THE TRUTH ABOUT THIRD YEAR

like leave you little notes about—

I don't think someone walks around anymore.

I think it's just all on Epic, but okay, well, somebody's sitting there on Epic and looking at these things.

So hi everybody and welcome to the podcast. This is Generations MD. My name is Stephanie and I'm joined here by my colleague, Dr. Sarah Davis, who's also my mother. Hello.

Hello. Excited to be here.

I'm glad you're excited to be here.

Me too. Good, good. Yes, well, you're now pretending to be a doctor, pretty much.

I am pretending to be a doctor, and it is— it's a lot of fun. It is.

I'm—

so I just started my third year. I'm a month in to my internal medicine rotation, um, and this month has flown by, honestly.

Yeah.

Yeah, I've—

and you had heard lots of horror stories of how awful the wards were going to be, blah blah.

Yeah, yeah. Um, and I mean, it's really great. I, I think it's really cool being able to take all the knowledge that we've learned and then apply it. Like, I'm having, I'm having a ton of fun. It's like, like just learning and Yeah, I definitely feel like in the past month I have learned more than I have like in the past year. I mean, it's really, I mean, not, maybe not really, but it's really just applying stuff. I mean, I talked a little bit about this on TikTok, but coming from the first 2 years of med school are just so isolating and everything's online and you're really just kind of in your room. You know, you go, you have a couple things that you go to school for, um, and you talk through pe— talk to people, uh, talk to your classmates about and study with them a little bit. But majority of the time it's really just in the books, in your room, just studying. Everything is all up in your head. And then like just coming from complete isolation and then going into the hospital and then just being thrown into rounds, having to talk about stuff, um, in front of doctors, in front of people who really know what they're talking about. It's really intimidating, but like. It makes everything just come together and click. I will also say coming from isolation to then straight into the hospital, which is a petri dish of just—

True.

Yeah. And particularly my floor that I'm working on, it's kind of known as just smelling like C. diff. And it had a particular C. diff stench today. But yeah.

So nice. But anyway, you know, you're really getting the full experience that way.

Seriously. Yeah. But yeah, I mean, so, you know, you're in the hospital all day and then you have to go home and study, but it kind of feels like high school when you have to be at school all day and then you have homework to do. Yeah, because the studying is not like— I guess it's not like you're learning a whole new body system or all new information. There's new stuff as in management and stuff like that, but a lot of it is kind of— it's, it's building on the knowledge that you already have. Yeah.

And just kind of putting it together.

Yeah. And applying it and talking about next steps and stuff like that. It's not like the studying before when you were studying all day every day to learn an entire body system.

Mm-hmm. And so do you feel like When they're talking about different diagnoses on rounds, for, for the most part, do you know what they're talking about?

Oh, for sure. I mean, for diagnoses and stuff. Yeah. I mean, of course it's like, yeah, you, I mean, like, you know what they're talking about. The stuff that you don't know is like, well, like, okay, DVT prophylaxis.

Okay.

How do you go about that? They don't teach you that in medical school. They don't teach you like, okay, you come into the hospital and everyone's going on low molecular weight heparin. Like, why are we doing this? And like, how do you choose which thing to do? That sort of stuff is the stuff that you learn and you pick up, and, and those sort of things. Also just medications in general, like, and knowing the common names to certain things. Um, wait, I have, I have a joke for you.

Okay.

Why do you have to, um, handle metronidazole with care?

I don't know why.

Because it's very flagel. Okay, that's kind of funny, which I didn't get because I didn't know what Flagyl was. I just know Metronidazole.

Okay, yeah, that's true.

Like all of this stuff, I—

some of these ones, yeah, that, um, that I still know by the brand names because they were brand name when, when we used them, and then they go generic, and then pretty soon everybody just refers them by their generic name. But when you're learning them in school, they always teach you the generic name, um, even when there's a brand name, and the brand names are so much easier to remember and pronounce.

