I hate housework. I am not sure if it a cause or an effect of my hatred, but I am also very bad at it. Don't think that I live in pig sty or anything. I still pick up the broom or windex when it is called for but it makes me angry every time. In fact, I think cleaning is the only thing that I do regularly that I am truely horrible at. But there are still month-old scuff marks on the limoleum that I can't get off with any amount of scrubbing and that tub ring mocks me every morning.

Of course everything else must be going pretty well in my life if this is the only thing I can think of to complain about. Have a great, cleaning-product-free, day.

On Friday we had our first 'formative' exam (monitored by an invigilator no less). It you don't know what they mean by formative you’re not alone. My favorite definition of formative is - forming or capable of forming or molding or fashioning. I could use some fashioning. Or at least some new shoes.

Anyway, it was a test that was formatted just like our final (or summative) exam with representative questions but doesn't contribute to our mark. It was a good judge of how we are doing so far. Except I already knew that I was very far behind because I have been working on some papers for my lab that have held over from my Masters, so for me it was mostly just a kick in the teeth. Probably a kick in the teeth that will be good for me in the long run but I am still a little bruised right now.

We also had clinical correlation on Friday. As always, it was the best learning experience of the week and provoked issues that I wasn't expecting. Specifically the issue of consent and the doctor - patient - student relationship. We have examined one patient that was alone and had ascites and encephalopathy from chronic liver disease. We practiced shifting dullness, fluid thrill and palpitation. Though we repeatedly asked permission, she was obviously in some pain and was having difficulty talking. I doubt she understood all that was going on even if she did know what she was agreeing to.

Another patient we visited (on a different occasion, with a different preceptor) was an older gentleman that was being visited by his wife. Though there was no issue of reduced capacity, it was clear from the interview that they did not know how the many tests were going and were hoping for some answers, even from us. The wife thanked me for coming and helping. I had to explain that we were students and not in any position to give her information. That we were there to learn. This took me aback because I thought our preceptor had explained this to them. All I could hear coming out of my mouth was 'No, we aren't here to help you. We are here to take from you and give you nothing in return." I know this isn't entirely true; that we have to gain experience and knowledge so that we can help other people later. It just feels a little too easy justifying our actions in the name of education. Maybe I am a too prone to obsessive self reflection but I feel like part of learning to be a doctor is examining how our actions have an effect on the people we are lucky enough to call our patients. The reason that clinical corre. is such a good learning experience is because we get to see actual people, not just study cases. If we can't see them as people and think about how we are affecting them then we are losing out.

It is always a good idea to count to ten and take a deep breath before blogging. If I had written this yesterday it would have been a much different post.

Yesterday we were had our first liver lecture. 8 hours of liver lecture. Aside from the very questionable practice of trying to cram info into malleable brains for 4 hour stretches, many of the lectures were of questionable value. I am not an expert but in my mind it makes sense to talk about the anatomy and function first, then the problems, next how to diagnose and measure the problems and then treat it.
Our agenda: First there was a lecture on physical exam to determine liver disease, then there was a lecture on laboratory tests for liver disease, then a lecture on all the different problems of the liver. A one-hour lecture (with 159 slides) on all the different liver problems. I think it was a record. After there were other lectures on individual diseases. It was mostly incomprehensible. By the end of the day I wasn't just exhausted, I was angry.

Last week were told that 70% of medical students were offered only one spot at a school. The implication being that most students do not have a choice. I don't mean to brag, but I did have a choice and yesterday I was regretting it.
Today was a different story. We again had 8 hours of scheduled time today but it included everything from small group discussion of cases, lectures and practicing of communication skills on standardized patients (actors). Predictably, my interviewing skills are very rudimentary but our preceptor (a family doctor from the community) was great and the patients were really helpful. Even on a fake patient playing doctor was exhilarating. I definitely didn't regret my choice today.

I have never been so tired after an 18 hour day before. I don't know if it is the continuing chaos of our ever changing schedule, waking up early for a full 5 days in a row, two late nights of studying earlier in the week, the last two twelve hour days at school, running all over the school and then the city today or the incredibly exciting/stressful experience of talking to actual patients this afternoon. We had our first clinical correlation today and saw two people with different blood diseases. It was great to actually see people and not just cases for a change. I am going to bed now.