Step 3 Anxiety

Just back from the step 3 class in Chicago, I have deepened my understanding of anxiety. It is a near continuous state that the anxious think is only experienced by them. All we can do is prepare. When nervous, study, when upset, contend. It is better to be angry than depressed. Anger can move you, put you into action. get you to be inventive. If you do not like the method, change it. If you are sad, get mad!

All of them are variants of fear anyway, so choose the most mobile. When you are anxious say ‘I have a lot of company’.

How can we struggle to remember that what we are learning for that ‘test’ is all needed, useful and potentially life-saving? this is really the question. Why don’t we remember? Because we can’t help but forget. It is like saying’ why do I get tired?” or ‘If I do not eat why do I get hungry?” . Our calling is to be of service to a suffering humanity, and our work is to learn the skills, knowledge and judgement to take care of them, and work consistently, and regularly to keep it emotional for us.

Emotions are the ‘fixative’ that change, ferment and make permanent, more quickly what is ‘information’.

Today’s information, is tomorrow’s salvation.

How to perform on the residency interview

As I watch a few hundred students come into Jamaica Hospital for residency interviews, I realize how little opportunity there is for feedback to improve performance. For instance, the US graduate who did not bother to shave. Perhaps he had not re-filled his prescription for psychoactive pharmaceuticals.
Or the applicant who did not like being interviewed by a resident and an attending. We do it to show partnership with residents and real authority in the program. The applicant was stupid enough to actually say out loud ‘why am I being interviewed by ONLY someone as low as a resident’. ON interview, even if you do not like what the program is doing, do NOT say it! Unless you have not interest.

Or the guy last week who bit his nails CONSTANTLY through the whole process. Here is what to DO:
1. Look interested
2. SIt up straight
3. Always have some ‘safe’ questions like ‘what do you like best about your hospital’ or ‘what unique opportunities are there here’or “How is the teaching’
4. Never tell a faculty member or interviewer if you are applying in two specialties and the program is a ‘safety’ for you. They cannot handle the ambivalence. I hear it from attendings ‘he has no direction’ . this is AMAZINGLY unfair,but unfortunately, do NOT tell them
5. come early. Leave late. Ask to come for a ‘second look’
6. Smile and make eye contact
7. NEVER NEVER NEVER criticize ANYTHING.
So, each year I get comments like ‘so you are telling applicants to LIE!!!” actually..,,, yes, withold your real feelings. Do NOT be completely honest about things you see as negatives.
If you don’t understand, you are an idiot.

Report of physician shortage, and rise in US grads

http://www.amjmed.com/article/S0002-9343%2809%2900680-9/fulltext#sec7

Remember also, that the number of osteopathic graduates will rise by almost 100% in the next 3-4 years

Who is going to save the world if not us?

The United Nations is creating in a month an Agency on Women’s Rights and the prevention of violence against women. The former president of Chile, Michelle Bachelet will be running this. She is a pediatrician who was first Minister of Health, then Minister of Defense then President of her country.

Part of the point of my book ‘Routine Miracles’ was to remind physicians and medical students that we, as a profession, are in a far better position to help the world and the civilization than most. Why do Americans immediately accept a 700 billion dollar military but begrudge 100 billion to implement healthcare reform?

If doctors were as aggressive as the national rifle association, every American would have two healthcare policies. The recent elections, with many, including DOCTOR Rand Paul in Kentucky running on a platform of repealing healthcare reform is a disappointment at best, and disgusting at worst. At the single highest paid, best educated profession in the country, we should be running on a platform of ‘Do the right thing, we will find a way to pay for it.”

It could have been worse, On the other hand, the right time to do the right thing for suffering people is….NOW! On a single shopping day post Thanksgiving, we spent nearly 20 billion dollars. It seems that we always have enough time and money for what is important to us.

If I can find myself a way into the U.N. to work in that Agency, I am going. What do I have to lose? I sent Michelle Bachelet a letter friday. Let’s see.

This is important for those of you out there wondering whether you should try to go for some dream you have. Maybe you think it is only advice I give to others and not myself.

This agency is to make sure that Violence and rape against women as a routine tool of statecraft is stopped. That U. N peacekeepers who did NOT intervene in Congo while women were raped on the doorway get their asses kicked so that they protect those women.

Time for the six foot four inch USMLE teacher to get on the ground in those places and control male bad behavior. I am not experienced, I don’t know that I am qualified, but I know that my cause is just. So, anybody got Michelle Bachelet’s Phone number or email? I need to tell her how I am going to switch from USMLE teacher to U.N. employee.

The worst thing that could happen is that I fail. So what?

The Greatness of a Society is based on how the BOTTOM 10% are treated, not the top 1%

Every society throughout time has had an aristocracy, a top 1%. Even the poorest countries have a luxuriant top few. That is not what distinguishes the greatness of a civilization. It is how we treat the bottom and the middle that makes a Civilization great. Universal public school education does not de-value the educational accomplishments of a Nobel prize winner, yet even this concept in the most affluent countries of universal literacy is only barely 100 years old.

There have been a top few treated well with luxurious food, servants, mansions and massages, but it is the discipline NEVER to mistreat the weak that makes the civilization great. The top people have ALWAYS gotten the best standard of the day in healthcare, but there is something very wrong about people so proud of withholding healthcare from vulnerable people they actually advertise that their number one public policy goal is to repeal healthcare reform.
First off, they will not succeed,but worse than that, they show the smallness of their souls and the narrow minded, dare I say discusting selfishness of their followers.

