FMS ending.

Its almost over. I have really liked this rotation for a lot of reasons. Tons of learning, both systems learning and professionalism learning, but also (more fun) academic learning. Its amazing how fast one can process new information with the incentive of patient health and wellness. That said, I have really disliked this rotation because I have had 24/28 days getting up at 0530, and not getting home until an average time of 1820. Thats a LONG time away from home everyday. And it gets old. It gets old really really fast.

Its still a great job though, with a great opportunity to learn. I may have to force myself to say that through gritted teeth, but that doesn't make it any less true. And its during rotations like this that I feel the march towards residency completion all the more. To think that I have three days left of my first FMS rotation... after this I only have one more rounding rotation... ever. Thats astounding to me.

And I learned something really fun today. One of my attendings was telling a story about a tradition in his family of the 11th commandment. Everyone knows about the 10 commandments, even if they can't list them everyone gets the idea. Don't steal, don't bear false witness (different than lying btw), don't worship false gods, don't murder, etc... But what this attending has proposed is an 11th commandment that I can really get behind.

So what is the 11th commandment? Thou Shalt not Whine.

Now, first let me say I mean this with no blasphemy intended. Of course this commandment isn't something that we should consider holy. I am not comparing my attending or myself to Moses or anything like that. This is meant as a play on words, and a quirk on a theme. Some of you might be surprised at such an honest disclaimer from me. Usually I just bull through this kind of stuff and damn anyone who doesn't like it. But I take blasphemy seriously, and I hope everyone knows that I mean this in a different way.

That said, I think its a great rule to live by. Especially here in the US. Whining, I think is a function of a sense of entitlement. After all, one cannot complain unless one feels that he/she is entitled to something better. And really, I live a pretty good life. 0530 mornings and everything included, it ain't a bad gig. And whining only belittles myself.

So no more whining! Or less anyway ;)

Stay healthy! And a happy end to FMS to you as well!

FMS

The temperature has dropped, Jay Cutler has a broken thumb, and I am on FMS. And still its better than MNPS! Woo hoo! So Family Medicine Service has begun. I am actually already a week down. 25% through with it. 28 day rotations tend to fly by. The Thanksgiving holiday was a large part of that. Left us with four straight days of half days. Nothing to complain about there for sure. This coming week is likely to be a different story.

Have already learned much though. All of the time is time well spent. And while 12 hour days wear at you after a while, its bearable when the rewards are so clear. Reviewing the Duke Criteria for bacterial endocarditis, or reviewing the empiric coverage on a patient with possible meningitis who we can't get an LP on. All very good stuff, stuff I could easily see myself using someday.

Thanksgiving was very nice. Mandi and I hosted a small event here with some of the other Residents/Spouses who were stuck in Peoria as we were. Nothing fancy, no turkey. But it was a good time. We ate a lot, drank a little, and played some board games. All fun.

And now we are gearing up for Christmas. As I speak Mandi and Shaun are decorating the tree. Had to get store bought this year as time was at a premium, sorry Warren Tree Farm. Having our tree up definitely makes the season feeling come alive. I will admit that the tree is pretty even if I don't like it. I just can't make it square that we celebrate Jesus' Birthday (at a very wrong time of year) during a pagan festival time, with a symbol of a burning tree. Not my style. A very simple cross, or even a nativity would be fine. But Mandi likes it, and she does put up a Nativity every year which is very nice. I would never want to put a damper on her Christmas joy.

Thats all for now, more to come as the season progresses I am sure. Gearing up for the holidays and seeing friends always leaves much to blog about.

Stay Healthy

MOHS and the Holiday Season

I love outpatient rotations. And among outpatient rotations, MOHS is especially good. Its essentially the rotation in which Residents learn the business of being a Doc. So rather than focusing on how best to treat patients, we learn about how best to charge for our services within the convoluted government/private insurance world. We do this so that we can stay in business, and continue to help more people.

