The Official Anti-Clinical Medicine Thread

[beary]

Yeah right, like they don't stockpile their own crap for home from those closets.

I know!! And it's TISSUES!! I am post-call today and this encounter basically left me in a rage for the rest of the day.

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[AngryTesticle]

I know!! And it's TISSUES!! I am post-call today and this encounter basically left me in a rage for the rest of the day.

Rage is good. Rage is healthy. Embrace it!

BTW, congrats on Michigan. Go Blue!

 

[drPLUM]

The only problem is you have every 4th day or so where you have to stay late, and you have to do 6 days a week.

Stay late?? If by that you mean stay overnight and until 3pm the next day on a Q4 schedule then you are feeling my pain.

 

[beary]

Stay late?? If by that you mean stay overnight and until 3pm the next day on a Q4 schedule then you are feeling my pain.

I exactly feel your pain Dr Plum. But only three days left right? Me too!

Then I have ob/gyn.

 

[drPLUM]

I refer to my time on OB/GYN as "the dark days".

 

[Aubrey]

My Ob/Gyn time didn't suck nearly as much as IM, but I think that was largely because of the residents to whom I was assigned. That, and Ob/Gyn was apparently desperate to recruit male residents. "Seriously, only about 30% of the patients will refuse to see you just because you're a guy!"

 

[yaah]

Stay late?? If by that you mean stay overnight and until 3pm the next day on a Q4 schedule then you are feeling my pain.

They still allow that? I know when I did M3 year the work hours rules hadn't taken affect yet so the residents were still Q4, there until 3-4pm the next day. And the surgery program director was saying the rules were not going to apply to med students...

 

[miko2005]

I refer to my time on OB/GYN as "the dark days".

I hated my ob/gyn rotation!!! I am sorry, but some of the residents were just evil. On call, they made us sit at this little station where all the nurses and residents hung out and if there weren't any chairs, you had to just stand...for hours. And when we didn't schedule any student for call the night before the shelf exam (it was an overnight call), they all got so pissed off at us...but still not one of us stayed . I am sure that kind of attitude contributed to my "pass" but its all over now...

 

[drPLUM]

I hated my ob/gyn rotation!!! I am sorry, but some of the residents were just evil. On call, they made us sit at this little station where all the nurses and residents hung out and if there weren't any chairs, you had to just stand...for hours. And when we didn't schedule any student for call the night before the shelf exam (it was an overnight call), they all got so pissed off at us...but still not one of us stayed . I am sure that kind of attitude contributed to my "pass" but its all over now...

This is remarkably similar to my experience. I didn't know this occured other places. We had to just sit at "the board" and watch it if there was nothing going on. Oh, and their philosophy was if you ask questions that means you aren't reading. I actually had the following conversation with a resident...

Me: (some OB question)
Resident: You shouldn't ask any question you can look up the answer to on your own.
Me: Can't you look up just about anything with all the online sources available these days (Up to Date, etc)?
Resident: Exactly.

Ofcourse this is a "malignant" program also, with so much hierarchy. For instance, you know how rotations are called "clerkships" right? Well they were calling students "Clerk PLUM" and stuff. The interns introduced themselves to students as "Dr. Whatever" so we had to call them "Dr. Whatever". The fourth year students were "sub-intern PLUM" and stuff too.

By the end of the clerkship I was like "please, please let me into your residency program. I love this stuff. I can't wait to be an OB/GYN".

 

[drPLUM]

They still allow that? I know when I did M3 year the work hours rules hadn't taken affect yet so the residents were still Q4, there until 3-4pm the next day. And the surgery program director was saying the rules were not going to apply to med students...

Well.. they don't "allow" it. BUT! If you "volunteer" to stay past the 30hr limit to "help out the team" and stuff then its OK. And I am all about helping the "team" don't ya know? Why would I want to go home? What can I do there besides take a nap? There are so many learning opportunities on the ward.

 

[beary]

Why would I want to go home? What can I do there besides take a nap? There are so many learning opportunities on the ward.

I can't tell you how many times my senior resident told me what an opportunity it is to get to spend so many hours in the ward.

