Author Archives: Jade M

Prospectives in Genetic Counseling: Transitioning into the role of genetic counseling student

The following is a publication from the Prospective Students Task Force, part of the NSGC Student/New Member Special Interest Group (SIG). If you’re not familiar with SIGs, keep reading!

You’ll also find:

  • Information on transitioning to graduate school
  • Reflections from a re-applicant
  • Resources and information on NSGC

Publication: Prospectives Newsletter_June2017

Grad Student

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How to Win Friends and Influence People … in the World of Genetic Counseling

Do you want to sound smart when you talk about genetics? Do you have graduate school interviews coming up and need to impress the director? Do you want to deep-dive into the world of genetic counseling to understand if this career is for you? (Is your cat making too much noise?)

If you nodded yes to one or more of the above questions, look no further. We’ve got you covered. Check out the below resources to stay on top of this crazy world of deoxyribonucleic acid.

genome

1. Genome Magazine

  • This magazine is cool…and FREE (but jump on the bandwagon before they start charging!). You can also read online.
  • It’s the opposite of reading dense medical journals – it’s interesting and broadly appeals to anyone who enjoys genetics. As an example, I save my copies and read them on airplanes, right along with my celebrity gossip magazines. That way, if anyone gives me the side-eye for catching up on the Kardashians, I just whip out my genetics magazine to uphold my integrity.
  • Use this magazine to think critically about relevant issues and widen your scope  on the community perspective regarding genetics

dna-exchange

2. The DNA Exchange Blog

  • This is where experienced GCs go to weigh-in on their field
  • I have yet to meet a genetic counselor who has not heard of this blog
  • Check out the side-panel to see additional relevant blogs (*cough* m+g is on there!)

reddit

3. Reddit – DNA Day Series | National Society of Genetic Counselors

  • NSGC hosted a few of these, so you may want to Google “NSGC Reddit” to find the rest (here’s another)
  • Peruse all those curiously fun questions about artificial intelligence, CRISPR, and ugh…MTHFR…
  • Questions are answered by genetic counselors and PhDs

BONUS: Follow @gcprobs on Instagram.  I don’t know who made this Instagram account, but whoever you are (all of you?), I’d like to congratulate you on being hilarious. Feel free to contact us to share your wit on maps and genes.

OPPORTUNITY: GeneDx’s Prospective GC Day | November 15, 2016

We are doing our best over here to keep you up to date on opportunities and experiences for prospective students looking to learn more about the field.  We even added a new tab to our site and aim to improve this over time.

For now, GeneDx is offering its fall Prospective GC Day with opportunities to join in remotely.

DETAILS:  http://www.genedx.com/whats-new/prospectivegcday2016/

Date: November 15, 2016
Time: 9am-2pm EST
Location: GeneDx 207 Perry Parkway Gaithersburg, MD 20877
RSVP: Meg Bradbury, MS, CGC, MSHS (mbradbury@genedx.com) by November 15, 2016

If you are not in the Maryland area please join us remotely by video conference! For further information please contact Mbradbury@genedx.com to RSVP and request a login to join us online.  Please pass on to anyone that might be interested.

 

 

Debunking Myths in Genetic Counseling

The following is a guest post by Anna Essendrup, M.S., CGC and Thuy-mi (Mimi) Nguyen, M.S.. 

 

mythbusters

 

Dear Readers,

Our names are Anna and Mimi, both graduates of the same GC program in Colorado.  We now work together as lab genetic counselors at Mayo Clinic. We are really excited about this blog and are enthusiastic about sharing our experiences with non-traditional roles of genetic counseling.  We are here to bust a few common myths about non-traditional roles.

 “Do not begin your genetic counseling career in a laboratory unless you want to stay in laboratory forever”/”Once you transition to lab, you cannot transition back to clinic”

One of the BIGGEST myths regarding laboratory genetic counseling is that it is a “dead-end” in the genetic counseling field.  You might think that once you have left the patient care arena and stepped into a laboratory role, you will lose your patient care skills and wouldn’t be considered for a role in that area today.  This could not be further from the truth.  Both laboratory and clinical genetic counselors use the same skills and knowledge base to interpret results, communicate genetic information, and develop a professional relationship with the client/patient.

