Feb gets political!

So, how long did I get to do my job practicing hospital medicine before I had to argue with someone about finances?

Nine days. And what's weird was, I wasn't fighting with the party I assumed I would be.

We discharged a guy from the hospital last week, and because he'd had an unexpected event happen (I'm being intentionally vague about the specifics, but it's in that category of "maybe you can predict who's at higher risk, but you never know for sure if or when it'll get you"), he had to be discharged on a medication that was new for him. It greatly lowers the chances of future badness, but the med itself isn't exactly a glass of warm milk. You need to watch people carefully at first, test some blood, make sure the level is right. If it's wrong, things can go very bad indeed. This requires careful follow-up with the primary provider.

So I'm calling Scheduling to make sure this guy can a) get the appropriate blood test in a few days, and b) get in to see his regular doctor pretty soon. The scheduler says, "huh, that's odd" and "I'm sorry, but I'll have to have you speak with so-and-so." Then I find myself on the phone with someone who says the patient can't be allowed to schedule these future appointments, because he owes our practice group over $2000. I'm speaking not to some insurance company, but to our collections person.

Turns out, the guy had tried to schedule an appointment a few weeks back, and was told he couldn't, unless he paid some portion of his outstanding bill. Again trying to be as polite as I could, I wondered out loud if maybe this unexpected nasty thing that caused him to be hospitalized for three days maybe could have been avoided if he'd, oh, maybe seen his doctor a few weeks ago. The collections person was not impressed. Fair enough.

But this person's heart was not made of stone, and when I mentioned that the patient, sent out into the world blindly with no assistance beyond me wishing real hard for their med level to be correct, could potentially die, they did relent, and allow for one visit, for both the blood test and the primary care check-in. But no more!

From now on, when I discuss how messed up health care is in our country, I will tell this story. It's personal, it makes me crazy, and I can see several sides of it, all of which are totally and utterly, for lack of a better word, fucked. In my mind, it all boils down to a few key things:

1) Sure, this dude smoked, drank, and ate cheeseburgers; in short, acted like most Americans do. Sure, if he'd been jogging, avoiding high fructose corn syrup, cigarettes, and other vices; if he'd been eating bran muffins and celery sticks instead, he'd be better off now. But we play the hands we're dealt, and the guy in front of me is this guy, with this history. I have to treat him, not the version of him I would prefer to see.

2) According to what I could tell, he has insurance. I know a former Blue Cross claims agent who pointed out that lots of people have "80/20" plans, where the insurance only covers 80% of anything. That fits with the amount between $2000 and $3000. And of course, that bill is about to go up, from this recent hospitalization.

3) We're a private clinic group, so my own salary quite literally depends on the collections person doing their job, and doing it well. This person is, and I have no ilusions about this, on my side. God knows how many situations like this I'll encounter in my first year. If, hypothetically, my bleeding heart insisted on enough people in this situation being given care anyway, and if enough of them were unable to pay, then eventually we'd collapse and be able to help nobody at all.

4) And yet, when it all comes right down to it, I am not willing or prepared to say "screw this guy." I won't let him go out and die, or (worse for the system) get sicker and rack up more costs, just because he can't get in to see somebody. There are free clinics, but not enough, and anyway he earns too much at his job to qualify. There are a handful of sliding-scale clinics, but they have a waiting list that's months long, and he needs to be seen in a week. The walk-in urgent care centers don't do the ongoing primary care stuff, and the ER can do any test you want but it's ten times the cost so that's no solution.

And while it makes good sense in several different ways for my respected colleague the collections manager to aggressively defend the solvency of our business, how much would we have to pay his family in the event something bad happened and someone made a convincing argument that we could have done something to prevent it? (Ahh, but you can't reliably measure potential costs, and health care is all about potential expenses vs potential savings. Ask anyone who works in primary care why they don't make more money, and that's essentially the answer.)

So, for me, that's what the debate about a public option boils down to: somebody has to be willing to look that guy in the eyes and say "no." No, you can't get treated. No, you don't deserve a slice of these limited, expensive resources. No, the situation you are in, when stacked up against the situation others are in, and compared to what we have to work with, does not warrant you having this test, this visit, this intervention. And by the way, no, there is no reliable, consistent safety net we can allow you to fall into, so that at least there is a minimum standard you can count on. Have a nice day.

Because here's the thing: we say no to people all the time. We ration health care in the United States. We just like to pretend that we don't. And it doesn't go to the sickest first. In my opinion, getting anywhere near that truth freaks people out.

