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Dr. Chan: What's it like growing up in healthcare? How does experience in customer service, such as Burger King, help you be a better doctor? How do you choose between two great acceptance offers? And how do you decide what field of medicine to pursue? Today on "Talking Admissions and Med Student Life," I interview Jordan, a third-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 Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Okay. I have a great guest today. Jordan, how are you?

Jordan: I'm good. How are you?

Dr. Chan: Doing great, Jordan. Okay, so third-year med school, correct?

Jordan: Correct.

Dr. Chan: Okay, so let's jump back because I want to hear an update.

Jordan: Okay.

Dr. Chan: But going back to the very beginning, why did you want to become a doctor?

Jordan: Wow. Okay, that's a loaded question.

Dr. Chan: It is loaded.

Jordan: Let me see if I . . . do you want me to use the answer that I used when I was interviewing or . . .

Dr. Chan: Sure. You can give the official answer or the unofficial answer.

Jordan: Well, I guess the unofficial and the official are kind of the same. So I was fortunate enough to have a close family member, my mom, be a physician. And so I got to grow up exposed to healthcare at a very early age. It was something that I was always interested in and excited by. And I had basically this really great role model of someone who was really passionate about their career and was able to make a lot of positive change for people. And that's kind of how I was first introduced to it.

Dr. Chan: And when you were born, I think you mentioned to me once, your mom was in her residency, right? Or something like that. I just remember you told me the story that she would take you on rounds or something.

Jordan: She actually had me in her third year of medical school. And I do remember spending a lot of time . . . like during didactics and stuff, when she was in residency, I would occasionally get bundled up and I would color and stuff under her chair, and during CME trips and stuff too, that's when I would . . .

Dr. Chan: You were carefully listening.

Jordan: Yeah, I was gleaning information.

Dr. Chan: With your crayons, you were just, you know, mapping . . .

Jordan: Yeah, exactly.

Dr. Chan: . . . the Krebs cycle.

Jordan: Yeah. I've always known the Krebs cycle, really. It was just the doctor . . .

Dr. Chan: Since you were 2 years old.

Jordan: Yes. And so that's kind of what first got me interested in it. And then as I got further along in school and I just realized that . . . it seemed like a really good fit for me in terms of the interplay between working with people, working with current research, and kind of this ever-evolving field.

And then as I've been in medical school, it seems like an even more . . . I feel like it's been kind of an affirmation of it being a good fit for me, because I am kind of impressed by the variety within medicine in terms of things that I'm interested in that I hope will be part of a future career for me, things like being involved in education and even administration, things like that, that I think are often overlooked when you first think of wanting to be a physician.

Dr. Chan: Before we talk about med school, I'm going to make you back up.

Jordan: Okay. Even farther than that?

Dr. Chan: Through a series of events, you find yourself at Idaho State University.

Jordan: Yes.

Dr. Chan: Living in Pocatello.

Jordan: Yes.

Dr. Chan: And so, during that time, going strong, what kind of activities were you doing to either get prepared for medical school, to get into med school, beefing up your CV? What were you doing in your Idaho State days?

Jordan: So I started undergrad wanting to go to medical school, so that was always on the forefront of my mind. Things that I was doing . . . I was told by a . . . well, I don't think she's there any longer, but she did give me one great piece of advice, which was, "If you want to go to medical school, the University of Utah has a great website and they break down exactly what they're looking for, what they're looking for in applicants, and if you can just kind of meet their criteria, you'll likely meet criteria for programs everywhere. So if you want to know what to do, just shoot for those things."

Dr. Chan: Look online.

Jordan: Yeah, look online. And so, at the time, there were requirements for leadership and volunteer work and patient exposure. There were, like, seven categories. There were some other things, but I kind of wanted to get a foot in the door or just get started early, I guess I should say. So I started volunteering at a local church on the weekends. I started working . . .

Dr. Chan: You were a youth minister, correct?

Jordan: Not a youth minister. I was like the . . .

Dr. Chan: An elderly minister? How would you qualify it?

Jordan: Well, I was pretty youthful. There were a lot of elderly people there. I was more of the technology operations specialist person. So I got to run all of the lights and music and PowerPoint slides to time with the presentations. The kind of person that you really don't notice at all unless they mess up. Very high stakes.

Dr. Chan: Did you ever mess up?

Jordan: Of course, yeah. But luckily, I was at a church, and so . . .

Dr. Chan: Did it kind of take away the gospel message and . . .

Jordan: I did, yeah. It was distracting from the delivery of the gospel. I was working at a church, so they don't really . . . they're not going to bully you. If you mess up, they're just going to . . .

Dr. Chan: When you say work, it was volunteer, right?

Jordan: Yes, volunteer. I was certainly not paid. I was volunteering at a church on weekends.

Oh, research was one. So I started trying to get involved in research really early on, found it to be relatively challenging. I did eventually find my way into a couple different research labs my junior and senior year of college, and I tried to do as much research as I could. So I ended up doing research in a . . . I found once I had gotten into a lab, for whatever reason, then the opportunities kind of kept coming. So it was hard to initially get started, but once I . . . and this just may be an ISU thing, but once you got in, then things were pretty open to you.

Dr. Chan: Were you doing pipetting or . . .

