First we have to clarify a few things here.
Medicine is not a one-size-fits-all career. You might think it is but it isn't. Let me explain.
Sure, some of you guys seem like the type-A, straight-A breed and that's fine. Excellence gets you far and it opens up more doors and more opportunities. But not all of us are interested in cracking chests, working within a trauma center, or seeing the rarest of cases at the biggest hospitals.
The focus on excellence I described applies to all in the profession. Any clinician, including, especially those in primary care, are responsible for an enormous amount of material, which you highlight yourself, below.
That might be what drew you to medicine but not me. I've worked in an ED, I've worked in a hospital for 15 years, I'm a patient, and I've paid attention during all of it. I've seen doctors treat the frequent fliers in the ED without really helping them actually; only to send them back into same environment that keeps sending them back to the ED, I've seen a doctor do an abdominal hysterectomy and cut a ureter, I've seen a doctor clip the hepatic duct during a cholecystectomy and tell a nurse to fudge the chart, I've seen a doctor kill a patient putting a central line in, I've seen a group of doctors go to federal prison for accepting bribes in exchange for lab referrals, I've seen doctors fail to catch a dangerous DVT because they were too busy focusing on the guy's Crohn's disease. I've seen a doctor diagnose a clot in the external iliac as sciatica. I've seen enough that if you were to ask me based on some of these shenanigans what I thought about doctors, I would say "I hope I never get sick and die of old age because these doctors are all stupid, incompetent, and corrupt." My point being is this, excellence does not breed excellence. Based on your theory of excellence, I would think the above is pretty basic stuff that should not happen with an MD or DO next to your name; but to each their own. I guess the adcom's forgot to screen these guys properly because they sure as hell are not how I would define excellence.
Aside from the bribes and dishonest documentation, everything you described are just medical errors. They happen to even the most knowledgeable and competent physicians. In fact, you sound rather arrogant for never having completed medical school or having any practice experience, to be hindsight judging what happened in those cases.
Clipping a ureter is the most common complication of a hysterectomy, and something ob/gyns work hard to avoid, because as it turns out it is quite challenging to make out the anatomy and landmarks in surgery. Same with the hepatic duct during a chole.
The fact that I actually know that, is because I have a medical degree, not because I'm a surgeon, I might add. Because of those pesky didactics Steps you think are so pointless.
Too busy focusing on Crohn's? Most of the time I had someone admitted for Crohn's we were worried about life-threatening bleed. Usually the patients are on mechanical ppx, and that can cause calf pain. Not to mention some DVTs can be more challenging than you think to catch. The ddimer is likely worthless. You'd have to go for an doppler U/S. If you did see it, I"m not sure how it would affect management. Plus, I have no idea if blood thinners would have been such a hot idea in the Crohn's patient, so it's possible that catching the DVT might not have affected management besides monitoring more closely for PE unless they were going to put in an IVC filter, which frankly isn't common to do.
A clot in the external iliac? Notoriously difficult to diagnose. Sciatica is exceedingly common. Mistaking a rare presentation for something more common, again, another common medical error, and it doesn't always represent incompetence.
From reading what you wrote, it's clear that you
think you understand more about what was going on than you actually do. Which is a really bad attitude to go into medical training with.
The whole point of a focus on excellence is to reduce those errors. Your argument is essentially, well hey the guys that proved that they have all the requisite knowledge to do their jobs still make mistakes, so why care about grades and scores? Or whether or not someone is a drop out?
That's fine even if most programs don't want to take a chance on me, I will accept that as a result of what I am bringing to the table. I would apply strategically and make the appropriate connections to locate programs that would be a better fit for me. All I need is one program, even a program in rural America that says "we think you'll be a good fit for our program." That one shot is all I need and that one shot is somewhere, and that one shot is the opportunity I need to prove my worth as a future physician. It might not be what you're looking for but it may what I need.
If you don't get that one shot, and the chances are exceedingly low, as is the chance of you doing well enough in the Carribbean this time around to even stand a chance.....
Your sense of what is realistic and grasp of statistics is enough to make me wonder.
Keep in mind that you can have a Caribbean grad complete all of their rotations at a small community hospital, match into a similar program, and be just as fulfilled working in preventative care within a small community without seeing any of the action you type-A people so desire. It's the truth; you might look down on them but they are still a doctor and they are still helping people in tremendous ways. Think of the frequent flier in the ED, if he had access to a good primary care doc, he wouldn't be in the ED in the first place. Medicine isn't always about treating disease, it's also about preventing it. I don't really watch TV but some of the stuff I see on these reality medical shows, well that doesn't happen at every hospital in America. It just doesn't.
Family medicine is not cardiology. Cardiology is not surgery and so forth. What about doctors that operate solely on an outpatient basis? Do you know of doctors who know everything about everything?
My initial post was just getting some feedback about where I was and where I was going. There are some people that gave me good, unbiased advice and then there were those that proceeded to attack me. For what? What I do? Did I commit a crime? I made a poor decision to apply to a third-tier Caribbean school with low stats and I did not succeed, I got back up and now I am devising a plan to fix my mistakes and get back on track. There is no need to tell me that I am done. We don't know that. Basic sciences is not clinical medicine. The issue here is basic sciences and passing STEP1 and 2. Lets keep the discussion focused on that right now, arguing beyond that is just splitting hairs right now.
Becoming a doctor is not for everybody, yeah the Dean told us that many times. But don't think that "everybody" is referring to people like me. "Everybody" could also be you. Grades are one thing, you don't know what else people like myself can bring to the table. And if you don't know that, I would never count us out.
Yes, the basic sciences and Step 1 & 2 have little to do with clinical medicine
That is so unbelievably untrue, that the only people that even try to make that claim are those that can't hack it.
Yes there is some obscure stuff on Step 1. Still, the knowledge base is broad for the MD/DO degree because it has to graduate a well rounded graduate capable of entering a broad range of specialty training.
The very idea that one does not need to show mastery of the material that is, well, medical school, to be a doctor......? That's like saying you just don't need to be able to land a plane to be an airline pilot.
Actually, no matter what type of doc you become, you will need to read the notes from cards, pulm, GI, surgery, etc, and while you may not have their knowledge to
generate their recs, you absolutely have to speak the same medical language and understand when/how to implement their recs, safely and appropriately modify them, modify your existing treatment in response, how to monitor, and to know when you need to talk more with the specialist. You do actually have to know a little bit of everything about everything.
Specialists in cardiology may know a little less than everything, but they still know a lot more than just cardiology.
At the end of the day, premed science prereqs, M1-4, the Steps, are all about the right hand knowing what the left hand is doing.
I didn't go into a super competitive field, I went into something quite general, and the knowledge based is huge for those in primary care fields. I am also pretty laidback personality.
However, it doesn't ****ing matter. When it comes to knowing how to read a fetal heart monitor, you can't **** that up. When you put in orders for units of insulin, your math better be right. So when it comes to your job, you bet your sweet ass you better type A and mind the details.
