Tag: resident

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What To Do With A Large Windfall During Residency

windfall

You may think it is just a pipe dream, getting an unforeseen large windfall. (and I’ve spoken about small windfalls before). Nevertheless, throughout my years of stewardship in the residency program, I have encountered a few residents who have had a significant life-changing amount of money fall into their hands. Some with cryptocurrency, others with family inheritance, and others with a stock pick that rose much more than expected. So, what is the best way to deal with a substantial windfall like this? OK. It might not happen to you. But it still occurs more often than you might think. And, if it doesn’t happen to you, it is still fun to mull over. So, let’s talk about some general advice about what to do with a windfall.

Give The Large Windfall A Little Bit Of Time To Sink In

In general, when you receive a windfall of a significant amount, your first thought is to do something immediately with the cash hoard. But your brain needs to catch up a bit with the reality of the situation. Typically, it would help if you waited a bit until the initial circumstances of the windfall had settled out. When it comes to money, emotion can interfere with the best and most rational choices that we need to make. So, give it some time. Waiting a bit won’t cause that much harm (just a little bit of a loss to inflation). But the opportunity cost of doing something rash with the money is much worse!

It’s Not All Or Nothing!

Just like you don’t want to put all your money on 00 on a roulette wheel (you will lose much more often than you will win!), don’t put all your money into one financial basket. Diversification is the name of the game. And you may want to consider not putting it all into one debt repayment or investment. Consider spreading out your newfound fortune on a host of different opportunities. It’s tough to predict the future. So, you are generally better off spreading your money into multiple options.

Consider Repayment Of Debt/Student Loans

Although many of your student loans are at low interest (or 0 interest rate currently), you should consider putting a large chunk of your fortune into your student loans. Why even at these interest rates? Well, there is always a risk that you may not be able to complete a residency, or an unforeseen event can happen that can prevent you from paying them back when the interest returns to normal. And student loans are generally not dischargeable in bankruptcy. So, taking these risks off the table is enormous. Furthermore, the peace of mind of knowing that your student loans are significantly smaller or even gone is priceless.

Savings/Investments

In addition to student loans, also consider putting some money away for a rainy day. Some good options you might want to consider as a low-paid resident will be an emergency fund for savings, a Roth IRA, or a hospital 401k if there is a match. And try not to buy individual stocks or bonds. That situation can lead you to a very undiversified state that can lose all your hard-earned money.

Other Depreciating Assets

Finally, if you still have some money left over, there is nothing wrong with a bit of enjoyment in your life. Just beware of taking too much to buy things like cars, boats, planes, or whatever else floats your boat. You may regret it later on. I recommend using no more than 10 percent for personal enjoyment related to these items. Otherwise, there is a good chance that you will regret any rash decisions you make for your future self!

Let A Large Windfall Be A Blessing!

Whatever the reason for the windfall, it is your opportunity to make it into a blessing instead of a curse. It’s an opportunity to make your life better and your future self happier. So, give it some time to sink in; don’t spend it all on one thing; consider repayment of debt/student loans, and enjoy a bit of it. Following these rules will make that obscene sum of money into something more than just a number. Grandma would be proud!

 

 

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Considerations For An Internal Medicine Resident That Wants Radiology!

internal mediicine resident

Question From An Internal Medicine Resident:

 Hi,

I am an internal medicine resident and want to switch to radiology. I’m also a DO and didn’t take the USMLE. I realize most programs require the USMLE exams. I am thinking of taking the exams and applying to advanced or R positions or completing an internal medicine residency and applying to radiology as a 2nd residency. What are your thoughts regarding taking the USMLE while in residency and switching residencies? Any words of advice regarding how to get letters of recommendation from radiologists? Thank you

 

Answer:

First issue For An Internal Medicine Resident

I would consider applying to radiology as soon as possible. Why? Because the longer you spend in an internal medicine residency, the more likely medicare won’t fund your entire radiology residency. That can deter residency programs from choosing you when you apply for a radiology residency. So I would not delay. After two years of other residency/internships, you lose a good chunk of funding!