Those saying healthcare reform will be dismantled won’t succeed

A lot of people got elected in a change two weeks ago simply because people are scared. The economy is not what it was, and that is frightening. However, with only one house of congress an the democratic president who originated the healthcare bill in place, there is no way to turn it back. Over the last year all the federal agencies have been preparing the rules and the procedures to implement a good way towards universal care, and this is a good thing.

I am generally NOT a fan of ‘Communistic’ systems that do not put competition in place. But, without the public option, there is still PLENTY of competition. Just remember, everytime you see an ad for an insurer, that was payed for by money NOT spent on healthcare. Someones premium payed for that ad.

That is why any time someone says ‘free market forces will solve healthcare’ they are crazy. the best way to make money in the free market is to give you nothing and have me keep everything. There is NO free market solution by itself that takes care of working middle class people.

What does that is called ‘Decency’. It is called ‘Healthcare is a Right’ not a privilege.

2011 Match: The Game has Changed, but the Players didn’t notice

There are three more medical schools graduating their first class this year in the United States. The existing schools expanded their classes four years ago and some are coming out now. But this little fact has escaped most of the applicants. People who go unmatched are often like those who die of cancer. You figure it is really sad, but it won’t happen to you and in any event, at least not today.

Yet, yesterday, I had to pare down those we were inviting for interview because we have already seen a LOT of people and the program director is getting fatigued. We chopped off all IMG with scored below 90 and chopped off all US grads who ever failed or had scores below 80.

What does this mean? It is getting harder and people don’t know.

Effect of HealthCare Reform on the Doctor’s Soul

You get the impulse to go to medical school You start out pure. You get tarnished along the way by the cares and worries of the effort.

Nothing could be more soul-killing than to kick someone out of your office knowing that a person in need will be neglected. Now we start the cycle of reaction formation and defense mechnisms that lead into the S*&T spiral that leads the physician further off course from ‘vocation’ into ‘business’.
In ‘Routine Miracles’ I wrote about how stunning it was that the Public Turst of physicians was at an all-time high, yet 85% of physicians and students did not believe it.

First I wondered where this false impression came from? Now we have to ask, what damage does it do to the profession that we have this negative self impression?
Here is my conjectural leap.
Until we become happy ‘Buddhas’ immunue to the impression and opinion of ‘the crowd’ we move to the external measurement device. At least psychologically. If the whole profession has this negative self-impression, they will not rise up and devote themslves to the eradication of disease. They will, instead, find a comfortable well feathered nest to hide in.

Our nobility will have been degraded, because we, as a profession cannot stand, cannot bear cannot tolerate thinking the public does not trust and admire us. Hence, we withdraw from the fray.
Healthcare reform will, I believe, help us to stand tall as a profession. No one kicked out for inability to pay, and we will, once again, perfume our minds iwth our sacred calling.

We can all today feel a little prouder to be a physician. We are on the way to a more universal goodness. Perhaps in a year or two, when no on is turned away for inabilty to pay, we will psychologically be able to accept what is a fact. The public trusts us. Perhaps, we will be less embarrassed and realize that with the profit motive becoming desatruated in the field, we really can stand tall and say “Yes, I am indeed worthy of the trust of my society. I stand up for the best in us and I practic compassion. I am trusted, and I am trust worthy’

Ooo!!!! New Video! New Step 2 course

ooo!!! My new video!
http://www.kaplanmedical.com/comprehensivecases
Next year there will be 19,900 FIRST year US med students.

This is after a 30 year FLAT enrollment. The number of First year RESIDENCY positions is FIXED at 23,000 WHO will you choose for the 4,000 spots for IMGs? Take a look at comprehensive cases. It is designed to get the higher score that will be Mandatory in order to get into those spots.

Don’t get shut out! The test is not graded on a a curve.

Forgive my absence, Finishing new Step 2 USMLE book

Hello Everyone,
I apologize to the many people have been writing and commenting without my response. I have gone straight from my ‘Routine Miracles’ tour (sept to Nov) I have spent the last five months day and night writing “Master the Boards:Step TWO” which will be out at the end of July. This endeavor takes all my effort, because as you may or may not know, I continue to work as a functional clinical doctor and teacher during the day.

My writing would, I believe, have MUCH less value if I were just some guy who wrote books in a vacuum. Every day I go into New York City and see patients, write prescriptions and deal with the ill, the surviving and the dying.

When a book comes to an end like this, I take time or I am almost forced to contemplate the highest good. Another book? or to contemplate ‘Eschatology’ LOOK IT UP.
What are the ultimate thing? Perhaps this is to be the last one?

In 2009 I produced
Feb 2009: Master the Boards: Step THREE
May 2009: iPhone App ‘USMLE Disease Deck”
Sept 2009: Routine Miracles
Oct 2009: ‘Comprehensive Cases’ an on-line step 2 course.

is my soul larger because of it?
Maybe time to stop. Yet, watching the selfish, hatred and mean spiritedness that I see in the OPPOSITION to healthcare reform, we see…. nothing stays neutral… removal from the fight means it goes backwards…. Never once in all the nastiness that I in those OPPOSING reform do I hear anyone say “Am I my brother’s keeper?” what of those who are sick and injured and need us?