Let's Get Physical

I don’t believe I have whined about this one yet…

On Thursday, I leave for Philadelphia. The powers that be in this country have recently added a fourth component to the medical licensing exam. It is now required for all US medical students to spend a full day being video-taped conducting histories and physicals with mock patients. It’s kind of like that episode on Seinfeld where Kramer got hired to pretend like he had gonorrhea for a medical school, only bound to be less entertaining. I will have 12 patient encounters, and I’ve already been forewarned by others that one of them will be a jerk to test how I interact with difficult patients. I guess maybe the whole thing wouldn’t be so annoying if it wasn’t costing me $1500, including travel expenses.

While I do think that it is important that future physicians be evaluated on their bedside manner and ability to communicate, I think that could have easily been objectively evaluated by certified preceptors at some point during my last two years of clinical evaluations. The test is also bogus, as something like 97% pass on the first try, so it’s really not even a valid test. Even more agitating to me is that my classmates have told me that my evaluation will be just pass/fail. So the day won’t even be a learning experience for me, as I’ll have no idea what I could improve on.

Whatever. My exam day isn’t until Saturday, so I plan on making a mini-vacation of it and exploring Philly on Friday as I have never been there before. The other bonus is that tomorrow will be my last day here. It really hasn’t been that bad, just boring.

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The other day we discharged “Old Blue Eyes”. He had brought in by his “caretaker” who insisted that he was demented, having increased falls at home, and needed to be placed in a nursing home. First off, it turned out that his increased falls were due to alcohol. Then it turned out that this woman was not even a family member or his medical power of attorney. She was just some stranger who had found him passed out in his car in the parking lot of their apartment complex on several occasions, and has made herself his personal nurse. Since OBE wasn’t drinking during his hospital stay, we found him to be completely lucid. Several thorough investigations by the physical and occupational therapists found that he had no trouble balancing, or getting around with his walker. She insisted that he couldn’t be left at home alone, and that she was exhausted from continually caring from him. Basically, the guy refused to go to a care home, but his “caretaker” made a big stink about it. I think she had several issues of her own, but that’s a whole different story.

I guess my whole point in bringing this patient up, is that one can’t force someone to get help. Sometimes, the best you can do is provide information and hope that people will follow your advice/recommendations. Unfortunately, it is not a crime for an adult to slowly drink themselves to death. People choose their drugs/drink over their family and their own personal health. I think that the depression that results from those losses just feeds their habit more. As long as a person is mentally competent and not putting anyone at risk with his/her habit, there is nothing that we can do about it. My psychiatry rotation last year was with an addiction specialist. We had several patients who just didn’t do very well with the program because they were simply interested in fulfilling a court-order or proving something to someone else, rather than being interested in seeking recovery.