Jordan: Yeah. So I did a couple different kinds of things. I did some classic bench work. The longest project I worked with was some classic pipetting bench work research project that most people probably hated, but I actually really liked, in an electrophysiology lab.

And then I also did some clinical research in the psychology department that was really, really fun and exciting, and, in hindsight, something that played a lot to my interest. We studied sleep and anxiety and how those manifested across the different depressive disorders.

Dr. Chan: Interesting.

Jordan: Yeah, so it was really cool. And then I also did a semester in an immunotoxicology lab, which was some more kind of pipetting stuff, but it was new pipetting because it was a different type of work. So that was fun too. And that was mostly just because I couldn't turn it down because the PI was somebody that I had really liked for a really long time, and I felt like I didn't want to miss out on working with her, and so I didn't, and it was great.

But that was the research component. And then the leadership experience, I had been employed all throughout college for the . . .

Dr. Chan: Yeah, talk about that, because I remember that was the most . . . you listed that as most meaningful and you told a Whopper story. Tell us about the Burger King in Pocatello.

Jordan: All right. Yeah, I certainly will. The leadership experience, I ended up counting it . . .

Dr. Chan: Because you were a manager. You were, like, a supervisor.

Jordan: Yeah, I was a shift supervisor. So my first job, basically, I graduated from high school and I was ready to move out, and I found myself an apartment in Pocatello with a roommate, and then I realized I needed a job to pay rent. And so I just drove up and down Yellowstone Avenue and I just walked into every single store. I was 17 years old. This was right after high school. And I asked every place if they were hiring and if they were, if they had a paper application or if I needed to apply online. And I probably applied to some 40 jobs. I mean, clearly, I did not have a preference or a care.

I stopped in at the Burger King on . . . it's a Burger King/Chevron combo on Bench Road. And I walked in and I was like, "Hi, are you guys hiring?" And I didn't realize it, but I happened to be talking to the general manager. And he goes, "Actually, we are. Someone just quit."

Dr. Chan: I love it.

Jordan: And he said . . .

Dr. Chan: And her name was also Jordan.

Jordan: Probably. The turnover there was really high, absurdly high, as I'm sure you can imagine. And I was like, "Great. Should I apply online?" He's like, "You have one minute to tell me why I should hire you." And I kind of like froze, and I was like, "I mean, honestly, I'm awesome. I'll do a great job." He was like, "That's less than a minute," and he was like, "But, you know, it sounds good. Just come in my office and we'll start working on the paperwork." And then he's like, "I'll just have you go ahead . . ."

So in his office, I filled out their online application. And I basically was hired like within 20 minutes. I was hired as a crew member, so I was started on the drive-through, and I think it was the . . .

Dr. Chan: Did you start that day?

Jordan: I started the next day.

Dr. Chan: Okay.

Jordan: I started the very next day. And I think that it was only tolerable and exciting because it was kind of like my first job and I was like so excited to be making a whopping $7.25 an hour.

Dr. Chan: All you can eat fries, right?

Jordan: Technically, no.

Dr. Chan: What was the policy?

Jordan: The policy was you couldn't eat food.

Dr. Chan: Okay. So if there was a mistake, someone had to bring the food back, you just threw it away? You guys didn't get to eat it.

Jordan: Correct.

Dr. Chan: Okay.

Jordan: According to store policy.

Dr. Chan: According to everything that is written in official policy.

Jordan: According to the employee handbook . . .

Dr. Chan: Yes, all 500 pages of it.

Jordan: . . . food was not to be consumed by employees. There was an employee discount on food, but you could only purchase and eat food on your designated break times. So you had to clock out, take your 30-minute break, and then you could get a snack with your discount.

Dr. Chan: Jumping ahead, I want to give a shout-out to all the listeners. Do you feel . . . I'm trying to draw a link, because my perception is, Jordan, you have amazing interpersonal communications skills.

Jordan: It's all from the drive-through.

Dr. Chan: Yeah, that's what I'm saying. Do you see any corollary or similarities between kind of like, you know, this customer service aspect, which you were really great at, and then interacting with patients or doctors or multiple treatment team members? Do you see any correlation there?

Jordan: Honestly, I really do. It's funny that you mention that, because I would not have anticipated that Burger King would have been a formative experience. At the time, it just felt like a job that I had for way too long. But when I look back, there were a lot of really useful things that I learned at a relatively young age. I was one of the youngest. There were high schoolers and then the kind of questionable 30- and 40-year-old adults working. That's kind of the dichotomy.

I think I left there when I was still . . . I worked there for a year. I think I was 18 when I left. But at a pretty young age, I feel like . . . I mean, I can't really say that it was a good store. We had a lot of unhappy customers. We were a very busy franchise, and we got overrun sometimes.

Once I was a manager, there was this kind of constant battle between trying to, I guess, reason with customers and make them feel valued and make them feel heard and make them feel like you were supporting them and that you were doing everything that you could to make their experience better. And then at the same time, you know, interacting with your staff and crew in a way that was like, "Hey, I'm your boss. You know, we need to be more efficient. We need to do this better. But I also need you to feel like I'm supporting you, encouraging you, motivating you and not just like shouting at you."

And it was pretty tough. When I think back to all the jobs I've had, like moments that were the most stressful where I felt like, "This is actually a hard thing to do," I think the only job I've ever had that feeling in was Burger King.

