Season 1: Episode 3 – End of Medical School & Renewed Purpose

Dear Healthcare It’s You: Episode 3

Elisha Yaghmai

And I did that with a private practice family doctor. Okay. And that, I would say, was really the formative experience for me in all of medical school, because I go out to the I go to this clinic and I work with them for two weeks, and then he took two weeks off a vacation. And I kept going to the clinic every day.

Elisha Yaghmai

And they had patients scheduled every day. As the doctor, it was it was me and his nurse practitioner. the two of us here of a regular patient of that right. That was coming in. And that that's the kind of thing I don't know if that would take place today.

Jo O’Hanlon

Or she would see him is the end.

Elisha Yaghmai

He was toward the I think he was at that point already. He was kind of toward the end of his career, I think. I think he represented the end of that.

Jo O’Hanlon

Era, afraid of losing a life.

Jo O’Hanlon

Welcome back to your health care. It's you. Welcome back to our podcast. We're here with Dr. Elijah Dagmar of the Free state Health care Clinic here in Wichita. Thank you for being here, Dr. Aisha. What we've been talking about so far is Dr. Elijah Jeremiah's medical journey and what that kind of looked like in going through medical school and where we've left off, I believe, is with your fourth year is kind of where we're picking up today.

Jo O’Hanlon

You were in New Orleans during the Hurricane Katrina when that all happened. And so that was part of your medical journey, was being in medical school during that and being shuffled and then ended up having to transfer to I'm sorry, what was the university one more time? Southwest U.T., Southwestern University of Texas. And so that's where you ended up finishing your third year, right?

Jo O’Hanlon

And so we were kind of talking about the abuse of nature of some of the, I don't know, the hospital settings there with your faculty and all of that. So what ended up happening in the fourth year, any changes or more of the same sort of abuse in terms of the kind of lack of oversight, in terms of teaching and just expecting a ton in those ways?

Elisha Yaghmai

Yeah. Third year, I think those that not everyone was abusive, those that were abusive, it wasn't expectations that was the issue. It was it was the way they executed their sort of theoretical teaching. And, you know, for for some of them, it was their criticism was personal, it was persistent, and they created a very difficult work environment. So in other words, they were asking they were asking medical students to do things that medical students were really not equipped to do.

Elisha Yaghmai

Yeah. And then when they failed to do it, not reflecting on the fact that this was completely the wrong set up to get the outcome that I wanted, but instead making it extremely personal in terms of the way that they were approaching it. Right.

Jo O’Hanlon

Of like first.

Elisha Yaghmai

You are stupid, right? That right not hey, this is something that you don't know. Yeah. Hey, you know, here's let me teach you how to do this better. Very, very different. Right? A kind of teaching style that I think almost anyone at any field would agree is probably not the right way to do it. But actually very common through medical education.

Jo O’Hanlon

Right.

Elisha Yaghmai

So fourth year, I would say there's also one of the dynamic in in particularly the third year medical school, at least in at least in the institutions that I was in and and and with my own personal experience, a lot of medical education and we talked about this a little bit last time is fundamentally driven by fear.

Jo O’Hanlon

Right.

Elisha Yaghmai

You have you have high achieving people who are used to getting really good grades, who are now in an environment with a bunch of other people that are like that. They're all competing with each other because they all want certain prestigious residency programs or whatever the case is. Right? Right. So the motivation for many of them, not everyone, but many, is fear of failure or fear of not getting that next gold star.

Elisha Yaghmai

Right. So in other words, it was not enough to have gone from high school to a good college and then gone from college to a good medical school and then, you know, go from medical school into a residency. It needs to be the right residency, right with the right name or the right specialty.

Jo O’Hanlon

And so can I positive. See, is that something that you feel like looking back is more just something that the type of people that ended up in medical school were putting on themselves? Or was this driving fear or is that something that was within the rhetoric of the teaching and such as. Well, but it was pushed that way.

Elisha Yaghmai

It's both. You have people that are predisposed. They're operating in an environment where that behavior is promoted.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Because, I mean, it doesn't take a genius, right, to, for example, look at the masthead at your medical school and realize that everybody at the top of it. Right. Seems to have they've all got a subspecialty for the people at the very top, seem to have come from one of about ten institutions in general, right? Yeah. I'm training in some of these places.