Because while most people like to believe that I should work for nothing or next to nothing, I have no intentions of doing that. Don't get me wrong, I didn't get into this job for the money. I could have made a lot better money elsewhere. But at the same time, I wouldn't have done this if I didn't know that it could provide a comfortable lifestyle for my family. I don't ask to be rolling on piles of cash or driving a Porsche, but I want to make sure I have a retirement, I want to have a few nice things, and I want to to be comfortable. And if I can't do that being a Doc, I will take my considerable amount of effort elsewhere into a field that will.

And if I am going to make any money, I have to learn to navigate an overly-complicated financial system that is set up to make sure I provide as much care as possible for the least amount of money. If you can't tell, MOHS has made me a little bitter about this. That said, its been a fun rotation, and I can't believe I only have a few more days left of it before FMS starts again. FLEW by.

And now its the Holiday Season. Which means Holiday shopping. Not only is that usually completely brutal, but I get to do the bulk of it while on service. Talk about rrrrough. 1st world problems right? It shouldn't be too bad though. This is the part of my job I like because I can learn from it. Even with 12 hours a day, 12 days in a row, with 4 days off in a month, I think I will have a good time, and I imagine I am going to be looking back 28 days from now unable to believe that I am almost done with FMS. The only difference between now and then will be a few inches of snow on the ground, and Christmas immediately ahead.

I also drew short straw on Thanksgiving this year. Again, not complaining. If one is going to work a holiday, Tgiving is the one to work. It means a few days that would have been full become half, and I get to round when there is a ton of Pumpkin Pie to be had at the various nurses stations. Jaaaam! I also have a real heart for those patients stuck in house over a holiday. Talk about a bummer. Its a lot easier to remember an adage one of my attendings uses when one is rounding during the holidays: It may be difficult to deal with some patients, but 99/100 times its even more difficult BEING those patients. That goes double on the Holidays. As much as working sucks, being sick is worse. And so I pray for the health of the patients. May there be very few to none in the hospital this year over the holidays. And I pray for my own health (and sanity) for another rounder. It will be a whirlwind of a month I am sure. Or worse, a blizzard ;)

Stay Healthy!

Done with BestBuy

So for those of you who know me you know that I used to love BestBuy. As someone who enjoys a good movie, video game, computer and large TV that should come as no surprise. BestBuy has all of those things, in spades. I even have a BB mastercard that earns me "reward zone" points as I buy other things. I have shopped there for... for as long as I have been shopping. I probably visited over 20 BestBuy's across 4 states. Not because I was ever a fan of the store, but because I enjoy movies, video games, and electronics that much. They typically have some of the best prices, and the best selection.

Well thats over with.

Those of you who know me also know that I have a very low threshold for dissatisfaction with poor customer service. It really takes so little to meet my criteria for what is acceptable. 1) Value the customer. 2) Meet the terms of the contract.

Its that simple. I ask them to not be rude, and to simply do what they say that they will do for the money I will give them.

BestBuy has now failed in this regard... twice. Twice in less than two weeks. I pre-ordered three games over the past several months. Gears of War 3, Battlefield 3, and Uncharted 3. Its the year of 3's. GoW3 arrives on time, like it should. But Battlefield 3 arrives two days late. So I call BB and ask them why I should use their service which supposedly gets me a game the day it comes out (you know, the point of pre-ordering it) and fails to perform. BB has no good explanation, but they apologize and I get over it. No fast forward to today, I come home from work excited to try out Uncharted 3 to once again find that the terms of the contract between BB and myself violated. No game. I check the shipping status online, sure enough, it may not be here until the 7th. It would appear that BB.com has absolutely ZERO idea why someone pre-orders a game. And while I don't claim to be an expert, I can tell you for sure its not for the purpose of waiting to get said game 3 days later than it could have been had at a store.

Once again I call BB.com. This time the representative lies to me. She states that the games ship on the day they are released. I call that garbage for what it is and then ask to speak to a supervisor. Word of advice to anyone in customer service. Don't lie. And especially don't lie when your customer has a legitimate reason to complain. Just say you don't know, you're sorry and fix it. I know taking crap sucks, I take crap from my customers all the time. But thats service. That's the economy. That's how it works.

