"How are you able to continue working after witnessing a death like that?"

I had a great question from a very insightful medical student after the first case of our day was to Code Blue that did not get any better. The code was on a young patient in my primary care. She was very unwell, and I'm sure nothing would that have changed the outcome. Tragic, true, circle of life type stuff. 

Initially, I felt really upset with myself. How could I just move on? I know this woman and her family quite well. Should not I be more upset with what just happened?

With every death, every code, I ask my team to do a quick debrief with me (longer if needed) to ensure that we did all that we could, and needed to do. I go over everything in my head as well. Where could I improve next time? Were we all wearing PPE? Did I speak with the family in a respectful, clear manner ?

This time around, the police were with us. We're a small town, so all tragedies involve them. It's great, because they call victim services if needed, get in contact with distant relatives, chase after teens who "can not take it" and run off. They are a really good bunch. They surrounded me and checked in on how I was doing. Asking if I would talk to someone if things went poorly. I am telling me I was a rock star in the trauma bay, That the family completely trusted me and was incredibly relieved to know that I would be the one working on their loved one. Basically making sure I do not get PTSD from the event - something I try to do for them all the time but was not used to having it in return. 

I was a bit upset, but felt like I was not upset enough. That I was a big faker pretending to care. 

It was not until yesterday that I was able to figure out why it is that I can just pick up and go on. This was the third patient that description fit that died in front of me this year that I was able to continue working after their pronouncement. 

I have a therapist. Everyone should. She helps me figure out things like this that niggle in the back of my head but that I do not take the time to work through. She helps me figure out when the culture of medicine is nutso and I'm right to ignore the culture and do what is right. 

Here is the answer, finally, med student of mine. I have an incredible resilience built around patient deaths. 

When I first got into med school, I knew that someone like me with a soft hear t might have a hard time with death so I sought out situations where I would be challenged. I thought about each deat h as an unavoidable event and looked for the way that I could make it the MOST comfortable for the patient and their family and (even when the patient is a baby). I learned that I could cry with family in a respectful manner. 

Each of those links is a blog post I've done during my training and practice to reflect on death and my part in it. I see myself as separate from the patient and their family. I love them in a way that is not family or friend, but caregiver. My role in their life is just a step in their journey through this world. They hold the same role in mine. While our lives intersect, my goal is to make our lives both better for the experience. I learn my lesson, then a go to intersect with another life. The lessons I've learned stay with me forever, but they are not necessarily emotional. 

Sometimes they are. A patient died of malnutrition at a young age, and you bet your ass I got angry and looked to make change. But, because I want the rest of my patients to be healthy, because i was not dwelling on his passing. 

So, my thought process goes like this; reflect on the death changeable and my role in it, reflect on the interaction with family and colleagues, move on to the next patient who needs to see me. This might happen many times during the day following that death. I still wonder if I could have done more for my patient before she died, but that use as a way to be a better doctor, not to dwell on the past. 

Death is part of life. My job is to keep moving forward. I see my getting back to work and helping other people as a way of respecting my patients' lessons to me. 

Pregnancy in Medical School

"Remember people, well except medical students, typically reproduce before the age of 30."

MD, cardiologist

(via coffeemuggermd)

I’ve had this in my drafts for a while. It still pisses me off a bit. Not that it necessarily should, the cardiologist isn’t saying that no med students have kids before 30 but it’s atypical. 

What pisses me off, is that those who recognize that their life starts NOW, not after residency, or fellowship, or any other magical time, and want to have children are treated as wackos by most of our community. I know I rail on about medical culture and why it is not reflective of reality, but I’m going to do it again. This is another example of thinking that we need to change. 

There is research on just about everything that med students do. You’re the easiest population for medical researchers to bug, so they do.

However, I can’t find much research on being a parent in medical school.  This focuses on mothers (wall free article). It’s the only paper I could find (lots for residents by the way, probably because they are also leading a lot of the research). A lot of the young women I’ve spoken with felt they were treated poorly by the fellow students because they were getting “so many” allowances for time. The new dads in my class felt like they were expected to carry on as if there wasn’t a new sprog at home.  