Elisha Yaghmai

Right. You can look at that. And so if your aspiration and again, I'm not commenting on whether your aspiration is valid or good, right. But if your aspiration is, you know what I'd like to do, I'd like to rise in this institution. And one day I want to be dean of whatever it is. Right. Well, you look at this and say, well, then I think I'm going to probably have to follow a similar path as the people that are already in these positions.

Elisha Yaghmai

Right. Right. So I need to keep going my way up that mountain right into more and more select programs, at least at least by reputation. Right.

Jo O’Hanlon

You don't really.

Elisha Yaghmai

Know anything about these places from the outside. So the motivation driving a lot of a lot of the behaviors is fear rather than love of learning.

Jo O’Hanlon

Right.

Elisha Yaghmai

And that and that's a that's a key difference. And so that speaking at a personal level that had never that never worked for me at any point in my education, even as a younger student, my driver had always been, this is so cool. Like, I just want I just want to learn this, right? I think it's interesting, right?

Elisha Yaghmai

And I and I want to get into it.

Jo O’Hanlon

And I heard early in your story that you were really driven to wanting to fill a need to help as well. I think that that's probably the start of a lot of people's medical journeys at the start.

Jo O’Hanlon

At the beginning, yeah.

Elisha Yaghmai

And then it gets it gets diluted then, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

In times of a lot of the conflict I think. Was that right. So medicine, first of all, is a high volume of information right there, giving a ton of information over a very short period time. You need to you need to absorb it and you need to be able to regurgitated in various high pressure situations, exams, oral exams, on rounds, wherever else.

Elisha Yaghmai

Right, Right. That doesn't work for everybody, for one. But there's a lot of fear and stress associated with all of those, all of those things, you know. And so you have that that as one driver of the I think the change the change for me began to take place beginning of fourth year. What they do in fourth year here again, things change over time.

Elisha Yaghmai

So medical education may have shifted, but fourth year you had a little bit more freedom. So you're allowed to go out and begin to work with a little bit less of a tight leash. You weren't somebody with a standing.

Jo O’Hanlon

In the hospital settings you're talking about in the.

Elisha Yaghmai

Hospital. So you could do a sub internship at the hospital and then also even in the outpatient setting. So I had to experiences. I mean, one was I went from a fairly sort of, you know, corrosive work environment actually to my family medicine residency, which took place at John Peter Smith's shout out to JP's and the people that were very different.

Jo O’Hanlon

And that was in your fourth year.

Elisha Yaghmai

That was no, that was.

Jo O’Hanlon

The.

Elisha Yaghmai

Beginning. That was the very end of my third year just before my transition.

Jo O’Hanlon

Although.

Elisha Yaghmai

Very different. They were they so they cared about medicine, they enjoyed learning and doing things, but they were nice, right?

Jo O’Hanlon

Not having that.

Jo O’Hanlon

Huge.

Jo O’Hanlon

Overarching fear was a part of it all. Is that part of it?

Elisha Yaghmai

It was just a different culture. That's just I can describe it. So they were they were kind people.

Jo O’Hanlon

Is that true of everybody in terms of like doctors on down through the facility or what? Well, stands out most.

Elisha Yaghmai

All I can say is that that's the for the people that I worked with in place at that time, they exhibited kindness. So they still cared about trying to do a good job medically.

Jo O’Hanlon

Right.

Elisha Yaghmai

But they were kind. And for a student who had just come from an environment which was the complete opposite of yeah, that was a revelation because I was like, Wow, you can do good medicine and still be a nice person.

Jo O’Hanlon

Right? Yeah, right. It's like an.

Jo O’Hanlon

Example of someone who didn't get chewed up by the machine and set out in that way.

Elisha Yaghmai

That's that's exactly correct. And so I went from then into a, into a sub internship, which I did in the hospital. There again I was working with at that point, my, my closest supervisor was a third year, third year internal medicine resident. At that point I was at Parkland Hospital in Dallas and he also had more of that, I think, kindness in him.

