Vacation, all I ever wanted!

What could be truer than the truths sung by the immortal GoGos?

I am done, done, DONE for THREE WHOLE WEEKS!!! At the risk of sounding Texan, YEEEEEEHAAAAAAAAAA!

I'm sitting here, on a Monday, in my pj's, with not a study book in sight. It's amazing.

The weird thing is that after a weekend full of playing catch-up for chores and errands, I'm not sure what to do with myself. I still have lots I need to do--for example, I can't see my desk due to the enormous pile of papers and mail and books covering it. Also, there are no fewer than two closets in our house which, if they are opened, would bury the poor hapless individual under a pile of random junk. Also, I need to get my hair cut (you know you're in bad shape when your hair looks bad even in a ponytail). But where's the studying? Where's the stress, and the fear? The frustration?

Hmmm. Strangely absent.

Anyway, due to our not so regularly scheduled vacation, I don't have a lot to ramble or rant about today. However we have something brewing on the back burner which may result in some awesomeness shortly. I'll keep you posted. And in the meantime, Dr. VonB abides.

Deep breath, deep breath, deep breath, deep breath, ok, breathe normally.

If you read the title, you've just experienced what it's like to have me perform a physical exam on you. Just envision me listening to each side of your back on the bottom, then each side on the top, then to your chest. I've done it so much that I catch myself doing it like a zombie sometimes.

Which is good, because it's important to get a rhythm going with the physical exam. This is for several reasons:
Reason 1: You don't want the patient to suspect you don't really know what you're doing.
Reason 2: You usually feel like a giant wonk, so it's easy to get flustered, which also tends to result in some patient uncertainty. If you have a system you tend not to get flustered, unless they have a really obscene tattoo or something (not that uncommon).
Reason 3: It's amazing how easy it is to forget to check things that you should be checking. For example, if someone has a URI (upper respiratory infection), you should listen to the lungs, and then often we throw in a heart listen for free, 'cause we're in the neighborhood, then you are supposed to look in their ears, their throat, and their nose (Believe me, it's as gross as it sounds. I used to always worry when the doctor looked in my nose that it was gross and embarrassing, and as it turns out, I was right. It is gross and embarrassing.). But for at least the first two weeks I would be looking in the ears, trying so hard to see something, anything, and I would get focused on that and inevitably forget to look in either the throat or the nose. If I had my rhythm down then, I wouldn't have had that problem.

The neuro exam is even worse, 'cause there's a bazillion things you are technically supposed to check, but most doctors only check about a million of them, but you don't always know which ones the doctor you're working with thinks are important enough to do. Then there's the abdominal exam, which sucks on 1) fat people, 2) people who currently have abdominal pain, or 3) both (this accounts for most of the patients I saw). It sucks because you feel really strange pushing around on this GIANT stomach and moving it around (I am not exaggerating), and you feel really bad pushing on it and making them cry out in pain (also not exaggerating).

Anyway I was thinking about the physical exam because I took that stupid Family Medicine test on Friday, the videotape one (see last post), and it sucked gluteus. It was actually four patients, and I think I did so badly that I am expecting a call any day now from the medical school advising me to go into a field more suited to my particular style of physical exam, such as herding cattle or mud wrestling. I guess I can at least be glad it's over, and I get about two months to sweat about my grade since it takes forever to get it back. This coming week I have a nice, short, relaxed rotation, followed by three weeks of vacation bliss. There will be painting of my grandmother's house, yes, but there will also be sleeping. And beer.

I'll be back when I have something interesting to say about resuscitating people. In the meantime, if you see me coming with a stethoscope, run the other way.

I have a fever... and sadly the cure is not more cowbell

This will totally shock those of you that know me personally, but I have a wicked head cold.

It was just a matter of time. I've been seeing about five to ten sick kids a day for three weeks. About 75% of them have some type of nasty virus which affects the respiratory tract, while the other 25% have some type of nasty virus which affects the intestinal tract; so, I guess if I was going to catch a virus, I'd rather have this one.

Anyway the main thing that is bad about it is that I have two choices: 1) feel totally spaced out due to the virus or 2) feel totally spaced out due to the only medicines which give me even minor relief from the virus. I've been alternating between the two and I can't decide which leads to more productive studying. Every time I pick up the pills it's like, "Well, would I rather have my main insight into diabetes be "uhhhhhhhhhhhhwha?" or would I rather have it be 'uggggggSNORTuuurhhhhhhh'?"

