Sunday, March 13, 2005

To this chapter, a conclusion

Yesterday I finished the second stage of my medical board licensing examination, meaning that I will now be able to practice medicine as an intern come July 1st. More importantly for me in the short term, though, is the fact that I can now go about the practice of life in an unencumbered fashion, reading and writing what I want, when I want. It's a nice feeling. Of course, nagging issues will arise and demand attention, such as ongoing student government duties and the detail of a graduation speech I have to prepare. However, those things will not seem too terribly painful now that my time is my own once again.

The exam was another exercise in attrition. I had to see twelve patients, performing a thorough history and physical exam on each, and then summarize my findings in a medical record note. It wouldn't have been so bad were it not for the unrealistic time constraint imposed upon us: 15 minutes to interview, examine, and counsel the patient, and 10 minutes to write it up. The latter time limit I could handle, but 15 minutes to see a patient borders on absurdity. Oh, sure, doctors do it every day in their clinics (we've all likely been on the receiving end of all-too-brief care, seeing a blur of a white coat move into the room and steamroll us with a mechanical diagnosis and treatment plan), but they do so with the aid of pre-printed patient history forms filled out in the waiting room, saving them the effort of asking about Aunt Clarice's psoriasis and other minute details. Nevermind the fact that practicing physicians have...well, years of practice, which tends to expedite the process of clinic visits. In any case, 15 minutes proved vastly inadequate for me to feel comfortable in creating a quality patient encounter. Yet, that was the scenario presented to me. So, for eight hours total (we had a couple of breaks, hence the failure of the math), I plowed through patient after patient... Oh, wait. I can't really say any more. See, the first rule of the Clinical skills exam is you're not supposed to talk about it. And the second rule of the clinical skills exam is you're not supposed to talk about it. Seriously. I could get in trouble. In fact, I may just burst into a smoldering pile of charred bones in an instant if I divulge any more details. Suffice it to say that I feel tired and worn, but glad to be finished. Now it's time to gather the scraps of my life, and during the next three months, paste them together into such a patchwork that, though it will not likely resemble the real thing, it may serve as a suitable substitute. So bear with me.

And thanks to everyone for persevering during the great Blogger comment famine. My trip to Chicago left me unaware of the turmoil, but I was pleased to find a couple of emails waiting for me upon my return. Thanks to KarbonKountyMoos for the great postcard, and sorry to Extreme Unction for the delay in providing apt medical terminology for toes. It's good to be back.


At 7:48 AM, Blogger KarbonKountyMoos said...

Congratulations! Welcome back, take a well deserved break & have some fun!

At 11:47 AM, Blogger Carol (Smiles and Laughter) said...

Congratulations on finishing the exam! I'm sure you feel more relief right now than one can express.

I was thinking...15 minutes per patient...I agree that probably isn't enough when you have to gather history, too. But, I was also thinking that most doctors I have been to in a clinical setting have 15 minutes to see the patient AND to write whatever they need to write. It just seems like nowadays with HMO's and insurance cuts doctors don't get much more than 10 minutes at best with each patient. Not long enough, really. Well, for some diagnoses, anyway.

At 12:43 PM, Blogger Ian said...

Thanks for the congrats!

As for the 15 minute issue, recent large-scale practice surveys in the US have shown that most primary care doctors spend a little over 15 minutes in the room with each patient on average -- more with some, less with others. (And of course the speedsters are balanced out by the slowpokes -- just depends on the Dr.). Paperwork moves pretty fast thanks to dictation systems. In any case, most docs now have their patients fill out surveys of their past medical history, meds, allergies, family history, and social history so that the doc doesn't have to spend time eliciting those facts. Alas, we did not have access to such a benefit this past weekend.

At 5:52 PM, Blogger L said...


At 9:14 AM, Blogger Carol (Smiles and Laughter) said...

If I think about it, that does make sense. After all, I'm a 32 year old healthy woman who only goes to the doctor for routine check ups, prenatal visits (now), and the occassional flu bug. They wouldn't have to spend much time with me. I'm sure they spend much more time with my ailing grandmother-in-law.

At 6:05 AM, Blogger Tom Naka said...

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