What motivates you to keep pushing forward?

[Dreamislandcaptive]

For example when you face obstacles?

---

Members don't see this ad.

 

[Monkey.King]

Is this a general question or are you trying to find a reason of your on? Shouldn't it be the end result of reaching your goal?

 

[ProspectiveKidd]

As far as the whole med school thing? Find your larger purpose in what you're doing...are you taking some class or are you taking a step towards becoming a doctor so you can save lives, enhance the quality of life for others? Assigning a meaningful purpose to everything I do has helped me keep moving forward. That of course applies outside of medicine as well.

 

[Dreamislandcaptive]

Is this a general question or are you trying to find a reason of your on? Shouldn't it be the end result of reaching your goal?

yes, it is just a general question.

 

[nomoreequationsplease]

I think everyone is different on this. For me, its the obstacle itself that pushes me forward. Any obstacle I see in my way, my goal is to overcome it. I continually push myself forward to overcome greater and greater things, I then use the knowledge I learned to help other people overcome it as well. I find it extremely rewarding in overcoming a big obstacle and using your knowledge to help others also overcome it.

 

[Astra]

Knowing that I am fortunate to be in a position where I can get an education and not worry about basic necessities. I am sure that there are brilliant kids in 3rd world countries who will never be able to express their brilliance. This makes me motivated to try my best at everything I do and not to let failures keep me down. Failures are a great way to learn what not to do and how to improve your strategies when tackling any problem. The trick to success is minimizing the large failures and learning from your day to day small failures.

 

[MerYangBey]

Think of all the money and chicks bruh.

 

[XxThaDoggxX]

The thought of holding that scalpel in my hand as the staff looks at me before I make that first cut and I say "lets begin"

 

[jqueb29]

The thought of being able to retire young and enjoy life quite comfortably for 10-15 years longer than most people get to spend retired.

 

[Petrichor1]

The adulation with which patients' families look up to you for treatment. The amount of knowledge that you know before even completing medicine that can be dispensed for use to people around you.

BTW...didn't even know what a rolex was

 

[RealHumanBean1]

For me, it's growing through compassion. I've always thought myself to be a compassionate person, but the past year working as an PCT in a local emergency department has really tested my mental and emotional resolve. I've gained recognition of personal shortcomings that I was previously unaware of, and that has pushed me to be a more compassionate caregiver and person in general. I look forward to facing difficult decisions that push me to expand my compassion, intelligence, work ethic, etc. because these are the experiences that are rewarding and motivating. Admittedly, the relative assurance of a financially secure future is also motivating in a sense (ability to support a family, provide for others, truly enjoy the time that you do have off).

 

[Crayola227]

don't push forward for medicine if it's for money or chicks or prestige
your patients will crap on you half the time, due to the "business of medicine" you will often be forced to be in such a rush you'll come off as a jerk, and even if it weren't for that, half the time they'll act like they know better, and that you are a rich bastard in the pockets of big pharma when you are truly busting your ass 12+ hours a day, and going home the last thing you're thinking about before passing out is worrying about their well being
people you date will think it's sooooo awesome they have a date with a doctor, that wears off *very* quickly as they deal with the downsides
that Rolex won't make you feel better about any of the above, trust me

however, do it because there's a certain joy you get when you *do* make someone's day better by caring for them biologically or emotionally

I just cured someone's 20 year history of constipation that has failed *everything*, with vitamin D supplementation!!!!
such a simple, almost obvious basic wellness intervention that no one had thought to suggest before, and it's made a *huge* impact on their *daily* quality of life!
*Dr. Crayola blows on her nails and buffs them on her white coat feeling like a genius before something humbling happens in the next 1.5 seconds*
*also feels particularly proud because it's a nutritional solution, take that critics that call docs drug pushers!!"
the last time I was able to spent the extra time answering a patient and their family's questions, going as far as to give them a mini-med lecture including diagrams on a white board, and the way the whole family said, "Thanks Dr. Crayola" with relief, one moment like that always makes my whole rotation, and this was in a time where I thought about jumping off the hospital at least twice a day

remember a time when you felt afraid, like crap, vulnerable, and had no idea what to do, and someone like a doctor or nurse or a teacher or a policeman showed you kindness in some small way and made you feel a lot better

even if they don't seem particularly grateful, if there's a certain warmth your heart feels bringing a patient ice chips, or even just a pillow, then I would say you may have found the right field. if that gives you some joy even amidst otherwise boring work.

remembering how much the little interactions can make a difference always helped me

hold onto *that* feeling

 

[Sardinia]

Fecal impaction.

