Ranking Programs

I've only done 2 interviews so far, and I am already continuously thinking about pros/cons of each particular program.  It is difficult because outside of the actual environment and teaching of the hospital there are other things to consider such as family, significant other, and lifestyle.

Residency Interview

First off all, it's just exciting to be in the position to have one interview, especially with the uncertainty of whether there were even any interview spots available by the time I applied.   I was fortunate enough to get 5 interviews, all in California, after I ended up applying to 36 family medicine programs.

This past week, I had two interviews, two days apart.  Both places seemed like programs that prepared their residents well. They both seemed great and similar on paper, but they both had a different "feel." Throughout my short interview trail, I've been hearing "gut feeling" as a term used to describe where a resident choose to work at. I've been starting to understand what they mean by gut feeling, as one program just seemed like a better fit for me despite both programs appealing in similar ways.

During my first interview, I made the mistake of leaving to the destination to arrive 10 minutes early.  The night before, I was sure to iron and lay out my clothes, but I still left a little later than planned.  I ended up making a wrong turn, despite directions from my GPS, and had issues finding the main lobby.  This accumulated in me arriving just in time for interview.  I was further delayed by these sweet elderly women volunteers who took a while to print my nametag.  My poker face was not up to par, as one of them stated, I know you guys think we're inefficient old women.  (She must have saw a look of concern on my face, because of my late arrival.)  I assured her that was not the case and was preoccupied about being late to the interview.  In retrospect I should have left at least 30 minutes before.

The actual interview went well. I had a great time discussing the program with the residents and program directors. The interviews were much more laid back than I was expecting.  Not many difficult questions, just a question about a time I had overcome a failure.  Mainly, it was just us two having a discussion and getting to know each other better.  After interviews, we had lunch with the resident, this is usually a way to get more informatoin about lifestyle, the city, and how well you would fit in with the group. We were then taken on a tour of the city and to the local clinic.  The interview was really fun, but also tiring, probably from the anxiety and anticipation of what the interview is going to be like and how well they will like you.

Applying for residency late

I should know better by now than to think things will go as planned.  Once I realized I wouldn't be taking STEP 2 CK until August 23rd, I figured I should postpone my match date to 2019.  I wasn't sure to have CK by the time residency applications opened, and all the upcoming CS dates were already taken up. I was told that it is best to apply only once I have a "complete" application in, including CK and CS.  Since this wasn't my case, I figured I wouldn't match until 2019, but that has since changed.

I was speaking to a program residency director who said it is not too late to apply, and this was in late October.  I began to contemplate if I could still get everything in, including LOR's, personal statement, and push up my CS date so that I could get results in by February.  She said I should apply, so I did despite the opposing advice from my school advisor.

As a caribbean student, you already have a baseline tolerance for risk, so I decided to take the much riskier route.  The risks are being labeled as a "second time applicant" if I don't match, which Ross statistics indicate will decreased my chances of matching next time by around 50%! Also, by the time I got my LOR's in, it was already Nov. 14th. By this time most programs have already filled all their interview slots.  As of now, I only have one interview and am waitlisted for another program.  We'll see how it all turns out.  Praying for a family medicine residency.

There was a opening for Step 2 CS in Los Angeles, so I managed to take it on Tuesday, Nov 14th. I think it went well, but we'll see.

Activities

If all went according to "my plan" I would have already have applied for the match, but as has been the general case for my medical journey, thsi train is running behind schedule. It's nice now having a few gaps in between rotations. I've been really doubling down on my Spanish having weekly lessons and chatting with amigos on WeSpeke. I still have  along way to go but I'm progressing slowly. I'm making good progress and learning.

Now it finally feels like I have a little more Time to pursue interests outside of medicine. More time to work on my Spanish and also more time to practice piano, which I've been putting off for a while. I've also been wanting to get into boxing or MMA to stay in shape and get more involved in church.

Step 2 CK

Well, I’m making my way up the ladder, slowly. Finally finished Step 2CK after a couple of postponements. Overall, it was a more enjoyable test than Step 1, because everything was more clinically relevant with not as much route memorization.

