Nov 14, 2018

Dr. Chan: What kind of impact does volunteering at the VA have on someone deciding whether or not to apply to medical school? What is the strategy behind applying for the Early Decision Program or EDP? What is the BioImmersion program? And how does it help one prepare for medical school? Today on "Talking Admissions and Med Student Life," I interview Alejandro, a first-year medical student here at the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world. This is "Talking Admissions and Med Student Life" with your host the Dean of Admissions at the University of Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: All right, welcome to another edition of "Talking Admissions and Med Student Life." I got a great guest today, Alejandro. How are you doing?

Alejandro: I'm doing pretty well.

Dr. Chan: Okay. Did I say it right?

Alejandro: Yeah, you said fantastically.

Dr. Chan: Can you say it for me?

Alejandro: Alejandro.

Dr. Chan: Okay. I can't say it like that. So . . .

Alejandro: It's a trick to roll the r's. It can be difficult.

Dr. Chan: All right, so we're talking incoming med students. How's does it feel?

Alejandro: Amazing and nervous at the same time. It's like staring into a giant ravine. You're excited to jump in, but at the same time, you know?

Dr. Chan: Okay. All right. Let's go back to the beginning. When did you think about becoming a doctor? When did that idea enter your consciousness?

Alejandro: It really started when I was young and I always was fascinated with biology and human anatomy and things like that. And, you know, my parents were very supportive of that. But gradually, over the years, I felt that it wasn't entirely what I wanted to do, but I knew I wanted to work in the health care field. So I ended up choosing biomedical engineering as my major. And I actually found myself following this cute girl into a volunteering opportunity . . .

Dr. Chan: You still together?

Alejandro: Yes.

Dr. Chan: Okay. Okay. Shout out to unnamed cute girl.

Alejandro: Sarah.

Dr. Chan: Okay, Sarah.

Alejandro: And I followed her into the local VA residents home and I just fell in love interacting with the residents there and like being a volunteer. I spent as much time as I could there. And eventually, when I found myself graduating from biomedical engineering, I was like maybe I should give this medical path a shot. And so they offered me a job part-time there working as, you know, just an assistant.

Dr. Chan: Yeah. What were you doing at the VA specifically?

Alejandro: I was a Recreational Coordinator Assistant.

Dr. Chan: Okay. What does that mean?

Alejandro: I helped develop the different events that people would go through for just entertainment. I would help transfer the residents. I would interact with them, talk, help move them from place to place, sometimes change them. Just pretty much whatever that needed to be done. And I loved it. I loved every second of it. And it was always so funny because all my colleagues kind of made fun of me to be like, "Here's the engineer working as a recreational therapist assistant." You know, I loved my time that I spent there. I developed a lot of lasting relationships with not only my coworkers, but also the residents there.

Dr. Chan: Do you come from a military background at all?

Alejandro: No.

Dr. Chan: Or was the VA completely kind of like out of your comfort zone?

Alejandro: It was out my comfort zone. I do not have any military background. But it was something where I got to obtain a lot of wisdom because a lot of times it's . . . I was working specifically with residents that were above the ages of 60 or whatnot, you know, the World War II vets, the Vietnam vets. And they're hilarious. They're an absolute blast, and you end up building these connections with people. But it's also kind of sad there because since it is . . . some of them are on there, you know, last steps and you meet a lot of friends, but you also lose them. But from there it was actually where I got the opportunity then to volunteer at the Hope Clinic because . . .

Dr. Chan: Where is the Hope Clinic?

Alejandro: The Hope Clinic is a clinic in Midvale, Utah.

Dr. Chan: Okay.

Alejandro: Where they offer free health care to those who are uninsured and below the 150% poverty line.

Dr. Chan: All right.

Alejandro: And I volunteered there initially as a Spanish translator, and then from there I went ahead and developed myself there working along Jane Powers, who is an absolutely amazing person. She's extremely gifted and talented at running this clinic all off of donations. Everyone there is a volunteer. And I got to really there realize my fascination and my true potential and what I wanted to be in my future.

Dr. Chan: So it sounds like you start off not sure about medicine, VA experience and that kind of morphed into a Hope Clinic experience. It's kind of like the backbone of why you want to go into medicine?

Alejandro: So, I mean, everyone always says that they want to help people, right? But I always understood that I could help people in many ways, even as an engineer or whatnot. It was really those experiences that helped solidify that this was the only option that was really viable for my happiness to be able to help people. That's actually one of the things that because I have the mentality that with any amount of determination and aptitude you can achieve almost anything, right? And I wasn't so much scared of the work or the work ethic of going into medicine. I was more timid if it was what I really wanted to do and if I could withstand it emotionally.

And those were lessons I learned at the Hope Clinic when many times I had to tell patients very bad news or news regarding cancers and whatnot, right, because since as a Spanish translator it allows you the unique opportunity to be in the shoes of a doctor, right? Because the patient doesn't understand the doctor and you're there translating for them and you're delivering this message and it's just . . . you know, that was actually one of the days where I almost said I couldn't do it. I almost gave up. But I was very fortunate to have a wonderful support group, family, friends, and fellow volunteers at the Hope Clinic that really helped me understand the emotional stress that you can feel sometimes.