 

[Crayola227]

My favorite quote from Thich Nhat Han,

"Dwelling in the present moment." While I sit here, I don't think of somewhere else, of the future or the past. I sit here, and I know where I am. This is very important. We tend to be alive in the future, not now. We say, "Wait until I finish school and get my Ph.D. degree, and then I will be really alive." When we have it, and it's not easy to get, we say to ourselves, "I have to wait until I have a job in order to be really alive." And then after the job, a car. After the car, a house. We are not capable of being alive in the present moment. We tend to postpone being alive to the future, the distant future, we don't know when. Now is not the moment to be alive. We may never be alive at all in our entire life. Therefore, the technique, if we have to speak of a technique, is to be in the present moment, to be aware that we are here and now, and the only moment to be alive is the present moment. "I know this is a wonderful moment." This is the only moment that is real. To be here and now, and enjoy the present moment is our most important task."

this link
http://www.redrat.net/thoughts/wtc/suffering.htm
has more of the passage this came from, it helps me a lot
it references mindfulness and meditation

remember, meditation is not necessarily about "emptying your mind" but rather can be more about directing your thoughts to something specific and not crappy!

 

[gyngyn]

I just cured someone's 20 year history of constipation that has failed *everything*, with vitamin D supplementation!!!!
such a simple, almost obvious basic wellness intervention that no one had thought to suggest before, and it's made a *huge* impact on their *daily* quality of life!

Can you give me a reference on this one?

 

[Dr.Kitty]

Coming from a disadvantaged background, the dream to change the field of medicine, knowing this is my life calling, the fact that I am fortunate enough to chase my purpose, choosing to believe life is beautiful, and knowing I will be the first doctor in my family.

 

[FCMike11]

Coming from a disadvantaged background, the dream to change the field medicine, knowing this is my life calling, the fact that I am fortunate enough to chase my purpose, choosing to believe life is beautiful, and knowing I will be the first doctor in my family.

How do you wish to change it?

Sent from my Nexus 6P using SDN mobile

 

[Dr.Kitty]

How do you wish to change it?

Sent from my Nexus 6P using SDN mobile

I want to go into Psychiatry and find a universal cure for depression and many other mental illnesses. Currently, Psychiatrists are giving medication to certain patients with a mental illness like depression and for some it works as treatment, for others they end up killing themselves. That's not okay, our knowledge of medicine and correlation to behavioral effects should be advanced enough that we can say it's going to treat you and cure you. Most of the mental illnesses that are said to be on patients are labeled as lifelong and treatable, but doctors need to be pushing for the cure and not be satisfied with a lifelong treatment. Every field has different things we can't quite cure yet, but Psychiatry has most of what it's treating as incurable. The study of the mind is fairly new in our human timeline, but I want to significantly make a difference and start pushing the boundaries of what we know of the mind and how we can master the cure of mental illnesses to give the next generations to come better and happier lives.

 

[aalamruad]

For example when you face obstacles?

I've found that it's helpful to "diversify" your motivation. For example, my motivation at any given point in time jumps between:

-thinking of some of the sick kiddos I've met at the children's hospital
-chasing the feeling of being the best student in any given class that I'm studying for
-wanting to secure a rewarding career
-wanting to make my dad and sibling proud
-wanting to be a great role model eventually for people in my current position
-not wanting to waste my intellectual potential
-$/financial comfort
-wanting to understand how everything works just out of an annoying level of curiosity
-wanting to emulate my mentors

etc.

I've found that it's much more difficult to burn out when you have a bunch of very different motivators that are all pushing you in the same direction.