Elisha Yaghmai

So it was just a better environment to learn because it was more it was it was less about fear of reprisal, fear of repercussion and more about how are we going to work with this patient today? Okay, that that's a positive motivation as opposed to the negative motivation, just trying to not get punched. Right. Yeah.

Jo O’Hanlon

These are two.

Elisha Yaghmai

Very different things. Or humiliated or humiliated and right. Yes, metaphorically.

Jo O’Hanlon

Right? Yeah. Sorry.

Elisha Yaghmai

Self. Those are nobody. Punch me.

Jo O’Hanlon

It's legal. We have.

Elisha Yaghmai

But metaphorically they did.

Jo O’Hanlon

So, so.

Jo O’Hanlon

Emotional. This is.

Jo O’Hanlon

Real.

Elisha Yaghmai

That's so working with him was kind of that was very helpful. And there were areas I mean thinking back that there are areas definitely where like I had I just either didn't know enough or I couldn't come up with the things on time. But again, it was just a different environment and it made it encouraging, it made it positive to try to to try to get better.

Jo O’Hanlon

And when you were in that scenario, just because I'm not used to all the jargon and I don't know exactly how it goes. Yeah. So when you're this was a residence residency doctor, what do you call it?

Elisha Yaghmai

Medical resident.

Jo O’Hanlon

They were physical.

Elisha Yaghmai

Medical. You go through medical school, you do four years of medical school, and then you do a residency of a certain number of years, which is basically you're doing practical work at that point. Right? So you are you have your medical degree, but you're not really allowed to do independent practice until you've done a certain number of years.

Elisha Yaghmai

And it varies by specialty of practice. In internal medicine, you do three years of an internal medicine residency. So when you finish your third year, you're officially done. At that point, you could be after you finish, you could be an independent internal medicine doctor.

Jo O’Hanlon

So this was someone in their third year.

Elisha Yaghmai

Right? So he was he was in his last year of residency.

Jo O’Hanlon

And so you go around on rounds with him and, you.

Elisha Yaghmai

Know, you go run errands by yourself, so you go running by yourself. You have a couple of patients to take care of, right. And you're trying to figure out what to do with them clinically. Right. So in third year, you had usually a junior resident in front of you and then a senior resident and then the attending physician.

Elisha Yaghmai

Now you're kind of the junior resident. That's how I would describe it. So that's why it's a sub internship. You're not the intern, you're not the first year resident that's there. But you are you're stepping into that role for a short period of time, right? Yeah. So but what that role facilitated again, was independent learning, right? Yeah. You've been given a case.

Elisha Yaghmai

No, you need to go. No one's there's no multiple choice exam, right. You have to go figure out who is this person, what's wrong with them? What am I going to do about it? What do I do? And then you take your plan back to your supervisors and say, Here's what I think is going on. Here's what I want to do.

Elisha Yaghmai

Here's why I want to do it right. Here's how I'm going to do it. And then they say, thumbs up or no, not a good idea. Let's modify. Right? Okay. I'm a teacher.

Jo O’Hanlon

So you're handling it all on your own, but you're kind of having this check back. That's right. This person ahead of time before you go back for the actual treatment.

Elisha Yaghmai

That's right. Yeah. So you can't just order it yourself. And one you it's checked, but your goal is to formulate an independent plan. Right. And then bring that in for a lot.

Jo O’Hanlon

More practical learning in that some of those ways for just hands on, like checking your actual knowledge of correct how stumped you are or not and a point. Gotcha.

Elisha Yaghmai

So it was a different that was a different animal.

Jo O’Hanlon

Yeah. And so that did that last for your whole fourth year. Then during that that was that was just one of. Yeah.

Elisha Yaghmai

Okay. So then you had to do an outpatient kind of sub internship or outpatient rotation, I guess what I would say and I did that with a with a private practice family doctor and that I would say was really the formative experience for me in all of medical school, because I go out to the I go to this clinic and I work with them for two weeks, and then he took two weeks off on vacation.

Jo O’Hanlon

Okay.

Elisha Yaghmai

And I kept going to the clinic every day. And they had patients scheduled every day as.

