Cramming II


This business of prepping for test

Is leaving me feeling stressed.

With style and flair,

I still love patient care,

While it’s cutting into my rest.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

I have given entirely too much power to the recertification exam I have coming up 60 hours.  Studying for an important test rates as a good idea, but I have past the point of diminishing returns.  The end result cannot hope to match the excess of energy I have invested in it.  Sure signs of overload start with sleep disruption: I fail to rest not because I’m worried but because my brain’s acquire-new-information circuits have taken over and don’t want to shut down.

Another sign comes in the form of loss of skin turgor: if you pinch the back of my wrist the skin tents up as it would with dehydration.  I noticed that finding while in private practice, and regarded its reversal, when I went walkabout, with elation.

I have registered more than 300 hours of Continuing Medical Education so far this year, and while I really, really like learning I feel like I’ve lost perspective on the process.

Yet the stress of exam prep gives a poignant joy to everyday patient care; the written material contrasts with the richness of interacting with flesh and blood.  I do a lot of pediatric well exams, and I always check the patients’ feet.  I would rather deal with the olfactory sledge-hammer of adolescent foot odor than pulseless test questions.

In the course of my exam prep I learned the recommendations against certain aspects of routine screening.  For example, I’ll no longer recommend breast self-examination, nor prostate cancer screening.  But, despite what I’ve been told, I’ll still check for scoliosis in growing children.  The recommendation against the spinal exam comes from the rareness of the condition, and the doubtful value of treatments.  My reasoning goes something like this:  why not run a low hazard, low-cost test that has the chance of uncovering other serious problems like physical abuse?

I attended a WWII veteran today and treated myself to an interview about his service.  For those golden minutes I wallowed in the reasons I love my profession; the patient enjoyed the attention and I listened, rapt.  By the end of the visit the patient chuckled as much as he spoke.

One of my many patients still smoking despite very bad lungs wheezed through the visit.  As always, I advised tobacco cessation, and for a minute tension hung in the air until I made a wisecrack and we both broke into laughter.  I finished the visit, as usual, with a joke, which provoked more laughter and prompted the patient to say, “I’m glad I came into to see you today, doc, you made my day.”

“You made mine,” I said, and meant it.

 

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