And when I really have no motivation at all and need a serious jumpstart (only has happened 2 or 3 times), I listen to "Ronan" by ya gurl T-Swift (not joking). Disclaimer: Don't listen to it if you love peds and don't want to cry

 

[tessellations]

- My parents. They have made so many sacrifices for my brother and me, and I really want to make them proud. Honestly, what field I go into doesn't matter to them, but seeing them proud of my goals makes me very happy.
- The hope that one day I'll get to make a real, lasting impact on other's lives. I worked at a nursing home last summer, and while it was rough, and I had residents who didn't like me, getting to make even one person's day better meant the world to me. To see one of my residents tell me they didn't want me to go back to school because they appreciated me almost made me cry.
- The dream of having a career that mixes science and humanity in such an interconnected way, and that will challenge me every day.
- My goal of having a life where I get to learn something new every day.
- The dream that I will be better off than my parents are and that I will have the means to take care of them and advocate for them as they continue to age.
- To have the opportunity to pass on the things I've learned both in my career and in my life to others.

 

[aalamruad]

- The dream that I will have the means to take care of my parents and advocate for them as they continue to age.

I can't wait for this one. It's terrifying to consider the possibility that school/training might take so many years that I'll be too late though. If only I could borrow money from my future attending self and help out my dad now, and then live like a resident for an extra 5-10 years. The time-travel-loan interest rate would be 0% too, which would be pretty nice haha. Ever worry about that type of thing?

 

[TraumaBlonde]

I can't wait for this one. It's terrifying to consider the possibility that school/training might take so many years that I'll be too late though. If only I could borrow money from my future attending self and help out my dad now, and then live like a resident for an extra 5-10 years. The time-travel-loan interest rate would be 0% too, which would be pretty nice haha. Ever worry about that type of thing?

Idk what your scholastic background is, but there are so many ways to pay for school that doesn't involve loads/debt.
It's a lot more of a headache at first, but it's amazing to be one of the few graduating without that hanging over you

 

[aalamruad]

Idk what your scholastic background is, but there are so many ways to pay for school that doesn't involve loads/debt.
It's a lot more of a headache at first, but it's amazing to be one of the few graduating without that hanging over you

Ways to pay potentially up to $80k/year for 4 years of med school? Do tell!

 

[TraumaBlonde]

Well scholarships are need or meri based, but grants, either from the government or from private businesses, are easier to get (from my experience)
And some pay for things like rent or books or school supplies,
And some pay a chunk of money periodically,
It's all dependent on that grant.

Honestly, it's time consuming at first, finding and applying, but they add up quickly, and it's money you never pay back.
So it's definitely worth it. I'll make a list of where to look for non-scam grants and how to resources and post it in the thread

 

[Lost in Translation]

Because what's behind is trash, so let's make what's ahead not.

 

[aalamruad]

Well scholarships are need or meri based, but grants, either from the government or from private businesses, are easier to get (from my experience)
And some pay for things like rent or books or school supplies,
And some pay a chunk of money periodically,
It's all dependent on that grant.

Honestly, it's time consuming at first, finding and applying, but they add up quickly, and it's money you never pay back.
So it's definitely worth it. I'll make a list of where to look for non-scam grants and how to resources and post it in the thread

Thanks, looking forward to the list! Maybe I'll just spend my whole senior year applying for those grants haha. Oops, my bad

 

[Dr Tony T. Chopper]

Leaving a physician legacy for my children because I am the first generation in my bloodline to be in America, to attend university, and to attend medical school. When I die, I hope to have fostered a beginning to a lineage of physicians many generations down the line that will carry on my family name, and my family tradition in service to others.