Back to the paper, “Medical School-Mothers” in the Rhode Island Medical Journal. I’ve never heard of this paper, or this journal and I’m pretty damn excited about all things undergrad medical education and feminism. That’s disappointing. (Have you heard of it and I was just under a rock?)

They don’t tell us how many medical students were interviewed. I want to know what several means - is it 4? Is it 34? Help a sister in research out.

They also don’t discuss fathers. I get that women in medicine is new and all, but I want my colleagues to be good dads. I don’t want any of my colleagues to be fondly remembered by their grandchildren because their own children never saw them. 

“As part of universal precautions, all female medical students who are sexually active with men should be mindful of potential pregnancy.” BARF. Shouldn’t our male medical colleagues also be mindful? This reminds me of the episode in 2014 where a female medical student was at risk of losing her funding to study in Cuba because she “fell pregnant”, while her XY partner was not reprimanded. BARF I say. IUSs, condoms, and access to family doctors for all med students who want them!!

This article is mostly focused on what Student Affairs type people need to know (which is fantastic). 

But. 

What I would like to see is something that talks to many more students to provide curious students with help making decisions, something that gets more into the pros and cons of an educated choice. No one knows when the time is right to have children. Everyone has an opinion on it though. 

I’d also like to see a nation wide mentorship program - to be paired with an attending, hopefully in your chosen field, who also was a parent in med school. Knowing you have someone who has been there and survived. 

I’d like a handbook for parents in med school. Tips tricks and downfalls to avoid. I’d like this to be an open topic of discussion that starts in Year one. I want the parental leave policy to be pointed out to all students during orientation week. 

I want to know how much post partum depression and anxiety are present in the learners having children. We are all pretty crappy at taking care of our mental health, and how many of us have med studentitis? (Pregnant med studentitis is like that on freaking crack - everything that could possibly go wrong, will and you will blame yourself, even though you would tell your patients to think better of themselves. My friend had 10/10 stress through the last 4 months of her pregnancy. Uncool.) 

I want there to be scheduled check ins with Student Affairs during pregnancy and post partum to ensure this isn’t an issue. My suspicion is that the numbers of sufferers in the medical community are high. 

I want to get rid of the shame associated with wanting to be a good parent when you are ready to be one. Seriously. If we don’t stop acting like families in medicine are bizarre while we’re in first year medical school, how can we expect attendings to respect their colleagues and learners’ choices?

One of my colleagues is pregnant. I’m over the moon for her and her MD husband. The amount of stress they underwent preparing to tell the rest of the team about the (wanted, expected) pregnancy was overwhelming to ME. I’m not having a baby. Jeepers. They felt they needed to make it very clear that they do not want to stop practicing for more than 2 months each (like it’s not bad enough that they don’t get parental leave from our governing body). They were shamed into divulging the information much sooner than they wanted due to morning sickness. Our colleagues (all XY but me), have children with stay at home moms and incredibly twisted senses of what parenthood should look like with a physician parent. 

This has got to stop guys. We need to treat each other better and watch each others’ backs. 

What would you add to my list to make it happen?

Can I possibly improve my blog? Maybe.

For kicks, I decided to look on PubMed to see if there was any research done on blogging. There is. Actual research done on how docs blog. Cool. But it's Saturday, so I'm only going to look at 2 of them.

First of all, did you know about Web 2.0?? I sure didn't but I've been using it like a mad person for years. Web 2.0 describes web sites that use technology beyond the static pages of earlier web sites.

This article makes a point I've been considering for a while - making my blog searchable in a way that will make it easier to match experiences I've had with my progress in my training and any applicable social aspects. They propose that bloggers use the usual tags they use (my favourite seems to be 'note to self''), they call these folksonomy - plus a diagnostic code from the ICD-11. The blogs that the researchers suggest these tags be used include WebMD, Kevin MD, and CasesBlog. My blog has little to do with these blogs - it's just me, I'm trying to learn more about myself as a physician not necessarily educate others (though I hope that's a happy bonus), and, for the most part, I hide my patients' true diagnosis. If I choose to follow the proposed system in this paper, which frankly isn't terrible, it makes it more difficult to hide my patients' identity. Unless, I use the ICD codes only for my rants on specific topics like suicide and HIV, and ignore the diagnoses of the cases I dissect. Which certainly is something worth looking at.  While I won't follow their algorithm to the letter, I will try to remember to tag liberally.

