MappedCon presented by Blueprint Test Prep 2024 is this Friday, October 26, 925 Eastern. I'm starting the day in my track, the pre-med track, planting the seed of your personal statement. We have three tracks going all day long and a couple hours of amazing exhibitors where you can learn more about their programs. Again, MappedCon presented by Blueprint Test Prep, October 26, register for free. It's a virtual event and all the sessions will be up after. So even if you can't make it live, go register and get access to the sessions. Go to MappedCon.com right now, register. That's M-A-P-P-D-C-O-N.com. If you're applying to medical school in 2022 to start medical school in 2023, join me Wednesday or Thursday, Wednesday night at 9.30 p.m. Eastern or Thursday at 11 a.m. Eastern at premedworkshop.com. Go register today. I'm going to show you how to tell your story in your application. Again, that's premedworkshop.com. If you are applying to medical school in 2022, be there or be square. The medical school HQ podcast, session number 71. Hey, this is Z-Dog MD, rapper, physician, legendary turntable health revolutionary and part-time gardener. And you're listening to the medical school HQ podcast hosted by the irredeemably awesome Ryan Gray. Welcome back to the medical school HQ podcast. I'm your host, Dr. Ryan Gray. And I believe that competition amongst your premed and medical student peers is detrimental to becoming a great physician. In this podcast, we show you how collaboration, hard work, and honesty are critical to becoming a superior physician in today's health care environment. Three in a row. Hello, Alison. Hello, Ryan. How are you doing? I'm good. How are you? I am doing well. Before we talk about the kind of fun stuff that we have to talk about today, I do want to remind you, if you haven't yet, or if this is the first time listening to our podcast, go to free MCAT gift.com and download a comprehensive 30 plus page report all about the MCAT. We're not going to show you a cool physics equation that'll help you answer 50% of the questions, but we are going to show you the information that is necessary to do as well in the MCAT in your applications as you can. So go to free MCAT gift.com and download that report today. So if you listened to last week's podcast, number 70, which you can get at medical school HQ.net slash seven zero, we asked, we asked you to comment, to write in and comment about any TV shows that are medically based. And Alison kind of went off on a little tangent almost. I stopped her about how much they're just inaccuracies in Grey's Anatomy and House and all these other medical dramas. And so we wanted to, this is kind of a new topic that we didn't really think about talking about until Alison went off on that last podcast. But we're going to talk about kind of a myth busters, what goes on in TV dramas and what real life is like for a physician during residency as an attending and kind of kind of just kind of maybe burst your bubble a little bit. If you think that you're going into medicine because you want to be like Meredith Grey in Grey's Anatomy, then we have some heartbreaking news that that's not really what it's like. So Alison, let's start off by talking about what in your mind looking back at all the TV medical dramas that you've watched and now being an attending physician. What has been maybe the most accurate TV show that you've watched that portrayed medical life as accurate as it could? Oh, I like this question. Definitely without hesitation, ER, still a fantastic show. I have to say in my humble opinion after having become a physician, I would still watch that show. I think they do a really good job. Part of the reason is that Michael Crichton, who was the creator of the show, was a physician himself. Yeah, many of you might not know that. Michael Crichton was a doctor. He was before he was a writer and sadly, he's passed away. But he, I think because he was a physician and knew the profession and said it out, he was able to provide a lot of that information that is generally extremely lacking in all of these shows. It just kills me because I think, God, do they have any medical consultants or anybody who actually knows anything about the practice of medicine? Because some of the errors that are out there are just so egregious and oh, I just want to tear my hair out when I see them. But yeah, ER did a really good job. It's, it shows a very busy emergency room in the heart of Chicago and it's now been off the air for a bunch of years. But it shows real people and real doctors and nurses and medical assistants and medical students practicing medicine and how it's not all glory. It's pain and sometimes miserable. And, and it just, I think they did really, they did a good job in, in showing different patient cases, patients coming in with different problems and what it really can look like when those patients are treated for those problems. So it's just, just more real, you know, not, not the fluffy stuff on TV nowadays. Yeah. I, I don't think I watched a ton of ER, but I would agree that probably out of everything I've watched, that's the closest. Now, I'm going to give a plug