The Boards for Life Just how ready are you? Edwin Leap, MD, FACEP
The Boards for Life <ul><li>You have to look at my family first… </li></ul><ul><li>It’s kind of the price of admission. </...
The Boards for Life <ul><li>Now, why should you care what I think? </li></ul><ul><li>Good Question, but then, I’m standing...
The Boards for Life <ul><li>I’ve been at this, in the same group, for 16 years. </li></ul><ul><li>I have had the same wife...
The Boards for Life <ul><li>I’ve seen thousands upon thousands of patients. </li></ul><ul><li>I have been yelled at by doc...
The Boards for Life <ul><li>I have driven my wife crazy. </li></ul><ul><li>I have been sued. </li></ul><ul><li>I have had ...
The Boards for Life <ul><li>I have also learned how to feel compassion. </li></ul><ul><li>People have moved me to tears. <...
The Boards for Life <ul><li>I write a column that lots of our colleagues read. </li></ul><ul><li>More importantly, I hear ...
The Boards for Life <ul><li>So, I know some of the struggles other docs face. </li></ul><ul><li>I know the struggles my pa...
The Boards for Life <ul><li>I realized one day that all of this experience would make a good board exam.  </li></ul><ul><l...
The Boards for Life <ul><li>I’ve compiled a series of questions about the practice of medicine. </li></ul><ul><li>Few peop...
The Boards for Life <ul><li>The doctor who wins has </li></ul><ul><li>A) the most wives (or husbands) </li></ul><ul><li>B)...
The Boards for Life <ul><li>Answer </li></ul><ul><li>E)  None of the above.  There is no prize for most wives, largest deb...
The Boards for Life <ul><li>Once you’re a rich doctor, you will romance your partner with: </li></ul><ul><li>A) Trips to T...
The Boards for Life <ul><li>D. Welcome to being low on the totem pole again!  You get weekends, nights and holidays. </li>...
The Boards for Life <ul><li>True or False: </li></ul><ul><li>Your spouse’s friends will drop their pants and ask ‘you’re m...
The Boards for Life <ul><li>TRUE! </li></ul><ul><li>Spouses…don’t feel bad.  Intercourse transmits lots of things, but not...
The Boards for Life <ul><li>True or False:  </li></ul><ul><li>When your spouse asks you to do something around the house a...
The Boards for Life <ul><li>True.  You can say anything, since this is America.  But you’ll regret that one for a long tim...
The Boards for Life <ul><li>Look, you’re a doctor at work.  At home, you’re a person who has to take out the trash like ev...
The Boards for Life <ul><li>You’re in a nice restaurant with your wife, when a beautiful, buxom waitress says, with a smil...
The Boards for Life <ul><li>D is a reasonable attempt, but there isn’t a good answer.  People will flirt, just don’t flirt...
The Boards for Life <ul><li>Additional Caveat:  </li></ul><ul><li>Your spouse doesn’t want to know how many people you see...
The Boards for Life <ul><li>While I’m on this point: </li></ul><ul><li>True or false:  It’s OK to have an opposite sex ‘be...
The Boards for Life <ul><li>Well, if your spouse were here, what would she or he say? </li></ul><ul><li>Let’s do a little ...
The Boards for Life <ul><li>FALSE!  </li></ul><ul><li>Listen, you can have friends at the hospital, but no one should be y...
The Boards for Life <ul><li>There will be NO sex at home until: </li></ul><ul><li>A) The bills are paid. </li></ul><ul><li...
The Boards for Life <ul><li>E. It depends on the couple.  The point is, romance and real life are tied together.  Pay atte...
The Boards for Life <ul><li>Now that you’re a doctor you are: </li></ul><ul><li>A) a highly trained medical professional <...
The Boards for Life <ul><li>D!  You are a factory worker!  </li></ul><ul><li>Your job is to keep the bodies moving through...
The Boards for Life <ul><li>Of course, you’re actually all of the other things too.  </li></ul><ul><li>Just keep it in per...
The Boards for Life <ul><li>The ‘customer service’ model will always guarantee good, cost-effective care for your patients...
The Boards for Life <ul><li>False.  We should try to please our patients to the extent that they’re customers.  Many of th...
The Boards for Life <ul><li>And by the way, our medical ancestors didn’t wade into Cholera epidemics, the Black Death or b...
The Boards for Life <ul><li>They did it because it was right and because they had a commitment to easing human suffering. ...
The Boards for Life <ul><li>When you die: </li></ul><ul><li>A) The house of medicine will collapse. </li></ul><ul><li>B) P...
The Boards for Life <ul><li>D.  People will walk over your dead body, take all of your vacant day-shifts and sift through ...