For example, laboratory counselors may call results out to an ordering physician while clinical counselors call out results to the patient.  Both calls require establishing rapport between counselor and client.  Once that rapport is established, results need to be communicated at a level that is appropriate for the individual at the other end of the call.  Genetic counselors have a keen ability to monitor the level of understanding that the client/patient may have and adjust the level of detail/explanation accordingly to ensure that each person fully understands the results presented to him or her.  Genetic counselors also have training in non-directive counseling, allowing the clients to make their own decisions based on what is right for them or their patient.

Genetic counselors use a variety of skills throughout their practice, regardless of the setting.  All settings for genetic counseling are critical for the quality care of patients awaiting a potential genetic diagnosis. We are able to educate and empower all healthcare team members to ensure that their patients received the best quality of care possible.

“Genetic counseling is all about stem cell therapy and genetic manipulation”

Genetics is a quickly growing field with many new developments that are highlighted in the media.  Some developments can be overstated and dramatized by news outlets or other sources to make them more attractive to the general population.  Buzzwords like “stem cell therapy” and “genetic manipulation” can take a dramatic spotlight; however, the majority of stem cell therapy and genetic manipulation has not progressed past the research phase. In actuality, and unfortunately, there are only a handful of clinically-available treatments which may be indicated based on results of genetic testing.  Fortunately, many genetic counselors may have the opportunity to work in research.  Research involves many aspects of genetics and counseling and can includes areas of gene-specific activity and expression, database compilation and review, best practices in selecting genetic testing, communicating genetic information, and supporting patients with and without a diagnosis.

The genetic counseling skill set is highly applicable to research.  It is now evident that informed patient consent is not only ideal but critical to the research process.  Genetic counselors are trained to have a wide understanding of scientific methods and concepts and, most importantly, are highly trained in translating complicated medical information at a level which can be understood by a variety of audiences.  Because of this training, genetic counselors become an important point person for communication between all involved research team members and research participants.  Genetic counselors are also able to bridge the gap between research and bedside to inform patients of research study options and increase access to these opportunities.

“A Geneticist is the same as a Genetic Counselor”

While geneticists and genetic counselors have a similar knowledge base and often work very closely with each other, our disciplines are unique and require different skill sets to become a master in the field.

Both MD and PhD geneticists train through at least 4 years of medical school and at least 2 years of residency.  This includes extensive training in overall medicine, including diagnostics, physical examination of patients, and dysmorphology (the study of different body structures/features/birth defects). Genetic counselors require a 2 year master’s degree.  This includes some diagnostics as well as counseling and education skills.  Both specialists must pass board exams put forth by their respective professional organizations: Genetic Counselors take the American Board of Genetic Counseling exam, while the Geneticists take the American College of Medical Genetics exam.

Within the clinic and laboratory, geneticists and genetic counselors often work as a team, but with specific roles assigned to each.  These roles may vary greatly based on setting but generally, geneticists are the individuals who are responsible for the interpretation of genetic testing and assigning diagnostics based on physical exam, clinical history or laboratory results.  Genetic counselors are typically in the role of providing education regarding genetic concepts, including test results, and counseling the patient through decision making and adapting to a diagnosis (or non-diagnosis).

“Genetic counselors sit in isolation and do Punnett squares all day”

We like to think of genetic counseling as more of a skill set that can be applied to many medical and scientific situations, as opposed to a specific activity or role. That being said, genetic counseling involves a wide variety of disciplines and interaction with individuals in many different fields. On a day to day basis, genetic counselors also work as part of a diagnostic team which may include physicians, nurse practitioners, nurses, medical assistants and administrative staff. Genetic counselors are involved in education, research, counseling and many other settings. In the lab specifically, genetic counselors are not only involved in education, but also in a wide variety of additional tasks, such as coordinating receipt/sending of specimens, troubleshooting issues with testing, ensuring the correct test is performed for the patient, helping develop new tests/technologies and many more. Punnett squares are used as an education tool or as a part of risk assessment. They are ONE among MANY tools that genetic counselors use to complete their daily tasks, but certainly not all that we do. Punnett squares are simply one way to teach genetic concepts.

Continue reading

So You’re Interested in Becoming a Genetic Counselor?

opportunity

We hear from many of you asking how you can become a better applicant.  After hearing this question many times over, I started noticing some concrete opportunities out there.

In the last post, I sent a quick announcement on the GeneDx Prospective Visitors Day.  This date has now passed, but consider checking the GeneDx website for an opportunity in 2017.

NOTE (6/8/2016): The following list was composed in 2016 and has been edited per reader comments and information from colleagues. It is probably not a complete list – and some of the dates are probably past – but we’re happy to continue adding. I imagine we will create a new list for 2017. In the meantime, if you have an opportunity you would like added here, please comment below!