for a show that the majority of people that I've talked to say, it's pretty good at mimicking real life, even though it's a comedy and, and I'm giving it a plug. I never really watched the show. But a lot of people say scrubs is, is very close to what life is like as, as a physician. Yes. And I'm a personal big, personally, a big fan of scrubs. I haven't seen all the episodes, but scrubs is actually based off of the place where I did my internship. Scrubs was based off of one of the brown affiliated hospitals. And it's really cool to think back on that. And there were actually some people who were modeled after in that show. But yeah, it's, there's so much silliness and just craziness on that show, but it really is sort of a good portrayal of some of the things that happen that go on in a hospital. So that's a good one. Yeah. And Zach Braff is hilarious. And the other people on the show, it's, it's, you know, good, good stuff. So let's talk about some of the Grey's Anatomy, some of the more poorly done medical shows. And we're not saying that Grey's Anatomy is a terrible show. But what we're trying to, to kind of come across and let you know is if you're watching Grey's Anatomy as a pre-medical student and you are kind of picturing yourself in that role, then you need to stop watching Grey's Anatomy because that's not what medicine is like. So one of the biggest things when, and Grey's Anatomy, I think, had just started when we started medical school. Yeah. I think it was in its first year. So it was, it was fun. We all used to gather around. We would sit around and watch it. Yeah. Because we're the new medical students. So this was what life was going to be like. But let's talk about some of the inaccuracies. Let's, let's bust some myths on, on Grey's Anatomy. So sex, in Grey's Anatomy, everybody's having sex, residents with attendings, residents with patients, residents with residents. Does that ever go on? So not in any of the experiences that I had or saw personally. I think, so it's interesting, actually, because if you read House of God, which is a great book about what it's like being an intern, it's a personal account from a physician who's now a psychiatrist, that book is filled with sex too. And I remember reading it right before my internship and thinking, oh my god, this is crazy. This book is like a graphic, pornographic novel. That's what grays in it. A lot of these shows are based off of that book. Yeah. And so it's funny because what I've talked to some of the nurses that I knew when I was doing my residency training, they would talk about how years ago, like 20, 30 years ago, because they've been there that long, there were some residents who would kind of shack up with the nurse or two. Well, when you spend back in those days, when you spend 36 hours or 72 hours, and that's the only place where you had time to have sex. Right. And you may not be seeing your family ever. Yeah. Also, I think just really on a more serious note, if you think about the culture of medicine and how it's changed over time, there was this sort of, I am the doctor, you're the nurse. And there is still some of that, but it's, I think it used to be medicine used to be male doctors and female nurses. And there was that blasting after people that you were at work with. And even just think about what people wore back then. And I know I'm not really being clear about when back then was, but it was definitely not recent. Nurses used to wear these little skirts and dresses. And now look, people are wearing, you know, a purple or green scrub outfit. It's not the most flattering thing in the world. It works, but so it's just changed, right? The whole kind of culture of medicine. And so it's just, but it's funny to think about, you know, maybe 30 years ago, people were having a lot more sex. I can tell you now, and Ryan can speak to his own experience. We are not seeing times when residents are sneaking off together during call or a resident is running in and having some, you know, a little, whatever, with a nurse. It just doesn't happen. Number one, you're far too busy for that. So maybe Ryan and I were just at really busy hospitals, maybe where it's quiet, people have time for that stuff. But it's, that's just not realistic. It's, it's not what's happening. Yeah. And relationships with patients is a huge no, no, big, no, no, it's not allowed period. Yeah, you can get your license revoked for doing that. And actually it's interesting. So it's something I learned not that long ago, maybe a few years ago, a physician and a patient, it is possible at some point for a physician and a patient to have a relationship, but obviously, or maybe not so obviously let me let you know if you have severed all ties with that patient in the sense that that patient is no longer your patient and being cared for by someone else. At a certain point in time, it actually is okay. It is ethical and it's acceptable for you to have a relationship with that patient, even a romantic one. However, interestingly, if you're a psychiatrist or you're seeing that patient from a mental health perspective, it's never okay. So even if you stop seeing that patient and