Another set of researchers looked specifically at learners' blogs. It's like they were looking over my shoulder. They found that learners used their blogs to reflect on their experiences. Their table 2 looks at the analysis of the blogs and what is covered and offers a few suggestions. My absolute favourite is the suggestion to share coping strategies with peers. Personally, I would have put it under "emotional distress" not "interaction with peers". I think that many learners are looking for other learners' blogs to find out how they deal with the big stuff in their lives - exams, residency matching, patient death... Having a fairly anonymous way of talking about things we are afraid of telling each other face to face would be helpful. There are many conversations taking place on twitter and in medical journals about burnout. It seems to me that using each other via the anonymity of Web 2.0 is one way to seek help without worrying about repercussions.

They also found that blogging learners were likely to preach the benefits both of collaborative learning and having a solid support system. Of course they do. Blogging learners rock.

Pinilla et al also makes some suggestions about how medical educators can use their students' blogs to enhance their learning. One suggestions is that the educators look for where their learners are having problems with exams, etc. This creeps me out. If I had any inkling that my teachers were looking at my blog I would have stopped writing. Or at least edited my posts to the point of ruining the point I was trying to make. Random, unknown educators would have been welcome to peruse, but not my own teachers. Looking at broad themes and concerns of the bloggers in general is a great idea. That it might even be an option makes me happy that I've stayed the Imposter.

So, to recap what I've learned:
1. Tag my blog liberally so that finding information in the future will be easy, both for me and for my readers.
2. Encourage the use of blogs as a way to share coping strategies.
3. Blogging learners rock.
4. Educators should not follow their own learners' blogs. It's creepy. But I'm all for qualitative research. Especially when it's done by someone else.

Pill Rolling Tremor

I'm on vacation while I wait for the FHT to sort out the red tape in me joining the practice. This is giving me time to sort through questions that have come up during residency. 

One was after a disagreement I had with a doc about what a pill rolling tremor is. The doc I was working with insisted it was a fine movement of the wrist. I was really sure it was a fine movement between the thumb and index finger. 

I love being right. 

You see pill rolling in some folks with Parkinson's disease. It's often a tip off for me that I need to look for other symptoms to determine if I should be worried or if its just a nervous tic. Because its a resting tremor it's one that is often difficult for the patient to hide and will present itself during the Q&A portion of our visit. 

Have a look at this article on how pills used to be made to get an idea of where the name came from. My favourite quote is:

Pharmacists could coat pills to disguise the flavour of the medicine, making them easier to swallow.  Depending on how much the client was willing or able to pay, thin gold or silver leaf, calcium carbonate (to achieve a pearl finish), sugar, or gelatin could be used. Many of these coatings made the pills indigestible. As a result, they would pass through the digestive system whole, without delivering medication.

My online appearance is more important than my physical appearance

I had a great time today reading posts and comments on Twitter about physicians' appearances.

Things I've learned:
1. Some docs really like this article from 2005 (!!!!) on the importance of dressing well for your patients. Remember it can take up to 3 years to publish an article so this data is from 2003 at the latest. Think track suits and Queer Eye for the Straight Guy.

2. The BBC would really like doctors to generally judge everything about their outward selves. This article looks at "scruffy doctors", overweight doctors, and doctors who smoke. They also acknowledge that many patients are expecting the white coated doctor to be male. 

Which brings me to...

3. A separate discussion has been playing out today on Twitter about how young female physicians are perceived spurred by this blog entry. Female docs are often (VERY often) mistaken for nurses. Even after introducing themselves as Doctor SoandSo. I know I've blogged on this before but I can't find it. We are also assumed to be the assistant, the secretary. As an older than average resident, I was usually mistaken for the social worker or my pediatric patients' mother DESPITE wearing an ID badge and my stethoscope. One intelligent staff member asked me 6 times during my 2 month pediatric rotation to fill out the insurance forms for "my child". She was shocked every time that I was *still* a physician. I was once blocked from a code by the nurse who called me to it because she thought I was a family member (again, with stethoscope and badge). 