 

Second issue

It would help if you took the USMLE before applying to radiology. Most programs use this as a screening criterion. And you will be screened out of most programs. You should take the USMLE exams if you want to significantly increase your chance of getting into a radiology residency program. It would be best if you took this as soon as you can. The COMLEX just does not hold as much weight in radiology residency circles.

 

Third issue

Letters of recommendations from radiologists are not necessary if you have great letters. Although desirable to have at least one letter from a radiologist, most programs would understand if you do not have access to a radiology program at your institution. The quality of the recommendations counts the most, not the recommending physician (unless it is some famous name somewhere!) Of course, if you can rotate through a radiology department somewhere and get a LOR, that would be good too!

Regards,
Barry Julius, MD
Radsresident.com
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Tracking Net Worth As A Resident: Does It Make Sense?

Every once in a while, I like to discuss resident finances because understanding how to manage money must begin early. Why? Because small mistakes as a resident become large errors later on in your career. At the same time, many of you have little or no practical know-how about financial matters. Part of it likely relates to the lack of experience. And, the other part connects to the lack of education about finances for residents. I get it. However, I will pitch to you why I think it becomes incredibly important to start tracking your budget, credit, and investments when you have less than nothing, so early in your career. In order to do so, first I will go through the definition of net worth. Then, we will discuss why it is so important to follow it. And finally, I will give you some simple tools for monitoring net worth.

 

net worth

 

What Is Net Worth?

The official financial definition of net worth is assets minus liabilities. That may not mean much to some of you. So quickly, we will define the terms.

Assets are anything that you own of value. That would include investments like stocks and bonds. Or, palpable things like real estate, cars, jewelry, baseball cards.

Liabilities are anything that you owe to others. For most of you, the first type of liability you probably think about is student loan debt. But, credit card debt, personal loans, and car loans count as well.

So, in order to come up with your present net worth, you need to subtract the liabilities from the assets. And, for a good chunk of you, that number is going to be negative. But, don’t worry! That is entirely normal any time during residency or as an early radiology attending.

Reasons For Tracking Net worth

The Trend Is Your Friend- Are You Becoming Richer Or Poorer?

Like anything else in medicine, the trend is often more important than the absolute value.  What do I mean by that? Well, let me give you an example of PSA levels in a patient with prostate cancer. If you look at one PSA level without any context it essentially becomes meaningless. PSA levels can relate to prostate inflammation, other nonspecific biochemical properties of the body, as well as cancer. However, if you perform serial PSA levels and notice an increase over time, well, that takes on some significance. You worry about recurrent prostate cancer or metastatic disease. Likewise, tracking net worth works in much the same way.

As a resident, if you notice that your net worth is negative, it’s not a big deal (everyone has a negative worth!). However, just like PSA levels, if you notice that your net worth significantly declines month over month and year over year, well, that could mark that you need to change your financial habits. Maybe, you need to spend less. Or, maybe you should consider taking that moonlighting gig if available. Bottom line. You do not know what actions to take unless you begin to track your own net worth.

Net Worth Tracking Should Become Habitual

Later on in your career, not knowing your net worth can lead to catastrophe. Many attendings learn too late that they have been spending more than they earn. And, where does that lead you? You will be forced to work longer than you want with shifts that you may hate to earn extra money. Even, patient care can suffer because you become more worried about your next paycheck than what may be best for your patients. Maybe, you read more films than you should.

On the other hand, forming a habit of monitoring what you have now can help you to change your behavior. If you notice a steep decline, you can stem the outflow of assets.  And, if you start tracking your net worth early, you will continue to do so later on in your career when money mistakes can matter even more. Why wouldn’t you want to form these good habits now?

Tools For Tracking

So, what are the ways that you can track your own net worth? First, you can use an old-fashioned excel spreadsheet. I have been doing that for years. And, it certainly helps to keep track of the large assets or liabilities. But, if you want to break down exactly where your cash flow goes, consider one of the online net worth and budget trackers.