Dr. Chan: Would you also say that you feel that way about medicine now?

Jordan: Yeah, definitely. I mean, a lot of times your patients are unhappy, and they're unhappy for any variety of things, or their family members are unhappy. And, you know, it could be with you. It could be with the physician. It could be with healthcare.

Dr. Chan: The system.

Jordan: It could be the system, yeah. It could be because they don't like how much they're being charged for their visit. It could be any number of things that you personally have no control over, but because you kind of are the face of what they get to interact with, you are the one that has the onus, I'll say, to try and placate them or at least help them to understand the situation better or at least give them an opportunity to feel heard. I think sometimes that's the most important part.

And that was the most important thing at Burger King too. If somebody had a poorly made sandwich, what was the most validating thing for them was, sure, you would replace the sandwich, not a big deal, but they needed the five minutes to sit there and tell you every single thing that was wrong with it, why it ruined their day, why it was a catastrophe. And sometimes your patients need that space too. Even if the outcome is the same and you can't really do anything differently for them, sometimes they just need that . . .

Dr. Chan: They need someone to validate, listen to them.

Jordan: They need that opportunity to feel heard. I mean, I honestly had somebody tell me one time to remake their burger because there was mustard on the side of it. I mean, okay, I'll remake that. Sometimes your patients just need that feeling too.

Dr. Chan: I think as individuals, as people, as humanity, as we kind of navigate this thing we call life, it can be extremely lonely. It can get really frustrating. And just when they interact with the system, whatever it be, people just want to be treated with respect and have a sense that, yes, they're being listened to and that their frustrations, concerns, questions are not just going out into the ether. It's like someone right in front of them is listening to them and being in the moment.

Yeah, I echo that. People have heard me talk about this too. But back in high school, college, I worked at an Olive Garden. Very similar experience to Burger King. And I just remember this feeling . . . when you said people just want to be listened to, yeah, I remember that. I remember that very distinctly.

And on both sides, like you mentioned. Sometimes people who work there got very, very frustrated with certain things that were happening. I was never "middle management" at that point, but I can kind of see the people who are in charge of things were trying to balance, like, "Okay, the employee is over here and the customer is over here, and these things are starting to happen." Yeah, it's rough. It's tough. Where else did you work?

Jordan: So I worked at Burger King. I worked retail for a little while. And I sold cosmetics at Ulta, which is kind of a large nationwide chain that sells cosmetics. I spent ironically one spring semester . . . I spent a spring and summer doing a pseudo-business internship selling exterior house painting contracts.

Dr. Chan: Jordan, you've done a lot of cool stuff.

Jordan: A lot of random stuff that all was kind of helpful in the end.

Dr. Chan: Yeah.

Jordan: So it was Burger King and then the house painting, and then Ulta, and then I started working for an urgent care doing admissions, and that's where I worked the longest and that's how I started to accrue my patient exposure hours for my med school application.

Dr. Chan: So you start applying to medical schools. What was your strategy? Did you apply to a lot of schools, if you can remember how many, or did you kind of have a more focused strategy? And how much research were you doing online? I mean, how did you kind of do this?

Jordan: Well, you might laugh because I think what I did was not what was recommended by any pre-medical advisor anywhere. I'm going to call it the very focused route, and I basically only applied to schools where I thought I could get in-state tuition. So I only applied to three schools.

Dr. Chan: So economic?

Jordan: Yes, the focused, economically-savvy application process. So I applied to University of Utah, obviously, University of Washington who has a similar program for Idaho residents, and then I applied to University of South Carolina, which is where my mom went to medical school. I grew up in South Carolina, and I have a lot of family over there. I knew that would be really easy for me to establish residency there again and get in-state tuition there as well. So I only applied to three schools.

Also, to be perfectly honest, I did not cast my net widely because I was not confident that . . . I guess since it was my first year applying and I wasn't sure how strong my application was, I was kind of using it as a way to kind of assess the strengths of my application, meaning like, "Okay, I didn't get in anywhere, but let me see if I can get some feedback from any of these programs," versus applying to 50 programs with a subpar application. And so I was kind of using it as a "if this application cycle doesn't work out, I'll apply to more programs next year."

Dr. Chan: Kind of like a learning experience.

Jordan: Yeah, but I'll have a better idea of what I can do to beef up my application for next year kind of thing.

Dr. Chan: And so then you go out and start interviewing, and then did you . . . I know you got at least two interviews. Did you interview at all three?

Jordan: I interviewed at just the two.

Dr. Chan: Okay. And then obviously you did well in the interviews?

Jordan: Yeah, I guess so. I guess I did.

Dr. Chan: Because I think you got into other places?

Jordan: Yeah, I did. I got into the two places I interviewed, yeah.

Dr. Chan: So what helped drive your decision to come here? Was it purely finances, or is it closer to "home"? But it sounds like you also had a home in South Carolina.

Jordan: Yeah. I mean, to be perfectly honest, I only applied to Utah initially because of the Idaho program. It just seemed like too good of an opportunity to not, you know, be interested in.

I think I was supposed to interview at South Carolina first. But then that was right when . . . I don't know if anybody remembers, but the whole state flooded and they ended up postponing the interview because the airports were closed. Well, actually I asked them, I emailed them, and I said, "Should I still come interview? The airport is closed. I'm not sure what's happening." And they rescheduled it for December.

