Friday, August 26, 2005
Like YIKES, dude! I had a pretty long day with 1/2 taken up by lectures. Every Friday is like that. I was super sleepy but went to pick ML up at her lab and we road the bus home together. We took a nap, which for me is usually 15-20 min if I'm pretty well rested. Well this was 1.5 hours! I started noticing that I felt a little crappy and that my back was a little tingley--a bad prognostic factor for me. Took my temp and it was 100.0F! which is a pretty big fever for me. I'm usually rock solid at 98.6F. I really don't feel all that badly, but the thermometer tells a different story. I suppose it is good that I have it during psych rather than one of the more difficult rotations, and that I was planning on studying all weekend anyway. Poor poor me! ;-)
Monday, August 22, 2005
I did something insanely normal today after work: I washed and waxed my car! I think this is the first time I've actually waxed it, which is sad. I was going to exercise after work, but I decided that the car really needed it because it had been attacked by birds earlier in the week. I was going to do it this summer, but never got around to it. The odd thing is this: I did not take a picture! Maybe tomorrow when it is actually sunny outside.
Sunday, August 21, 2005
Make that 164 tomatoes! But we are starting to come to the end of the crop...I think! There were a second wave of flowers not too long ago but it will depend on the weather, ultimately.
There’s this thing called “learned helplessness.” It is exactly what it sounds like it is and it is pervasive in medical school in its purist form. (Yes, I was trying to see how many i’s I could fit in that less sentence.) One acquires learned helplessness by having an authoritative body subtly and continually break your ego down--especially in such a way that there is utterly no recourse. One of the ways occurs when an attending decides to hit you with a rapid-fire pimp session on details that even the fellows do not know and continues despite the obviousness of the fact that you don’t know the material. In fact, the other attending in the room does not know either. I got slammed last Monday in a team meeting, but that’s okay. They don’t bother me so much, but I did have a lot of people giving me condolences afterwards, in private of course, because no one is willing to stand up to such onslaughts--including myself.
Alas, that is not as egregious as what goes on with the M3 grading. That is where the real damage is being done to me. In theory, 15% of each group is supposed to get honors, 35% get high pass and 50% get pass. I have been working extra hard since so some of the deficit in my board score can be made up but I keep hitting this wall: I am ranked in the top 10% of the class but not recommended for honors. So, how can I be in the top 10% but not 15% you ask? I asked one of the professors that question and this was the answer I got:
I truly think that all of our students are above average (the Lake Woebegone effect), so you can be in the top 10% but not be in the top 15%! As you know, if a student gets a 4 or below they are put on the "watch list", so everyone gets 5s or greater, unless they are truly lousy which is very uncommon. I rarely rank anyone for honors this early in the year particularly when i only work with them for such short intervals; that may be unfair but i just cant assess well enough since everyone is rel. clueless at the start of year 3. In any case, my my review will have virtually no impact! Whether you get honors or not will really depend on those that have had the most contact with you, esp. in Gen Med month and your subsp. month. Cyril is very good about consolidating all the reviews and knows who the "easy" and "hard" graders are.
Yes, most of what is in the second paragraph is true except the no impact part. I think it will have an impact, but, what is worse is they’re doing it wrong. I get to you plural here because I have another review that has me in the top 10% but not top 15%. I have not asked the other doctor as to how that reconciles.
Let me pump your ego with my left hand, but, please ignore this nice surgical needle in my right which I will use to completely deflate you. And so we have learned helplessness.
But wait! You say to me, “why don’t you call this Cyril person and see what’s going on?” Excellent question! I did. I asked him for a quick 5-10 min phone call and said that he could page me and I’d call him back. That was at the beginning of last week. I may pop in to see my class counselor next week and see if he can shed some light into the situation.
On the lighter side (isn’t there so often a lighter side?) our tomato garden has provided 132 vine-ripe tomatoes! Well, maybe a half dozen were still green. I’ve made two batches of spaghetti sauce, one batch of tomato soup and one batch of salsa. Not to mention using them in a lot of our at-home-dishes! YUMMY!
Cool! I just figured out how to put pictures right into the blog! (It's also the first time I actually tried...) No, that's not all 132. It's just some of them.
I suppose there’s also a medical school lighter side. I’ve been in my psych rotation for a few weeks now and the doc’s are letting us do more and more. We saw one patient with her husband and I performed the interview. She is older and has a lot of recent medical issues that have resulted in a colostomy. She also lost one of her daughters and that still has overwhelming emotions for her. She has been trying psychotherapy alone for several months now and the therapist thought the she may benefit from medical therapy in addition to the talk-therapy. In general, the two work better together than either one separately. She was VERY reluctant to the additional medication as she is already on a handful and she was worried about interactions and cross-reactions. I explained why we thought the SSRI would help her work through her problems faster but that it was ultimately her decision to make. We provided a prescription in case she decides to try it and scheduled a revisit in a few weeks--which is important if she starts the medication. Apparently, she enjoyed my help so much that she called the doctor and left her voicemail requesting that I be at the next appointment! That would be patient #4 that wants me to be their doctor! The others were in cardiology--they wanted me to be their cardiologist. I wonder what a dual fellowship would be like? So, now that the grading process has beaten me down so much, I have to publicly pump it back up. Hmmm, I wonder how that makes me feel? (Psychiatrist joke there!)
