back into focus 

as i shared in my last post, i’d unknowingly hit ‘pause’ on my life and my dreams these past couple years once a measly little exam seemingly took over my life but i’m back now reclaiming my time and my joy.

in that process i’ve made a few pretty big decisions about my future and just wanted to share with you all. thank you for your company on this journey. i used to constantly be in awe – and still am – of folks in the arts or humanities or really anything that didn’t have a set multistep plan for their careers. i used to find so much comfort in being a traditional applicant to medical school – straight out of college, no decisions to make about what to do with years off, etc. but the older i get the more i realize that no one’s life path goes in a linear fashion. we all face expected and unexpected challenges and have to roll with the punches. here’s how i’m choosing to roll with mine:

i’m going to be a psychiatrist when i grow up! i’m guessing that this does not come as a surprise to most of you. pretty sure most people knew this was where i was destined to be before i was able to fully embrace it myself. there were many things that fueled my uncertainty but most of them boiled down to giving too many effs about what other people think.once i set all that aside – worrying about ‘hanging up my stethoscope’ and not being considered a ‘real doctor’ (what does this even mean?? i’m in medical school, which contrary to the belief of people who continue to ask me if i’m going to be a nurse when i tell them that, i’m going to be a doctor!!), stigma against mental illness and providers in communities at large and within my family of origin, folks assuming that i’m only going into it to have a good lifestyle (anyone who knows me this is probably at the bottom of the list of reasons – and anyway what’s wrong with wanting balance in my life??) – i realized that by caring about what others thought i was simply holding my own happiness and passion hostage.

i came into medicine because of my passions for social justice and mental health and i can think of no better way to execute my dreams than by being a psychiatrist. i love getting to know my patients. i’m good at it.

of course i still have concerns – am i risking my own mental health? will my empath self be able to hold down the boundaries necessary to function in my own life without absorbing the struggles of others? will i regret missing the opportunity to be the patient’s first line and home base as their primary care doctor?

but there’s an underlying peace that i’ve found from leaning into this. into what feels right for me and what’s brought joy in some of the darkest days these past few years. into what i’ve always envisioned for my life.

i’m moving to NYC! i’ll be at columbia this upcoming year obtaining my MPH. my struggles with USMLE greatly robbed me of my passion for medicine. it often left no time or energy to explore my activism and advocacy. getting an MPH was always a part of my life plan but it’s something i’ve decided to pursue now (rather than later) in an effort to rekindle the flame and remind myself of my goals for my life, beyond passing an exam. i still have no idea where i’ll be living or how i’m going to balance moving several times this summer while taking shelf exams and OSCEs and step two. but for the first time in a long time, i’m truly excited about the future and it feels so damn good.

i only have a few more weeks of core rotations remaining in third year and i’m so happy and proud that i chose to advocate for myself to start rotations before retaking step one. i’m not exaggerating when i say that decision probably saved my life. in the past year i’ve learned so much about myself and the physician i aspire to be. i’m so excited to continue to move forward in my career and this life i’m building. grateful for your company through it all.

onward

it’s been a minute since i’ve blogged, mostly because it didn’t feel like i had anything to say, but i’ve realized that sometimes finding healing in writing means pushing yourself to face things when it would be much easier to just run and hide. i started sharing my journey online because i felt alone in my failures and i didn’t want anyone else to ever feel that way too.

it would be easier to share after everything has worked itself out somehow – after i can pinpoint how each failure actually led to a success i may not have had otherwise. there’s, of course, courage involved in admitting to failure at any point throughout our lives but i’m choosing to take you along through the thick of it – when it’s messy and unclear how things are going to work out. because, as much as i often wish we could, we can’t fast forward through the difficult parts like they do in the movies. so let’s all try to be a little vulnerable and walk with each other through the hard parts.

one of the biggest lessons i’ve learned from all these failures, other than how to advocate for myself, is learning how to come up with a PLAN B (or C or D or E in some cases). so today i thought i’d share my plan F with you all. if you’ve been following along for some time, you probably know that i’ve struggled a lot with USMLE step one. i’m not going to go into details about how many times i’ve taken the test or what went wrong or any of that because that’s something i’m still figuring out and simply, i don’t want to. i’m trying to live without seeking validation from the others.

after finishing my core rotations in third year, i’ll be taking a year off to complete an accelerated MPH program (and also take USMLE step one and two CS & CK during that time). when i applied in november i was, of course, hoping to take this step under different circumstances but i’ve learned that we often have to just roll with the punches. so far i’ve been accepted to columbia (still pinching myself about this!!!) and am waiting to hear back from a few other schools. so excited to take this next step in my career!