Dr. Chan: I'm just curious because I'm just, you know, learning about our system. So that the Hope Clinic if someone is underinsured or uninsured and they received a cancer diagnosis, like as a translator, how would you . . . you know, because there must be a lot of questions about follow-up care and chemotherapy and things like that. Are they eligible to get that at the Hope Clinic, I mean, or would you become kind of like, you know, an expert in follow-up care or like social work types? I mean, like how would that happen?

Alejandro: Working at the Hope Clinic you really develop a Swiss Army knife approach and to be able to do a bit of everything. And I found myself before walking into the room because I was one of the best translators there at that time. One of the other translators approached me and said, "Hey, could you translate this to this individual?" And I may try understood what it was, what was happening, potential future options. And I spent a solid half an hour before approaching the patient to really understand and grasp around what I needed to say and how to best express it. And how it went down was I essentially went into the room and she was very ecstatic and happy awaiting good results and actually asked me, you know, "Bring me the good news."

And it was that difficult, just you feel that big sigh when it's not, you know, and you just start elaborating on the test results and you start describing them. And you really just get to see the look on the patient, right, and it's a time in which they're extremely vulnerable, upset. But I found myself just instinctively reaching out, holding her hand. And I just sat with her for about an hour and a half and she cried. And then once she finished crying, whatnot, then we went to the next step where we spoke about the results a little bit more in detail and then also options.

And from there at the Hope Clinic we don't offer those kind of services, but we connect people with programs that allow them to receive those services. So I spent the next week just calling every single cancer institute or whatnot in the area just to be able to find some way that she could get free chemotherapy or . . .

Dr. Chan: Become eligible for Medicaid or all different programs. Yeah. It sounds pretty tough.

Alejandro: Yeah, it was. And honestly, I would say that was a near breaking point. That dissuaded me entirely from this dream, but . . .

Dr. Chan: So what pushed you forward? I mean, what kept you going?

Alejandro: The next patient.

Dr. Chan: Okay.

Alejandro: Because, you know, you find yourself right after doing that you have to keep translating. You have to go to the next person. And really I had to understand it as sometimes you'll find yourself in those situations that are just horrendous. But other times you'll find yourself in the capacity which you're helping people mentally. And in both situations, regardless, you're still helping people. And, you know, at the end of the day that's part of the job.

Dr. Chan: That's awesome.

Alejandro: Yeah, it's great I know.

Dr. Chan: So Alejandro . . .

Alejandro: Sorry to be a downer.

Dr. Chan: No, no, no. You know, VA, Hope Clinic. Anything else that you did prior to applying to med school that you felt really prepared you or got you ready for this like medical school journey you're about to embark on?

Alejandro: I mean, beyond studying biomedical engineering where I was able to get wonderful opportunities, I already I had dissected cadavers with Bo [SP] and in several classes that are only offered to engineers. And then I also participated in BioImmersion program, which I thought was fascinating.

Dr. Chan: What's that? Let's talk about that.

Alejandro: So BioImmersion is this wonderful program offered here at the University of Utah where they take several design students and biomedical engineers and they pair them together and give them actually very nice stipend . . .

Dr. Chan: How much?

Alejandro: . . . for the summer. I think it was something around $4,000 or something.

Dr. Chan: That's a lot of coin. Yeah.

Alejandro: It's been a long time so I could be wrong. But regardless, I found myself able to just shadow doctors every day for 8 to 12 hours a day even. And I just would go in and watch, but it's very interesting because you're not watching and shadowing just from the perspective of looking at the doctor, but you're trying to look at it from the perspective of an engineer. Like what you can fix. So I found myself interacting and talking to a lot of doctors. A lot of them are just so involved and happy and they all have this awesome idea. Every single doctor has an awesome idea. And I'm not saying that sarcastically. Everyone has an awesome idea because they describe to you, "Oh, well, it'd be great if we had this stent that, you know, is biodegradable so it doesn't have to be extracted later on."

That's awesome idea. You go ahead and you try and develop ways to come up with that, feasible ways. And from that program, you essentially only go to the first step of the development cycle. You can develop a prototype and you work with the design students to develop a poster board that kind of describes the approach and the initial goals of this prototype. But later on, then you can take it on forward and participate in other programs that we have here such as Bench-to-Bedside. I was not familiar with Bench-to-Bedside until later on, and it was by then far too late for me to get involved. But I'm really looking forward to, once I'm a medical student, getting involved into that.

Dr. Chan: Yeah. I think there's a lot of collaboration with the biomedical engineering program and I think it's been a recent change. Like it wasn't bioengineering and now like they rebranded as biomedical engineering.

Alejandro: Yeah.

Dr. Chan: Were you involved at all or did they send out some poll to you guys?

Alejandro: No. I think they were just like this is going to be a great new name. As soon as they changed, they changed the whole backdrop. I mean, it was David . . . Mr. Tresco, Patrick Tresco, yeah, who really spearheaded that evolution in the biomedical engineering program. And it looks real cool.

Dr. Chan: All right, so undergrad here at the U. Did you work with the premed office or . . .

Alejandro: I worked with a premed office. Way later. Way, way later.

Dr. Chan: Okay, let's talk about that. Did you not know about them? Or because you're kind of engineering you didn't know about them or what . . .