Jo O’Hanlon

The new.

Elisha Yaghmai

Doctor. It was it was me and his nurse practitioner. Okay. Two of us taking care of a regular patient panel. Right. That was coming in. And that that's the kind of thing I don't know if that would take place today.

Jo O’Hanlon

I don't is the end.

Elisha Yaghmai

He was toward the I think he was at that point already. He was kind of toward the end of his career, I think. I think he represented the end of the era.

Jo O’Hanlon

Afraid of.

Jo O’Hanlon

Losing a lot. So that's you at this point, your medical to.

Jo O’Hanlon

Anything go wrong?

Elisha Yaghmai

No, actually, but that is the thing, right? So I understood that responsibility, Right? I was like, these people are coming in here.

Jo O’Hanlon

Rare opportunity. Yeah. It's like first in your.

Elisha Yaghmai

Position, my doctor is gone and this was but we didn't have email. There was an email, right? But we were emailing back and forth like we didn't have the ready contact. I forget where he'd gone. I think I've been out of the country for a while, so whether he was checking back in, in the background to see, yeah, I don't know if he may have been doing that, but in terms of our direct communication, we weren't communicating.

Elisha Yaghmai

So it was just, just me. And then and then his nurse practitioner would see her patients. Right. And we would talk about them every day and try to review them. So it was a it was being given responsibility. Yeah. And, and with that responsibility came, I think it went back to that original motivation. Right. I got into this to try to learn a skill to help people.

Elisha Yaghmai

Right. Well, now here I am in a practical situation where these people are coming to me expecting answers.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

What am I going to do? Right? I have to know something. So that motivated a lot of. All right. I got I got to read, you know, I got to look at what cases are coming in and try to learn something before I go in and then after I talk to them and learn more. I got to go read some more about this and try to educate myself and figure out what to do about these cases.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And that that again, was a very positive motivation. The positive motivation was trying to help people with a real problem. It didn't have anything. I wasn't getting a test on it. There was no grade assigned at the end of it or whatever the case was. This was just people need help. What are you going to do now? You know, at least enough to know where to look to find the answer.

Elisha Yaghmai

Right?

Jo O’Hanlon

Right.

Elisha Yaghmai

Even if you don't know the answer, what are you going to do? Right.

Jo O’Hanlon

Was there a difference in that scenario also because of it being a outpatient clinic, rather than in the hospital setting?

Elisha Yaghmai

I mean, those the main difference was different types of problems at different times. But occasionally people would come in to the outpatient clinic with an inpatient problem.

Jo O’Hanlon

And.

Elisha Yaghmai

Would come in and be realistic. And you'd have to yeah, we'd have to order some tests and figure out what to do. And then in some cases you sent them to the hospital if you don't have the capability to handle it. The Yes. So it was different levels of severity and just different types of problems. Right. But but I think the main difference was, was really the work environment.

Elisha Yaghmai

It was the people I was working with. And again, that that autonomy and that responsibility of, you know, we expect you to we expect you to handle this.

Jo O’Hanlon

Right. Right. Did that kind of I mean, did you have a question for yourself prior to that setting of whether you really could handle it? I mean, it sounds like there was a lot of the fear mongering and a lot of that. Yeah. You know, shaming of like not knowing things that you maybe shouldn't know yet even. But to this point now you're in the last year of medical school was that kind of of reassurance of like this is the right yeah for you.

Elisha Yaghmai

I didn't you know as for even during the roughest times I would say I didn't necessarily feel like that it was something I could not do. Yeah, I did feel like this is a thing I do not like.

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

I don't know how to describe it. It would be like I just think about any anything in your life where you have the ability to do it, but you do not enjoy the thing itself. You don't enjoy that activity. You don't enjoy the process of gaining the skill at it, right?

Jo O’Hanlon

It's like getting get it running or something like that.

Jo O’Hanlon

That's probably the time for some of us. Like, I mean, there's.

Jo O’Hanlon

Like that more like I can do.

Jo O’Hanlon

It. I know I enjoy it. Like, not at all.

Jo O’Hanlon

But you found some enjoyment in that.