my passion for public health began pretty much began with my passion for medicine because, to me, they go hand in hand. public health is the marriage of medicine and social justice and i love that. i actually applied to dual degree MD-MPH programs when applying to med school back in 2013. i’d planned on getting my MPH at some point during med school but kept putting it off because of my struggles with step one. and then i realized that i’d hit ‘pause’ on my life because of this test and that had turned it into an even bigger monster in my mind. i started putting everything off until after. but that’s not how life works. or at least not how my life works.

so i’m reclaiming my time from this dragon (i.e. step one) that took over my life there for a minute. it’s a battle i’ll have to face again. but instead of allowing it to pause my life, i’m choosing to keep living and instead hit pause – no, stop –  on all the stress and anxiety and negative self talk and depression and darkness.

i’m sure this plan doesn’t make sense to many of you. ‘how is she going to study for and pass this test while doing an accelerated master’s program when she couldn’t even do it during a year off without anything else to worry about?’ that’s a great question. one i’m choosing not to answer because i’ve decided it’s time to stop seeking approval and do what feels right for me. instead of telling y’all why this is the best way forward for me, i’m simply going to show you – by living it. and to clarify – this does not mean i’m giving up on medical school by any means. i’ll be back to finish my fourth year rotations and apply to residency in 2019 after completing the accelerated MPH program!

so ahealersheart may be heading to NYC or Cambridge or Berkeley oooooor who knows!? but first, we’re going to get through peds and obgyn and psych and OSCEs and step two CS and CK. one step (pun definitely not intended) at a time. deep breaths. one foot in front of the other. we got this.

these are my confessions

Anyone else’s mind jump straight to the Usher track whenever they hear the word confession? No, just me? That’s cool. I’ve come to terms with my embarrassing and unwavering love for Usher during my junior high years. It’s fine.

But on the real – I thought it was time for a life update since it’s been a minute. I started sharing my journey through medicine, and life in general, on here and Instagram because I wanted people to feel less alone in their struggles. In this age of social media, it’s easy to fall into the mentality that everyone has their life together except you. But that’s obviously not the case – we just choose to present our best selves to the world. And on the surface there isn’t anything wrong with that as long as we can remember that there is so much else going on that is not being shared. But in the past couple months, since finding out I failed step one again, I’ve started to feel like I’m folding into myself and only presenting the highlights of my life. And while I don’t owe anything to strangers on the internet, I feel it’s important for me that I continue to present myself honestly.

Since December I’ve hit one of the most severe bouts of depression I’ve had in my life. I’m pretty sure I’ve struggled with both depression and anxiety for most of my life but wasn’t clinically diagnosed until starting medical school. Stress has always been a huge trigger for me and obviously failure, and step one in general, is stressful. Having been through similar, but less severe, episodes in the past I tackled my depression head on with the things that have usually helped me. I continued taking my medications, working with my therapist, etc. I put away my books and I traveled. I spent time with loved ones and my kitten. And I convinced myself that I was feeling better and dove back into studying as the new year began in January.

But I wasn’t okay. I was struggling badly. I couldn’t focus. I was irritable. I had so much trouble sleeping. I was nauseous all the time. I hand anxiety attacks weekly that were almost as bad as the ones that initially drove me to seek help. So I sought council from those I trust and one of the deans at the SOM recommended that I get tested for learning disabilities in case that there was something making it harder for me to succeed and adding to my stress. I realized that it was important for me to set my ego and internalized stigma towards disabilities aside and truly find out if there were accommodations out there that would help me with both my studying and in my exam taking. It took months before I was able to find someone who accepted my insurance and saw adult patients but I finally got an appointment about a month and a half out. Those of you becoming psychologists, thank you, you are so needed.

Around this time, 45 also started his presidency in the United States. I think it’s pretty clear from my previous posts where I stand politically. The US has always had a dark history when it comes to marginalized peoples but something about the blatant disregard/outright support of the xenophobic rhetoric during the elections made the inauguration sting so much more than I had anticipated. Every executive order and tweet and confirmation has truly felt like a personal assault. It’s taken weeks for me to be okay with the fact that my resistance, at this moment in my life, is almost always in pursuit of my career. I will continue to do my best to be aware. To understand the struggles of those who look and live differently than I. To educate and have the difficult conversations. To organize. To put my body on the line as often as possible when my sisters’ and brothers’ human rights are at risk. But for the most part – my resistance is hours and hours of studying to pass an exam so that I may advocate and care for my patients. And for now, that has to be enough.

