Nisha Ukrani

Diagnosis😜 ? If you know you know!!! #usmle #step1 #uworld

85 to 90 percent of women physicians are eldest daughters. That is not a coincidence. That is a pipeline. Eldest daughters are trained, before age five, to over-function. They take on a parent's worry. They organize the family. They clean up without being asked. They do not ask for help, because they were rewarded their whole childhood for not needing any. Then they walk into medicine. A career that demands hyper-responsibility, hypervigilance, perfectionism, and silent sacrifice does not have to ask these women to give those things. They were giving them before they could read. The system is not stumbling into a burnout problem. The system is recruiting from a pool of people whose entire childhood was a training program for it. This is what pediatrician and certified coach Jessie Mahoney has been finding when she asks the room. In every group, in every retreat. Maybe one or two women are not eldest daughters. The rest have been carrying something since before they could spell their own name. Most of those women blame themselves. "Why don't I have boundaries?" "Why do I over-function?" "Why can't I delegate?" Because at five years old, your family rewarded you for over-functioning. Because every teacher praised you for it. Because the medical training system selected for it. Because every job since has reinforced it. The pattern is older than your medical degree by twenty years. The other piece nobody names: by the time these women are in their fifties, they are carrying eldest-daughter responsibility for aging parents AND running a department as chief AND running a household. The role does not retire when the children do. It just compounds. Jessie's reframe is the part worth bookmarking. The "hero" framing is the trap. Eldest daughters were made the savior of the family before they could read. Then medicine made them the savior of the patient. Then the department made them the savior of the team. At every stage, they learned that if they did not do it, terrible things would happen and it would be their fault. Awareness is the first move. Non-judgment is the second. Excellence is not doing everything yourself. Excellence is letting other people do their jobs. You are allowed to gift some of it back. You can ask your siblings to carry the aging parent. You can let your medical assistant do the medical assistant's job. You can stop covering the gap that nobody actually asked you to cover. Most eldest daughters in medicine have never asked for help. When they finally do, they discover people are willing to help. The asking was the whole obstacle. Listen to the full conversation on The Podcast by KevinMD. Link in the replies. What is the one task you have been carrying for your family or your team that no one ever actually asked you to carry? #ThePodcastbyKevinMD

It's chaotic, to say the least.

You are a doctor and you wake up thinking you missed the exams because you overslept, but you are a 47 year old endocrinologist on vacation.

Believe it!

When someone asks how I am while i have a career in healthcare

We can calculate drug doses, anion gaps, and risk scores… but calculating age is asking a lot.

A DOCTOR ISN’T BORN, A DOCTOR IS MADE.

Know your tumor markers for easy points: AFP → HCC, yolk sac tumor, hepatoblastoma β-hCG → Choriocarcinoma, testicular germ cell, molar pregnancy CA-125 → Ovarian cancer CA 19-9 → Pancreatic cancer CA 15-3 → Breast cancer CEA → Colorectal cancer PSA → Prostate cancer S-100 → Melanoma, Schwannoma Chromogranin A → Neuroendocrine tumors 5-HIAA → Carcinoid syndrome (flushing, diarrhea, right-sided heart disease)

This guy literally dropped the best mindset shift you’ll ever hear

@PoodleMama2010 You might want to look into how the Match algorithm actually works it might give you some insight.

This is a blatant lie. They aren’t taking the spots left behind. They’re taking the most desired and competitive spots, and AMERICAN students are getting the leftovers…if they’re lucky. Not a single foreigner should be matched until every qualified American has a residency placement.

Instead of mocking IMGs, be proud they’re willing to serve here. U.S. grads often match at top programs while many IMGs take the spots left behind. It takes immense sacrifice to get here. Mocking poorer countries and their doctors is shameful. I am proud of each and every IMG.

@_thisisthegirl_ You’re free to choose whatever doctor you want. But the U.S. physician shortage and medical school costs are a system problem, not something you fix by insulting immigrants online. Most people trashing doctors wouldn’t survive the 10+ years of school and residency. you wouldnt!!

@NishaUkrani They take the spots b/c IM is low paying, and U.S. medical schools are expensive. This is a problem America can fix without importing 3rd worlders from Cow Dung University as cheap labor. We don't want to be treated by foreign docs, particularly this demographic. Hope that helps.

This is a fair observation that students from India/ Pakistan do not have debt that distorts their risk taking. They can do 1-2 years of research to get into a better residency program. What @MaryBowdenMD is not seeing is that USA gets top 5% - 10% of graduates of these markets. These IMG from Pakistan or India aren’t your average or above average graduates, these are your top decile academic performers, who are super committed to get into U.S. healthcare. They are competing against 50 percentile medical graduate in USA. So, mathematically and logically having IMG will improve the quality of pool of doctors in USA.

Hot take: Resident doctors should be valued, appreciated, and respected. Not only because it’s the ethical & human thing to do, but for the way they care deeply for patients, take on a huge amount of work, and actively advocate for patients in a deeply unfair healthcare system.

And that's because most of AMGs don't apply for these positions as they want to be in better residency programs. Beside that most of IMGs that got these positions are very good applicants with excellent scores and research background.

@slmimorgan Lol

@NishaUkrani Every person in support of this is a foreigner. You do not have a say in our country. You ALL want more of your own. We are not going to stand for it anymore. No one is being mocked here. You say that because you know it gives you power. You mock science with your fallacies!

@fubots1 You stay home too!!🤣

@NishaUkrani 3rd world countries need their doctors more than the 1st world. GO HOME, STAY HOME!

Real talk.