Why the Best Doctors Go Above and Beyond

I have, I have a story to tell, but it might be kind of inappropriate. Wait, okay, now you have to tell the story. 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.

Great to hear from you.

Thank you. Great to hear from you.

Yeah, uh, we haven't been quite as active on our podcast recently, and I know everybody's been missing us, but we're back stronger than ever.

We are back stronger than ever. Went through a little bit of a hiatus studying for STEP, but now that is behind me, so we are moving forward. And now I'm going into my third year clinical rotation.

Yay! Yeah, exciting! It's finally getting real. You finally get to do the stuff that you have been been practicing to do all of this time. Mm-hmm.

So I guess going in as a third year, what advice would you give to me for making a good impression? Because I know, you know, obviously like I want to do well and I want to learn a lot and I don't know, just kind of the balancing the thing of understanding my role as a learner while still trying to be helpful to the team and, um, and obviously make a good impression on attendings and stuff because that is a part of my grade too. It is.

I think the mistakes you can make are overstressing on trying to be perfect for your attending. Unfortunately, there's, you know, all you can do is prep. When you're rounding and you have certain patients that you're presenting and so you want to make sure you know the patient, you know the history and the physical exam and the lab results and everything that you want to present about, and then you've read about the condition because the attending's going to ask you about that. So, you prepare on that, but you know, it's also, it's not a, you know, it's not a performance. It feels like a performance, but it's not a performance. And that's preparing and presenting is only one part of it. There's lots of other things that you're doing all throughout the day, and some of that is just taking care of patients. I found more and more as my, you know, as I went through more rotations that, you know, sometimes these patients just need you to bring them a fruit cup.

Yeah, yeah.

Sometimes they just need help. I remember I was at the VA one time and this guy, the VA just all, do you guys go to the VA at all?

No, we don't get the VA.

Okay. It is the VA is kind of nice. For some reasons, but it was so, you know, kind of dysfunctional and disorganized at times. And like, I remember this guy was waiting to leave. We had discharged him at like 8:00 that morning. We had written all his stuff. We didn't need to do anything more for him. And then he was just waiting and waiting to go because somebody had to bring his clothes up from the locked up in a locker somewhere or in the basement and Finally, I was just like, gosh darn it, we're just waiting forever for this. And I went down to that basement and I went searching for this guy's clothes and brought it back to him. And he was so grateful. And that was just the type of stuff that I would not have done early on because I'd be like, well, there's people for that. That's not really my job. And again, it was one of these days I was on call, I was hanging out, there was nothing going on. And so, you know, why not sort of go out of your way and try to, do nice things for people if you can. Yeah.

Yeah. And I think like that is an important aspect to think about of like, you know, you do have the privilege of being able to like make a small impact like that. Like you can't, there's, there's a lot that you can't do, you know, you can't necessarily tell a patient their prognosis. You can't tell someone like you don't have all that knowledge. You're learning that. But the things that you can make an impact for, yeah. Like getting the clothes for the patient, finding them a blanket when they're cold. Like, yeah.

Yeah. Some of that stuff. And they do, they appreciate it. Yeah.

Someone was telling me a story about, um, a patient that they saw who had neurosarcoidosis and like very rare, right? So like, you know, they had been through the wringer of all the places in the Houston Med Center and then like at the Mayo Clinic. And you know, like when you have a rare condition too, all the med students, everybody's coming in staring at you like you're a freak.

Yes.

And like apparently he kind of took some time to talk about like just where they were from and was actually interested in like the country that they were from and like had some, that he had visited there before and talked about some restaurants with them. And they told him that he, that was the most impactful encounter that they've ever had.

Oh my gosh. That is like heartbreaking, isn't it?

Right? Because it's like, yeah, because everyone wants to come see this pathology when, and then you just kind of forget that, okay, this is.

There's actually a person attached to that disease. Yeah.

And it's like, okay, he spent an extra 5 minutes, but The 5 minutes for a med student doing that, it's just, you know, it's, you don't have as many patients as the attending and all of that. So like, I don't know, you're kind of able to give a little bit more. I don't, I mean, I don't know, I haven't done it, but.