Alejandro: I knew about them. I was a little bit timid. I think I went into their office once freshman year. But since I wasn't quite dedicated, it was just like, okay, that's cool. Those are the prerequisites. And it was kind of falling to the back of my mind. But I found myself using that valuable tool later on when I really dedicate myself and started taking my extracurriculars seriously.

Dr. Chan: How did you end up in University of Utah for undergrad? Is there a story there?

Alejandro: So I was in Saudi Arabia.

Dr. Chan: Okay?

Alejandro: So a little bit of background. So I've been moving every two to three years of my life. So I was originally born in Spain in the Andalusian Province, in a town called Cadiz. And from there we moved around to Venezuela, Argentina, California, Utah, Oregon, Spain again, Saudi Arabia, and then back to Utah. And part of the reason why I came here is because my older brother was studying mechanical engineering here. My older brother, Daniel, he's my best friend. You know, when you move so much, he's the only person that sticks around with. So I was . . .

Dr. Chan: For better for worse.

Alejandro: For better worse. And I was happy to come here and still be with them. And it was nice to have that support with the family here and whatnot. Also skiing is fantastic.

Dr. Chan: Okay. Where is Daniel now?

Alejandro: Daniel is still here. He's working at a company called Packsize.

Dr. Chan: Okay. So you used the premed office a little bit. Let's talk about your decision to apply to med school. Now you chose a certain path.

Alejandro: Yes.

Dr. Chan: EDP. What does EDP stand for and let's talk about the strategy.

Alejandro: So EDP stands for Early Decision Program. And the strategy to it is it's essentially a contractual obligation that defines that if the medical school accepts you, they are the medical school that you will go to, right? And then they will let you know ahead of time, sometime in September, way before anyone else really knows. And if you don't get accepted through the early decision program, then you're just moved to the regular applicant pool and you have your opportunity to apply to other schools.

However, I personally knew that I wanted to go to the University of Utah. I wasn't certain I was going to get in this year as I was telling you before the interview, but I knew that if I didn't, I would just work as a biomedical engineer, buff up more of my resume and save some money and then reapply the following year. But I knew I wanted the University of Utah to know that they were my top choice and this was a way for them to know for certain that this is . . .

Dr. Chan: That it's a strong signal. A lot of people say, "Oh, we're your number one." This forces you to put your money where your mouth is.

Alejandro: Exactly. And, I mean, it doesn't make it any easier to get in. It doesn't lower the standards or anything of the sort. But it does really let you send a clear message to the university you're applying to.

Dr. Chan: Did you talk about this with the premed office? I mean, were you kind of bouncing this idea off family or the pre-med office, or it was just kind of in your mind? Because of Sarah the girlfriend somewhere or . . .

Alejandro: No, no. I had spoken to my father and mother a lot about it and my dad was like, "Yeah, Utah is great. Go for that one." And I spoke to the premed office, and they tried to somewhat dissuade me from it because it is a risk, because when you apply late . . .

Dr. Chan: You put all your eggs in one basket.

Alejandro: Exactly. And applying late to other schools, you know, a lot of them have rolling sometimes.

Dr. Chan: Yeah, and you're less likely to maybe get that coveted interview spot.

Alejandro: Exactly. So I was fine putting all my eggs in one basket because I was for certain this was the school I wanted.

Dr. Chan: And why is that, Alejandro? Why did you like the school so much?

Alejandro: So I had many opportunities to go through the University of Utah's right here the wonderful health care system they have, such as my opportunities in BioImmersion. I got to not only speak with doctors but the medical students, and I heard a lot of wonderful things. I also really appreciate the mission statement that is here, and I like the focus on how we have so many opportunities here. The University of Utah specifically is just, what, a top tier research facility. And it really is a place that I would find myself able to maximize my potential. Really just learn because every time I've ever interacted with anyone here . . . I mean, maybe I'm biased, but I've had a wonderful, wonderful experiences.

Dr. Chan: That's great. It's awesome. Coming back to your interview day, did you do any practice MMIs before you got here, or was that kind of method completely new to you? And what tips do you have for people?

Alejandro: Another side note, another reason why I really wanted to go was your YouTube videos.

Dr. Chan: So you're the person that watches them.

Alejandro: Yeah. I'm at least three of those, and my father is probably eight.

Dr. Chan: Okay.

Alejandro: But I apologize. Your question was?

Dr. Chan: Oh, like your MMI experience. I mean, did you do practice MMIs, or was that a completely new method when you showed up here?

Alejandro: So I was a little disappointed that first why that they didn't have the one-on-one interviews, because I very much, just from my experiences of always meeting people and things like that, I am a very people person. I enjoy sitting down and having a chat. The MMIs I was scared that it would be too short and succinct, that a lot of potential connection could be lost. But I found that to be completely wrong. I love the MMIs. I did practice a bit going through several different questions. You know, the different typical circumstances of, "What would you do when someone comes in and they need a blood transfusion but they're a Jehovah's Witness?" And like, you know, this . . .

Dr. Chan: Was that one of ours?

Alejandro: No. That's an internet one.

Dr. Chan: I was going to say I don't think we would have that one.

Alejandro: No, not at all. But if you Google MMI questions, they have some of just crazy circumstances.

Dr. Chan: Yeah. There's all, yeah, the good old internet community. Internet premed community.