  • Sarah Lawrence College also hosts a Genetic Counseling Career Day.  According to their website, this day will be held in June 2016, though agenda and registration are still in development.  You’ll want to check here: https://www.sarahlawrence.edu/human-genetics/career-day.html
  • The University of South Carolina (alma mater shout out) also offers an online course with both Spring and Fall enrollment.  The course is called Genetic Counseling: Career for the Future.   The course is offered online over a twelve week period with 2-3 hours of self-paced activity.  Read more details here: http://geneticcounseling.med.sc.edu/onlinecourse.asp
  • Wayne State is offering an open house on two dates in 2016 (one in June and one in August).  The open house gives potential students the chance to learn more about the GC field and the Wayne State program.  The flyer is here: http://www.genetics.wayne.edu/sites/default/files/docs/Open%20House%20Flyer%202016.pdf
  • Indiana University opens applications May 2, 2016 for their graduate program open house: http://www.ingc.info/site/indiana-university-genetic-counseling-graduate-program-open-house/
  • The University of Cincinnati/Cincinnati Children’s Hospital Genetic Counseling Program has a DNA sample day every year as well as an Open House. The DNA Sample Day is an overview of genetic counseling as a whole. The Open House features the UC/CCHMC program itself. The next DNA Day is on August 12, 2016 (http://www.geneticcounseling4u.org/prospective_students/DNA%20Day%202016.pdf). The Open House is usually in the fall, around Thanksgiving.
  • The Genetic Task Force of Illinois and the Northwestern University Graduate Program in Genetic Counseling is hosting a genetic counseling workshop. This will occur August 12, 2016 at the Robert H. Lurie Medical Research Center. Additional details and registration information is available here: http://www.illinoisgenetics.org/event-2251863
  • The University of Wisconsin-Madison is offering a Master’s Program Open House on 8/23/2016: http://www.med.wisc.edu/event/master-of-genetic-counselor-studies-program-open-house/48946

 

Laboratory Genetic Counselor Q+A ((By Jade M.))

mad-science

A day in the lab.

I wanted to write a post about life as a lab counselor, but I wasn’t making much progress.  Luckily, Sarah posed some questions to help get the wheels spinning!

A little background: I work remotely as a report writer for cardiology testing and have been in this position for about 8 months.
Would you make the transition again?

Yes! However, I was always drawn to a laboratory position.
During graduate school, we had a laboratory counselor speak to us about her job – I loved the idea of flexibility in your work schedule along with the option to work remotely. Apart from these perks, I was always academically fascinated by the molecular aspect of genetic counseling and how the gene/protein level corresponded to the outward phenotype.  Combine this with a love for writing and research – and lab counseling was a perfect fit for me.
Is it more stressful or less stressful?

Much less stressful. However, I came from a busy clinic where we were short a genetic counselor for 50% of my employment. Furthermore, I had to navigate the stickiness of insurance authorization for commercial and medicaid providers – I do not miss that.

Do you spend more hours working or fewer?

Fewer.  But I was working a lot at my previous job.  Like, a lot. The whole crew was, so it’s not like I over-carried the burden.  But if I didn’t start working fewer hours, I would have all gray hair by now.

If you were to give advice to a senior GC student, would you recommend first taking a clinical position or do you wish you would have gone straight into working for a lab?
I would absolutely recommend working in a clinic first.  My thought is that if you want to be a great lab counselor, you need to put your brain through GC training camp.  You need to work out your clinical muscles and tone up your patient-centered thinking.  You need to do some heavy lifting in clinical note-writing and strengthen your core in clinical diagnoses.  You need to bench-press empathy and take a long, slow run through family histories.  Are you nervous that this explanation is becoming way too cross-fitty?
In other words: when you work in a laboratory, you tend to switch your brain to the molecular side of things.  But I am far better at variant interpretation when I call upon my clinical skills – for instance (1) how to read physician notes (2) how syndromes/conditions are identified clinically (3) how a variant call will affect a person/family (4) bearing in mind the “fight” the GC undertook for insurance authorization or the burden the family incurs for paying more than they can afford (5) recognizing the impact of turnaround times (6) feeling confident that I can speak to GCs/doctors who call with question from the clinic, because, hey, I’ve been there.

Best perk of the job?