 

[Crayola227]

Can you give me a reference on this one?

off the cuff I can explain the pathophys that I was addressing here, and you tell me if it's in line with what you learned in medical school, and if not let me know and I'll try to find a good source (I read this somewhere and filed the fact away, not the source as it typical for me)

one of the side effects of calcium supplementation is constipation
part of the rationale of including vitamin D in these supplements is not only that it increases calcium absorption, but in doing so you will also decrease the incidence of this side effect, essentially, calcium supplements shouldn't be given without vitamin D unless there's some other contraindication for D
basically, if the calcium remains unabsorbed in the gut, it can cause constipation
if you can encourage the gut to absorb it, you can decrease that side effect

anyway, this patient had lots of dairy in their diet
lactose intolerant patients will of course complain about diarrhea, this patient was not lactose intolerant
I read somewhere that the calcium in dairy is to blame for constipation due to dairy (only milk has D added, and some would argue it's not enough but in any case the rest doesn't)
patient wasn't taking vitamins, had an otherwise poor diet, and spent all their time indoors, it was reasonable to assume they had a vitamin D deficiency, or even if they would test normal, that vitamin D supplementation in a 50 year old sedentary woman with poor diet aside from hefty dairy intake wasn't a bad plan

they weren't hypothyroid
I had them increase water intake, increase dietary fiber, and use psyllium, and PEG, and docusate, all with no success (they didn't tolerate senna 2/2 bowel cramping pain) they were only pooping 1x per week and had so much nausea it was affecting their ability to eat. I ensured they were getting enough water with the fiber that the increase in fiber was not the culprit.

within 1 week of starting 2000 IU vitamin D daily (we continued water, good dietary sources of fiber & docusate, all of which had not been effective on their own but were tolerated unlike the psyllium and PEG), and they were pooping almost daily and felt loads better

I am crediting the addition of vitamin D and not increased water intake/dietary fiber/docusate because on their own that had failed, and it wasn't until vitamin D was added that the patient had benefit

this shoudn't seem shocking to you guys, do I really need to cite a source that one that unabsorbed calcium in the gut/ca supplements causes constipation?

 

[Nerdeka]

 

[gyngyn]

off the cuff I can explain the pathophys that I was addressing here, and you tell me if it's in line with what you learned in medical school, and if not let me know and I'll try to find a good source (I read this somewhere and filed the fact away, not the source as it typical for me)

one of the side effects of calcium supplementation is constipation
part of the rationale of including vitamin D in these supplements is not only that it increases calcium absorption, but in doing so you will also decrease the incidence of this side effect, essentially, calcium supplements shouldn't be given without vitamin D unless there's some other contraindication for D
basically, if the calcium remains unabsorbed in the gut, it can cause constipation
if you can encourage the gut to absorb it, you can decrease that side effect

anyway, this patient had lots of dairy in their diet
lactose intolerant patients will of course complain about diarrhea, this patient was not lactose intolerant
I read somewhere that the calcium in dairy is to blame for constipation due to dairy (only milk has D added, and some would argue it's not enough but in any case the rest doesn't)
patient wasn't taking vitamins, had an otherwise poor diet, and spent all their time indoors, it was reasonable to assume they had a vitamin D deficiency, or even if they would test normal, that vitamin D supplementation in a 50 year old sedentary woman with poor diet aside from hefty dairy intake wasn't a bad plan

they weren't hypothyroid
I had them increase water intake, increase dietary fiber, and use psyllium, and PEG, and docusate, all with no success (they didn't tolerate senna 2/2 bowel cramping pain) they were only pooping 1x per week and had so much nausea it was affecting their ability to eat. I ensured they were getting enough water with the fiber that the increase in fiber was not the culprit.

within 1 week of starting 2000 IU vitamin D daily (we continued water, good dietary sources of fiber & docusate, all of which had not been effective on their own but were tolerated unlike the psyllium and PEG), and they were pooping almost daily and felt loads better

I am crediting the addition of vitamin D and not increased water intake/dietary fiber/docusate because on their own that had failed, and it wasn't until vitamin D was added that the patient had benefit

this shoudn't seem shocking to you guys, do I really need to cite a source that one that unabsorbed calcium in the gut/ca supplements causes constipation?

A reference would be a study (preferably an RCT) indicating that Vitamin D is superior to placebo in the treatment of intractable constipation.

 

[Sardinia]

A reference would be a study (preferably an RCT) indicating that Vitamin D is superior to placebo in the treatment of intractable constipation.

http://www.doctoroz.com/episode/vitamin-americans-aren-t-getting-enough

 

[gyngyn]

http://www.doctoroz.com/episode/vitamin-americans-aren-t-getting-enough

I knew better than to click on that.
I feel dumber now.

