One of the most common concerns about becoming a doctor is how long it takes. After high school, four years of college, 4 years of medical school, 3-7 years of training, it's a long haul and requires a special kind of endurance and dedication.

Confession: Neither of us likes to run, especially not long distances. But what we do is a lot like a marathon. Six principles cover most of the ground. Here are the first three; stay tuned for the next!

1. Keep your eye on the finish line. Picture yourself as a doctor, in your own office, in an operating room, teaching medical students, working abroad, inventing new tools, discovering new cures or whatever you imagine. It will help you stay focused and motivated.

Dana: “In my second year of grad school I'm starting to get really excited about my research project, I keep fantasizing about the cover and title of the book I'm going to write!”

Linda: “I think about all of the children I have helped and now how they bring me their children. From generation to generation.”

2. Keep one foot in front of the other. Runners in it for the long haul tell me that they break up the race into “the next corner to turn” or the “next bridge to cross.” Depending on where you are in your “becoming a doctor” journey, your goals will be different. By approaching hurdles in bit-sized pieces, taking each one at a time, the process is made so much easier.

Dana: “Right now there is so much between me and my PhD and that fantasy book, but I focus on the little, defined, do-able steps: the grant proposals I'm writing, the book I have to finish reading this week, and the presentations I have to prepare for.”

Linda: “I still think about each patient encounter, each surgery, each day in the office or the operating room as the only thing that counts at that moment. It helps me to stay focused and fresh for each patient.”

3. Have cheerleaders on the sidelines. Everyone loves to have family and friends watch them run a race. People who will cheer you on because you are doing something very difficult, something that perhaps they can't do. You get a lot of energy and motivation when others are helping you through the journey. Don’t go it alone. You don’t have to.

Dana: “I often get discouraged, want to quite, feel inadequate for the task, but then I just call my support system. They remind me of what I already know: that this is what I love...then they scold at me for ever doubting myself, which I secretly love to hear.”

Linda: “Over the years, I have made many friends who are my colleagues. I depend on them for support when I want to try something new, have challenges, or just need to share what is special about being a doctor, who is also a wife, mother of 3, and very, very busy.”

This is a marathon post. Time for a break. Stay tuned for the next installment and join us at the finish line.

Okay, now for the truth. Being a doctor is hard. Expectations, details, and enormous pressure. It seems to get worse all the time. New things to learn: medical technology, medical knowledge, business know how, rules/regulations multiplying like bunny rabbits. For example, the soon to be released new 3 volume set of disease classification (ICD-10) has almost twice as many diagnoses as the two-volume old ICD-9. Getting the information into electronic health records which we all must master is no easy feat!

So while you are writing your kick butt essay, think about where you are going to find the right amounts of these 6 ingredients that one needs to become a really good doctor:

1. Commitment — one large cup of putting aside your own needs to tend to others who are not your family.
2. Confidence — a heaping tablespoon. It takes a lot of guts to embark on a journey where your own skills in so many areas have such huge consequences for others.
3. Curiosity — two dashes. What we think we know today will be replaced by a different understanding tomorrow. Be curious, always challenge and ask questions of what you know and believe. Your patients will help a lot!
4. Conscientiousness — mix with precise measuring tools. The details of the patient’s life can crack the code. The details of the physical examination, the x-ray that was taken, and the details of how you communicate will get you into and keep you out of trouble.
5. Communication — 2 large cloves. One for listening and one for explaining.
6. Compassion and caring — as much as needed.

These 6 ingredients are not found in the books you buy or the courses you take. They are found inside yourself. They are learned from your family, your friends, your teachers. They are more important than the Krebs citric acid cycle or even knowing the four basic nucleotides that make up our DNA.

Find ways to acquire these critical ingredients. Make them part of your daily habits in everything you do. When you finally get that green hood (the cowl that you get when you graduate medical school), you will truly be ready to be the doctor the MD degree says you are.

Next month: Roadmaps on the way — Dana’s turn.

First, you become a doctor because it is exciting to solve often difficult problems that concern other people. You might work on a macro scale -- caring for populations as a public health doctor or making discoveries that impact thousands of patients as a research doctor. On the other hand, as is more often the case, you might work on a micro scale -- becoming a clinical doctor and taking care of one patient at a time. But whichever kind of “doc” you become, there is always one challenge: keeping up with what is new -- or, as we say in the biz, lifelong learning.

I had a friend in college whose father was a doctor (turns out he was an ENT like me). She told me that he got up at 5:30 a.m. every morning to read his journals. I didn’t believe it. Now I do. (BTW, I get up to exercise and save my reading for later, usually in chunks on less busy days.)

After more than 25 years in the field, I still find in my reading something new and interesting and applicable to what I do every day. It takes effort, energy, and discipline. Not only are there scientific journals to read, but the internet offers endless sources of information and mis-information for our (and our patients') consumption. Today, patients are likely to come to you with a lot of information they have learned online. Sometimes it's relevant, sometimes it is not. But it’s there to be dealt with, answered, and considered with an open mind.

We say that doctors “practice” medicine because it is always possible to become a better physician. Good doctors don't just keep up with the latest medical discoveries, but also keep up their excitement and enthusiasm for applying newly acquired knowledge to the patients for whom they care. Every patient teaches you something, and if you keep an open mind, patients will teach you as much as any book or article.

And that’s the next hard challenge—keeping an open mind. Every patient really is different. Medical knowledge is derived from groups of patients who are similar, so we can “control” for the variables of disease and make some sense of a new treatment or how a disease behaves. Sound good? Sound scientific? It is, but it may not be the best way to care for the individual patient. And that is a whole other discussion.

Stay tuned for an upcoming post about the competing interests of the individual patient and society. Dana, what is your take on this one?

Seasoned physicians will identify closely with the experiences of most of the authors. Sayantani DasGupta’s “Intern” leads off the series with a description of her experiences as a young physician trainee, who wants reassurance that she is not alone. The reader will be amazed by her never-ending (but entirely accurate) list of “things” a new intern hoards—tongue depressors, tourniquets, time—ever mindful that the most important parts of her life cannot be hoarded. Memories of her past life recede as the person she once was transforms into a new being, a physician. This often humorous, yet all too poignant, first story aptly sets the stage for one of the major themes of the book—the physician as an isolated, almost entirely self-contained person who shoulders an awesome burden that is at times overwhelming and sometimes unbearable. Almost all of the stories that follow are existential explorations of the rewards and challenges familiar to the veteran physician.

