had Multiple Sclerosis, and the medications he was on were costing a fair amount of money. And luckily our insurance company was picking up a good amount of that, well then we lost that insurance, had to pick up another insurance company, and they required- it wasn’t pre-authorization but they wanted him to try a cheaper medication first before they would put him on the more expensive. And his doctor wrote to the insurance company saying, ‘He’s on this one, it’s working, just for the love of God let him keep taking this medication,’ and the insurance company flat out told the doctor no.

Dr. Ryan Gray: That’s too bad.

Levi: So you were saying patient care is the key- or like kind of what you were centralizing around was patient care is the heart of it, which I agree with totally. Now am I over-reading it by saying like systems- being overly concerned with systems medicine or delivery science is a negative, or is like superfluous?

Dr. Ryan Gray: No it’s not negative because it’s the system that you’re going to work in. But I think as students coming in, you need to understand that- and we all need to understand, even those that are in it now, is that things are going to change. And that’s the problem we’re running into where we’re dealing with these forty, fifty, sixty year old physicians who are tired of the change, and they’re being grumpy, and they’re getting burnt out, and it’s like okay it’s more change, and the Affordable Care Act, and you’re taking my money away, and oh you’re going to judge me based on patient happiness, okay what’s next? And oh, more documentation, and blah, blah, blah, blah, blah. And focusing on that is what I believe is what’s triggering the burnout, triggering the jadedness, triggering the frustration, and if you’re able to understand that all of those moving parts are always going to be moving, and if you focus on the patient care first and foremost- your own care first and foremost, you’re own health and wellbeing first and foremost (I think we do a terrible job at that), patient care second, and everything else after that, then I think we get into a space where we are much happier, or have the ability to be much happier because we’re not focusing on all the other crap that’s going to change.

Advice to Premeds

Alright so let’s wrap up here. I want to go around the table, starting with you Levi, my audience nontraditional premed students, traditional premed students, those that are wanting on day to be where you are as a medical student; what advice would you give to a premed student besides listening to The Short Coat Podcast?

Levi: Just you know, find ways to get involved with organizations and stuff that are in line with your passions. As I know coming right out of it, the premed, it can be daunting and definitely find the select few things that you’re really passionate about and really pursue those, because those are what help make you who you are, and kind of help you to tell your story later, and once you get to medical school if you’ve kind of delineated what your passions are, you’re going to want to stick with those because they’re going to help you maintain a piece of yourself as you kind of start the journey into diving head first into all the studying and all the things that are going to take hours out of your day, you make sure that you’ve found a few things to kind of keep yourself centered.

Dr. Ryan Gray: Corbin?

Corbin: I have two pieces of advice I guess. One is to- this is a little controversial advice. One is to give yourself permission not to go to medical school.

Dr. Ryan Gray: Yes.

Corbin: But give yourself permission to decide that this isn’t what you want, and make sure that it’s what you really, really want before you decide to do it.

Dr. Ryan Gray: Yeah, it’s okay to change your mind.

Corbin: Yeah it’s okay to change your mind and decide you don’t want to be a doctor. I think it’s totally okay. And two is kind of what Levi was saying, like don’t forget who you are in the whole process, stay home if you will to what you care about and what you value because in premed they’ve probably already experienced it, people will tell you what you need to do to get in, they’ll tell you who you need to be, what you need to say when you go to interview, and that continues on in medical school. People will tell you what research you need to be in to get the residency you want to be, people will tell you what you need to do to impress this attending to get good evals. But the most important thing is that you stay true to who you are because that’s what it’s all about in the end, and that’s what’s going to make your life worthwhile. I mean if you’re true to who you are, you’re going to get good patient care, like that’s what it’s about.

Dr. Ryan Gray: Awesome. Mark?

Mark: So gearing towards the nontraditional person, or the traditional individual that feels that perhaps they’re not ready to get into med school, the advice I would give is look at the support systems around yourself as you start kind of gearing up the machine of preparing for medical school and preparing all your premed courses and all that. And I think a lot of the determinants of whether you succeed or fail have more to do about what you’ve built around yourself to succeed, and I think one big thing is like success isn’t defined by, ‘Did I make it immediately? Did I go straight from high school, to college, to medical school, and I’m shooting straight through, and I’m going to get the residency and start my practice by the time I’m 30 and I’ll be killing it.’ I don’t- I think the biggest thing is focus on the support systems, and it’s okay to extend that process, and I think you will find yourself in a way better position not just for succeeding in med school but just as an individual as a whole. If you take that time to look around and say, ‘I know what I want, but this isn’t the moment yet. I’m going to go ahead and work on these other things in my life and become a total individual before I really gear-‘ and I don’t want to call it a machine but the idea is you’re really going through a process. You’re going through a refinement of yourself to become a product that is going to be the best for your patients. So make sure that you are presenting the best version that you can be before you start into that world. And I just- I don’t know, I feel like the nontraditional path is an awesome way to go, and if you are losing hope earlier, it’s okay to start considering that, and I think that’s the big thing like Corbin was saying. It’s okay to say med school is not for me right now. It’s not a one-time thing where you make that decision and it’s over. You can always come back to it.