For sure, for sure. So like, I mean, there's learning curves with stuff like that. And yeah, and obviously like making different differentials. I think a lot of the learning stuff too is, you know, being like, okay, I think this person— this is a good example of like a good pimping question that I got on rounds is I had this patient that came in and Um, they had some various stuff going on and I thought that they were at risk of acute pancreatitis. So during my rounds I was like, acute pancreatitis on my differential. We maybe we should order a lipase. And then the attending was like, well, how, like, okay, if the lipase comes back and they have acute pancreatitis, like how would that change? We're still keeping her in the hospital and all this stuff. And I was like, oh, I was like, do you give antibiotics? And he's like, no. I'm like, do you give steroids? No, you don't change management. So there's no point in ordering that lipase.

Okay. That's super interesting because we used to do all of those things for acute pancreatitis. We gave them Zosyn, broad spectrum antibiotic. We sometimes gave them steroids and we kept them NPO. They couldn't eat or drink anything because it was supposedly going to flare up the pancreas. And I remember hearing as time went on, they're like, yeah, you actually don't need to keep them NPO. That's— that doesn't really help the healing process. But, you know, like, it takes a long time to adopt these changes. But I didn't know that they weren't doing antibiotics anymore.

Yeah, I mean, I didn't— I mean, I learned that too. But I mean, stuff like that is— because you're kind of building your differentials and, you know, you— and that's— I think in the past month, one of my attendings asked me what I thought I got better at, and I would say that's the thing, is, you know, thinking 2 steps ahead of is this important to do? Is this pertinent right now? This also is just very depending on like the team that you're on and the person that you're working with. I have had the experience of having 4 different attendings for the 4 weeks that I've been here, or—

oh wow—

which is, it's, you know, I've gotten to see a lot of different vibes, which I, I think is cool. Um, but it is definitely hard to adapt and hard because the first day of a new attending, it's kind of like you're, you do your presentation, they're kind of like, ah, med students, like, you don't know, and you don't know anything. You kind of have to like prove your knowledge a little bit for them to trust like what you're saying. And then it's kind of like day 2, they're like, oh, okay, yeah, like you can go, you know, go in there, talk to the family, do, you know, counsel them. And a little bit more, they kind of hear you saying some stuff, and then it's like, okay. And then the The next day on rounds, then they're, then they're engaged with you and they're like, what do you think about, you know, they actually trust you a little bit more. So it's kind of like also learning how to build that trust with your team and all of that.

Yeah. And that it's interesting on that style thing because, or like the thing of like, and it's very good to think two steps ahead. And I will say that even in regular practice, I see doctors order stuff all the time that is not going to change management one bit. Which does kind of drive me crazy. But that type of thing of like, okay, why order the lipase and really thinking it through, okay, what are we going to do differently is really good. Now, I mean, my cost on a lipase is like $2. So I don't know, sometimes I might just want to know that just for prognostic kind of indicators. But there's lots of other stuff that people order that you're like, why are you ordering that? If it's abnormal, there's nothing you're going to do about it. And it's just kind of one more thing to worry about. And some of those, you know, some of those studies are a bigger deal to do. So I think that's good. But my point on that is that sometimes the attending wants you to say order a lipase because they want to know that you've thought of pancreatitis in the differential. So, um, I think that that can be really different according to the different styles.

100%. That's what you kind of— you don't really know their expectations. I had a brand new attending today who walked in. I had I saw my 3 patients and I didn't know the style of what this attending was gonna be. I didn't know if they were gonna be, you know, they wanted a full thing. So I prepared all of my presentations with like a bunch of detail. And he walks in, he was like, listen guys, I'm a hospitalist. I'm coming here. I have a lot more patients than just this. Um, like you guys just get right to the point. And I loved it. I was like, great. Awesome.

So that was Matt Davis right there.

No, really. I mean, it was like, he was just— which I'm really glad that he said that and set that expectation.