Well, the next person I encounter who doesn't believe in reform, or thinks a public option is Communist, is going to hear this story. And then I'm going to tell them I'm not willing to be that person who says "no, there's nothing, now get out." And then I'm going to ask point-blank if they would be willing.

I'm Going In...

Wish me luck. The last of the standardized patient training deals is coming up for me.

You'll recall that just a month or so ago, I learned the correct way to perform a breast exam. The right kind and amount of pressure; the right technique to make sure you don't leave anything out, so I'd feel a suspicious lump, but I wouldn't take forever either.

Then I learned how to work the male exam; the outer and inner survey of the twig n' berries, the dreaded hernia check. I'd had these in yearly checks, but this was from the examiner's side. And then I got schooled in the prostate, a skill that I know will eventually become not just un-special, but actually boring.

Consider that, right? A day is coming, and it's not too far, when I'll not only be the guy responsible for giving the one-fingered salute to people, I'll grow to hate it not because eww, it's my finger in somebody's pooper, but because gawd those are so boring.

Well, another one of those things we do a lot of in the ol' clinic or Emergency Department is the friendly neighborhood pelvic exam. Guess what I'm doing this week?

I definitely feel like I'm turning into a clinician, so that's good. But, man... I am getting SO TIRED of looking at either male or female genitals. And how messed up is that?

It may look like a walnut...

There is a notorious phenomenon that occurs in people who are in medical training; as you learn more and more about the various things that can go haywire with the human body, you gradually come to believe that an implausible number of them are happening to you. I believe that some of the reason my school's student-health clinic is staffed with semi-retired old docs is that they've seen and done everything, and most of the reason is that none of us are ever actually sick.

I, being older and presumably wiser than many of my classmates, have avoided too much trouble with this. I had a hacking, body-shaking cough for about 8 or 9 weeks, but I knew that was just a virus, combined with the dry air, combined with my train commute and incarceration in the same windowless classroom every day. Even when Teslagrl told me to go get a damn chest x-ray, I knew it wouldn't show anything. And anyway, we covered chests & lungs in the Physical Exam class, and nobody could hear anything wrong.

But then, a couple weeks ago, we got around to the male genito-urinary exam. Yeah... so I'm 37. You see where this is headed?

Before learning the correct way to inspect, cradle, squoosh, and prod another man's junk, and then go around back and knock on the back door, we learned the right way to talk about the exam. What it is, what it isn't, and why it's important. At my school we use 'professional patients,' people who are trained in much the same way we are, with all the attendant anatomy, physiology, and pathology... but from the other side. They learn how the exam is supposed to feel, when done correctly, so they can tell us stuff like "okay, you can press a lot harder than that," or "yep, you're right over it now; you should be able to feel it."

Yes, it's weird, and even though we'd already done the breast exams, the five dozen or so in my program were all quietly freaking out on "Nuts & Butts" day. We went into rooms in groups of four, which somehow made it worse. But once the guy did his intro speech, dropped the Caesar Ocatvius sheet he had added to his patient gown, and the first volunteer got to business, it was all very technical and interesting, and somehow we were all professional and more or less relaxed.

So, speaking now as a future professional, it's not a big deal. And the thing is, it's really super-imporant. A decent exam takes three minutes out of your life, it doesn't hurt, and it involves no needles and no radiation, unlike so many other tests. And the risks of being a big wuss about it and doing nothing are fairly dire. Ask Lance Armstrong about that.

Which brings me back to my own experience. Having honed my little speech, I had to consider my own very mild symptoms, from the past year or so. Nothing major, really, but some research pointed me toward an issue with the tissue, in the palace of the pants. Gradually I had to admit that if I were hearing from a friend what I was thinking, I'd tell that friend to go in and get checked. So I had to go see the stately, joke-cracking, HMO-hating doc over at the clinic.

This is a guy who graduated the very same medical school, more than 40 years ago. He's kind of a role model for me. He works pretty much because he loves medicine, and he'd be bored out of his mind puttering around at home with, I don't know, bonsai trees or model trains or some shit. He'd much rather be gloving up and getting to know me better than either of us anticipated.

He needed to leave for a minute to go find the tube of lube. I told him to TAKE ALL THE TIME YOU NEED, man. Search high and low.

And it turned out fine. My prostate is, apparently, awesome. I have no blood anywhere it's not supposed to be. Best of all, that info is documented, bitches! I'm not saying the exam doesn't suck just a little, but it's no worse a sensation than, say, the feeling of having crud stuck under your contact lens. It's less painful than irritating. You go ow ow ow ow shit ow, and you take out the lens to wash it. Then you're fine. And I'd rather have a rectal than some of that bullshit that dentists do to your gums with metal hooks.

