Fifteen Minutes of Anonymous Fame

Derm Resident Finds Lessons Beneath the Surface, by Nicholas Genes, MD, PhD

In the competitive world of dermatology, one resident has decided to take frequent pauses to reflect on the meaning of her experiences. She shares her thoughts anonymously on her blog, Wandering Visitor. I corresponded with her recently about her writing and her preconceptions about her work.

Dr. Genes: You come across as a very thoughtful, introspective writer. I recall entries in which you lamented the dehumanization of medical training, and others in which you talked about how your peers disappointed you with some of their behaviors. So I was kind of surprised to learn that you're a high-powered derm resident (judging by your approach to the inservice exam)!

Wandering Visitor: Contradictory, huh? Well, I take work very seriously. My job is to learn how to be the best physician I can be for my patients. In real life, I'm an eternal optimist and an artsy-fartsy type with my "head in the clouds." I don't take myself too seriously and am very laid-back. It's medicine and it's the responsibilities therein that have really grounded me. In some ways it's good; I've learned to be more serious, more responsible. In other ways, it's not so good; I've become more anal (although much less so than many coworkers), more blunt, and I care much more what people think of me (which is no good, and I'm trying to get back to "normal").

In terms of becoming the best physician, part of that is not losing the humanity (that we all have) in the process. It's about learning what really is important, which I've been struggling with this year -- that what my attending thinks of me is not that important (besides that they think that I'm competent), and that I'd rather spend some more time with the patient rather than shuttling them through like a piece of meat.

At times it seems like I don't really belong in medicine. But what drew me to derm was, among other things, how happy people were, and I'm still trying to find a balance of what I want out of a career in medicine.

Dr. Genes: Some months you write a lot about medicine, about patient encounters, healthcare, and the process of residency. Other months, it's more about nature, or travel, or food. Is this because of your schedule? Is writing more of an escape for you, or more like analysis?

Wandering Visitor: 'Tis the cyclic nature of life. I write whenever the mood strikes. There are just times when there are thoughts that need to be worked through, or lessons that need to be put down somewhere. A lot of my posts are reminders to myself so that I don't turn into something I never wanted to be.

Sometimes I want to write more about work but don't. Derm is too small of a field, and anonymity is important. (I think there are something like 400 residents a year in the country. The average derm program has 1-2 residents a year, and a "huge" derm program has maybe 7 residents per year.)

Dr. Genes: You started your blog for many reasons, but you seemed a little unsure of the medium and the message you wanted to convey. After a year and a half, do you have a better idea of what blogging does for you and for your readers? I have a sense that you're trying to capture and communicate good behavior and good intentions. Would you be happy if your blog made readers more thoughtful, more conscientious?

Wandering Visitor: I started the blog because one of my friends has an amazing blog. In reading theirs, it was not only hilarious, but just a great way of keeping in touch, even though we were thousands of miles away. It's definitely evolved since then. I'm not blogging to keep people updated, and it's not a "diary" of my life (how boring!).

The blog is something that I hope people find interesting, but also something that, 10 years down the road, I want to be able to look at and use to remember that inspirational patient or great life lesson that came up along the way.

For me, life is about learning what is important and throwing away what is not. It's about cherishing the moments one spends with another individual, and in being able to offer the other person what they seek -- companionship, understanding, a listener. The posts are random thoughts in the process of life, and I would be very happy if they offer a reader what they meant to me.

Dr. Genes: What blog entries have you enjoyed the most?

Wandering Visitor: My favorite posts are the ones where I feel like I learned something important, or where something that I fundamentally believe in was reinforced or taught to me in another way. I also like the ones that push the boundaries of what we know and do not know (near-death experiences, meditation, neuroplasticity), because people often create a comfortable box of knowledge, don't realize that they have become stuck in there, and fail to appreciate the mystery of our world.

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