In Danielle Ofri's essay, “Pas de Deux,” she relates the escape from the uncertainty that the “science” of medicine requires of physicians. She struggles to find the beauty of life in her ballet class, beauty that she cannot find on the medical ward where she is a second year resident faced with the unending, yet all too familiar, desperate lives of those she cannot cure.

One essayist, Marion Bishop, who now works as an ER doctor in rural Wyoming, is forever haunted by the cadaver, number 13, that she dissected as a first year medical student. Their relationship gnaws at her even to this day. Awakening deep memories of my encounter with my first year cadaver, Bishop illuminates the gruesome responsibilities placed on the newly-minted medical student—to dissect and dismember, while respecting and honoring the humanity of the dead individual who donated her or his body to teach a future healer.

Becoming a Doctor describes the transformation of the physician from a passive observer of life’s traumas to a protagonist, who must not only bear witness, but also alleviate human suffering. In the “Family Room,” Teri Reynolds tries desperately not to confuse the names of the three brothers brought to her emergency department as she tells the family about the brother who has perished. This is her first time in the "family room" and she must turn immediately from the adrenaline rush of keeping two of the brothers alive to the somber responsibility of facing the hopeful, yet stricken, family.

In his essay, Clint Morehead initially admits he does not understand what it is to be ill (because he has never been sick himself.) He then describes his encounter with a physician-patient who teaches him that there is a relationship beyond the white coat. Morehead's transformation is completed through encounters with two more cancer patients. He goes from being just “The Cleverest Doctor” and becomes the most caring doctor.

In “The Patient Narrative,” Peri Klass takes us into her clinical classroom as she informs the student physicians about the importance of narrative. She reminds us that with each new patient encounter, the physician is transformed by that person’s life. She warns the students against letting their professional filters get in the way of listening. “Listen with both your heart and your mind,” to these private stories, she advises.

The “aha!” moments of discovery are enlightening to those who want to know, “how did you become a doctor, an oncologist, a pediatrician, a surgeon…..?” Thomas Gibbs in “Magic Hands” recounts one pivotal patient who helped him identify his calling. He tells of a woman in a remote, rural area who came to him because she couldn’t hear. After Gibbs extracted cotton from deep in her ear canal, cotton she had placed there to quiet the voice of her abusive husband, the patient told him he had magic hands. His destiny was sealed; he knew he would become a surgeon. I, too, had a similar awakening when I witnessed the sincere gratitude of an 80 year old woman who, relieved of her impacted wax, was once again able to hear. I am now an otolaryngologist. These awakenings can be so simple, yet so profound.

In “Sine Qua Non,” Peter Kramer finds his calling in geriatrics when, at his mother’s bidding, he reluctantly examines his own ailing grandmother. Though he is only an intern, he discovers that her bedridden state is from a gallbladder problem. Taking the time to examine the elderly, with their seemingly endless and often difficult to explain complaints, touched him deeply. In “A Fire, Deliberately Set,” Peggy Sarjeant finds her calling in adolescent medicine when she witnesses the slow and tragic loss of a young person’s life. Both Kramer and Sarjeant chose unexpected directions in their career because they met special patients who became their special teachers.

The strength of this book is that no one universal experience dominates, precisely because none exists. Becoming a Doctor is about as many different experiential paths as there are people. As this book so beautifully expresses, it is also true that practicing physicians are forever “becoming” doctors.

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Dr. Brodsky is formerly Professor of Otolaryngology and Pediatrics, State University of New York at Buffalo, School of Medicine and Biomedical Sciences. Presently she has a busy clinical practice and is President of Pediatric ENT Associates, Buffalo, NY. She is also an impassioned crusader who has started her own venture and movement: Expediting the Inevitable….Tapping into the Workforce of Women in Medicine.

Dr. Brodsky can also be found at www.lindabrodskymd.com. Additionally she blogs at www.thebrodskyblog.com, www.parentingpink.com and our own www.talkingscience.org.

The simplest answer would be, “A good one. A kind one.” You might get a chuckle and perhaps some relief from prying minds, at least temporarily. But that question will quietly nag you through your long and difficult journey until it is finally decided.

“How did you decide?” I am often asked. It was quite by accident that I stumbled on this small specialty, otolaryngology—ear, nose, and throat (ENT). The story goes: I had just finished my surgical rotation and had only 6 weeks of psychiatry and 6 weeks of vacation to complete the year. My fourth year elective schedule was due in student affairs the next day.

I ran into a fourth year student I knew who was getting ready to graduate. I asked him what he was going to do and he told me about ENT. Sounded interesting. I'd see all ages of patient, practice both medicine and surgery. An ENT's expertise ranges from microsurgery on the ear, to plastic surgery on the face, to removal and reconstruction of complicated head and neck cancers. Mysterious in a way.

I signed up for this usually popular elective during my “vacation block” when there were no longer any fourth year students and only 18 other students "on vacation" during that rotation. None of the other students wanted this elective so I had two great professors all to myself—Dr. Frank Marlowe and Dr. Robert Wolfson—both of whom loved to teach, not only about the patients, but also about the specialty and its history. After only 3 days, their love of this quirky specialty was completely transferred to and embedded in me.

What was it that ultimately made me decide to become an ENT specialist? Was it the 80 year old woman who came to us because she couldn’t hear? She exclaimed, “Thank you! I can hear again,” as Dr. Marlowe removed of the large wax balls from her ear canals. So simple a treatment (or so it seemed,) yet so impactful. Or maybe it was the 45 year old man who was having an operation to fix his hearing. He couldn’t hear because the smallest bone in the body, the stapes, was “fixed” instead of “mobile” and therefore it wasn't able to transfer the sound to the inner ear. The immovable bone was replaced with an operation called a stapedectomy. As the ear bone prosthesis was placed and the ear drum put back into place, the patient exclaimed, “Thanks, doc, I can hear again.” I was amazed. It was like magic. Dr. Wolfson pulled off his gloves and the operation was over. I was hooked.