Meanwhile, I did my best to continue studying. I searched online for tutoring programs for medical students that worked through video chat. I wasn’t ready to pick my whole life up and move to another state again, as I did when attending Wolfpacc in the summer. It was clear that I had made the most progress in my studying in the months after I had returned home and worked hard on my own. I’m certain that the most helpful aspect of being at Wolfpacc was being in a supportive environment surrounded by people who truly understood the struggle but I did also miss the tutors and the structure they provided. I also missed having someone to run my study schedule by to ensure that I was as effective as I could be in my studying. I missed doing questions with a tutor and running through my thought process with them so that I could identify holes in my knowledge. And that’s when I stumbled across Med School Tutors and was immediately intrigued. I had the opportunity to do one-on-one tutoring from home with someone who would also help me create a schedule that worked for me. It sounded perfect!

Now, I don’t think that this is something that necessarily everyone studying for USMLE needs. But having been at this for so long, I knew I needed more encouragement and reassurance this time around and I’ve found exactly that in working with a tutor through MST. Their entire team has been so incredibly supportive of my goals. The thing that I love most about MST is that they share my values. When I opened up to them about how much I had been struggling, they immediately reassured me that taking care of my health, both physical and mental, is the priority. They helped me rearrange my tutoring schedule at no additional cost to work best for my needs. Having a group of people who’ve essentially been cheering me on through the struggle of doing this for a third time has been such a blessing. If you do decide to check out MST, please cite me as your referral. This post isn’t at all sponsored by Med School Tutors but I do want to disclose that I will get a free hour of tutoring if you decide to work with them.

While struggling through all this I started falling victim to some really serious negative self talk and began to struggle with so many of the things I often warn you all about: feeling shame in the face of failure, constantly comparing myself to others, etc. and it started to take a serious toll. Part of the ugliness of depression is that it’s hard to separate when your thoughts are due to the illness versus when you’re actually right in your introspection and reflection. It’s taken me some time to be able to separate those two things and journaling daily has really helped me with that. I’ve been drowning myself in self care & self love and really doing my best to replace the negative self talk with positive affirmations.

I’ve taken the last couple weeks off from studying and really focused on getting back to feeling like myself. In my appointments with the neuropsychologist, we ruled out any learning disabilities but in talking to him about everything I’ve been through and am going through the past couple years, I realized that my depression and anxiety haven’t been managed as aggressively as they should’ve been. My primary care physician had been treating me until now and she isn’t the greatest when it comes to mental illness. (Another reason why I continually come back to a career in family medicine. We so badly need primary physicians who can provide holistic care. Shout out to all my future FM docs! I’ve got so much love for y’all). While talking to a close friend about this, she asked me why I hadn’t sought care from a psychiatrist over the past couple years that I had been dealing with my undertreated depression and anxiety. And I had no real answer. I later realized that it was because I, someone who constantly advocates against mental illness not being a true disease, had been downplaying my own mental illness for years. I hadn’t sought care from a psychiatrist, knowing that my PCP wasn’t doing a great job treating me, because I didn’t think it was that bad. I expected myself to pick myself up and just brush it off. I didn’t want to be someone who had a psychiatrist, and thus, label myself crazy. Why is it so much easier to show others compassion than ourselves? If I’d sought treatment for my mental illness as I’d encourage my patients and loved ones to do, the past couple years would have been so much easier.

So in the past few weeks I’ve talked to therapists and psychologists and psychiatrists and finally feel like I’m getting the care that I need. And while I’m still not feeling 100% like myself again, I’m finally caring for myself as I’d want my patients to care for themselves. I’ve spent a lot of time protecting my heart from those who try to dismiss my experience when I share my struggles and recognizing how strong I’ve been for so many years. I’m spending the rest of this week doing things that truly bring me joy, surrounding myself with the incredible people who have held me up in these difficult times often without even knowing it and simply finding gratitude in the little things.

I found out last week that the NBME accepted my appeal to expunge my score from my second attempt – you can read about my test day experience here. That news really helped restore my faith in ‘the system’ because I’ve recently been feeling like I’ve dedicated so much of my life to a field that doesn’t truly care about its people. I also found out that I was accepted to WISE’s Muslim Women’s Summit later this year, which will help me become a more effective activist and advocate. I’m still figuring out the details of my trip to the east coast but give me a shout if you’ll also be at the conference!