You're done with the sub-I from hell right? I am and am much enjoying my weekend off!

Six weeks of ob-gyn to go. I guess I am being demoted from sub-intern beary to clerk beary.

 

[drPLUM]

DONE! That's right, done. Well, I still have a lighter surgery rotation left to go but sub-I time is over! No more Q4 and I have spent my last night in the hospital for the rest of my life. I can't tell you how good that feels.

Right now I can't even decribe my apathy toward this current surgery rotation. The good part is that my residents appreciate this fact and remember "being there" as well.

 

[beary]

Right now I can't even decribe my apathy toward this current surgery rotation. The good part is that my residents appreciate this fact and remember "being there" as well.

I'm the only M4 on my rotation - everybody else is M3s.

 

[JaneDough]

I'm the only M4 on my rotation - everybody else is M3s.

Same here. 4 days to go (then on to medicine sub-I, god help me)

 

[beary]

We had a lecture today from a midwife who introduced herself as RN, BSN, CNM, ARNP.

beary, BA, BS, MS (ok, I don't actually have an MS, don't be picky), Ph.D., FWUIAAMD (five weeks until I am an MD)

 

[drPLUM]

Just got out of an 8.5 hour surgery. No lunch today. Still so much better than medicine rounds that i had a smile on my face the whole day.

 

[JaneDough]

I feel so yummie- I just scrubbed my last case EVER! 4 weeks left on the wards for a medicine sub-i. Bring it on, b!tches!

 

[beary]

Good luck finishing up DrPlum and JaneDough!

 

[CameronFrye]

I can't believe how many "real" rotations you guys are having to put up with at the end of your 4th year. Just about everyone in my class is finished and most people haven't had any serious rotations since the fall.

 

[yaah]

I can't believe how many "real" rotations you guys are having to put up with at the end of your 4th year. Just about everyone in my class is finished and most people haven't had any serious rotations since the fall.

I had 8 required months of rotations 4th year out of 11 total months (July-May). Third year was regimented in terms of what we had to take. So 4th year wasn't as flexible. And one month had to be neurology, and one had to be your medicine subI. So that left 6 months. You could only do two months that were not related to direct patient care. Thus, if you want to do path and radiology, you couldn't do any research or independent study or whatever. I had to do 4 months of other internal med electives (because no way I was doing surgery or pedes electives). Derm, Cardiology, ID, heme-onc.

 

[CameronFrye]

I had 8 required months of rotations 4th year out of 11 total months (July-May). Third year was regimented in terms of what we had to take. So 4th year wasn't as flexible. And one month had to be neurology, and one had to be your medicine subI. So that left 6 months. You could only do two months that were not related to direct patient care. Thus, if you want to do path and radiology, you couldn't do any research or independent study or whatever. I had to do 4 months of other internal med electives (because no way I was doing surgery or pedes electives). Derm, Cardiology, ID, heme-onc.

Oh wow, that sucks. We had to do a month of neuro and then a month-long sub-I in something clinical. The rest of the year was up to us. Our only restraint was that we couldn't do more than 12 weeks in the same field/research. I definitely did the 3 month maximum of path rotations.

 

[beary]

Since I am in the MSTP, we have a different schedule than most M3s and M4s. I am doing my core ob/gyn rotation right now, which is weird since I have already matched and taken boards, etc. (Everybody else on the rotation is an M3).

Today, I was chatting with one of the residents and a nurse practitioner started arguing with me that there was no possible way I have already matched since I must be an M3. I tried to explain the situation, and she was still convinced I was just totally making up this whole story about me matching into path.

 

[beary]

I am generating lots of things to add to this thread lately.

We have "grand rounds" on Tuesday mornings at 8. It is somebody who comes in to talk about some incomprehensible ob/gyn topic. I have had a terrible toothache and got added on to my dentist's schedule this morning at 7:15. I thought I would be back in time, but didn't quite make it. Therefore, I didn't sign the all-important sign-in sheet, and therefore, I have already gotten a nasty email inquiring about my absence.