Elisha Yaghmai

Yeah. Yeah. I would say for the first time, that's probably the best way to describe it. I actually found some joy in the work.

Jo O’Hanlon

Life.

Elisha Yaghmai

For the very first time ever because previously it was just a miserable slog through. Right. One requirement after another one. Yeah. You know, sort of competitive. Yeah, after another.

Jo O’Hanlon

How long did that joy last you that.

Elisha Yaghmai

Lasted through most of fourth year, actually, because you had more freedom to choose your electives, right? So you could do things that were interesting and you went around and did stuff and start interviewing for residency programs. So you're traveling to do that. You did a rotation in forensic pathology, right? Which is actually even weirder than it appears on TV.

Elisha Yaghmai

But it's actually really cool.

Jo O’Hanlon

It's forensic pathology. Is that like I mean, forensic makes my mind go FBI. Yeah, yeah.

Elisha Yaghmai

No, no, no. It's when people come in dead, right? Yeah. For whatever reason, died in the hospital, they're found dead or whatever. Right? Someone has to do an autopsy. Right. And try to determine what the cause of death was. Right. And forensic pathology was, at least here again in Dallas at that time, was filled with a really eclectic group of people that were just fast that I could just as people.

Elisha Yaghmai

They were really interesting. They were also doctors.

Jo O’Hanlon

Yeah. You know, So it was.

Elisha Yaghmai

Just first things I learned all kinds of random.

Jo O’Hanlon

Things. So is that the same as being a coroner if you're first? Yeah.

Elisha Yaghmai

So you can have a coroner that is not a forensic pathologist, but in a big city, often that would be they would be the one. Right. Doing that death exam offering like a reason for cause of death,

Jo O’Hanlon

Yeah, that is interesting, because, I mean, that's how that how they learned in the Roman times. They were operating on people after the arena situation because they weren't allowed to work on anyone that was dead at the time.

Jo O’Hanlon

Right? Right. Yeah. But, you know.

Jo O’Hanlon

That is a whole different view of the body. I'm sure that, like, gives you stuff that you're not able to learn. Yeah. Cuff in class on an autopsy.

Elisha Yaghmai

No, no, no. Just, you know, stuff like, okay, when did the bug show up? Right? What type of bugs show up? And then when does rigor mortis set in? Does it not? Right. And so that was when you learn, Right, that those kind of forensic TV shows. Right. It's all baloney. And they're like, yeah, I got it three and a half hours ago.

Elisha Yaghmai

Right? I didn't.

Jo O’Hanlon

Have, you know, this much wider. Do you.

Jo O’Hanlon

Watch CSI while you were doing.

Jo O’Hanlon

It? I just but.

Elisha Yaghmai

But but they would joke about it in their like what you could and could not actually tell. Yeah. Yeah. But that.

Jo O’Hanlon

Was interesting. Yeah. So you kind of got to explore some of that. Is that is that the time when does a student already know what they're wanting to specialize in? Like when they enter medical school or would that be a time that you're kind of exploring some of that?

Elisha Yaghmai

So in theory, in theory, a lot of people come in with a preconception about what they want to do. Okay, For a lot of people, it changes over the course of medical school and I was the same actually, it shifted for me a couple times. So by that time, fourth year, usually you have to know already because you have to already have applied.

Elisha Yaghmai

this is a fundamental flaw with medical education in general. You you have to decide in theory what specialty you want to do. Yeah. And you're only real exposure to it at best is what you got in your third year of medical school at best. Right. Which is you.

Jo O’Hanlon

Applied before your fourth year. Right.

Elisha Yaghmai

For your resident, starting your fourth year, you're already applying. Right. So too late. I mean, I guess you could theoretically apply for multiple different types of residencies, but in general, you have to make a choice and then you have to apply for it. And then you're you're locked into that, at least to going at least to starting it right.

Elisha Yaghmai

Locked into it. And you may not really appreciate the difference in medicine between watching someone do a job and then doing the job yourself. There's a big difference, right? Do things right. And so something can look really cool when you're not responsible for doing it all day, every day. And it's very, very different when you are and you don't get that exposure, right.