So my first interview was actually here at the U. And so it was my first time really even seeing the campus or parts of Salt Lake. I'd really only been in Salt Lake City for the occasional concert and the airport.

And as soon as I just drove down here, I remember I really liked it. And then when I interviewed here, I was really blown away by how much I liked the program and I liked the people and I really liked all of the medical students that I interacted with. I really liked all of the people that did my . . . I guess they were all fourth years, but they were the people that did the MMIs.

I felt, at the end of the day, I . . . you know, I was expecting to feel exhausted and I just was like, "Wow, I feel like that was such a fun day." And I would not have expected to feel that my interview day was fun, and I just really liked that.

Dr. Chan: Good.

Jordan: And so, after I interviewed here, it certainly became my . . . initially, my number one choice was to go back home to the east coast of South Carolina, and so South Carolina was my first choice. And then after I interviewed here, I was like, "Oh, gosh, I think Utah might be my first choice."

This is kind of silly, but I found out that I got accepted to USC before I'd heard anything back from Utah. And I remember being like, "Okay, yay. I guess, you know, I'll go to med school." But I wasn't . . . I remember still feeling disappointed because I was like, "Man, I just want to hear back from Utah." And I called my mom and she thought I was crazy because she was like, "Who cares?"

Dr. Chan: That's your mom's alma mater, right?

Jordan: Yes, it is. I ended up just like not feeling . . . when I went there, I really didn't feel like that was a good fit for me. And the more I think about it in hindsight, I could not be more glad that I chose the U. That was kind of everyone's idea. It was like, "Just get in somewhere and then you can . . ." They're like, "Once you get in somewhere . . ."

Dr. Chan: It's really competitive.

Jordan: ". . . you should feel relieved." And I was like, "I don't feel relieved because I have not heard from Dr. Chan." So that was pretty funny.

Dr. Chan: I remember you on your interview day. You were so quiet, and I just had this image of you of being this little kind of church mouse. Then I remember you the first couple weeks of med school, and you were like the life of the party. You're so gregarious, and just hearing stories . . .

Jordan: Yeah, I get that a lot, strangely enough.

Dr. Chan: I'm sorry if I'm feeding into the stereotype.

Jordan: No, at least in terms of the onset of medical school thing. And I know for sure that I was way more subdued during my assessment day, but largely it's because I have a pretty, I'll say, outgoing, kind of bubbly personality. But a lot of times I feel like that comes across or it can come across in a way that is seen as less professional than somebody who is more kind of reined in.

Dr. Chan: I just think you're funny. I think you're a comedienne. I remember I always am bugging you and I still say that you should emcee all the different med school . . .

Jordan: I'll emcee something before I graduate, I promise.

Dr. Chan: Okay. I'm on that . . .

Jordan: Will you allow that?

Dr. Chan: Yes.

Jordan: Actually, I think I was to help out with lunch for . . .

Dr. Chan: You're student officer now. You've risen in the ranks. Talk about leadership positions. Now you have the biggest bullhorn because you get the . . . I get those emails you send out. I'm like, "Oh, I get to hear from Jordan," and you're so funny. You're very plugged into the artistic scene and the foodie scene. You have all these little nuggets.

Jordan: I spend way too much time on Instagram, I think.

Dr. Chan: Oh, is that where it comes from?

Jordan: Well, sometimes. I stalk a lot of places on . . . there are several Instagram accounts that talk about up and coming things in downtown Salt Lake City. Or I'll find things that we'll talk about, specials or deals or stuff, and I just pass it along.

Dr. Chan: I love getting your emails. There's so much like . . . they're just full of life, and that's why . . .

Jordan: I'm glad you liked it because I'm kind of the maniacal person. I'm typing it and I'm just sitting there laughing at myself because I'm like, "This is hilarious. Everyone should laugh at this."

Dr. Chan: So explain what's your position and what do you do?

Jordan: I am the student body secretary, or the SBO secretary. And the secretary is in charge of . . . probably they're most recognizable for sending out the weekly newsletter, which is an email that goes to what I originally thought was just all the students, but apparently lots of faculty get it too. And I have found that out in hindsight when faculty . . . when people like Dr. Samuelson or something mentions they've read your email and then you kind of cringe on the inside because you're trying to remember if you said something that was maybe a little too flippant or not.

Dr. Chan: Well, if you bury it in the deeper thread . . . yeah. I think studies have shown people only really read, like, the first four sentences of emails.

Jordan: It's true.

Dr. Chan: If you start to go risquÈ stuff, just bury that.

Jordan: I'll start putting the naked pictures at the end.

Dr. Chan: On Page 3. I'm not going to talk about the naked pictures.

Jordan: Okay, maybe no naked pictures.

Dr. Chan: Okay. All right. So last few minutes, Jordan. Biggest surprise after you started med school?

Jordan: Biggest surprise after I started med school?

Dr. Chan: Yeah. Again, everyone has this image of medical school. You may have had an image or thought it was going to be like X or Y, but then you get here and you start kind of progressing through the curriculum and it actually is more close to Z. I'm just curious, you know, what that was for you.

Jordan: I guess my two surprises were . . . one of them is just kind of a reflection of the inadequate amount of research I put into the healthcare field prior to starting med school, which was just kind of the volume of testing. I mean, I knew that there would be exams and licenses and things, but I've been kind of just learning as I go along, you know, what the formal testing actually looks like.