 

[b&ierstiefel]

I am generating lots of things to add to this thread lately.

We have "grand rounds" on Tuesday mornings at 8. It is somebody who comes in to talk about some incomprehensible ob/gyn topic. I have had a terrible toothache and got added on to my dentist's schedule this morning at 7:15. I thought I would be back in time, but didn't quite make it. Therefore, I didn't sign the all-important sign-in sheet, and therefore, I have already gotten a nasty email inquiring about my absence.

It's unfortunate sometimes how medical school can be so unrelenting and unforgiving when it comes down to a med student's personal schedule. I knew a med student who had a death in the family and the clinical team tried to make him feel really guilty about taking a day off of work to attend funeral services. And physicians are supposed to be compassionate...

Hang in there...you're almost done with med school. The light at the end of the tunnel approaches!

 

[beary]

It's unfortunate sometimes how medical school can be so unrelenting and unforgiving when it comes down to a med student's personal schedule. I knew a med student who had a death in the family and the clinical team tried to make him feel really guilty about taking a day off of work to attend funeral services. And physicians are supposed to be compassionate...

Hang in there...you're almost done with med school. The light at the end of the tunnel approaches!

Thanks AT! My grandfather died when I was on peds (this was a year ago). They said that they would "graciously" let me miss two days to attend the funeral, but I would have to make up the days later. Since I had another rotation right after that, I was like, how exactly am I supposed to do that?

 

[weaseldom]

Collateral sucked balls.

 

[deschutes]

Ha. As a first-weeker on surg path, I'm not good for much scope-teaching of med students, but at least I know to let them go by 4 at the latest

 

[drPLUM]

Collateral sucked balls.

Thats kinda random... but hey, thats what this thread it for right?

 

[beary]

There are not words to adequately describe how much ob/gyn sucks.

I feel like I will not make it these last four weeks.

 

[JaneDough]

There are not words to adequately describe how much ob/gyn sucks.

I feel like I will not make it these last four weeks.

I hear you. Of all the rotations, OB/GYN was the only one that I actually hated. I used to dread call. I'm sorry, but I have no desire to stand between some lady's legs for 45 minutes for any reason. Especially if she's screaming and pooing and ripping and eveything smells like amniotic fluid. No thank you.

yeah yeah, I know it's the miracle of life and whatever, but that doesn't make me dislike it any less.

 

[beary]

I hear you. Of all the rotations, OB/GYN was the only one that I actually hated. I used to dread call. I'm sorry, but I have no desire to stand between some lady's legs for 45 minutes for any reason. Especially if she's screaming and pooing and ripping and eveything smells like amniotic fluid. No thank you.

I haven't even made it to obstetrics yet, so I'm really in trouble.

The people are so malignant!! All I want to do is get out of here and I am with all these gunner M3s.

 

[deschutes]

I haven't even made it to obstetrics yet, so I'm really in trouble.

I recently learnt the meaning of the slang-term "taco".

I also recently learnt that a woman can have many things in her taco: cheese, sour cream, meat, guacamole, and salsa.

If you're not already grossed-out, see UrbanDictionary.com, my handy reference for all things American

 

[JaneDough]

 

[Non-Trad DO]

TACO! Where I love tacos. ohhhhhhhhhhhhhhhhhhh!

 

[b&ierstiefel]

TACO! Where I love tacos. ohhhhhhhhhhhhhhhhhhh!

Tacos are delicious and all...but man, they give you the runs. Farts become sharts. Sharts are no good.

 

[JaneDough]

7 weekdays, 2 weekend rounds and 1 call to go and I am DONE!!!


I hope I make it. How is everybody else doing? Beary- how goes the birthin' of babies?
ALMOST THERE!

 

[drPLUM]

2 days and 1 Step II Clinical Skills exam to go and I too am done.

Since this is the anti-clinical medicine thread, does anyone have any tips for Step II CS?

 

[Aubrey]

2 days and 1 Step II Clinical Skills exam to go and I too am done.

Since this is the anti-clinical medicine thread, does anyone have any tips for Step II CS?