Yeah, yeah, you can. And I think that, I think early on you kind of think like, oh, I don't know, in be, when I do have extra time, I should be studying for my shelf exam or reading up more on my patients or going through the chart to, you know, really review all their labs or some of those things. And of course you got to do all of that, but at some point you've, you know it all well enough and you can, you can spend some of that time doing, doing some other things that just make a difference to the patients.

Yeah.

And I think that, I, I think that helps with, number one, it's just a good thing to do, but number two, it just kind of helps you have a broader perspective because there are going to be times when the attending asks you some question, you don't know the answer to the question, you feel stupid, and now your day is totally ruined. But your day will be better if you feel like, okay, at least I made a difference in somebody's life today.

Yeah, I think it's hard too when that is separated, when you are trying to make— you know, it just, it gets sticky, I guess, when you're trying to make such a good impression on this attending, and sometimes that doesn't necessarily correlate with the care that you're providing to the patient. Yeah, sometimes it does, I'm sure. But like, I don't know, maybe sometimes it's like if you are spending that— those extra couple minutes having a conversation about something else with the patient, then, you know, the attending doesn't necessarily see that.

And it's like, it's just wasted if the attending's not seeing it.

Well, you know, that's kind of the mindset I feel like a lot of people get, and maybe that's where people run into trouble. I don't know.

I think they— I think that does make you run into trouble because Again, you're just focusing your attention on the wrong thing, and I think that that can kind of come across too. There's some people that are going to spend every minute trying to impress and, you know, trying to impress that attending, and I just think people can kind of see somebody who's a total suck-up.

Mm-hmm, yeah. Some people like a suck-up though.

I guess.

Really? You don't think so? I don't know.

I mean, I guess it depends, you know. I guess some people, some people might like that. I don't know. It just, it's so cringy because I just think it's so embarrassing when you're— somebody's obviously just sucking up to you. Yeah, I saw a TikTok of a girl, uh, oh, it was a resident who said, oh, this was so sweet, this med student came in on her day off and brought me a Starbucks. Isn't that great?

Was she like being serious?

She was being serious.

See, that's what I'm saying, some people like it.

Yeah, and everybody in the comments said exactly what I said was please don't normalize this. Yeah. Good God, med students have enough to do. They don't need to be coming in on their day off to bring a Starbucks to the resident so that the resident likes them and they get a good evaluation and blah, blah, blah, blah, blah.

Let's, let's— yeah, I feel like that's again back to the thing of like we're losing the plot here, right? Like this is like giving, you know, obviously you want to be respectful to everybody, but it's like the, the— we're losing the plot of the point that we're here is not to spend our time taking like getting a Starbucks for the resident. We should be taking time getting a warm blanket for the patient or like trying to do something that would actually like benefit the patient.

Yeah, yeah, I don't know, I just, I You've got to believe that you just do the right thing and eventually it will pay off for you.

Yeah, that's true.

I have a story to tell, but it might be kind of inappropriate. Okay, now you have to tell the story. So talk about going above and beyond for a patient. Oh no. Okay, but let me just say there was a patient on the gynecology service when my— one of my friends was rotating on that service and she was having— she was born without a vagina. And so she was having a surgery to create a vagina for her. And the attending, who was not a real nice person, came through and said to her, said to the patient, well, you're going to need some type of device Well, he said in a very crass way, he said, you're going to need a dildo to put in there to kind of to keep this dilated so that this vagina, you know, keeps its shape.

Like at home? Like, why did they not have anything to do that?

Right? They didn't have anything. Like, what do you mean? Yeah, exactly. I don't know. Right. There should have been some sort of medical device for this purpose. But he says, oh, yeah, you need to go, you know, you need to have a dildo. And the patient is like, What do you mean? I'm in the hospital.

Yeah.

Like, how am I going to do this? And, um, and then the nurse said, oh no, he was just kidding. He was kidding. And she was like, oh, okay. Well then he came back and he is like, okay, so do you have that? Because you're gonna need that before you go home. And she's like, no, I don't have it.