Alejandro: Yeah, exactly. I enjoyed those questions. They were challenging, but I also really enjoyed the people asking me the questions. They engaged you very well. They weren't just there reading off a piece of paper. They sat down and . . . I mean, I don't want to elaborate too much on the questions, I guess.

Dr. Chan: Yes, don't. Yes.

Alejandro: But there was where if someone did something wrong, right, and would I tell on them or not. And at first it was a classmate and I said, "Yes, you know, you have to tell on them. It's the right thing to do." And you approach the student and then later on you go ahead and kind of approach the faculty. Then later on that person evolved to my girlfriend. I was like, okay, well, this is a little more difficult. Yes, I would expect that our relationship and things. Then it evolved to my wife. At this point, I was kind of laughing with the interviewer and I'll say, "Well, if she's my wife, you know, I really appreciate a strong woman. So I probably wouldn't be able to go against her." And I just I really liked how it evolved in many ways. But it was very organic. It wasn't as synthetic.

Dr. Chan: Yeah, I mean, I think that's a great fear with MMI that . . . I mean, yeah, so one of the reasons we do MMI, I think there's greater research there. There's a lot of research that shows that people who do well in MMI, do very well on something we call OSCE within med school, step two clinical skills exam. And it is a different type of interaction. But what our physicians are required to do more and more nowadays is you have to walk into a patient's room and form almost that instant connection and talk about treatment plans, delivering bad news, things like that.

So it's definitely a skill set. I think if the applicants if they have the right attitude, it can be a lot of fun because everyone goes through the same experience. I think it really minimizes bias and chance, and you get presented some really cool scenarios and just kind of talking through it and get to meet some really cool people too.

Alejandro: Yeah, and it's also kind of a wonderful parachute too, because if you mess up on one, it's not the end of the world.

Dr. Chan: Oh, yes, the power of redemption, man.

Alejandro: Yeah, there's that redemptive capability.

Dr. Chan: Yeah, the traditional interviews. If you bomb in traditional interview, it's like that's it.

Alejandro: A funny moment that I had is I was so nervous, and one of the interviewers that I don't know they put their hand to their chest and said, "Welcome," and I said . . .

Dr. Chan: Yeah, I don't think I told him to do that.

Alejandro: I said, "Hello, Mr. Welcome."

Dr. Chan: You thought their name was Mr. Welcome?

Alejandro: I don't know. He put his hands to his chest. I was pretty convinced.

Dr. Chan: That's very endearing. I love that. Yeah, it's a good story. All right, so where were you when you got the phone call? What were you doing?

Alejandro: I was in the shower. It was . . .

Dr. Chan: Did you answer the phone in the shower?

Alejandro: So I was . . .

Dr. Chan: There's a story here, yes.

Alejandro: Yeah. So the phone was right outside on the sink and I was showering. And I hear the my ringtone and I look out and I see U of U Med School. And my first thought was, "Ah, I must have messed up somewhere."

Dr. Chan: Your brain just goes . . .

Alejandro: Yeah, I must have written something wrong or misspelled a name. And I go ahead and I turn off the water and I answer it and then I hear your voice. I'm like, "Oh, this is uncomfortable." So I run over and I grab a towel and you're telling me, "Hello, is this Alexander?" And I'm like, "Oh."

Dr. Chan: Yeah, because I remember that it said Alexander.

Alejandro: I was, "Yes, this is he." And you went ahead and told me the good news, and I just I started jumping. I so excited. I was so excited. I couldn't believe it. I was still waiting for, you know . . .

Dr. Chan: You were still figuring you were going to get the "not accepted."

Alejandro: Yeah. And it is that kind of feeling like you feel over the top. You're just full of adrenaline and excitement. But there's some part of you that always feels that, you know, imposter syndrome like, "Do I really deserve it?"

Dr. Chan: "Did they have the wrong name? Did Dr. Chan have the wrong email or phone number?"

Alejandro: Exactly. But I remember I took notes of the things you were telling me because I went ahead and grabbed a marker, and I started writing down on this note card as many things as I could while you're telling me. But I think I was hyperventilating because when I look at that note card later on it says, "Good essay. Love volunteering. Nice." I went back and . . .

Dr. Chan: That was in Spanish too. Remember that, all this in Spanish?

Alejandro: Yeah. You're actually very proficient in Spanish.

Dr. Chan: Yeah.

Alejandro: I'm a little curious where did you learn your Spanish?

Dr. Chan: I just picked it up here and there.

Alejandro: Really?

Dr. Chan: Yeah.

Alejandro: That's . . .

Dr. Chan: I'm not going to say any Spanish because my accent compared to yours is horrible. No, that's French. "What are you saying?"

Alejandro: Horrible.

Dr. Chan: Horrible.

Alejandro: Yeah, muy bien.

Dr. Chan: All right. And then you called your family right afterwards?

Alejandro: Oh immediately.

Dr. Chan: And did they believe you?

Alejandro: Oh yes.

Dr. Chan: Okay. So they're like, "Oh, this Alejandro just making . . . pulling our leg."

Alejandro: I have no idea why, but they must see someone much more brilliant than I see.

Dr. Chan: Don't minimize your intelligence. Yeah.

Alejandro: No. Yeah, but at the same, you know, my mother, there's only been one moment that she's ever like said one negative thing on me, and it's when I grew a curly mustache, right?