Yeah.

So then I didn't— then our presentations were just a lot more like, this is this, this is why we're not— this is why we're keeping them in the hospital, this is what they need to do before discharge. And it's like very that, that versus— I know I'm about to move to a more academic team and it's going to be a lot more like in-depth, but A lot more of the, hmm, that is very interesting.

Why would the MCV be 105, do you think?

Well, yeah, and also some stuff like that. And it's actually— it is that I'm on now. It is fun that they're giving us more autonomy. We're able to— I mean, I've placed a bunch of orders. It's not a pro— like, they'll have to— the residents still have to approve it, so there's— there is a barrier there. But it is like, okay, well, I'll see, okay, this person has macrocytic anemia. I'm just going to like give them some B12 and folate. Like, I'm just going to like, I put that in the order and then they'll be like, oh, I saw you put that in. And then on rounds I'll be like, okay, I ordered that if you want to approve it, which that feels more important than the white coat, honestly. And being like, I think you should order a chest X-ray. So I'll just put it in and then we'll talk about it on rounds and then they'll be like, yes or no.

I think that Yeah, that's actually really great. We did not have that. We didn't— we— I, I think the— if we wrote an order and then the, then the resident had to like co-sign it right there. But I like that because, you know, it shows that you thought about it before rounds. So you really get to kind of show, yeah, I already thought about B12 and folate deficiency.

And it is helpful to the residents to just— because sometimes it's just annoying having to put all those orders in and just making— checking and making sure the meds are all right. So those little things. Yeah. But I mean, that's also very student and team dependent because sometimes it's like, okay, you don't wanna overstep, but yeah, I think, you know, managing, it's all about managing personalities. Um, oh, also, yeah. In regards to ordering excess labs and that sort of stuff, I have realized I, yeah, I really, I don't wanna do academic medicine at all because I really have vibed a lot with just the hospitalist, like, these are the barriers to discharge, or like, just kind of, again, how would this change management sort of thinking?

Yeah. Yeah. Some of that stuff, it, I don't know. It's hard for me to, it's hard for me to really get on board with things that are just really impractical and something that's not really, not only is it not helpful to the patient, it's kind of detrimental to the patient.

Oh yeah. The guy was not sick. He wasn't sick. He didn't need to be in the hospital. I think that's the difference too. If this was an outpatient workup, workup, that's completely different. If they come to you in your clinic and they're like, you know, and you need— you have the time and you can do a full workup and you're trying to figure— put, put together this whole picture, there's difference versus key. Like, when somebody's in the hospital, I'm really just like, people get so sick in the hospital is what I've noticed.

I'm like, it's not good.

The risk of them being in the hospital I feel like so much of the time and is a lot higher than the whatever it was that brought them there.

Yes, it's just always keeping them there. Yeah. Um, yeah, and I tell patients, um, like, your recovery time after being in the hospital, even if you don't get any secondary infections and everything goes well, because you're so inactive in the hospital— like, if you're in the hospital for a day, it's going to take you a week to recover. If you're in the hospital for a week, it's going to take you a month to recover. Those are not based on any actual facts, but it's just, it takes a long time to get back to your regular activities because, you know, especially older people when they're at home, you know, they're cooking for themselves, they're going to the grocery store, they, even if they don't have a super active life, they're doing some different things and they don't have to do any of those things in the hospital. And so it's, it does, it makes it so, you know, they lay around, they get sicker, they get pneumonia and lots of other stuff. So you got to get them out.

Yeah, yeah. But, and also, you know, different attendings have different styles with that. Some people are more inclined to keep, you know, obviously we'll want to make sure that this person doesn't end up back in the hospital, of course. So I think different attendings have different kind of risk tolerance with that sort of thing.

Um, and that depends a lot on the patient's social situation, of course.