While I was on rotations in other hospitals, I would carry a small bag with my "pocket" stuff. Pens, a Drug Pocket, my phone. Most "professional" women's clothing prohibits actually using pockets if they do exist. This teeny satchel was usually the scape goat in my mis-identification. 

This is one of those issues that makes me a bit cranky. Have I told you yet about the preceptor who told me that it was perfectly reasonable to be mistaken for the social worker since "doctors don't have long curly hair, you can't expect to be taken seriously"? It makes me see red. 

If, in real life, I'm mistaken for another profession or not a professional at all, based on my hair and my satchel, what must the medical world think of me based on my online profile? 

Some argue that our online presence allows others to see our "true selves" (it's the basis for many relationships that start online). Social media (SoMe), plays a big part in my life. I'm in a tiny rural town, most of my friends are in different provinces. Without my online presence, I would be entirely isolated. My professional online presence is split between The Imposter and Dr. SoandSo. Maintaining my anonymity on this blog is important to my being able to use it as a sandbox for trying out ideas and ways of dealing with patients in a safe environment. As Dr. SoandSo, I have opinions on family medicine and its role among the specialties. As just me, I am on Facebook with my friends and family so I can watch my family grow up from a distance. 

I'm seeing guidelines and suggestions about how docs (and everyone else) should behave online. It's true, many docs are illiterate in the ways of SoMe, but I think that they are aware of how to behave in a crowded mall. The same rules we learned in kindergarten apply. 

1. Share everything. Post your references so others can also be as smart as you.
2. Play fair. Don't overload your online profile so that your friends aren't also visible. 
3. Don't hit people. Don't call them names. Maybe they have had a really bad day.
4. Clean up your own mess.  Untag any photos that you wouldn't want your mother to put into the family Christmas card. 
5. Don't take things that aren't yours. Credit any source that you use. You wouldn't want someone else prancing around in the sweater you took 3 years to make claiming they knitted it themselves. Our intellectual property is just as important. 
6. Say you're sorry when you hurt somebody. Apologise when you make a mistake and correct those mistakes.
7. Wash your hands before you eat. MRSA y'all. 
8. Live a balanced life - learn some and think some and draw and paint and sing and dance and play and work every day some. Your online friends are interested in the new bottle of wine you found just as much as they are the new journal article that you found so fascinating. Share. But please don't overshare. 

Truthfully, first impressions are just that. The patients who mistook me for a social worker trusted my ability to care for their medical needs. First impressions don't matter nearly as much as who we as health professionals truly are. How many times have you heard from your patients the story about the surgeon in his million dollar suit with no bedside manner? Could you possibly sleep well at night knowing that you had treated your patients in a way that would have put you in the corner during kindergarten? My online presence is as close as it comes to knowing the real Imposter and how she speaks with her patients. 

Dress respectfully for your patients but act respectfully (online and face to face) for yourself as much as them. 

Changes are coming in residency training

The CMA posted this morning that residency expectations will be changed by 2017. It will be competency based  rather than time and exam based. In theory, this is already going on. You need to be recommended to sit your licensing exam by your program. If your program sees you as a resident at risk, they should not recommend you. From what I understand, this rarely happens, what Dr. Jason Frank in the article calls "failure to fail". Medicine in general has a tendency to pass students who should be re-mediated, or, kicked out. People are shocked that my school kicked 3 people out of our program, despite being a pass/fail school. So, sub-par residents can make it through to their exams missing essential skills.

My clerkship program was quite focused on our actions - for example, we all needed to deliver one baby vaginally, place 5 peripheral IVs, etc. etc. Students were not always able to complete the activities though because their residents scooped them all, their consultants didn't have time, or there just weren't enough patients. Fake signatures abounded, our teachers were willing to sign off when we were able to describe what we would do if given the opportunity. My exam in IM was meant to be hands on, but ended up being a  seated conversation between me and my preceptor.