Dr. Chan: With the handlebars?

Alejandro: With the handlebars. The whole thing. And that's when I knew that's it. Immediately I shaved it because, you know, I've . . .

Dr. Chan: For the people who can't see us right now, you do not have a handlebar mustache.

Alejandro: No, I don't. Not currently. If I did, you know.

Dr. Chan: Cmo se dice handlebar mustache?

Alejandro: Oh, [Spanish 00:24:11].

Dr. Chan: Okay. No, I love it. I love it. Okay.

Alejandro: There's the thing with the Spanish that . . . I mean I obviously don't speak with the accent and that's thanks to my parents. When I first went to California, when I first came to stateside, my mom made me practice with Hooked on Phonics. Are you familiar with that?

Dr. Chan: Personally, no, but I've heard of it.

Alejandro: Yes. For those who don't know . . .

Dr. Chan: I haven't done the program. I'm not actually not personally Hooked on Phonics.

Alejandro: Yeah, I've been Hooked on Phonics.

Dr. Chan: You're Hooked on Phonics. Yeah.

Alejandro: And it's the suitcase full of cassettes that helps you enunciate your vowels. And I remember as a child my mom would sit me down and put on this thing and it'll go, ";A, apple."; And I'd be, ";A, applet." I had so much sass about it because I hated it. But then eventually, you know, I just I learned to enunciate as an American does. My mom was concerned that if I spoke with the Spanish accent, if I talk like this, I would have difficulty getting a job in the future. And that was a different time. And now I think it probably is better.

Dr. Chan: So let's jump back to the handlebar mustache. Why were you against that?

Alejandro: I looked hideous. I just I really wanted to grow curly mustache. I had dreams as a 19-year-old.

Dr. Chan: Okay. This is when you were young, in your youth.

Alejandro: Yeah.

Dr. Chan: Okay. All right.

Alejandro: And it's not, no. It's I'm glad. But it really was a big, clear signal because my mother supports me in almost everything I do and, you know, for her to shoot down that, that was a clear sign that that was something not . . .

Dr. Chan: Will they be there at White Coat? Will I get to meet your mom at White Coat?

Alejandro: Sadly, no. They're in Spain. But they'll probably come in later on, sometime in September.

Dr. Chan: Okay. I look forward to meeting them. All right. So how did it feel to know that you got into med school? When did you get the phone call?

Alejandro: Sometime in September.

Dr. Chan: September.

Alejandro: It was in the morning.

Dr. Chan: So we're talking almost an entire year.

Alejandro: Yes.

Dr. Chan: I mean, like was that hard? Was it annoying when people, you know . . . or was that just really minimal compared to just the feeling that you got in? You know what I'm saying? Because that's a long time to wait before you actually start.

Alejandro: So you would think that the energy dies down, but it just ramps up and I was looking for biomedical engineering jobs the day before you called me. Because I was like, "I'm going to work as biomedical engineer. I'll see." And as soon as you gave me the call, it's a great feeling to have your life on a track, right? With the level of uncertainty that comes with applying to medical schools, it's so wonderful to finally know that, you know, this is what you're going to do. Now you have this much time to do whatever you want. And I asked a lot of the med students that I had formed connections with and whatnot what they recommend doing, and they all said travel and just enjoy yourself. And so I worked part time at the VA because they offered me a job after I volunteered.

Dr. Chan: Well, sweet.

Alejandro: And I just traveled. I went to Spain. I went to Japan. I backpacked through Japan for two weeks.

Dr. Chan: Wow, do you speak Japanese?

Alejandro: No.

Dr. Chan: Okay.

Alejandro: Google translate is amazing. You know, I developed a lot of experience moving around so much to be able to communicate with my hands and extremely, you know, verbacious nods. But it was wonderful. I had a wonderful opportunity. I flew standby, so I got to save my money. But I did sleep in a couple airports a couple times.

Dr. Chan: That's tough.

Alejandro: It was.

Dr. Chan: Every 10 minutes you probably were reminded not to leave your baggage unattended, right?

Alejandro: Exactly.

Dr. Chan: Like that just come blaring across.

Alejandro: Yeah.

Dr. Chan: Yet people still leave their baggage unattended.

Alejandro: At that point you think they'd have just someone coming around and like chaining it to people.

Dr. Chan: Yeah, yeah. So is flying standby common for you?

Alejandro: No, it was a wonderful opportunity offered by . . .

Dr. Chan: Because I'm about to say like do all your family members works for the airline or something.

Alejandro: Correct. Yeah, exactly. And so I was able to just fly for cheap paying the tax and able to see as much as I can. And I stayed in crappy hostels and even just, you know, living off of 40 bucks, 30 bucks a day including room and board. But it was amazing. You know, you go around and you really just develop some interesting experiences. I highly recommend it to . . . You know, the early decision program I think is a wonderful opportunity for people to, if they get accepted, really help complete those last few things you always wanted to do before you start.

Dr. Chan: Yeah, it's good. So it sounds like almost like a mini bucket list. Travel, see your family in Spain.

Alejandro: Yeah. I love spending time with my grandma knowing that I'll probably not be able go back in quite some time because I'll be busy with studies.

Dr. Chan: No, you can still get breaks here and there. Yeah.