The Boards for Life <ul><li>It’s 3 am on your fourth night shift. </li></ul><ul><li>Bubba’s back pain has returned.  Do yo...
The Boards for Life <ul><li>C!  Remember, when fatigued, sometimes it’s OK take the path of least resistance.  And remembe...
The Boards for Life <ul><li>No, no, no, don’t give everyone drugs.  </li></ul><ul><li>And always be thorough or you’ll reg...
The Boards for Life <ul><li>If you suddenly can’t be a doctor, because you’re miserable or ill: </li></ul><ul><li>A) your ...
The Boards for Life <ul><li>B.  You’ll still be the same person.  See, medicine doesn’t define you.  It’s a job.  Remember...
The Boards for Life <ul><li>IF you decide to let your career validate and define you, you will be: </li></ul><ul><li>A) ch...
The Boards for Life <ul><li>C.  You’ll be the sort of miserable doctor that says to me ‘how is that my problem?’ </li></ul...
The Boards for Life <ul><li>True or False:  </li></ul><ul><li>The Golden Rule also applies to your partners. </li></ul>
The Boards for Life <ul><li>True.  As much as you can, create a family in your group.  Help each other, support each other...
The Boards for Life <ul><li>Now that you’re out of residency: </li></ul><ul><li>A) You need a Lexus convertible. </li></ul...
The Boards for Life <ul><li>D.  You need to be smart.  Don’t spend money like a doctor; spend it like a factory worker (wh...
The Boards for Life <ul><li>Doctors get miserable when they have to do too much of what they don’t love in order to make e...
The Boards for Life <ul><li>If you’re free of both traps, you’ll be a rare commodity…happy at work and at home. </li></ul>...
The Boards for Life <ul><li>If you are sued you should: </li></ul><ul><li>A) Immediately leave medicine since you’re a fai...
The Boards for Life <ul><li>C.  You will probably be sued.  And it may not be for an obvious error.  (Though it will be ob...
The Boards for Life <ul><li>Over your career, you will have helped and saved exponentially more than patients than will ev...
The Boards for Life <ul><li>And remember this:  </li></ul><ul><li>Everyone, everyone, everyone dies.  </li></ul><ul><li>Ev...
The Boards for Life <ul><li>Be careful, be compassionate, pay attention and stay up to date. </li></ul><ul><li>Remember, t...
The Boards for Life <ul><li>What your wife and children want most is… </li></ul><ul><li>A) your time </li></ul><ul><li>B) ...
The Boards for Life <ul><li>Well, they might want all of that, but what they want most is your time, lavished on them with...
The Boards for Life <ul><li>In Emergency Medicine you have the unique opportunity to arrange a schedule that truly fits th...
The Boards for Life <ul><li>Your spouse wants to explore a new career or interest that will require your time. </li></ul><...
The Boards for Life <ul><li>C is the quick ticket to a head injury. </li></ul><ul><li>D is the answer. </li></ul>
The Boards for Life <ul><li>Remember always to help everyone fulfill their dreams if it’s in your power; especially those ...
The Boards for Life <ul><li>The best way to get your point across as a doctor is to: </li></ul><ul><li>A) Be calm and in c...
The Boards for Life <ul><li>A.  Nothing unnerves other doctors and patients like calm confidence.  Always control your emo...
The Boards for Life <ul><li>When people do annoy you: </li></ul><ul><li>A) Be passive aggressive. </li></ul><ul><li>B) Cow...
The Boards for Life <ul><li>Well, sometimes passive aggressive makes you feel better.  ‘So, what’s your emergency?’ </li><...
The Boards for Life <ul><li>Further consultant taming advice: </li></ul><ul><li>Don’t back down, look them in the eye, be ...
The Boards for Life <ul><li>When you’re finally alone and in charge in an emergency department: </li></ul><ul><li>A) You’l...
The Boards for Life <ul><li>The answer is D! </li></ul><ul><li>It’s terrifying and wonderful.  Being scared means you’re i...
The Boards for Life <ul><li>The stupid feeling goes away after 20 or 30,000 patients.  But it’s normal to feel unprepared;...
The Boards for Life <ul><li>Patients will usually present with textbook signs and symptoms:  True or False? </li></ul>
The Boards for Life <ul><li>False!  Textbooks are good and useful.  But patients don’t read them.  </li></ul><ul><li>Patie...
The Boards for Life <ul><li>For example: </li></ul><ul><li>A ruptured appendix is usually preceded by: </li></ul><ul><li>A...
The Boards for Life <ul><li>D, though C is a close second.  The combination of tingling all over and a sound like a shotgu...