I mean, we, I mean, yeah, we deal with that all the time too. Some patients like being in the hospital because that's their— so like, you know, it's kind of that's a bed that they have access to. It is— it makes the whole thing come together more. And also, yeah, it's all just like very problem solving. I just like it all because, yeah, you do have to take into account, okay, are we going to— you can't say follow up with PCP for every patient because they don't have that, you know. How are we gonna manage these discharge medications, you know? How are we gonna do— there's all of these certain things I learned today there was a patient on dialysis who I had, and, um, I was concerned about management of her hypertension. And I was like, okay, well, can we send her home with some medicines? Like, I just wanna make sure that she's compliant. And they were like, dialysis patients are the best patients because they see a doctor 3 times a week. So like, I'm less concerned about a dialysis patient following up than I am somebody else, which I was like, okay, that's good. Stuff like that that I'm learning, you know.

Yeah, yeah. And it's some of those antibiotics, it was perfect for dialysis because you give them a dose and then they go to dialysis and then they get another dose and they don't need another dose until they come back for dialysis because it's going to stay around in their body that whole time, right, and not get, not get filtered out. So good, it's, it's in there, it's working, and then, then it comes off and then you give them their next dose, which makes the dosing really easy for some of those things.

Um, but yeah, I mean, I'm, I'm learning so much. I think I still kind of like am getting the thing a little bit like, oh well, you know, you're early on, you're gonna burn out, which I'm sure I will, you know. I'm still like, I feel like it's always the worst is yet to come, you know. I, I, before third year, it's like, oh, third year is the worst, third year is the worst. You get here, I'm like, I'm I'm really enjoying it. Um, they're like, oh, we'll wait till the first shelf, which, you know, I know is going to be hard. And then they're like, okay, well, you know, it'll, it'll just get worse, which I'm sure I'll get tired of it. It's all new and exciting right now. But, um, I do think— I really think a big part of it is what you make of it. Um, obviously there's going to be times when you get stuck with a bad team or you get stuck with an attending that you don't vibe with. But I think the people that say that, like, they always get screwed over every time, it's like, okay, well, I don't know. I think the odds of you having a bad attending for every single rotation, every single week—

yeah, you know, seems a little unlikely. But no, who knows? Yeah, I'm not here to judge, but, um, Well, I mean, the thing is also, if you get a bad attending, I mean, you're not with them for that long. I mean, I don't know with other rotations if you're— for us, a lot of times it was a whole month that you're with a particular team, um, like the same residents, same attending for a month. But it was not— it was never any longer than that. A month is a long time, but it's not, you know, it's not a lifetime.

Yeah, yeah. Oh, you know, I will say I think I would rather have a mean attending that doesn't keep me late than like a really nice attending that keeps me super late. Fair. Normally I feel like those things might, you know, kind of correlate, but I just realized like, you know, when you're— so much of your life is really just dependent on whether somebody is around and decides to be like, hey, you guys, you guys can go.

I know it is. It's really— and you're just kind of, you're just hanging around, hanging around.

Something happens, which, you know, it's fun if you're learning. But I will say, like, especially for the rotation that I'm on right now, it's the mornings are busy, busy. You go, you see your patients, and then you're rounding and you're talking, and it's like go, go, go. And then it's— then all of a sudden it slows down a little bit and it's like, okay. What do we do?

Yeah, I mean, if your team is not on call for new admissions, um, then a lot of times there's not that much for you to do once you— I mean, you know, that's what Dad does. Dad goes in the hospital, rounds, sees everybody, writes his notes, leaves.

Yeah, yeah. Oh yeah, I will say too, just the team that I've been on, because you're right about the month on, it was like that. I was with the same residents, but the attending was switching every week. And then this week is my last week at the hospital that I'm at, and then I switch. But the— our team just got along so well. All the residents were just so nice. Like, everyone is just so helpful and just like really made the experience and transition the best it could possibly be.

Oh, that's amazing.

