Counterpoint: So you think medical school is for you? Good for you!

This Counterpoint is an open letter that was written in response to a recent Globe & Mail editorial (Think medical school is for you? You’re probably wrong) which took a pessimistic perspective on the pursuit of medicine as a career. This is the fourth in a series of replies, written by the BoringEM team.

Each part of this series features a reply from a person at a different level along in their medical career. The following is from an emergency medicine physician and residency program director at McMaster University. Join the conversation in the comments below or on twitter with #DearPreMed


Dear Aspiring Medical Student:

I’ve spent the last few days thinking about how best to address Ms. Sinclair’s recent article in the Globe and Mail in a discussion with a premedical student. That contemplation has been consolidated into this letter of advice. I hope you find it useful.

First a bit about myself, I am an Emergency Physician at a busy academic Emergency Department in Ontario. While a medical student and resident, I was involved in student and resident leadership on the local, provincial and national levels. I’m heavily involved in both medical education and hospital administration and have worked with hundreds of learners (from medical students to residents) over the past 5 years I have been a staff physician.

I was none of the things Ms. Sinclair talks about in her article. My GPA in University was far from perfect (I think I got a C in first year Biology), my MCAT score was good but not perfect, and I was far more interested in being involved in everything than spending my life in a textbook (that has not really changed). I still don’t think I have read “Doing Right,” but I do have a copy of it somewhere on my bookshelf, which has as many (if not more) fiction books than medical textbooks.

Most medical schools and residency programs are not looking for a canned version of that clichéd answer – “I want to help people”, though we hope that is true. We are looking for, well, real people. Do you have to have good grades? Sure you do. But when I am sitting across from prospective candidates, I am looking for something else.

Medical school is not easy, but that is not because of many of the reasons Ms. Sinclair articulated. That’s why we are looking for people who have lives, play well with others, can carry on a conversation about what’s going on in the world, and are able to empathize with others. Many of our students have worked outside medicine, conducted research, and had another career before they arrive in medical school. Many have experienced failure and hardship in their lives.

Contrary to Ms. Sinclair’s supposition, Medical school is far from an easy answer… To give a bit of perspective, here are a few facts:

  • Medical school debt often runs into the hundreds of thousands of dollars.
  • In your first two years, you will try to cram a new language and skills into your brain before your senior years where you will suddenly be ‘part of the team’ (albeit under close supervision) and responsible for making decisions and caring for patients. With that new stress on your mind you will still be trying to learn everything you need to know to get ‘MD’ after your name. And it does not end there.
  • Residency is your on the job training. You are both a health care provider and a trainee, trying to juggle your clinical work with learning the specific knowledge and skills of your chosen field.
  • Sometimes the hours are long (although significantly improved over the past two decades). When it’s 4am and you are on your fourth bottle of diet coke, you’re not sure when you ate something other than chocolate, and you can’t remember when you last went to the bathroom you do begin to wonder: “What did I sign up for?”

Burnout is a real problem in medicine. Not because we don’t love what we do. And not simply because we experience conflict in the workplace. Sometimes there are disagreements in the hospital, but most of these are resolved by aligning interests with the question: “What is in the patient’s best interest?”

In my opinion, burnout comes from systems level issues. What hospitals and health care professionals around the world are facing: higher patient volumes, more complex patients, limited resources, and unreasonable expectations. Add to that working long hours (it’s 2am now), being on call or working when your friends are on holiday or sleeping, taking on the emotional load of those you care for, and having to make high-stakes, life-altering decisions with little to no information.  Although most of us learn to deal with it – it is one of the hardest things in the world to tell someone their loved one has died, to watch someone die right in front of you despite your best efforts, to tell someone you made a mistake, to playing musical beds at 3am in an over-capacity Emergency Department so that there will be a bed for the next critical patient rolling in the door.

On the flip side, sometimes we win. Sometimes the system magically aligns to work for our patients. Sometimes, we can restore a pulseless patient’s circulation, quickly identify-and-escort a patient with early necrotizing fasciitis to the operating room and save their leg, or simply brighten the day of a petrified 4-year-old that needs stitches.

All of that being said, is it worth it?
Sure it is.

Most of the people I work with, from medical students to senior colleagues, love medicine. Sometimes, that love is the only thing that keeps you going.

Many of us take on other roles (many of them volunteer): teaching junior colleagues, sitting on committees to improve patient care, working on curriculum planning, or designing new care paths and medical directives. Why? We do it because it makes the system better.  Why is that important? Because together, our teams of nurses, respiratory therapists, social workers, child life specialists, environmental aids, porters, doctors and innumerable others actually want to help people. Most of us do it, not for money, nor prestige, nor security, but because we actually really like what we do and we think it will help make the world a better place.

So to you, the aspiring medical student, I say: “Good for you!”

Medicine is a long road and it takes hard work. The work isn’t just in medical school and residency, it continues even when you finish your training. When you start your practice you will need to stay up-to-date in the ever-changing world of medicine.

However, there is nothing more satisfying then when you can help someone get better, or tell someone their loved one is going to be fine, or hand a popsicle to that child whose cut you just fixed… They may never know your name or remember you, but you will remember them.

Best of luck with your applications.

Alim Pardhan, MD, MBA, FRCPC
Royal College Emergency Medicine Program
Program Director (& Alumni), McMaster University


This part 4 of the #DearPreMed Series by BoringEM.