The Boards for Life <ul><li>Most Myocardial Infarctions present with: </li></ul><ul><li>A) Crushing substernal chest pain ...
The Boards for Life <ul><li>E.  But watch out for the prevalence of tingling in any and all disorders.  It is very powerfu...
The Boards for Life <ul><li>Toxicology means: </li></ul><ul><li>A) Cool envenomations </li></ul><ul><li>B) Fascinating nom...
The Boards for Life <ul><li>The answer is D.  Doesn’t anyone keep Cobras anymore? </li></ul>
The Boards for Life <ul><li>Ejection from a vehicle requires: </li></ul><ul><li>A) Whole body CT scanning </li></ul><ul><l...
The Boards for Life <ul><li>The answer, again, is D. </li></ul><ul><li>I was never so surprised as when I realized that pa...
The Boards for Life <ul><li>The point is this: </li></ul><ul><li>Things don’t always look like they should.  </li></ul><ul...
The Boards for Life <ul><li>Patients who appear to be wing-nuts: </li></ul><ul><li>A) Usually imagine their illnesses. </l...
The Boards for Life <ul><li>C.  They get sick too!  </li></ul><ul><li>Don’t get burned by assumptions.  </li></ul><ul><li>...
The Boards for Life <ul><li>Back to other stuff: </li></ul><ul><li>Your worst enemies, as physicians, are: </li></ul><ul><...
The Boards for Life <ul><li>C.  Yourselves.  No one has power over you that you don’t give them, and no one can make you u...
The Boards for Life <ul><li>As an emergency physician you can: </li></ul><ul><li>A) Live where you want. </li></ul><ul><li...
The Boards for Life <ul><li>This is Olinger’s Rule, named for one of my instructors.  The answer is D.  You can, generally...
The Boards for Life <ul><li>Which of the following are signs life is not going well: </li></ul><ul><li>A) You wish you cou...
The Boards for Life <ul><li>Well, everyone wants to be a fighter pilot. </li></ul><ul><li>Everyone IS out to get you. </li...
The Boards for Life <ul><li>A few closing points: </li></ul><ul><li>You will be fine.  You are motivated and capable.  You...
The Boards for Life <ul><li>If your heart calls you to some other path, that’s OK too.  You may practice medicine until yo...
The Boards for Life <ul><li>Love the people entrusted to you.  Love them with total, fearless, reckless love, and lavish t...
The Boards for Life <ul><li>If you want to be a great physician and human, listen to old Philo of Alexandria: </li></ul><u...
The Boards for Life <ul><li>Final Question: </li></ul><ul><li>Yes or no:  Has it been worth all of the years and effort yo...
The Boards for Life <ul><li>Answer: </li></ul><ul><li>It’s up to you to decide, and to live accordingly.  </li></ul><ul><l...
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Boards For Life Revised 6 09

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The transition from residency to practice can be difficult. But all you really need is a little bit of perspective. This presentation attempts to offer it, with a little humor and a little reflection.

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Boards For Life Revised 6 09

  1. 1. The Boards for Life Just how ready are you? Edwin Leap, MD, FACEP
  2. 2. The Boards for Life <ul><li>You have to look at my family first… </li></ul><ul><li>It’s kind of the price of admission. </li></ul>
  3. 3. The Boards for Life <ul><li>Now, why should you care what I think? </li></ul><ul><li>Good Question, but then, I’m standing up here and you aren’t. </li></ul><ul><li>Actually, I’ll tell you. </li></ul>
  4. 4. The Boards for Life <ul><li>I’ve been at this, in the same group, for 16 years. </li></ul><ul><li>I have had the same wife for 19 years. </li></ul><ul><li>I have experienced a lot. </li></ul>
  5. 5. The Boards for Life <ul><li>I’ve seen thousands upon thousands of patients. </li></ul><ul><li>I have been yelled at by doctors. </li></ul><ul><li>I have wanted to quit. </li></ul><ul><li>I have been angry over and over. </li></ul>
  6. 6. The Boards for Life <ul><li>I have driven my wife crazy. </li></ul><ul><li>I have been sued. </li></ul><ul><li>I have had to learn how to bill to make a living. </li></ul><ul><li>I have learned how to get along with partners. </li></ul>
  7. 7. The Boards for Life <ul><li>I have also learned how to feel compassion. </li></ul><ul><li>People have moved me to tears. </li></ul><ul><li>I have no regrets about my career. </li></ul>
  8. 8. The Boards for Life <ul><li>I write a column that lots of our colleagues read. </li></ul><ul><li>More importantly, I hear back from them about their struggles. </li></ul><ul><li>They teach me a lot about the world of EM. </li></ul>