It has been exactly one hundred years since the first comprehensive report on medical education, The Flexner Report (1910), revolutionized US medical education. With the publication of Educating Physicians: A Call for Reform of Medical School and Residency the stage has been set for the next, badly needed, revolution.

In their introduction, the authors do exactly what expert educators do, they carefully lay out the four part plan of the book. They tell the reader what, when, why, and how each critical area will be discussed, then reinforce their message in each section. This preparation leads the reader -- even one who is not heavily invested in medical education -- easily through the detailed and often technical material. The journey is exciting as the authors build the case and the road map for creating the “ideal” physician and discuss the role of the medical educator in the environment in which he or she works.

Part 1 gives historical background that sets the stage for describing how we got to where we are today. In this section, the authors elegantly identify the “core domains” of a physician’s work—caring for patients, participating in a professional community, instigating improvement, and inquiring. The latter two have been sadly neglected in most curricula, and at many institutions where the work of education has largely focused on preparation for information-based certifying exams. The book goes on to describe what the educational milieu needs to look like in order to create a medical educational experience that includes all three domains.

Part 2 describes the nuts and bolts of what medical education looks like at present -- from medical school (undergraduate medical education—UME) through residency and fellowship (graduate medical education—GME). Just pages before this section, the authors stunningly opine:

“We believe that transformation of identity should be the highest purpose of medical education. If the naïve enthusiasm can be tempered and be forged into a commitment to do better for patients and populations, partnered with the recognition that this work is never done, and fortified with the resilience to carry on through disappointment and failure, the more familiar goals of medical education will largely take care of themselves.” (p. 65)

This section of the book carefully dissects the different models for pre-clinical and clinical medical education. They base their descriptions on several previously recounted premises: learning is progressive and developmental; learning is participatory; and learning is situated and distributed. The authors take the reader through the experiences of UME and GME sequentially, using these premises to make a cogent, reasoned, and compelling case for reform.

Part 3 is necessarily less exciting as it deals with the byzantine structures, policies, and rules that have evolved to regulate, finance, and advance medical education. Even for someone who has spent 25 years in academic medicine, this section offers insights and information which are invaluable in understanding how both internal and external forces have molded medical education in the United States. Charts and graphs help elucidate concepts that are far from easy, and certainly not universal to each medical educational system. By simply expounding on the situation as it is today, the authors make a compelling case for the reform of tomorrow.

However, undaunted by the morass of solutions each institution has developed, the authors identify five key ingredients that can be generalized (and therefore built upon) across institutions. Transforming medical education means: transforming leadership; creating a culture of creativity, inquiry, and continuous improvement; building organizational structures that promote action, discipline, and innovation; securing educational resources; and building cohesive academic communities dedicated to advancing scholarship and learning (p. 191). Using examples from the 14 medical institutions they studied, the authors provide concrete examples of how transformation might take place.

Part 4 is where the authors share their visions for a better tomorrow. They offer examples, make recommendations, and give us a road map that might be useful as we struggle to overcome many of the challenges so clearly describe in the preceding several hundred pages.

Two disappointments are worth mentioning. First, while the authors clearly acknowledge that the culture of medical academia needs to change, they ignore the very real but thorny issue that medical institutions need to better integrate women physicians. We, as a society, cannot expect all the adaptation to be by women who had little to no part in the creation of a culture that is often heedless of their particular learning styles and different approaches.

Second, adding a section on continuing medical education (CME) would have made this excellent book even more outstanding. Life-long learning is indeed one of the greatest challenges in today’s rapidly changing medical environment. The authors' breadth and depth of knowledge, coupled with their holistic approach to UME and GME, could do nothing but inject a much needed shot in the arm to CME.

While this book might be of greatest interest to medical educators, it might also be helpful to policy makers, healthcare systems, physicians, and even many patients who are trying to understand the political debates facing any “overhaul” of our healthcare system. It is not the several hundred references and careful research that are the heart and soul of this fine work, but rather it is the commitment and passion of the authors that make this book an excellent and exciting read.

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Dr. Brodsky is formerly Professor of Otolaryngology and Pediatrics, State University of New York at Buffalo, School of Medicine and Biomedical Sciences. Presently she has a busy clinical practice and is President of Pediatric ENT Associates, Buffalo, NY. She is also an impassioned crusader who has started her own venture and movement: Expediting the Inevitable….Tapping into the Workforce of Women in Medicine.

Dr. Brodsky can also be found at www.lindabrodskymd.com. Additionally she blogs at www.thebrodskyblog.com, www.parentingpink.com and our own www.talkingscience.org.

Lots of others have the title of “doctor”. They have PhDs, AudDs, PsyDs and other “Ds”, doctorates which indicate they have obtained the highest of the advanced degrees. Literally, the ultimate pursuit of wisdom through acquisition of in-depth knowledge.

Medical doctors (MDs) sometimes also obtain PhDs, usually in biology, chemistry, physics, and biomedical engineering, to name a few. Those who do might be planning a career in research; others might want to have a deeper knowledge of one of the medical sciences. They want to know, they want to learn.

Dana’s PhD is in medical anthropology. Never heard of it? Neither had I until Dana found one of her several passions. It all started in college, at Barnard, when she took an anthropology course. She loved it. And she also loved biology. And she wanted to become a medical doctor. And she found a way to do it all.

She is becoming a medical anthropologist. She will study and advance the knowledge of the many ways in which “culture and society are organized around or impacted by issues of health, health care, and related issues.”
Sounds complicated? It is. It requires the reconciliation of the science of medicine with the culture and society in which people experience their medical problems. This intersection takes a very special personality—one who can think in the scientific world at once with the social/cultural world. Go Dana!

So now, after her first 2 years of medical school, heavily immersed in science, she has started her 4-5 year “graduate” program in anthropology. It is joint program that is jointly degreed between UCSF and UC Berkley. Switching gears from the enormous amount of memorization of facts of disease, she now reads and digests theories in the thousands of pages of the highly analytic subject matter needed to gain the “wisdom” that will eventually bring her the degree of PhD.