it's years later, you're never allowed to to have a romantic relationship with that patient. Isn't it interesting, right? It's interesting. Yeah. Yeah. So anyway, it is so not okay to have sex or anything even resembling it with your patients. So that is just not happening. The first, I remember when we watched the first season of Grey's and Izzy and Denny were checking up in the hospital, that's not okay. How do you remember their names? I don't know, I have a weird memory. Anyway. So. All right. Another thing on Grey's anatomy that I remember clearly is it's Seattle, right? I think it takes place in Seattle. Seattle, Greece. And so one of the things that we always saw was everybody sitting outside enjoying a leisurely lunch. First of all, in the sun, it's Seattle. It's not sunny in Seattle. Yeah, failure number one. So that's failure number one. But number two, I don't remember many times being able to just kind of kick my feet up and relax and sunbathe during the middle of the day. Yeah, not happening. I mean, there were so many, even as a medical student, a lot of times you're so busy. And also, by the way, if you're a medical student, you're going to that noon conference. You're going to an educational session. Your school is not going to be saying, Oh, hey, take an hour for lunch and go and do some sunbathing and come back. No, they want you to be educating learning. And so medical students wouldn't have been outside. And then residents, yeah, you don't have time for that. You are rushing to the cafeteria or maybe to that noon conference. And even if you don't have time to actually sit in and listen, you're grabbing food, shoving it down your face, rushing back to work. And so that kind of like feet up on those chairs outside the hospital is such a joke. Yeah, is there anything else about Grey's Anatomy that you remember? Uh, I think, yeah, I mean, just the focus on the drama of it, the sex. It's a drama. They want that. That's what the producers, you know, that's how people get hooked and excited and blah, blah, blah. So the attendings yell at the residents a lot. That's normal. Yeah. That happens. It does. It does. One thing, they're surgeons. They're doing, I think it's just a general surgery residency. They always seem to be fighting over the operating room of clawing to get the best procedures and work with the best attendings. Yeah, they're very cutthroat. It's true. Cutthroat. That just doesn't happen. And you know what else? They make it seem like if you're doing a general surgery residency, that you do everything surgery, like all the different subspecialties. Yeah, your cardiothoracic surgeon, you're this, you're this, you're that, you're a neurosurgeon. Like for as an example, a neurosurgical residency is seven years usually, and it's separate. It's very specific. Yes, neurosurgeons do have some general surgery training, but you're not going to be in there like Meredith and the other guys, they're all like, you know, one day, they're with neurosurgeon, you know, McDreamy and the next day, they're with McSteamy in the ortholab and blah, blah, blah, blah. Wow, you know too much about this show. You do, you do do rotations and stuff. And so as a general surgeon, you are rotating. True. But they make it seem like you're always with all the different subspecialties, and that's not true. Yeah, that's true. Yeah, definitely. Right. Also, just the amount of stuff that happens that goes wrong. I mean, that's just, again, also part of it being a drama, but it's, you know, how many bad, terrible tragedies can one hospital go through that are, I mean, it's a little, you know, obviously hospitals do deal with tragic accidents where, you know, a lot of people come in and they're injured and a bus accident or something, but it seems like every time you turn on Grey's Anatomy, which I don't anymore, but every time I had, you're seeing like some cataclysmic thing happen and they're taking care of like all these, you know, victims and it's just outlandish. TV ratings wouldn't be very fun if it actually portrayed what a real hospital would be like. But see, that's what's so funny though, right? Like ER did. I mean, ER had it's a share of different tragedies and things that they faced as well, but it was more lifelike. And I think ER had some pretty stellar ratings. So, it's true. And less sex. Yeah. So I want to get into probably a show that we watch the most or for the longest time together. But in the end, I had to stop watching because you would yell at the TV the whole time. Oh, I know what you're talking about. House. House. Oh, house. What is it about house that you just didn't like? Oh my God. What did I, what did I like? There was nothing left. So the funny thing is, I remember I loved house when it first came out. And again, I think it was early on when we were medical students and we were in our first year. I think first and second year, I thought house was so awesome. And then we got into our third year and I realized how much BS there is in that show. And it just made me crazy watching it. There were so many things about it that were just so wrong and so annoying. Oh, and Ryan's right. I literally