Yeah, I mean, the resident— and we saw them today actually because we have to go to noon conference for IM. So all the residents and med students have to like listen to a lecture during lunch every day. Um, but— and we saw some of them and like we sat together again.

And nice, not because you had to but because you chose to.

Because yeah, because the residents wanted to hang out with us more.

They didn't say the team eats together.

No, no. So Um, so they were just— I mean, that like helps so much, like the, the residents being like going out of their way to just help us. And yeah, I mean, it was so— it was— it really, I couldn't have asked for anything better.

That's so good. Now, question, I mean, right now it's May, um, I'm assuming that these residents are like, they're nearing the end of whatever year they're on, right? So even Even the interns have like almost a full year of being an intern under their belt, which is actually really great. We started in July, so we were all new, they were all new. I don't think that was really ideal.

Yeah, they'll start in July, the new people. Um, yeah, it's not ideal. Also, like, for certain stuff, like, the residents don't— are not as The, this is their last block, especially for IM. There's a lot of prelim people who aren't even doing internal medicine. They're just there because they have to do their intern year. Um, so they kind of just rotate through everything and a lot of them, they're at the end. They're not really, they know so much and then, then they know how things flow and they don't really, they just let us do a, a lot of the stuff. Um, because they're kind of done with it. Like, I don't know. And also like little stuff like a paracentesis, they're like, yeah, if a med student wants to go do it, just like go do it. Like, I don't need—

yeah, and you guys are fired up to do that. Yeah, I'm gonna do any of this.

Uh, I didn't do it, but, um, yeah, I mean, a lot of people do like LPs and paracentesis and all of that because it's just, you know, yeah, just cold news to them. Yeah.

Oh, that's great.

Yeah, yeah. So Um, but yeah, in July apparently people said the new residents come in and now you're gonna kind of know a little bit more about the hospital. So sometimes it's like, okay, you can kind of like help them where things are and all of that.

And yeah, yeah, well, that's helpful. That's actually— so that's something for people to think about when they're choosing, you know, or putting in their preferences for how they want to do their stream, as you say, or the order of your different rotations is, um, I think doing internal medicine like you are doing early on, I think that's, you know, when you've got this seasoned team, is really good. I think it's, um, you know, and then whatever you do in July, that's—

I don't know, I—

it's just something to factor in of the different people and where they are versus where you are.

So 100%, I think like there's all things to consider and there's pros and cons to everything. Like, but coming off of Step 1, having all of that fresh knowledge and going right into internal medicine is really helpful because a lot of it is just, you know, it's just all medicine. And also just learning straight off the bat how to present, how to work Epic, how to chart check, how to like see patients in an efficient way.

You—

it's a good— I really am glad that I, I think it's really been good to start on. The only negative versus like some of my friends who are starting on psych right now They're kind of like, they hear us talking about all this medicine and everything, and then, you know, they're like, oh, I don't, you know, once I get to my more medicine-y things, they feel like they might feel a little bit more behind, which is not true. They'll definitely like catch up on the whole thing, but it's just, it's just different. The con though is that 60% of Step 2, which I take at the end of this year, is internal medicine. So people say like you forget it, but at the same time, I feel like you're using medicine throughout all the time here, so— but I don't know.

Yeah, I don't know. Well, you'll see how it goes. But yeah, I feel like medicine is just kind of in, in everything, especially if you're paying attention. Yeah, so that's good. But it's so nice that you're like, you're finally in the hospital, you're finally doing what you are there to do. Yeah, it's exciting.

I mean, it is exciting. It's exciting, like, even just kind of noticing the things that you have improved on, like, yourself. Even, you know, beyond just rounds and talking about patients and knowledge, but even talking to patients. Like, at first it's like, okay, I don't really know, you know, what— how long does a patient like this stay in the hospital? You don't really know. And then they're asking you, they're like, okay, well, what— when, when am I going home? And you're like, I don't know. And now just kind of seeing that and, you know, now understanding, okay, well, they're on IV antibiotics, like, you know, we can put a PICC line in versus like switching them to— or like, you, you kind of have an idea of like what the options are and we're kind of able to talk through it with the patient more, which I think is also really helpful. So yeah, yeah, yeah.