At first a fish out of water, she is now happily ensconced in the rhythms and thought processes of graduate school. She left the second year of medical school, after exciting times in surgery, otolaryngology (ear, nose and throat) and dermatology with some regret. But now she has re-discovered her love for the study of anthropology. And now she has some idea on how it will fit into the medical world she tasted, albeit briefly.

How long does it take to get a PhD? That depends on the subject and the school. But for Dana, at UCSF/Berkley, 2 years of course work, one year of field work and then 1-2 years writing her thesis.
Self-direction in graduate school has been replaced by the highly directed “what do I need to learn” of medical school. She has already started thinking about and planning the project for her dissertation—that piece of work that is specifically and uniquely hers. She will bring new knowledge and ideas to medical anthropology.

In “the field” she immerses herself in a culture and observes, reports, analyzes and gains knowledge. The “field” can be found in her own backyard or a far-away place half-way around the world. Health and healthcare knows no geographic boundaries.

Dana will then re-enter medical school and finish her clinical courses. Then off to 3 to 7 more years of residency training. It takes a long, long time.

So becoming an MD, PhD is not easy. When finished, Dana will become unique in the medical field. She will be able to lead in helping medical doctors, policy makers and healthcare advisors bring together the science and culture to deliver to us and the entire world, the best health and medical care.

Great question, Rosie! Ask a dozen people and you will get hundreds, maybe thousands of answers. Hey, Dana, you are in the middle of it, so maybe you will comment from your deeply involved, finger-on-the-pulse point of view. Here are the top 7 most difficult setbacks that I (or one of my friends) weren’t prepared for but wish we were. Some are external, some are internal. Recognize and react to lessen the negative.

#1 Self-doubt. This is a very common setback that happens many times during the journey. Am I good enough? Will I have what it takes? Remember, everyone has these doubts and they are normal.

#2 Failure. Bombing on your first set of SAT or MCAT scores. Not getting into medical school the first time around (like me). Hey, pick yourself up, brush yourself off and start all over again. Do not settle on something else because it may be easier. If you have a passion, follow it. Passion is not always easy.

#3 Naysayers. People in your life, especially those who love you, might feel your hurt from the lumps and bumps you will inevitably experience. They might ask you, “Why are you doing this to yourself?” My parents asked me (during a time when fewer women went to medical school, and fewer yet became surgeons). Try to tune them out, or at least gently ask them to get their fears and noise out of your head. You will march to the beat of a more mellifluous drummer.

#4 Environmental Adaptation. Interacting and reacting to the new environments. College and often being away from home, medical school with its own unique culture, residency in many hospitals and dozens of different environments. It’s hard. Watch and listen carefully. Learn to adapt.

#5 Economic Challenges. Getting into college and medical school, staying in college and medical school and then paying back all those loans is daunting. Funding sources may dry up. Most need to work at least part time to defray costs. Shop very, very carefully when applying. You want to get the biggest bang for your buck.

#6 Life Gets in the Way—things happen. Divorce, death, and dreaded diseases. With no intention to sound harsh, sometimes you have to put on your blinders and keep moving on. Okay, so your grades won’t be perfect during a life crisis setback. Don’t expect miracles. My mother was diagnosed with breast cancer in my first year in medical school. It was awful. We lived with that diagnosis for another 20 odd years. My first year wasn’t the best, but when the tears dried up, I learned my gross anatomy.

#7 Discrimination—gender, age, racial, ethnic, and religious. It’s all there. Medical progress is slow. Doctors by nature are not suited to change. Cross that with a rigidly hierarchical system of education and training and discrimination is bound to find its way into everyday medical life. (If you are interested in my story, please see www.lindabrodskymd.com.) My mission is to make sure that my daughter and the other women of her generation will not have to face that obstacle. We all dream, no?

So there you have it, Rosie. Not everything is rosy is the house of medicine. But if more young women like you and Dana invade this world, I am sure it will get better and better.

But as I listen from afar, I hear the memories stir that I have stored of my first patient encounters in the daily dramas of her medical student life. Getting to the “wards” (as we used to call the patient floors, a term left over from the open hospital wards that characterized a hospital almost a century ago) was a real milestone. And it meant that you were going to meet real, live, actual (not simulated) patients. That alone was awesome and frightening.

And to the uninitiated, no matter how close to medicine she/he may have been, no longer are the scientific facts and concepts enough to guarantee your success in this new environment. There is a large and rather complex layer of people that comes between the student and the patients. This layer is known as the “service.” A service, in a medical school/university teaching hospital, consists of many types of medical students, resident trainees at different stages of training, and the attending or staff physician. The attending (or staff) doctor is the doctor who has completed all her/his training and is now responsible for the patients on the service. He/she teaches at the medical school in a clinical capacity. He/she is the ultimate decision maker. That’s a lot of responsibility.

But in order to teach and take care of patients at the same time, a large cadre of helpers/learners is available to help the attending. Each has a different role that may change daily depending on the situation. One example is on round. On rounds (going around and seeing the patients two or three times a day to check on their progress) the student may present a patient at one time, or the chief (most senior resident) at another. Knowing when to do what can be very confusing and stressful. Another example is helping in the operating room. Knowing what and how to do something which might seem as simple as holding a retractor, can be a major life challenging experience! Let that retractor slip at a critical point in the operation, and significant harm might result. What lecture covered that in the pre-clinical years?

Thus, new skills come into play at this point in the student’s medical school journey. Social skills. Skills needed to assess a situation and respond quickly and correctly to the social cues of a totally new environment. When do I speak up? When do I volunteer to see a patient? How am I supposed to present this patient? Was I too long-winded? Did I leave out any pertinent information? Did I speak loud enough and with enough authority? When do I tell the surgeon my arm hurts and if I don’t get a rest soon, the retractor might slip?

Sometimes, when I was worried about all of these other things that go into becoming a doctor, the medical concepts I learned would fly right out of my head. I might stammer or think that I looked kinda jerky. And I guess sometimes I did. And yes, sometimes the retractor slipped, but the surgeons always saw it coming and I don’t remember any harm (even the time I fell asleep holding the retractor on a liver during the removal of a gall bladder at 4 am!) And somehow I made it.