In my experience, preceptors who are not in academic centers are not great teachers and can be even worse at giving feedback. Many I've met choose to stay away from academic centers to keep away from the extra workload of teaching and research. For residency programs to have such a strong focus on competency and the improvement of those competencies, there needs to be a significant improvement in the training of preceptors, especially those who are based in the community and in rural settings. 4 years is an optimistic turn over time. Many of the docs I've worked with this year are holding me to the same standards they were held to 15 years ago in their training in a specialty other than family medicine. Getting those docs into this decade, into my specialty, will take some effort. It will take much more to get them in line with an entirely new way of completing residency.

If however, this is based on objective observations by a small number of mentors/preceptors who can watch the resident progress from tadpole to frog, it will be a step in the right direction. These observers will need to have their own mentors to help them differentiate where a new resident should be versus a senior. The proposed evaluation program assumes that those evaluating residents will be able to make these distinctions. Unless you have experience with many residents at various levels, knowing how a resident is performing can be tricky.

Most concerning to me though, is the dependency of this type evaluation on numbers of patients. I've been worrying about this since I noticed the rising number of learners coming behind me while we are rushing patients out of hospitals. Despite taking on extra call shifts, totally ignoring PAIRO's rules about hours working, and leaving my cell number for all attendings to call me with juicy cases, at the end of my residency I have spaces in my skills log that are empty, experiences my residents told me I would get after clerkship. If I was graduating from residency in 2020 with the bad luck that I've had for catching cases that are on the relegated list of "must do's", it would take me extra time to finish. Which is fine. But it also means that I'd be taking those vaginal deliveries from junior residents and clerks, because shit does flow downhill.

In an ideal world, this is a great proposition. I try to be optimistic but  my experience with community docs having something extra to do makes it hard. I expect the community and rural programs to lose preceptors when their responsibilities change.

Learning radiology on your own

Check out the radiology channel on you tube. It includes such BRILLIANT gems as the ossification centres of the paediatric elbow. Awesome.

And don't forget the Wheeless Orthopadics text book. It gives advice on doing the physical exam and management.


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Why cats are not doctors

Good to know.



But somewhat patient centred right?




This is unfortunately not species specific.

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OMG I passed.

Be afraid.


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Bias from preceptors

I've experienced so much bias an prejudice during my training. I plan on writing more about this soon, but until then, here's my favourite "constructive criticism".

Of course no one is going to think you're a doctor. People don't take women with long curly hair seriously.


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Waiting on exam results is painful

"The mountains of madness have many little plateaux of sanity" - Terry Pratchett, The Truth.

Our exam began May 3. We should expect results by mid June. MID JUNE. ARE YOU EFFING KIDDING ME.?????

I swear I'm having more, and scarier, nightmares now that I've written. All I can do is rethink everything I did during those three days. I'll see a patient with chronic renal disease and remember a test that I ALWAYS do but forgot to mention. Or, I'll see someone who reminds me of the fake patients in the SOOs and almost burst out crying. Unreal.

If, as my mommy thinks, I passed, at least this will be the last round of exams.

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Residency blues. Again.

I'm lucky enough to not have lost any colleagues to suicide...yet. In the US, physicians are the profession with the highest rate of suicide. Pamela Wible has described three scenarios that I know have at least flitted past my consciousness. The idea that we are supposed to take on as much responsibility as we do and not be allowed to address our own distress is appalling. We shouldn't be afraid to ask for help for fear of losing malpractice insurance.

I know I've blathered on about the stress associated with residency, but honestly feel that I just can't do it enough justice. The words to describe the emotional roller coaster just don't exist. Instead, I'll give you a list of events that I have experienced, usually many in the same day.