I know that I have what it takes to pass this exam and have an extraordinary career in medicine. But I’m still learning and unlearning what it takes to truly care for myself and be my best self. Thank you for your company on this journey.

fred & far

 

Many of us who aspire to be care givers tend to be exactly that: givers. And as we continue through our rigorous career paths, we often push aside our own needs and continue to give and give until we have nothing left for ourselves. I’ve been guilty of this for most of my life. I used to think this was a noble, unselfish way to live. That I was living the way God would want me to – by continually putting the needs of others before my own. And up until I started medical school I did alright living my life this way but as soon as school started I began suffering. It took me months before I realized that living my life in this way was not sustainable, was actually detrimental to my own health and inhibited my ability to succeed in school.

For the first time in my life, I began to consider what I needed and it was a very strange feeling. There was a lot of unlearning that had to take place about what it meant to be a ‘good friend’ or ‘good daughter’ or ‘good wife.’ I learned my limits and realized that I was of no use to anyone – not my family, my friends, my patients – unless I was good on my own. I started incorporating self care into my daily routine through various means like journaling, yoga, exercising regularly, evening strolls, writing & sharing my struggles, and learning the word no (& being able to say it without feeling guilty).

I’ve always loved the idea of wearing jewelry that’s meaningful in some way. I wear mantra bands that say ‘be you, love you. all ways, always.’ and ‘SHE BELIEVED SHE COULD SO SHE DID.’ Other pieces I’ve collected in my travels. So when I stumbled upon Fred + Far’s Instagram account, I was immediately intrigued. Self love is a work in progress and I can constantly sense myself falling back into old patterns so having a ring that reminded me, every day, to prioritize my own well being has been wonderful.

When I first started wearing the ring, it felt too big or too flashy for a ring that’s meant to be an expression of self love. I felt guilty for spending so much money on something for myself. But as with prioritizing self care in my life the past two years, it started to feel as natural as wearing my wedding set every day. If I’m ever so blessed as to raise a daughter, I hope that I can pass this ring onto her. This life can be stressful and beautiful and heartbreaking but I know that as long as I’m in my own corner, I can get through it all.

You can visit Fred + Far’s website here to learn more about their story and products.

study tips: practice questions

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I’m currently studying to retake USMLE step one and while I’m disappointed that I wasn’t able to pass this exam the first time around, I’m definitely grateful for the opportunity to hone my test taking skills and learn how to be a better physician with the wonderful people at Wolfpacc.

One of my biggest problems while taking multiple choice exams is being ‘seduced’ by some of the other answer choices so I’ve always felt that my exam results don’t always show how much I know about a topic. In undergrad, and now in med school, I’ve always performed better on free response questions because I have the chance to display what I know about a topic. In the past, I’ve tried to answer multiple choice questions as if they were free response (not looking at the answer choices) but I finally feel like I have a strategy I can use for the many tests I will be taking over the years.

People’s test anxiety presents in different ways. For some, the days leading up to the test they’re unable to sleep properly. During the exam they’re tachycardic and cannot focus long enough to get through a question. My problem, and maybe this isn’t even test anxiety, is never truly feeling sure of my answers and doubting myself easily. I’ve gotten into the habit of never changing my answer unless I’m 200% sure that the second option is correct. But often, even when I’m just thinking about what the answer can be, I question my instincts to the point that I don’t actually know which one feels more right to me.

Since arriving at Wolfpacc, I’ve changed my study strategy so that I’m forced to answer every MCQ question as if it is a fill in the blank and I don’t fall prey to any of the other appealing answer choices. Below I’ve shared the steps I’ve been implementing this past week for UWorld questions and aim to use for all MCQ tests I take in the future:

  1. Cover your answer choices. Don’t just say ‘I’m not going to look at them’ because you will. Use a sheet of paper or something to physically block you from seeing the answers.
  2. Read the last sentence of the vignette and summarize it. Most of the time there is a lot of excess information in the paragraph above. If you read the question before reading the paragraph, it’ll be easier to identify what information is actually relevant. So take the time to really understand and simplify the question.
  3. Talk to your patient and find hints. One of the professors here has encouraged us to think of the vignette as your patient. Some of the information they tell you will be very relevant to answering the question and the rest may be useless. You have to learn to distinguish between the two. As you do more and more practice questions, you’ll pick on some patterns.
  4. Answer the question yourself. Before you’ve uncovered the answer choices, write down what you believe the answer is. Sometimes you’ll remember some details about it but won’t remember the exact answer but you should write down whatever your answer would be if this was a free response question.
  5. Uncover the answer and pick whichever one matches what you wrote down. Even if one of the other answer choices starts to look more appealing, you still need to choose the one that matches what you wrote as your own answer. This is important for when you’re going over your question set afterwards and I’ll explain why later in this post.
  6. Move on. Don’t overthink the question or your answer. Sometimes you won’t really know why you think something is the answer but you need to trust your gut.