Elisha Yaghmai

So so you're making a somewhat blind decision about what you want to do and how you want to do.

Jo O’Hanlon

It, or even like what you're saying about your third year with like when you're in the OB department, you know, realizing that you I forget which way it was that you liked being there for vaginal birth and C-sections or, you know, it's like you don't know that. Yeah. So right until you do a C-section and you go, maybe not.

Jo O’Hanlon

Yeah. Yeah. Well, interesting. And so then with your fourth year with that experience, what were you what did you apply for your residency to.

Elisha Yaghmai

Apply for From the.

Jo O’Hanlon

Family that.

Elisha Yaghmai

I applied for. Then my thought at that time. So I'd had two things. One was that I had gone to John. Peter Smith Yeah, right. That hospital and had a really good experience. So I was like, okay, family medicine seems to be like internal medicine, but nice.

Jo O’Hanlon

Yeah. And.

Elisha Yaghmai

And it also has, it enables you to have a broader skill set because you also see some children and you also do some obstetrics. Yeah. And bear in mind at that point I still thought, I'm going to go do international medicine at the end of this, right? So. Right. Okay. I need to really be able to see a broad variety of ages and yeah, do a little bit of a lot of different things.

Elisha Yaghmai

So it seemed like that was the right fit. Yeah, at that point in time.

Jo O’Hanlon

And so then anything more to that you want to share about your fourth year in terms of those experiences?

Jo O’Hanlon

No, I don't.

Elisha Yaghmai

I don't think so. I think well, sort of.

Jo O’Hanlon

There was one.

Elisha Yaghmai

Interesting experience here. Again, just to kind of convey the culture. Yeah. So at one point I think this is in fourth year they have a meeting with us Southwest, and the meeting was, well, we recently had a really humiliating experience, which was that we had there were 250 people in the class every year. We had an experience where multiple our students applied to the same program and they all claimed to be the number one ranked student in the class.

Jo O’Hanlon

gosh.

Elisha Yaghmai

So we went back and looked and they were pretty much all tied in terms of GPA. So they could they could validly make that claim. we heard back from the residencies that said, how can it be possible that you have four people that are all number one, Right.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So, you know, this is ridiculous. Again, speaking to the culture of medicine, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

We have four people that all ranked number one like that that can't fly. We need to know which one of them was really number one. Right out of these. And they realized that their grading wasn't passed tightly enough to differentiate between number one and number four. They were too close, right to tell.

Jo O’Hanlon

So. So they come in to tell us in this meeting.

Elisha Yaghmai

So we're changing the grading scale. What's going to happen is everyone else's grade is going to get lower, but it's going to enable us to more accurately.

Jo O’Hanlon

Pass.

Elisha Yaghmai

Out the grades.

Jo O’Hanlon

That are going.

Jo O’Hanlon

To be.

Elisha Yaghmai

At the very top. Right.

Jo O’Hanlon

And so, you know, really.

Jo O’Hanlon

Like for people that there would be.

Elisha Yaghmai

Or yeah, I was about four, if I recall, that may have might be a little off of the detail. But I think it was an approximate number right now. So you're sitting there and saying, okay, so, so all of us here have to fly to residences. We're all going to get lower grades, right? We're going to get lower grades so that the people at the very top of the class terms of GPA can differentiate those few hundredths or tenths of a point that they need to to decide who is really number one.

Elisha Yaghmai

Right. But the reality is all four of those people are going to go basically wherever they want because they have a great GPA, right, coming out of a medical school. So they're not going to have any problems. Right. It's a matter of choosing between Harvard or UCSF or something like that. Yeah. And everyone else is going to look worse on paper.

Elisha Yaghmai

And the reason you've done this is because you were embarrassed because they all went and applied to Penn or whatever. And that was mad because they were all ranked number one, Right? Right.

Jo O’Hanlon

That's awful.

Jo O’Hanlon

And it's almost like they felt embarrassed because they yeah, they didn't have a hard enough program. So it sounds like.

Jo O’Hanlon

Yeah, well, no, not it was.

Jo O’Hanlon

Not hard enough. But like that it was that they were not like Yeah it was passing.