This whole event has made me much more nervous about having my pediatric rotation in Nov/Dec. From what I've heard, peds during this particular period becomes like a frickin' flea market of RSV (respiratory syncytial virus, a super nasty respiratory tract infection), rotavirus (Severe diarrhea and vomiting! Yay!), and various other unappealing and highly contagious infections. Hopefully my pathetic excuse for an immune system (that's right, immune system--you heard me. I called you pathetic. If you want some respect, take a moment and contemplate why you go into full red alert over dust mite poop but roll out the frickin' red carpet for Mr. Nasty Flu) will manage to scrape together enough sense among its billion cells or so to remember whatever I have now and keep me from getting it again. But I'm not holding my breath. Which is good, because it's not easy to breathe when your nose is completely blocked off and draining into your throat, choking you. Stupid virus.

Anyway, otherwise, things are going well. I feel pretty good about studying for Family Medicine because it's kind of like a sneak preview for the rest of the year: peds, medicine, OB/Gyn, psych--it's all here. Just laying good ground work for everything that's ahead. It's great! (Psst: does that stuff sound convincing to you? 'Cause it's not really making studying sound any better to me. Stupid hypertension drugs!!) My husband just got his residency applications submitted, which is a load off his mind and mine, plus I don't have to listen to him whine about them anymore. He finishes his current rotation Friday, after which he will be free to be my personal servant until Christmas. Just kidding. Kind of. Actually, he will have to study for Step 2 of the boards, and then he will have residency interviews and stuff, but I trust that there will be lots of servitude blended in. Right, honey?

As for me, I have one more week of Family Medicine--my exam is on Friday. The exam, as I mentioned, consists of a multiple-choice test, a videotaped interview and exam on an actor playing a patient, and a brief written/oral exam. Allow me to express my feelings about this exam: YIPE. I mean, videotape? Ugh. My theory is that all the doctors get together and have a big party, and show bloopers from people's exams where they inadvertently poke the actor in the eye or knock him unconscious with a reflex hammer and then sit down on the floor and cry. In any case, I will try to update the blog with details of that super fun experience once I am done.

The following week I have a one week course where you learn about acute care--mostly resuscitation stuff. Then I get a glorious vacation before starting peds. I can't wait... I can almost smell the vomit now.

How about filling this prescription for STOP EATING

A few confessions right up front: I am not a skinny person. I never have been. And, I love food. A bunch. Finally, I am not athletic. I've always been one of those stereotypical nerdy kids who likes school and has asthma and tries for the cool hairdo but falls sadly short.

However, I have a rule. If my pants start to get tight, I institute THE diet, the most fantastic diet in the world. There are two parts to this diet.
Part 1: Eat less.
Part 2: Exercise more.

Amazingly, it works every time. I think about that two part diet a lot. I first heard this precise diet from a doctor I worked with my first year of medical school. He is an amazing doctor. He trained in India and could diagnose twenty diseases just by looking at a patient's hands. We would see tons (no pun intended) of patients come through his practice who were not only overweight but have diabetes and countless other health problems. Some of them would enthusiastically tell the doc about whatever new crazy diet they were trying; all liquid, no carbs, only carbs, only foods that start with the letter z, whatever. And he would always close his eyes and shake his head and say, "It is good you are trying to losing weight. But there is only one way to lose weight, and that is to eat less and exercise more."

The best part is that 99% of the time the patient would look at him like he was nuts.

It's a simple concept, people. I didn't say easy; it is, however, undeniably simple. Every single day in Family medicine we would see patients who were easily 100lbs over their ideal weight, and, shockingly, they would have all kinds of problems. Doc, my knee hurts. Doc, my lower back hurts. Doc, my heart's bad. And oh, by the way, I smoke 2 packs a day.

I am not minimizing the problems of all those people in the US who are overweight. As I said, I struggle with it myself. It is very difficult living in the US today, with mounds of delicious, tasty, and horribly bad-for-you-food not only available but in your face constantly, day in and day out. Lots of them have all kinds of other difficult psychological and social issues which I am very fortunate not to have to shoulder. But, OH MY GOD, people, STOP. EATING. And, occasionally, consider moving your ass.

It gets very frustrating. Even besides the fact that I want to do clinical research, I know now that I could not go into primary care. I don't think I could spend every day overlooking the major problems in people's lives and trying, usually in vain, to treat the results of those problems. Yes, this is an overly simplified view of primary care, and yes, there are truckloads of amazing doctors who do manage to change people's life every day. But, in my experience, even those doctors will admit that they are happy if they reach even 10% of their patients.