Time for our traditional Sushi.come Sunday lunch!!!
Alas, that is not as egregious as what goes on with the M3 grading. That is where the real damage is being done to me. In theory, 15% of each group is supposed to get honors, 35% get high pass and 50% get pass. I have been working extra hard since so some of the deficit in my board score can be made up but I keep hitting this wall: I am ranked in the top 10% of the class but not recommended for honors. So, how can I be in the top 10% but not 15% you ask? I asked one of the professors that question and this was the answer I got:
I truly think that all of our students are above average (the Lake Woebegone effect), so you can be in the top 10% but not be in the top 15%! As you know, if a student gets a 4 or below they are put on the "watch list", so everyone gets 5s or greater, unless they are truly lousy which is very uncommon. I rarely rank anyone for honors this early in the year particularly when i only work with them for such short intervals; that may be unfair but i just cant assess well enough since everyone is rel. clueless at the start of year 3. In any case, my my review will have virtually no impact! Whether you get honors or not will really depend on those that have had the most contact with you, esp. in Gen Med month and your subsp. month. Cyril is very good about consolidating all the reviews and knows who the "easy" and "hard" graders are.
Yes, most of what is in the second paragraph is true except the no impact part. I think it will have an impact, but, what is worse is they’re doing it wrong. I get to you plural here because I have another review that has me in the top 10% but not top 15%. I have not asked the other doctor as to how that reconciles.
Let me pump your ego with my left hand, but, please ignore this nice surgical needle in my right which I will use to completely deflate you. And so we have learned helplessness.
But wait! You say to me, “why don’t you call this Cyril person and see what’s going on?” Excellent question! I did. I asked him for a quick 5-10 min phone call and said that he could page me and I’d call him back. That was at the beginning of last week. I may pop in to see my class counselor next week and see if he can shed some light into the situation.
On the lighter side (isn’t there so often a lighter side?) our tomato garden has provided 132 vine-ripe tomatoes! Well, maybe a half dozen were still green. I’ve made two batches of spaghetti sauce, one batch of tomato soup and one batch of salsa. Not to mention using them in a lot of our at-home-dishes! YUMMY!Cool! I just figured out how to put pictures right into the blog! (It's also the first time I actually tried...) No, that's not all 132. It's just some of them.
I suppose there’s also a medical school lighter side. I’ve been in my psych rotation for a few weeks now and the doc’s are letting us do more and more. We saw one patient with her husband and I performed the interview. She is older and has a lot of recent medical issues that have resulted in a colostomy. She also lost one of her daughters and that still has overwhelming emotions for her. She has been trying psychotherapy alone for several months now and the therapist thought the she may benefit from medical therapy in addition to the talk-therapy. In general, the two work better together than either one separately. She was VERY reluctant to the additional medication as she is already on a handful and she was worried about interactions and cross-reactions. I explained why we thought the SSRI would help her work through her problems faster but that it was ultimately her decision to make. We provided a prescription in case she decides to try it and scheduled a revisit in a few weeks--which is important if she starts the medication. Apparently, she enjoyed my help so much that she called the doctor and left her voicemail requesting that I be at the next appointment! That would be patient #4 that wants me to be their doctor! The others were in cardiology--they wanted me to be their cardiologist. I wonder what a dual fellowship would be like? So, now that the grading process has beaten me down so much, I have to publicly pump it back up. Hmmm, I wonder how that makes me feel? (Psychiatrist joke there!)
Time for our traditional Sushi.come Sunday lunch!!!
Friday, August 12, 2005
Hot DAMN! Reason to celebrate!! I pass both my self exam and the pattern recognition exam for internal medicine! Don't know exactly how well I did, but at least I don't have to worry about taking them again.
My mom and my "aunt" Terri were in town last weekend and we had fun kayaking down the Huron river. It is running really shallow right now and I had to get out and pull both kayak a couple of times. Otherwise, we just paled around and talked--a good time was had by all! They drove up in one day, right as 12 hours and got to go to Lake Erie and Lake Michigan while they were here. They went while we were at work. That weekend I had my first psychiatric emergency room (psych-ER) (sorry, I have to be better about doing that or my dad gets lost as to what I'm talking about). Since it was Saturday night from 1800 till 0000 (that's military time, dad), we had quite the parade of people having emergencies. Nothing too far out there, but we certainly were busy.