Received lab results back that confirm invasive breast cancer in my neighbour.
Been so overwhelmed at work I haven't cleaned my poor kitty's box in well over a week.
Delivered a beautiful baby girl to a mom and dad who couldn't stop kissing each other or the baby to let me congratulate them.
Delivered a beautiful baby boy to a mom who because of her own brain injury will not be allowed to keep him.
Revive a patient during a code blue and have him go on to living a healthy happy life.
Help a young woman suffering from a painful cancer sleep away her last week of life. And then help her parents cope with their daughter's decision.
Lost track of so many emails and Facebook messages from friends I'm surprised they still answer me when I do send a note.
Been told that I'm an incompetent physician who needs to do at least 6 months of remedial training.
Been told I'm a brilliant physician and that my preceptor is excited to have me as a future colleague.
Had patients hug me for telling them about their cancer, their lack of cancer, that I'm leaving a practice, that their mom just died.
Newborn baby exams. Smelling newborn babies.
Helping moms learn to breast feed when they've given up hope.
Missed my nephews special events for work.
Finding my own worrisome lumps.
Had my vacation time continually denied until I just gave up and have weeks of vacation at the end of each residency year left over.

The ups and downs never end. It can be absolutely exhausting. My blog has provided me with some outlet for what I'm doing. I also have a fabulous partner who is extra supportive and a BFF who is going through the same crap. But even with all of the help, residency is incredibly isolating.

This doesn't make sense to me.

Residency is supposed to be preparing us for practice. We should be learning the coping mechanisms now that will keep us from planning a 03:00 dive off a bridge.

Which I suppose leads to the question, what prevents us from becoming hopeless? How do we keep our light shining when we barely have the energy to wash our hair?

Zakari Tatasuggests monthly counselling sessions for residents to address the extra stress that residency incurs. She also says "The idea is not to find a perfect solution but to openly discuss and accept that physicians are vulnerable. The current culture that presents physicians as always being in control of their psychological health should be discarded."

I know an attempt was made in my med school to encourage self care, but it wasn't given as much attention as the importance of knowing how to write a clinical note or avoiding embarrassing the school. Lip service from the chosen few lovey dovey types that isn't also reflected in regular practice is soon lost.

Next week is resident wellness day at my institute. Events will be held in a city I try to visit and will include a speech and yoga. One day a year doing something I could do at home by watching a Ted talk while stretching.

As with most other behaviours, I argue that we need to learn and be taught by example. After breaking bad news, do a debrief and check in on one another. A preceptor who is willing to admit to difficulty dealing with everything on their plate and going through the options of dealing with said overflowing plate teaches a valuable lesson. We are trained to recognize depression and anxiety in our patients but rarely ask our colleagues about it. I've seen a doc whom all his colleagues stated was burned out but none were willing to talk to him or ask how to help him slow down and recharge. The lesson I learned is that my own mental health doesn't matter in my profession.

That can't be right.



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This is NOT a 2 am consult

I'm always afraid of being wrong and making a stupid mistake in front of colleagues. I think it's fairly common, we all want to be seen as competent care givers. We never want to admit that we don't something but when our patients need us to 'fess up about our lack of knowledge, we will, and call a friend.

Working in a small ER means that rather than having in house specialists I can bounce questions off of in the middle of the night, all my specialists are elsewhere in hospitals where they are expected to be allowed to sleep from 11pm on because they'll be on call all weekend. It takes a lot of guts to call after midnight.

I'm sure you can see where this is going.

I've seen a lot, but I haven't come close to seeing everything. I try to extrapolate from what I do know to what I'm seeing in front of me. Given what I saw the other night, and what I know from other similar structures, I was going to need help. Apparently I should have known better and that I didn't need help.

I still feel like I did the right thing. I had a patient in front of me with unbearable pain. The resources in front of me where not at all helpful, though I could have looked for the procedure on youtube... I called. I got snarked at. I also got the info I needed and my patient left free of pain.

Since this blog is about making me a better a doctor, what would I do differently next time?
1. look in even more basic books than I was, something like Tintanelli's.
2. YouTube the procedure.
3. Start my consult (if I still decide to call) with "I'm not sure this is a 2am consult, but my pt is in quite a bit of pain...".
4. Take a breath and put everything in context. I frequently let my nurses guide my care. I trust them to know what to do and very often, that's a good call. But sometimes, I need to listen to my own brain and cut them out.
5. Work out how I would do what I need to do - get the patient into position, get the equipment I need in position. There's something about going through the steps first that makes a procedure easier to do and less scary as well.