You know, zeroing in on why is the patient in the hospital, what is the one thing that's keeping them here in the hospital, that is the thing that we need to fix. I mean, there's people who never get that down. It's not—

it's hard, especially coming from a med student side when, you know, you have attendings that want to—

you—

and the problem is too, when you present, because these patients are so complicated, and also at like a tertiary care center. Like, it's, it's, you know, level 1 trauma. We have everything gets transferred, and we have these patients that have 20 different problems. And some people want you on your presentation to talk about every single problem and have like a reason and how we're managing it, when it's like, this person, everyone has diabetes. Like, do I— and they're on sliding scale insulin. Like, I do— I need to say this in every single thing, but And then also just making these differentials. Okay, this person maybe has gastroparesis. Okay, I think we should order a scope. They— we're not managing the gastroparesis in the hospital. Like, we don't need to do this. We, we don't need to do this full GI workup. And this is not keeping them in the hospital. So I think it's— it is hard though to balance those two things of being thorough and full with all these problem lists and making all these differentials And then having a plan for them. And then also the other side of it being like, this, I don't want to manage this right now. We can't manage this right now.

Yeah. And I, but those are really great skills to learn and it's knowing that everything's there and then prioritizing it. Uh, it's not that you don't know these things aren't a problem. You know that they're a problem, but there's just not anything that you can do about it at this juncture. And so, but But like I said, it's very intuitive for you. And hopefully that is with like your group of med students, but it's not intuitive for everybody. There's a lot of people who have a really hard time prioritizing those things. And they're very bothered when somebody has all these different things and they're not all perfectly managed and their sodium level is a little on the low side and they don't want to let them go home. And I mean, like I said, there are residents that I worked with that just had a really hard time with lots of those things. You don't get hospitalized for a sodium of 130. And that's not, that's not a reason to be admitted to the hospital. It's not a reason to stay in the hospital. Um, just, you know, get— send them on their way. We've done everything we can do. Um, but it's, you know, I don't know if it's like a little OCD that these people have, or I don't know, I just think they're just not great at prioritizing. And so, um, anyway, I think that's— I think that's good that that seems to come naturally for you.

Yeah, just like reading through all the labs. Well, their hemoglobin is a 10, which is a little low. So then, um, and then their white blood cell count is an 8, so we're back. And just like it, you know, going through all the different things, uh, but at the same time, you know, you don't want to miss anything and you don't want to— it Like, yeah, you don't want to miss something that could be important.

So it's better to be more thorough. Um, it's the— and I don't know, I don't know how the billing works in an academic institution, but, you know, in, in regular hospitals though, it is— it, it's important to realize that, you know, they get paid based on this, you know, DRG. Um, and so like when a patient comes in with pneumonia, the hospital is only going to get paid X amount of money whether that patient is there for a day or 3 weeks. Um, and so, you know, there— when we were in residency especially, and I'm sure these people are still in hospitals, I just don't work in hospitals anymore, but there was the utilization review person who was always coming by and looking at your notes, and then they'd like leave you little notes about—

I don't think someone walks around anymore. I think it's just all on Epic.

But okay, well, somebody's sitting there on Epic and looking at these things. Um, But it's— it is important to not waste resources of, you know, doing tests that you don't need to do or that are going to be repeated later on or something else. And which I think is what that person was getting at with, you know, not ordering the lipase, which, like I said, it's not a very expensive test, but multiply that times, you know, 1,000 and it does start to add up. But yeah, so I think that's, that's something that you— that is, it's important for the patient, but it's also, you do have to, you know, be a little bit more— I mean, you got to realize that, like, you know, the hospital's not in the business of giving away free money, and so they want you to keep an eye on those things.