I am sure Dana has had some of these experiences. I know that she thinks that she is unique in her mis-steps, but that just isn’t so. I hope in the next post she will tell you about her first clerkship and how she felt about stepping into a whole new world of learning how to take care of patients in the social system we call health care.

At Dana’s medical school, the University of California, San Francisco(UCSF) the students get a 2 week transitional period to ease them into clinical medicine. I am told that they learn about hospital culture, basics in chart notes, how to keep from being a pest, and how to get the nurses on your good side (so at least if they don’t help you, they are not likely to bite off your head!) These are things I think my generation of doctors just picked up as we went along, for better or for worse, for both the patient and for us.

A lottery system assigns who gets which “rotation” (another name for a clerkship) and when. You put in your request, and the computer spits out a schedule. Dana wanted to start with surgery and she lucked into a very busy hospital, one with a lot of trauma, one where medical students are likely to be needed. A lot.

She also got lucky in that her first night was a call night. She was there working for 24 hours straight. She watched a tube being put into a chest to drain an infection, and she stayed up all night except for a few hours of sleep in the wee hours of the morning before she had to get up at 4 a.m. to pre-round with the interns (real doctors in their first year of training after medical school) which happen before the usual work rounds with the residents (the more senior doctors in training) which occur before the operating room schedule starts, and most certainly before the attendings (the real doctors) come on the scene to make sure everything is being done exactly right. So as you can see, Dana is really the low woman on the team, but it’s a start!

We didn’t hear much the first few days. Only that she hadn’t been in the operating room yet. I had to wait until Sunday afternoon when she finally called and told me all about her first week.

She told us that she has great senior residents, and a great team. I knew this was very important, because if your team players (and surgery training is most certainly a team sport) are not willing to teach, you will be miserable. Inwardly I heaved a sigh of relief. Hurdle #1 overcome.

“Mom, I scrubbed on a hernia. My resident, a really nice guy from Stanford med, sat down and prepared me for all the questions I would be asked about the anatomy. When the attending asked me a question, I didn’t get the first one because I wasn’t quite sure what she was asking me. But after that I knew all the answers.” There was more than pride in my baby’s voice. A pride I couldn’t help but feel as well. Hurdle #2—she would not fall apart under pressure, even in the operating room.

“That’s good Dana,” I replied. But she really didn’t hear me, as she rushed on to the next operation.

“Then we had a perforated bowel (a hole in the large intestines) and the patient was really sick. It was the first time I had seen the intestines. They were sooooo beautiful, orange and shiny and glistening. We did a side-to-end anastamosis. It was so cool.”

Dana continued to report about the personalities. She heard others complain about the all night call which didn’t bother her. And even though it was suggested that women might not (yet) have the physical stamina, Dana was quiet. She has a lot of knowledge about that sort of thing and knows that her surgeon Mom is far better than her surgeon Dad at staying up all night and handling all sorts of physical and emotional trauma surgeons must learn to endure. Good move, Dana, I thought. Hurdle #3—she knows when to speak up and when to keep quiet.

Then, I couldn’t believe it. She said, “Mom, I could so totally see myself in surgery. I love it!”

Will Dana really become a surgeon? Maybe. And maybe not. It’s really too early to say. After all, it’s her first clerkship, and I am sure she will be drawn in many directions before her journey is complete. (But it would be really cool if we were the first mother-daughter ENT doctors!)

So after we hung up the phone, I heaved a sigh of relief as I thought, ahhhhh, she’s over hurdle #4. She is going to love being a doctor, and that’s a great feeling. I know.

All doctors are expected to continue their medical education and there are requirements for learning which have strict standards. But doctors who do research with patients and in the laboratory more often have the opportunities to present their work to the medical community at national and international meetings.

My husband, a pediatric urologist (a surgeon who cares for the medical and surgical problems of the urinary tract in kids), and I travelled to spend a week in Israel at the American Association of Pediatric Urologists. This was the first time they “internationalized” their annual meeting. It was fun, informative and very fruitful in making the contacts and plans he needed to extend his NIH (National Institutes of Health) funding with his fellow pediatric urologists. We wives also had a great time, having known and seen each other for the past 22 years this group had formed and met. For this part of the trip I was on vacation and had opted to not lecture or make contacts with my colleagues in Israel.

When it was over and we had visited family and travelled other parts of the country, we left for Greece. It was there that we switched hats and I was the “professor.” I visited with one of my former trainees, originally from Greece, who had spent 2 years training to be a pediatric otolaryngologist with our group at the Children’s Hospital of Buffalo. Her name is Dr. Sofia Stamataki.

I lectured at the University of Athens Medical School, met her colleagues, lunched with her director. We toured the children’s hospital where she worked and learned about medical care in Greece.

We talked and compared notes and discussed cases. We planned some research and for her next visit to the US. And, of course, over the course of the 4 days, we toured.

I am very proud to have been part of the training of the first US fellowship trained pediatric otolaryngologist in Greece. It was wonderful to see my former student, now colleague, climbing the ladder to success. She is in a good place and that made me feel good.

So if you want to be a doctor and also a teacher and researcher, you will find yourself travelling to places you never thought you would visit with people you never imagined you would meet. So become a doctor, travel the world.

Dana, when you get back from your vacation (after you just took part 1 of your medical boards), as an MD/PhD in anthropology, could you tell our readers some of the other ways doctors travel the world?

First the skills. Doctors learn to apply scientifically based knowledge to human beings who live, behave and act in wholly unscientific ways. Biology intersects with culture and politics and geography and much more. Cultural values and social systems may impact our health and well-being as much as or more than our biology in some cases. Think about the violence in some communities that takes the lives of innocent people. A doctor can treat the wound and maybe save a life, but only society and culture can control the behavior.

All doctors do not need the same set of skills. So there is no one “doctor type.” There are doctors who spend most of their day in their offices seeing patients, talking, looking at lab tests and doing what most people think doctors do. It made for a great TV series 30 years ago when Marcus Welby was popular. And there are some doctors who spend all their time seeing patients for a few minutes in a hospital emergency room and then move on to the next (do you any of you remember ER?)