Elisha Yaghmai

Grades were not passed.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

In a in a if finally enough Right. To differentiate between those people.

Jo O’Hanlon

What were your class standings. A really big deal throughout the whole of.

Jo O’Hanlon

No I mean there.

Elisha Yaghmai

Wasn't something it wasn't something that was tracked. I don't think I ever even knew what mine was. But but it well, like anything else, right. There were people that really did care. Right? And they were trying to get an A and everything and get the highest grade and the highest. Yeah. And again, why were they doing that? Well, some of them were motivated because they loved medicine.

Elisha Yaghmai

A lot of them. It was because, you know what? I'm not going to do this. I'm not going to get into that residency. I'm going to get to my dermatology residency unless I have an A and everything.

Jo O’Hanlon

Right? Right.

Elisha Yaghmai

So they didn't matter what it was. It didn't matter whether they cared about it. They're going to get an A in it. Yeah. And it didn't even matter ultimately whether they knew it in a fundamental sense. Like it doesn't it was the knowledge absorbed and retained or was it just absorbed and put onto the test and moved on?

Elisha Yaghmai

That also was really not relevant. Yeah, it was a matter of do I get an A so that I can get it at the residency that I was right that that was for some. Yeah. The driver.

Jo O’Hanlon

And the residency the specific residency had the importance of the place of where the residency was, but then also the type of residency is.

Elisha Yaghmai

That Yes. That what specialty is and what name is on the door. Right. Both things are relevant to the people that cared about.

Jo O’Hanlon

Gotcha. Okay. And so then when did you end up starting your residency? What year we end, datelines?

Elisha Yaghmai

So now this is my fifth year of medical training. So I started I finished my fourth year medical school and I started residency.

Jo O’Hanlon

So this 20.

Elisha Yaghmai

600, that was 2000. That was a summer of 2007 seven.

Jo O’Hanlon

Okay, so now ten seven, you're starting your residency. Where did you end up going for that?

Elisha Yaghmai

So I ended up at the family medicine residency at Christy in Wichita, Kansas.

Jo O’Hanlon

Okay. And that's how you came to.

Elisha Yaghmai

Which that's how I came here.

Jo O’Hanlon

Well, welcome.

Jo O’Hanlon

That's almost.

Jo O’Hanlon

You know, not posthumously.

Jo O’Hanlon

But.

Jo O’Hanlon

I don't know what the word is for him to Wichita. I was not here at the time, but so Villa Christy and you were doing family medicine there, and so does your residency. Do you still, like, focus on specific? I, I don't know how residencies work. Do change location throughout it. Do you do a little bit specialties throughout it like focus that?

Elisha Yaghmai

No, you don't. So you pick a specialty and then you start doing rotations within a specialty. So in family medicine world, for example, that might be an inpatient specialty. You might have some clinic time, you might have pediatrics, you might have obstetrics, sports medicine, a general surgery rotation. Okay? And you go around to these different things and try to pick up different skills and knowledge.

Elisha Yaghmai

Yeah, that you would need to use again, kind of family medicine approaches things from a broad perspective as you're trying to gain a broader base of knowledge. Okay, in all of these different areas. And so you wrote, you may rotate from side to side or whatever, but you're generally in one, typically one geographic region of doing these different rotations.

Jo O’Hanlon

Okay. And how long are the rotations for?

Elisha Yaghmai

Typically about a month.

Jo O’Hanlon

A month. And what was your experience? What's that like for you, Christy? What type of rotations did you do? What were your kind of takeaways from it?

Elisha Yaghmai

Yeah, so it was a very I mean, it was quite different from what medical school had been, very different culture. Yeah.

Jo O’Hanlon

In a positive or negative.

Elisha Yaghmai

Mostly in a positive way, Yeah. There were aspects of it now that I, you know, there are aspects of the work. I mean I ended up changing residencies, right? So yeah, I had some issues with it, but, but the culture overall I think was a positive probably. I would say the there were two really good aspects of it.

Elisha Yaghmai

One, at least from my perspective, one was that they allowed a significant amount of autonomy.

Jo O’Hanlon

Yeah, which I mean, it sounds like you really flourish in that kind of learning environment.