Yeah, I mean, you do bring up a good point though, and I don't know the exact ins and outs of all of it, but what I do know is, I mean, Everyone that we work with is a, like, my school's physician. So it's, they work for the hospital and they are not billing themselves. They are not in charge of the billing side. They get paid a, a solid, a flat salary despite how many patients they see, despite any, any of that. If they order the lipase or not, you know, like all of that stuff. So I will say, I think in a big academic institution, people, you know, like I was saying, there is a lot more of a full workup with everything you have. A, you have all the resources right there, um, at the touch of your finger. And then two, you don't see the backend of that as much. And again, I'm sure there's that person that's looking on Epic and probably will like call you out for it or whatever, but like versus being in a small group when I think it's more so not money coming out of your pocket, but like you see the money in and out more. Um, so I don't know, that's a good point because I was talking to the— our attending today about just hospitalist medicine in general, about— I asked, he was like, well, no, I— he was saying the benefit of not being a part of a group and working for the hospital, you just deal with less admin and all that stuff. And we've talked about that at length on this podcast, but it is just like, it is a difference that you see because I think like you're less— when you don't see that money and it's just the hospital, you know?

Yeah, you're not thinking about it as much. Well, I do, you know, so in my residency we were at a private hospital.

Okay. Yeah.

Um, it did actually end up getting bought by the university system and kind of changed over when I was there, but I still— it still kind of operated somewhat independently, but I remember specifically that they had— they were comparing us residents and our internal medicine service that we had. We, you know, we're family medicine, but we called it internal medicine when we had our inpatient service and comparing that to the doctors in private practice and how much resources we used compared to them. And I remember like most of the stuff was really pretty similar, like our length of stay was similar and other things. But one of the things they said was that we we ordered a lot more labs than they did. And I remember thinking like, oh yeah, well, you know, I pretty much ordered labs every day on every patient.

Yeah, yeah, you do.

I was afraid that somebody was going to say— that the attending was going to say to me, well, what's their white count today? And I'd be like, well, I don't know, I didn't order a CBC today. And then they'd be like, oh, what, you didn't order CBC? And so, so even with that, they started saying, you know, every patient doesn't necessarily need all these labs every single day. Um, and so we, we tried to look at that a little bit, but I, you know, again, we just— when, when you're in training and you're learning, you don't exactly know like when you could get by without getting those things.

Yeah. Yeah. It is crazy though, just, I mean, talking about pay and cost and all of that, that residents run the hospital and it's like the point that these, they make nothing for working 6 days a week, every week. And just, I mean, they really do and like run the whole thing. And I don't know, it's crazy.

My friend was watching ER and I was a resident at the time. And she said, "You know, these doctors, they're like, they're residents, but they're like the real doctors." I'm like, "Yeah, I know. I'm a real doctor." That's what she's like, "Well, you're not doing the stuff that they're doing." I'm like, yes, I am. That is what we do. She's like, well, that's weird.

It's no, but it is funny when you're, I mean, I can see, you know, when I'm actually starting to do the whole thing and slowly, I mean, I can see like throughout third year you just learn so much and all this stuff. And then all of a sudden you're like, oh, like now you're, now you're a doctor. And it's just, yeah, I can, I mean, I'll even think about that with my friends in med school, my classmates. I'm like, oh, like I feel like I'm, I'm some point it's gonna be like, oh, you're a doctor, wow. I know, it happens.

Thinking that about your friends too. Someday I'm going to be referring patients to them, maybe if they end up in my area, which would be fun. I'm going to call them up and tell them, you know, you better take care of this patient right away.

All right guys, well, thanks for listening. Um, you know where to find us at Generations.md on TikTok and Instagram, and you can find my mom at Dr. Davis PGY30 on TikTok, um, and you can email us at askgenerations.md@gmail.com, and we will talk to you guys soon. Bye!