would. We'd sit down to watch an episode and I would just start yelling at the TV. And at some point, he's like, this is ridiculous. We're not doing the same work. Yeah. So what's one of the biggest things in house that you just, as a physician now working that you just called BS on? Okay. Well, the fact that they all do everything. I mean, so if you look at house and also, by the way, these are, I guess they're not residents. They're not even necessarily fellows. I think they're all attendings, but they're like, they're like his minions. Yes, his minions are his apprentices or Prantai. He can picks them. He goes to Cuddy. Is that her name? Yeah. See who has a good memory? He goes to Cuddy and says, I want to work with these three people and they're mine now. Right. And then these people somehow have the training to be able to do heart surgery one minute and then they're radiologists interpreting scans. Oh, and then they're in the lab and they're processing a gram stains and looking under the microscope. It's so ridiculous. So it's just a joke, right? I mean, one physician has a certain set of credentials and is trained in a certain field. Sometimes physicians do get double boarded and things, but the idea that you go into a hospital and this same physician is doing all of these things is silly, right? It doesn't happen. Yeah. The physician doesn't greet the patient in the emergency room and then walk them to the CT scanner, actually run the CT scanner machine and then walk them to the OR, scrub and do the procedures in the OR and then walk out, go to the pathology lab and look at the slides of what they just operated on. Yeah. And then oh, by the way, they're also in the room when the patient codes and needs to be resuscitated and yeah, it's pretty silly. That was a huge pet peeve. Yeah. And so one of the most favorite things that I wish we did more as physicians was break into people's houses. Who does that? You know, that actually was probably a saving grace sometimes because it was just so funny and so entertaining that they would do that. But yeah, sadly, we do not have the authority to break into houses. It's okay. I'm a doctor. Let me in. Let me find where you've been hiding this nasty bacteria that's killing you. It's like so silly. Yeah. But the other huge pet peeve, which we've talked about, is what does it say on houses door about what he is? He is a diagnostic something or other. Yeah, he's the head of diagnostic medicine. Yeah. Excuse me. That's what we all do. Yeah. We are all diagnosticians. So that's part of what you do, right? As a physician is you take a history, you do an exam, you put together in your head and with other people, what is going on with this patient, you make a diagnosis, hopefully, and then you provide a treatment plan. So for house to have this on his door, he is the king of diagnostic medicine. It's like so, so when all everybody else doesn't know what to do, you're supposed to go to house. But I just found that to be so annoying too. Yeah. And also, if you watch the show long enough, it's the same show every time, right? Yes, it is. A patient comes in. They're very sick. Oh my God. What do we do? Let's throw these meds at them. Oh, they're getting better. Oh, wait. They're getting sick again. What happened? Oh, we saved them. Yeah. It's a lot of like treatment and what works is how you diagnose. And we don't practice like that. We don't throw things at people we like to think that we don't. We don't throw treatments at people and then say, Oh, well, that one works. So this must be the diagnosis. Can you imagine? That's not right. That's not how it goes. And I think that was the biggest thing you didn't like. Yeah, that's right. It's just the medical inaccuracy isn't. We could go day and night about all the medical inaccuracies on these TV shows, but we won't. There's one other huge thing though that I mean, so if you've seen Nurse Jackie, which is actually a really funny show, she has a serious addiction problem and it's it's serious. I mean, it's a comedy, but it's a real problem. She's she's hooking up with the pharmacist in the show and she's sleeping with him and then she's getting all these free drugs and hooked on narcotics. But in house, right, the guy is popping Vicodin's by the handful and then going to work and you're seeing him and he's half the time he's like intoxicated. And then in these periods of of lucidity, he's coming up with the diagnosis. And yeah, it's it's kind of it paints him in a really bad light, but he's also it's interesting because they make this guy, you know, so revered by by the public because he's he's this master diagnostician, but in the background, his life is such a disaster. He's, you know, he's hooked on narcotics. He's also a terrible person. I mean, what of of any show to watch if you're trying to develop a good bedside manner, he is not a role model. That is true. So lots of problems with house. He is the kind of the poster child for that more of the paternalistic physician. Yeah. And in a like really over the top way, I mean, he's he basically completely demeans people. And the sad thing is I've seen physicians act this way toward