Growing Pains

Tell me why I went into this weekend TEN lectures behind in material.

TEN LECTURES BEHIND.

The sad part is, I was actively trying to keep up all last week. But between the SIXTEEN lengthy lectures given to us just last week, my three and-a-half hour clinical skills class, my Clinical Practice Assessment Exam (CPX) where I had to interview & perform a physical exam on a standardized patient and then complete a write-up which took me FOUR HOURS to finish, and all the other little things I did on the side this past week, it’s been one hell of a struggle trying to keep up. So much for Pulmonology being a chill block.

sad annoyed whatever done facepalm

But let’s backtrack to my CPX first. Why did it take me four hours to complete that write-up man? I’ll tell you why. It’s because not only did I have to summarize the patient’s History of Present Illness, Past Medical History, Review of Systems, Family History and Social History, but I also had to go on and describe her physical exam findings, write up an assessment of the patient, come up with a differential diagnosis of what I believed the patient had, and then describe in detail as to why I picked each of the conditions I believed she had. Ohhh but that’s not all folks. After describing my differential diagnosis, which took over an hour itself, I then needed to come up with a structured plan as to how I was going to move forward with this patient, which included my diagnostic work-up, the anticipatory guidance I was going to provide to the patient, my treatment recommendations, and my disposition of the patient (where I’m going to eventually send her). That’s an unbelievable amount of work yo. And to think that this will become a regular routine as I get further in my training and eventually work as a doctor…😥. Why do I get the feeling that the doctors out there reading this are chuckling to themselves? Maybe because writing patients up isn’t actually as big of a deal as I’m making it seem and I’m just being all dramatic about it. Or maybe I went way overboard with my assignment. Regardless, I put my best effort in it and it took me a really long time to finish it. I pray that no other write-up will take me as long to finish. But if I get this diagnosis right thoooo…..😏.

The actual encounter with the patient was straight though. I’ve really come a long way in my interview skills, but I can still be better. I kicked myself for missing a couple of questions that I would have liked to ask and as for the physical exam portion, I did just about everything I needed to do but forgot to do one or two maneuvers that just so happened to conveniently spring back into my mind right after I walked out of the exam room. It’s whatever though, I felt like it was my best CPX performance yet. Can’t wait to finally get some feedback this week from the doctor who was grading me. Also the standardized patient did a phenomenal job acting out her severe chest pain…I did get her to crack a few smiles though, hehehe.

A couple days prior to my CPX, I watched a documentary screening with other classmates who are in the Service Learning Scholars program like me. The documentary was called “Private Violence“, and it followed the lives of a few women who had tragically been in very abusive relationships. These women had been beaten very badly by their spouses on a constant basis, but were also finding it hard to leave their spouse for good due to the unhealthy psychological nature of their relationships. It also didn’t help that the varying state laws in place for domestic violence cases were flawed enough to not help the victims feel any safer from their spouse. One woman was severely beaten over and over again and when she finally mustered up the power to seek justice, her pictures of her bruised and bloody body didn’t meet some type of “standard” set by specific states’ laws, so the man accused would only have to go to jail for a maximum of 180 days. It’s insane. In some states, you sell weed and go to jail for years…but then you can beat up your partner on a constant basis and the most you’ll go to jail for is six months?? There are a lot of flawed laws out there that need to be changed. We then also had a discussion about the documentary as a group and touched on the challenges that physicians need to face as well as what needs to be done when dealing with the issue of domestic violence in their patients’ lives. It was a very interesting and necessary event to have overall. It also gave me a framework to keep in my head whenever I interact with patients in the future who are dealing with domestic violence issues. After attending that, I proceeded to go and watch the first presidential debate…mannnnn don’t get me started on that bull. Actually I’m not even gonna go into how I’m feeling about this “presidential race” right now. Just please go out and VOTE for the sake of not only you but this country as a whole.

