June 8, 2008

• An impersonal statement or two

  Before I begin the next choose your own adventure post, allow me to briefly insert the first of what will probably be many online panic attacks.

  ***
  The most terrifying part of the residency application process for me is probably the personal statement. My grades and boards scores are pretty much over and done with, since I cant change my past performance. My clinical evaluations arent particualrly worrisome, because I know i relate well to people i can interact with in person. But sitting down and coming up with a page of why I want to be an ophthalmologist and showing my personality through it, well I just draw an instant blank.

  Personal statements are so freeform…no guidelines are given, and very few people are willing to discuss what they did, and even for those who are, there are no clues as to what a given grader will feel makes a good statement. Do i talk only about the history of my interest in ophthalmology? Do i talk about some special moment that made me realize the field was for me? Do I mention why I would be a good addition to their program? DO i talk about outside unrelated interests like cooking, or traveling, or stand up comedy? I just dont know

  And the biggest irony of this textual rorshach is that sitting down and writing should be one of the easiest parts of this application, given one of my hobbies is keeping this blog! It doesnt get more freeform than that. Is blogging something i should even mention? (probably not, but who knows?)

  And I have little over a month to get this done and sent out, with nothing more than an introductory statement. My muse needs to stop bumming around and come visit already!
  ***

  This has been a test of the emergency bitching system. Had this been a real emergency, this rant would have been followed by several expletives, and government instructions. thank you

  ***
  For todays Choose your own adventure post, Some of you were curious about the situations when antibiotics, or medical intervention is NOT indicated;

  Sometimes, people get sick. Actually, people get sick all the time. While most of us just make ourselves ignore it, some folks actually go visit the doctor. A few pills or a shot, and we are treated, cured, and good to go. But what about when medical intervention isnt needed? Sure, it sucks to get a cold, but since it is caused by a virus, there is no point in prescribing antibiotics right? And do i really need a flu shot if all I came in to the office with was a headache? Why in the world would doctors give uneccesary treatment…isnt the first rule of their hippocratic oath do no harm?

  Well for the record, no, primum non nocere is not part of the oath. The oath deals mostly with keeping secrets, not helping people shuffle off this mortal coil, and absolutely no abortions, or cutting of those who labor under the stone. true story.

  But seriously, why do doctors give unwarranted medications?

  1. Because the evidence may be controversial; Perhaps your diagnosis is something that can be caused by a bacteria OR a virus. Sure, we may supect one, but if we can attack several options with one drug, and we are not entirely sure of what is ailing you within this range, this is not actually a bad idea. Not too mention it covers our asses in case of lawsuits.

  2. You dont come visit often enough; yes, us doctors get treated like your poor old mothers-you never call, you never write, and you rarely stop in to visit unless you want something. So when we do see you, we try and get you to take care of a lot of preventative medicine. So perhaps you have the sniffles now, but your last tetanus shot was 12 years ago. Or you are in the AARP nation, and it is almost flu season? Or there was an outbreak of meningitis near your college? or you were a female who had not had the vaccination to help prevent cervical cancer? This may be the one chance we have to arm your bodies defenses as best we can, even if it is not pertinent to your chief complaint

  3. Because you just dont trust us; Okay, let’s face it-very few folks look at a trip to the doctor as a pleasurable experience. It ranks right up there with going to the dentist, paying the bills, or seeing a george lucas or m. night shyamalan film-you may have to do it every once in a while, but the less the better. That said, if you go the doctor, and we look you over and say okay, you’re sick, go home and get some rest, you feel cheated. Why did you waste all this time and money to learn something you already knew? So in order to alleviate some of your tension, and make sure you keep coming back to see us before something serious develops, we will agree to, or sometimes even suggest you take shots or drugs that we privately feel are a waste of time. Hey, dont blame us, we are a customer service industry

  4. Billing; doctoring is expensive. It is not like the old days of medicine when every hot young punk physician was tooling around in a porsche on the way to the helicopter pad to fly out to the yacht moored on our private island resort. No, most of us now are prisoners of debt, with the wardens the HMO’s and setting us with strict regulations on how to bill. We can diagnoses you with condition A or B when you visit. You have features of both, but if B goes on the billing form, we get paid more by the insurance companies for your visit. In this same vein, if we give you a diagnosis of B, we are required to give you a specific treament for B, because that is how the algorithm works. Stupid, but them’s the breaks. You want to be a lawyer, go to lawschool. You want to make money, go to business school. You want to be a doctor, you go to medical school and then frantically have to learn business and law along the way just so you can keep practicing your actual job

  There are probably more reasons, but those are the ones I tended to notice the most often during my clerkships, especially family practice. Until next post

  -Almost Dr J.

  • 11:22 pm
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