their peers and other people, maybe not so much toward their patients because in this day and age, I don't think you could get away with that. But he's yeah, he's he's got his problems. So yeah. So we could go on and on about all these shows, but I wanted to talk about kind of what a true day in the life for a physician would be. And actually, if you're listening to this and you haven't heard about the website that Allison and I run called the Academy, which you can find at medical school hq.net/academy. We have interviews with different specialists. We have just when did we post that? Just recently, we posted an interview with a nephrologist. We have an interview with a psychiatrist, obviously an interview with Allison, the neurologist. We have physiatry. We have a specialty series interview, interviews, where we talk to these specialists about what a day in the life is like as each one of these specialties and what are good traits to have to be a dermatologist and orthopedist, what life is like. And so if you like the rest of this conversation, go check out the Academy, medical school hq.net/academy. Yeah, we're releasing one a month of those and they're really, they're really fun. And I think we're learning also from our colleagues who practice in these different fields and people really enjoy learning about it. Because I think a lot of pre-meds out there, you may be thinking, I really want to be an orthopedic surgeon or I really want to be a pediatrician. But what does that actually mean? What does that actually look like? And this really provides a direct window into what these people do on a daily basis and how also what are the key things you need to know if you want to pursue that field? Yeah. So let's kind of recreate this day in the life for you, Alison. You're an attending physician now. And for those of you that don't know Alison's story, she graduated from her residency back in June of 2013. Almost got my years mixed up. June of 2013, and it has been in private practice now for a good six months. Longer than that, but yeah, something like that. And so she's going to paint a picture here of what it's like to be in private practice in a clinic, in an outpatient setting for a neurologist. And this would probably be very similar to any outpatient physician working. So tell us what life is like. What is life like? Well, I get up in the morning and I make breakfast now. Life is good. I really enjoy what I do. If you've ever heard me on the podcast before, I legitimately really do love my job. I love what I do every day as a neurologist. So to give you a flavor, I generally will. So first of all, I'm primarily outpatient based as Ryan said, I'm at working at an outpatient practice, much of my time. I do some amount of inpatient consultation work as well, which is right now about eight weeks a year with some weekends and nights in there. And that's at a local hospital near to where I practice. And when I do consultation work there, I'm seeing patients who are admitted to the hospital or who are in the emergency room and for whom a neurology consult has been requested. So that patient may be coming in with a stroke. He or she might have a really bad migraine. They may have a very terrible infection in the brain or a seizure or there are so many different things. So I'm seeing patients in the ER on the wards and the ICU. And really, it varies so much when I'm on call for the hospital. I could see a few patients in a day or a few new consults and a bunch of follow-ups. I could see a lot of new consults. It really varies. It's unpredictable. But I do really enjoy that inpatient time because it also gives me the opportunity to interact with residents and medical students and that team that I love working with. So that's what some of my time is spent doing. In the outpatient world, which is where I spend most of my time, I also am working with a team. But it's a little bit different. So in my office, we have office staff, which really is made up by receptionists at the front desk. And we have a lovely office manager who is really responsible for making sure things go well at the practice. And there's a lot that they have to do thinking about insurance and lots of lots of different issues that come up. I have my own office at the practice and I will see really on an average right now, maybe about 10 to 12 patients a day. That can vary a lot. It could be up to 18. It could be four. I mean, it just really depends on the day. So it's hard to say exactly. But I see a lot of different patients and patients may be coming in for new consultations. For example, a primary care may refer a patient to me who has been having new word finding difficulty, new difficulty coming up with words. And maybe the patient's also been showing signs of some memory loss and their family is very concerned. So that patient may be referred to me for a consultation for memory loss and what could be going on here. And so I'll see a certain number of new patients in a day. And I'll also see some follow up. So patients who are already established with me, they've seen me before. Maybe this is the second time they're seeing me and I'm providing