Future Docs 4: Thinking Specialties, Gaining Real Experiences

Nov 28, 2012

Sarah Rapoport is a second year student at Brown University's medical school. She's 24, a New Yorker, and already an accomplished scientist. When we last checked in with her, she was waiting for her cardiology exam results and had just started doing shifts in an emergency department. She did great. Now, she's thinking about her future.

"It's constantly a conversation in the back of my head," she says.

And the conversation about what area of medicine she should specialize in goes something like this:

"If I meet a doctor, I want to know how they chose that specialty, how they knew that was the right decision for them, why do they love it? I really want to find something that I will love every day of my life."

Rapoport will spend the rest of her two and a half years in medical school at Brown University gaining clinical experience in a wide range of specialties. But she'll have to choose one when she begins her residency training after graduation. If she picks something like general surgery, she can still specialize even further later on. But Rapoport says she's already looking for clues to help her decide.

"Someone once told me to just pay attention to what you enjoy. And I think there's a lot of wisdom in that, that you can be surprised by what makes you happy."

Before last year, Rapoport says she never would have thought that radiology would interest her.

"But last year when we had our anatomy class, whenever we would dissect a certain part of the body we would also learn how to read the CT and X-ray images that correlated. I loved the CTs and the x-rays. I thought they were so beautiful."

The artist in her appreciated those images. But the scientist in her loved the unit on cardiology - the physics of the heart pumping blood. Still, what interests her in the classroom might look a lot different when it comes to hands on experience with patients with real medical problems. But sometimes, it's not so different. Part of Rapoport's schedule this year includes shadowing a doctor at Rhode Island Hospital. And twice in the past month, she says she's seen patients who seemed to walk right out of her textbooks.

"There was a man who had come in in DKA, which is diabetic ketoacidosis, so someone who is a diabetic but somehow for whatever reason, their glucose is through the roof. Usually glucose is supposed to be no more than 125. And this patient came into the hospital with a glucose reading of 570 something."

Rapoport says it was thrilling to recall the classic DKA symptoms she'd studied in class a fruity odor on the breath, blood sugar through the roof, frequent urination and observe each one in this patient. Thrilling but tough to watch a patient suffer. On another shift a man with jaundiced skin and a bulging belly showed up on her unit. She recognized the signs of end-stage cirrhosis of the liver.

"I'd heard of everything he was telling me. But in terms of hearing it from someone who personally was experiencing it and struggles with what all of these symptoms are, that was new."

She'll never forget him. It was also one of the first times she encountered a patient whose disease was so severe there wasn't much doctors could do. She knows there's no way to be fully trained for those kinds of situations, but she can practice other skills like putting in stitches, or sutures. All she needs is a fruit bowl.

"The bananas I sutured probably wouldn't pass the test of my putting them in the fruit bowl and someone not realizing that they had been sewn back together. But maybe that's something to aspire to."

This is the busy caf on Brown medical school's first floor where I met another Future Doc, Peter Kaminski, who you might remember. He's also a second year student at Brown, the one who listens to lectures at double speed on his computer. Kaminski has been exploring his own interests. He says he's pretty clear that he wants to specialize in some kind of pediatric medicine. And he'll have lots of opportunities to gain experience in that field over the next two years. But he says he hasn't gotten as much exposure to something else he loves: health care policy. Namely, the nation's changing and, he says, broken health care system. So he and a few fellow students launched a lecture and discussion series to fill in some of the gaps.

"What me and this team of medical students have done our best to do is try to line up a variety of speakers from the area and also just nationally to talk about topics as diverse as Medicare, Medicaid, the development of community health centers, private health insurance, and things like the Affordable Care Act."

Kaminski says turnout has been so high they've moved to a bigger lecture hall. And he says that signals how closely his peers are following the implementation of the Affordable Care Act legislation that's reshaping the national health care landscape.

"I think they don't just have their eye on it. I think they're intent on being the creators of change. I mean we recognize that things are going to change one way or another, whether we want them to or not. But with that comes tremendous opportunity to reshape things in a way that has tremendous benefit, not only to patients, providing direct care, but family members, and also to providers as well. It's hard work taking care of a population when the system's really not functioning the way it should. And if we can provide better health care more affordably and in an easier fashion, that makes our lives easier too," says Kaminski.

So, he runs this lecture series, plus another extracurricular project he helped launch that pairs undergraduates with senior citizens in the community who need a health care advocate. And he still manages to have fun.

"I've been learning tango for the past two months."

That's right. Tango lessons.

"When I was in high school I was very into singing and sailing. And my friends used to joke about me becoming a wandering troubadour at some point."

So perhaps he'll be a wandering troubadour who also happens to practice medicine, shape health care policy, and advocate for vulnerable patients. But will all these extracurricular activities look good on his transcript and help him get into a good residency program?

"Maybe they might help me. Maybe some residency directors will look at them and just think I'm very good at distracting myself. But to be honest I'm not really doing it for anybody other than myself or my sense of the fact that I live in this community, I want to be an asset to this community, and if I can provide some beneficial service then I'm going to do that."

Future Docs Peter Kaminski and Sarah Rapoport are wrapping up the first half of their second year of medical school. They've learned the basics of nearly every kind of physical exam. How to interview patients about what's wrong. How the body's major systems function and what happens when they're not working right. They're just beginning to call on all of this new knowledge on the hospital ward. But next semester, they'll have to put it to a much scarier test: the first major licensing exam of their careers.

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