Other doctors never (or hardly ever) talk to or directly see a patient. Those doctors still can play an extraordinarily important role in a patient’s care. Take the pathologist. A pathologist is a medical doctor who is responsible for looking at samples of tissue or body fluids that are removed from a patient in order to determine a diagnosis. They may be given very little information about the patient. Sometimes they just know the age, sex, and where the tissue sample came from. And yet their assessment, based on the different types of tests that might be done on that tissue, will determine everything that happens to the patient after that. They have an awesome responsibility in the patient’s care.

Their participation is more likely to rely on knowledge in the “science” of medicine (and physics and chemistry and imagery) than in how they interact with patients, which they rarely do. They need sometimes interact with other doctors. But their skills are more like those of a detective who has to take all the clues scientific testing of parts of the body (or in the case of an autopsy, a dead body) and try to figure out what has or is happening to that patient.

The radiologist is a doctor who interprets “films.” He or she is presented with images made from x-rays (radiation), MRIs (magnetic waves creating images), ultrasounds (sound echoes against tissue interfaces), PET (positron emission) scans and other types of imaging taken to determine the problem a patient might face. Radiologists need to have an in-depth understanding of physics (not my best subject for sure!) than might another type of doctor. Being able to imagine 3-D anatomy and computer savvy skills are also helpful.

Or take a doctor such as the pediatric surgeon. That doctor has to develop skills in caring for children, listening to families, and manual dexterity in working on small, fragile patients. Fixing very small delicate people who are fiercely protected by their families requires a completely different set of skills.

So you see, Rosalee, science, while very important, is not the only area of study that helps you to become a doctor. To become a doctor you have to be determined to become one. Learn your science, but study anything else that might interest you. Whatever you learn, you will find useful in whatever type of doctor you want to be.

No one likes taking tests. Unless you are really well prepared and know the answers to all of the questions. And then it can be fun as an affirmation of your hard work, perseverance, and mastery of the material.

My first big, important, life-changing test occurred in the 8th grade. The DATs—tests to help you figure out what career you might be good at. Don’t remember what the “D” stood for. On this 6 part test, I scored in the 99th percentile in spatial relationships, mechanical thinking, scientific reasoning and mathematical concepts. But I only scored 80th percentile on transcription and memorization. When the test results came out, the guidance counselor met with my parents to tell them what line of work I would best be suited for.

Based on my scores, my counselor told my father I would be a very good secretary! To his credit, my father told the counselor that his honor student daughter could be other things beyond a secretary. And then he told me to ignore her the same way she ignored those tests.

Why do I tell you this? Because tests, while important in helping someone else determine your strengths and weaknesses, are only one part of what you are and what you are going to become. They are simply not a complete picture of you.

Having said that, it is important to know that test taking is a fact of life if you are going to become a doctor. The tests start early and they seem to never end. In fact, every time you take on the care of a patient, in some way, you are being tested as to how good you are as a doctor.

But let’s leave that particular philosophical debate aside for the moment. Practically speaking: What kind of tests will you encounter? How important are they in becoming a doctor? When do you take your last test?

First, it is very important you know how to take tests. The subject matter is important, and preparation is the key to success. There are the tests you take for classes. Teachers are usually pretty generous in letting you know what to study. But then there are those dreaded standardized tests that colleges require for your application to their school. Unfortunately, many times these tests are used as cut offs to separate out students who will be considered for admission and those who won’t.

The last time I looked, the pre-SATs (scholastic aptitude tests) are taken early in the junior year of high school. These tests help determine who will receive national merit scholarships. They also give the student a taste for what’s to come.

Then comes the big sister test. The SATs. They have three parts—math, English and writing sample. These scores are weighted more or less heavily towards admission depending on the college. Their results are also provided to colleges which then begin the process of sending you material encouraging you to apply to their school.

Prep courses abound. Is Kaplan better than Princeton Review? Don’t know. But they can be expensive, and I do not think there is financial aid for the near $1000 fee charged for college preparatory tests. (I sent an inquiry to each last month, but have yet to receive and answer). But they also can help boost your scores and even guarantee it or your money back.

Even without test prep courses, you can find used test prep books on-line. And then: Practice. Practice. Practice. The discipline is not only useful for these first tests, but also will help you learn how to learn to take tests for the rest of your life. Alas, a painfully necessary skill.

Hey, Dana, now that you are back from the Big Sur, what do you think of my take on tests?

So while Dana is off with younger sister Becca exploring the beauty of Big Sur, CA, during their winter break, I will tackle the first of the many great questions Rosie asked.

“How long is it to the step where you can finally say that you are a doctor?” Hard question. The answer starts with “it depends.” When is someone really a doctor?

Becoming a doctor is a process. A long process, which doesn’t really ever end until you stop caring for patients.

It can begin in high school, college or even later on. There is no one route to get there. But for the purposes of answering this one question, let’s look at the straight and narrow path to becoming a doctor.

Start with graduating high school. Take challenging courses. Get good grades. Learn to study and take tests. Find other interests. Take care of yourself and the important relationships in life. Takes about 4 years.

Go to college. The best one for you. Sometimes people don’t want to leave their family to go to a “top-rated” school or they don’t have the money, or the grades. Don’t let that stop you! Find the best fit and do your very best. Find your academic interests (may not be science, but you still have your pre-meds). Take challenging courses. Get good grades. Learn to study and to write well. Learn to take tests. Build on your outside interests. And take good care of yourself, your family and your friends. (College is usually four years, but there are some programs which combine college and medical school in 6 years.)

Go to medical school. There is no one “best” school. Medical school is almost always 4 years in length, unless you pursue a PhD in the biological sciences or, more often now, in the social sciences (like Dana who is also getting a PhD in medical anthropology).

At the end of medical school you are allowed to call yourself a doctor. The title of MD (medical doctor) or DO (doctor of osteopathy) is appended to your name. Does that make you a doctor? Well, it depends on what you want to do.