No more “Sunday night blues.”  My Sundays are full, happy, beautiful days.  As opposed to the previous 3pm anxiety onset when you realize you have to do yet another workweek.
Also, I don’t have to run into people on the elevator who say stupid things like “Happy Humpday.”
Least favorite job duty?

I love reading scientific articles and digging deep into literature.  But sometimes, ugh.
Did anything surprise you about your new lab position?

I am surprised how transparent we are.  For instance, I assumed laboratories hid their classification calls and supporting evidence.  It’s quite the opposite – we upload all of our calls to ClinVar and make an effort to root out any inconsistencies with other labs.  This is excellent for patient care.

M&G FAQ ((Jade M.))

Vintage image of boy raising hand in classroom

So anyway…we checked our m&g email account recently *insert embarrassment emoji*…

Yowzers, apparently we have not responded to email messages in over a year.  And some of you posed some really good, important questions.  We sincerely apologize for our oversight.  Your questions did not deserve the cyber snub treatment.

After reviewing about 50 emails, some common themes emerged.  This is great because it means we can draw some statistically significant FAQs (thesis much?) that can be addressed on this larger platform.  

So thank you for your questions!  Without further ado:

How did you choose which programs to apply to?

To answer this, you have to (1) consider and (2) pick your priorities.  Go ahead: seriously brainstorm all the factors that appertain to graduate shool-ing.  Here are some ideas to get you started: location, number of students accepted, where the rotations occur, cost of program, when you start clinical rotations, whether classes intermix with medical students, option to pursue a concurrent public health degree, whether there are housing options for rotations, public/private university, etc., etc., etc.  

After you brainstorm, step 2 is to prioritize which ones are most meaningful to you. Of course, there is no right answer, and this necessitates some soul-searching on your part.  

A couple pointers….

Before you begin, I would recommend spending time perusing all the program websites and getting a feel for each.  

Here they are (US and Canada): http://gceducation.org/pages/accredited-programs.aspx

International: http://tagc.med.sc.edu/education.asp

Do not be afraid to write down notes.  Or type up notes.  Or create crazy excel sheets like a super weirdo (you’ll eventually find out that you’re not that weird and everyone does it).

Another trick is to just start applying.  The application process is distinct for each school and therefore grueling.  You will probably subconsciously start with your favorites.  After the process wears you down, and you’re wondering whether you should apply to that last school, any motivation mustered will reflect your true interest in the program.

What happens if I do not get in the first time?

If you do not get in the first time, eat an entire carton of fro-yo, cry/journal/jog, then pick yourself up, and apply again.  Because I promise you that this scenario is not that uncommon.  I don’t have any numbers, but anecdotally, it is just not that uncommon to to not get in the first time.  Ouch, double-negative.  Plain English:  Many people do not get into a program on the first round.

The important thing here is to ensure that the “not getting in” does not drastically harm your sense of self-worth.  You are a smart, good person and this does not mean you shouldn’t be a genetic counselor!  Maybe you had an “off” day of interviewing.  Maybe you had an awful semester and did poorly in a class.  Maybe you need some more experience.  This is all OK.  Roll with the punches.  Take a year off.  You’ll be fine.

More practical advice: Sometimes lack of acceptance is a matter of gaining more solid volunteer/shadow/work experience.  Check out our resources page, but some good ideas include shadowing a GC (find one here: http://nsgc.org/p/cm/ld/fid=164), working for a crisis center, volunteering for a center for individuals with disabilities, working for a laboratory (if qualified), finding a position as a genetic counselor assistant, taking a relevant research positions, and so on.

Chin up and continue to chase your dream.  I promise that a one-year delay is irrelevant in the grand scheme.

I’m confused about the job description of a Genetic Counselor vs. Geneticist…

Ah. yes. OK.

Genetic Counselor and Geneticist are distinct professions.  Different but definitely collaborative.  Let’s begin with training.  GCs hold 2-year masters degrees.  Geneticists are MDs and therefore attend 4 years of medical school, followed by residency and then a fellowship in genetics (often more than one fellowship).  If we use pediatrics as an example, both specialties often work directly with patients to make a diagnosis.  While not always true, GCs tend to do more of the counseling and psychosocial component of the diagnostic process.  MDs are qualified to perform physical exams, treat, and order tests (GCs that are licensed can also order tests).  Sometimes GCs work very closely with Geneticists (like in pediatrics), other times they work separately.  Each can hold non-traditional (non-clinical) roles if that is what is desired.  

