Bestselling Physician & Patient Medical Ethics in 2020
Kill as Few Patients as Possible: And Fifty-Six Other Essays on How to Be the World's Best Doctor
- Ten Speed Press
In Shock: My Journey from Death to Recovery and the Redemptive Power of Hope
Being Mortal: Medicine and What Matters in the End
Slow Medicine: The Way to Healing
What Patients Say, What Doctors Hear
- Beacon Press
Doing Right: A Practical Guide to Ethics for Medical Trainees and Physicians
The Patient-Physician Relation: The Patient as Partner, Part 2 (Medical Ethics)
Attending: Medicine, Mindfulness, and Humanity
- Scribner Book Company
Medical Ethics: Accounts of Ground-Breaking Cases
Confessions of a Surgeon: The Good, the Bad, and the Complicated...Life Behind the O.R. Doors
Case Files Medical Ethics and Professionalism
Ethics and Professionalism: A Guide for the Physician Assistant
- Used Book in Good Condition
Blind Eye: The Terrifying Story Of A Doctor Who Got Away With Murder
Medical School and Beyond: An Interview with Dr. Sabine H. Manoli
A surgeon discusses what it takes to become a doctor and what challenges she faced in medical school and residency
I was fortunate enough to converse with my long time friend about her journey in becoming a doctor and advice she has for students out there considering medical school.
Thousands of pre-med college students today are attempting to get into medical school with the goal of becoming a doctor. What areas should pre-med students focus on to increase their odds of getting into the medical school of their choice?
Dr. Sabine H. Manoli: Premed students obviously have to fulfill the basic premed requirements: Biology, Chemistry, Physics, etc. But what most medical schools are looking for is diversity. They want to see someone who excels at their premed courses, but also has other interests- possibly a major or minor in a non-science field, lots of extra-curricular activities, athletic abilities, volunteer work, anything that sets you apart. An excellent GPA and a good MCAT score will be the first screening cutoff at most medical schools. After that, it's being diverse and somehow interesting/different that makes them take a closer look at you as a medical school applicant.
Picking the right medical school can be a daunting task for a young pre-med student. What certain criteria do you think every applicant should consider when choosing the right medical school?
Dr. Sabine H. Manoli: The right fit really depends on the individual applicant. Some medical schools are bigger, some smaller which affects class size. Obviously, the right size depends on an applicant's preferred learning environment. One must also consider location. Most medical schools are located in large urban centers because they are affiliated with large training hospitals. If you have a choice of schools, figure out where you want to live. Medical school is a very busy and stressful time in life, so there is little time for leisure activities. It is wise to choose a city where the things you enjoy doing outside of school are easy to access and the climate is one that lends itself well to your personality (i.e Colorado if you like skiing/cold weather, San Diego if you are a beach bum, etc). Plus, where you go to medical school is where your first medical connections will be. You will get to know residents, professors and doctors who can help you with your future training. Approximately 10-15% of med students stay at their medical school to complete their residencies, especially if they meet their spouses and get married while in medical school. If your future spouse has a well-established job there, you may end up staying there. So make sure the medical school you choose is in a place you want to live, potentially long-term. And of course, pick the highest ranked school you can get into.
Are there resources out there available to pre-med students who plan on getting into medical school to become a doctor? Did you specifically use any resources to help you reach your goal of getting into medical school?
Dr. Sabine H. Manoli: I read lots of books about getting into medical school at Barnes amp; Noble. I talked to other premed students to find out what they did. These days the internet is probably the best resource. Most universities and colleges probably have a Premed Advisor too.
You were accepted to the Baylor College of Medicine- a highly rated medical school in Texas. What did you find were the biggest challenges in making it through a medical school training program?
Dr. Sabine H. Manoli: It is hard to find yourself no longer being the smartest kid in the class. Medical school classes are comprised of the entire nation's top students; somebody still ends up at the top, and somebody has to be last. Remember, even the student who graduates at the bottom of a medical school class, is still an MD and still gets called Dr. (not that that was me). There were many days in medical school that I wanted to quit. It was probably one of the hardest times in my life (next to residency). I often lost sight of why I decided to become a doctor in the first place. Once I started my clinical rotations in medical school and started to deal with real patients, I was reminded of the human quality of practicing medicine and it became easier to study and learn the subject matter because I could apply it to real people which helped me remember it. And you start to see the reward of how your knowledge helps others get better. The two yrs before clinicals when you're in medical school classes learning all the background info, however, is much less fun and much more overwhelming. There is tons of information and it often seems like rote memorization. Often I just had to remind myself that I had come this far and quitting medical school was not an option.
After becoming a doctor, you then went on to do a surgical residency. What can a new doctor expect in a residency? Also, what compelled you to choose such a demanding field and what advice do you have for women that want to pursue a career in surgery or other male dominated medical fields?