And then just to kind of learn there were large exams at the end of every clerkship and things like that, that was kind of a less than pleasant surprise. But I guess, again, if I had spent enough time on what . . .

Dr. Chan: So it was the frequency of testing?

Jordan: Yeah, but I guess if I had spent, you know, more than five minutes on Student Doctor Network or whatever, I would have known that. But strangely enough, I had never heard of Student Doctor Network until orientation and everyone thought I had. They were like, "Who are you? What is wrong with you?" I was like, "Well, I don't know."

And then probably the better surprise that was more of a surprise in that it wasn't something I expected, not something that I think was unreasonable, but I'm surprised almost every single day by how much I've come to value my classmates. I know that people have always said that they made lifelong friendships in med school and that they've really stuck with them, etc., ad nauseum, yadda yadda yadda.

But I felt like when I even showed up for second look day and then started, you know, orientation and even just the first week of classes and foundations, I kind of felt like, for the first time in my life, I was with a group of people that all kind of got me. I felt like I was with my people for the first time.

And I have, you know, met some of the best people in my entire life and made some of the best friendships I think I ever will make among my classmates. And even people that I wouldn't even describe as my closest best friends are people that . . . maybe they're classmates I haven't gotten to know as well because I haven't been with them as much, but I'll be with one of them on a rotation or something and I'll realize that they're just incredible.

Maybe that's just throwing it back to admissions for picking good people, but I think that was . . . my classmates always surprise me with how great they are and how generous and kind and just good-hearted people.

Dr. Chan: I mean, you're three years in now, Jordan, and I just kind of think there's something . . . I get it. I echo what you said. You know, I understand people have a lot of really good relationships and friendships from their undergrad days and I get that, but to me there's something special about medical school because you literally advance with the same cohort of people year after year in all these different experiences, be it anatomy lab to small groups, to now on clerkships, so different rotations.

I remember I really got to know . . . you know, when you're on call with your classmates, when it's like 2:00 in the morning and you're interacting with someone, and part of me . . . people's personalities start to come out when you're under stress or sleep deprived, so you get kind of close to people when you kind of go through these stressful situations.

Jordan: Yeah. I can pinpoint on every rotation a time when a classmate just totally saved my butt.

Dr. Chan: What does that look like for someone? I mean, can you give an example? You don't have to mention names. How do medical students help each other during rotations? I mean, what does that look like?

Jordan: I mean, the ways are endless, but my first rotation was on OB/GYN. I was with two awesome classmates, and my phone had an auto-update overnight and my morning alarms weren't saved. And OB/GYN is a rotation where you have to be at the hospital by 5:00 a.m. And usually, you're pre-rounding and stuff and have your notes and rounds and stuff done by 6:45 or so. And my alarm didn't go off and I woke up in my bed at 5:45, which is normally, you know, when you should be . . .

Dr. Chan: Still asleep.

Jordan: Well, you normally should be still asleep, but you should be at the hospital 45 minutes ago. I kind of woke up in a panic. Luckily, I could wear scrubs, so I was able to be in my car on my way in five minutes. I reached out two my classmates and I was like, "Guys, my alarm didn't go off. I'm on my way in. If there's any chance you guys could lay eyes on my patient before rounds, I would be super appreciative. I'm so sorry."

And I rolled into the team room and they had already seen my patient. She needed a translator, which is why it was kind of a bigger deal. Seen my patient and had started my note. And I basically sat down and was able to kind of bang out the rest of my note. And then the resident walks in and he was like, "Oh, good morning. How is everyone?" And it was like this huge sigh of relief basically because my classmates were so awesome. The resident had no idea that I was an hour late.

Dr. Chan: They could've thrown you under the bus and tried to make themselves look better by kind of labeling you as the problem medical student.

Jordan: Yes, easily. And they didn't and it didn't even occur to them and they just went above and beyond. I mean, I think everybody has stories like that on every rotation. I've never really experienced . . . I mean, I'm sure that it exists, but I have never been the recipient of or even witnessed a classmate trying to make other classmates look poorly.

Dr. Chan: Tear someone else down to make themselves look better.

Jordan: Yeah. I've never seen that. I feel like med students come across as a pretty united front. I've also never had a resident go out of their way to make the medical student look bad in front of the attending.

Dr. Chan: That's great.

Jordan: Yeah. I've had a lot of great residents. I've had some bad ones too, but I've had more good ones than bad ones. So it does kind of come across as the rest of the world versus the attending. But the attendings love that. They love that. They love that they inspire fear.

Dr. Chan: That's why we get to make the big bucks.

Jordan: Somebody has to go because I'm sure not.

Dr. Chan: All right. Last few minutes, Jordan. Last question. We kind of talked about this before we turned on the pod. As of today, little bit more than halfway through your third year, what's kind of your career choice? How does that decision-making process play out?

I know people start this journey and they kind of have an idea. And I think my perception is you've always been one of those people who has kept your cards very close to you about what kind of doctor you want to be. I know there's been a lot of teasing and speculation, but I'm just curious. Like you just said, fourth year schedule is around the corner. So either your personal thought process or . . . how are you arriving at this decision? Because it's a big decision.