The preliminary diagnosis? It would be nice if I didn't have to sit motionless for ten hours a day. So basically, my man-bits are suffering from IRONY. But yes, I absolutely did the right thing by going in.

The moral of the story for all my friends who are, or who love, guys: a dude should check his sack, once a month. And don't fear the finger.

A case of the Mondays has been scheduled for Thursday

So, I am all excited to start school. Except for the first day. Day after tomorrow.

I'm in my little study-nook area, where untold amazing things will start to pour into my noggin soon. It's late, but I power-napped today... just because I could. So it's me, a cup o' tea, and Teslagrl's younger and weirder cat, who is apparently diggin' the wood floor because she's rubbing her back on it. So this is what they get up to at night. No wonder they rest up for it all day.

I have most of my forms filled out; the school I was at last year will be sending some immunization stuff, and the school where I did the distance Biochemistry course will send a transcript just as soon as they get the request for it. I read the online orientation info and the student handbook. I have begun to feel like a medical student.

For the Biochem, by the way, I got my usual chemistry grade. Which is to say, I'm a little better than average, but it's clear I'll never be an actual chemist. I always heave a big sad wet sigh of regret when I find that out, but somehow I soldier on.

I know where and when to catch my train on Thursday morning. I cajoled the Future Wife into giving me some cash so I can buy a ticket and everything. (All I had to do was promise not to call her "mommy" when I ask for stuff like that.)

I even have a classmate living a mere four or five blocks away. This will be my daily commuting (and studying) buddy. I guess she'll need some kind of blog code name, but I don't know her well enough for one to present itself yet.

When I left my former job, one of my cohorts in the maroon-scrub-wearing ranks of the ER techs gave me a present: she had gone school shopping for me following the template of shopping for her kids. It was sweet, and wicked useful. Now I have notebooks and pens and a bitchin' stack of note cards, and a box to put 'em in.

I even got myself some new shoes, after about a year of listening to everybody yap about how great Nike Shox are -- and about five seconds after realizing that actually, clogs still look really ugly to me, and anyway in my new lifestyle I'll be sitting down, sometimes.

So, why am I not completely pumped? Why am I a little "mehh" about this orientation day thing? They're providing food, after all.

It's because aside from a tour and some introductions, most of the day will be team-building exercises. Ewwwwww.

I spent twelve years in the corporate world. During some of the most fun years, I was one of those corporate trainers. Although I had my cranial vault firmly incarcerated a fair piece inside my own rectal vestibule, even the younger and far stupider version of me could tell that some of that forced jocularity is just wrong. I know, we have a limited time to stop being 50 to 60 individual schmoes and become a class. We'll have some heavy cadaver-lab stuff to deal with, as a class, as soon as next week. We need to learn a little about who's next to us in the classroom and at the tank. It's a necessary evil. But it's still evil.

Some glimpses of the day, based on photos I saw as part of the tour when I interviewed, and now in the handbook, make me suspect company-picnic-style physical challenges. Didja see "The Office" a couple weeks ago?

I will most assuredly have to say something about it later. But if I don't, it's because it was too horrible to recount, and I've chosen to just move on and concentrate on something more pleasant... like my dead guy.

Champion of Justice

There's been this silver SUV parked in the apartment building's lot lately. The manager had told me there were painters coming and going for a while, but that was over with weeks ago. Yet the thing kept coming back like a fuel-inefficient bad penny. There's a bulletin board inside the building where the manager tacked a note stating that the MPD would be on the lookout for any cars parked in the lot without a permit, but that had no effect. I suspect the interloper was a friend of someone who lives here, or maybe just someone who hates to pay for parking. The SUV had no parking permit sticker, and tended to be right up along the row of signs reading 'FIRE ZONE' and 'NO PARKING ANY TIME.'

Except the other day, when I returned from my future wife's to find it parked in my spot.

I'm a generally easygoing and forgiving sort; in real life I don't usually get worked up as much as it might appear from reading my brain-spew here. But after I found a street spot and walked back home, I was ready to smack a bitch up, as they say. Or maybe slash some tires, or install some new after-market options. With a brick.