  9. 9. The Boards for Life <ul><li>So, I know some of the struggles other docs face. </li></ul><ul><li>I know the struggles my partners and I have faced. (And faced, and faced!) </li></ul><ul><li>I know what my family has had to deal with. </li></ul>
  10. 10. The Boards for Life <ul><li>I realized one day that all of this experience would make a good board exam. </li></ul><ul><li>I mean, after your first board exam experience, how many practitioners can still write out the metabolic pathways in most poisonings? </li></ul>
  11. 11. The Boards for Life <ul><li>I’ve compiled a series of questions about the practice of medicine. </li></ul><ul><li>Few people ask you these things. </li></ul><ul><li>They are seldom covered on in-service exams. </li></ul><ul><li>Here goes… </li></ul>
  12. 12. The Boards for Life <ul><li>The doctor who wins has </li></ul><ul><li>A) the most wives (or husbands) </li></ul><ul><li>B) the most money </li></ul><ul><li>C) the largest debt </li></ul><ul><li>D) the best patient satisfaction scores </li></ul><ul><li>E) None of the above </li></ul>
  13. 13. The Boards for Life <ul><li>Answer </li></ul><ul><li>E) None of the above. There is no prize for most wives, largest debt, happiest patients, most alcohol consumed or even most money earned. </li></ul><ul><li>There is no prize! There is only your life. </li></ul>
  14. 14. The Boards for Life <ul><li>Once you’re a rich doctor, you will romance your partner with: </li></ul><ul><li>A) Trips to Tahiti </li></ul><ul><li>B) Trips to San Francisco </li></ul><ul><li>C) Trips to Chicago </li></ul><ul><li>D) Trips to the grocery store </li></ul>
  15. 15. The Boards for Life <ul><li>D. Welcome to being low on the totem pole again! You get weekends, nights and holidays. </li></ul><ul><li>But, fun and romance can be just as good in the middle of the week at home as they can on a weekend far away. </li></ul><ul><li>‘Embrace your place.’ </li></ul>
  16. 16. The Boards for Life <ul><li>True or False: </li></ul><ul><li>Your spouse’s friends will drop their pants and ask ‘you’re married to a doctor, what’s this rash?’ </li></ul>
  17. 17. The Boards for Life <ul><li>TRUE! </li></ul><ul><li>Spouses…don’t feel bad. Intercourse transmits lots of things, but not a medical education. The answer to the rash question is always ‘syphilis!’ </li></ul>
  18. 18. The Boards for Life <ul><li>True or False: </li></ul><ul><li>When your spouse asks you to do something around the house after work, you can say, “Give me a break, I worked all day taking care of sick and dying people!” </li></ul>
  19. 19. The Boards for Life <ul><li>True. You can say anything, since this is America. But you’ll regret that one for a long time. </li></ul><ul><li>Tip: Comfort Inn is usually a nice place to stay, and has breakfast. </li></ul>
  20. 20. The Boards for Life <ul><li>Look, you’re a doctor at work. At home, you’re a person who has to take out the trash like everyone else. </li></ul>
  21. 21. The Boards for Life <ul><li>You’re in a nice restaurant with your wife, when a beautiful, buxom waitress says, with a smile and wink, ‘Hey Doc!’ You should say: </li></ul><ul><li>A) ‘Her name is Chastitee. Isn’t that cute?’ </li></ul><ul><li>B) ‘That reminds me, do you like leopard print?’ </li></ul><ul><li>C) ‘She has the hottest tattoo on her…’ </li></ul><ul><li>D) Explain that she’s a transgender patient. </li></ul>
  22. 22. The Boards for Life <ul><li>D is a reasonable attempt, but there isn’t a good answer. People will flirt, just don’t flirt back. Remember to pay attention to your spouse and don’t be flattered by patients, who are mostly crazy as bed-bugs, however cute they may be. </li></ul>
  23. 23. The Boards for Life <ul><li>Additional Caveat: </li></ul><ul><li>Your spouse doesn’t want to know how many people you see naked on a daily basis, even if you explain that they’re mostly disturbing. </li></ul>
  24. 24. The Boards for Life <ul><li>While I’m on this point: </li></ul><ul><li>True or false: It’s OK to have an opposite sex ‘best-friend’ at work? </li></ul>
  25. 25. The Boards for Life <ul><li>Well, if your spouse were here, what would she or he say? </li></ul><ul><li>Let’s do a little survey. </li></ul><ul><li>True or False? </li></ul>