Because I’ve just started using this new strategy, I’m doing my questions in un-timed mode and actually writing down my thought process for each question so that I can get used to it. My paper looks like the following for each question:

  • Q: the question restated here in my own words
  • Pt: information from the vignette that is applicable to answering the question being asked – keep this short (5-6 words max)
  • A: my own answer to the question, without having looked at any of the answer choices.

Now, when you’re doing practice questions you have to remember that reviewing the entire test, including the questions you got correct, is just as important as answering the questions. This is when you correct both your technique and any holes you have in your knowledge.

For answers you get correct, make sure that the answer you wrote down matches exactly the answer choice selected. If it does, just move on – you don’t need to read the explanation or anything else from that question stem because you had the correct thought process and arrived at the right answer.

If you get an answer correct but your written answer doesn’t match the answer given in the options exactly but is generally related, you have a small hole in your knowledge and need to read the summary sentence at the end and add that to your written answer in your notes. If that still does not clarify the connection you missed, you should review more of the explanation.

If you get an answer incorrect, you repeat the same process as above but read the entirety of the explanation because this is a clear hole in your knowledge. The reason I’m recommending that you choose the answer that best matches the answer you’ve written, instead of choosing the ‘more right’ answer, is because it will be easier to correct that hole in your knowledge. If you change your answer and get it right, you’re less likely to take the reviewing process as seriously because you got it right but it’s still a hole in your knowledgeOn the real exam, if you’re 200% sure that the other answer is correct and the one you came up with on your own isn’t, of course you should pick the right one. But when you’re doing practice questions, you’re still learning and you learn the most from questions that you get wrong.

Also, I usually use a different color pen to add my notes for questions I get correct (usually blue) and questions I get incorrect (usually red). If I’m ever reviewing this notebook, I usually focus on the notes I’ve written in red since those indicate the biggest holes in my knowledge.

Don’t get hung up on how many you get right or wrong. Focus on improving your technique and finding the holes in your knowledge. As you get more comfortable with the new technique, you should not have to write out as much and start doing the question sets in timed mode. And, of course, this technique may not work for everyone. It’s just something that I’ve been trying and feel more comfortable with. Happy studying!

review: talkspace

A few months ago, I changed health insurance plans and my new insurance was not accepted at my therapist’s office so I was being charged about $100 per session, which honestly isn’t even that high but I just couldn’t afford to keep going on a student budget. After months of neglecting my mental health and reaching somewhat of a breaking point, I started looking online for remote therapy alternatives to traditional in-person therapy and talkspace was immediately on my radar.

Disclaimer: everything I’ve written below is from the perspective of a consumer and not, in any way, medical advice. 

What talkspace is about:

Therapy for how we live today

Introducing Unlimited Messaging Therapy, affordable, confidential and anonymous therapy at the touch of a button. Your professional licensed therapist is waiting to chat with you right now, and help you make a real difference in your life. You can message your therapist anytime and anywhere, from your smartphone or the web, 100% safe and secure. Welcome to the wonderful world of therapy, re-invented for how we live today.

When you first go onto the website you go through a free initial assessment with the therapist on that ‘shift.’ The assessment honestly isn’t their strongest point – it feels a lot like the messages are just copied & pasted and that they’re just feigning empathy regarding why you’re pursuing therapy, if you’ve ever done therapy before, etc. Eventually this person sends you a form to fill out, a lot of which you’ve already said so you end up repeating yourself. There’s also a place on the form where you can write any preferences for your therapist (male/female, younger/older etc.). I believe that part of the reason it sounds scripted is because, legally, they have a very narrow set of language they’re allowed to use in their assessments.

After that, you select a payment plan – paying monthly, quarterly (for 3 month period) or annually (for the whole year upfront). The longer the period you pay for, the cheaper it comes out to be per week. Initially, talkspace started as just messaging therapy but they have now added a live session component and each video chat is about 30 minutes. The unlimited messaging only comes with a complimentary ten minute live chat as a way to ‘meet’ your therapist before starting your journey together.

