Shadowing Basics

I saw a recent discussion about shadowing so I wanted to throw out my two cents. I think shadowing is fantastic. You get exposure to the real work a physician does, and often it isn't glamorous. It's great at giving you a perspective into different specialties, and I almost think it should be required that you should shadow a primary care physician in addition to a specialist.

What I've done as well, is try to shadow physicians at different points in their careers. I have shadowed a specialist who is close to retirement, a mid-career specialist in a different specialty, and a primary care physician a few years removed from completing her residency and becoming board-certified. One of the great benefits of approaching it like this is getting different perspectives. For example, while they all agreed that universal healthcare is a great idea, and healthcare access needs to be improved, they all had different ideas about the healthcare reform passing through Congress, and what kind of an impact any reform would have in the U.S.

My shadowing was all very enjoyable, particularly just to see the rapport that the physicians had developed over time with their patients, where it seemed like two friends meeting and oh-by-the-way let's talk about your blood pressure, or do this quick test and then we can get right back to talking about your kids and how great they're doing. I could almost pinpoint who was a newer patient without knowing any of their history by how open or guarded they were in their discussions with the various physicians I shadowed.

Here are the basics though, in my humble opinion, in seeking out physicians to shadow and how to behave well:

• For starters, try to contact physicians that you either know by being their patient or have a friend who is a patient of theirs, or a parent who is their patient, and explain your intentions. A great resource here is if you have a good relationship with your PCP, if you have one, and ask them about specialists they frequently refer to, in addition to seeing if you can set up shadowing with them.
  
• It's pretty important to set up expectations at the outset when you first make contact and set up the shadowing experience. Let them know your availability and ask if there's anything you should know before the first day.
• Unless you're shadowing in the OR--which I haven't done, but maybe it's possible from an observation room, I doubt you're going to scrub in for a surgical shadowing experience--you should wear business attire, which for men means slacks and a tie. Maybe throw a shirt on underneath the tie too, unless you look like one of the guys in the Handsome Men's Club. For women, I guess you know what business attire means, probably no open-toed shoes, conservative, hair up/out of your face, etc. That goes for dudes with long hair, too.
• Keep track of your shadowing hours, I did this when I got home at the end of each shadowing day. I'd write the date, the hours, anything interesting I learned or any interesting patients/cases I saw without many identifying features, i.e. "saw a patient with DM and HTN" not "saw a 67 y/o Caucasian female with Type II DM and HTN who was the divorce lawyer for (insert celebrity here)."
• Whether you are shadowing in the office or hospital, follow the physician's lead, but don't follow them around like a lost puppy, especially if it seems like they are going to the bathroom. That's just awkward. You can be pretty sure they don't need help making a pee-pee. If they're heading to a patient's room or exam room or to get some coffee, by all means, follow them.
• If you're uncertain about something, ask a question - just don't do it in front of the patient unless they say it's okay to do so. Example: if you shadow an ophthalmologist and they ask the patient if you can look at their eyes through the slit lamp, and the patient okays it, and they ask you if you see some feature about the patient's eyes, it's okay to ask a question about it if you don't understand what you're looking for. Use discretion though, some are a lot more laid-back about it, and I would say it's probably the physicians that aren't constantly having students come in to shadow them - they usually enjoy the opportunity to teach you something.
• Make sure you thank the physician at the end - a simple thank you note or card will usually suffice, but also thank the office staff, and any other clinicians that were around, you interacted with, and maybe taught you something.

You can get a lot out of shadowing, and some last bits of advice: stay humble, be grateful you have the opportunity to shadow and stay out of the way. That's pretty important, actually. Ask questions, especially if it's encouraged and it seems like they enjoy teaching you something. In some cases you'll be more of a passive observer and in others you can be more proactive and not just a "fly on the wall." Lastly, here's two thoughts: first, don't be in a rush to leave the office/hospital, even if they say, "We're done, I just have dictations to do" etc., and if they offer you some kind of reading material pertinent to their specialty, take advantage of it - it will make the shadowing make a little more sense even if you have only a rudimentary understanding of what's going on. I had two different docs where one gave me some journals to browse and the other gave me a textbook related to the field and a specific thing to look at since I would see it later in the week. It was useful, and I got more out of the experience that way.