The one that I have used for several years that is free is Personal Capital (Yes, I am an affiliate and if you are interested, click on this link!).  I prefer Personal Capital because I have found it to be very useful for the granular tracking of net worth. It is very easy to tie/link investment accounts, credit card accounts, mortgages, and individual assets to the system to make accurate tracking of your net worth fairly easy. And, it adds graphs and easy to use interfaces to capture the trends of what goes on with your finances. That’s exactly what you want from a net worth tracker. (It takes a bit more work to do the same from a spreadsheet)

Bottom Line

Net worth tracking should become a tool in your arsenal to prevent financial mismanagement. Consider practicing it now both to change your current behaviors as well as to maintain good habits throughout the rest of your career. As Benjamin Franklin once said, “An ounce of prevention is worth a pound of cure”. This certainly applies to tracking your own net worth!

 

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HSA Plans: A Cheatsheet For The Radiology Resident

HSA

Over the past several years, how health insurance covers residents has drastically changed. And residents have been caught unwittingly in the crossfire. Many hospital health insurance plans have recently moved to a high deductible version from plans that cover most day-to-day expenses to save money. Since these changes have taken effect, many of you must contribute more pocket money to pay for these medical expenses. The government has created a new savings vehicle called the health savings account (HSA) to meet these healthcare expenses. (1) Many of you can participate in such a plan. But is it worth your while? How much should you contribute, if anything? These are some of the questions that I shall attempt to answer today.

The Mechanics Of The HSA

In summary, this savings plan can serve several purposes. First, you can use the HSA plan to cover those expenses that do not meet the deductible amount. So, how does this work? Typically, the institution you work for will take out a certain amount of money from each paycheck on a pretax basis, biweekly or monthly. And they will add these dollars to your HSA account. Depending on the resident’s needs, you may decide how much to add to this account for the year up to a maximum of $3850 for a single resident and $7750 for a resident family in 2023. So essentially, you can use this pretax money for your health benefits.

Most importantly, however, you can roll this money over from any given year. What you leave in your HSA account stays inside the account in perpetuity and can be added to the HSA at your next job. It’s all yours!

Best Way To Use The HSA Account

Even though you are saving tax dollars to pay for your day-to-day expenses, think twice about using these extra savings for your present healthcare needs. Why would I say something like that? Well, since you get the money pretax and then you can take the money and invest it without paying a dime on the interest earned if you use it for health care, it is the ultimate account to not pay taxes both on the front end and also on the back end when you take it out. Think of it as a way to avoid taxes altogether. So, it has become the best investment vehicle for most of us. No other accounts give such a significant tax benefit like this.

Let me give you some comparisons. We all must pay income taxes on Traditional IRAs and 401k plans when we take the money out. And we all must pay the income taxes on the funds in a Roth IRA before putting them into that account. Unlike these other accounts, the HSA account is the only one that allows you never to ever pay a dime of taxes on the money! Therefore, if you can afford to put away some of this money without using it yearly, you can invest it tax-free and get the most benefit possible.

In addition, typically, most retirees use over 300,000 dollars to pay for medical expenses. (2) That’s a lot of dough! And through the magic of compounding, since residents have a long career ahead of them, this account can potentially cover those expenses. So ultimately, this can be your medical care retirement account!

How Much Should You Contribute To The HSA?

This question is probably the toughest of them all. It depends on what you can afford. You probably shouldn’t fill the account to the maximum for those with very high debt loads. Instead, pay down at least some of the interest on your loans up to the $2,500 maximum deductible amount. But it certainly pays to put at least a little into this account since the tax benefits are so high. For those with a lighter debt load, maximize what you can put into this account. You may want to substitute some of the money for savings in other vehicles to pay for the investments in this account.

Final Thoughts About Resident HSA Plans

There is no such thing as a free lunch. However, the HSA comes as close as I have seen to one. So, make sure to consider the benefits of an HSA seriously. And think hard about contributing as much as you can. It can make the difference between a harried and a worry-free retirement!

