How to get the most out of shadowing a physician – advice from Dr. Harvey Katzen

Dr. Katzen is a oncologist and MedSchoolCoach advisor. He is also a professor at George Washington University Medical School where he sat on the admissions committee. We sat down with Dr. Katzen to ask him some questions about his work as an oncologist and also what premedical students should know about shadowing a physician. We wanted to understand how a premedical student can get the most out of shadowing a physician and learning about the various specialties. Here is an admissions committee members take on shadowing and applying to medical school!

Dr. Katzen, you tell us about a typical day at work in your speciality?

Sure, I’m a haematologist oncologist, and I happen to be the president managing partner of my practice for many years. So my day starts very early and I usually spend about an hour every morning before 7 o‘clock doing administrative functions. I usually will meet most days with my office manager at about 6:30 to either go over items that are on her list or items that are on my list. Anything ranging from personnel, to equipment purchases, reviewing the financials, you know I have a regular schedule of how often I do that and where the accounts receivable are, and so forth. I usually start seeing patients by seven most days and my days are pretty packed until five. I finish scheduling at 4:30 and I schedule my new patients for hour visits and I try to utilize that time to not only meet the patients but I invite their families to come. As an oncologist, I spend a lot of time educating patients who may be getting chemotherapy. In my follow up visits, I usually spend anywhere from 15 to 30 minutes, either determining continuation or alteration of the therapeutic regimen and it goes on through the day like that in a very regimented way. In my practice we sometimes do bone marrows, sometimes we do intravenous chemotherapy, intravenous iron, and what not so we oversee part of our practice in the infusion centre and part of my responsibilities throughout the day are to deal with any problems that may arise, either a patient having a reaction or a patient that is ill in the infusion centre. We sort of have a rotation of the physicians that have that as an additional responsibility on a daily basis. We have a rotating evening and rotating weekend call schedule and then we also have a rotating office and hospital rotation schedule, so if you have hospital rotations, your office day is shortened and by several hours usually for hospital rounds.

Alright, that is quite interesting. So then, if there was a pre-med student shadowing you, what would you say are the key aspects that they should keep in mind while observing a doctor?
I think there are several things that they should do whether it’s my specialty or another specialty. First of all, I think that they should look at how the patients are brought into the room, whether it is or is not by the physician himself. They should spend some time with either the medical assistant or the nurse and get some understanding on the preparation before the physician goes into the room. It could be something as simple as weighing and taking vital signs. Usually the patient is asked by whoever puts them in the room, if they have any new problems or specific problems they want to discuss today. Have they had any recent scans, surgery, hospitalizations or biopsies, so that if the information is not already there, ideally the information becomes available before the physician goes into the room. I think as an observant student I would also want them to see how the physician enters the room and how he or she conducts themselves in the room. Do they walk in the room and formally address the patient or formally introduce themselves? Do they question the patient, do they question them in a head to toe review system, or is it a system oriented and that varies obviously from specialty to specialty. When they ask questions do they listen, or do they cut the patient off? Do they allow them to talk? What is their method of questioning? What is their method of obtaining information, that is very important. Then I think of course when you examine the patient, it’s very important to think number one, observe how to do a proper physical exam, but I also think it’s important how you respect whether it’s a male to male or male to female, female to female or female to male examination. They have appropriate chaperone and do they make proper allowances to respect the patients’ modesty and so forth. I think that is not getting too specific diagnosis and procedural knowledge but I think those are significant basic courtesies and manners that one should conduct themselves in, as a physician. I once heard an introduction given for first year medical students by actually a surgeon general, who very much captured his audience attention by telling these young students (that were to be given a ceremonial event, a white coat), reminding them that they will ask questions that no one else will ask them, you will ask them questions that their family won’t ask them, you will touch them in areas that no one else won’t touch them and you need to be respectful when you do that. I think that is very good advice that you can give to young physicians or people aspiring to be a physician.

I think there are significant basic courtesies and manners that one should conduct themselves in as a physician. I once heard a general surgeon say to medical students- ‘you will ask (patients) questions that no one else will ask them, you will ask them questions that their family won’t ask them, you will touch them in areas that no one else will touch them and you need to be respectful when you do that.’

That anecdote definitely makes you think about how you’re supposed to be with a patient when you are training to be a doctor or when you do become a doctor. Can you also give us any one main piece of advice or what you think is extremely important for any pre-med to know?
Number one, I think it’s important to develop as soon possible good study habits and be devoted to the facts that if they are interested in being a physician there is a significant work load and they have to be willing to make that commitment. I also think it’s important that they realise the process of application is not an overnighter, a one semester process and by that I mean if they are going to do events such as shadowing or volunteering or something, I personally don’t think they should all be done in the last year of college. Instead, it should represent more of a long term and on-going commitment. You like to see somebody who has long term experience, over a number of semesters as compared to seeing somebody in the second half of their junior year just starting to do those types of events. That to me doesn’t exhibit the same conviction as somebody who has done that on a longer period. But obviously I think a commitment to their studies is exceedingly important as well as trying to excel as much as possible. I think that getting advice from people that are senior, trying to get the proper courses in and doing well but spacing them properly so that they are not overstressed with the multitude of courses at one time.

If you are going to do shadowing or volunteering or something, I personally don’t think they should all be done in the last year of college. Instead, it should represent more of a long term and on-going commitment

On that note, is there anything else you would like to share with us?
I think the main theme for me is to show a long term commitment. Very rarely do I feel that it is very effective for somebody who all of a sudden woke up and felt life this is a field they want to pursue. I personally got more confidence in the commitment that the the rigours of training and of practice. When I see that somebody has multiple experiences and number one, I think it exhibits the commitment but the other and I think just as important is, they’ve exposed themselves to different aspects. I don’t really think it’s appropriate when you hear a fourth year college student say I am going to be an orthopaedic surgeon, I think that shows a very narrow minded approach and that is not the type of student you want entering. You want someone who has an open mind to learn and may see something that piques his interest once he or she sees it in more depth. So to me I think that anyone entering medical school, should be entering it with an open mind and not with a preconceived notion as to what their final destination will be.