Yeah. What? So that's like telling someone, oh, you need to like have this certain ice pack after your ACL surgery and it needs to like, that needs to, and we're not gonna tell you how to get it or where to get it or whatever. You just need to have it.

You just need to have it.

Yeah.

And remember, this is before the internet. This isn't, you couldn't just get get online and get this type of thing. So my good friend, who is just this type of person, goes to this sex shop called the Pleasure Chest in this kind of seedy part of town and, you know, goes shopping for this thing. And I think he brought another friend of him with him, a friend with him.

And they—

Oh, this is a guy too? This is a guy. Yes. So he's going around and he was like, wow, who knew there were so many options? Oh my goodness. He was like, what exactly size and color and shape and all of this. But he, I think he may have even got her a few options. I'm not really sure. But he finally, he found something that seemed acceptable and brought that back to the patient. And then she was able to be discharged from the hospital because, because she had this thing.

Wow.

And I was just like, You know, that's just like, that is so sweet that he did that.

Right?

Yeah. Yeah. I mean, again, that's really—

I mean, seriously, I thought going and finding a warm blanket for a patient was going above and beyond.

Going to a sex shop. That's a whole different deal. That's a whole different thing.

Man. Wow. Yeah.

Yeah. And he, he is that type of person that just, you know, does do lots of things for people. And but again, you know, she was so grateful she didn't have somebody to, to, to go out and do this for her. And, um, and you know, I don't think he got any credit for the attending for that. I don't think his grade was any better. Um, but he made a difference and we all still remember it to this day.

Yeah. Yeah. I mean, it was a good story. I think that's true. Just like, I don't know, in the sense of like, yeah, karma and doing just like doing the right thing too. I think that that goes so much further than just like getting this question right and impressing the attending in like one moment. I don't know. Yeah, it's hard to get— look in the broad scale of things, especially when you feel like you're doing everything right and then your grade or whatever it is is like still not reflecting it. Like, I can just imagine. And I think that's where a lot of people run into frustration too, is they feel like they're doing all the right things, they feel like they're going above and beyond, and then they're still not getting—

I know, they're not getting that kind of reward. Yeah. Um, Yeah, and that's, I don't know, I think that's just kind of, that's just part of life.

Yeah, that is part of life.

And that happens in medicine too. I mean, sometimes you really do work super hard for your patients and you are doing, ordering all the tests or listening to the history, I mean, doing all of the stuff and the patient is still unhappy. Sometimes they're unhappy because they get a diagnosis that they don't like and they're upset with you. And it's a bummer. You're doing your very best, but you're not— it's like you're not getting rewarded. But again, I think that happens in all kinds of different things in life.

That's true. I mean, or like you're trying everything you can, the patient's not getting better, right? Yeah, yeah. So it's like—

that happens as well. So, um, but I think it all comes from that not being so results-focused, just trying to do the the best you can with the knowledge that you have and the skills that you have at the time.

Yeah, that's true. But then I don't know, that is really hard. I feel like we're so like, get to the next step, get the results, do, like that's what we're ingrained to do. So it's like, yeah, I don't know.

Yeah, that's been your whole path so far is do this, do this, do this.

And then it'll work out, study hard. And you'll get the good grade, you know, do this. But then it's like, okay, now you throw another curveball in there of like a lot of it is not your control anymore. And it's like you can still work hard, work hard, work hard and not get what you want.

Because these evaluations are very subjective.

Yeah.

I mean, sometimes people like you and sometimes they don't.

Yeah.

It's—

did you have anyone that didn't like you?

Oh, can you imagine anybody not liking me? Yeah, I mean, I didn't have any, like, really the, you know, other than those, you know, some of those attendings just being total jerks. But I didn't have anything that I think was really like totally affected my grade. But I just had, I don't know, just having to work with some of these dolts, like the guy who always said the team eats together.

Oh, have you talked about that before?

I don't know. This one resident who didn't have any friends.

Who was a resident?