(1) https://20somethingfinance.com/maximum-hsa-contribution/

(2) https://www.fool.com/retirement/2017/12/31/96-of-people-with-a-health-savings-account-are-mak.aspx

 

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I Am Caught In An Early Vicious Cycle: Help!

vicious cycle

Question:

Hello Dr. Julius,

I found your article about the struggling radiology resident and looked at your previous answer to a similar question. I am an R1. At the end of October, the program informed me that I was struggling and having problems with synthesizing information and communication issues. Since then, they told me I haven’t improved and am still behind my peers.

I know that you mentioned getting out of the vicious cycle will be difficult, but I feel that every time I’ve spoken with my PD or assoc PD, they think my problem is inherent and I can’t be a radiologist. I’ve seen a psychologist for help, and I accidentally got the GME involved in seeking information. I’ve been studying harder, but I have a shaken confidence. And I keep missing things and not improving. I am concerned that they will fire me. Where do I go from here? Do I start looking for another specialty or stick it out until they’ve had enough and will not renew my contract?

Name

Scared R1

————————

Answer:

Dear Scared R1,

Before anything else, you need to ask yourself if you have been putting in many hours of studying each day and have immersed yourself in radiology. If you are honest with yourself and have genuinely been putting everything you have into learning radiology, you shouldn’t be so hard on yourself. I am going to assume in your case that this is true.

So, what bothers me most about your situation is how you explain it. You said you just recently started as an R1. That would mean that you just began the second half of your first year. And yet, it seems that you assume that your PD and associate PD think that, inherently, you will not make it through your program.

It would be highly unusual for a PD to know that you can’t make it through your residency so early on. In my experience, I have had several residents who had a questionable first year, only to discover that they became more than proficient when they started on call. Typically, they can know only by seeing how you do on call. (assuming you passed a precall assessment) So, it seems they haven’t even given you a chance. From what you are saying, you may be in the midst of an early vicious cycle.

Remediation of the Vicious Cycle

Second, the ACGME requires the program director to allow you to remediate your situation. They can’t just indiscriminately fire a resident without due process. And, since you have barely started radiology, there is no way you could have had an adequate opportunity to remediate the situation. Again, this assumes that you have not done anything to endanger your patients or fellow staff that would require them to prevent you from working.

So, where does this leave you? Well, improvement is an incremental process with occasional setbacks along the way. You may feel like you are not improving, but you are. The key is to learn from your mistakes and not repeat them repeatedly so that the vicious cycle continues. It’s ok to have missed at this point. You certainly can’t expect a first-year not to make any mistakes.

All this being said, occasionally, some residents can’t cut it. But these residents are rare, and I certainly would not be ready to pack it in just yet.

At this point, you should view each mistake as a learning opportunity, not as something to get discouraged about. You need to stick it out with some grit and determination to get through this difficult time. Radiology residency can be very tough for first-year residents. Staff can be unforgiving.

Improvement is a gradual, almost imperceptible process in any small time frame. You may notice the changes from reading and studying in a more extended period. Continue to soldier on, and let me know how things go!

Sincerely,

Barry Julius, MD

 

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Question About Improving The Vicious Cycle:

Hello Dr. Julius,

Thank you for the encouraging reply. In your experience, what is the usual time frame for struggling residents to see improvement? I’ve finished four weeks on a must-cover, and my faculty state that I am not improving. I have another four weeks to go, but I am concerned that if I haven’t improved much in the first four weeks, what are my chances of improving in another?

Sincerely,

Scared R1

———————-

Answer:

Scared R1,

Four weeks is a concise amount of time to assess for global changes/improvement. If we are talking about more specific goals you have set, that would be more appropriate. Based on what you are saying, it is hard to determine what improvements they are trying to assess. Global assessments don’t work too well. I am writing an article talking about that.