  26. 26. The Boards for Life <ul><li>FALSE! </li></ul><ul><li>Listen, you can have friends at the hospital, but no one should be your intimate confidant besides your spouse. </li></ul><ul><li>Otherwise you’ll be confiding in an attorney. </li></ul>
  27. 27. The Boards for Life <ul><li>There will be NO sex at home until: </li></ul><ul><li>A) The bills are paid. </li></ul><ul><li>B) The dishes are put away. </li></ul><ul><li>C) The kids are asleep. </li></ul><ul><li>D) The bathroom is clean. </li></ul><ul><li>E) It depends… </li></ul>
  28. 28. The Boards for Life <ul><li>E. It depends on the couple. The point is, romance and real life are tied together. Pay attention to the minor details of your world, that is, if you want to keep having sex. </li></ul><ul><li>More to the point, pay attention to the details of the lives of your loved ones. Put them first. </li></ul>
  29. 29. The Boards for Life <ul><li>Now that you’re a doctor you are: </li></ul><ul><li>A) a highly trained medical professional </li></ul><ul><li>B) a life-saving member of the emergency response system </li></ul><ul><li>C) a heroic figure to nurses and patients </li></ul><ul><li>D) a factory worker </li></ul>
  30. 30. The Boards for Life <ul><li>D! You are a factory worker! </li></ul><ul><li>Your job is to keep the bodies moving through, and to do it as quickly, safely and efficiently as possible, so that no one has to wait so long that you give them movie tickets. </li></ul>
  31. 31. The Boards for Life <ul><li>Of course, you’re actually all of the other things too. </li></ul><ul><li>Just keep it in perspective. </li></ul>
  32. 32. The Boards for Life <ul><li>The ‘customer service’ model will always guarantee good, cost-effective care for your patients. True or False. </li></ul>
  33. 33. The Boards for Life <ul><li>False. We should try to please our patients to the extent that they’re customers. Many of them are not. Customers pay when they leave the store. </li></ul><ul><li>It’s OK that some of our patients don’t pay. But that makes them patients. We care for them because we’re dedicated. </li></ul>
  34. 34. The Boards for Life <ul><li>And by the way, our medical ancestors didn’t wade into Cholera epidemics, the Black Death or battlefields because the customers were dying everywhere. </li></ul>
  35. 35. The Boards for Life <ul><li>They did it because it was right and because they had a commitment to easing human suffering. </li></ul>
  36. 36. The Boards for Life <ul><li>When you die: </li></ul><ul><li>A) The house of medicine will collapse. </li></ul><ul><li>B) Patients and staff will wail in sack-cloth and ashes. </li></ul><ul><li>C) They’ll name a procedure or drug in your honor. </li></ul><ul><li>D) People will walk over your still warm body and keep working. </li></ul>
  37. 37. The Boards for Life <ul><li>D. People will walk over your dead body, take all of your vacant day-shifts and sift through your pockets for change. </li></ul><ul><li>You are disposable, so don’t let this medical thing be your whole world. Again, it’s all about perspective. </li></ul>
  38. 38. The Boards for Life <ul><li>It’s 3 am on your fourth night shift. </li></ul><ul><li>Bubba’s back pain has returned. Do you: </li></ul><ul><li>A) Schedule an MRI </li></ul><ul><li>B) Do a textbook neuro exam </li></ul><ul><li>C) Write for 15 of his favorites and say ‘bye bye’ </li></ul><ul><li>D) Give him a sound lecture on drug use </li></ul>
  39. 39. The Boards for Life <ul><li>C! Remember, when fatigued, sometimes it’s OK take the path of least resistance. And remember, always, that ‘The big possums rule the night.’ You aren’t one of them, so don’t try to make sense of them.’ </li></ul>
  40. 40. The Boards for Life <ul><li>No, no, no, don’t give everyone drugs. </li></ul><ul><li>And always be thorough or you’ll regret it. </li></ul><ul><li>Even annoying people need MRI’s sometimes. </li></ul><ul><li>Even possums get terrible diseases. </li></ul><ul><li>But don’t feel guilty when you’re too tired to fight anymore, that’s all I’m saying. </li></ul>
  41. 41. The Boards for Life <ul><li>If you suddenly can’t be a doctor, because you’re miserable or ill: </li></ul><ul><li>A) your life isn’t worth living </li></ul><ul><li>B) you’ll remain the same person </li></ul><ul><li>C) your wife will run off with the broker </li></ul><ul><li>D) your children will mock you </li></ul>
  42. 42. The Boards for Life <ul><li>B. You’ll still be the same person. See, medicine doesn’t define you. It’s a job. Remember that! It’s a job. You are a person. And your family loves you, not your degree or title. You are not wholly defined by your career. </li></ul>