These are the current plans that are available for one-on-one private chat:

  • $32/week of Unlimited Messaging Therapy (billed as $128 monthly)
  • $43/week of Unlimited Messaging Therapy + 1 Live Session (billed as $172 monthly)
  • $69/week of Unlimited Messaging Therapy + 4 Live Sessions (billed as $276 monthly)
  • Couples therapy is available for $189 per month or $499 per quarter (12 weeks).

Finally – after about a day – you are paired with your therapist and you start therapy. The first couple days are mostly your therapist reading through your initial assessment and asking questions to get a better idea of where you’re at in life and get an idea of what your goals are with therapy. Then gradually you’ll start working on specific issues and moving forward. Unless you have an alternative arrangement with your therapist, she/he will check your chat two times a day during the weekdays and not at all on the weekends. Initially, it may feel like you’re moving really slowly, especially if you’ve done the traditional 50-minute therapy sessions but one week of chatting on talkspace should be considered equivalent to a traditional session.

When I first started working with my therapist, I felt that the focus of our conversations was shifting from where I wanted it to be so I just talked to her about it. Initially, it felt like she was offended but we completely cleared that up during our introduction video chat. She actually stayed in touch with me during our first weekend working together because I started therapy on a Friday. Additionally, if you feel like you’re not meshing well with your therapist, you can simply request someone else. So far I’m really happy with my experience on talkspace and finally feel like I have a consistent source of help. Below I’ve shared the reasons I think this platform is absolutely perfect for young professionals, especially those of us in medicine.

  • Access. I love that I can literally text my therapist whenever I have an experience I need help processing or figuring out the best way to approach a specific situation. With my previous therapist, I would not be able to get an appointment with her until at least a month after I called. Right now – I’m going to be in Florida, away from pretty much my entire support system, studying for what’s probably the most difficult exam of my career. Having someone who can provide insight during trying times – literally in my back pocket – has removed a lot of the anxiety associated with living in a new place, surrounded by new people, overcoming this hurdle.
    During the clinical years of med school and residency, I will likely have several days when I start working before any therapists’ office is open and leave work after all therapists’ office close. Having the freedom to text my therapists at any time, day or night, makes it so much easier to get help when you’re working that ridiculous schedule – when you often need therapy the most but can’t access it. Additionally, you’re not limited by geography – even if I move to Vermont for residency, I can continue working with the same therapist remotely.
  • Time. When working or studying all week, the last thing I want to do is drive twenty minutes to my therapists’ office and talk to her for a whole hour about things that have added up since our last session. Sometimes I feel like a 50-minute session is too long and I don’t even have enough to discuss and other times it feels like the time just flies by and I have to wait until our next session in 3-4 weeks. I can start messaging my therapist about something and I’m able to say as little or as much as I want (or have the energy to) at my own pace.
  • Referring Back. Unlike with traditional therapy, unless you’re taking notes, you can actually refer back to exactly what your therapist said in your conversations, even after you’ve ended your subscription. So if something similar happens in the future, you can refer back to your conversations and regain that insight.
  • Continuity. I started using talkspace during a difficult time in my life when I needed help to best process and prioritize my life to set myself up for success on this exam. But after I’ve passed this exam, I may not need to work with a therapist for a few months or even a year. I can stop paying for my subscription with talkspace as soon as I feel I don’t need it and if I have another difficulty arise in my life, I just open talkspace back up and continue working with the same therapist. Those of you who have worked with multiple therapists know how exhausting it can be to repeatedly tell your story to someone else, over and over again so it’s incredible that I can just continue working with the same person!
  • Long Term. A career in medicine comes with many, many emotionally challenging times. The first two years are a marathon of constantly feeling like you need to prove your worth and taking test after test. The rest of medical school is that but also facing the realities of medicine: death, dealing with insurance companies and difficult patients, etc. It’s a life time of helping people through some of the most difficult times in their lives and we’re somehow expected to handle it all without seeking help ourselves. Talkspace allows you to stay with the same therapist throughout your years in medicine, even if you travel all over the country for your training.
  • Long Distance Couples Counseling. Many ‘medical couples’ or couples in which both people are pursuing rigorous careers often find themselves in a long distance relationship at some point in time. And while long distance comes with its own challenges on top of the challenges of learning how to ‘life’ with someone, traditional counseling is not usually an option because of said distance. We haven’t used this aspect of talkspace yet but if it’s as promising as individual therapy has been, it would be worth a try – especially for long distance couples.