On the other hand, programs and residents can assess and create incremental specific goals. Hopefully, they are creating these for you, and you have made some for yourself. You can undoubtedly reach specific smaller goals within a 4-week block if these goals are appropriate.

Barry Julius, MD

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Phone Etiquette For The Radiologist

phone etiquette

Back in the day, I remember my former program director/chairman at Rhode Island Hospital, Dr. John Cronan, lecturing on the basics of the business of radiology. (if you’re reading this, I bet you’re impressed that I remember!) He mentioned the three A’s of maintaining a good radiology practice: affability, availability, and acumen. And, after all these years, I still take this to heart. Good phone etiquette also fits into the equation of the three A’s. It is one of the keys to maintaining a quality practice to entice repeat customers, fellow referring physicians, and patients.

And the rules apply not just for standing phones at your practice but also for cell phones too (We are not living in the 1980s, folks!) With the tens of thousands of phone calls, you will receive over your lifetime, the concepts behind good phone etiquette remain the same. So, let’s go through each of these threads to guide you on how to approach the phone.

Availability

Let’s address the most controversial area first. How can we be available by phone most of the time when I create a post such as Should Radiologists Ignore the Phone? Well, it creates a conflict of interest. We do need to make sure that we concentrate on our films first and avoid errors. On the other hand, it does not mean that we should ignore the phone. So, how do we solve this dichotomy? If you are not actively reading films, always pick up the phone. And, if you cannot pick up the phone now, at least you can promptly return messages that you may receive from the secretary or your voicemails.

If a clinician can never get through to you, you know where their business will go- down the street to the other guy! So, allowing your clinician to contact you is of the utmost importance.

Affability

Affability implies more than picking up the phone and being friendly. It also means an air of professionalism. What do I mean by that? If you are picking up a phone in a particular location, let your caller know they have reached that specific destination. So, if you are in CT scan, you may say Your Hospital, CT scan, Dr. X speaking.

Like us, clinicians run short on time, and we must respect their demands. They may arrive on your line through an operator, unsure of their destination. Taking the time to announce exactly where and who you will go a long way to establishing a rapport between you and the referrer.

In addition, treat your referring physicians on the phone as if they were a friend, not just another burden of the day. Even if it is 4:55 PM and you are about to leave the department, don’t be curt on the phone. Our referrers are the lifeblood of a radiology practice, so creating a relationship between the radiologist and the clinician is crucial. In the end, we need to develop friendships, or else why should the clinician refer patients to you instead of his friendly radiologist down the street? (We live in competitive times!)

Acumen

Finally, just as you treat any consult, on-phone or in-person, we need to ensure that we do our best to solve our referrers’ questions. Be direct. Make sure to answer any questions that you can answer correctly off-the-cuff. And, if you don’t know the answer at the moment, you can always look up the information and get back to the clinician. It is our responsibility to help our fellow doctors. That is just part of our job.

It is also awe-inspiring when you can give a source or a paper to your referring physician documenting why you think your recommendation is correct. It goes a long way to show that you keep up with all the literature. Additionally, it makes it more likely your referrer will return the next time.

Final Thoughts About Phone Etiquette

Many radiologists may dismiss phone etiquette as an extraneous part of our practice that is not worth their time. But, I beg to differ. Instead, it is an essential part of an excellent radiology practice. It is how we connect with our referrers, make friends with our fellow physicians, and direct our clinicians to the next step, whether ordering the appropriate test or solving a diagnostic dilemma. So, make sure to follow the rules of the phone!

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Can Introverts And Extroverts Thrive In The Field Of Radiology?

introvert

Students and physicians compartmentalize the different medical subspecialties into different personality types. And from what I hear, stereotypical radiologists tend to be introverts (formal definition- shy, reticent people). But, do most of us radiologists prefer to be alone? And, can extroverts thrive in the radiology specialty? I will try to answer these questions and give you my thoughts about the personality of the folks in my field.

Are Most Radiologists Introverts?