So now enter Tony the Supervisor. Tony talks to me in that deep, authoritative supervisor voice, trying to convince me he knows what he is talking about. And maybe he does. But much like representative #1, he fails to offer me any new information and his apology sounds less real than hers. I am done. By this point the rage is rising, and I know if I don't disengage soon I will start letting it out. I tell Tony to forget it, I don't want his 10% off, I am done with BestBuy. Forever. I am answered by silence on the other end. I've been hung up on.

Keep in mind, I never yelled, I never asked for anything, I never demanded something in return. All I wanted was to know why the contract hadn't been fulfilled for the last two orders. I wanted to understand what had happened. I was given, in the following order: lies, and rudeness. This from the people who screwed up. Wow, if I pulled that kind of garbage I get sued.

Long story short. No more BestBuy. Amazon offers better prices, better service, and a faster loading website with a greater range of products. Never has Amazon failed me, or anyone else I know. Heck, if I want an in-store experience I will go to GameStop or Wal-Mart, both still have better customer service (which ain't saying much) and more or less the same prices/selection.

And let me tell you, I spent a lot of money at BestBuy. Are they going to go broke because they lost me? Probably not. But if they treat all of their customers this way I can't imagine they won't go broke eventually.

Do what you say you will do. If you don't, make it right. And do it with a smile. Its that simple.

Stay Healthy

MOHS and more Fall Fun.

I am done with Obstetrics. Forever. Thank you Jesus, forever. Well, that is until Mandi and I have children (she does most of the having, but I will share in the credit amyway :D ). But I feel like that will be a different experience. Barring some Emergency Department deliveries or country road deliveries I could possibly be called on I am done. And I while I will always try to be up to date on OB in case I need to know that stuff for emergencies the part of my life where I am expected to do that stuff is past me. Thank goodness.

People often mistake my distaste for OB for a distaste for Women's Health as a whole. And nothing could be further from the truth. I like Women's Health. Meeting the challenges of health maintenance among the fairer half of the population is fun and rewarding. And important! One can't really be a Family Doc if he has to ignore Mom and Daughter. If you count the dog that means I am only taking care of 2/4.5 of the traditional family members! Hardly comprehensive. No, I like women's health just fine. Mammograms, Osteoporosis, PAP smears, and any/all feminine issues are no problem for me.

I just don't like obstetrics. And I don't like obstetrics for the sole reason that I don't like being on call 24/7. I HATE it. I have no problem with home call, as long as I know that 1-2 dedicated nights a week, that I know in advance, can be set aside for call. But one can't do that with OB. When you are doing obstetrics, you're on call for 6 weeks at a time practically, and really even longer than that. Babies come when babies want to come, and all of the miracles of Western Medicine still haven't managed to change that (not much anyway). And while I love caring for my patients, and while I want to be there for them... I want a life too. And my psychology just can't handle that kind of 24/7 pressure. Never knowing when I might get called in, never being able to relax, never knowing what time is truly mine. Ugh... I can't do it. And to all you Obstetricians out there, kudos to you for doing it. I admire that in you, but have no desire to mimic you in that.

So that said, OB is done, and I am on to MOHS! Its essentially learning how to run an office. A rotation that I will actually USE when I leave this place. Talk about FANTASTIC. I am pumped. I get to spend a lot of time with two of my favorite attendings: Dr. J. Golemon and Dr. Awesome Jaffer. (Awesome isn't really his first name... not exactly anyway). It should be a lot of fun, and equate to a lot more time to have fun while off, and sleep. WoooT!

It also continues to be fall. I took a fun trip to Geneseo yesterday to visit Ethan. That was a blast. Ethan, Aaron and I saw a movie (In Time... it was meh), traded some cards, ate some Shanghai, and played some MtG. Overall a pretty Jaaaaam day. And to top the day off, like the icing on the cake I got to meet Katie, Ethan's sig-O. She was super fun in the two minutes we crossed paths, and it was nice to finally make contact with one of the most important people in Ethan's life.

