Sunday, March 6, 2011

Starting over, again.

I just finished studying for the national board exam (way more to come on this, but first I have to drive all that bullshit knowledge out of my head. And get over my post-traumatic stress disorder) and went back to the clinics.  This was a bit of a shocker.  I left clinics 2.5 months ago feeling as confident as a med student can be.  I could walk blindly into a patient's room and come out 15 minutes later with the most complete history and physical this patient has ever received.  I'm talking full review of systems.  I'm talking recent pet exposures. I'm talking auscultation and palpation*.  My fellow students and I were armed with a complete set of medical knowledge (as defined by our ability to bullshit our way through pimping questions).  We could stand for 18 hours without even so much as an awkward shift.  We gave up the instinctual need to urinate.  Those things are for the weak.  We were medical students done with our clerkship year.  We were the strong.

Then we went on winter break.  Then we went on extended winter break.  Then we sat down and studied 12 hours a day for the board exam learning the most clinically useless information ever to be associated with medicine.  Then we went on another winter break.

Then we went back to clinics.

And guess what? We didn't know shit. Again.  As my one friend put it, "I forgot to do an assessment and plan.  I finished my presentation, presented the lab values and radiology studies and just stopped.  Everyone was just staring at me. I was like, 'That's it'.  Then a resident politely said, 'We were kind of waiting for your assessment and plan.  You know, what we should do with this patient now that we know about him'.  I just completely forgot we did that."  We are back to being worthless, awkward, stupid med students. Two months and we are already back to borderline lay people.

I think if you could find the end of a rainbow, you wouldn't find gold, you'd find all that shit you used to know.

*These are med school jokes. A review of systems is a review of asinine things completely unrelated to the patient's symptoms.  Pet exposures are very important if your patient is a walking board exam question.  Inspection and palpation are parts of a physical exam to be done on all general parts of the body and are therefore never done.  Ever.

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