One more thing, I officially applied for my Step 1 exam this past week. Let me repeat that. I’VE OFFICIALLY APPLIED FOR MY USMLE STEP 1 EXAM. This has gotten so real so fast. I registered to take it in mid-April so I got a good amount of time before then, but I’m well aware of how fast time can fly. I’m just gonna work my tail off until then and pray that I get the score that I feel I deserve. I’m already thinking about how my nerves the night before will probably keep me from being able to fall asleep…I’m gonna have to find a solution to that. Oh, and you wanna hear something ridiculous? The exam costs $605 to take! SIX HUNDRED AND FIVE MOTHERLOVIN’ DOLLARS!!! I very audibly gasped when I saw that amount and immediately closed my laptop. But then guess what I remembered? My school reimburses us for the cost of the exam! Wake is soooo clutch man! THE REAL MVP. So I deposited the check that Student Affairs gave me, applied for the exam, and gleefully checked my bank account to verify that the amount in my checking account was unchanged. And lo and behold, it was unchanged.

Geek & Sundry dancing happy dance kid president dance

Gotta get back to catching up to these lectures though, I only have three more to go before I’m all the way caught up again! I definitely don’t wanna be behind before facing the four lectures we have tomorrow morning along with the longitudinal classes that will be taking up my afternoon. Jeez.

Have a marvelous week! 

“Inaction breeds doubt and fear. Action breeds confidence and courage. If you want to conquer fear, do not sit home and think about it. Go out and get busy.” – Dale Carnegie

– Black Man, M.D.

Final Push!

TEN MORE DAYS.

That’s what’s separating me from now and freedom. Well, freedom from anatomy. Biochemistry is right around the corner but we won’t talk about that right now. Just ten days. Granted, I gotta take two different tests in this ten-day span but at this point I don’t even care. I’ve finally developed a study groove in anatomy and I plan on finishing strong. Bring on test #4. Bring on that CAS Cumulative Final Exam. Speaking of which, who’s idea was it to have a cumulative final exam on 12 weeks of jam-packed anatomy FOUR DAYS AFTER our fourth exam?? Like, how could someone possibly cram details of the whole body in four days, especially right after taking an exam? I don’t know what kind of games they playing or what they’re smoking. But it’s gotta be done. So this is what I’m going to do. I’ll give it my all once again on my next exam this Friday and then I won’t stress about the final. Sure I’ll study during the four days before it, but I’m not going to kill myself over it. As a matter of fact, I’ll mix some Bernie Mac Show, Netflix movies, college football and FIFA into my studying. That’s the beauty of pass/fail y’all. If I do decent enough on the test before my final, I don’t have to worry about scoring high. Shiii, it may even be possible to score a zero on the final and still pass the class. Granted, I’m not scoring a zero…I literally won’t allow myself to tank a test on purpose lol. But I also won’t spend 18 hours a day trying to digest material that I spent the last 11 weeks learning at an accelerated pace. You see, I’m convinced they’re playing mind tricks y’all. Alongside learning the art of medicine, I’m convinced some of the faculty wanna see us stress and struggle as well as observe how we handle all the stress they put on us. They not gonna stress me tho! No suhhh, NOT ME!! I’m really about to be on that “work smarter, not harder” grind during the four days before the final. They really got me all f-ed up if they think ima be posted in the library studying till 6 AM like it was the USMLE Step 1 exam.

So yeah, ten more days and I’m done with anatomy. It’s come to the point where I’ll be unconsciously naming muscle groups in my head while I’m lifting weights. I even go as far as trying to figure out what arteries and nerves supply the muscles I’m working on. That’s when you know it’s gone too far. Anatomy has taken over my life y’all. 😳 If I had this same study mentality in college, I know for a fact that I would’ve gotten summa cum laude. But I also had a much bigger social life in college, and I wouldn’t give that up for the world lol. Enough about anatomy. In regards to the practical skills that I will actually use as a doctor, I’m finding that I’m starting to feel more confident in patient interviewing. I don’t know what it is about taking a patient’s history, but I was having a good amount of trouble at first trying to keep a conversation flowing while remembering what specific questions to ask and how to specifically ask them. So I ended up getting additional practice with my clinical skills coaches, because although I’ve been told my personality has been helping me with my patients, my patient interviewing skills were pretty sub-par. Which means your boy can only go up from here and shoot for Most Improved! The more I practice patient-interviewing, the more I realize that the whole process is a game, in a way. You see, you gotta go in there hella confident and have the purpose of getting the patient to trust you while you are getting to know the patient. Confidence is key because even if you are only four months into medical school, the patient is going to see you as a doctor of some sort since you have a white coat on. Then as you’re learning from the patient, you gotta hit the key points of the interview:

