Tuesday, February 14, 2006
  Match day...
First of all - Happy Valentine's Day! I hope you were able to tell all your loved ones how you feel for them: good or bad :)

Yesterday was Match day. The day when the magical computer program does whatever it does and medical students find out where they will spend the next years of their lives. At least, if you go to an Osteopathic medical school...

As I've stated before, I go to an Osteopathic medical school and I've chosen to participate in the AOA match - for better or worse. So, yesterday was the day I learned my fate, where I will spend the next year training as an intern.

It really is not as bad as it sounds. My fiance and I (it feels weird to type that word here instead of girlfriend, but I should call her by the correct title) went through the match as a couple, and so we are both going to the same hospital. It wasn't our first choice, nor our second, but at least we didn't have to go too far down the list and at least we matched!

We will be spending the next year at Geisinger Medical Center in Danville, PA. I interviewed there in the beginning of January and liked it - even though it is truly in the middle of nowhere. The hospital is actually HUGE and has a cachement area of over 2.5 million people. This single hospital serves as a tertiary referral center for most of central and northeastern Pennsylvania. Other good things about the hospital include an active Emergency medicine program (which makes me happy) and a pediatric hospital attached to the main hospital (which should make her happy). Downsides include the relative isolation of the hospital, the size of the town, and the fact that it is one of two programs to which we applied that are not dually accredited by the AOA and the ACGME. While I do not think this will be a program given the volume of patients the hospital treats, we mostly applied to dually accredited programs to ensure the training we received meets the highest standards.

While I am disappointed we didn't match at our #1 or 2 program, I'm actually excited to be going to Geisinger. I think it will be a good experience. I think it will be exciting to live in an area completely surrounded by mountains (you can't look in any direction and not see them), and it can't hurt to be within 1 or 2 hours drive of a half-dozen ski resorts. The area is also purported to have excellent hiking trails and picturesque state and national parks within close proximity. It doesn't hurt that Danville is also King of Prussia Mall. I know she'll be happy about that - she'd spend all day, every day at that mall if she thought she could get away with it!! New York City is also within 3 hours, with its endless entertainment opportunities!

I just wish I knew we'd actually have time for all this fun!

Of course, I still haven't even considered having to re-apply for residency next year - but that is another post for another time. I still have a new Personal statement to write and a wedding to plan!

Tuesday, February 07, 2006
  Delayed Gratification
As if going through college, applying for medical school, and going to classes for more years than you thought you were capable wasn't bad enough, after you're done with all that and your life-long dream of becoming a physician has finally come true, you're faced with residency.

Or, in my case: Internship, then residency.

Why did I choose to pursue an internship before applying for and entering my final residency? Several reasons, actually.

While some may have no cares in the world, may fly through life willy-nilly with the only dream they have left being to complete their training and finally become that attending physician they've always dreamed they'd be - I have other dreams. I've dreamed many things, one of which is the very same as I just "said." Who wouldn't love to have no other obligations except to themselves? I know I would.

However, I've made choices that forever alter my course in life. I have others to concern myself with - my girlfriend being one of them. We are in a very committed relationship and have made the decision to try and stay together throughout our residency training - something that is not easy, but not impossible. We are couples matching, which means we have decided to link our rank lists in such a way that unless both of our lists match exactly with the programs we have ranked, neither of us will match. I don't foresee any problems next week or down the road. However, it is a choice that has altered my training decisions.

When I decided to attend an Osteopathic medical school, I made a committment as well - a committment to follow the recommendations and requirements of the governing body for Osteopathic physicians: the AOA. Currently, the AOA requires a traditional internship for licensure and acknowledgement by the AOA. Thusly, I have applied for an internship this year, and will be re-applying for my final residency next year.

Finally, both my girlfriend and I want to transplant to another part of the country. Since we have both spent some time in the northeastern part of the country and liked it, we've decided to seek our training in that part of the country.

Given this mixture of conditions, we've decided to pursue an internship together and to reapply for our final residencies next year. We both have decided that in order to be together, it is worth delaying our final training.

Besides, what is a year? I've spent 28 of them getting to this point.
Monday, January 23, 2006
  I'm so sorry...
As I stated in my main page, I've been very lazy and have not actually blogged in a few months. I feel terrible about it. Ah well. I can always pick it up again, right? All is forgiven and forgotten.

The latest news is such:
  1. I received my scores for the COMLEX Step II PE in late December. I passed!!! Nothing to worry about now - smooth sailing until graduation.
  2. I certified my match list today. Match day is February 13, 2006 - less than 3 weeks away! I'm so excited. Soon, I'll post my match list with some explainations.
Enough for now - I must go. I'm relaxing before bed so I can work again tomorrow.