  43. 43. The Boards for Life <ul><li>IF you decide to let your career validate and define you, you will be: </li></ul><ul><li>A) chairman of the department </li></ul><ul><li>B) residency director </li></ul><ul><li>C) ultimately a miserable individual </li></ul><ul><li>D) Winner of the Nobel Prize for Medicine </li></ul>
  44. 44. The Boards for Life <ul><li>C. You’ll be the sort of miserable doctor that says to me ‘how is that my problem?’ </li></ul><ul><li>Or that answers out of town pages by calling collect. (True Story). </li></ul>
  45. 45. The Boards for Life <ul><li>True or False: </li></ul><ul><li>The Golden Rule also applies to your partners. </li></ul>
  46. 46. The Boards for Life <ul><li>True. As much as you can, create a family in your group. Help each other, support each other, stand by each other. Be fiercely protective of each other. </li></ul><ul><li>Don’t be snarky. </li></ul><ul><li>In the end, it will all pay off. </li></ul>
  47. 47. The Boards for Life <ul><li>Now that you’re out of residency: </li></ul><ul><li>A) You need a Lexus convertible. </li></ul><ul><li>B) You need a beach house. </li></ul><ul><li>C) You need a home by a golf course. </li></ul><ul><li>D) You need some common sense. </li></ul>
  48. 48. The Boards for Life <ul><li>D. You need to be smart. Don’t spend money like a doctor; spend it like a factory worker (which we’ve established you already are). </li></ul><ul><li>People will only be able to push you around to the extent that you need a lot of money. </li></ul><ul><li>Don’t be a slave to money! </li></ul>
  49. 49. The Boards for Life <ul><li>Doctors get miserable when they have to do too much of what they don’t love in order to make ends meet. </li></ul><ul><li>And when they believe that doctoring is everything to them. </li></ul>
  50. 50. The Boards for Life <ul><li>If you’re free of both traps, you’ll be a rare commodity…happy at work and at home. </li></ul><ul><li>You’ll drive other doctors crazy, too! </li></ul><ul><li>And you’re patients will love it. </li></ul>
  51. 51. The Boards for Life <ul><li>If you are sued you should: </li></ul><ul><li>A) Immediately leave medicine since you’re a failure </li></ul><ul><li>B) Start drinking heavily and fall into a spiral of bitterness </li></ul><ul><li>C) Recognize that you’re just part of the food chain and move on </li></ul><ul><li>D) Double or triple your CME participation </li></ul>
  52. 52. The Boards for Life <ul><li>C. You will probably be sued. And it may not be for an obvious error. (Though it will be obvious to everyone who reviews the case after the diagnosis is known) </li></ul><ul><li>A lawsuit does not reflect on your person, skills, or worth. You’ll have helped and saved exponentially more than patients than will ever sue you. </li></ul>
  53. 53. The Boards for Life <ul><li>Over your career, you will have helped and saved exponentially more than patients than will ever sue you. </li></ul>
  54. 54. The Boards for Life <ul><li>And remember this: </li></ul><ul><li>Everyone, everyone, everyone dies. </li></ul><ul><li>Even if you get a clean kill, they were not going to escape the reaper. </li></ul><ul><li>Not an excuse, just more perspective. </li></ul>
  55. 55. The Boards for Life <ul><li>Be careful, be compassionate, pay attention and stay up to date. </li></ul><ul><li>Remember, though, that you’re part of the economic food-chain. </li></ul>
  56. 56. The Boards for Life <ul><li>What your wife and children want most is… </li></ul><ul><li>A) your time </li></ul><ul><li>B) a vacation in Australia </li></ul><ul><li>C) a ski boat </li></ul><ul><li>D) a home theater </li></ul>
  57. 57. The Boards for Life <ul><li>Well, they might want all of that, but what they want most is your time, lavished on them without reservation. </li></ul><ul><li>Time is the most precious thing you have. </li></ul>
  58. 58. The Boards for Life <ul><li>In Emergency Medicine you have the unique opportunity to arrange a schedule that truly fits the needs and desires of your family. </li></ul><ul><li>Take advantage of this rare gift. </li></ul>
  59. 59. The Boards for Life <ul><li>Your spouse wants to explore a new career or interest that will require your time. </li></ul><ul><li>A) Tell him to wait until you both retire. </li></ul><ul><li>B) Tell him you’re a doctor and he doesn’t need to do anything else except help your career. </li></ul><ul><li>C) Laugh and tell her to get you a beer. </li></ul><ul><li>D) Help her in any way possible. </li></ul>