Who was a resident. Oh. And so it was on surgery. And surgery, you just move around like a little unit. And we had to be all together the whole time, which there's lots of sitting around on surgery. You wouldn't really think that, but surgery is all about hurry up and wait. Yeah. Come on, we've got this case. It's coming up. We gotta be all ready. And then you get there and then you wait because the operating room's not ready. And so then you sit there for 2 hours and then it's like, come on, come on, it's time to go now. Okay, been sitting here for 2 hours. But anyway, we had to move as a unit everywhere. And then, okay, it was time for lunch. And then I'd see my other friends down in the cafeteria and I wanted to go say hi. But then I was like, "Oh, okay, well, I think I'm just going to go over here." And he said, "No, the team eats together." That's so weird. Yes.

It's like, what do you do to, you know, be respectful? Right.

And you know, what can you do? You just have to sit there and eat with the team. And there's my friends just like 2 tables over and they're all laughing and having a good time. And I'm stuck with this this weirdo.

Well, also that, I mean, kind of goes into what you're talking about, about on your TikTok, about like residents being mean to med students and stuff, and how like that's just, again, not good karma and not good— like, getting good for business. It's not good for business.

Yeah. And I— it's— it is a— I don't know why people don't think about that a little bit more, um, because— and, and just to explain, I Heather Bartos saying how for residents, when you're trying to build up your future practice, you really need to be starting now. And these med students who you think are annoying or inconsequential are the people who sometimes are going to be the doctors who are referring patients to you in the future. And so, and they're going to remember that you were a jerk to either them or to their partner or their other friends or anything else. And so, and trust me, they're not going to refer you any patients if you, if you do that. And it is just, it's really a funny thing to be, because you're going to go through this and you're going to have all these people be all mean and toxic to you and stuff. You'll be okay. Don't worry. But— Thanks. Thank you.

Encouraging.

But these people, I mean, they are coming to my door all the time, like begging for my referrals.

Yeah.

And they're all, I mean, I want to think that the people that I refer to hopefully were never like that to anybody. But it's really funny because the same people who you— especially you call them for a consult when you're a resident, you've got to call for a surgery consult or something. And there's a million reasons why this is a terrible consult and you don't need a surgical consult and blah, blah, blah. And they just complain and complain. This is the same people who I could give the exact same consult to now and they're like, yes, Yes, ma'am. Thank you, ma'am. Really appreciate you. Oh, thank you so much, Dr. Blah, blah, blah. Like, oh my God, how the— how it's very, very different when you're actually getting paid for the consult versus just extra work. But it's just, it really, it does just kind of make me laugh, especially when they're, you know, they're always like nice and professional, but they're— I mean, it's always lots of please and thank yous.

Yeah. And also just such a shift from, I feel like, the respect given to people going into primary care in medical school and then versus all the specialists now. All the specialists are at your feet.

You're begging me.

Yeah, exactly.

Yeah.

It's like, okay, you can say like, oh yeah, I think I'm going to do family medicine. Oh, so good for you.

Wow.

And then all of a sudden it's like, okay, I have all these patients now. I'm looking for cardiologists. Yeah. Yeah.

All of a sudden they're your best friend.

Yeah, exactly.

Yeah, I went to one female doctor networking event and I came home and I was like, I was the belle of the ball. Everybody wanted to talk to me. I mean, at one point I had like 5 doctors around me all trying to hand me their business cards and like, oh, your primary care. Oh, blah, blah, blah. I'm this, I'm this, I'm this. Like, okay, back off, people. One at a time.

Wow, paparazzi coming in. Yeah.

Sort of along those lines though is, um, and this is, this is going to happen a lot as well, is when you should be confident and when you should say, I don't know that. That is something that you have to deal with your entire career, especially if you're like me in family medicine. There's stuff I don't know all the time. I can't possibly be an expert in every single thing. And I have to be comfortable saying, I don't know. I don't know. Even things that I—

I wrote an essay and talked about this in my interviews even.

Oh, you did?

It was— this was like a go-to thing that I talked about.

Yeah. Oh, so— oh, well, go ahead.