Alejandro: But, you know, I really enjoyed the opportunity to be there, and I learned how to make tortilla de patata which is like the special Spanish . . . It's not a tortilla. It has nothing to do with what people think here in America as tortillas.

Dr. Chan: Tostada?

Alejandro: Yeah. So it's always very difficult because Spain is one of those . . .

Dr. Chan: Oh, tapas.

Alejandro: Yeah, yeah.

Dr. Chan: I'm just throwing all the Spanish words.

Alejandro: Yeah, you doing so well.

Dr. Chan: Tapas, tortillas, tostada.

Alejandro: Muy bien. Spain is a difficult thing because not a lot of Spaniards leave the country. It's so rare that there's a television show in Spain called "Spanish people leaving the country" where they just go and interview people. And they always ask the questions like, "How are you enjoying your time out of Spain? Don't you miss it? Why don't you just come back?" And that's what they always ask. And so many times I found myself adjunct with Mexican a lot of times growing up.

Dr. Chan: Do you mean they're not the same?

Alejandro: I know, right? I mean at this point it might as well be because throughout my lifetime every time I'm invited to like a social event or something that I bring Spanish food and there's always those one or two people who are always like, I bring a tortilla de patata, or I bring a tapa or something like that. And they always say, "Where's the tacos?" It's always . . .

Dr. Chan: Oh God.

Alejandro: It's always a fun time. You know, I've developed a wonderful sense of humor. I can thank my last name to that. My last name is Blitch.

Dr. Chan: A very common Spanish last name.

Alejandro: Very common in Spanish last name. That's because my grandfather on my father's side is from South Carolina. There's a town nearby in Georgia, though, where they originated from called Blitchton. And that's where all the Blitches are from. Yeah.

Dr. Chan: That's awesome.

Alejandro: Yeah. It's one of those just odd balls in the family genealogy.

Dr. Chan: All right. So Alejandro, I'm not going to hold you to this but what kind of . . . you know, I'm just curious today what, before med school starts, which will be soon, what kind of doctor do you want to be and why?

Alejandro: A good one.

Dr. Chan: I know, but what field? What discipline?

Alejandro: So I have a heavy interest in orthopedics, because one of my mentors and friends, which was Dr. Moore, that I made at the Hope Clinic is an orthopedic surgeon and he just . . . I really enjoyed the mechanical aspect of it. I am a huge geek and gamer at heart. So I've always worked with my hands and have those reflexes. So they always say surgery is good for you. I've always understood the mechanics of it, bringing in my biomedical engineering background again. So I look forward to being an orthopedic surgeon and probably developing some sort of new prosthetic or whatnot, combining both of my skills and knowledge.

Dr. Chan: I mean, that sounds fantastic and that just lends itself to the bio innovates, Bench-to-Bedside that kind of program.

Alejandro: Yeah.

Dr. Chan: I know a lot of students that are interested in orthopedics they're doing a lot of research.

Alejandro: Correct, yeah. That's why . . .

Dr. Chan: With kids, adults.

Alejandro: Oh, so I love pediatrics. I volunteered at the emergency room down at the pediatric clinic and it's wonderful, but its lows are low. It always sucks to see a kid hurt, right? But it's always so great because, you know, children are adorable and it's so fun to just help interact with them and be able to help them because, you know, doctors are these magical creatures sometimes to these children.

Dr. Chan: Yeah. Very cool. All right, well, last question, Alejandro, what advice do you give to people out there who are thinking about applying to medical school or maybe in the middle of applying to medical school? What would you tell them? What would you say to them?

Alejandro: So try not to be cookie cutter. I mean, it's important that you complete all the required prerequisites and the volunteering and the patient exposure. But really just be yourself, right? Discover your own capacity in who you are and what you love. And really test your limits on your comfort zone, right? Don't be scared to push out and just approach someone who you know is in some clinic and say, "Hey, is it okay if I come shadow or if I come work for you guys or whatnot," you know, and develop those skills that you have, because ultimately, at the end of the day, when I feel like you guys are looking through thousands of applicants, right, the thing that will really stand out is just the person who is a person, right? Not just this robot who's completed the job. And then that would be my greatest recommendation.

Dr. Chan: Awesome. Well, Alejandro, thanks for coming on. And I'll have to have you come back after med school starts just to kind of get your perspective on . . . because there's an image of med school what it's going to be like and then you get in there and it's going to be different or same or it might . . . So I think it's a beautiful journey you're about to start.

Alejandro: So far I'm trepidatious. I'm a little scared.

Dr. Chan: You're going to do great.

Alejandro: I did want to ask you a question.

Dr. Chan: Sure. Oh, yeah. Throw the questions back at me.

Alejandro: So you working in psychiatry, correct?

Dr. Chan: Mm-hmm.

Alejandro: What is the greatest passion that led you into that field? Like why did you choose and specifically it's for child . . .

Dr. Chan: Yeah. Child psychiatry, child and adolescent psychiatry.

Alejandro: Yeah.