Well, I believe that, on the whole, radiologists lean toward the introverted portion of the personality spectrum. I mean… Can many extroverts stand to sit in front of a computer for hours at a time culling through images and dictating reports? You need to spend a bit of time on your own in between interruptions. On the other hand, you probably know a few radiologists that are not wall-flowers. Most of the more extroverted radiologists gravitate toward the field of interventional radiology or mammography, fields with more frequent patient interactions. Additionally, many of these extroverts enjoy performing additional highly social responsibilities such as heads of medical staff, chairs of departments, or hospital administration. All these roles benefit from an extroverted, gregarious sort. But, these folks tend to be the minority.

Why Do Some Introverts Thrive In Radiology?

OK. So, the field lends itself to a more introverted personality. But why is it that introverts have the potential to thrive in radiology? Some of the noted qualities of introverts, such as paying sharp attention to detail and processing large amounts of data, are personality traits that allow an introvert to succeed. And, no matter what your colleagues say, introverts have the potential to enjoy fewer personal interactions in radiology than in other fields such as medicine or surgery. These features of radiology allow the introvert to thrive in his profession.

Nevertheless, the typical introvert needs to learn some extrovert skills. For example, with the many phone calls we make and the numerous technologists and nurses we must manage, it is next to impossible to bury one’s head in the sand. And to run a group as a stakeholder, the introverted radiologist needs to learn leadership skills. Completely isolating oneself from others does not work well in our profession.

Why Do Some Extroverts Thrive In Radiology?

In baseball, we find the lefty pitcher more likely to succeed because he throws differently from most pitchers. Likewise, the extrovert is likelier to shine in a group of individuals dominated by introverts. Every group needs folks that can shmooze with the right people, interact well with the administration, and lead a group toward success. These folks tend to shy away from some of the more analytical independent areas of radiology. And many opportunities exist that require the skills of the extrovert in our field. The introvert cannot go it alone!

Introverts/Extroverts- Does It Matter?

In our field, no one size fits all. We both need introverted and extroverted radiologists for our profession to thrive. A group without an extrovert is a recipe for disaster, with poor communication skills leading to anarchy. And, a group without the analytical skills of an introvert will not last long. So, let us try to appreciate one another for who we are. In the end, the best groups are a combination of both.

 

 

 

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Top Eight Advantages Of Living Close To Work As A Radiologist

close

Driving 50 miles to and from work or over 1.5 hours each way is undoubtedly a recipe for a problematic residency or career. (I did that for six years as an attending!) So, I recommend that you heed the following advice. Live close to the hospital and enjoy life! We will go through eight tangible benefits I have discovered now that I live close to work to support this argument. Try to do the same!

Traffic And Stress

Arriving at work after a school bus, a large white van, and a Toyota Prius cut you off during your 1.5-hour journey versus stopping at the one traffic light between my house and the hospital. Which one is more stressful? Hmmmmm… I can say that stress levels have declined by 95 percent at the beginning of the workday. Who cares if that guy in front of you cuts you off in the parking lot when you are five minutes from the hospital. You’ll still arrive on time!!!

Forgetting Things

The feeling of forgetting something important halfway through a 1.5-hour journey still sends shivers down my spine. I can still remember filling out the medical staff renewal forms due the same day, only to discover they were not in the car halfway through my trek to the hospital. If that happens now, no big deal. I just go home in the middle of the day and pick it up!

Healthier Lifestyle

All those hours on the road wreak havoc on your body. The body should not sit in a car for 3 hours a day. Fast food outlets become your friend. Fat accumulates in the wrong places. All that time that you lose, you can spend exercising or creating a healthier lifestyle for yourself.

Taking Care Of Things At Home

Occasionally, you need to drop off something at the house. Or, you may meet with a contractor to fix your ceiling leak. When you are 50 miles away, it is next to impossible. On the other hand, if you are right around the corner, you can usually stop by for a moment!