Thats enough for today,

Stay Healthy!

MNPS Ruins My Life.

So last month I talked about how MNPS was starting this month. I was somewhat cheerful about it then... well eff that. MNPS ruins my life. I had really underestimated how bad the 6AM start times were going to be. Getting up at 0520 is ridiculous. The month is probably 98.5% service and 1.5% learning. Thats low value for those select few (around 30%) of the residents who want to do Obstetrics. For the rest of us that means 1/2-2/3 of that 1.5% learning is completely wasted. Compare this to the FMS service in which you have a higher base % of learning to service, AND all of it is pertinent. Because in the end, I will get up at 0520 every morning for the rest of my life if its for purposeful gain. I will work 12 hours a day and not blink an eye if it matters. But this? This is meaningless to me. This is me filling a G.D. slot for a bunch of faculty who have an inflated sense of the importance Obstetrics has to the Family Medicine field. /rant.

Anyway, it sucks. Hard. But I am almost done. 3 more days left. Just three more days. And then I am on to a rotation that is going to be fantastic. I get to learn about appropriate medical coding, patient satisfaction scores, and how to work within a health system. Talk about valuable. And following that month is FMS, which as I mentioned above is PACKED full of value for me. Even if it is hard. And we are coming in fast and furious into the holiday season which is always fun. This time of year typically flies by and then BAM, into the late January/February crawl. Still, can't knock on Christmas. The novelty of the first snow which still resonates with me, even if I have to scoop it. Pumpkin pie, holiday shopping, christmas parties, family, annual nerd-a-thon, gifts, and vacation time. Always a lot of fun.

Enough for now.

Stay healthy.

Football.

And so it begins. The NFL Sunday opener was today. The real opener was this past Thursday, but I don't want to talk about that.

It is finally starting to feel like Fall. Football on Sundays, the air is dryer, and I have my first seasonal cold. So long summer 2011, you were nice while you lasted. Thats okay though, I love fall. And it would be my favorite season if it weren't for the fact that it heralds the coming of winter. I need to live where it is always warm. Florida? Georgia? Surely not Arkansas.

Anyway. Outpatient Pediatrics goes well, and it is a fine lead in to MNPS (Maternal-Neonatal-Pediatric Service) which is next month. 6AM start times are going to be a real bummer, but I guess that's just the way it goes. It might even be nice, because as soon as this round of MNPS is done I will be DONE with Obstetrics for the rest of my life. As a doctor at least, as a husband I suppose I will get some more exposure when Mandi and I decide to have kids. Should be fairly different.

After that its only two units of FMS and I am outta here. At least in terms of hard duty. June can't come soon enough. I have had enough Peoria. Enough residency I am ready to be DONE.

In other news, I will be headed to Monticello this week for the Kirby Hospital VIP Grand Opening event. I am not entirely sure what it is going to be like. I know I had to get a blazer and a new pair of shoes. But I can't imagine it would be anything other than fun. More on that once its over.

Go Bears!

Passed

As many of you will remember from a mere two posts ago, I recently took my USMLE Step 3. The longest and final of the United States Medical Licensing Examinations.

Well as my subject/header would imply, I passed. And not only did I pass, but it was my highest USMLE score yet. Not that this is a surprise, Step 3 is often the highest score of the three. I think this is because as we march through the Steps the information shifts from being information you learn from studying to information you learn from your everyday work. Studying for Step 1 is kind of an option. Studying for Step 3 is called Residency. Not an option. It also has a lot to do with relevancy of the information. As medical science has grown... no wait, exploded is a better word, doctors have been expected to learn more and more minutiae about various mechanisms of pathology, physiology, pharmacology. We now understand things on a molecular level. Doctors 50 years ago didn't have to worry about that as much. And as important and amazing as these discoveries are, they are really really hard to memorize. For one, they are incredibly complex and second they conceptually hold little connection with the visual, visceral, real world medicine that we practice every day. Of course I know they are connected. But applying that is so tertiary that it becomes an exercise in testing and memorization.