Dr. Chan: Great question. I wanted to be a pediatrician for the longest time. I loved working with kids. And so the first two years of med school was peds, peds, peds, peds. And then during my third year, that's where you go out and do different rotations in the hospitals and clinics. My rotation in pediatrics was just not what I thought it was going to be. It was not very positive. Was much more difficult. And it was kind of a wakeup call, because, you know, you think you're going to go down this path and, you know, kind of put all your attention and focus towards this path. And then when you do your audition, when you actually get to do that, you know, it's hot really for me. I did enjoy talking to a lot of the young kids and teenagers, and I enjoyed getting to know them and talking to them.

And a lot of pediatrics I learned was dealing with babies and I enjoy babies, but I just found it really stressful because they couldn't tell you what was wrong and they're so little and it's just, you know, it was really hard, but I did enjoy . . . I remember specifically a teenager who got admitted, newly diagnosed type 1 diabetes, you know, and just the educational process of teaching her what that meant and teaching the family and kind of processing what that means and just a huge shock that came over the family and I enjoyed that. I loved that. And so one of my mentors in med school said if I really like talking to young kids and teenagers, I should really do this rotation called child and adolescent psychiatry.

I didn't really know that was a field or discipline. I had no idea. So I did a rotation. I just loved it. Because that's all you do is talk to young kids and teenagers. So I made a switch. I went from pediatrics to child and adolescent psychiatry. And that's why I switched, you know, because it's just working with young kids. And to this day like, you know, people ask me all the time, "Oh, you know, do you still do clinical stuff?" Totally. Like I always think any administrator or educator should hold on to their clinical knowledge. And so I do rotations over at Uni. That's our psychiatric facility here.

So I'm an inpatient hospitalist, meaning I don't have an outpatient clinic. I just take care of kids and teenagers who get admitted to the hospital for a wide variety of reasons. And I take care of them for a short amount of time, and then when they're feeling better and doing better, they get discharged and everyone who gets discharged gets an outpatient plan. And so that's when we connect them to resources in the community. So I don't really have that longitudinal relationship with them because I just know them for these short, intense of bursts of time. Not kind of a longer . . . you know, I don't have monthly check-ins with them. I'm not an outpatient person.

Alejandro: Yeah. And I feel like what you have there, you bring a lot to it back here because you have a certain skill when speaking essentially to us kids, right?

Dr. Chan: Well, I was going to say that. You are the millennial generation, and there's a certain way that you guys approach things and so it could be helpful. But you know, yeah, I think it all goes back to communication and leadership and teamwork and those skills. So I think those skills easily exist in psychiatry or orthopedics. I think they exist in medicine in general, but also think that has to exist within a medical school and how you educate and how you teach and how you are leaders in complex organizations. And so, yeah, I agree with you. I think those skills are easily translatable across multiple dimensions. So a great question. What other questions you have for me?

Alejandro: Oh, well, okay. So one of the other ones that I wanted to know because some of the things that, I mean, personally I struggled with and from what other people have told me they struggled with was the emotional drain that working in health care can do, right? You don't have to be a doctor specifically. Like nurses have it and whatnot. I actually did a rotation just shadowing nurses because I was curious on that aspect. And how do you deal with that emotional drain? Because I'm certain you see some cases are just . . .

Dr. Chan: Yeah. So to me, to answer your question is finding wellness and personal balance. And it is intense. The journey is long. It's hard because in medicine you deal with death, dying, the inherent unfairness of life, how people are just unlucky. It's rough and it's not fair. I mean, life's not fair. I mean, the most dangerous thing that you and I do every day is getting behind the wheel of a car driving around, because like you drive 50, 60, 70 miles per hour and by the grace of God, you know, someone could just like run a stoplight and hit you.

And so yeah, I think it's good to take breaks. I think it's good to have a healthy family supporting you. I think it's good to have a sense of humor. I think it's good to have a life outside of medicine. But it's really hard. And I think as you progress in your medical training, there are certain fields and disciplines that definitely have, I would say, maybe kind of like a more of a heavy lifestyle or more intense lifestyle. Like neurosurgery is a great example. They have to be on call a fair amount, and those operations are very long. It's very hard, and God bless them, we need great neurosurgeons. That's not something I could have done because that's not who I am or, you know, or what I valued or, you know, and it doesn't allow me to have time to do stuff with family and loved ones and hobbies.

So, you know, I think everyone kind of has to find that balance. And then people are different. People have different ways of approaching things and dealing with the stress. I mean, so to me, like med school is not super different than undergrad. I mean, how did you find relief from the stress and the grind as you went through undergrad? Because, you know, I would say undergrad is also stressful.

Alejandro: Yeah, I find a lot of comfort working in groups, right? Some of my most satisfying memories in working undergrad were falling asleep in the engineering building with three or four other people just working all night on this code and waking up the following morning and it's just dusk and you finally walk out finished project and it's that sense of unity that you're not alone in this that really helps you deal with it.

I feel though a lot of times people have this image of doctors as these super humans, right? They're able to deal with all this. They come into a room and they know how to assess a situation when someone is injured or hurt. But from my experiences of shadowing and just sitting down and having, you know, not so much in the medical field, I actually learned most from the doctors I shadowed by inviting them to lunch and having a meal with them.

Dr. Chan: That's a good tip. Yeah, it's a good idea.

Alejandro: You really get to see this human side, because one of my favorite things I ever learned from a doctor was when he said, "I don't know," right? It's such an odd thing to hear your doctor say because everyone always comes in. It's like, well, "The doctor is going to know what's happening to me now." It's so often where they just don't know.