Jordan: It is a big decision. I will say, though, if I've kept my cards close to me, it's because they're actually blank if you look at them. I haven't really been sitting on any big secrets. I largely went into third year pretty open-minded because I really didn't know what I wanted to do. I've had an easier time saying or deciding, "What do I want my career to look like?" more so "What kind of specialty do I enjoy the most?" I've ruled some things out.

Dr. Chan: Do you feel comfortable in sharing those and why?

Jordan: Yeah. So I'm just kind of going through the rotations and realizing, "Hey, this was fun, but I don't want to do this every day of my life." That was OB/GYN. Really fun rotation, had a great time, but it was like, "I don't . . ." I mean, personally, I'm not that passionate about the pelvic floor, so probably not for me.

And then surgery, there was some cool stuff. I did get to work with some cool people and see some cool things, but kind of a similar story where I just didn't feel like . . . I didn't really feel like I loved it. You know what I mean?

People who talk about wanting to go into surgery, when they talk about the OR, it's like this otherworldly thing. And when the residents talk about . . . when you ask them what's their . . . I routinely ask residents and attendings . . . well, more residents than attendings, but why did they pick this or how did they know this was the right choice for them, almost all the surgery residents will have something kind of emotional to say about the OR in terms of it being just the most validating place in the world. And while I thought the OR . . .

Dr. Chan: Like holy ground.

Jordan: Yeah. And while I always found the OR to be interesting, it was not a place where time stood still for me.

Dr. Chan: You didn't have a transcendent experience in the OR?

Jordan: Yeah. And I kind of just realized when people talk about if you could . . . there's this idea of, "If you like surgery but you could do something else that would make you as happy, do that because the lifestyle would be easier than being a surgeon." I mean, there could be some truth to that, I don't know, but I just felt like I liked it, but I didn't love the OR enough to make me feel like the grind would be worth it.

And then in terms of the things I liked the most, I liked my medicine rotation a lot. I also really liked my psychiatry rotation a lot. I just finished up family, and while I found a lot of value in that and it was really good for me to see . . . the number of times I've written on discharge summaries "follow up with PCP outpatient," it was really good to see what that actually looks like since so much of our third year is largely inpatient.

Dr. Chan: Yeah, it's more hospital-based.

Jordan: Yeah. So it was really good for me to spend a chunk of time doing all outpatient care. It's definitely not something for me though. I didn't feel like I connected well with it in terms of something that I would find to be a validating career. Although I worked with docs who were very inspiring and you could tell that they got a lot out of it, it just didn't feel like it fit things I was excited about.

So when I said it was easier for me to kind of . . . I realized it was easier for me to think of the kind of career I wanted versus the specialty. The things that I thought were interesting, that I liked the most on medicine and on psychiatry that were kind of the commonalities, were I really liked the inpatient care model. I really like the idea of being on service for a week, getting . . .

Dr. Chan: It's like a hospitalist model.

Jordan: Yeah, I really like the hospitalist model. I liked the inpatient adult psychiatry at UNI that has almost the same model. You're on service for a week or two, and you get continuity. You get to see the same patients, you know, for that week. And hopefully, you don't see them again.

Dr. Chan: Sometimes people get readmitted.

Jordan: Yeah, sometimes you might. I like that model. And I like that a lot of hospitalists also . . . it's like you're on service, and when you're off service, you're off service and you have time to work on other projects and things that you're excited about. And I do know that I'm more interested in academic medicine and I would like to be involved with research and . . .

Dr. Chan: I think you'd be an excellent teacher too.

Jordan: . . . education and things like that. And so I kind of feel like that lends itself really well to that model of healthcare delivery in terms of . . . And then when I think about all the cool docs that work in our faculty and administration, that's what a lot of them do.

Dr. Chan: Little bit of this, little bit of that.

Jordan: Yeah, you're on service for a week and you're seeing the patients, and then cool, now you're doing admin time and projects and serving on committees and teaching and . . .

Dr. Chan: Helping form policy.

Jordan: Yeah, and I really like that.

Dr. Chan: Helping the curriculum in some way.

Jordan: Yeah. I was like, "Hmm." So I don't really know exactly what specialty I'll end up picking, but I kind of like knowing that that's where I would like it to ultimately end up, something like that.

Dr. Chan: It sounds like you're in this very self-reflective phase right now, because of these choices you're going to have to start making. It's only going to be a few short months and then residency applications are due, which is terrifying, right?

Jordan: It is terrifying, especially because I feel like when I . . . I mean, it makes sense, but when I went into medical school, I had this idea . . . for whatever reason, I was thinking, "Okay, you have four years to figure it out," kind of thing. But really, you have three. You have three years to figure it out.

Dr. Chan: Yeah, three years, a couple months.

Jordan: Because your fourth year is really all about . . . the bulk of fourth year is spent interviewing at programs. And at the time, I felt like, "I'm getting shorted a year," but then I neglected to remember that it took, like, a year to apply to medical school, so why would it not take that much time to apply to residency? But that's okay. I was naive then, but I understand now. Yeah, it definitely has gone by a lot faster than I anticipated. We only have two more clerkships left. I just have . . .

Dr. Chan: It's weird to me to think of you as a fourth year, because I still remember your first week of class. Now you have this wisdom and gravitas about you.

Jordan: Wisdom. It's because I hold all these empty cards close.