 

[confidentandgood]

1) I grew up with an unsupportive father and a determined and loving mother. When my father left, my mother was still finishing an undergraduate degree in biology (she didn't attend college until her forties). I will never forget her strength. Taking care of two children as a single mother, working part-time, and still chasing her passion... in short, she inspired me. Anything is possible.

2) Love for the sciences. Chemistry, especially. I remind myself that I'm learning things about the world that many people take for granted.

3) Financial stability. Income obviously shouldn't be the only factor in career choosing, but it's comforting to know that money won't be a problem.

4) The human mouth intrigues me. Yeah, I'm that person. I'm captivated by how much we can find out about the rest of the body from observing oral health.

5) This quote by Stephen Hawking (I keep it hanging up on my wall): "We are just an advanced breed of monkeys on a minor planet of a very average star. But we can understand the Universe. That makes us something very special."

 

[Turkishking]

Girls

oh right, because im interested in the sciences.

 

[d0hv]

My two severe medical conditions. One is life threatening and painful, the other is just painful. I was never aloud to play sports or do anything fun growing up because of these issues. I never had a talent or was good at anything. I wanted to be a High school athlete like all my friends were. They always asked me why I didn't play sports and I always made up BS excuses as to why I don't. I was just ashamed and still am embarrassed about having these diseases. I don't like to tell people about them or talk about them. The only thing I could do for fun is play video games, and that has started to bore the crap out of me for the past few years. I have no talent or anything. I want to help people (so cliche) who went through the same bullcrap I've went through my whole entire life. Being a Doctor is the only career I can ever see myself doing and actually enjoying, if I don't get into Medical school I'll have nothing to live for. This is what I'm living for. For that slim extremely small chance that I'll get into medical school.

And it's crazy how now that I'm typing it out I just realize that the only thing I am living for and pushing through these horrible illnesses for has a extremely slim chance of even happening. But I'll try, and if I fail life doesn't have anything for me. I want to be there for people who go through what I do and help them keep pushing. If I can become a Doctor, I believe it would be motivation for many people who have the same condition as I do and many others.

I've never had anything in my life to be proud of, or anything in life to look forward too. If I can become a Doctor it would be the greatest thing ever for me and I would finally be truly happy for the first time in my life and something to be proud of. I'll actually be something. Financial security and job security is also another reason. I know it's not about the money, but currently I had to quit my job because I have to get a surgery and it hurts me so bad to work. I have negative funds in my bank account, I have no money for anything. I have nothing, not even a car and I'm turning 20 next week. I'm just happy I can still have my parents to live with and get food from for now. As a Physician I'll be able to sleep comfortably every night knowing I can actually have a car of my own to get to my Doctors appointments or work without having to call people or ride a bus, actually afford to have my own roof over my head, actually afford to pay for the best Doctor that can help me, and actually afford to help my parents out every month.

 

[DetectiveAlonzo]

I just want to be able to put extra guac on my chipotle without having to contemplate the additional charge.

Give me $400,000 a year and I'm good fam. Ballin' out at chipotle is a must.

 

[MoDiddy]

I just want to be able to put extra guac on my chipotle without having to contemplate the additional charge.

Give me $400,000 a year and I'm good fam. Ballin' out at chipotle is a must.

Real ballers get double guac double steak fam

 

[Crayola227]

A reference would be a study (preferably an RCT) indicating that Vitamin D is superior to placebo in the treatment of intractable constipation.

I ended up doing some research and couldn't find anything!

Not sure where I read or got that "pearl" to add vitamin D to decrease constipation one might suspect is due to calcium in dairy.

I didn't include that this patient had also been on promotility agents like Remeron (which the GIs are moving away from more and more) and failed.
No IBD red flags. Is due for a colonoscopy but this issue predates that.

I just got off another thread last night from EBM purists. And it comes up that quality large gold standard RCTs are often difficult to find when it comes to nutrition for a number of reasons. Someone made the case that one level of evidence is going to be what is biologically plausible/theoretical. Yes, as you point out, some things are attributable to placebo and I cannot rule out placebo effect without an RCT.