Au revoire
Wednesday, November 09, 2005
  The "Doctor" Difference
I must admit that I've been reading the forums too much and my perceptions have probably been just a bit jaded by some of the things I've read there. I already know that I am quite cynical by nature... I think I was born that way :)

Bear with me, I'm coming to my point:

About every week, there is an argument about who should or should not be called "doctor." I'm sick and tired of it and I think the term doctor should be abandoned completely.

Once upon a time, doctor meant teacher and friend. Somehow, over time, it has come to mean something more (or less, depending on your point of view). A doctor was a family friend (every family's friend, actually) who would take care of anyone because they needed the care. He was given respect for what he did and his willingness to come out at anytime, day or night, whenever he was needed.

Progressively, however, doctor has come to mean less and less friend and more and more a demand for respect, whether it was earned or not. I've written about this before - see this link for the previous post.

Now, there is concern, given the fact that patients are confused by numerous health care providers and hospital workers (nurses, techs, physical therapists, nutritionists, pharmacists, social workers, housekeeping, dietary, NPs, PAs, and physicians) and begin to call all of them "doctor." Is there anything wrong with this? Yes and no. There is nothing wrong with it if the person corrects the patient and says "No, I'm not your doctor - I'm the nurse/dietitian/etc." What commonly happens, however, is the person does not correct the patient and merely goes about his/her job until finished and leaves the room. This creates confusion when the actual physician enters the room to evaluate the patient and the patient asks about something they told/asked that "other doctor" who was in fact housekeeping. See the problem?

The other complaint is what does one call a Ph.D? Ph.D is a doctorate degree and the person has the right to be called doctor, since they are a teacher, right? However, what happens if you have a RN, Ph.D? Is it then Doctor-nurse? While the nurse may have a doctorate degree in nursing, in the clinical setting he/she is not a clinical "doctor." More confusion for everyone, especially the poor patient. Consider all the other permutations - a Pharmacist who is a PharmD or a psychologist who has a PsyD, etc, etc. It only gets worse and worse with time.

My solution: noone is called "doctor" and everyone goes back to their proper titles. What was "doctor" is now "physician," PA is "physician assistant," NP is "nurse practitioner," etc. Ph.Ds will be called "professor," since Ph.D is a teaching or research degree and that is what college teachers are called. RN, Ph.Ds will be called "nurse" or "nurse practitioner" (depending on his/her training) in the clinical setting and "professor" in the research or teaching environment. Everyone will have the option of being called by his/her first and last name, however, so long as your job is clearly explained and displayed for the patient.

This will alleviate a lot of problems of confusion for everyone, and will stop some midlevel providers from trying to back-door their way into the title of "doctor" in an attempt to legitimize their plea for independent practice rights.
Friday, October 28, 2005
  Step II COMLEX and USMLE passed
I finally received the score from the COMLEX part II today (well, I didn't receive it - it was finally put online where I could view it). I passed, pretty convincingly. On COMLEX step 1, I scored in the 99th percentile nationally. I repeated that performance on step 2. The same for USMLE steps 1 and 2 - with the exception that I scored in about the 94th percentile on both in the nation. Still, very impressive in my opinion.

I'm still waiting on my PE score - which I think will be in about 3 months, but I may be surprised. They told us 10-12 weeks for scores to be released. I don't know what they are waiting for. They should have the score almost that day, except our progress notes, which they scan and send to various parts of the country to be graded by actual physicians. The rest of the exam is graded by the lay performers who are paid to act like they are sick.

Wonderful system, huh? Physicians being graded by people with no medical knowledge. Sounds like we're asking for trouble...
Friday, October 21, 2005
As threatened, I took the physical examination portion of my medical board exams today - the COMLEX PE (Comprehensive Osteopathic Medical Licensing EXam) Physical Exam. Ever since I first heard we were going to be required to take this exam nearly 3 years ago, I have been (usually quite vehemently) opposed to it. When the president of the AOA (American Osteopathic Association) came to our school to "answer questions" (read: tell us what he wants us to know and avoid answering any questions we might ask), I was there asking what was the need for this exam when the schools test us on the exact same things that were to be tested on this exam.

The reasons we were given is that there was a "public outcry"to the schools of medicine to prove that their graduates are adequately trained to talk to patients and take medical histories and perform physical exams. This test has been around for years - it was previously administered only to foreign medical graduates who wished to enter residency training in this country, and it was called the Clinical Skills Assessment (CSA). Everyone knew the exam basically tested proficiency in spoken English language and had very little to do with actual clinical skills. This is one reason I opposed the exam - everyone graduating from a US medical school already has demonstrated English proficiency and does not need to be tested on their English language skills.

