Spencer C. Knox, MD

Internal Medicine Resident Physician, PGY-3

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Origin of ‘Doctor,’ a Resident’s Perspective

It’s extremely helpful and interesting to know the origin of words.  People working in medicine are delineated, in part, by their title.  It assists patients and professional colleagues in knowing who to trust when information is needed.  A key member of the medical team is the doctor, also known as physician.

Where does ‘Doctor’ come from?

A quick query in the dictionary yields the origin of ‘doctor,’ docere (translation:  to teach).  First coined in De Oratore (55 BC) by Cicero, the famous Roman politician and lawyer, the word has solidified its place in our lexicon.  It defines an individual who is expected to know relevant facts, be able to apply those facts in a logistically feasible fashion, and efficiently communicate that information to the patient and/or staff.

Of note, the role of a resident doctor/physician is humbling in a number of ways.  Perpetually learning myself, I find that the more I know, the more I realize I don’t know.  Translation:  there is always something new to learn.

As part of an academic program, residency gives us residents the opportunity to impart our knowledge on medical students.  I love to teach what I know.  It’s especially enjoyable to see the reaction on a student’s face when your explanation results in a “lightbulb”-type moment.  No matter the level of training, the role of the doctor is to teach; the list includes medical students, nurses, medical assistants, and non-medical staff.

Origin of ‘Physician’

Doctor and physician are synonymous.  I find it important to remind myself that physicians are expected to provide a trusted source of information in the treatment of living beings – people.  We are also looked upon to prove that our teachings – recommendations – translate to a healthier life.  I hope to improve my knowledge and wellbeing a little everyday, so that I can one day show a new med student, resident, anyone that anything is possible.

Definition source:  New Oxford American Dictionary

Goals for 2018

This weekend has been really relaxing and re-energizing.  Weekends are rare during residency, and are exceedingly sparse during the first and second years.  This year, my third and final of residency, has ushered in more weekends.  It’s been awesome for organizing and cleaning at home.  Today, I’ve been able to vacuum, clean the kitchen, and am in the process now of organizing my desk.

Goals for 2018

In taking a new approach to the prototypical “New Year’s Resolutions,” I decided to rename it “goals” for the year 2018.  Earlier today, while jamming out to music on my Bose Mini Soundlink, I did some thinking about my goals for this year.  I’ll share my big three.

#1 Studying with a fresh perspective

   I will study with a new purpose, as if I have a patient sitting right in front of me

Sounds strange just writing this, but I recently sat in on a lecture that drove this very point home.  I’ve been fortunate to have success on many exams utilizing the “study [x, y, z] material for the exam” approach.  I want to extend and improve on my success with a more diverse and more detailed working knowledge of medicine.  Also, I want even better exam scores.  How I plan on doing this will involve approaching reading and answering practice questions differently.  Starting in 2018, I pledge that I will study with a new purpose, as if I have a patient sitting right in front of me.  This will impart relevance to the study topic at hand.

Note to self when answering practice questions:  you may very well see a patient with the same presentation and be faced with the same problem.  Learn from it.

#2 Improve my communication

The hope is to improve on two fronts:  answering my text messages promptly and reaching out to family and friends more often.  Time seems to be accelerating the deeper I get in residency/training; I need to take pause and appreciate others in my life with a simple “Hi, how are you doing?”  Time constraints are often an impeding factor, but I plan on using breaks in the day to reach out more often to develop quality relationships.

#3 A focus on my well-being

Super complex and relating to a myriad of areas of my life, this is the year to enhance my health.  Despite eye-popping reports of physician burnout, I remain very happy with my choice of practicing medicine as a doctor.  Training takes a toll on everyone in residency, but I plan to stay ahead on the wellness curve.

Exercise, something I frequently recommend to patients and seldom do myself, is first and most important on this list.  I’m happy with weight lifting, elliptical/stationary bicycle/treadmill, or a walk outside even if for only 30 minutes, if that’s what I can do in a day.

Diet, another key element in my life, has suffered as of late.  Instead of reaching for pizza/fries/Lo Mein, my 2018 diet will consist of less carbohydrates and more protein.  When possible, I’ll make fruit smoothies with fiber and protein sources.  Lastly, looking forward to the future is super invigorating.  I will begin training in a GI fellowship, aka my dream career.  To be the best physician possible, it has to include personal improvement all of the aforementioned categories.

Let’s do this!

2017 In Review

Writing my 2017 year-end article as a third year resident (PGY-3) is truly something.  I find myself reflecting on a myriad of things; vying to be a competent physician, enjoying my first wedding anniversary with my wife Claudia, bringing home our Cavalier King Charles puppy, and finding my niche within the ever-changing landscape of healthcare.  I’ll explain a particular highlight of 2017, relating to personal professional development.