Whereas in Step 2, and even more in Step 3 I am asked to practically apply what I have learned about Dr - Patient medicine, rather than some academic concept, or biochemical mechanism.

The incentive is easier to understand. And as we all know, effort and performance directly follow incentive.

Anyway. I passed. Yay me! Now time to go to work.


Stay Healthy.

Getting Organized, Getting ready.

Still waiting on those USMLE results. Hadn't expected them back yet anyway. Still annoying.

I have been doing three things recently worth blogging about. Number 1 I have been trying to be a good husband. I do love my Chinchy.

Number 2 is trying to get ready for moonlighting in several months. I hope it goes well, its a great opportunity to make some extra money, and get some extra experience. I am also gearing up to finish Residency and head to Monticello. This includes considering our living situation, moving, and getting all of my licensing in order.

Number three is getting Organized. This has been on two fronts. On the boring front there is the Dr. organization garbage. Again licensing, paperwork, and all that stuff. Boring. The other has been organizing my DM'ing stuff. I have recently started using GDocs to get session outlines ready, and it has been super useful. I think this, along with the wiki can completely revolutionize the way that I DM. Right now I am trying to get my players into it as well. I will be sure to keep the Blog filled in as I can.

Keep looking up.

USMLE is Done.

Well, I hope so anyway.

I took Step 3 today and yesterday. Thats right, two days of testing. Nasty. But anyway its done. I feel like I studied as much as I was expected to, and I believe that it was enough. But one can never really tell with a test like this.

You have to understand, these tests are the hardest of the hard. There are 3.5 of them. Step 1 which is a entire day of multiple choice questions that encompass all of first and second year of medical school. Step 2 CK and CS (the 1.5 tests) which are two full days, one of questions and another day of fake clinical scenarios. This is meant to encompass all of 3rd and 4th year. The final step, Step 3 is two full days of computer questions, around 400 some odd, and 9 simulated cases. Step 1 is a major determinant in your eligibility for residency, the better your score the better your chances at "more prestigious" residencies should one desire them. Step 2 solidifies that impression, and can be make or break as well. Step 3 is pretty much pass/fail, and doesn't affect anything but a few fellowships. But one must pass all of them to be federally licensed to practice medicine, a requirement to be licensed in all 50 states (and Puerto Rico). Without the training of medical school and internship a person has virtually no chance of passing these tests, and they are in place (supposedly) to weed out the incompetent.

In reality, they are a load of BULL, and a giant waste of my mother****ing time. /Bitterness. I believe I passed, I hope I passed, and I will find out if I passed in 3-4 weeks. I hope I passed for a lot of reasons. I want to be able to moon light, I want the validation, I want to know this stuff so I can count myself a competent physician... but honestly... I want to not have to do it again. Its that miserable.

Now, I passed the other 2.5 Steps, with flying colors. My scores were such that other than a few of the elitest of the elite residencies were an option for me. And by all projections I should pass this one just as easily. But one never knows until the scores come back. Here's hoping.

Either way, tomorrow my 12 day leave from work ends, and its back to the grind. The 3rd year grind its true :) But the grind none the less.

Keep looking up.

A New Day, A Good Day

Once again it has been a long time since I have posted. The past almost... year, has gotten away from me very quickly. In a lot of ways this is a good thing. While second year was better than first year it was still tough. Lots of call, increased responsibility. Less hours than first year to be sure. But still very busy.

But now here I am, a third year. 10 months from Monticello and beginning my life there. I am, without a doubt, pumped.

Right now Mandi and I are up at the lake. Bond Lake to be exact. I think of it more as heaven and home than anything else. My parents moved around so much when I was young that this place, and my grandparent's places in Monticello were the only two permanent residences I have known. And its heaven for other obvious reasons. Sun, beach, lake, boats. Everything a man could want. This is without even mentioning the best part, the company of my grandmother and grandfather. Nothing beats a week of vacation here, swimming in the crystal clear waters of Bond to wash away the first two years of residency.

But enough blogging, time to get back to more fun.