No, I just had a— I had one thing and I talked about it in some secondaries and also like this this was— I know I talk about my TikTok a lot, how I had like a couple of stories that I would tell in interviews for medical school that kind of I would shift to answer whatever kind of question. But like the essence of this story was essentially just like that, just teetering the line between being confident, making patients feel comfortable, and, uh, like setting expectations and saying I don't know and still like saying that you're not perfect. And I just told a story about like drawing blood on a kid.

Oh yeah.

Yeah. And I like, I told the mom that I could draw the blood and that it was going to be fine. And then I never was able to get the blood. And, um, I kind of told a whole story about that and just like, you know, and then I felt really bad because again, I told them I could do it. I said like 100% I can do it when the truth was there's always a chance that it's not going to work out and there's always a chance, you know, the procedure's not going to go as it should. And I don't know, and it's just kind of trying to have the balance between those two things, I think, is like a really important skill to learn.

Yeah, and that's a tough one though too, because you have to be confident if you are trying to draw blood on a kid. You have to say like, look, I got this, trust me, it's gonna be okay. Uh, because if you say, yeah, I might get it, I might not, like, nobody's gonna want to let you stick a needle in there. For sure. So I think it's— that's a—

but still, I mean, at the same time, like, you can never— in anything, you can never like tell a patient 100% they're going to be okay.

No, you can't. Yeah, you can't. You can't guarantee any outcomes. Yeah.

And, um, yeah, that's something I honestly still struggle with now, is because you want to reassure patients, right, in anything, and they get a diagnosis, whatever it is, and you want to reassure them. I think especially just as I was saying earlier about what med students can do for a patient. It's like, I feel like that's also going to be something that I really have to, you know, not— I guess I really have to— what's the word I'm looking for— like censor myself. Because when a patient asks a question that I don't know the answer to, yeah, it's like you can't answer it and say whatever because you don't know.

You don't know. And Yeah. And you could kind of mess everything up.

Exactly.

Yeah. If you, if you, if you're overstepping. But there are questions that patients ask you that you can answer. And so you can tell them the stuff that, that you do know. But when they— you just have to get comfortable with saying, I don't know. I think that, you know, you can ask the resident that when they come in later today or try to maybe give them an idea of when they can have get that information. But, um, but look, people ask you all the time for predictions. Mm-hmm. When do you think I'm going to go home? When is this CT scan going to be done? Every day patients ask me, when is my prescription going to be ready? I'm like, I don't— yeah, I don't know. I mean, I will send— I'm sending the prescription in right now. It depends on how long it takes them to get it ready. And I don't have any control over that. So, and you try to just I don't know, be, be as nice as you can, but also, but scheduling tests too. I'll say, okay, we want to get an MRI. Well, when do you think it's going to get done? Well, depends on the imaging center and all kinds of things that are totally out of my control. So, and you know, but you want to tell them some, something to expect. It usually takes 2 to 4 days. If it takes longer, if they haven't called you in 3 days, give me a call or some sort of parameters. I think that that's helpful to people. But when you're getting into the nitty-gritty of the medical questions, that's when you do have to be really, really careful about how exactly you answer those and try to give them some information. But, you know, they do see you as an expert and they're going to want information from you.

Yeah, for sure. Like, my friend's still always texting me and calling me for information. Right. Like, I don't know anything.

Yeah, you haven't even started your rotation.

No, I haven't.

Yeah, anything.

I'm gonna throw out some crazy diagnoses because I have no idea. Yeah, um, yeah, but I guess in regards to like being confident in like the learning setting with attendings and on your team and stuff, what do you have a point about that?

Yeah, I think that's really hard too because you do have to have— people don't like it if you're too wishy-washy, so you have to have a certain level of I don't know, confidence just in yourself and, and that you read about this and you know these certain things. And so you have to present yourself that way, even when sometimes you're feeling a little shaky.

Yeah.

Um, but I don't know, I feel like you're good at that stuff.

I don't know. I do feel like I am self-aware in some sense, and I think that's an important thing. It's like, okay, I know this and this and this, they asked me about this, I don't know, I don't know that, I didn't read about that. Like, I think I can just like admit when I'm wrong, admit when I'm— I don't know. Yeah, yeah, I think that that's important, I guess. But I don't know.