As I type this out, I realize it is difficult to paint a really good picture of our different and overlapping roles due to contingency on specialty/facility/location.  So I would recommend two things: (1) Go ‘head and Google your heart out for more specifics (you know, like internet homework) and (2) Spend time shadowing both geneticists and genetic counselors (you know, like real life homework).  That will give you the best sense for each!

How easy is it to spread out your time over different fields of genetic counseling? AKA – are you pigeon-holed or what?

This is a wonderful question.  Because I’m proud to say that No, you’re certainly not pigeon-holed.  It is very possible to make a career out of multiple subspecialties.  Not everyone does this, but there are many GCs who fill their career with focuses in prenatal, pediatrics, cancer, cardiology, laboratory, public health, newborn screening, inborn errors of metabolism, sales/marketing, research, etc. etc. etc.  Many people will hold a job that combines two or three specialties at once.  Others prefer to spend an entire career in one niche area.  

Once you achieve board certification, you’re technically qualified to do it all.  Naturally, work experience plays into this. If you work 30 years as a prenatal counselor and want to make the switch to cancer, you can.  However, you’ll likely have to do major catch-up learning and potentially compete against applicants who have more experience in the cancer realm.  Alternatively, if you work 30 years as a prenatal counselor and then want to take a position for a laboratory that performs research on prenatal testing technology…well, congratulations, you’re hired!

I’m in middle school/high school.  I totally have my act together and know without a doubt that I want to be a genetic counselor.  What’s next?

Ummmmm.  Why you gotta make the rest of us look like our 16-year-old selves were just infants in disarray? But, hey, you go Glen Coco.

Honestly though, it is stellar that you have an ideal career path before you even enter college, and you’re certainly a step ahead of the game. I encourage you to both (1) chase this goal and (2) give yourself some wiggle room if you find that perhaps a different career suits you better – you’re so far ahead that it’s even OK if you change your mind. I grant you that magical permission.

At this point, one thing you may want to consider is your major in college/university.  Here’s the fun part:  You can major in anything under the sun, as long as you fulfill prerequisites for graduate school.  

Prerequisite classes = The bare minimum classes that you must take before eligible to apply for GC graduate school.

Each program may have just ever-so-slightly different prerequisites, but for the most part, they are aligned.  You will have to visit each program’s website to know for certain what you need and whether you’re eligible.  But, basically, if you enroll in the following classes, that will get you where you need to go:

  • One year of general biology
  • One year of general chemistry
  • One semester of biochemistry
  • One semester of genetics
  • One semester of statistics

Additional courses may include: Developmental Biology, Counseling Psychology, Developmental Psychology … but don’t beat yourself up if your school does not offer these.

Now, it is certainly easier to fulfill these courses if you are a science major.  I have met many GCs who majored in Biology or Genetics or Psychology….or perhaps double-majored.  Alternatively, you could do a Public Health, Anthropology, or Kinesiology major, or any subspecialities of Psychology that your school offers.  These are just ideas.  All are good.  You can major in Underwater Basket Weaving as long as you fill your prerequisites….and uh, are able to defend your choice of major when asked during interviews.

Here are links to graduate programs: http://gceducation.org/Pages/Accredited-Programs.aspx

I think I sound like a broken record with this suggestion, but you’ll also want to shadow a genetic counselor(s).  Some potential students get anxious about the AMOUNT/TYPE of shadowing that is advisable! This is not one-size-fits-all.  If you live in a city that has no opportunities to shadow a genetic counselor, well, hey, it is a little more difficult for you and also out of your hands.  You may have to think outside the box a little: try contacting genetic counselors and asking to interview them by phone.  In general, strive to obtain at least a few weeks of shadowing, spread across different facilities and subspecialties.  Find opportunities to shadow for a few days over school breaks.

Other resources that you may find helpful:

NSGC for prospective students:

http://nsgc.org/p/cm/ld/fid=43

Day in the Life:

http://allhealthcare.monster.com/training/articles/236-career-profile-genetic-counselor

Robin Bennett MS Interview:

https://www.nwabr.org/sites/default/files/pagefiles/IntroGeneticCounselor.pdf

Vignettes from US News & World Report:

http://money.usnews.com/money/careers/articles/2007/12/19/genetic-counselor-a-day-in-the-life

My grades right now are not so hot (mostly Bs), will that hinder my acceptance into a program?

Probably not!  It is apparent that so many of you are your own worst frenemies.  You’re stressing me out, so I can only imagine how stressed you all must feel!

