The clinic staff throws a party for my last day. One of the secretaries brought in homemade rhubarb turnovers. I express my gratitude and they respond with “We take any excuse to throw a party!” I am sorry to bid farewell to Doctor Dunker.
Family Medicine students then go to a culinary medicine workshop at the YMCA. Our school gives us each of the five groups a Visa gift card to buy food for a hypothetical family of four, one of whom has a medical issue, e.g., a diabetic child or an adult with a heart condition. A recently graduated dietician leads the class. She teaches different ways to cut an onion, but is unable to answer our questions about the current popular diets (e.g., ketogenic versus intermittent fasting versus carnivore). After an hour cooking our respective meals (paella, lentil soup, and Korean chicken with rice, etc.), it was time to eat and rate. Our paella won!
Gentle Greg organized a musical variety night at a local bar for Tuesday. Several weeks ago, 15 classmates had agreed to perform, but only 5 showed up due to exam pressure. Greg had to sing every song (examples: Silver Lining by Mt. Joy, Going to California by Led Zeppelin, and Mama, You Been on My Mind by Bob Dylan).
Exams begin with two standardized patients. The first is a 65-year-old female active smoker presenting for cardiovascular risk assessment and blood pressure management. We had to indicate all the USPSTF grade A/B recommended screenings and appropriate medications to deal with elevated blood pressure.
The second standardized patient was a 78-year-old cheerful female presenting at the behest of her daughter who wrote a note expressing concern about her ability to drive: “She is forgetting where she parked.” I perform most of a mini mental status exam (MMSE) by asking her to recall three words, name a few objects (a pencil, watch), and serial sevens. I mistakenly forgot to ask the standard “orientation” questions (person, place, and time). Afterwards in the debrief, I learn that the patient believed that it is 1961 and the president is Richard Nixon.
[Editor: Maybe she was cheerful because Nixon was an awesome president compared to Donald Trump!]
The main exam is a 100-question multiple-choice exam on Blackboard. There were several questions on differentiating gastroesophageal reflux disease (GERD) from peptic ulcer disease (PUD), and on the workup of PUD (proton-pump inhibitor trial versus Helicobacter pylori stool antigen test). Every time a question had statin as an answer, it was always correct. A challenging question: A patient on warfarin for atrial fibrillation recently started treatment for symptoms suggestive of GERD. What medication caused an elevated INR (delayed clotting) test? (answer: Prilosec). I missed a question on what antihypertensive medication is contraindicated in gout (answer: thiazides because it decreases urate excretion).
After the exam, we have a debrief with the clerkship director. Pinterest Penelope complained about the limited time on family medicine: “We learn about all the different stress-relieving practices like mindfulness in this rotation, but we don’t have enough time to practice what you preach.” Clerkship Director: “Yeah, you’re going to be busy as a doctor, get used to it.” Gigolo Giorgio complained about the different format of the exam: “I couldn’t mark questions for review.” Father Fred: “I thought we could’ve done without a day at the nursing home, and instead spend a day with Sports Medicine. I don’t feel comfortable with a lot of fractures.”
Statistics for the week… Study: 5 hours. Sleep: 8 hours/night; Fun: 1 night. For Gigolo Giorgio’s birthday, he requests to go to the gay nightclub for a night of dancing after several margaritas at his downtown apartment.
The rest of the book: http://fifthchance.com/MedicalSchool2020
> because Nixon was an awesome president…
He was in one way at least. It was his initiative that turned relations with China from “pariah” to “cordial”. The US succeeded in getting closer to both the USSR and China than either of them were to the other.
Nixon’s more recent successors managed to achieve the opposite, driving Russia and China together while pointlessly antagonizing both. There are some parallels between the US’s bungling foreign policy and that of the German Empire before WWI that strengthened the triple entente.