Community

Are you volunteering for the community? No problem. Want to coach a kid’s baseball team? You can manage it. Join a local symphony? It’s possible to find the time. Living close opens up many local opportunities you would never have otherwise!

Emergencies

Sometimes disaster strikes. When you live far away, it is almost impossible to help out. On the other hand, if your child injures a leg playing soccer or falls off a horse and you live right near the office or hospital, you are no more than a few minutes away. You can even pick him up and drive him to your hospital yourself!

Family Time

Want to spend quality time with the kids in the evening? You will now have the time. Think it’s essential to go on date night with your spouse? It’s possible to make plans, even during the week. Need to plan family outings- like the school picnic or that hockey game in the evening. Not a problem!

Call Issues

Have to reduce an intussception at 3 AM? At least you are around the corner. You can get in and out in minutes. And, before you know it, you are done. Need to check a scan because the internet froze? All you need to do is drive-in for a moment or two, not 1.5 hours!

Live Close To Work!

As you can see, living close to the hospital makes a world of difference. And the advantages are almost endless. So, go ahead and try to live reasonably close to your work. You can live your life the way you want while not burdened by all the time wasted in the car!

 

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Should I Attend The Radiology Department Holiday Party?

holiday party

 

It’s almost that time of the year. And if you have not received an invitation yet, it will probably arrive in your email or mailbox soon. Yep… It’s time for the annual radiology department holiday party.

Our department has hosted a party every year since I started as an attending in my practice. (over 17 years ago!) Faculty expect most of our residents to attend the festivities since it is such a deep-seated tradition at our organization. And most do.

But what if you are on the fence? Maybe you have other obligations or are not the party-goer type. Whatever the case may be, you need to decide whether to attend or not. Well, I am here to help you with that decision! Let’s go through six reasons you should try to make that holiday party if possible.

Esprit De Corps

You are not just a radiologist but also a team member. Showing up displays your pride in the organization and lets everyone else know you care about the department. Now, all the others will understand that you are a team player, too!

Befriending Your Colleagues

What better opportunity to get to know your colleagues? Not just your fellow residents but the technologist who works down the hall and the nurse who cares for your patients. You can finally see these people not just as hospital employees but also as living human beings. You can even dance the Macarena on the dance floor with them, too!

Get To Know Your Attendings

It can be hard to get to know your bosses when they are involved in patient care and running a residency, telling you what to do. You may feel uncomfortable with the party because you now must sit down with them and chat. Now, you can spend time with your “difficult attendings” in an environment unrelated to your primary occupations. Who knows? Maybe it will lead to an excellent recommendation!

To Be Polite

You know… Someone had to shell out the money for the party. And the radiology department invited you to enjoy a party with them. Is it nice to skip out on an event created just for the benefit of all to enjoy? Not really!

Getting Involved

You can’t always study. Sometimes, you have to get out there and get involved. Getting involved can be as simple as showing up early to work up your patients. But it can also mean attending a party. You’ve signed up for this residency. So, show up for the events!

Find Out What Really Happens In The Department

Few better opportunities arise that allow the resident to see what happens in the radiology department. When the attendings “let their hair loose” and have a few drinks, you know who plays with whom. And, you get the real low down about what goes on. You can’t learn everything from a book!

Is It That Important to Attend The Holiday Party?

Yes!!! We struggle all year to work hard to learn and improve patient care. It’s now time to take some time aside to get to know our department. Let us enjoy the fruits of our labor together!

 

 

 

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Loss Of A Pet- A Lesson All Residents Can Learn About Quality Of Life

Today’s post is not for everyone. For those of you that have never owned a pet or do not understand why anyone would decide to keep a pet, especially during residency, you can stop reading here. But for those of you that take a keen interest in living with a pet of some sort, I think you will find this post very enlightening.

Most posts I write are not personal. Today’s post is very different. It serves several purposes. First, I aim to show my readers how we dealt with a sick beloved pet during the past few weeks in order to give examples of tough decisions that need to be made. Next, I am going to translate this episode into a life lesson about maintaining a good quality of life, translating it to residency. And finally, more importantly for me, I am going to be a bit selfish and eulogize the recent loss of my best friend and dog, Otis. The past few days have been some of the most difficult days of my life. I already miss him dearly.