  • When did your symptoms first start?
  • How long have you been dealing with your pain?
  • Where exactly is the pain located/Where is the pain radiating?
  • How would you describe the pain? (Quality of pain)
  • On a scale of 1-10, how bad is the pain? (Quantity/Severity)
  • What are some activities that alleviate the pain?
  • What are some activities that aggravate the pain?
  • What are some associated symptoms of your condition?
  • How is the pain impacting your quality of life?
  • What were you doing when you first noticed the pain?
  • Have you had any past experiences with your current condition?

And each time questions are answered in the interview, you get points. The more points you get, the better your chances of winning the game when you have to give a patient presentation. Trick is, you have to ask these questions without coming across as cold or disassociated from the patient’s emotions. You have to let the patient have some control over the interview and show them that you care if you want to get as much information as possible. But you see how hard it is to remember all that while trying to hold a regular conversation with the patient?? Okay maybe you don’t, but I found it very challenging. And that’s just the history-taking portion! In real life, I’ll have to do a physical exam, a separate family and social history, a past medical history, a review of systems and a treatment plan.

I think my problem was that I gave the patient way too much time to talk about his/her life and that I couldn’t necessarily redirect the interview to where I needed it to go. Hell, the last two patients I interviewed ended up crying mid-way thru the conversation. That’s where my empathy skills shined bright. It goes to show how human the patients are and how as doctors we have to remember that we are treating more than a disease; we’re treating a human being with a disease that is impacting his/her overall life. I definitely plan on keeping my empathetic skills strong, and I’m glad to say that I’ve been recently doing better gleaning vital information from the patients I’ve been interviewing. As a matter of fact, one of the patients I interviewed made me promise to her that I would keep my bedside manner and active listening skills as I grow into a doctor. So I intend on keeping that promise.

I mentioned patient presentations earlier. That’s when you go to your team and present to them the information you got from the patient. I had to do that for the first time last Thursday and mannn was that a challenge. My clinical skills coach didn’t even give me time to gather my thoughts 😐. There’s actually a certain way you have to present patients and the presentation comes with certain terminology. I was forced to think quick and use the notes I hastily scribbled down during the interview to come up with a presentation. I’m not sure if that’s how patient presentations work though, I could have sworn doctors had more time to organize their notes before presenting…

Oh and I am also currently learning how to do patient write-ups, which is where we write a formal description of the patient that includes the answers to all the questions that we asked them in the history-taking portion of the patient interview. The overall write-up also includes the other parts of the patient encounter such as the physical exam review, the family and social history, the past medical history, the review of systems and the treatment plan for the patient. But we’re taking baby steps right now, so I’ve only done the HPI (history of present illness), family/social history and review of systems portions. I thought it was simple enough to write a description of the patient, but I’ve been ripped both times I’ve submitted a write-up so far lol. I’m not sure if my coach is just being hard on me or if my write-ups actually suck, because I genuinely thought I was doing a good job on those. 😅 Well we all gotta start somewhere right? I’d rather suck and learn valuable advice now than go into my third-year with no prior clinical experience. Shoutout to Wake for having us interact with patients often throughout our first two years of medical school, this experience is really helping me out.

Alright, I’m finished.

Thanksgiving needs to hurry on up and get here.

Have an incredible week everyone! Stay positive and focused on your goals! Be blessed!

– Black Man, M.D.

P.S. Shoutout to everyone back in Miami that got tapped into Iron Arrow!! I was very excited to see all of the new members of the tribe! I wish I was there for the tappings and for Homecoming…nevertheless, Welcome to the Tribe! Y’all deserve it!!!