them with results from some of the workup that we've started for them. I may be providing them with a new diagnosis. I may also for a follow up visit be seeing someone who has a seizure disorder and is on a regimen of meds and we're just checking in for six months like a checkup. So lots of different kinds of encounters. I also do lumbar punctures in the office, which is otherwise known as a spinal tap. So it's a lot of different things. And I work with medical assistants as part of my team. And they're so helpful in helping me navigate all the administrative stuff that has to go on and getting scans ordered and talking to insurance companies. And when the insurance so let's talk about that some more. So what you've portrayed so far is what I think most people would consider the life of a doctor seeing patients taking care of patients, interacting with patients, treating patients, patients, patients, patients. When you actually at the end of the day, sit down and try to estimate the amount of time that you're spending with patients versus writing notes when the patient's gone, calling I guess the calling patients back or emailing patients, which we don't do emailing patients, calling patients, tracking down labs, working with insurance companies or fighting against them a lot of the times. That's a large part of your day, isn't it? It is. I was talking with Ryan earlier, talking with you earlier about how I don't like to necessarily think about how much time I'm really spending doing all of that stuff. I mean, in all fairness, I do spend, I'll spend 40 minutes with my new patients in 20 minutes with my follow-ups. And so that's a lot of patient care in there, which I really do enjoy a lot. And Ryan is right. I spend lots of time responding to patient phone calls and responding to primary care physicians who may be emailing me about issues that have come up with our mutual patients. Insurance companies and pharmacies, boy, they take a lot of time. I mean, you have to often fight with an insurance company, explain why you are prescribing a certain medication and why the insurance company has to pay for that and approve it because the patient has failed the other medication or they can take it because they have had a terrible reaction to it. So a lot of your time is spent getting in touch with these insurance companies and fighting for your patients. They have these things called peer-to-peer reviews where an insurance company will say, "Well, I'm not going to cover that MRI. I'm not going to approve it. You have to provide me examples or A, B, and C reasons for why. Why should we approve this?" And you have to get on the phone with them and say, "Hey," and you're talking to some random physician in another state, maybe not so random. In your specialty? Yeah. But not always, though, surprisingly. Yeah. You may be talking to a physician in another specialty and nothing bad against those people. I mean, they are practicing medicine, but they're doing it in kind of a different way. I don't know if they're practicing medicine, but they're working as physicians in a different capacity. Nothing wrong with that, but it's very frustrating when you're on those phone calls because you're trying to advocate for your patient and say, "Look, this is why this person needs an MRI and I'm not just trying to waste healthcare dollars. They legitimately need the scan." So that's frustrating. And then there's faxing, you're signing orders, and you're signing prescriptions that you're getting these requests from pharmacies all day long and feels like, "Please renew this patient's medication." And it's not just as simple as, "Oh, yeah, sure. You have to go into the record, make sure it's appropriate that you're renewing the medication at this time." Make sure they had labs done in your specialty. Yeah. It's a whole thing, right? So there's just so much—that's why I kind of don't like to sit back and think about it because it's unfortunate, right? There's a lot of administrative stuff we do. It actually goes back to that Hopkins article that we've talked about before, right, about how patients care in the hospital. If there was a study done where they looked at how much time interns are actually spending with their patients and how much time they're spending on the computer, remember the statistic on that? It was like 11 percent. Yeah, it was like 11 or 12 percent. It's so sad. 11 percent of a resident or an intern's time. It's an intern? Yeah, I think it was an intern, yeah. 11 percent of an intern's time is spent in direct patient care. The rest of the time is spent with administrative stuff. It's related to patient care. It's charting and medications and doing meetings with the rest of the team and everything else, but indirect one-on-one patient care, 11 percent. And that, I mean, we all go into medicine and you listening, you're going into medicine hopefully because you want to take care of patients. And when you hear kind of staggering statistics like that, and you're sitting back and watching Grey's Anatomy and watching House going, "Wow, look how cool their job is." They're just, they're with patients all day long. When's the