Bring a stethoscope. Wash your hands. Try hard not to roll your eyes. Practice your clinician catchphrases:

"What brings you in today?" (open-ended)
"That must be very difficult for you." (empathetic)
"There are many things that could cause your [nonspecific symptom], most of which aren't going to kill you anytime soon." (reassuring)

Oh, and don't drink too much coffee, as bathroom time can be hard to come by. Have fun!

 

[Pingu]

Do not stand up before they tell you to. Same with sitting and making any sudden movements. Also, if they tell you to stop writing, drop that pen like it is covered in hydrochloric acid.

Be prepared for the most delicious meal 1 grand meal ever!

Be prepared for bizarre cases. There was one with just a telephone and i had to consult over the phone. Be on the lookout for domestic violence stuff and always ask the patient if it is 'okay' to examine. Explain every last minute detail to them. For the written part, have memorized a list of tests that you can order even if you dont think anything is wrong.

 

[Stinger86]

-Just don't be that guy who, during orientation, raises his hand and asks the proctor "so how are we supposed to drape for the breast/pelvic exams?"

I.e., know the basic rules beforehand.

-Seriously, when the overhead voice says "time up", they mean TIME UP. You can keep writing, and they'll probably let you leave early, but of course you'll have to visit the testing center again in the near future.

-Know in advance whether you prefer to type or write the patient note. Typing is less stress on your hands, but beware the character limitations for each paragraph (ie 250 characters). Abbreviations are helpful, but make sure they're common enough that the graders will identify and understand them. If you handwrite like an epileptic, you probably should stick to the keyboard.

In the exam room:
-be nice, be understanding, be empathetic, be a patient advocate
-shake hands, talk before touch, ask if they have any questions or concerns
-as soon as you introduce yourself, look for the drape sitting on the stool, and ask the patient if it would be ok if you went ahead and placed the drape on them. Remember, when in doubt, always ask the patient if it's ok before you do something. Let the SP be in control of his/her own comfort
-be on the lookout for nonverbal clues, like a patient who gets to the middle of her sentence, then looks down and doesn't finish. Depression, anyone?
-if you palpate, and produce pain, acknowledge it and don't do it again. If the physical exam requires you to do more painful maneuvers, tell the patient empathetically you understand he's in pain, explain the importance, and then ask if it's ok to proceed.
-don't be afraid to chat with the SP between the history and physical, or whenever you wash your hands. A strategy I used was to think of something everyone would relate to, such as July 4th (since I took my exam a week after that date). I would ask each patient how their 4th went, did they spend it with family, how's the family, get to spend quality time with the kids or grandkids, etc. Old SPs seem to light up when you ask them about grandkids.
-If you don't finish the encounter before the overhead voice tells you to stop, don't let it worry you. Plenty of people don't finish at least one or two encounters, myself included, and pass the exam.
-when talking to the patient, use common language (xray, draw some blood). Always watch the patient and explain any procedure they don't seem to understand. When writing your note, use medical jargon

-Remember that as a doctor, and for the purposes of this exam, you are one who ADVISES patients, not ORDERS patients. When outlining your work-up, SUGGEST some things to the patient (CBC, Xray) and ask if they're ok with that. Do not TELL them all this stuff you're going to do and then say "ok see ya later."

I still believe that the purpose of this exam is simply to see if you can communicate from one human being to another, appropriately. I wouldn't be suprised if the "checklist sheet" the SP fills out simply asks two questions:

1. Would you feel comfortable with this person as your doctor?
2. Would you recommend this person to a friend or family member?

Get a YES on both and you pass. Who knows.

 

[JaneDough]

Wash your hands.

Word. I would announce to the SP, "I’m just going to wash my hands and then I will take a look at you". Then while standing at the sink washing your hands, give a big thumbs up to the police-interrogation-mirror, from where you are (presumably) being watched. Then ask the patient open-ended, empathetic questions. Then sing kumbaya together.

Seriously, you just need to be nice and considerate. For example, if you have a pt w/ a HA and light sensitivity, offer to dim the lights and don't yell in their ear or bang your clipboard on the sink. Even if you forget to check for kernig or brudzinski's sign, you will still pass (this I know for a fact)

 

[Tappat]

2 days and 1 Step II Clinical Skills exam to go and I too am done.