I think the truth is that Americans take things for granted. Their wealth, their lifestyle, and as I have learned, their health. Most patients want to abuse their bodies for 40 or 50 years and then get a pill to make it all better.

I salute all those doctors who are happy with 10%. I am in awe of them. I can't do it.

I need to go work out.

Cough, cough, fever

Kind of like duck, duck, goose, only with more mucous. That pretty much sums up Family Medicine.

Actually, I like it. I don't know that it is for me, for a lifetime, but for now it's good. There's a lot of variety, and good practice for general and focused H&Ps (history and physical). My preceptor is very very nice. I do have to admit that, unfortunately, I feel that the slope of my learning curve has really leveled out. That could be because I'm studying way less than I was on Surgery. Why? Well, first, the textbook we are supposed to use pretty much blows. Also, in contrast to Surgery, with Family, you don't have The Fear.

The Fear is very important, and it isn't just about the Socratic method, pimping, or angry, angry surgeons yelling at you. It's also about having a lot of patients who might just die on you if you don't figure out what is going on and how to fix it. It gives the whole thing a sense of urgency that frankly is lacking in Family Medicine, an urgency you can use very well to fuel your studying.

Don't get me wrong, there is a ton to learn--for example, I'm trying to remember at least three major medications and what they're used for (I try not to set my standards too high). There is a ton of breadth, but not a lot of depth, and I think that works against my disposition a little bit. Anyway, writing about this has made me feel that I should really go and get some studying done. So I will. That's a very, very important thing to remember in 3rd year: when you get the urge to study, for whatever reason, run with it. Just remember to put down the scissors.

And we're back

Family medicine is a lot busier than I expected it to be.

First of all, I have to commute a little more than an hour each way (that's more than two hours of driving per day, for those of you who are math-challenged). Then, there's the homework.

Yes, that's right. All of a sudden you're like a frickin' 5th grader, with homework.

They try to dress it up; they're "presentations" and "research summaries", but honestly, that just makes it more insulting. In my opinion, it's time to stop this ridiculous crap. There's already a big exam at the end of the rotation (written and verbal). Plus--and I hope I'm not understating this here--I feel that if the motivation to NOT KILL PEOPLE isn't enough to make someone learn of their own volition, then I don't see how homework is going to do it.

Let me learn on my own. I am NOT a 5th grader. I don't need your damn homework. I can learn all by myself, just like I brush my teeth without being told and wear matching socks without you picking them out (well, most of the time).

My other gripe (Yes!! There's more!!) is that a big part of being a doctor (okay, a GOOD doctor) is to be what they like to call a "self-directed learner". This means--stick with me here, because this is a startling and complex idea--that if you don't know something, you look it up. Radical concept, huh? Well, they tell you that it's time that you become a "self-directed learner", and in some rotations (coughSURGERYcough) if you don't do that you are a dead doornail, while in others, I'm talking to you, FAMILY, they make you do stupid. Frickin. Homework.

The cherry on top: I won't be able to say for sure until after the exam, but my hunch is that these homework assignments are not going to be super helpful on the exam. I mean, I think that they are overall theoretically important things, but the kind of things that I could have learned on my own in about one third or less of the time it took me to put it together into homework.

There is another part to this that I have to confess. One of my biggest pet peeves--other than having homework at the age of 32 and the song "American Pie"--is a little something I like to call "forced audience participation". I bet you know exactly what I'm taking about. It can happen anywhere, from a "Hey, let's put those hands together!! I can't hear you!" to "Where is everyone from?" to what I am experiencing now: "What kinds of psychosocial issues do you think we should consider in this patient?". Ironically, I don't really mind the more Socratic surgery method, where they direct a question to one particular audience member (usually warmly and personally, as in "that guy back there in the blue shirt who isn't paying attention"). But when they ask this very subjective, open-ended question, and just sit there, silently, waiting for someone to speak up, which finally someone does, but inevitably doesn't give exactly the answer the person wants, so they say something inane like "Um, yes, okay, but what else?", I just want to punch their face in.

Wow, okay, I've really woven all over the blog road here. Let me wrap up and we'll come back to some of these hard-hitting issues--plus the things I LIKE about Family Medicine--after a brief commercial break. Seriously, I will try to post again this weekend. In the meantime, keep on keepin' on, people, and let me hear you put those hands together!!