Dinging Outdated Medical Education by Pat Conrad MD

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Back in 1992 I was a first-year med student paddling to survive the white water of first semester, you know, the one with all the dissociated body parts. That semester we covered gross anatomy, histology, and basic radiology. Our medical school had an impressively organized approach to cramming all of this into our noggins, including written exams one day, followed with the highly orchestrated “bloc” exams the next day.

Bloc exams were a series of stations that wound serpentine routes down halls, through the gross labs, past banks of microscopes, and x-rays suspended on light boxes. The three-hour exam was comprehensive, fast-paced, and grueling. The thoughtful staff put out several tables at intervals with bottled water and bowls of M&M’s and pretzels to keep everyone’s strength up. Each of a hundred or so students had a randomly assigned starting station, and simply kept going until they had been through the entire course, at which point we all finished the exam simultaneously. One walked up to a twisted piece of formaldehyded flesh with a small shred tagged, indistinguishable from the rest, and wrote down the (imagined) part. Likewise, one looked through the microscope to identify the function of whatever the pointer indicated, or looked at whichever x-ray to answer which highlighted bone was attached to whatever muscle, and so on. Every two minutes, a loud solitary bell rang once (DING!) throughout the basement complex, and everyone shuffled to the next station. Even if you were close to discerning which small subsidiary nerve was poking from behind the split sternocleidomastoid, on a head/neck split, flexed forward, half-twisted, and the whole mess looking like it had just come out of the food processor, but you were so close to getting the answer, and (DING!), time to move on, but the last question was still stuck in you brain but then you were down to 90 seconds for the next station, and oh crap (DING!)…it’s a wonder I don’t still have nightmares about that damn bell.
After the bloc exam, like many of you esteemed colleagues after whatever format was inflicted on you, we all got to the nearest bar and hammered it out. But were those quaint strolls through dreary and mundane sciences really applicable to anything? Haven’t the Harvard academicians come up with anything more updated for all of their government grants?
Bloc exams for the patient-centered, population health oriented 21st Century could be far more realistic. To learn real medicine, the student should encounter stations that measure more relevant topics. Sample questions:
– A thunderstorm caused a power surge, and your server crashed. Your EHR’s are all dead and the lobby is full – do you call your IT expert, and how much as a percentage should you expect to pay him for a monthly contract?

DING!

– Your billing manager just got off the phone with the rep from Happy Wellness Insurance, and the -3.14159 modifier was mis-entered and all of last months claims have to be resubmitted. Should you call the bank manager now to get a bridge loan for payroll, or call the insurance rep back?
DING!

– A 60 year-old chronic pain patient is on the phone demanding that you call in his hydrocodone 10mg script now, and refuses to come to the office. Do you check the state drug database? (Bonus: do you call the local ER?)

DING!

– You get an email from the senior partner in your group notifying you that you missed your ACO’s quality targets for this quarter, and will be assessed a financial penalty. Define the term ACO and explain briefly how they improve a physician’s ability to care for a population.
DING!

– A Medicare auditor is on the phone and would like to schedule an appointment to review your charts. (There is no correct answer – you automatically get this one wrong).
DING!

– You get a notification from the American Board of Medical Specialties that, in order to better serve their members, they now require fingerprinting of all diplomates as part of the new customer-friendly Maintenance of Certification. Do you miss an afternoon of work to get fingerprinted, or do you try to cram it in during lunch?

DING!

– A subpoena arrives from a local personal injury attorney, naming you a co-defendant for an obese 45 year-old female patient of yours who suffered a fatal arrhythmia after ingesting cocaine. Do you increase your tail coverage?

DING!

– A 28 year-old bipolar female brings in her 6 month-old son, and demands that he be tested for ADHD. Do you have to get prior authorization for a psychology consult?

DING!

…at this point you get a rest stop in front of the snack table, featuring kale chips (one of your classmates complained about gluten intolerance) and plain M&M’s (someone has a peanut allergy!)…

DING!

– A family brings in their 90 year-old father to establish as a new patient. He brings in a thick folder of records that he knows “you will want to review.” He is on 15 different medications and the family wants to know what possible cross-reactions there might be. They also want to know why he has seemed weaker lately. You are over one hour behind on your schedule, the lobby is full, and you have this patient scheduled for a 15-minute slot. According to HIPAA, are you allowed to take this patient’s records home to study on your own time?

DING!

– The hospital administrator called to remind you of the team building supper in the hospital cafeteria tonight. Do you go to the meeting to reduce your risk for being labeled “disruptive”, or go home to drink and review your disability insurance policy?

Test over. Till tomorrow.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “Dinging Outdated Medical Education by Pat Conrad MD

  1. Chris
    September 17, 2016 at 11:41 am

    A established patient of another physician comes in during your walk-in hours. He was late to his pain management appointment, they would not refill his medication and they rescheduled him. He wants you to refill his narcotic pain medications. You refuse. He goes to an on-line doctor review site and gives you 0 stars, revealing the details of the encounter and his distaste for your hairstyle (true story).

    Do you leave the review there to scare away other drug seekers or ask the site to remove the libelous review because it brings your average review down?

    Bonus question: Will risk management lawyer claim you are violating HIPAA for writing this question?

  2. HJR
    September 14, 2016 at 7:50 pm

    Your walk-in patient who agreed to pay cash but then dashed without paying calls back and says he can’t afford the antibiotic you prescribed and wants to know what you’re going to do about it. What do you do?

    DING!!

  3. HJR
    September 14, 2016 at 7:32 pm

    -Your 35yowf patient who is “disabled” because of her fibromyalgia demands a written prescription for her Swedish and Deep Tissue Massages so that Medical Assistance will pay for them. Do you write it, call her and explain why it’s an inappropriate request, or connect a garden hose to your tailpipe and run it through your window?

    DING!!

  4. Bill Ameen MD
    September 14, 2016 at 4:06 pm

    Wow! Beautifully written. I was a first-year medical student in 1969 and our neuro anatomy practical exams were like this. I’m taking a tour of our new med school education building in a few weeks at homecoming. I wonder if they’ll do anything, or much, to prepare students for the real world. I’m beginning to think medical practice is like the old grammar school joke: Why did the little moron bang his head against the tree? Because it felt so good when he stopped. That’s why retirement is so nice!

  5. Mary,RN
    September 14, 2016 at 3:36 pm

    Very funny. Sad, but the truth. Damn spell check!

  6. Perry
    September 14, 2016 at 9:23 am

    Hilarious, but frighteningly apropos.

Comments are closed.