Since this is the anti-clinical medicine thread, does anyone have any tips for Step II CS?

After you read the doorway information, take a moment before going in to jot down five things for a differential diagnosis. This REALLY helped keep me focused during the history taking. I was always one of the last couple people to go into the room, but it saved me a lot of time once in. I also found it helpful to practice typing out a few notes at home, using for case information the First Aid book -- makes typing out (or writing, if you choose that) the notes on the actual test seem much more automatic. Good luck!

 

[beary]

7 weekdays, 2 weekend rounds and 1 call to go and I am DONE!!!


I hope I make it. How is everybody else doing? Beary- how goes the birthin' of babies?
ALMOST THERE!

I'm almost there too! I think I have a week more than you though. 16 days to go. 2 days of them are off (this weekend - I'm going to Michigan to hopefully buy a house! )

Thanks for asking. Birthin' of babies is painful. Today I had multiple interactions with patients (and nurses) that were very good reminders of why I wanted to do pathology in the first place.

 

[beary]

2 days and 1 Step II Clinical Skills exam to go and I too am done.

Since this is the anti-clinical medicine thread, does anyone have any tips for Step II CS?

Wow! Good luck on the BS! Does your school not require it for graduation?

 

[drPLUM]

Wow! Good luck on the BS! Does your school not require it for graduation?

We only have to have taken it; it doesn't matter to my school if we passed or not. My score will be in (hopefully with a P) before residency starts.

 

[yaah]

I'm almost there too! I think I have a week more than you though. 16 days to go. 2 days of them are off (this weekend - I'm going to Michigan to hopefully buy a house! )

I recommend a countdown. http://forums.studentdoctor.net/showthread.php?t=123442

That way, you can go back and read it and remember just how much it all sucked.

 

[drPLUM]

Done with Step 2 CS!!!!!!!!

That test was painful man. I hope I don't fail because I'd probably literally quit med school before I take that thing again (ok maybe not). I can't believe how much stuff I missed on. I'd go out and be writing my note and get to a certain part and be like "oh no, drPLUM, you are kidding! you didn't ask smoking/EtOH/drugs! AARRGGHHH!" Whats worse is that I would then make a mental note of it and the next time I'd miss something totally different. Its like I was chasing my tail all day long.

Whatever. I just wanted it over and to not have to take it again.

I am now officially done with all things pertaining to medical school except walking across the stage in 4 weeks.

 

[beary]

I am now officially done with all things pertaining to medical school except walking across the stage in 4 weeks.

Congrats Dr. Plum!!!! Step 2 BS sucked. If I passed, I am sure you did.

I only have 10 days left now! All L+D. No more clinic.

 

[JaneDough]

OK- here is something I won't miss: inappropriate admissions. I don't understand some of the patients we get. Seriously, we have a pt who is the relative of somebody of important, but who is very un-critical. Being related to a big wig does not mean you need a frickin' MICU bed x3 days.

Hey, my brother stubbed his toe yesterday, can we admit him to MICU? I got a papercut today, can I check in too?

 

[yaah]

It is interesting to see how people get different care because of who they know or what they are, and what is also interesting is that doctors and staff will often fall all over themselves to say they don't give different levels of care to different people, even while they are prioritizing their rounding or case review to do just that. Thing is, I'm not sure they end up DOING anything different, it's just a higher level of cover-your-ass. Like if we get a biopsy on a VIP that doesn't need an immunostain, some people will get it anyway just because. And biopsies on VIPs often get shown around to other people to "make sure." But nothing really changes. I had an autopsy on a VIP and the attending made sure we signed that one out on time.

Of course, it doesn't just affect doctors - another autopsy I did on a VIP which we didn't know about (that he was a VIPs relative, anyway) turned out to be a pain in the butt because of all the questions and complaints and pressure brought to bear on the clinical staff by the family. It gives everyone a lot more work, and probably ends up harming care because people are too careful.