Anyway, I didn't mention that I actually lived with this person 24/7 during this time, and I know their med history quite well (have reviewed all records) and so I was able to observe compliance. In any case, they are more the type to have a nocebo effects and for "nothing to help" them. They were frankly shocked.

It's possible that bowel movments going from 1x weekly to every other day with only the addition of vitamin D in a patient who did not expect benefit is placebo, in my opinion the physiology I explained makes more sense to me but as you point out we would really need a study to determine it.

I'm not claiming the results here are hugely generalizable to the gen pop, but seeing as vitamin D was already indicated for this patient according to USPTF guidelines....

I don't really see the utility in arguing this particular case. I could write it up as a case study and just leave it at that. I'm sorry the evidence doesn't exist or if you either don't believe things as I have documented them. If you're just skeptical because it's an n=1 and case study evidence, I can certainly understand that.

I did have a chance to review some treatment algorithms for chronic constipation, and I would still argue in the vitamin D deficient patient where vitamin D is otherwise indicated anyway, there's no harm to trying vitamin D prior to initiating promotility agents which can have significant side effects.

Given what I know of this case, I believe that the supplementation made the difference, which is why I mentioned it in my original post.

YMMV.

 

[gyngyn]

I ended up doing some research and couldn't find anything!

Not sure where I read or got that "pearl" to add vitamin D to decrease constipation one might suspect is due to calcium in dairy.

I didn't include that this patient had also been on promotility agents like Remeron (which the GIs are moving away from more and more) and failed.
No IBD red flags. Is due for a colonoscopy but this issue predates that.

I just got off another thread last night from EBM purists. And it comes up that quality large gold standard RCTs are often difficult to find when it comes to nutrition for a number of reasons. Someone made the case that one level of evidence is going to be what is biologically plausible/theoretical. Yes, as you point out, some things are attributable to placebo and I cannot rule out placebo effect without an RCT.

Anyway, I didn't mention that I actually lived with this person 24/7 during this time, and I know their med history quite well (have reviewed all records) and so I was able to observe compliance. In any case, they are more the type to have a nocebo effects and for "nothing to help" them. They were frankly shocked.

It's possible that bowel movments going from 1x weekly to every other day with only the addition of vitamin D in a patient who did not expect benefit is placebo, in my opinion the physiology I explained makes more sense to me but as you point out we would really need a study to determine it.

I'm not claiming the results here are hugely generalizable to the gen pop, but seeing as vitamin D was already indicated for this patient according to USPTF guidelines....

I don't really see the utility in arguing this particular case. I could write it up as a case study and just leave it at that. I'm sorry the evidence doesn't exist or if you either don't believe things as I have documented them. If you're just skeptical because it's an n=1 and case study evidence, I can certainly understand that.

I did have a chance to review some treatment algorithms for chronic constipation, and I would still argue in the vitamin D deficient patient where vitamin D is otherwise indicated anyway, there's no harm to trying vitamin D prior to initiating promotility agents which can have significant side effects.

Given what I know of this case, I believe that the supplementation made the difference, which is why I mentioned it in my original post.

YMMV.

What you describe is not a case report.

 

[Crayola227]

What you describe is not a case report.

Did I say it was? I said I suppose I could write it up as one.

"Intro to the topic. Patient X had X presentation. They were treated with X modality. There were X results. Discussion on the part of author on why/what this might mean future directions. The end."

SDN is just the biggest bunch of nitpickers I've ever seen

people offer anecdotes of things they've tried that helped patients on this board all the time, and it's pretty much acknowledged that a lot of it will be n=1.

you don't acknowledge a single point I've made, just disagree wherever you can

it was hardly even the point of my post

and you still are not making the case that it was the wrong thing to do to for this patient, you just disagree that the results I'm saying we got are do to the intervention

 

[Crayola227]

I'll start doing the same, when it's not even pertinent to the topic and I see a single poster share a clinical anecdote, all I'll do it post "reference please"