Dr. Chan: I didn't call them empty. You're calling them empty. Personally, I think you've got some aces and jokers in there, but you're not sure.

Jordan: It's all jokers.

Dr. Chan: All right. Last question, Jordan. Any advice to people out there thinking about going to med school? What would you say to them?

Jordan: Thinking about going to medical school or applying?

Dr. Chan: Applying or . . . yeah.

Jordan: Advice for people applying? I think don't be discouraged. Don't be discouraged if you don't get in the first time you apply. The vast majority of my classmates applied more than once. Whenever I talk to people who are pre-meds now and applying, a lot of them seem to kind of say, "Well, I applied and I didn't get in anywhere," and they seem to be kind of really discouraged by that. And I think that it's way more common in this day and age to have to apply multiple times. So I would say don't be disheartened. Keep applying. You'll get in.

And then for people thinking about medical school, I think shadow as much as you can. I know that can be kind of hard to do depending on the policy of your local hospital and stuff.

Dr. Chan: Yeah, there are more and more barriers, unfortunately. It's harder for pre-meds.

Jordan: Yeah, and it was a bit of an issue for me, which is actually why I ended up getting a job where I did so I could be an official employee so then they would let me shadow, but I had to go very roundabout in that way.

But anything that you can do to kind of talk to as many physicians as you can I think would be helpful, even just kind of asking questions of them like, "Why did you want to go into medicine? Do you regret going into medicine? What do you wish you had done differently?"

I mean, a lot of docs, if they're kind of outside of this sphere of academic medicine, those may be questions they haven't been asked ever or in a really long time. And so sometimes an honest perspective can be really good, and it may sway you one way or the other. But I think just talking to as many physicians as you can is really helpful.

Dr. Chan: Okay. Great advice. Jordan, I want you to come back. I love talking to you. It's so much fun.

Jordan: I know. This is a good office.

Dr. Chan: Yeah, I want you to come back in a few months after you kind of make your decision and I want to hear about it.

Jordan: I'll come back.

Dr. Chan: All right. Well, thank you, Jordan.

Jordan: Thanks, Dr. Chan.

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 thescoperadio.com.

Interviewer: What's the better option for breast cancer treatment? Is it a mastectomy or a lumpectomy? Turns out it is a very personal and it can be a very difficult decision to make. We'll look at some of the reasons why on The Scope.

Announcer: Medical news and research from University of Utah physicians you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: By the time you have to make a decision whether you should have a mastectomy or a lumpectomy to treat your breast cancer, you've likely to have already been on quite an emotional journey, so things can be pretty scary and confusing. I'm going to try to add some facts to the equation. I'm going to try to help you make the decision that's right for you. We're with Dr. Cindy Matsen. She's a breast cancer surgeon at Huntsman Cancer Institute. So when it comes to breast cancer, is it always a surgical procedure. Is it going to be the mastectomy or lumpectomy or is there something else somebody needs to consider?

Dr. Matsen: So for the majority of breast cancer patients who have been diagnosed with cancer that has not spread to other parts of their body, surgery will definitely be a part of their treatment.

Interviewer: Okay, so that's just going to be a part of it. No way around it at that point. What's the biggest struggle a woman faces when making this decision between the two procedures?

Dr. Matsen: So there's a lot of different things women take into consideration when they're thinking about what type of surgery they would like to have for their breast cancer. One of the first things to emphasize is that there are certain women who will not have a choice. The majority of women do, but about 20% of women will require a mastectomy just based on how big their tumor is or based on other factors related to their disease. So for those women, we tell them upfront, "The option for you is very limited." But for that 80% of women, there is a choice.

Interviewer: Okay, is it usually a difficult choice for most women or is it pretty simple? What's your experience been with that?

Dr. Matsen: My experience with it is that most women struggle with that.

Interviewer: Why is that?

Dr. Matsen: I think it's because they get a lot of different information from a lot of different resources and it's a hard time processing what's going to be valuable for them. And it's very difficult when you're given a cancer diagnosis, "Okay, well what's going to happen 5, and 10 and 15 years from now?" And how do I make a decision that I'm going to be happy with at that time because right now the only thing that most women are thinking about is that they want to be cured. The good thing about the options for surgery are whether you have a mastectomy or a lumpectomy which is also called Breast Conservation Surgery, the outcomes, meaning that the likelihood you are going to survive your cancer, is the same regardless of which procedure you cho0se.

Interviewer: So neither one is going to offer a benefit in outcomes?

Dr. Matsen: Right, in terms of survival.

Interviewer: So I scratch my head, why would a woman want a mastectomy? Why would a woman want to go to that extreme at that point is both of them are the same.

Dr. Matsen: Well, let's first just describe what the procedures are so we have a good understanding of what it is that it means to have a mastectomy or a lumpectomy. A mastectomy removes all of the breast tissue, and if you don't get reconstruction, it leaves you with just a flat chest wall. Now women who get a mastectomy obviously have reconstructive options, but it is important to understand with breast reconstruction, that simply creates a breast shape. It doesn't recreate a breast. So it doesn't function like a breast. It doesn't feel like a breast. But it does help with body image, and it does help with how your clothes fit and how you feel with losing a body organ.
A lumpectomy on the other hand retains most of the breast tissue, but removes the tumor and a rim of normal tissue around it. Even with a lumpectomy there will be some changes with what your breast looks like, so there will be a scar. There will be some changes in the contour of the breast and almost always for breast cancer, lumpectomy is followed by radiation, and radiation can also have a significant impact on what your breast looks like afterwards.