I had a second call last night (1800-0000) which was not quite as busy, but busy enough. Other students have reported only having one patient during their entire time. I had three last night and about five last Saturday.
The outpatient residents have started letting us conduct the interviews and that's going really well. I find talking to the patient WAY easier than dictating the note about the patient into the phone! I suspect that will get better in time, but it really doesn't matter cause I can always type it up. But, the phone may be faster once I "get up to speed."
There was one big event that happened today that I am patting myself on the back because it could negatively impact my grade. I think it is rightfully called one of my "Elliott" moments. We were in team meeting discussing this new patients case and how to best treat her. Her diagnosis is not perfectly clear but is either depression or bipolar II (depression with hypomania). The attending did a really nice quick interview with her in front of the team to elicit some of her more classic and interesting findings. Then, we started "talking" about the plan and he (the attending) was about to put this woman on anti-psychotics and Li+ for her refractory depression--which is what you do for refractory depression.
However! I "softly" pointed out that, in fact, her depression was not refractory and actually quite responsive to prozac alone. She had stopped the prozac (on her own) because she felt so good! (Which is something that patients often do when they are not carefully followed by a physician.) We'll see how negatively it impacts my grade, but there was no way in hell I was going to let him put her on Li+ (that's Lithium, dad) because of a misunderstanding in the presentation. The attending did thank me for that correction, but it seemed a little awkward on his part. So, we'll see. I have no regrets...yet.
In other news, the med school is asking for people to publicly publish their blog and I'm thinking about throwing my hat into the ring. If so, I will probably just copy the med-school stuff into that blog and this one will be a mix of personal stories and medschool. Yea, I think that's the way I'll do it if I'm selected.
Now, I just have to wait for my loving wife to get home so we can go out and celebrate!
My mom and my "aunt" Terri were in town last weekend and we had fun kayaking down the Huron river. It is running really shallow right now and I had to get out and pull both kayak a couple of times. Otherwise, we just paled around and talked--a good time was had by all! They drove up in one day, right as 12 hours and got to go to Lake Erie and Lake Michigan while they were here. They went while we were at work. That weekend I had my first psychiatric emergency room (psych-ER) (sorry, I have to be better about doing that or my dad gets lost as to what I'm talking about). Since it was Saturday night from 1800 till 0000 (that's military time, dad), we had quite the parade of people having emergencies. Nothing too far out there, but we certainly were busy.
I had a second call last night (1800-0000) which was not quite as busy, but busy enough. Other students have reported only having one patient during their entire time. I had three last night and about five last Saturday.
The outpatient residents have started letting us conduct the interviews and that's going really well. I find talking to the patient WAY easier than dictating the note about the patient into the phone! I suspect that will get better in time, but it really doesn't matter cause I can always type it up. But, the phone may be faster once I "get up to speed."
There was one big event that happened today that I am patting myself on the back because it could negatively impact my grade. I think it is rightfully called one of my "Elliott" moments. We were in team meeting discussing this new patients case and how to best treat her. Her diagnosis is not perfectly clear but is either depression or bipolar II (depression with hypomania). The attending did a really nice quick interview with her in front of the team to elicit some of her more classic and interesting findings. Then, we started "talking" about the plan and he (the attending) was about to put this woman on anti-psychotics and Li+ for her refractory depression--which is what you do for refractory depression.
However! I "softly" pointed out that, in fact, her depression was not refractory and actually quite responsive to prozac alone. She had stopped the prozac (on her own) because she felt so good! (Which is something that patients often do when they are not carefully followed by a physician.) We'll see how negatively it impacts my grade, but there was no way in hell I was going to let him put her on Li+ (that's Lithium, dad) because of a misunderstanding in the presentation. The attending did thank me for that correction, but it seemed a little awkward on his part. So, we'll see. I have no regrets...yet.
In other news, the med school is asking for people to publicly publish their blog and I'm thinking about throwing my hat into the ring. If so, I will probably just copy the med-school stuff into that blog and this one will be a mix of personal stories and medschool. Yea, I think that's the way I'll do it if I'm selected.
Now, I just have to wait for my loving wife to get home so we can go out and celebrate!
Monday, August 01, 2005
I started psych today. It is MUCH better organized than internal medicine! This afternoon I had Adult out patient and met a young lady who has recent onset of depression. We found out that she had been molested by her grandfather twice when she was very young. We were the first people she ever told and it was very sad. It took her about 5 minutes to finally say it. I was almost crying by the time she said it because I knew pretty much what she was going to say. She'll get counseling for that and I think that will help her a great deal. Tomorrow, I will have Child psych all day. Both of these are up the street, which is nice.
Oops! Time for bed! G'night!
Oops! Time for bed! G'night!