But it's, it's kind of both. It's, it's fine to admit when you don't know, but it's also important to realize that sometimes you do know. This is the situation that would happen a lot of times is you're, you're sitting there at rounds, the attending is asking a question to Joe and Joe is sitting, he's not really answering it very fast. How long do you let Joe stumble before you jump in with the right answer?

Yeah, I mean, I don't, I don't really know the answer to that.

Yeah, me neither. But, but I will tell you, I found that to be a very tricky thing. I personally, and I feel like this is a little bit genderish, but I don't know, or maybe it's personality, but I feel like women are more likely to let that person have a chance to answer because he's thinking. Joe's thinking about the answer and I want to give him a chance to answer. This is his time to answer this question. But I found that when I got asked a question and if I didn't answer it right off the bat, I'm taking my time, I'm about to answer it. Joe jumps in right in front of me and answers it before I even get, even though I know the answer.

Yeah.

But I just didn't get it out fast enough. Fast enough and tending to just, oh, excellent job, Joe. And you're just like, yeah. And I would— I got really irritated with it. But then I found that that was a very socially acceptable thing to do. Nobody else seemed to be mad. Well, the men didn't seem to be mad when other people did that, but I never got comfortable doing that. I just, I just didn't think it was the right thing to do. I want that other person to have a chance to answer. And so I, I didn't do it, but, um, I don't know. You'll have to figure out where your comfort is. I feel like you're not gonna start just jumping in and talking over people.

Yeah. I don't know. That's the thing too. I just, yeah. So much of even what, what I've talked about for the past 30 minutes on this podcast, it's like there's so much that I don't know and I'm still learning the, the dynamic of these situations. Yeah. And I'm sure it's gonna change from rotation to rotation. Yes. And like different people and different, like, I don't know what the vibe is gonna be. So a lot of this is me just theorizing, but I don't like, I don't know. Yeah. Yeah, and I don't know what I don't know.

And you'll have to— in different groups of students do this differently as well. And you're kind of with this particular group, and then you mix it up a little bit on, on different things. But sometimes, like, I was with this one other guy for all 12 weeks of internal medicine, like each rotation. And, um, yeah, I didn't— I got real tired of him by the end.

Well, just, I mean, you're talking about attendings and Or I mean residents and med students, like residents being kind to med students for business and stuff. It's like your classmates too. Like you don't want to like make a bad impression on those people. Like you want to be nice to every— like, yeah.

Yeah.

Even when you're with 12 weeks with somebody and they're really on your nerves.

Right. Right.

Yeah.

But yeah, just stuff like that. Like, because people do undercut other people to make themselves look better. And so. Yeah, maybe it did. Maybe you got a better grade or you looked better, but long term, I just feel like that's just not a great way to live your life.

Yeah, it's hard to think about that in the moment though.

Mm-hmm. It will— we'll see the next— well, next time we're— sometime soon on a future episode of the podcast, you'll have some insights of how things are going so far.

Yep. And I'll have more exciting things to talk about rather than just Step 1.

Yeah. Yeah. It'll be good. Good to get you out of your room.

Yeah.

Yep.

Definitely will be good to get out of my room, even though I know it's going to be hard. I know it's going to be really hard. And I don't know what I don't know.

I know. Right. Right. It's— It is. Everything's hard.

I'm going to be miserable. I know.

Everything's hard and everything's different. But it's, it's, it's exciting. It's exciting to have the next thing. Come along. You've, you've been doing this thing for long enough.

Again, I'm ready for the next challenge.

So yeah, yeah, yeah. All right, all right.

Well, well, um, thanks for listening, guys. Uh, you know where to find us at Generations.md on TikTok and Instagram, and you can find my mom at PGY—

oh, Dr. Davis PGY30 on TikTok.

And if you have any questions or interested in being a guest on the podcast, you can email us at askgenerations.md@gmail.com, and we will talk to you guys soon.

Bye! Bye!