On further reflection, as a pending charge for vandalism isn't something that would help me much in PA school, I settled on the tamer, but by Minnesota standards still pretty aggressive, approach of "nasty note on the windshield." This, after the nice man at Gopher Towing explained that unless I was the apartment manager, I couldn't actually call them to yank a car out of the apartment's lot. At the moment, witty retorts about how Mark Yudof never needed to sign off on their fascist tactics all over the U of M campus circa 1996 did not occur to me. Alas.

So I fired up the printer, and created a flyer that proclaimed in big block letters that if this vehicle was seen in this lot one more time, towage would ensue. No fire lane, no stealing parking spots from residents. Grrraaah!

I walked my handiwork down, and slapped it under the SUV's windshield, hoping for an alarm to go off to draw the owner out, so I could confront the evil-doer in person. Again, alas. Then I went back up to my studio, which has a window overlooking the parking lot.

Ten minutes later, I noticed the offending silver SUV pulling in. It turns out my spot had been taken by yet another, unrelated silver SUV. This prompted a brief Homer Simpson moment. Then I rebounded, and threw my jacket around my shoulders as I picked up my keys and charged out the door. Vengeance would be mine!

I totally busted the guy in the SUV. Now that I looked at it, the thing was boxier than the one in my spot, and this was clearly our frequent visitor. He even pulled into his usual spot. I got the nastygram back from the new SUV, and assessed the situation. One guy, still in the car. I walked over to the driver's side, and he lowered the window suspiciously. I can't vouch for the expression on my face, but judging by the tone I heard in my own voice, it may have been the same hard-assed demeanor we use in the ED when our patience with belligerent drunks is juuuust about over, and physical and/or chemical restraint is one phone call away. The "I'm trying to help you, but you still have the power to mess it up for yourself" one.

I asked if the gentleman was planning to park there. I called him "sir." I explained that if the gentleman intended to wait in his vehicle -- I used the word "vehicle" like three times, god help me -- that would be no problem, but made it clear this was not a parking spot. This was a fire lane. Further, I explained, it's a problem for the people on this end of the lot who need to get in and out of their assigned spots, if anything is blocking their way. Finally, I told him about the sign that management had posted inside, and the looming threat of MPD intervention. I closed with the "it's your choice" tactic: do what you want, but you should know that if you leave this vehicle here, there's a chance it won't be here when you get back.

He nodded, and said "okay" a lot, and as I turned to go back to minding my own damn business, he asked "who are you, by the way?"

I did not say, "F%$@ you, is who I am." Nor did I say "somebody with a parking permit I paid for, asshat." If I had done either, it would have sounded awesome. Very David Mamet. I just shrugged, and said "I'm just somebody who lives here, and needs to get his car in and out of this lot sometimes."

By the time I got back upstairs, the SUV was gone. I didn't see when it happened, but a while later when I looked out the window, the other SUV was gone as well. I like to think the earth shook with Viking rage, just a little, and whomever had decided that my spot being empty all night and all morning was their invitation to use it had sensed in the air that they had overstayed their welcome.

The Reckonynge

I just completed my financial aid application stuff for PA school. I also recently took stock of everything I've spent so far in my college career. Wow. That's a lot of double cheeseburgers, people.

Let me put it this way... what I spent on my original undergrad degree -- which covers the roll of fin-aid derived quarters that fueled an all-day "Rampage" marathon at the junior college, all the way to the diploma the U of MN printed with my name spelled wrong -- is about equal to what a 2003 Mercedes SL would run me today, on eBay Motors.

Last year's post-bacc adventure, meanwhile, with the rolling green vistas and the continual looming threat of failure, more than doubled that. The new portion of the loan total ups the ante by a approximately the cost of, for example, this Maserati Spyder or this Dodge Viper RT/10.

And am I deterred? Am I overwhelmed? Hell, no! I need to keep going. Eventually, a year's pay will come close to what I owe in loans, and at that point, in theory, there's a way to make decent payments while still enjoying the perks that come with a decent income level. And anyway, flippin' burgers won't feed this here bulldog, nossir.

So what I just signed up for is another vintage 1967 Dodge Dart Magnum or, for something a little more fun, TWO brand-new BMW R1200 motorcycles.

Of course, by the time you click these, the prices are likely to have shot way up. I would merely respond that I worked in the financial aid division of a grad school for long enough to feel okay about that, as an expression of how much this crap costs.