  60. 60. The Boards for Life <ul><li>C is the quick ticket to a head injury. </li></ul><ul><li>D is the answer. </li></ul>
  61. 61. The Boards for Life <ul><li>Remember always to help everyone fulfill their dreams if it’s in your power; especially those you love most. </li></ul><ul><li>You got what you wanted so far, didn’t you? </li></ul>
  62. 62. The Boards for Life <ul><li>The best way to get your point across as a doctor is to: </li></ul><ul><li>A) Be calm and in control </li></ul><ul><li>B) scream </li></ul><ul><li>C) use a lot of @#$% profanity when you &*$*& talk to those &^$#@doctors and patients! </li></ul><ul><li>D) Throw things </li></ul>
  63. 63. The Boards for Life <ul><li>A. Nothing unnerves other doctors and patients like calm confidence. Always control your emotions. Act, don’t react. And remember, don’t be an jack$#%. </li></ul><ul><li>Doctors who scream and curse are acting like children. Don’t be one. </li></ul>
  64. 64. The Boards for Life <ul><li>When people do annoy you: </li></ul><ul><li>A) Be passive aggressive. </li></ul><ul><li>B) Cower before them. </li></ul><ul><li>C) Plot revenge. </li></ul><ul><li>D) Remember your power! </li></ul>
  65. 65. The Boards for Life <ul><li>Well, sometimes passive aggressive makes you feel better. ‘So, what’s your emergency?’ </li></ul><ul><li>Generally, just plow through and don’t let them control you. </li></ul><ul><li>For difficult doctors, remember Chisholm’s rule: </li></ul><ul><li>‘You can always hurt them more than they can hurt you!’ </li></ul>
  66. 66. The Boards for Life <ul><li>Further consultant taming advice: </li></ul><ul><li>Don’t back down, look them in the eye, be firm, be prepared with data, be educated, leave emotion out of the discussion as much as possible. </li></ul><ul><li>Don’t offer to take them outside…like I did. </li></ul>
  67. 67. The Boards for Life <ul><li>When you’re finally alone and in charge in an emergency department: </li></ul><ul><li>A) You’ll feel powerful. </li></ul><ul><li>B) You’ll feel stupid. </li></ul><ul><li>C) You’ll feel terrified. </li></ul><ul><li>D) All of the above. </li></ul>
  68. 68. The Boards for Life <ul><li>The answer is D! </li></ul><ul><li>It’s terrifying and wonderful. Being scared means you’re intelligent. Being confident means you’re well trained. Thinking you’re stupid is just… accurate. </li></ul>
  69. 69. The Boards for Life <ul><li>The stupid feeling goes away after 20 or 30,000 patients. But it’s normal to feel unprepared; you aren’t. You’re just honest. Which brings us to the next question… </li></ul>
  70. 70. The Boards for Life <ul><li>Patients will usually present with textbook signs and symptoms: True or False? </li></ul>
  71. 71. The Boards for Life <ul><li>False! Textbooks are good and useful. But patients don’t read them. </li></ul><ul><li>Patients have a surprising way of making you wonder what you were doing during medical school. </li></ul><ul><li>Other than treating your hangover… </li></ul>
  72. 72. The Boards for Life <ul><li>For example: </li></ul><ul><li>A ruptured appendix is usually preceded by: </li></ul><ul><li>A) Fever, nausea and migrating RLQ pain </li></ul><ul><li>B) A funny feeling of tingling all over </li></ul><ul><li>C) A spider bite </li></ul><ul><li>D) A ‘sound like a shotgun goin’ off!’ </li></ul>
  73. 73. The Boards for Life <ul><li>D, though C is a close second. The combination of tingling all over and a sound like a shotgun has a very high positive predictive value for a ruptured appendix. </li></ul>
  74. 74. The Boards for Life <ul><li>Most Myocardial Infarctions present with: </li></ul><ul><li>A) Crushing substernal chest pain </li></ul><ul><li>B) Pain radiating to the neck and shoulder </li></ul><ul><li>C) Nausea and diaphoresis </li></ul><ul><li>D) A funny tinglin’ all over </li></ul><ul><li>E) All of the above, emphasis on tingling </li></ul>
  75. 75. The Boards for Life <ul><li>E. But watch out for the prevalence of tingling in any and all disorders. It is very powerful magic among your patients. </li></ul>
  76. 76. The Boards for Life <ul><li>Toxicology means: </li></ul><ul><li>A) Cool envenomations </li></ul><ul><li>B) Fascinating nomograms </li></ul><ul><li>C) Interesting pharmacology </li></ul><ul><li>D) Pathetic rednecks taking Xanax </li></ul>