Shadowing Part Deux: Electric Boogaloo

So the past two weeks I had shadowed a specialist.

One thing I noticed - quite a few of his patients were older and on Medicare/Medicaid. Another thing I noticed was that the older the patient, typically the more positive and happy the patient's outlook. The younger patients (younger as in, 50s/60s), weren't too bad off, but it was really the 80s, 90s and the 103! year olds that had the best outlooks on life and attitudes.

It made sense to me. People that are constantly negative, bitter, and bitching about their lot in life are probably the ones that are not survivors, and do not make it to 70, 80, or 90. Some people may get cancer, or have a heart attack, and succumb to the illness... but I think it's typically the people with a negative outlook and pessimistic tendencies that do not make it over the long run. So lesson learned: stay positive. I feel like I am an optimist at heart and want to find the best in people and situations but it is not always easy.

Several patients had faced adversity over their lifetimes - sometimes disability, a heart attack or quadruple bypass here, cancer there, diabetes and high blood pressure everywhere. Still, they had a positive outlook on things and that seemed to make all the difference in that they were still there, smiling, catching up with the doctor in the exam room and wishing each other well. Even the patients with disabilities, like reduced vision, etc., seemed to get along okay, for one older gentleman, as long as he could do his crossword puzzle and play tennis, that's all he cared about. In my mind, that's great!

More to come later... along with what else I will be up to a month from now: running the Austin Marathon!!

Hi, 2010. Nice to meet you!

First, Happy New Year to the three people that read this! I hope you each have numerous blessings and great stuff happening to you this year. You deserve it.

What's been happening? Surprisingly, not much. For the past week and a half, I've been shadowing a specialist physician. My dad is actually a patient of his, and the last time my dad was in town, I asked him to see if it was cool with this doc if I could come in and shadow him, he offered up a two week window between New Year's and when he is going on vacation, so I said yes.

I haven't shadowed before, and my main experience with clinical medicine had either been as a patient (rarely, as I am lucky enough to enjoy good health overall and I'm thankful for it... I think if you have good health you are rich in life, because if your health sucks you aren't going to be happy, but I digress), or as a family member, mainly with my mom during her eight year battle with cancer.

This was a different beast. As we entered the exam room for each patient, the doctor would greet the patient by their name (i.e. "Hello, Mr. Smith" not "Hi, John!"), and introduce me, "We have a student/young doctor-to-be with us today, this is ASK." Most of the patients have been with this doctor for a long time - some for thirty years. Over the past week and a half, all of the patients were very cooperative and seemed okay with having me in the exam rooms. It was odd the first time, after asking if she had any more questions and finishing up with a patient, and when we were leaving the exam room and wishing her well, telling her to stay warm, when she thanked me and said, "Nice to meet you, Dr. K."

The first time I corrected the patient and said, "I'm not Dr. K yet, but hopefully will be one day." Of course I liked hearing it, it had a nice ring to it. After that first day, I stopped correcting the patients if they ever said, "thank you, doctor" or "nice to meet you, doctor" to me. I realize that while I look the part, and while I want to be one, I am not a doctor yet, but in the grand scheme of things, while I was introduced as a student, not "medical student," it doesn't matter to the patient, and I did not feel like I was being disingenuous or misled any patient. I did not offer any medical advice, since I am unqualified to give it, but I was lucky enough to take part in certain non-invasive parts of their exams. A few times, I was encouraged to start taking a history, informally, just to get more used to speaking in a "doctorly" capacity with patients.

I have definitely learned a lot this past week and a half. I feel like now more than ever, after seeing the rapport of this doctor with his patients, most of whom have been under his care long-term, I am convinced that this is what I want to do and will be satisfying to me in so many different respects as a career.

But, man! How much would it have sucked if the first day I went in to shadow, after doing all of these prerequisite classes as a post-bacc pre-med, that I realized I hated clinical medicine? I'm glad I really like it. I like this specialty in particular too, but I am still keeping an open mind and looking for other opportunities to get clinical exposure in any capacity... not to make myself a stronger applicant all though it would definitely not hurt, but just to be around the patients more and see what the different practices are like on a day-to-day basis.

I will update more on shadowing later. :)