A Scribbled Story on the back of my Ob/Gyn Orientation Packet

The woman was clutching her left shoulder with her right hand. Intermittently, as she spoke, she would press against it, as though she could fix her heart by coaxing the arm into a well-massaged, relaxed and quiescent state. Her skin was loose and wrinkled, falling away from her hands, her arms, her face, her bones that were most likely thinned out and brittle. Despite drowning in her own skin, she looked her stated age of 82. Maybe even a few years younger. I had originally approached her and let my crossed arms lay on the railing that had been pulled up from her emergency room bed. But regardless of my physical closeness and what many have told me is a great bed side manner, the woman did not warm up to me initially. She was serious. She had a serious complaint, of course, otherwise why bother taking a day off work going to the emergency room. She would later tell me that she worked as a Walmart cashier. She loved working there, being surrounded by people. She didn't want this job--this world--to be taken away from her because she didn't take the warning signs of a heart attack seriously. 

- true story from my emergency medicine rotation -

Assumed, Actual, and Average Performance: Preparing for the horrors of Step 2 using the defense mechanism of Intellectualization

In exactly one week (7 days -- 168 hours -- 10,080 minutes -- you get the idea) I will be sitting in a prometric testing center taking, depending on whom you talk to, the most important test I have ever taken capable of determining all of my future career successes, or just something I need to pass to graduate: The United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge.

Tensions are running high, but I am actually quite proud of myself. I began studying weeks, no... months ago, and I find that even though I only have a week left, I am doing a lot less cramming than I had to do for Step 1. And I actually might finish reading an entire review book cover to cover. I may actually do well on this exam.

But do you know what's more important than doing well on exams? Knowing, fairly accurately when you leave the testing center, that you have most likely passed the exam with a 95% confidence interval (did I use that term correctly? I still haven't studied biostatistics). Which is why I have begun analyzing my Usmleworld QBank tests. Upon hitting submit, I quietly contemplate how well I think I may have done, remembering how many questions I "knew" verse how many were "good guesses" verse the inevitable "I have narrowed it down to two, equally likely choices" verse "I have not heard of any of these conditions. I will choose the answer choice that seems most viable." Then I write down my assumed score. Then I write down my actual score and the national average for those 44 questions.

Test Results of QBank tests numbers 93 through 101

What conclusions have I come to? First, my actual performance varies widely. Hopefully over my next tests I can become more consistent, although this isn't likely. I believe this is the nature of any test designed to ask many questions on broad topics.

Second, my predictions are much more conservative than my actual performances. Which is nice to know, although a given: more people feel like they failed an exam than actually did, at least in medical school.

Third, my predictions seem to follow my actual scores fairly closely, although doing really well on test 94 improved my confidence so that on test 95, I assumed I did much better -- even though I in fact did much worse.

And now I have to study for at least six more hours before I can go to sleep. I love summer break.

"Unique Opportunity" for the PCP (i.e., psychotherapy)

"Primary care practitioners have a unique opportunity to address the emotional needs of their patients, but regardless of their importance, these needs must be handled in a time-effective manner. The psychosocial aspect of patients' problems must be effectively addressed within the regular 10 or 15-minute medical visit. The therapeutic goal is to help patients reorganize some small aspect of their self-concept or behavior in a more comfortable, productive, or, at minimum, less destructive manner. The healing grows out of the established practitioner-patient relationship."

Stuart MR, Lieberman JA III. The Fifteen Minute Hour: Therapeutic Talk in Primary Care. United Kingdom, Oxon: Radcliffe Publishing Ltd.; 2008.

Very interesting thought. And I suppose, a good goal for someone like me who--if I ever become comfortable enough with it--would spend much more than 10 - 15 minutes on therapy with a patient.