I began studying for the test in May during a radiology rotation but was only scoring in 40-60 percentile on the exam.  I then went home in June and was studying about 5 hours a day, thinking that I would be ready to take the test by the end of the month. However, I was quickly reminded of my knowledge gaps after failing COMP in late June, so I postponed the exam.  I took the exam again in July and passed with a score correlating to approximately 200. In July, I was doing a busy family medicine rotation, so I did not devote as much time to studying as I had planned.  I finalized a date of August 23^rd.

Due to my subpar performance on Step 1, I was paired up with a mentor provided by Ross who had performed well on Step 2 CK. I met with him weekly leading up to the exam on August 23, and he helped my stick to and create a study plan for myself.  Having someone hold me accountable was a tremendous help.  It is not a good feeling to meet in consecutive weeks after not accomplishing the goals you have set for yourself, so it pushed me to study more. I bumped up the studying to 8-12 hours/day in August, when I did not have any rotations.  I set goals for the week such as going through internal medicine questions that week on going through a certain number of online med ed videos by splitting up the videos each day.

Overall I met my goals of going through UWorld questions 2x and subsequently going through incorrect questions until there were none left.  I must have done some of the same questions at least 4 times before I finally got them right. I’m so stuck in my ways.  I watched all the online med ed videos, which were immensely helpful for general understanding despite how well or poorly I may have done on the exam, I am glad I watched these videos.  I also looked through the notes, which were well worth the $90, without watching the videos.  I read through Master the Boards, some seconds twice, but this did not stick with me nearly as well as the Online Med Ed notes. I took 3 NBME exams and did the free 150 question exam.  This helped to get my timing down and build stamina for the actual exam.  My scores on NBME were 183, 200, and 230.  I also took Uworld self assessments 1 and 2 with scores of 183 and 215 respectively. 2 days before the test I rushed through USMLE secrets, which got me a few points on the actual exam, and I also rummaged through forums for high yield images, including ophthalmology, which also got me a few points. I did a much better job this time around of limiting my resources as opposed to step 1 when I used multiple question banks and multiple review books.

The actual test didn’t feel as long as even the 4-6 hour practice tests I did.  Probably because I took a quick break after each section, I didn’t feel as fatigued after the test was over. My snacks were 2 pb &j sandwiches, a trader joe kale, broccoli, chicken prepackaged salad, and trail mix. This gave me good energy throughout the test.

I recognized a good amount of questions from uworld, and I didn’t run out of time on any of the sections. And just did my best to not second guess myself and trust that I know the material.

I was so happy for the test to be over, and return to a somewhat normal life. Then I took a trip to Vegas with some friends and put the test in the back of my mind until my score comes back in a few weeks.

Family medicine ineficiencies

I will be entering my last week of family medicine rotation this week. I'e been able to see a wide range of patients and gather a plethora of new knowledge about medicine and the politics that go with operating a clinic that is primarily for low-income populations.

One of the things that plagues these types of clinic is the forced inefficiency.  With every patient with medicare, especially with children, there are a certain amount of boxes that you must check in order to "complete" the visit.  In theory, this would be beneficial to make sure that nothing gets looked over, however, it takes away from focusing on a chief complaint if there is one. The same concept can be applied to review of systems in general.  If every system was reviewed in detail for every patient then it would be nearly impossible to have a visit and note completed under thirty minutes, especially if the patient has complaints.  This takes away time from the other patients being seen on time or at all, as patients are having to wait longer and longer to get an appointment.  Furthermore, going through a review of systems, especially in an elderly patient, would lead to a wide range of problems to then be addressed.  So for most patients, the technique I've seen utilized the most for doctors, and seemingly the most effective, is to address one problem then speak quickly about the treatment plan and leave before the patient has a chance to ask follow up questions.  This unfortunately, seems to be the best way of having a quick visit without leaving too many patients in the waiting room when you have a busy clinic.