You can read about how talkspace protects the privacy of their clients here and about how the select the therapists available to work with on the website here. In doing my own research about reviews on talkspace, I came across several that were concerned about the text-only basis of the therapy especially since a healthy connection is a vital part of working with a therapist. However, I do think that some of these issues are addressed with the availability of live sessions and ability to send voice and video messages to your therapist. Here you can read some pros and cons of talkspace from the perspective of both consumers and therapists working on the site.

Todd Essig, psychologist and a writer at Forbes, has shared his mistrust of talkspace here and more recently here. I do agree with some of the points he makes, especially the points he makes about the limitations in your therapist’s ability to respond in the case of an emergency. For that reason, I do believe that talkspace is not the best platform for those with acute mental illness in a current state of crisis. In that case, immediate and acute intervention should be sought at the nearest psychiatric institution with extensive follow up with regular in-person sessions. However, for those of us who have been managing our mental illnesses and need additional help in doing so, this can be a great and convenient option especially when there’s no realistic alternative.

If you do decide to try out talkspace, you can get $50 your first month by using my referral link. Full disclosure: I will also receive $50 off a month if you do use that link but that’s not at all why I’ve spent hours on this post and this post is not, at all, sponsored by talkspace. I’m truly passionate about future health care professionals taking better care of themselves and I believe talkspace is a great option that removes many of our barriers to mental healthcare.

Have you tried talkspace or any other online therapy platform? What has been your experience?

edit: here is a more current comparison of betterhelp vs. talkspace by zencare.

med sisters series: Cassie Majestic, MD

The Med Sisters Series is a series of interviews of women in various stages of their careers in medicine: pre-med, medical school, residency, fellowship and attending physicians. As women, I believe we face unique challenges within any field, medicine included. As I’ve moved along on this journey, I truly believe one of the biggest support systems we have is each other. Society works so hard to pit women against each other in every situation you can think of but, as feminists, I think it’s so important to combat that urge to try to ‘beat each other out.’ There’s room for all of us on the other side of the glass ceiling. The goal of this series is to shed light on the challenges women face in the field of medicine and how they achieve a work-life balance that works for them. This blog has always been a place for me to share the realities of this journey, both the highs and lows. I thought of this series as a way to share the perspectives of the other extraordinary women on this journey too.


Dr. Majestic is an attending emergency medicine physician practicing in a community hospital in Orange County. She recently finished her residency and you can follow along on her journey at her Instagram.

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Q: Why did you decide to pursue medicine as a career? How do you stay motivated on the difficult days?

A: Medicine somehow spoke to me when I was very young. I remember knowing I wanted to be a doctor in 4th grade. I had no friends or family members in medicine. I simply knew that I wanted to do something great with my life that involved the human body and educating others. I was serious about school since I was little, and I thought it would be fun to treat diseases.

Staying motivated on the difficult days is truly a challenge, especially because there are so many difficult days in medicine. I actually let myself take a break on those days. Talking to my mom has always been helpful when I am doubting myself, and a nice long workout with my favorite jams (Journey- Don’t Stop Believin’) has always kept me inspired to finish what I started and reach my goals as planned.

Q: What has been the most emotionally difficult aspect of your career thus far? How did you cope?


A: The Emergency Department unfortunately doesn’t provide time for me to experience much emotion. It’s so fast paced, and I rush from one patient to the next delivering good and bad news without much time for preparation or mental emotion. The toughest situation for me however, is delivering news of death to family members and loved ones. This is the one time that I have to slow myself down, and really prepare myself mentally. In addition to this, I think the most emotionally difficult part of medicine and Emergency Medicine in particular, is dealing with making mistakes and missed diagnoses, especially when this results in a bad outcome. I think the only way to cope with these situations, are to understand that we are human, we make mistakes. I also believe that maintaining open discussion with patients and their families is helpful, and allows them to see that doctors are only human. I feel better being brutally honest with each patient and their family, and addressing my mistakes if there are any that occurred.

Q: If you could go back and do undergrad and med school again, what would you do differently? 

 
A: I would honestly cut myself a little more slack. I missed a lot of family and friend functions, because I thought that if I didn’t study a certain number of hours each day, I was doing something wrong. There were many days that I beat myself up internally, for not studying 12 hours per day. It took me a long time to realize that quantity does not equal quality. I would tell my younger self that it is possible to study well without spending every hour worrying about the amount of time I was putting in.

Q: What are some of your favorite medical apps to use while at work?