The Ultimate Responsibility of Pet Ownership- Our Story

When we decided to commit to getting a dog, we committed ourselves to its entire life. We are ultimately not only responsible for feeding, comforting, bathing, and taking our pets outside but also the decisions we need to make when facing an inevitable loss. The difficulty is only compounded when you are training during the incredibly busy time of residency.

In our case, our incredible dog, Otis, had an episode of spontaneous agonal breathing. Like a madman, I rushed him off to our car and drove him to the animal hospital nearly 70 miles per hour through side streets. I passed him off to the technologist like a football so that the emergency veterinarians could instantly treat him. And, they treated him rapidly and professionally with a pericardiocentesis to drain off fluid during an episode of pericardial tamponade. While performing the ultrasound, the sonographer discovered a right atrial mass. Then, in the morning, the veterinarian radiologist scanned his abdomen, only to diagnose him with splenic nodules as well. They declared that he had untreatable metastatic hemangiosarcoma, a terminal cancer of dogs. It would consume him possibly in days or weeks, and if we were lucky, months.

We faced the ultimate decision after the veterinarians stabilized him. What do we do next? Do we bring him home now? Should he be euthanized? I couldn’t bear to say goodbye at this point because he seemed like he returned to his normal self for the time being. We decided to bring him home, hoping he would have a few more good weeks, maybe months.

The next week was one of the best weeks I ever had with my dog. We walked, let him roll in the grass (his favorite activity!), and allowed him to sniff just about everything. It was great. But, the day of reckoning finally arrived too soon. This time, the whole family came with him to the hospital after we noticed some subtle discomfort and worried that he was to become unstable.

The Big Decision- Quality of Life Issues

We knew at this point we had the big decision to make. Do we treat him with serial pericardiocenteses aware that the fluid accumulation and new episodes of pericardial tamponade would become more and more rapid? Or, was it time to say goodbye? We based our final decision on his quality of life. We had to say goodbye.

It was one of the most gut-wrenching decisions, I ever had to make. He was my best friend on earth.  We slept on the same bed, traveled together, and ate meals with each other. He was always there for me over the past 10.5 years. It was his helplessness and innocence that pulled at my heartstrings. And now, I had to put him down. It was for the best. But, it made the decision no easier.

Life Lesson

What is more important than the quality of life? Whether it is a person or a pet, it does not matter. We need to do for our loved ones what is right for them and not for ourselves in the moment.

Translated into the residency experience, we should always think about the quality of not just our own lives but also the quality of life for our spouses, relatives, friends, family, and beloved pets. It’s not always about reading the most cases, staying late every day, only to miss out on our loved ones as time passes by. Bottom line. We need to sniff and smell the roses, just like Otis always did.

Ode to the Memories of Otis

You were the size of a toy truck when I picked you up in Charlotte, North Carolina over 10 years ago. You lovingly sniffed me and graciously accepted me into your life. I thank you for that.

Driving home from the airport, you slowly pushed open the Sherpa bag with your nose as I drove you to our house to see what was happening. Your curiosity was always without boundaries. I thank you for that.

Rolling in the grass was your heaven. You could always spontaneously enjoy the moment. I thank you for that.

When other puppies would bite the hands of their owner to get a treat, you would make sure to take the treat carefully always making sure that we were OK. You were always like that in your life. I thank you for that.

Sitting crosswise, you were always there to protect the kids. I thank you for that.

Good-natured and non-aggressive, you were beloved by all the people and canines you have ever met. I thank you for that.

For all the wonderful memories we had together over the past ten years, I wish we had more. Your life was too short. And, we will miss you dearly. The great memories of you will last our lifetime and beyond. I thank you for that…

From Your Beloved Family- we give thanks for every moment we shared together. Rest in peace…