last, well, I think I've seen some House episodes where I think Cuddy got it housed because he was late with his charting and stuff. But you ever actually see him doing it, right? Yeah. It's the same with Grey's Anatomy. Those surgeons in real life are actually taking time to dictate an operative node. You never see that. You never see that. Yeah, they don't show any of kind of the scut work. It's not really scut, but it feels like it's that unpleasant. It's not scut work. Yeah, it's not. But it's all that stuff, yeah, because scut has like no educational value and all that stuff. Anyway, it's stuff that is not fun, but it's part of what we have to do. That's part of it. At the end of the day, we're still taking care of patients, but you just have to go in with that mindset. That's why we're here doing this podcast. You to open up your eyes to all of this so that at the end of the day, you understand what you're getting yourself into. It's not like Grey's Anatomy. It's not like House. It's yes, taking care of patients and then doing everything else that's involved with patient care or doing computer based training to make sure that you still have credentials to use all the computers in the hospital and recertifying your HIPAA training and redoing your ACLS and ATLS and pals and every other certification that you have to have to be working in a hospital so you don't lose your credentials. By the way, if you're board certified, then you need to make sure you're maintaining all your continuing medical education units and going to conferences so you can get lots of units and education units in one kind of bundle. There's so much else out there. So much. You know, there's a new one recently. Every 90 days, every 90 days, I have to go in and let the insurance companies know that, yes, I'm still the same person. I'm still practicing at the same practice and I still have all the same insurance numbers and DEA numbers so that you can still get reimbursed for services that you're providing from the insurance companies. Every 90 days, I have to let them know that I'm still me. It's crazy. It's crazy. But you know, I will say one thing. When I think about inpatient versus outpatient time, I love the inpatient time because it's that acuity of care and working in teams and interacting with medical students and residents. I really enjoy that and the variety. But in the outpatient setting, there's almost more dedicated time built in with patients because your visits, you have 40 minutes with that patient and you don't always necessarily use all of it or you have that 20 minute visit with the patient. But some days, I feel like I'm spending more time interacting with the patient one after another after another because it's actually built into my day. Whereas in the inpatient setting, you may fly in, you know, for 20 minutes on a consult here and then 40 minutes on another and it's just it feels like you're kind of sitting more at the nurse's station for more of the day. You're with that computer and the computer's not your patient. You know, I don't know. The necessary evil in a certain sense. Yeah. And actually, pre-meds out there who are scribing now, I mean, that's a whole interesting concept and it's great, I think, because a lot of a lot of us as physicians, we we moan and groan about how much we are kind of a slave to the computer and explain scribing real quick for somebody that doesn't know. Oh, sure, definitely. So scribing is a great newer thing that is not new at all. It's not new at all. Okay. It's very old that's making a resurgence. Yeah. Well, and a scribe. I mean, that was like ancient Egypt, I think, right, where they had people who would just write down what was happening and would be be the writers of telling the stories of what was going on at the time. So, but in medicine now, they have have positions positions where a medical student or not a medical student, but a pre-med or or or anybody anybody else's job can come in and be hired to actually run around with or walk around with a physician often in the ER is where these these folks are are working, but it could be in other places as well. And they're actually documenting for that physician or other health care provider what is going on during the visit with the patient. And I've also seen this being used in primary care settings. It's great because if a physician has 10, you know, 15 minutes to go over the entire history of how a patient's been doing for an annual visit and do the exam and everything and then, oops, up, now you're up to your next patient and keep going and keep going. You don't have a chance to even have two seconds to get all your thoughts down on paper. So scribes allow that. Yeah. And if you don't have a scribe, then you end up what what Alison typically does is she comes home at the end of a long day and then works on her notes at home. I do. I've had periods during my first year as an attending where I've been great and I'm, you know, I have some time right at the end of each visit to dedicate to dictating that note and getting it down and in ink, well, in typing. But some weeks are hard. And some weeks, you're, I'm sleep deprived