Elisha Yaghmai

I did.

Jo O’Hanlon

Yeah. So I'm assuming that a lot of people probably need.

Elisha Yaghmai

Some do and some some don't. It's quite different now. I mean, there's there's wide differences in medicine and personality and learning style. So some people need a regimented oversight. Oversight? Yeah. You know, you're going to you're going to work through these things in a structured, disciplined manner. Right? And other people do much better if they're allowed to learn through doing and learn through the practical experiences that are rolling across right across their plate.

Elisha Yaghmai

So but because their time is very autonomous, but I mean, by that here again, and some of the medical people will cringe when they hear this because from a patient care perspective, it's a little dicey. Right. But you would come in as an intern and you would be on call for the hospital. Yeah, like the whole hospital. You or the person on call as a.

Jo O’Hanlon

Floating to admit.

Elisha Yaghmai

Patients to the hospital to handle cross cover calls. If somebody started going downhill in the ICU, that was your job to you were to go around and do all of those things. Yeah. So the the plus side of that was you had the weight again of that responsibility, right? So you had to try to figure out what to do.

Elisha Yaghmai

The downside of it was you had, you know, two months of, of medical experience outside of medical school. Right. And you're trying to run an ICU.

Jo O’Hanlon

Right?

Elisha Yaghmai

Right. And in theory, there was a senior resident that was supposed to be on call with you, but in practice wound up happening was that they would usually go to the OB floor because there will be deliveries and things going on all the time. They were running that and the intern was frequently, at least when I was there, was frequently out there basically on their own running the medical for.

Jo O’Hanlon

Because the what did you call the senior resident Senior resident. Right. They were.

Elisha Yaghmai

Otherwise.

Jo O’Hanlon

Needed, right. Yeah. Yeah. So lack of I mean that's another glimpse of just a lack of enough care on the floor.

Elisha Yaghmai

Yeah. Well well the issue was you're you're the patient here. Again, in retrospect, what patients don't understand is how heavily dependent their care is on who they get. When you roll into a hospital, your care depends very, very much on who specifically you get. Yeah, Patients have this idea that like, you know, M.D. equals M.D., right? Doctor is a doctor is a doctor is a doctor.

Elisha Yaghmai

And that is not at all true, right? Not at all true. And so imagine. Right? You roll into this hospital with your illness and the person that's treating you is me who has just finished medical school a month ago.

Jo O’Hanlon

Right. Right here. And narrow it down because ran in is.

Elisha Yaghmai

And is trying to kind of figure all of this stuff out. Right. As is in the first environment with some higher level of responsibility and is trying to learn medicine is trying to do all these things and that's that's largely who's taking the calls in your care and who's TRIA. It's not that there's not an attending physician. There is there at home, right.

Elisha Yaghmai

There is an attending physician. But who's deciding what's important, right? Because if a nurse calls, the intern who got the call decides, is this important enough that I need to escalate it up the chain, Right. For the attending physician, do I need to inform my senior resident? You see what I'm saying?

Jo O’Hanlon

It's a whole new, like, internalized flow chart that we've talked about earlier, about like your, you know, your muscle memory of what questions are asked. It's the same thing. But prioritizing of like whether to run it up that chain of command or whether you can handle it.

Elisha Yaghmai

That's correct. And how do you do it? And so that that was a significant responsibility. I think it's arguable whether an intern should really shoulder that entirely by themselves. But that was how it was done and right. And that was, again, that had flow that had flowed through from the culture of medicine that had existed for decades. Right.

Elisha Yaghmai

It wasn't just in this place. This is in a lot of places. Right. Like I said in Dallas. Right. The guy just, you know, took a vacation. It was like if you go to medical school.

Jo O’Hanlon

Right. See into the unknown, it's.

Elisha Yaghmai

You know, it's a vote of confidence. On the other hand. Yeah, you you can look back and see how you could have some suboptimal outcomes.

Jo O’Hanlon

Yeah, definitely from that. Well, we're out of time for this episode, but we'll be catching up with you again and we'll be picking up where we left off about how you changed presidencies and why that happened. All right. Thanks for being here. Thanks, guys.