The various inefficiencies I have noticed include patients coming back for lab results, having patients come in for prescription refills. prescription writing, filling out check boxes on CDHP (well child visits).  Sometimes, it seems like medicine is always lagging in innovation when it comes to the medical/medicare patients.  In an ideal setting, I imagine their being more telemedcine follow-ups for situations such as common medication refills or discussing lab results.  Or simply emailing all prescriptions to a given pharmacy (Faxing seems so outdated).  Or even finally having a central database for all patients where all visits, prescriptions, and previous notes from all providers can be seen.  Eliminating the whole going back and forth from one clinic to another with this paper and that paper and needing certain documents signed.

Maybe I can implement some of this if I start a clinic.  Or maybe I'll find that I was just a naive medical student and conform to the notion that these inefficiencies will always just be a part of medicine.

Postpone

Looks like I may have to postpone my residency match date a year.  I didn't do nearly as well on a Uworld self-assessment practice test as I had hoped for so there's no way I'm going to take a chance of scoring poorly on Step 2.  My original date was in three weeks but i only got a measly 198 on my practice exam. My new tentative date is August 3rd.

Step 2 studying

I have began studying for step 2, my last big test before residency begins. For step 1 I felt like I used too many materials so I decided to limit the resources I use to three.  UWorld, Master the Boards, and MedEd videos.  I'm going to set small weekly goals for myself in concordance with the plan my mentor has set up for me.  Ross provided a mentor for students who they felt would benefit based on low Step 1 scores, so I decided to utilize the resource.

My study plan for this week is to compete at least 2 Uworld blocks/day on tutor mode, read 40 pages of MTB per day, and complete at least 2 hours of medeq videos/day.  I tried to keep it simple and manageable.

Other lost files

Last week of IMF

APRIL 16, 20162 COMMENTS

These 6 weeks have went by pretty quick. General consensus was that it was pretty chill, but there was more work than I expected.  On Friday we presented a SOAP note (write up of history/physical/assessment and plan for a specific problem) to one of the doctors at Cleveland clinic, which was pretty laid back. We will be doing a lot of presenting cases on the island. Next week we have one day at the cardiology clinic, OSCE final (practice for step 2 cs) and our final exam on Thursday. I’ll stay in Miami for a couple days then it’s back home to Bakersfield to start rotations at Kern Medical Center. I’ll be beginning with family medicine.

EDIT

APRIL 14, 20162 COMMENTS

Only a week and a half left of IMF.  Our typical schedule is 2 days of clinic days, usually from 9-5.  Most of that time is spent studying or talking with classmates.  On  a lucky day we’ll see 4 patients, but usually only 2-3 per day.  This is because we generally only see the new patients, as we are taking a complete history and physical.  Otherwise the clinic is very busy, and the doctor wants to go through the routine check-ups quickly by himself.

The good thing is that we are able to see pathologies that typically wouldn’t be seen or heard in a primary care clinic.  We’ve hear bruits, murmurs, seen abnormal ECG’s, and abnormally high BP.  I’ve also learned how to use the electronic medical records system.

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You make time for things you love

APRIL 6, 2016LEAVE A COMMENT

Las Olas in ft. Lauderdale has an art fair 2 times per year. Artists from around the country come to show off their work from woodworking to ceramics to a lady who was literally selling toy frogs glued onto shells (that one confused us). 

One artist was led a team of engineers, managed rental properties, and took classes at university. In addition to this she created beautiful oil paintings, one of the pieces took her 4 hours just to complete one of the eyes. I asked when she found the time and she responded that she just doesn’t sleep much because she feels a need to make time for all of her hobbies.

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Cardiology

APRIL 1, 2016LEAVE A COMMENT

Starting off in cardiology has been a good first rotation. We get to hear a lot of pathologies such as bruits of the carotid artery, mechanical valves, pacemakers, extra heart sounds, aortic stenosis, mitral regurgitation. So many things I wouldn’t be hearing on a daily basis in another clinic. It’s definitely a trial by fire event. Last week I got chewed out for not presenting the patient in the manner our doctor prefers or reporting the wrong finding on auscultation of the heart.  I prefer an environment like this, as I’d rather make these mistakes now before I’m the doctor of these patients.  The transition to clinical thinking has been more difficult than I anticipated.  It is no longer, just memorizing a mechanism of action, but figuring out which symptoms correlate to how the patient is presenting and how to ask questions in a manner to get that information from the patient.  For example, rather than asking if they feel shortness of breath, I should ask how long do they walk before the feel short of breath and if that is any different from before the precipitating event.

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Secrets to Longevity

MARCH 29, 2016LEAVE A COMMENT

One of the patients in our cardiology rotation stated that he keeps himself strong by hittting himself on the arms vigorously.  The 80 year old man demonstrated by pounding his triceps with vigor.  He also stated that whenever he felt tired or sore he would throw himself on the floor then pop up immediately.  This man was full of energy, so whatever he was doing was working, but probably not anything that I will try in the near future.

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Secrets to Longevity

MARCH 29, 2016LEAVE A COMMENT

One of the patients in our cardiology rotation stated that he keeps himself strong by hittting himself on the arms vigorously.  The 80 year old man demonstrated by pounding his triceps with vigor.  He also stated that whenever he felt tired or sore he would throw himself on the floor then pop up immediately.  This man was full of energy, so whatever he was doing was working, but probably not anything that I will try in the near future.

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IMF

MARCH 28, 2016LEAVE A COMMENT

The first week of IMF felt like a bunch of well intentioned, but mostly forgetable lectures delivered from 8-5.  It was tought to transition back to sitting in a classroom for that long.  Especially since I thought that many of the orientation lectures could’ve been condensed into a powerpoint sent via e-mail.  I feel that a structured schedule can be bad because it leads to the prolonging of the delivery of information.  For example, if a speaker is given 1 hour but only has 15 minutes worth of information to deliver they will usually fill that extra time with fluff instead of ending early.  

The second half of the first week and second week was much more engaging.  It has been more work and reading than I had expected based on talking to previous students.  But it is a nice change of pace to actually be dealing with patients on the cardiology rotation.

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Step 1 done!

MARCH 27, 20162 COMMENTS

This is an overdue post, but I passed the step 1 exam! 7 sections of 44 questions, and 45 minutes of break is over.  It was such a relief to be done and have the freedom to not be studying or feel like I need to get back to studying.  There were definitely some questions that had me thinking I was sitting down for a radiology or pathology specialty board exam rather than an exam for second year med students, but I just mentally marked those questions as experimental. This only worked for so long, as there’s no way half of a session on the exam is experimental lol. 

The test didn’t seem that long, maybe because of the adrenaline or because of the many practice questions I had done. I passed with a modest score of a 210, which was a little lower than I hoped for but close to averages for family medicine residencies, which I am hoping to match in. So overall I’m pleased, and my score went up quite a bit from the first NBME practice exam that correlated to a failing score.

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Pura Vida

MARCH 8, 2016LEAVE A COMMENT

After spending months studying for the step, I decided to… surprise… do more studying.  But this time it was mixed in with some fun.  I stayed with a Spanish speaking family for a week and took 6 hours of class studying Spanish in a town called Heredia in Costa Rica.  The Sunday I arrived, we took a trip to a beautiful volcan, Volcan Poas, which was a volcano in the form of a crater.  My host parents were a sweet 73 year old woman, her 79 year old husband who still worked near a waterfall.  Everyday she would cook breakfast consisting of tropical fruit and eggs or oatmeal.  Then I would take private classes with an instructor.  Our sessions were fairly casual, discussing verb tenses one moment and our shared disdain for Trump the next moment.  Then I would return home to chat and eat dinner with my host family.

Over the weekend, I visited a hostel near Jaco beach called, Riva Jaco.  It was a decent hostel, with bamboo tents and mattresses outside and bunk beds inside.  Most people staying there were Germany, a couple form Austria, a couple of women from Costa Rica, and one person from Oregon.  One couple from Germany rode their bike much of the way from Southern California to Costa Rica over the course of months.  I couldn’t imagine riding my bike more than a few miles, let alone through Central America, but they were the type of people you immediately exude an adventurous personality.  That weekend we went clubbing and I did some surfing, and a lot of falling, at Jaco beach.  I returned to my host family for a day, then it was time to go back and prepare for the trip to Miami for IMF.

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USMLE Step 1

MARCH 2, 2016LEAVE A COMMENT

I started the day with a short run, prayer, and some sweet potatoes and eggs.  Then I was off to begin the most important test of my life.  I walked into the test room and attempted to suppress the pressure that accompanies a test of this magnitude.  Questions of what would I do if I don’t pass, are you prepared enough?  I changed my thoughts to thoughts of how far I’ve came to get to this point, how much I’ve studied, and how I’m proud of the effort I’ve put in prior to the test.  I would be able to live with any result I get whether favorable or not.

The test is composed of 7 blocks with 44 questions each and 45 minutes of break time (could be up to 15 min. more if you skip through the tutorial).  After opening the tutorial, I started to jot down some equations of the “whiteboard” provided instead of scratch paper I wrote some of the epidemiology questions and the “qiss qiq siq sqs” mnemonic then proceeded to the first block  Some in the blocks seemed like as if I was just doing another practice exam, others contained images or content I wasn’t familiar with.  It was definitely a beast, but I feel like I passed it.  I’ll find out in a couple of weeks.

Once I finished it was a relief just to be done with studying for a while and putting an end to the anticipation.  I then proceeded to pack for my week long trip to Costa Rica.

The lost files from another site

Peds Physical Exam

JULY 10, 2016LEAVE A COMMENT

Pediatrics has been a blast so far.  I’ve found myself paying more attention to minute detail with infant and small children, as they are not able to describe the extent of their illness.  This forces me to consider more options, and really become a better diagnostician, as the differentials aren’t eliminated by the patients’ narrative as they tend to be with adults.  The harder part can be the physical exam with a fussy patient.

What used to be a routine procedure, has suddenly become more complex.  The general physical exam with adults follows a pattern that becomes routine, however with the children, the order varies with each patient.  There are the children who have no problem being placed on the exam table and being poked and prodded in the ear canal and nose.  Then there are those who are a ticking time bomb.  They are placed on the examination table and give that look of concern as the stethoscope touches their chest.  They then glance at the mother then back at me with that “stranger danger” look quickly followed by a trembling of the lower lip.  Sometimes a sticker is enough to console them.  Other times, they have had enough and and are hungry, tired, constipated, and/or have had enough of my face.  They let out a scream that lets me know I am a nuisance and then I proceed to the more invasive parts of the exam: looking into the mouth.  Then proceed to look into the ears with the parent/s holding their arms as I stabilize the head and look into the ears and nose.  Then the hard part is over, they hold their parents and look at me with a piercing glance.  One 3 year old patient then proceeded to tell me to “go away.”

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Fam med schedule (roughly)

JUNE 5, 2016LEAVE A COMMENT

5:00 Exercise

6:25 drive to hospital

6: 45 head to rounding room

7:00 night shift gives updates on patients

7:30-11: Round on patients, individually and with resident/ Finish SOAP notes

11:-12: Round with attending physician

12-12:45: discuss plan and updates with patients

12:45-1:15: lunch

1:15-1:45: Update SOAP notes

1:45-7 (Options): 1) One of the three students goes to the FM clinic 10 min away

2)  One student can go home

3) One student stays until 7 PM to study/ wait for another patient admit                                           and complete an H&P/ Follow up with to-do items for patients

7-10: ??? Eat, study, read, piano, social activity,  sleep

There is no set schedule, really everything varies depending on how many patients we have and how many complications they have, and which resident we’re working with, some will keep us at the hospital longer than others.  Also, each student has a week of nights from 7pm-7am and a week at the clinic from 8-5pm.

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Rant

MAY 29, 2016LEAVE A COMMENT

Sometimes I try to make the posts flow with a topic, I think I’ll now just go into a random flow, if you hate it let me know.  So much goes into rotations.  The other day one of my classmates was making a joke about how the other students were sounding.  A very knowledgeable yet pompous doctor, just ask him and he’ll tell you his accomplishments, was passing through the hall and the other students were hanging on to his other word and you could just tell they were feigning interest.  My collegaue was like I know I sound like that too, trust me espeicially with the surgeon.  He was like I’ll be “yes sir that is the most amazing story ever, so extraordinary” lol.  I know i some of that, laughing a little too hard at the doctors’ jokes that aren’t that funny, and just trying to be likeable, but when I notice I try to stop.  For the most part, I think i just try to do teh best for the patient, and try not to care about what grade I’ll get at the end.  Then there’s the dilemma of studying to get a good grade on the shelf exam vs. studying the disease of a patient and studying the disease of the patient that will not be on the test.  Then there’s the feeling that you’re not responsible for the patient, because you’re not the doctor, you just gotta go home and study.  Feeling like you don’t really know enough to really make a difference, but then realize that this is probably the most time you’ll ever be able to spend with the patients.  You are able to do more educating and more thorough physical exam that the docs simply don’t have the time to do.   You’ll see the residents stressed from all the documentation, and you’ll also be doing alot of the same documention thinking you’d rather be spending time with the patient or looking up the pathophysiology of their disease, and get disheartened because alot of medicine these days is simply that, documentation.  Then I spend time thinking about maybe I should just go into a concierge practice or other priate practice and not have to worry about insurance, but then realize that that will likely alienate the same underserved medicare population that was part of the reason you went into medicne.   Then you look at the schedule and realized that you won’t be able to have months off for vaction to travel or otehrwise like in undergrad, but then you realie that you’re actually looking forward to going to work and that you’re amking a difference in that patients life and that makes it all worth it.  Then the next day you don’t remember which types of bacteria are gram positive rods when you just spent months studying for a test that covered all that, and feel like stupid.n… Then you run up and down flight of stairs just to get a hold of medical records of another hospital to get the records of another hospital.  Then get placed on hold, then find out that they never received the fax.  Then you wonder why in 2015 you can’t just send a picture of the document or why there still isn’t a  central database where all hospitals can access a patients info.  Then after many calls back and forth and holds, you realize that the other hospitals’ records don’t match this hospitals’ so the patient was given a higher dose of pain meds than necessary, causing the patient to be somnolent and barely responsive.  Then you worry about whether or not someone will take you for residency and after that how long it was pay off these pesky loans.  Then you have the nurses who treat you choose to be less than helpful,  but you can’t blame them cuz it because being nice probably leads to being overworked and over questioned by these pesky students who don’t know much.  But we’re still a part of the medical team and want to be respected as such.    But we’re the bottom of the bottom because we’re paying to be here and everyone else, including the janitor, is being paid to be here.  Then you think how great it is to be learning about the human body and get to see God’s intricacies everyday, and find peace in the fact that you’re making subtle differences in people’s lifes

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Zebras

MAY 29, 20162 COMMENTS

Sometimes medicine is like putting together the pieces of a puzzle.  We had a patient who has been in and out of the clinic and hospital, depressed from not being able to determine the cause of his chronic illness.  Over the years, doctors had run multiple tests to determine the cause of his systemic skin problems and lung problems.  It got the point where we couldn’t provide any answers, so we had to release him.  Then suddenly an obscure lab result led to further investigation and the eventual confirmation of a suspected diagnosis.  The patient was elated and for the first time, eager to come back to the hospital.  Now we can finally begin treatment with prednisone.  It is important to have a diagnosis, because steroids can cause multiple adverse effects such as impairing wound healing or worsening osteoporosis, but with a diagnosis you have studies that can confirm that the benefits outweigh the risks.

EDIT

MAY 21, 20162 COMMENTS

The night shift hasn’t been so bad so far.  Initially I was thinking that I would have to stay up the whole time (7pm-7am), but I’ve been able to get more sleep then expected if it’s a slow day.  Yesterday, we only had three patients, so I got a full night’s rest.  The call room for the students is pretty nice, with a computer, desk, bed, and bathroom.

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Night Shift

MAY 16, 2016LEAVE A COMMENT

Tonight will be the first day of my week on the night shift.  I’ll be working 7-7, should be fun!  There is a room for medical students to sleep in with a desk for studying, but I guess it will depend on how busy we are to see if I’ll be using that room or not.

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Relationship Advice

MAY 14, 20161 COMMENT

I always assumed that residency is when it would be really difficult to sustain a relationship (especially a new one), as the partner realizes how little they will see the resident who is usually studying, in the hospital, or too tired to function.  Boy was I wrong.

Today I learned the formula to relationships during residency from a resident at the clinic who is an expert on the topic. Apparently,  the number of girlfriends you should have during residency should increase linearly in proportion to your year of residency.  During year 1, you’re still trying to figure things out with the hospital system, having increased workload, complicated and chronic pain patients that get passed down from more senior residents, and the other “hazing” that accompanies first year of residency.  Therefore, you can only handle one woman at a time.  Then you gradually get more and more accustomed to the processes, get better with time management, and get faster with seeing patients, procedures, and paperwork.  Naturally, you use the extra free time to add another girlfriend to the roster.  By third year of residency, you’re pretty much a full fledged physician, and you have more autonomy and ability to trickle tasks down to the interns and 2nd year residents.  Of course you then add the last girlfriend to the roster.  Today was the first time I heard of this, but it’s common sense, I’m surprised they didn’t mention this during orientation.  It’s definitely something that needs to be addressed in the future.

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Death

MAY 12, 20162 COMMENTS

A constant fluctuation of emotions, whether revealed or concealed, accompany the practice of medicine.  Death is one of these unavoidable triggers of emotions.  I experienced the death of a patient for the first time this week.  The art of being a physician is more than just knowledge of how to diagnose and treat the disease, but also how to manage the expectations and emotions of a patient and their families.  When diagnosing a terminal disease, whether it be pancreatic cancer, advanced heart failure, or chronic organ failure, the hardest part is often breaking the news to the patient and families.  As difficult as this can be on the family, sometimes dealing with sudden, unexpected deaths can be even harder.  As doctors, we can estimate, but we are never certain of when a patients life will end.  You can image the agony of a family who had no idea that a disease of a relative would progress more quickly than expected.  Words that will forever remain unspoken, grudges that can no longer be rectified, or expectations that will go unfulfilled.  Sometimes the anger of a sudden death or quick change from a stable to unstable patient, will leave the physician as the blunt of the blame, whether justifiable or not.  We are taught to discuss the code status of the patient during the first visit, but it is often a question that goes overlooked.  Questions for the physician begin such as when will be a good time to talk to the angry family about options for resuscitation?  How would the family react to 20 people in a room crushing the ribs of an old man or woman in attempts for revival?  Is the patient competent to make their own decision?  Which family member should have the ultimate say?  Is there a chance for this patient to regain normal mental capacity?

Throughout all this, the physician is required to maintain composure, suppress their emotions, and address the family and develop a plan on how to proceed next.  Then go on to address other patients that have been squeezed into a tight schedule without a moment to fully process the moment.

I had a chance to witness residents an attending physician address this situation with a level of empathy that cannot be feigned.  They addressed the families concerns and explained the disease, while walking a tightrope in the middle of being too reassuring or too insensitive.

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FM Rotation

MAY 5, 20161 COMMENT

Family med so far has been interesting.  I split my time between the hospital and a clinic nearby.   According to the residents, these last few days have been unusually slow, as we have only had one or two patients come in to the hospital per day.  However, the patients we did have were pretty complex.  I had the day off yesterday, but apparently one of the patients screamed that she didn’t want to see another med student, but this morning she was in a pleasant mood.  The beauty of the rotations is that now I am able to make connections between the information I learned in the textbooks and finally apply it to a patient, it makes the studying and  learning much more fun.  There is a steep learning curve when it comes to learning the electronic medical records, drug names and dosages, questions to ask of the nurse, fax numbers, interpreting lab values, and coming up with an assessment and plan to present to the residents and attending physician.

EDIT

Beginning rotations

MAY 1, 2016LEAVE A COMMENT

It’s starting to get real now. I begin my family med rotation tomorrow. I never thought I’d be this excited to receive a pager, but they used to be so cool when I saw the older people with one when I was just a young lad.