Cards Against Humanity

Today was the first of three days of my family medicine licensing exam. It was the short answer management problem day, 3 hours in the morning, 3 hours in the afternoon with an hour for lunch in between.

I had room in my bag for either my notes or my box of cards against humanity game.

I made the right choice.

Playing a silly, irreverent and occasionally dirty game was the perfect mid exam break.


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My partner isn't immune

My partner is incredibly supportive. Like ridiculously supportive. To the point that he is also having exam nightmares.

What a good fellow.


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Exam nightmares

Last night, I was senior resident on call in a teaching hospital. I'd never done this before so it was acknowledged that it was a favour.

My consultant was my grade one teacher. I was still anxious about talking on the phone with her. Not knowing I was on call, I was drunk, and had to speak with her. Mrs. Grade One didn't seem to notice but it was mortifying.

There was also a lot of explaining my age and still being a resident. Also explaining that I'm used to emergencies coming in drips and drabs at my wee hospital.

No actual medicine, just feeling fully out of place and not at all ready.

That's what nightmares ate for though right? To show you what your insecurities are so you can analyse them in the cold light of day and kick them to the curb?

Rawr. I've got this.

Not even the end of second year

And already my colleagues from medical school who have chosen other specialties are dissing family medicine docs.

We are not just a dumbed down version of your specialty, or even all the specialties.

We are a specialty of our own. We deserve your respect. I guarantee, no matter what you think, you could NOT do my job for a day. I couldn't do yours. And that's ok. It's why we chose different specialties to match to.

I know we need to be cocky to do our jobs well, but it should never, ever, be at the expense of another specialty.


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You might be a rural resident if...

You've used the phrase "the antibiotics I usually use for manure spreader injuries are..."

You need to avoid the horse plop when running between the clinic and hospital.

Your nurses are just nurses, not OR nurses and ER nurses and post surgical nurses. They do it all. And rock.

You ask all patients how they heat their homes and what kind of flooring they have. I have several patients who use wood exclusively to heat their homes and others with dirt flooring.

You've diagnosed ORF.

When screening for suicidality, checking for firearms in the home is a real concern. As is rope in the barn to hang from.

Your grocery buying habits have greatly improved because the store is full of your patients who are watching your cart.

Almost none of your patients are full code "I wouldn't treat my horse like that, why would I treat myself that way?".

Happiness is...

Having a giggle fit at one in the morning with a five year old boy who bumped his head while being silly.


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And the exam nightmares begin

Even in my dreams, I would rather hunt zombies than study for the exam.

Right now I'm regretting not doing the MCCQE part 2, if only because it would have forced me to start studying a heck of a lot sooner. It also wouldn't have been so shocking to me to find out there is a day of OSCEs as well as the day of SOOs.

This is the second time they're running the CCFP exam this way. It was run in the fall, no problems from what I can tell from my friends who wrote. That gives me hope that it won't be the gong show that the first computer based MCAT was.

So, this nightmare was one of those that make you feel totally helpless. The usual high school crap. I have been studying, but for some reason, haven't written any exams for the past two years and even miss the final exams. I'm looking at never being a doctor again, ever. Not only have I not written exams, I seem to have entirely missed several classes and was never able to find the text books. And, for some reason, I've moved back into my parents' home, along with all my siblings. There is no place for me to study and too many chores to get any studying in. Then, out of nowhere, zombie apocalypse. And I'm relieved? WTF.

I've been interested to see how different residents are choosing to study for this exam.

Some are studying at least 12 hours a week. Coming together in groups weekly and preparing their 99 problems to discuss with each other. Others aren't studying at all.

I'm just trying to stay on top of my clinic work, study when and if I get time.

I've stocked up on herbal tea. I've set up 3 study areas in the house. I have a back up cafe I can use plus the clinic when it's shut.

I've got this.