Dr. Sabine H. Manoli: Residency is tougher than medical school (but I did one of the toughest so my perspective may be a bit biased). As an intern, you are responsible for patient's lives, and you know very little about how to care for people. Sure, the basic medical knowledge of how their anatomical parts attach to one another, how the anatomy works together, and the names and symptoms of particular diseases are fresh in your mind. But how to apply that information to actually making diagnoses and treatment decisions is something you have to learn on the job. As an intern you are also the lowest person on the totem pole. Every bit of trench work falls on you. Every bit of blame also falls on you. A lot of people take their stress out on you. You spend your life rounding on patients, checking their labs and test results, writing notes in their medical charts, making phone calls to various consultants and specialists, getting patients discharged and most importantly, kissing up to a lot of 'higher ups'. You often don't feel like much of a doctor, just a glorified scut monkey. Life does get better though as you move up the ranks. And by the time you move up in the world, you will be much better versed in caring for patients. They will trust you as their doctor, and you will start to feel like you are actually making a difference in their lives. Much like with medical school, in the first few years while you are learning the fundamentals, it is easy to lose sight of the reasons that you chose your particular profession.
As for choosing your specialty, it should be fairly obvious to you where you fit and what your passion is while you are rotating through your clinicals during medical school. You will quickly figure out where your personality fits the best and which mentality is most like yours. Every specialty within medicine definitely has a distinct personality type that is suited for it. Surgeons tend to be impatient individuals who want to see quick results (instant gratification) and who are very decisive in their approach to patient care. Other specialists are more analytical (Internal Medicine), less invasive (Psychiatry), or more behind the scenes (Radiology, Pathology).
To women like myself entering male-dominated fields, my advice to you is that you will have to fight an uphill battle. Thankfully, many women before us have already fought the battle which makes our climb a bit less rigorous. But opinions and stereotypes take a long time to dissipate. If you love what you are doing, keep at it. I cannot tell you how many times while I was taking surgical electives in medical school, I was told by my male professors: "What are you doing on this rotation? You're a girl!" or "You're way too pretty and nice to be doing this." And still to this day, sometimes patients' families will assume that I am a nurse when I come out to the waiting room to tell them that their loved one's operation went well. Priceless to see the looks on their faces when I tell them that I am the surgeon!!
As you know, there are many popular shows on TV such as Grey's Anatomy and The Practice, that depict doctors in supposed everyday situations. How realistic are these shows and do you think they can mislead pre-med students who show interest in going to medical school?
Dr. Sabine H. Manoli: Grey's Anantomy and The Practice are great shows that I enjoy watching, but they are completely different than my life. First of all, on Grey's Anantomy there are a number of physical relationships between residents and attendings. There is a distinct hierarchy in the surgical world, and these types of relationships interrupt the hierarchy and are therefore taboo. Human nature does at times take over and chemistry cannot be fought, but when such relationships occur, they are kept fairly quiet and they certainly are not happening on a frequent basis. There are also far fewer female surgeons than what these shows depict, and many of the surgeons in the real world are a lot less attractive than their Hollywood counterparts would lead you to believe.
Compared to TV, my cases are usually a lot less exciting because the circumstances are more controlled and things run more smoothly (of course my life would make for boring TV but I would rather have a boring predictable day than an out of control day where patients are crashing left and right). And by the way, people don't start dropping their blood pressure or dying the minute you "hit a bleeder."
If pre-med students think they can get a sense of what to expect in medical school or residency by watching these shows, they need to remember that TV is meant for entertainment. Even reality TV is far from anyone's reality...
Graduating from medical school obviously has one big downside: the financial costs. According to Wikipedia.org , the average debt of a student graduating in 2020 was $157,000. What techniques or recommendations do you have for students on managing their debt?
Dr. Sabine H. Manoli: Yes, medical school education is quite expensive. If you can get scholarships or grants, get them. If you cannot get free money, borrow it in financial aid. Get as much of your loans as you can from the government or consider getting your medical school education through the military. As for paying your loans back later, the government lets you defer loan repayment while you are in residency. During deferment, your loans will still accrue interest but you won't have to pay them off until you finish residency and start your career. When you do start working after residency, look for a job with loan repayment benefits or negotiate for it. Also, consider working in an underserved rural area for a short period of time. Those areas are often desperate for physicians and offer an attractive loan repayment package to attract doctors to their areas. The commitments to those areas are usually only for two to three years, and they will pay everything off for you in addition to paying you a nice salary. As for the military option, you usually have to train within a military residency and/or work within the military for a few years after completing your residency to pay them back for your medical school education. Many of these options are easier if you are single and/or unattached. If you do borrow the whole amount in loans, it is feasible to pay it back once you start your career. As a physician, you will earn a nice living and as long as you don't spend beyond your means and budget your loan repayments into your monthly expenses, you should be able to pay things back over time.