and I don't have a chance to do it. And then I'm sitting at home and poor Ryan is listening to me whine about how many notes I have left to catch up on. So that's, that's the realness. That's the reality. That's where you've been these last several weeks. Oh, jeez. Yeah. The last two weeks have been a little brutal. I've been a little behind, but, but yeah, you can't really get too behind because then the hospital gets mad at you. So you actually, you're required in a lot of hospitals and a lot of patient practices, outpatient practices to get your notes in within a certain period of time. Yeah. All right. So that's scribing for those that didn't know. And yeah. So that's, that's life as a doctor. But tell us, Ryan, I know you've talked about what it's like to be a flight surgeon, but tell, tell us why your job, what's a day in your life? How is it different as, as a flight surgeon from a neurologist, obviously a very, very different kind of job? It's different, but it really is the same. It's, it's, I'm in an outpatient setting. I'm seeing patients just like you are. I'm not dealing really with insurance companies since I work for the government and our insurance is pretty good. But I, I know we have some people that do manage some insurance stuff. But for the most part, it's dealing with patients, calling in medication refills and dealing with patient questions and labs and all the, the same stuff that you deal with, just primary care. Yeah. So Ryan is referring people to specialists. I'm inheriting those consultations. Yes. So that's, that's an important or an interesting difference. Yes. No shenanigans that they're better not be. Let's say for me with anybody else. No shenanigans and, and oh, can I just also mention as we're winding down here, the other two things that make me crazy about TV, just in general, TV shows have no idea about what it means to be in a coma. They show all these different patients on TV and they've had these terrible things happen and the patient is in a coma and the patient has no breathing tube. For God's sake, people, if a patient is comatose, they need protection for their airway. You need to have them be intubated. It just floors me every time I see this and the person's lying there peacefully, you know, like they're sleeping and oh, it's just so unrealistic. It's, and I, you know why I don't like it? Because then patients watch this on TV and then it's horrifying to them when they actually see their loved one in an ICU bed and the, and that patient is intubated. It has a breathing tube in and all sorts of tubes and lines and machines and buzzing and beeping. That's real. What they do on TV, the patient is often like in this beautiful room and it's very peaceful and quiet. It's just not real. So I think it gives people the wrong message and just to add one other thing, they always shock people who are flatlining. It's not, it's not a shockable rhythm. Okay. All right. I could go on. So my, my biggest pet peeve that will end on is nobody knows how to put on stethoscope. Oh, yeah, that's right. You always say that wrong way, wrong way. Wrong way. So for, for you listening, when you watch a commercial or a TV show, stethoscopes need to point towards the front of your face, towards your nose, they're angled towards your nose because that's the way that your, you station tubes, your, your ear canals go. And when you watch people put them on backwards pointing to the back of their head, it's just, I want to slap them. It's so funny about the things that annoy Ryan and the things that annoy me. They're very different, but yeah. Anyway. All right, folks, that was three weeks of a little bit different content. Yeah. But I think last week's when we started getting off on that tangent of medical shows, we needed to talk about them a little bit and kind of paint the, what really happens in, in medicine. It's not all guts and glory. It's, it's a lot of administrative stuff. Which is needed, but you know, hopefully this is also entertaining for you. Yeah. At the end of the day, we're still taking care of patients. It's still human-to-human interaction. And that's at the end of the day, what continues to drive us and hopefully what continues to drive you. So if you have any thoughts on this podcast, if you have any big pet peeves in medical dramas, go leave us a note, medicalschoolhq.net/71 for today's episode. If you're on Twitter, come say hi to me. I am at medical school HQ. Allison is at Allison_MSHQ. If you found today's show entertaining and somewhat informational, go to medicalschoolhq.net/itunes. If you have not done so already and take a minute of your time, if you would, and leave us a rating and review. Doing so greatly improves our visibility in iTunes and allows more people to find us when they're searching for valuable podcasts to listen to. So we think everybody that has done so, we're up over 145 star ratings, which is amazing. Thank you so much. So again, I hope you got a lot of great information today that will help better guide you on your path to becoming a physician. And as always, I hope you join us next time here at the medical school headquarters. [Music] [BLANK_AUDIO]