Now the reason why women may chose to have a mastectomy versus a lumpectomy is that there is a slight difference in what we call the risk of recurrence and that means cancer coming back within the chest wall or the breast. Even with a mastectomy, it's not perfect. So even if you get a mastectomy there is still a chance that cancer can come back in the chest wall. That chance is low. It's around 1 to 3%. That's what I typically quote patients.

Interviewer: Do you feel that is statistically low.

Dr. Matsen: Yes it is. The ranges can vary depending on what study you are looking at. In general, it's around 1 to 3% and that's at 10 to 15 years out from your surgery.

Interviewer: Oh okay.

Dr. Matsen: And that's based on data that is about 30 years old now, so that's very mature data that we feel very confident about. For breast conservation surgery, we know that in modern data, meaning that in the last 10 years or so, with the kind of radiation we give, with the kind of medications that we use for treating breast cancer now, that the risk of recurrence after 10 to 15 years is probably somewhere in the 5 to 7% range, and that's much lower than what it was with older data. So there is a difference, but it is very small. So you're look on the order of 4%.

Interviewer: Is that a factor that should be considered into a woman's choice at that point? It is a small difference. Are they essentially equal in your mid?

Dr. Matsen: In my mind, they are essentially equal.

Interviewer: Okay.

Dr. Matsen: However, there is sometimes a psychology benefit that women feel to getting a mastectomy because it reduces the risk maximally.

Interviewer: Sure.

Dr. Matsen: One of the interesting things when you look at surgical choice, is that what happens in America is quite different than what happens in other parts of the world. America seems to be more driven to bigger surgery and this belief that bigger may be better. We don't necessarily feel that, as breast cancer providers, feel that's true. But there is a misconception, that by having a mastectomy, you're doing more to treat your cancer.

Interviewer: So, I'm finding myself confused. I can only imagine at this point, a woman who has to face this decision, what she is going through. Because still there is that slight chance, and what's the impact on the mental, and then there's the visual and the appearance. How do you help a woman make the right decision for her?

Dr. Matsen: That is one of the most difficult challenges we face. When a woman comes in to see me, one of things I tell them is that every woman feels differently about their breasts. And every woman approaches their decision making and breast cancer differently. I can't be the one who tells them the right or wrong thing to do. And like I said from a medical point of view, these things are equivalent in my mind. So it has to come down to other factors that are important to them.
We haven't mentioned this yet, but a lot of women are concerned with the other breast. What we are typically seeing nowadays is that people are not necessarily choosing between just having the cancer side taken off, but they are actually making a decision between having both breasts taken off versus just having a lumpectomy. The conversation gets very complicated because we have to talk about things that are outside of what we are concerned about medically.

What we are really talking about is, what are the concerns psychologically. What are the sexual, physical, psychological implications of having your breasts removed? How are you going to feel 10 or 15 years from now? If the cancer does come back, are you going to feel responsible because you feel like you maybe should have had more surgery even though we are telling you that's not the case.

So, it's a really difficult decision for women to make. We try to provide them with the best information possible to help with that, and help identify the values that are most important to them in deciding. But in the end, the woman really has to go home and contemplate on her own what information we've given her and what's important to her. It's a very difficult decision, and I think there are a lot of good resources out there, but you do have to be a little bit choosey about which ones you look at.

The Komen Foundation tends to have some very good resources. The American Cancer Society has some very good resources. There are a lot of support groups out there for women with breast cancer. And some of these decisions are very different based on a woman's age, too. If you are a younger woman, the decision might be very different if you're a younger woman.

There are support groups that are age specific, and some of those can be found through social media. Every woman, like I said, approaches this differently. A lot of women talk to a lot of other patients and people who are around them because breast cancer is a very common disease. There are a lot of people, when a woman is diagnosed, who come out of the woodwork that tell them their story.

Interviewer: Do you have a team approach Huntsman Cancer Institute? Do you have someone to help with that mental aspect of it?

Dr. Matsen: Absolutely. We actually have a social worker in all of our clinics who is incredibly helpful with helping to identify the other concerns that patients have outside of just the medical concerns, and helping to address those and give them resources to help with some of those decisions.

Interviewer: So it sounds like what we've learned is nobody else can make the decision. Each woman has to make her own decision. It's probably going to be a difficult decision. Best thing to do is talk to other survivors. Get out there. Read some reputable resources. Use a social worker at a place like Huntsman Cancer Institute to help gather all that information to figure out what's important to you. And it's not going to be easy.

Dr. Matsen: It's not easy.

Interviewer: But all the other things aside, I think the important thing too, from what I'm hearing from you, that regardless of if it is a mastectomy or a lumpectomy, they are going to provide the similar outcomes. So at least that's one thing you can kind of push aside and not worry about as much.

Dr. Matsen: Right. In terms of the cancer, similar outcomes. I wish hat I could make it easy, but it's just not. And it's a very vulnerable time period. It's a new diagnosis, and women are scared. It's a very hard time to make a decision like that, and we try to give them the most support possible, so that they can make a decision they are going to be comfortable with in the long term.

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