Edited by Teresa Chan (@TChanMD), Brent Thoma (@Brent_Thoma), and Eve Purdy (@purdy_eve)


Author information

Alim Pardhan
Alim Pardhan
Alim Pardhan is an emergency physician in Hamilton, ON. He is an Assistant Professor and Program Director of the Royal College Emergency Medicine program at McMaster University.

The post Counterpoint: So you think medical school is for you? Good for you! appeared first on BoringEM and was written by Alim Pardhan.

Staghorn Calculus

This fellow had a chronic history of renal stones (also a stent). The POCUS showed his collecting system filled with calculus. The entire calyceal system and pelvis was packed with stones.


Pull my finger. Dorsal dislocation of PIP

A young adult male sustained an open dislocation of the PIP for his middle finger while playing rugby.

Pull my finger

Hopefully he wasn’t doing a Hopoate.


The finger was neurovascularly intact.  The wound was not obviously contaminated.

The finger was anaesthetised using a ring block at the level of the web space and the wound was cleaned.

The clinician puts on gloves to give a better grip.  The proximal phalynx was held in the clinicians non-dominant hand with the clinician’s thumb on the palmer aspect where it can be used to stabilise the distal end of the proximal phalynx.

The clinician then grabs the rest of the finger in her/his dominant hand and pulls and hyperextends the middle phalynx.  The middle phalynx is then flexed reducing the dislocation.

The PIP joint was grossly unstable indicating disruption of the volar plate – the ligament joining the palmar aspect of the proximal phalynx to the palmar aspect of the middle phalynx.  The volar plate prevents hyperextension and dorsal dislocation of the joint.

Volar plate

Where there is a large avulsion fracture, say > 30% of the joint surface talk to hands/ortho about potential fixation of the fragment.

Generally the PIP is splinted with 30˚ of angulation with a zimmer splint (1cm wide malleable aluminium strip with foam on one side).  The middle phalynx does not need to be taped to the splint – so it can flex but not extend past 30˚ of flexion.  This is called a dorsal blocking splint.

dorsal blocking splint

If the joint is not unstable when relocated some advocate simply buddy strapping the finger to one of its neighbour.

The laceration was cleaned and sutured (being careful to avoid the flexor tendons).

Any finger dislocation should be reviewed by a hand therapist at about a week.

Open dislocations should be discussed with hands or ortho who may want to wash the joint.



Diagrams from:

Music: Flume remix of Tennis Court by Lorde

The post Pull my finger. Dorsal dislocation of PIP appeared first on EM Tutorials.

I am Victoria Brazil, Academic Lead for Clinical Skills and Simulation at Bond University: How I Work Smarter

How I Work Smarter LogoIn the first post for the “How I Work Smarter” series, I called out one my favorite, accomplished clinician-educators Dr. Victoria Brazil, because she makes extreme-productivity look easy. Victoria was kind enough to provide her trade secrets, and it is with great pleasure that I share her responses to the questions in this series.


  • Name: Victoria Brazil
  • victoria brazil photo 2012Location: Gold Coast, Australia
  • Current job: Emergency Physician, Gold Coast Emergency Department Associate Professor and Lead for clinical skills and simulation, Bond University (aka ‘Bond girl’)
  • One word that best describes how you work: Enthusiastically (mostly)
  • Current mobile device: iPhone 5 (… there are other devices?)
  • Current computer: ASUS Ultrabook 13’ (that’s right… not a Mac)


What’s your office workspace setup like?

It’s definitely ‘the cloud.’ I have 5 ‘offices’ – two different EDs, 2 different university sites, and home. My satchel carries a laptop or ipad, phone, portable laptop speaker, earphones, remote clicker, iPhone microphone adaptor, and adapters for lightning to everything AV, and occasionally lipstick.

Vic's office

What’s your best time-saving tip in the office or home?

Inefficiency is not necessarily poor productivity…. I spend a lot of ‘office time’ just chatting with people But I do use Dropbox, Any.Do, and Mozy back up to manage projects/ activities/ documents.

What’s your best time-saving tip regarding email management?

  • Delete most.
  • Ferociously ‘unsubscribe’.
  • I use tags in Gmail. An email has to earn getting into my ‘AAA to do’ to be given attention.

What’s your best time-saving tip in the ED?

Try and build relationships with everyone, so you can delegate effectively and safely to junior staff, nurses, orderlies and even patients.

ED charting: Macros or no macros?

No macros. Write less. Disclaimer: our billing is not tied to our documentation in Australia.

What’s the best advice you’ve ever received about work, life, or being efficient?

  1. Armani is always worth it (from my mother).
  2. Self discipline is far better than self esteem (also from my mother, I think)
  3. Very successful people are absurdly selective (from a random self-help blog)

Is there anything else you’d like to add that might be interesting to readers?

  1. I choose projects, jobs, and talks all based on who is involved – mates should always take precedence over prestige.
  2. Running is my creative time.

Who would you love for us to track down to answer these same questions? (list up to 3 names)

  1. Hillary Clinton
  2. Chris Nickson
  3. Natalie May

Author information

Michelle Lin, MD
ALiEM Editor-in-Chief
Editorial Board Member, Annals of Emergency Medicine
UCSF Academy Endowed Chair for EM Education
UCSF Associate Professor of Emergency Medicine
San Francisco General Hospital

The post I am Victoria Brazil, Academic Lead for Clinical Skills and Simulation at Bond University: How I Work Smarter appeared first on ALiEM.