So, the arms on the clock have turned enough times that I have now taken this exam. Still, I claim it is a waste of time and a very large amount of money. The exam charge is $995.00, which is outrageous enough until one considers the exam is administered in only one place in the US - Conshohocken, Pennsylvania. This means that all 4th year students from all Osteopathic medical schools must travel to this one site and take the exam. Travel and lodging is not included in the exam fee, nor was it included in my loan disbursement. I was told that I would need to "budget carefully" to allow extra money to travel to the site and stay in a hotel (for an average of $150 per night) while there. All this to take a test that has not been proven to be necessary by any study or even common sense.

Needless to say, I'm a bit pissed. I'm even more angry after having taken the exam. It was poorly designed, poorly run, and I assume will be poorly scored. From what I understand, something on the order of 96% of exam-takers pass the test, if not more. This means that basically, I could have gone up there, given the NBOME my $1000 and (statistically) walked back out without having to waste a whole day taking this ridiculous exam.

Why is it poorly designed? Let me explain: The exam uses Standardized Patients (SPs) as their subjects. They are "extensively trained" to perfectly emulate whatever condition they are supposed to "have." They use a series of tricks to try to emulate physical exam findings - none of which are particularly successful or accurate. For instance, if one is trying to elicit reflexes and they want to show them to be decreased, they will contract their muscle as you strike the tendon, thereby diminishing the visible reflex. On the other hand, if they want to show hyperactive reflexes, they will exaggeratedly flex the muscle after the tendon is struck. These two are the most believable methods they use to fake physical exam findings. Others they use is saying "Hush, Hush" while you listen to their heart to fake a murmur, moving their chest wall and not actually breathing to emulate decreased breath sounds, whistling to emulate wheezes, and more.

The problem with these maneuvers is that they are not realistic, and they are frequently inaccurate. For instance, on several patients, I thought they were trying to emulate "crackles" in their lungs, but I could not tell what it was they were trying to do, since I had no idea what their "trick" for making crackles is. Maybe they were trying to emulate "crackles," but maybe they are just coarse breathers. I couldn't tell. All I know is that it didn't sound like any crackles I'd ever heard before.

I suppose we'll see how it all turns out in the end. I'm expecting my Pass/Fail score sometime in January 2006. I expect to have passed, but I really think it's a toss-up. I could have flipped a coin at the front desk and had just as good a feeling about the outcome of the exam as I do now. Funny for someone who always as people remark to him how good his clinical skills are, eh?
Sunday, October 09, 2005
  Another night on call
This is now my third call night - and the second with my current intern.

A few things have changed since my last call - we have a new attending, who everyone said was very hard-nosed and would chew you out for nothing. On the contrary, I have found her to be quite amiable and easy-going. This was a great relief, since our first day with this attending was after my second call. I was having palpitations at the thought of having to present all my patients to her from memory, since she does not like notes being used for presentations.

Anyway, aside from that big change, Ashleigh is now on my team. That means we are on call together - and also that we had Saturday off together. What did we do with our awesome time off? Well, we got rained on... a lot. It dumped about 6 inches of rain on us on Saturday, causing so much flooding it shut down many of the highways and flooded most of the major rivers in southeast Pennsylvania! The good news is that we left early enough in the morning that everything was not completely flooded and we got back just before they shut all the roads down.

We left at about 1130 to go to King of Prussia, Pennsylvania to their HUGE MONSTROUS mall. The mall is so big, it is two buildings!! Something like 400+ shops and restaurants are housed within this monstrous complex. It was freaking HUMONGOUS!! Other than that, I wasn't too impressed. I got to spend some time with Ashleigh, so that was nice, but I'm not a big mall person. Obviously, she is.

So, after my (almost) eventful day on Saturday, now it is Sunday (or by the time I'm done typing this, Monday) and I'm on call. So far, I've had one admission and one consult. The great thing about having Ashleigh on the team is that now we split the admissions :) That's ok - Ashleigh has only seen one consult and no admissions thus far. In fact, as I type this, she is asleep in the call room - hopefully for the rest of the night. I'm hoping we're done (knock on wood) for the evening.

The final BIG change that's happened in the past few days is that with the new attending came new rules. Since Ashleigh and I are 4th year medical students, we're now being treated more like interns - we are seeing our own patients (mostly) independently, writing their notes and their orders and having them co-signed by the intern. Our intern loves it, since he doesn't have to do much, aside from make sure we don't kill anyone :) Just kidding. I think we're doing pretty well for ourselves here.

Ok, I should probably go to bed soon, so I can be fresh and chipper in the morning for rounds bright and early.
Ahhhhh.. 4th year. If the rumours are true, this will be a cake walk. Herein is my online account of my 4th year of medical school - follow with me to see if the hype is true or lie.

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