Residency Trains the Human to Be A Doctor

As of today, I have completed 30 months of a 36-month program.  With the passage of time comes (limited) experience in the clinical medicine world.  This year, more than others, I have noticed that the practice of medicine is just that.  It is adaptable, and largely dependent on knowledge plus experience.  Guidelines and standard-of-care are two cornerstones of modern medical care.  Evidence-based and peer-reviewed literature is the precise mechanism underlying the success of western medicine.

Oddly enough, the more knowledge I gain, the less I feel I know.

Residency is the formal time period wherein academic hospitalists, sub-specialists, and experienced nurses teach people — my co-residents and I — how to be a doctor.  Accomplishing this intricate task in a mere three years is sort of mind-boggling.  Personalities transmogrify.  Knowledge expands.  Oddly enough, the more knowledge I gain, the less I feel I know.

How Personalities Change During Residency

Medical training is arduous.  Hours are long.  Rounds are often both mentally stimulating and exhaustive.  It is all necessary to mold the best clinical physicians.  A side-effect of the process is a change in personality.  Whether or not we realize it, residents’ personalities adapt.  Usually for the better, people emerge from training an evolved version of themselves.  A key area I am trying to improve is to more efficiently condense lots of patient data.  Keeping the best bedside manner is also pivotal.  The overarching message, though, is to always bear in mind that people are seeking a doctor’s expertise.  I am honored to have the opportunity to treat, and sometimes cure, both routine and complex ailments.

Becoming a Gastroenterology Fellow

I am so proud to be a part of GI medicine.

I discussed the pure joy of matching into a Gastroenterology (GI) fellowship in a previous post, but to properly review 2017, I would be remiss if I didn’t talk about the Match.  I am so proud to be a part of GI medicine.  It is by far the most interesting subspecialty for a multitude of reasons, some more personal than others.  I’ve said to many colleagues and friends that gastrointestinal medicine is the #1 most enjoyable topic I study.  Coupled with a family history of Celiac disease, matching into a GI fellowship is a dream come true.

As an aside:  statistically, GI is the most competitive Internal Medicine subspecialty.  The NRMP compiled interesting data to back this claim.  GI programs as a whole received 1.5 applicants per available training position in the 2017 cycle.  By contrast, Cardiology, historically the most competitive field, had a ratio of 1.3 applicants:position.

2017 In Summary

  • I am incredibly happy at my residency program, and have experienced a positive metamorphosis as a person and professional.
  • My wife and I had our first wedding anniversary!  🙂
  • I matched into my dream subspecialty field, Gastroenterology and Hepatology.

Here’s to an even more AMAZING 2018!

I Matched into GI Fellowship!

Matching into a three-year clinical Gastroenterology fellowship program is a dream come true.  Match Day was December 6th, 2017.  I remember anxiously driving home to meet my wife Claudia and puppy Chloe so that everyone was there to hear the news as soon as I pulled up the NRMP 2017 Medical Specialties results online.

Sitting down at my desk, I opened Chrome and started to type the NRMP’s website address.  My web browser filled in the rest.  I scrolled down to the results area, and was stunned to see I matched!! 🙂

NRMP Fellowship Results

We shared a celebratory toast, thanking God, our family, and my new GI program for… the opportunity.

Hugging Claudia, we both instantly knew our lives would change.  “I’m going to be a GI doctor!” I exclaimed to my wife.  We shared a celebratory toast, thanking God, our family, and my new GI program for allowing me the opportunity to train in the art and science-based medicine of Gastroenterology.

Suddenly, the text messages and Facebook posts came in.  I recall thinking, I feel so blessed to have family and friends in my life who are so supportive and genuinely happy for me.

In the hours and days after the shock gradually wore off and reality set in, my mind began running through all of the things that need to happen before starting day one.  Licensure in Massachusetts, finding a suitable home for the next three years, the unknown of who our new Massachusetts friends might be, and so much more.  It’s such an exciting time!

 

Fellowship Candidacy

Life in residency is always busy.  Time flies by.  I am nearly three months into my third and final year of residency (PGY-3).  I was scrolling through social media earlier today, and noticed a familiar big announcement:

The start of a brand new cycle of residency applications is a momentous event.  For MS4’s, it marks the official beginning of what will be a life-altering season.  Interviews will be sent out to deserving applicants, and both the programs and applicants work towards a match.  I can’t help but remember the feeling of pure joy at the sight of each invitation email.  It’s been over two full years since I went through the process.

Right now, as I enter the fourth month of my last year of residency, I can say that I am so very honored and happy at my current residency program.   I like my co-residents, and call many of them friends.  Attendings have been extremely supportive.

Now, I am a candidate for a fellowship in Gastroenterology (GI).  I recently went on my first interview for a 2018 position, and felt very, very honored to be in the presence of so many professionals who are making GI their life’s work.  Meeting current GI fellows and attendings is extraordinarily invigorating.  I can see myself diagnosing and treating patients with disorders of the small intestinal including Celiac Disease and malabsorption.  I want to make it my career to protect and prevent complications of Barrett Esophagus, IBD, colon cancer, and various other downstream problems of the gastrointestinal system.  A Gastroenterology fellowship would mean the world to me!

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