Blog Niblets

1. A Tip o' the Hat

A couple of visits ago, I left my Team Ortho baseball cap behind at the M. Giant household. I got it a little less than two years ago, when I shadowed an ortho surgeon friend of mine. Before the scrubbing-in part of the day was the setting-down-my-stuff part of the day, so we started in the doctors' tiny offices. One of my friend's office-mates is the guy who is in charge of recruiting for the "team," which is a combination fundraising and public outreach entity. Every Ironman event and triathlon within a few hundred miles usually has a Team Ortho contingent, in snazzy blue and white bullseye jerseys. The recruiter guy introduced himself, and pretty much right after "hello" was "you look like a Medium." This confused me, until I was thrown a free shirt and the aforementioned ball cap -- all I had to in return do was promise to check my calendar for good times for me to swim, run, or bike a great distance longer than I otherwise would, or realistically could. I checked. I checked twice, in fact. There were none.

Last time I was down at the Giant homestead, I inquired about the hat, and MG said, "oh... that was yours?" It seems M. Small has adopted it into his compendium of random cool stuff. This is a kid who can derive hours of enjoyment from the plastic spindle-thingy that outdoor Xmas lights are strung on, and so it's a pretty good compliment. Besides, maybe he'll be a triathlete someday, and at the very least he can spread the public awareness. People notice stuff on adorable moppets in a way they don't, on surly Nordic ER techs. So, seeing as how my hat is in a better place now, I switched to the ball cap I had stashed in the closet: the NASA one.

This one I got at the Kennedy Space Center, in Florida, when Teslagrl and I went down there later that same year. I am something of a space freak. The rocket garden, with its recreated shells of Atlases and Saturns, command modules, and a LEM you can crawl around in was like holy ground to me. I got a little choked up at the recreation of the Apollo 11 launch. Ron Howard can make crappy movies the rest of his life and Apollo 13 will still be on my top 10 all-time list.

And today, at work, I discovered the NASA hat has ironic hipster cache now, too. A co-worker asked me, "where's your diaper?" Heh heh. Thanks, love-crazy astronaut! You've made space cool again... kind of.

2. Guitar Anti-Hero

I hate this kid. Eight years old, and he pwns a song on Expert I can barely handle on 'Hard.' I got to see the original Star Wars in the theater 13 times, though, so nyaaah. I'd love to say the video is somehow faked, but that would be sour grapes on my part.

3. This is why they invented the Internet

Speaking of YouTube, I guess last year's most fun video is this year's most kickass meme. I guess I really am growing up, if high school kids actually look somewhat cool for even a minute.

4. This week's medical mystery

So, the kid with the five-week case of hiccups finally got relief? Awesome. And although there was no story as such, Friday's Strib had a little blurb that said the 15-year-old was crediting a chiropractor, an acupuncturist, and a hypnotist (more about that, in the link above). Sure, fine, cool. No love for the medical establishment. We're used to it; we don't need outpourings of gratitude. Besides, it's not like the establishment has weird ideas about curing intractable hiccups... like, say... digital rectal massage.

Yessir, nothing balances the q'ui, aligns the shakras, or increases the flow of your positive energymeridians like the old fashioned gloved digit up the ol' pooper. It's peer-reviewed Western medical journals, baby. Read it and weep. Some days, the Q-ray bracelet has nothing on our side. Those are fun days.

And if I ever have hiccups lasting that long, and it turns out the "intern year salute" is what brings them to an end, I'll probably credit something else, my own damn self. That, or just smirk mischeviously at Katie Couric when she asks me about it...

...and a grateful nation rejoices

Spotted at Costco, in a dream I had last night, printed in black lettering on a yellow sign, and just in time for the holidays:

COSTCO HAS CURED HAM!

Underneath, it continued:

WE WILL NEVER SUFFER FROM HAM AGAIN!

Sometimes, I just crack myself right the hell up.

blog niblets, historical edition

Okay, because it's been a few days since I've posted, because I want to keep up the flow of ideas, because I'm always talking about how I'm going to get around to telling some cool ER stories, and finally because I'm always obsessing about how to do that while also respecting confidentiality, here's what we're going to do today: I now present to you a list of very short-but-true little factoids. The following things happened to me at some point within the past three years or so, although the non-clinical stuff goes back farther. Note: the few identifiying details that might be present are subject to change, so you'd never figure out who, when, or where, don't even try.

* The first time I set foot in an emergency department as a patient, I very nearly, as my British friends say, pulled. I struck up a pleasant conversation in the waiting room with someone who I think was there with her friend. My swollen glands and constant pain were not enough to keep me from turning on the charm.