A: I love Epocrates for up to date drug information. The upgraded version also has an awesome section where you can plug in a condition and it will give you treatment and further recommendations, in case help is needed with a certain clinical scenario. PediSTAT is my favorite pediatric app and I feel much safer on each shift having it in my back pocket (literally). Uptodate is great as well, and is one of my most reliable and “up to date” resources for current guidelines on any medical condition.

Q: How did you decide on Emergency Medicine as your field? What advice do you have for people who are also interested in EM?

 
A: My interest in Emergency Medicine began as an undergraduate student at Arizona State University. Most of the volunteer opportunities were in the Emergency Department, so I received most of my early exposure then. The Emergency Medicine physicians that I have met throughout life were always enthusiastic, fun, and seemed to love their job. They made it tough for me to love another field of medicine.
That being said, I still planned to go into surgery all throughout medical school, up until it was time for me to apply for residency. I made a last minute career switch to Emergency Medicine when I realized I wasn’t excited about my lifestyle as a surgeon. Once I allowed that change to happen mentally, I was SO excited and happy for my future.

For those of you interested in Emergency Medicine, I encourage you to start early. There are lots of opportunities for shadowing/volunteering in the Emergency Department. This is really important to see if you can function well in a stressful, busy, and crazy environment. Be aggressive and up front about what your interests are, when gaining experience. Persistence and follow through is key in Emergency Medicine. It is becoming a competitive field; boards scores and medical school grades are very important.

Q: You have such a passion for educating the public about health care issues! Why do you feel that this is important?

 

A: I am concerned with the way healthcare in the United States is going. Now that the Affordable Care Act is in place, all physicians are seeing extremely high volumes of patients, especially in the Emergency Department and Primary Care offices. There aren’t enough hospital or Emergency Department beds to accommodate the patient volume. Part of this problem stems from the lack of preventative medicine in the United States. I feel American medicine needs to provide more education starting from a young age, to help with prevention of diseases. Social media is a huge part of peoples’ lives. Part of the reason I started my educational Instagram account, was to attempt to reach people that otherwise wouldn’t be reached, with medical, health, and wellness education. I see many financially poor patients, and most of them have a cell phone with Internet connection and access to social media. My hopes include using social media in a positive way (since it is very easy to use in a negative way) and provide education to everyone. Maybe in the future others will start doing the same, and there will be more health and wellness programs and education in schools that will improve our lack of preventative medicine awareness.

Q: Who is a woman in medicine you look up to and why? 

 

A: My program director at University of California Irvine, is a true inspiration. She is young (under 40), married, has two children, and is in charge of a residency program at a large academic institution. She happens to also be beautiful, fit, and so smart. I know that she is confident in everything she does, despite the criticism and challenged she faces as a mom and a physician everyday.

Q: As a woman in medicine, have you faced any discrimination (either blatant or more subtle)? What advice do you have for women who go through similar challenges? 

 
A: I haven’t faced any significant discrimination, thankfully. I grew up around men primarily, as my father is military, and I enjoy working with men in the Emergency Department.

I will say that it can be intimidating at times. In the past, I believe I made some of those intimidating feelings worse by allowing myself to feel less smart and confident. Women in medicine are not unusual these days, but it can still be common for women to have emotional feelings about themselves being less adequate at a job than a man. This is very well known. So my advice to all women out there who feel they are experiencing discrimination, is to remember how far you’ve come. Your mind is powerful and confidence is a necessity in medicine! Maintain the confidence and discrimination will not set you back. Speak with confidence, make decisions with confidence, and everyone (even the men you work with) will see that and respect you!

Q: What has been your favorite part of your journey so far? Where do you see yourself after residency? 

 
A: My favorite part of my journey has been the people I have met along the way, both colleagues and patients. I have the privilege of knowing peoples’ secrets, fears, and gaining their trust to care for them. I get to work with my best friends, who I identify with, and love. During residency, I feel like I have finally found “my people”. Even across various hospitals, most Emergency Medicine physicians share a similar personality type and I have so much fun at work.
After residency (3.5 short months away!), I plan to stay in Orange County and work in a community hospital as an Emergency Medicine physician. I am delighted to say that I will also still be working at my current academic hospital sporadically. It is the best of both worlds! I’m excited to work in a smaller hospital but also maintain affiliation with the residents and medical students in the academic world as well.
Update: Dr. Majestic has completed her residency and is currently practicing at a community hospital in Orange County!

Thank you so much for stopping by our corner of the internet Cassie! We wish you the best on your journey.

Past Interviews: