13 doctors vs. 1 patient

So I am currently on the inpatient portion of my pediatric rotation.  I loved the outpatient portion.  I was able to see patients, talk to patients, examine patients, etc.  I am currently at a large teaching children’s hospital.  Every morning our group of 2 interns, a senior intern, 3 medical students, an attending, fellow, nurse, social worker, nutritionist and whomever else decided to jump on the bandwagon goes around and talk about patients.   This is why I don’t like inpatient medicine.

 
In my opinion the focus is not so much on the patient himself, but rather what problems he has, what medications he is taking, and what orders need to be placed.  It is more of a logic game than taking care of patients.  The day is spent writing notes, charting hospital courses, walking around the hospital and writing history and physical notes rather than talking to and examining patients.  I know I never want to be treated at a teaching hospital.  While the quality of care is high, I simply can not stomach having 12 people examine me by the bedside at 6 am.  I have experienced this – being a patient in a teaching hospital and it was the most awkward experience I have ever had.  I was forced to tell my story to about 9 people sitting around in a circle in some strange room.  Not for me.  I really like pediatrics, but the inpatient experience seems to have ruined it for me.  I don’t understand, and never will, why all residences and internships have such a strong (i.e. exclusive) focus on hospital medicine.  Even in family medicine, where the vast majority (if not all) residents and interns will work in a non-hospital setting, the majority of training is in hospital medicine.  The same is true for internal medicine – even for residencies with so called “primary care tracks” the bulk of time is spent taking care of hospitalized patients.  I simply don’t get it and honestly didn’t think this out when entering medicine.  Sure the training is good, but if you don’t want to work in a hospital this is an awful amount of time to sacrifice working in a setting that brings you little joy (i.e. at least 5 years).

Most of the interns are younger than myself which is fine as long as they are nice.  I recently had a super awkward interaction with one hat obviously had no idea how to interact with people.   I asked her about a patient that was on our service and she snapped back with a contorted face “this is our patient”.  Okay, first I was trying to be nice.  Second you look 12.  It was only after this interaction that I was warmed about this particular team and how medical students should not interact with them.

Call is also another shitty part of being a medical student.  I am not going into a profession where I will have to work twice as many hours a week as the average person.  Even with hour mandates, residents are capped at working 80 hours a week with no more than 30 hours in a row on call.    I have done these overnight calls, and except for the bravado of being able to brag that you worked a 30 hour shift, there is no educational benefit of being at the hospital that long.  I am going into primary care, because there is absolutely no way ever I will work an 80 hour week.  Even the though of doing so in residency makes me want to vomit, but just one more hoop to jump through before I can finally work in a community clinic and have a somewhat normal life again.   I love certain aspects of my training and learn a lot, but there are several things I can not stand.

Those who have never had a normal life outside of medicine and school can’t understand it – but medicine cannot be shoved down someone’s throat 24/7.  Let’s take an example – I recently had a late evening call until 9pm (after arriving at 6 am) which was fine.  However during the day there was a teaching session, followed by rounds (educational), followed by two more teaching sessions during the lunch hour.  There is only so much education I can take.  Never in working in the hospital have I had a lunch hour as they are always taken by lectures.  All I ask is one hour free of medicine and duties to not have to think about medicine and not be in the hospital (i.e. leave if I want).  Is that too much to ask? Isn’t this part of union’s such as SEIU push to have employees have breaks during the day? There came a point when my brain was tired and I didn’t want to hear anything about medicine anymore so I just shut down and stopped listening.  I decided this was fine, since it was the only break I was going to get.  I miss being able to eat lunch in a park with coworkers, maybe god forbid even go to a scheduled doctor’s appointment during the lunch hour.   Nope, not on hospital medicine.  You will shrivel up since you are never exposed to sunlight so you better take you Vitamin D.  One poor intern told me she never sees light since shes been on night shift for two weeks and must make sure to take her vitamins.  Sad.  Well soon I will be out of all this ane be nonethewiser.  And at least I’ll be damn good at writing a hospital progress note and eating nonnutrtive snacks such as candy and caffeine all day and night and evening and morning.

So what is studying for the United States Medical Licensing Exam Really like? Going loco down in Acapulco (aka my desk and computer)

So I have seen posts from my friends on Facebook complaining about MSI finals, and how much they never want to see biochemistry.  Well as I have commented, studying for school is nothing compared to when you have to study for the USMLE Step I (for non medical folks – this is the first part of the three part licensing exam that medical students have to take after their second year of medical school.  The score attained determines your admission to residencies, how selective you are for certain residencies, etc.).  Unfortunately your biochemistry will come back to haunt you for hours on end for days on end.  Here is a typical day of studying.

9:00 Wake up

9:00-12:00 Typically watch 3 lectures – I am doing a review course called Doctors in Training which is a series of about 120 videos and quizzes.  I will not comment about this course here.

12:00-1:00 (“lunch” in my schedule but I usually don’t take this and just work through it)

1:00-4:00 ish More videos and quizzes

Maybe a break, walk my dogs some dinner. Maybe nap.  Maybe workout.  Maybe use Facebook.  Try to do nothing that involves studying.

8:00-whenever More studying. More videos.  More quizzes.

Rereinse, repeat, relather X18 days till you are done with the video series.  Then move on to the 2000 questions from the question bank all day for the next few weeks.

It’s a pretty miserable existence and there is nothing that prepares you for how isolated, tired, bored, lonely (hmm did I say isolated), stressed, anxious, etc. insert negative adjective here. Medical school on crack and everyone else is so busy studying that no one talks to each other, uses facebook and everyone is in their own USMLE derived depression.  In the words of my sister (and therapist) “does it really need to be like that?” Somehow the NBME has said yes.  Would one really be less qualified to be a doctor if they took a 3 hour test instead of 7 hour test? (oh I forgot the test consists of 7 hour long sections each of 48ish questions each for 400somethingish questions).

But I try to look on the positive side.  I will be a doctor (and a damn good one) one day.   This is yet another hoop I must go through.  Someone today asked me if I would do this again, or if I regret it.  I said I would not do it again if I knew what it entailed.  I know I will not say this later down the line, but I had a graduate degree and a job before this, and if I knew this is what was coming I probably would have steered clear.  I am sure my views will change when rotations begin (at least I hope). I’m not being negative (in fact I try to espouse positivity these days to get me through) just honest.  Obviously I want this – if I didn’t the out was a long time ago and I wouldn’t have suffered through this.  I have other careers I can pursue.

I’d like to also note that a)I have still not received my grade on a practical exam taken a month ago b) I have not received a grade on a scantron shelf exam taken over two weeks ago c) have not received grades on multiple choice practice of medicine exams taken two weeks ago d) have not received grades on a mock board exam taken almost two weeks ago (we were promised the grade a week ago).  Not like I care, but I do like to get feedback from time to time.  Ahh… the administrative hurdles continue.  When I get to create my own medical school there will be rules to eliminate such issues…..

 

 

Backstage pass to exam day!

So what is a med school exam day really like? I say day, because at least in the case of my school, MS II (second year) exams typically take about a day. Here is a breakdown of today’s exam (I think someone counted this was exam #63 of our current med school career):

Arrival: 9:00 am – exams are distributed and students proceed to assigned seats.

The exam is about 130 questions and lasts 3 hours.  Students take out various snacks including bananas, chocolate, granola bars, etc. to make it through the long haul.   Several cans of Redbull, Monster, etc. appear and are opened simultaneously.  Some students wear bright orange earplugs – I’m not sure where this came from.  Perhaps it’s an evolutionary withdrawal to past behavior – you are given those orange awkward headphones to wear at the computerized MCAT testing site.  Granted we have distractions in our testing room on the first floor like garbage trucks, construction vehicles and the like.  But I’m just saying it is foreign and unnecessary to me…. But perhaps some are more sensitive to noise than others.   Test begins. During the test one must sign in and out to go to the bathroom (which isn’t so unbelievable considering you have to fingerpint in and out for most computerized standardized exams) by either the blue or pink piece of construction paper (which seems a little gender biased considering all we have learned about trying to maintain gender sensitivity).

Today’s “integrated” exam consisted of 80 hours of material from the following disciplines:

-Pharmacology: Diabetic drugs, estrogenic drugs, thyroid drugs, bone and parathyroid drugs

-Pathology: Endocrine system, male and female reproductive system

-“Clinical Medicine”: Reproduction, Urology, Endocrine and Geriatrics

Yes.  All on one written exam. And by written I mean multiple choice, since I have never with the exception of two biochemistry exams,  had to write any answers in med school that don’t fit within the bubble of a scantron.   I can see why physicians are such poor writers.

Then there’s my favorite part – not just one or two questions but BLOCKS of several questions which were clearly never covered in class.  I’m not talking about minutiae that was included in notes or lectures that one doesn’t know and clearly knows they just didn’t study or forgot, I’m talking about material that was just blatantly never taught.  I don’t know if these is because exams are recycled from year to year and professors just don’t know what is taught and what is not, but whatever the reason it’s not acceptable.  I can’t figure out what skill such questions are designed to teach us – how to make logical deduction and reasoning which you’ll have to do a lot of in medicine? The problem was it’s not like we were ever given the material or had past material to draw upon to answer such questions.  The questions related to specific terminology that was just never taught, not in lecture notes, not in lecture.   I went to every lecture live for these sections.  I challenge our dean to look through the packets and “supplemental” readings we are given to try to locate where in the objectives or lecture material such answers and information  are.   Some of the questions were extremely obscure, and clearly not part of our curriculum – and we were not directed to outside sources during the course of the unit to consult where possibly we would have gleaned such information.  I just really don’t get it – and the saddest part is that there’s no one in our administration to talk to about such things, and even if there was student wouldn’t.  Part of me doesn’t care since the school year is done and I just want to move to the next test (finals are approaching) but part of me wants to understand why we were tested on such things and change the exams for future years.  But this won’t happen.

Of course people (including myself) bitch after the exam about how ridiculous and unfair it was.  Normally, I’d dismiss this.  But in this case, I think it was warranted.

Then comes lunch.  And by lunch I mean more studying.  The lab practical is in the afternoon!!! Don’t think the day is over just yet.  The class is divided up into two groups for the lab practical – one group goes at 1:30 and the other at 2:30 and the test lasts an hour – so after the morning’s written test most students scurry to the library to cram for this exam.  The student is presented with images and asked a series of questions about many gross and microscopic images.   Most of the time it will be things we have seen in our pathology case studies and labs, but often they’ll throw a zinger (or in this case two) at you that you have never seen before.  The problem is if you don’t pick the correct diagnosis for the case presented most of the following question answers will be wrong (they purposely make answer choices so if you answer one incorrectly its difficult to answer the others correctly).

This whole day is a pattern that is repeated about once a month.  It’s really healthy!!! Especially because you don’t sleep much right before!

Then finally the day has ended and one can go nap (or in the case of many of my classmates get obscenely drunk).

And for those of you that responded that you love med school, I don’t buy it.   Some of you may be MSIVs who have a light year and have had clinical experiences that you loved in school – this I can buy.    There are several reasons one can reply that they do: they don’t want to admit to themselves that they don’t love it and are indeed sad or depressed because med students pretend everything is always peachy 24/7 because they don’t talk about emotions, social desirability (they want people to think they love it, etc.)  So I am dismissing the scientific validity of my poll.   If one needs to convince themselves that they love it in order to function, than I suppose that’s fine.  We all do what we gotta.  I thrive on being honest.  Sometimes it gets me in trouble.

5 hours of lecture later….

So I must go to bed so I can wake up in time for my 8:00 Problem Based Case Based Learning (PCL) Class.  This morning was 4 hours of lecture (8-12).  The first two hours were straight with no break since he went over the first hour.  Lots of neuro from last year but he assumed we knew it all even though we haven’t seen it for a year.  Also got concerned that all of our notes were still in the box and none of us preread the lecture.  Really? At least I told him that we didn’t know what “OS” meant (left eye – another example of clinicians not remembering we are in training and don’t remember what certain things mean) and he made an announcement.

I’m not quite sure what happened at the 1:00 pathology lecture – several people said they really enjoyed the lecture but it was way too fast for me (102 slides in 60 minutes).  Some slides he flashed for all of about 12 seconds and I could not keep track of what he was saying – yes I know there is a notetaker service so I can look back and I have numerous textbooks at my disposal – however I simply can’t learn like that and that’s the bottom line.  Had I know that is how med school instruction would be the majority of the time, I probably would have chosen not to attend.  Yes, lecturers may gifted clinicians, but there is a difference between clinician and educator.

I cam home to watch half of 90210 (my brain was shut off and I needed to do something that did not involve thinking) and took a nap.  Then I did laundry like a real person) I still have about 12 loads and only studied 4 out of today’s 5 lectures.  Guess I’ll have to do the fifth tomorrow……

Tomorrow’s lecture:

8-10 PCL (not sure what we are covering tomorrow in the case based class)

10-12 class (two lectures)

1-4 Clinic (clinical apprenticeship).

So about the same length of day I had in the working world (will be twice as long next year) – except a) I’m not getting paid and b)I’m in school.