Prairie Doc Perspective Week of March 26th, 2023
“Medical School Journey”
By Samantha Darnall-Werlinger, MD

It has been 9 years since my medical school acceptance. I can describe my personal process in 2 words: arduous and lengthy. Now, this may not be the case for all people that apply to medical school. A few individuals may be able to apply directly out of undergrad and be accepted. I’ll speak from my experience which had a few more detours involved. 
I am the first person in my family to become a physician. This added unique challenges while applying to medical school - I essentially had to blaze my own trail. The journey starts during undergraduate education. Many students major in the sciences and take the courses to build a strong foundation for the coming years. Regardless of major, your GPA plays a role in medical school acceptance. Surround yourself with like minded individuals that will help you succeed in your goal. 

The application and acceptance process is a dynamic one. The initial hurdle is the MCAT (Medical College Acceptance Test). After my first MCAT, I realized I needed a structured approach and direction to succeed. I highly recommend an in-person class or an online study group that offers insight into test taking strategies and practice exams. These resources will be worth the investment. My score drastically improved and made my application much more competitive. 
Unfortunately, the number of medical school applicants is staggering in comparison to the limited number of seats available. This is where building and personalizing your application comes into play. Inquire admission committees on how to bolster yourself on paper. Many highly recommend experiences in patient care. These can come in the form of volunteerism or employment at local hospitals or nursing homes. Some individuals do research, shadow physicians, become scribes or work other skill-building jobs in the field. I decided to work at a local hospital providing direct patient care. Through this, I gained the experience I needed to stand out. The patients you meet along the way will teach you more than you realize.
I also furthered my education with a Master’s degree, focusing on human anatomy and physiology. This gave me the opportunity to teach undergrad students and gain even more foundational knowledge. 

The perseverance and experiences paid off. I was accepted to Ross University School of Medicine in 2014, spent 2 years in Chicago, graduated with Highest Honors and matched into my first choice residency program for Family Medicine. I graduated in June 2021. 
There is no wrong way to go about getting into medical school but there are more efficient routes. Have a mentor. Utilize appropriate resources. Stay focused and on track.

Prairie Doc® Perspectives for week of March 19th, 2023
What do you say?
By the late Richard P. Holm, MD
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Before my junior year in high school, I returned from a Boy Scout canoeing trip to discover my sister had been killed in a car crash. I will never forget the sadness of the moment when I walked into the house that was filled with what seemed like half the caring and wonderful town of De Smet to find my mom and dad there grieving. It was near the end of that summer, but the beginning of a long period of mourning for my family and me.
There were lessons that came to me after my sister’s death. I realized how important support from a community could be. Consolation came from our friends, neighbors, church community, as well as people we barely knew. It seemed more about their presence and not their words. I noticed there were people who had trouble themselves dealing with such loss, and they sort of disappeared.
Also, I realized that a funeral is not exactly a time of closure for a family, but really just the beginning of a time to accept reality and forge ahead with the difficult changes that life can and does deal out. It took me years to think about my sister and relish in her memory rather than cringe from the pain of the loss. In that sense, I know I will never have closure and that’s good.
Some 14 years after her death, while I was on the faculty of a medical school in Georgia, I found myself having to advise medical students how to talk to patients or family about sad news. I reviewed the medical literature on the subject at the time and concluded that there is no right way to do it except to be 100 percent honest and to say whatever is needed with compassion. 

Through the years those guidelines have sustained me while I have had the burden of sharing awful news. 
Bottom line, it is being there, more than words that consoles. Never worry about what to say, just show up, be honest, and care. 

Prairie Doc® Perspectives - Week of March 12th, 2023
Humanities and the Physician
By the late Richard P. Holm, MD
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After 40 years as a doctor interacting with patients, in the last two and a half years the tables turned, and I’ve become the patient. Although most are good, I’ve found some doctors are detached, some are too quick, some would rather be somewhere else, some are even angry; but, when a physician who cares walks into the room, and I’m not exaggerating, the day becomes better, the pain becomes less, and hope fills my heart. Scientific knowledge is important, but the ability to convey honest concern, human thoughtfulness and compassion is equal in importance in this healing profession. So, how do we select pre-med students for that, or teach compassion in medical school?

There are studies that show those interested in humanities or taught disciplines that explore how people tick, do better in the compassion department. These disciplines include history, literature, religion, ethics, anthropology, psychology, cultural studies and the arts of theater, film, painting and poetry. Some explain that the humanities give us the very reason to learn science and mathematics. 
Several studies support the value of humanities in medicine. Seven hundred medical students were surveyed about their lifetime exposure to the humanities and the results indicated that those who had more humanities knowledge had more empathy, tolerance to ambiguity, resourcefulness, emotional intelligence and less burnout. Another study found that a med student’s ability to recognize diagnostic clues increased by more than 35 percent after taking a visual arts class. Another study found practicing improv theater helped med students learn to prepare for unexpected questions and conversations. A fourth study showed how writing exercises helped med students have foresight into what a patient may be experiencing. Clearly, an exposure to the humanities makes a better doctor.

I believe that care providers who have had a well-rounded humanities education have a better chance of understanding about how it feels to face pain, nausea, loss of bodily functions or even a cancer diagnosis. Those steeped in good literature or art have a better opportunity to tap creative juices to problem solve and tolerate a life that can be ambiguous and unpredictable. Those who are knowledgeable of history, ethics, cultural ways will find it easier to know when it is time to stop aggressive care and move toward comfort.     
This is a call for all students to become readers, to find time to enjoy the humanities, to exercise your caring and compassion muscles; so, when you come into the room of a person suffering, it makes their pain less and day better.

Prairie Doc® Perspectives - Week of March 5th, 2023
“Fearing Death Can Cause Suffering”
By the late Richard P. Holm, MD
When in life does one come to confront the tough truth that each of us will eventually die? In my years as an internist caring for young and old alike, some people understand this early, and some people never get it. In denying death, we intensify our fear of it. Usually, however, it is sometime during their 50s that people first look into the eyes of death. Put it off as we may, the hard certainty is that we are all aging and one day an end will come. Shakespeare described advanced age in his play As You Like It, Act II, Scene VII (All the world’s a stage):
“. . . Last scene of all, That ends this strange eventful history, Is second childishness and mere oblivion, Sans (without) teeth, sans eyes, sans taste, sans everything.” 

Shakespeare’s description of advanced age during the 1600s is rather bleak and scary. I think, with modern medicine and the support of a loving family, we could do better. I clearly believe that advanced age and facing our own death should not fill us with dread. The following is a more hopeful version to end Shakespeare’s excerpt: 
“. . . He did not have to end his life alone; If over time he’d shared his caring, raised  
the worth of others, fed the love he’d sown. His death would find him kindly prized and praised, While kin sang festive songs of joy, amazed.”
Fear comes from the oldest reptilian part of our brain. Fear helps us run from attackers but can also make us run from making important choices about our health. Fear can even bring us to push forward with treatment that may cause significant suffering, even when we are very old and even when treatment is futile and it’s time to quit.

Fear of dying can prevent us from making plans about end-of-life care and, most importantly, prevent us from talking to our families about those wishes. How do we want to be cared for if we should lose mental capacity from a stroke or dementia? Do we wish to have a feeding tube, resuscitation, antibiotics when there is no quality of life left, when one doesn’t recognize family and when the only option will be residing in a bed somewhere “sans everything.”

I would rather die and be: 
“. . . kindly prized and praised, While kin sing festive songs of joy, amazed.”