If you want to go into related fields where an MD or DO is helpful and your primary job is not one-on-one patient contact, then you have become a doctor. One of my medical school classmates works in research designing clinical trials. He never “touches” a patient but his valuable work truly touches the lives of many patients by providing information helpful to thousands of people.

But if you are like most people who travel the first 12 years, you want to take care of patients. How long? It depends on your field of medicine.

The day I graduated medical school, Dr. David Wagner, pediatric surgeon and director of emergency medicine, “hooded” our class. As I accepted the white fur cowl bestowed on one who earns the MD degree, he said to me, “You will live, eat and breathe medicine for the next 5 years. Learn everything you can about diseases and everything you can about the people who will suffer from those diseases.” Great advice that I took very much to heart.

Now you become a resident. You make the most of every patient encounter. You learn all kinds of skills, study hard and work long hours. The patients become your teachers while you are closely supervised by more experienced doctors.

Your formal training is over. It is 3 or 5 or sometimes even 9 years later. You can finally go out into the world and show people that you have learned and earned what it takes to be called a doctor, a healer. Sound daunting. It is. But it goes very fast. Be propelled by how exciting and important your life’s work is to you and for everyone who will help.

Yes, my daughter the doctor-to be, if it were only our career choices that created confusion and uncertainty! How your words (and your angst) resonated with me and my own daily struggles in caring for patients. Even after a lifetime of practice (nearly 30 years), not a day goes by that I don’t feel humbled by a problem I cannot solve or a patient I cannot heal.

Learning to deal with the confusion created by the rapidly changing science of medicine which needs to be practiced on the ever changing cultural, social and economic playing field has placed enormous demands on today’s physicians. How will this new generation of healers handle this explosion of information and the ever increasing societal expectations for perfection and performance?

“Medicine is a calling; it is not just a career. It is a way of life.” How many times I have heard and repeated the mantra of medicine of my generation? But as I watch you go through medical school and see how you lovingly and thoughtfully embrace your future, without losing your love (or time) for other parts of and people in your life, I have begun to reconsider my position.

Perhaps the attitudes emerging from the upcoming generation of physicians are their protective reaction that is not only necessary but also good. This talk of balance and lifestyle. To have time with our families. To have time to restore ourselves. To have time to have and be friends. To us, who have spent decades in the trenches, this sounds so foreign. We believed that these times were denied to us so we could prepare and become and remain really fine physicians.

But the practice of medicine has become so demanding, that in order that we “first of all, do no harm,” perhaps we have to be mindful of our need to more regularly replenish our minds, our bodies and our souls. This may be essential if we are to be more than the mechanics for the human biological machine.

Medicine is unique in the sciences because it is not just a science. The intersections of culture, social, political, economic, and biologic is no more apparent than in the one-on-one critical encounter between someone in need of caring and curing and the someone who not only has the competence, but also the compassion to make that happen.

One can learn competence in a lab, on a cadaver, from a lecture or the hundreds of supervised hours of seeing virtual or real patients in the emergency room, in the hospitals, and in the clinics. But compassion is learned from nurturing the feelings that sometimes are buried deep, deep inside, which allows you to respect and receive someone else’s needs.

So if we are tired or worn, as so often we physicians can become, maybe we will be less to our patients than they really need. Less able to both care and cure.

Yes, Dana, I am sure you will continue to experience periods of confusion and uncertainty all the days of your medical life. Finding people to lean on and places to retreat to may give you, and the people for whom you care, fresh and essential energy to be that physician we all want for our own.

Does anyone remember the scene in the movie Bye, Bye, Birdie, when the MacAfee family learns that Kim is going to be on that really big show, The Ed Sullivan Show? Does anyone remember how, transported to a scene in heaven, likely cloud nine, they sang, in four part harmony, “We’re Gonna Be On Ed Sullivan!”

Not a totally unbelievable scene for a family in the 1960’s. It was exciting to have a TV, much less to be on it. Back then the media consisted of print newspapers, magazines, radio, and the nascent, still black and white, television.

But here, almost 50 years later, in the first decade of the 21st century, I am on my own cloud nine. I am getting ready with my video camera to produce my own song to be distributed on YouTube. And what will I sing? “We’re Gonna Blog for Ira Flatow!”

Some of you reading this blog don’t know Ira Flatow (and probably not Ed Sullivan either). Ira started his radio career in Buffalo and rose to the national scene with his unique radio brand of popular science—Science Friday. Aired every Friday afternoon, Ira talks, educates and interviews to bring science into the everyday life of everyday people. That includes me and you. Whenever I am in the car on Friday afternoon, I forgo my book on tape, and turn the dial to SciFri. I love this program. Ira loves doing it—you can tell. I love Ira.

Problem is, I am told, that the demographic of his show is somewhere north of 50 years. A fact I find hard to believe. But I also learned that Ira Flatow is trying to change this in a big way.

This summer I received an email (almost as exciting as a call) from SciFri executive director, Ann Marie Cunningham. It informed me that their teenage summer intern, Rosalee Washington, had chosen me as a blogger, from all the other bloggers in the blogosphere, to be a blogger for SciFri’s website for the next generation, Talking Science. They wanted a blogger who would talk about being a woman in medicine and science. How does a girl get into medical school? What do you have to do in college to become a doctor? What are the barriers? What is life like for a woman in medicine? Can you combine medicine and a family? As you might imagine, many women could write this blog. But they chose me!

Next came a conference call. Ann Marie introduced me to Rosalee who shared with me her immediate concerns (presumably those of other young women) about how to get from high school to college to medical school. I could do this! How fortunate that I was really close to that phase, as my daughter Dana had just finished her first year as a medical student. She could be a resource.

And then, there in a flash, I thought, why not do a mother/daughter blog? Would Dana agree? Would she have time? (She was the first real blogger in our family (www.danainnz.blogspot.com), so I knew she could do it well.)

You cannot imagine my excitement when Dana agreed. So now, the two of us have begun a joint venture for the newly designed Talking Science website, aimed at the 15-35 year old demographic. We branded our blog, "Like Mother, Like Doctor." Catchy, no?