Dr. Ryan Gray: Awesome, I love that.

Rachel: And to the nontraditional students don’t be afraid of being there and being like, ‘Oh I don’t want to go back because I’ll just be surrounded by 22 year olds because that’s not the case at all.

Mark: That is not the case at all.

Rachel: And it’s so interesting to like meet people who have like gone into the work force for like six years, or done something neat. Weren’t you a balloon-

Mark: I did a couple things. We don’t need to go into them now.

Rachel: It just makes it a lot cooler as an experience just to have a really well-rounded class, and as a nontraditional student that definitely helps round it out more. But I guess my advice would be don’t be boring.

Dave Etler: Don’t be boring.

Rachel: Don’t be boring. Don’t be the person who-

Dave Etler: Don’t suck.

Rachel: Like if you ask them, ‘What do you do?’ You’re like, ‘Oh I study. I work really hard.’ Don’t just do that. Have other things that you’re interested in, maintain those interests, don’t just retreat and become a hermit occasionally.

Mark: Don’t be a gunner.

Dr. Ryan Gray: That’s great. Dave, as the mastermind behind The Short Coat Podcast, how can students take what you’ve learned and hopefully implement podcasts in their undergrad or in their medical school in the future?

Dave Etler: I’m so glad you asked that. So I always say that medical education has a problem, or a problem to solve, and that is to make sure that while you’re providing all of this information to your students that they were going to need to practice, that they continue to be human beings, that they continue to be empathetic, good human beings. And I think one of the things that podcasting can do, and one of the things I hope that we do, is to provide a space to consider the implications of the system that you’re in, of the process that you’re engaging in. There is very little protected space at this point in the world of medical education, there’s a very little protected space to sit down and think about what it is you’re doing. And that’s one of the things that I think podcasting can do. I’d love to see more podcasts in medical school. The other thing I think it does is it gets you used to the idea that you could be a force for communication in the public sphere. And I’m thinking- when I think about this, there are people who you can readily point to, the most famous one being Dr. Oz, right?

Dr. Ryan Gray: That’s a terrible example.

Dave Etler: Well it is.

Corbin: I’m thinking Atul Gawande.

Dr. Ryan Gray: Yeah Atul Gawande, much better.

Dave Etler: But I mean I say Dr. Oz because you know, in the past anyway, he’s- and I don’t know what his current situation is, I stopped worrying about him. But in the past he was not a force for good in my opinion as it relates to communicating medical information to the world.

Dr. Ryan Gray: He still does.

Dave Etler: And you know, in a sense we need counter- we need people to counter that. And I hope that podcasting could be a way. I think- I definitely think that podcasting could be a way to expand one’s sphere of influence for good.

Final Thoughts

Dr. Ryan Gray: Alright that was Dave and all the students from The Short Coat Podcast. Again go check them out, www.TheShortCoat.com. Thank you to Dave and all the students that take the time out of their day to come on this podcast.

I hope you got a ton of great information out of the podcast today, and I want to remind you that I have a book out. It’s called, ‘The Premed Playbook: Guide to the Medical School Interview.’ And you can go get it right now on Kindle. The paperback version is coming, it might be available by the time you check it out over at Amazon, but I’m not sure yet. Again you can go check it out on Amazon or go check it out at www.MedSchoolInterviewBook.com. If you get the Kindle version you can actually get it for free for thirty days I think if you sign up for a Kindle Unlimited trial. So you can read the book, you can definitely read it in thirty days, and get all the useful information out of it, and you don’t even have to pay for it. But that’s okay, I wrote it so it will help you on your journey to getting into medical school, so hopefully it will help you do that. Again, www.MedSchoolInterviewBook.com or go to www.Amazon.com and search for ‘Medical School Interview’ and I’m usually right there in the top one or two. So I would greatly appreciate you going and checking out that book.

Alright I hope you have a wonderful week. Next week is number 200. I still don’t have any idea as we record this what I’m going to do for episode 200, but I’m sure I’ll do something fun, or interesting, or neither, but there will be an episode 200 at the very least. So I hope you join us for that, and have a super collaborative week, and check out everything else that we’re doing over at www.MedEdMedia.com.