Socially Valuable

"Remember that competitiveness does not equate to what is rewarding or socially valuable. The least competitive specialties, Family Medicine and Internal Medicine, are highly rewarding and are perhaps in the greatest social demand." - Dean of Students in an E-mail to fourth year students

A comment from an article from io9.com: "The Herd Mentality of the Anti-Vaxxer Movement"

Pediatrician: Will you be vaccinating your children?
Parent: No.
Pediatrician: Please leave my office.

He then goes on to explain himself -
I often wonder why a parent who believes vaccines are harmful would want to bring their children to a medical doctor at all. After all, for immunizations to be as malign as their detractors claim, my colleagues and I would have to be staggeringly incompetent, negligent or malicious to keep administering them.

If vaccines caused the harms Jenny McCarthy and her ilk claim they do, then my persistence in giving them must say something horrifying about me. Why would you then want to bring your children to me when you're worried about their illnesses? As a parent myself, I wouldn't trust my children's care to someone I secretly thought was a fool or a monster.

probably something guys don't have to think about

While I was at the National Conference for Family Physicians, I had the opportunity to walk around and meet residents from over 400 family medicine residency programs. It was... awkward.

I am a socially awkward person. Put me in a room of a 1000+ people who I have to present my best features to and well... yea. Not so much fun.

But definitely interesting. I remarked to someone that had this been a conference for any other type of physician and I would probably be crying in a corner. Family practitioners are usually pretty funny or at least try to appear friendly. So that's.... something to comfort the social anxiety.

A strange thought occurred, however, when I was talking at length about a program with one resident. I think he was flirting with me. Which would be inappropriate so he probably wasn't... but what if he was? I mean--I'm also terrible at telling if a person is attracted to me and everyone was earnestly trying to be friendly. My face always hurt from awkward smiling once I returned to my hotel room. But seriously... what if he was? Could I use that? Could I take advantage of that to get into a residency program?

Sick, right?

Strange.

This is probably something most guys don't have to think about.

Brainwash 'n Vent

There it was. The truth. Stretched out in front of me like the end of days. And loudness. So much strife and bustle. Everywhere. Cars and the people with their voices and the humming of buildings with their AC units pumping in cold to isolated rooms separated from the world and the streets within the city of Chicago. And the El up ahead a block, three or four stories high with always the same voice alerting passengers and future passengers alike: "Doors opening." Then two bells. Then: "Doors closing." This was my present but less than an hour ago I was in a completely different world. Oppressive silence. The distant sounds of mouses being clicked at other terminals was the only thing to distract the dull buzz that came with inactive listening from taking hold on my ears. Distant, fluorescent lights. Everything controlled. And cold. So cold. That was the world of the United States Medical Licensing Examination Step 2, the second of three licensing exams. And I realized on the streets of Chicago, I could not remember a single question. 355 questions. 9 hours. And I couldn't remember a single thing.

What could possibly be more horrifying?

Step 2 is a serious exam, of course, otherwise, why would we have to pay $580 to take it? If cost equals quality, then Step 2 is a lot more important than the scantrons and blue notebooks I used to use in high school to take advanced placement (AP) exams--which actually helped me take less courses in college, saving me thousands of dollars. I think those cost $25. USMLE tests cost me money to prove that I can be a doctor. I guess if failed enough times, I would have to take a year of medical school again: $50,000. Okay.

AP scores can be dolled out in a simple 1, 2, 3, 4, or 5. Step scores are much much much more complicated. Not always was this so, of course. In the old days, you passed or you failed. Quite simple really. Because we all must be evaluated and found worthy of the MD that will follow our names for the rest of our lives, but do 355 randomly selected and sometimes silly questions mean that we deserve or do not deserve to put our hands on a patient, to share in their suffering, to help and to heal and to comfort and advise? No. They really, honestly shouldn't.

This year the passing score on Step 2 jumped up from 200 to 209. Was this arbitrary? How was this determined? And isn't nine points.... a lot of points? More importantly, if the passing grade was just determined based on how many people passed Step 2--which is the way some courses are run-- wouldn't this imply some kind of insidious ploy to make sure that enough people fail so that the administrators of USMLE can charge some poor soul another $580 and increase revenue? Or does the increased score make everyone feel better that residents are intelligent enough to be able to control and manage possibly dying patients, and the additional money made is just an extra benefit?

How many times have I heard a discouraged patient say something along the lines of, "I know you just see me as money to be made at my expense." Should I also feel the same way, as a medical student, stuck in a world of constant cost with no monetary profit?

Let's assume however, that a lot of thought was made into making it so that 209 was meant to really pick out who would do well as a resident in terms of knowledge. Isn't it possible that there are people who score below 209 who would make good residents because they know how to look up answers on uptodate or even google? And who work hard to make sure that they overcome their deficits? Conversely, couldn't someone with above a 209 simply make the worst resident ever and incur a lot of lawsuits because of they have the worst bedside manner? Or couldn't someone with a +209 score completely slack off for the rest of their career and be unable to provide the standards of care for anyone besides the hypothetical patients he saw before him in paragraphs on a computer screen on test day? I mean statistically, some people who score below 209 will ultimately practice great medicine while people who score above 209 will do absolutely terrible things.

So did I really need to be locked in a room for 9 hours--an amnesia-inducing, cubicle-filled room with no music, no food, no human contact for 9 hours--so that I could answer 355 questions that I would instantly forget and then spend the next three weeks until receiving my score panicking and scratching at my skin, picking at my scabs, and eating antacids like candy because how can you feel like you did well on a test if you can't remember any part of it? Only to find out that I did pass and that I did do well.

All that nervousness and I have to pay $580. Infuriating.

Family Medicine Conference

Last weekend I drove eight hours to Kansas City, Missouri for a national conference for residents and medical students in and interested in family medicine. My specialty adviser suggested I go since almost all of the residency programs in the United States set up booths to interest and inform students. I require a few more weeks of electives in the year, and it was her hope (and mine, too, although I am always much less optimistic about my ability to socialize and form plans with strangers than most people who know me) that I'd be able to establish some sort of elective in rural medicine there.

I did not.

All totaled, the weekend cost me around $800 - $900. But I would have gone back if I had the choice, because despite being really draining to walk among so many strangers constantly, it was really inspiring. I feel really inspired. I have felt this way previously at the end of AMWA conferences, so I can only assume I love conferences more than I love school.

The lecturers were phenomenal. They were so passionate. And so funny. And so personable and nice. After spending a year interacting with doctors who seemed dissatisfied with their career choices, it was nice to see people loving what they did.

And everyone spoke in such a way as to relate several main themes:

1. Many physicians think family medicine is a joke but that is slowly changing.
2. There's a lot of good you can do as a family physician--be it for your patients or even in changing politics.
3. Job satisfaction. Family practitioners have more of it.

There were more ideas but I've started having a hard time writing anything of importance. More to follow.