Hope you will read it regularly, share it with your families and friends, and add your own comments and questions as we try to serve as a resource for the next generation of women physicians, new age style, on our blog, on the web. From the black and white TV screen to the color, flat panel computer screen. Science Friday, Talking Science, Ira Flatow, here we come!

The first mentor ever mentioned is found in Greek mythology. When Odysseus begins his journey, his son, Telemachus, is left in the care of Mentor, for guidance and protection. The story unfolds with the goddess Athena intervening and assuming the form of Mentor in than she could encourage Telemachus to assert himself and take charge of his role in the lives of his mother Penelope and father Odysseus.

Is it an accident that the very first mentor in literature is both a mortal man and a female god? I think not. The moral of this mythological story is that the role of protector and guide is complex and can be filled by many different types of people (and to those who they help can even take on god-like qualities!)

So, who and what is a mentor? On the most basic level, a mentor is anyone who will influence your growth and development in a positive manner so that you can determine and then achieve your life’s goals. Mentors are role models, teachers, cheerleaders, and trusted friends. Mentors are experienced and willing to open doors to opportunities. Mentors help you develop skills, both practical and personal.

And mentors help keep you out of trouble. And when the deed is done and you are already stuck in the mud, mentors help lift you up, clean you off, and get you going in the right direction again. Mentors help you believe in yourself, especially when the going gets tough, as it is bound to from time to time. Being a mentor is not an easy job.

And mentors are sometimes found in the most unlikely places, teaching you the most unlikely things. Sometimes you don’t know that person is a mentor. When I think about it, first mentor (except for my parents) was my Aunt Marilyn. She is my mother’s youngest sister by 17 years, and a mere 5 years older than I. At our present ages, the age difference doesn’t mean a lot, but way back in my early childhood, it was a huge difference. She knew all the new dance steps, the new rope jumping steps and new ball games girls would play with the pink hued Pensy Pinky ball or the sturdier Spaulding. (I preferred the latter).

As we tossed the ball against the side of our house, bounced it over and under our legs and arms, and threw it “like a girl” to and at each other, I discovered my rather decent hand-eye coordination, my love for games which morphed into my love of sports, and revealed to me the satisfaction gained from my competitive spirit. These early self-revelations were all critical to my life’s path.

My next important early childhood mentor was my fifth grade teacher, Rita Braver. She had been warned that I was “challenging” by my fourth grade nemesis, Miss Z. Miss Z. ranked me at the bottom of the class for hygiene because I bit my other-wise clean nails, could not control my unruly hair, and always had rumpled clothing from being slightly chunky and preferring to play with the boys. This not so subtle form of gender stereotyping plagued many ambitious girls of my generation who spent more time on our books than on our looks. Despite this not-so-rave review, when I reached the fifth grade, Mrs. Braver chose me, out of all the girls in our class, to help with kindergarten set up when school began. I could join my class 10 minutes late every day! Someone important believed in me! She knew I could make up the work load. She new I could be reliable. She recognized me for important characteristics and gave me an opportunity that set me apart from the rest. I never have forgotten how much she changed my life.

So you can see that mentors are all around. They can be found in unexpected places and can be unexpected people. While letting people help you in life, you can learn about yourself, develop skills, and move towards your goals. If you look around you will find these people and you will learn to develop these increasingly important (and as you go along increasingly more complex) relationships.

As my life went on, I gathered up mentors wherever I went. And when I got into high school, these critical guides became increasingly more important. Shaping my education, the foundation for giving me the choices I needed to follow my dreams, was one of the most important gifts I received from my next level of mentors.

To begin our blog, “Like Mother, Like Doctor”, we, Linda and Dana, decided to interview each other about our experiences with becoming and being a woman in medicine. After all, between the two of us there’s a lot of firsthand experiences of what it means to be a woman in medicine—as seasoned practitioner, newly minted medical student, and for both, as patients.

So here we go! To begin, we offer a series of discussions, in which both of us weigh in with our perspectives and insights at times generated by your questions and comments. Others post will feature “A Day In the Life”, “Ask the Doctor”, and random, interesting observations and stories that will make you think, laugh, and maybe even cry.

DG: Hmmm. Where to start? Well, for this first blog, how about at the beginning? The question I want to ask, is “Did you always know you wanted to be a doctor?”

LB: No, I don’t think so. When I grew up in the 1950s and 1960s, your Grandma Zelda wished for me the college education she never had. “Be a teacher,” she told me again and again. “Teaching is a good profession for a woman.” For a long time I thought teaching would be my path, but when I reached high school I realized it was her dream, not mine.

And so my “non-specific” dreams loomed large over my early life. I was always very driven to achieve. Whether it was a pick-up kick ball game on Jackson Place where I grew up in Bellmore, NY, or the fifth grade spelling bee, or being editor of the Buccaneer, my high school newspaper, I always gave it all that I had. I totally immersed myself to be the best I could be. I liked a challenge.

I finished my first year of college still without a clear direction, and still without a plan. Admiration for my Aunt Roberta, a clinical nurse specialist and author, led me to discuss my plans with her as I thought I could become a nurse just like her. Her response startled me into a new mindset. “Why don’t you become a doctor like your Uncle Murray (her husband and my mother’s brother)?” I hadn’t thought about that possibility. My Uncle Murray was a family icon—first and only in his family to go to college. Medical school was beyond the family’s imagination. If my aunt and uncle believed that I could become a doctor, well then, maybe I could. And so I decided I would try to become a doctor.

I returned as a sophomore to Bryn Mawr College. Pre-med courses intermingled with my History of Religion major and Chemistry minor, kept me really busy and really challenged. Not the typical science pathway for anyone who wanted to become a doctor in the 1970s, especially a woman. But as I have learned through these many decades, there doesn’t have to be a typical pathway.

What I also learned was that having someone believe in me really helped me to believe in myself. And as I am writing this blog, I just now realized my aunt and uncle were my first mentors, but thankfully not my last. I knew I could make this difficult journey. And now, 35 years later, my mentors, my drive, the intellectual stimulation and the deeply felt need to make a difference in the lives of others has pushed me on this long and winding road.

And you? Did you always know you wanted to be a doctor?Di