  77. 77. The Boards for Life <ul><li>The answer is D. Doesn’t anyone keep Cobras anymore? </li></ul>
  78. 78. The Boards for Life <ul><li>Ejection from a vehicle requires: </li></ul><ul><li>A) Whole body CT scanning </li></ul><ul><li>B) ATLS protocol </li></ul><ul><li>C) Rapid sequence intubation </li></ul><ul><li>D) Security to keep the drunk patient from smoking in the parking lot </li></ul>
  79. 79. The Boards for Life <ul><li>The answer, again, is D. </li></ul><ul><li>I was never so surprised as when I realized that patients just don’t die when they should, and frequently do when they shouldn’t. </li></ul>
  80. 80. The Boards for Life <ul><li>The point is this: </li></ul><ul><li>Things don’t always look like they should. </li></ul><ul><li>You aren’t stupid or unprepared. </li></ul><ul><li>Real life medicine is just weird. </li></ul>
  81. 81. The Boards for Life <ul><li>Patients who appear to be wing-nuts: </li></ul><ul><li>A) Usually imagine their illnesses. </li></ul><ul><li>B) Invent silly symptoms to drive you bonkers. </li></ul><ul><li>C) Actually get sick with bad things. </li></ul>
  82. 82. The Boards for Life <ul><li>C. They get sick too! </li></ul><ul><li>Don’t get burned by assumptions. </li></ul><ul><li>Don’t practice what I call ‘wishful medicine.’ ‘I don’t want it to be a stroke, so it can’t be!’ </li></ul>
  83. 83. The Boards for Life <ul><li>Back to other stuff: </li></ul><ul><li>Your worst enemies, as physicians, are: </li></ul><ul><li>A) Your patients </li></ul><ul><li>B) Administrators </li></ul><ul><li>C) Yourselves </li></ul><ul><li>D) Lawyers </li></ul><ul><li>E) Insurers </li></ul>
  84. 84. The Boards for Life <ul><li>C. Yourselves. No one has power over you that you don’t give them, and no one can make you unhappy except yourself. </li></ul><ul><li>And all of them, like you, are just trying to get through the day, go home to watch American Idol and frantically clean the bathroom. </li></ul>
  85. 85. The Boards for Life <ul><li>As an emergency physician you can: </li></ul><ul><li>A) Live where you want. </li></ul><ul><li>B) Work as much or as little as you want. </li></ul><ul><li>C) Make as much money as you want. </li></ul><ul><li>D) Only have two of the above. </li></ul>
  86. 86. The Boards for Life <ul><li>This is Olinger’s Rule, named for one of my instructors. The answer is D. You can, generally, only have two. Choose wisely, young Jedi! </li></ul>
  87. 87. The Boards for Life <ul><li>Which of the following are signs life is not going well: </li></ul><ul><li>A) You wish you could be a fighter pilot. </li></ul><ul><li>B) Your wife just got implants and colored her hair. </li></ul><ul><li>C) You feel that everyone is out to get you. </li></ul><ul><li>D) Your children never let you sleep. </li></ul>
  88. 88. The Boards for Life <ul><li>Well, everyone wants to be a fighter pilot. </li></ul><ul><li>Everyone IS out to get you. </li></ul><ul><li>Your children don’t let you sleep because they like you. </li></ul><ul><li>If your wife changes her breasts and hair simultaneously, you need to be home more. The answer is B. Doubly true if your husband gets implants and changes his hair. </li></ul>
  89. 89. The Boards for Life <ul><li>A few closing points: </li></ul><ul><li>You will be fine. You are motivated and capable. You will touch lives in ways you never even imagined, and ways you will never know about. </li></ul>
  90. 90. The Boards for Life <ul><li>If your heart calls you to some other path, that’s OK too. You may practice medicine until you die, or until next year. Either way, it’s fine. </li></ul><ul><li>Be true to your calling, whatever it is. </li></ul>
  91. 91. The Boards for Life <ul><li>Love the people entrusted to you. Love them with total, fearless, reckless love, and lavish them with your time. </li></ul>
  92. 92. The Boards for Life <ul><li>If you want to be a great physician and human, listen to old Philo of Alexandria: </li></ul><ul><li>‘Be kind, for everyone you meet is fighting a great battle.’ </li></ul>
  93. 93. The Boards for Life <ul><li>Final Question: </li></ul><ul><li>Yes or no: Has it been worth all of the years and effort you’ve put into it? </li></ul>
  94. 94. The Boards for Life <ul><li>Answer: </li></ul><ul><li>It’s up to you to decide, and to live accordingly. </li></ul><ul><li>Congratulations! </li></ul>

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