This was an early experience that cemented two ideas for me: one, I'm even more charming and attractive when I'm in the healthcare environment (which is weird, because way back then I was only an erstwhile transcriptionist, and was still in deep denial about the idea that I'd ever want to practice medicine myself). Two, upon thinking about it, something about hitting on chicks in a hospital, or having chicks hit on you in a hospital, is just plain weird. The professional detatchment thing would later turn out to be easy for me, and maybe this is part of why.

It would be a cooler story if I got those digits, though... it woulda been nice to have a better self-image back then. And besides, my strep was gone in like a week.

* The first time I set foot in an emergency department as a student, I observed an attempted suicide case. The patient would turn out okay medically. The note was sitting out on the countertop. I don't remember it word-for-word, but I remember how it felt to read, and how clear the writing was. Here's where I learned about the reverent, church-like feeling of being witness to the extremes of human experience; how people's bodies and the artifacts of their lives are laid out for view.

Now that one of my job responsibilities is gathering and packaging trauma patients' clothing and personal belonings, it's hard not to think of this clinical, dispassionate view in chaotic, passionate times. We take care of that stuff, man. We document piles of clothing and the contents of pockets like archival materials, and handle them like just-purchased Christmas presents.

The one time I, in my capacity as a lowly tech, walked upstairs to sit in the surgery waiting room and talk to the family of an accident victim was to explain to them that their family member's clothing had been so thoroughly cut by our shears, and was so saturated with his blood, that I felt they would agree it was better to throw it away. Red-eyed and waiting for news from the OR, they considered what it would have been like to open a brown paper bag and see their loved one's stuff like that, and told me thanks for thinking of it, of them, in that way. I'm glad I was right in this case, because the hospital's rule is right, in general: that decision was just plain not mine. If it had turned out they'd wanted the shredded, soggy stuff, I would have gone searching in medical waste.

* I'm pretty good at reading X-rays, although I need to get over this thing where I spend significant time looking at the wrong part of the picture entirely.

* I've been offered the opportunity to do all manner of things with needles and blades that I probably shouldn't do quite yet. I've turned those down, but I do know how to put a dislocated finger back in place.

* I was an EMT for just shy of three years, and I carry a bag in my car with splints, bandages, scissors, and basic things. I stopped by the side of the road as the first responder to an accident, last winter, while I was out east. I didn't use anything from the bag except a pair of purple gloves, but speaking as a guy with a four-year acting degree behind me, I'll tell you what: those gloves, plus the shoulder strap of the bag slung across your chest? The knowing what to say, and what to do? That shit is theater. Pure and simple. And it helps people. All I had to do was talk, really, until the volunteer rescue squad came. Those guys were basically me, plus of course years of experience, plus a big truck with all the necessariy equipment and cool lights.

But the theater is the most important part of the equation.

term-ending madness

Necrotizing fasciitis
Microbes come and try to bite us
Overwhelming our immunity
Getting busy with impunity
Turning tissues black and gangrenous
They go all, like, damn and dang in us
Try the topical negative pressure
Pump the Vanco, up the measure
Cutting-edge docs have been learning some old tricks;
It seems maggots work via proteolytics
Whatever it is that finally works
You'll wish it was what you had thought to do first.

(In my head, there's a jaunty little music-hall sort of a tune under all that. Welcome to the final week of my classes, and t-minus seven and a half hours until the deadline for this paper.)

I feel your pain

Over at Ah, Yes, the Fake Doc continues to impress me with a possibly-still-kinda-drunk post about interviewing "standardized patients." These are, in a nutshell, actors hired to play the part of patients, so medical trainees can hone their skillz with history-taking and exams (although not even the med schools that are literally off-Broadway actually have the students do much by way of examining; the actor/patient gets a little card with various results and outcomes listed). I had enough to say in response that I'm copying myself here.

1) I just read something in (an admittedly last-year-ish) JAMA about how lame standardized patient "encounters" are. I think the jist of it was, "wow, these suck, but I guess they're slightly above totally useless." I'm paraphrasing.

2) Speaking as a dude with a Theatre Arts degree, who is now heading into the medical-education meat grinder, my first day with a standardized patient is going to be the BEST DAY EVER.

Pt: "I, um, have this chest pain. It feels like--"

Me: "Bullshit. I didn't believe that for a second. What objective are you supposed to be playing? Are you trying to bring that weak-ass Uta Hagen crap in here? Are you? Huh? Oh, does this bother you? Criticism of your lousy technique? You want to cry? Yeah? Well, imagine that irritation you're feeling toward me is coming from your chest... Okay. Now do it again."

Ahhh, I miss undergrad sometimes.