Remember, you are a whole human, composed of more than just your grades.  You are not a report card.  You are a person with experiences, extracurricular activities, time spent volunteering or coaching or mentoring; you are a person with a compassionate personality and a passion for the field; you are a person that has something to offer that someone else may not; and you also have some grades sprinkled on top.  You are a bolstered applicant.  Again, you are more than just your grades.

What’s that – You want a more concrete answer?  This is what I think:  A grades are super fantastic! A/Bs are really great too!  If you get a C, can you justify why that is the case?  Did you take 20 credits that semester?  Did you have something going on in your personal life that dampened you academically? If the grade is really nagging you, do you have the option to retake the course?

It is worth mentioning: One of the most compelling questions I was asked during a graduate school interview was “How do you practice self-care when you’re stressed/anxious/worn down?”

Let me ask you: How do you practice self-care?

Think hard about this.  Journal your answer, or write a little memo on your phone.  Return to your answer when you’re in need.  Ensure you’re taking care of yourself.  If you’re stressed now, can you handle the continued and concentrated burden of graduate school? I am positive that you can, but you need a plan, man!

Have a plan for self-preservation so that you can enjoy the journey.

I am a last-semester senior OR I have already graduated…and I just decided I want to be a genetic counselor!  Help! Am I too unconventional to apply to GC programs? Does it look bad if I go back now and take prerequisite courses?

I love this question!  Congratulations on deciding you want to be a genetic counselor!  

NO, you are not unconventional.  In fact, you may even be the norm.  And No, you will not look bad – you will look like a person that puts in the extra work/time/money to enter a career you care about.

This “non-traditional” path includes myself.  I graduated from college  and then spent a year taking chemistry, biochemistry, and genetics at a local college.  I totally moved back in with my parents and worked part-time at Target as a coupon-passer-outter while having awkward run-ins with former high school classmates (ahh, the glamor of working towards a goal, am I right?).  I felt lonely and behind the eight ball as I watched friends enter professional careers or graduate programs.  But here I am, years later, working as a GC and smiling fondly to myself when I shop in Target.

As I said above, I sincerely promise that a one or two year delay in “getting where you want to go” is completely irrelevant in the grand scheme of things.

Use the resources above and on our resource page to make yourself the most bomb.com applicant you can be, and go get ‘em!  BOOM SHAKALAKA

2 Years Out ((By Jade C.))

Jade C. here.  Checking-in after checking-out after graduation.  Olivia and I began this blog with the intention of being student-focused.  This became problematic after we were no longer students – Have we become the Van Wilders of a graduate student blog? For shame.

Jade and Olivia

Luckily, there is value-added in providing perspective After Graduation.

So what happened After Graduation? – I have been employed by a pediatric specialty clinic in Florida for the past 2 years.  Here are some thoughts…

Boards. – I opted to take boards 1 year after graduation.  Naturally, there are pros and cons to this.  The pros include indulging in a study-mental-vacation after (seemingly) a lifetime in school.  Further, you have time to hone and ingrain some textbook skills in the real world.  But, with regard to cons, the struggle is real.  Learning proficiency at a new job and studying after work is not fun.  It’s awful.  It’s downright awful.  I thought.  Plus, you really drag out the pain of getting to the end of the road (if the end of the road has a sign that reads MS CGC).  Thus, my advice – bite the bullet and take boards sooner rather than later, while the student mentality is still hot.

Difficulties. – I encountered a number of unanticipated difficulties right out of the gates.  For one, I wanted to physically fight the Electronic Medical Record (EMR) every. single. day.  We were enemies.  Why wouldn’t it route my messages?  Where did my documentation go?  Why do I have so many open telephone encounters? At this point, I am more collaborative with the EMR, though I use it as my grandparents use the internet (very cautiously and at surface-level).  And, a second difficulty – insurance authorization.  Specifically, insurance authorization in the state of Florida without a state laboratory.  It’s been a tough path to hoe – telling patients that a test exists, and we would recommend it, but there is no way to pay for it. So……

Excellencies. – Well, let’s be honest – earning a paycheck and weekends off is nice.  But, on a higher level,  it has been rewarding to see myself grow.  I can mentally compare earlier counseling skills with later counseling skills, and understand the growth.  I also start to recognize patterns in medicine: differential diagnoses, recommended tests, and the right questions to ask have become more apparent.  Ordering the right tests has become easier (bar insurance authorizations).  And, providing care over time has been powerfully rewarding (the babies are now walking and talking!).

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