Dr. Chan: There's a hierarchical nature to medicine and lends itself to that. And it's hard to say I don't know.

Alejandro: I just feel like doctors have it tough because if someone goes to a doctor and they pay $300 to see a doctor and they don't get anything and doctor says, "Go home and sleep." "Ah, I wasted $300 to get to go home and sleep." But then if they go to the doctor and the doctor gives them an antibiotic, they're like, "Ah, the doctor is always just giving me pills."

Dr. Chan: Yeah. You can't win.

Alejandro: Yeah, you can't win, but you do. You win by never seeing that patient back. That's the way I see it. I was always happy when a patient say, "Thank you for helping me. See you soon." I say, "I hope I never see you again. I hope you are just healthy and happy for the rest of your life. But in the case that you're not, I'll be here." And that's one of the things I always enjoyed. And just being a simple, you know, Spanish translator hands in a health care field. I have one last question.

Dr. Chan: All right, last question. Hit me.

Alejandro: So the medical field has now transitioned. A lot of times when I speak to older doctors and to younger doctors, there's this change in which it's more focused on these aspects of teamwork, of patient and autonomy, and of communication, right? And I really appreciate that. Because one of the biggest complaints that we hear nowadays is that doctors don't spend enough time with their patients and they lack that connection. What is for you the biggest struggle or the biggest difficulty you find when working in the field, very deep and intrinsically in the shift, right? Like how do you see doctors struggling to make that connection with their patients or whatnot?

Dr. Chan: I mean, you're exactly right, Alejandro. Like I think, again, kind of going to talk from my perspective as an inpatient child psychiatrist. So one of the things that gets in the way is that people are busy. It's a very busy atmosphere and maybe, you know, more so in psychiatry than other fields, but there's a lot of profit in medicine. There is a lot money in medicine. There's a machine. And so one of the more negative things that I have to deal with or I get to work with is health insurance companies.

Alejandro: I heard.

Dr. Chan: And I understand that they have a role, we have a role, and everyone has a role. But it's really hard when I feel pressure from insurance companies to discharge someone early, or I feel pressure that the medication I may recommend is not on the approved list. Then maybe I get on the approved list, but I have to fill out 20 pages and fax, you know, fax and all that stuff. So I think the teamwork becomes essential, because I think you need to gather information as a team and clearly present it to outside stakeholders, which includes insurance companies, which may include work. You know, we were talking in FMLA, Family Medical Leave Act. There's like there's all these people that kind of count on the system to run efficiently and to run on time.

So I think you need to get everyone hands on deck to present a unified, you know, diagnosis, unified kind of working. You know, we may not know what's going on but, you know, this is what we're thinking. We need more time or we want to order this test or we want to start this medication. And I think it's essential to work as a team and this is why. If you look at what's going on across the country, more and more doctors are joining group practices, or they're joining hospitals, or they're becoming tenured, or salaried faculty because they don't have the bandwidth. They don't have the capacity to be solo practitioners because essentially you need to hire all these people to fill insurance forms and, you know, deal with the electronic health record and all this stuff.

And so there is definitely a movement our country away from being a solo doc to work in these practices where you are supported by nurses, physician assistants, like all these different types of providers just to help the patient to help doctor. Does that make sense?

Alejandro: It does. But that just kind of brings up the other idea of was it easier when America was shifting to a socialized medicine? Because from Spain we have socialized health care, right? Medicine is real cheap for me there and . . .

Dr. Chan: Yeah, I mean, I don't have a good answer because like I think our country is struggling with this. Like what should we do? Where should we go? You know, like I think every system has its strengths and weaknesses. I use the word "Balkanized," like coming out of the Balkan Wars. You know, like there's all these different factions within the American health care system. It is different insurance companies, hospital groups, physicians. Like all these different entities and they're all kind of competing and jostling, and there's winners and losers and that's how our society is set up. And so I don't know, you know, like the VA, you know, you volunteered in the VA. You worked for the VA.

It's a great example. It's like really different and there's some things that really work well with VA. There's other things that don't work so well. And I don't know. It's I don't have a good . . . like I'm a doctor so I'm not afraid to say I don't know. So I can tell you that it's changing. It will continue to change. The problems you face will be slightly different from the ones that I face. But I think our system is always evolving and that's kind of the beauty and the frustration of like the American health care system. Like a lot of innovation, a lot of disparity, a lot of winners and losers, and everyone kind of falls in between in a way. So I'm sorry, I'm trying to be practical as possible.

Alejandro: I know. I know it's difficult because it does get into a political issue and whatnot, but it's . . .

Dr. Chan: We'll save that for next time.

Alejandro: Yeah, we'll save that for another interview.

Dr. Chan: Cool. Well, Alejandro, this has been fantastic.

Alejandro: Yeah.

Dr. Chan: Oh, wow. We've been talking a long time. All right. Cool. Well, you know, I wish you the very best during orientation week, and we'll chat again. All right?

Alejandro: Yeah, I look forward to it. Thank you so much.

Announcer: Thanks for listening to "Talking Admissions and Med Student Life" with Dr. Benjamin Chan. The ultimate resource to help you on your journey to and through medical school. A production of The Scope Health Sciences Radio online at the scoperadio.com.

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