Agraphia Medical Tragicomedy


Golden Rules

The USMLE is a funny thing. In order to test the "fuzzy" side of being a doctor, there are a number of social/behavioral sciences questions (affectionately referred to as "SBS" or, simply as "Such Bull Shit"). Of course, being medical students, we attempt to remove any hint of "fuzzy" by turning it into "science" - developing a set of golden rules that may be applied to any SBS-style question on the USMLE.

Usually the question goes something like this:

The nurse asks your patient, a quiet 33 year old woman, to put on a patient gown and hop up on the examining table while you are seeing your other patients. As you enter her room, you find that she is still in her chair, clothed, avoiding eye contact. Your most appropriate next response would be:

(a) I can't believe you didn't listen to my nurse. I shouldn't treat you.
(b) Hi, I'm Dr. Zac. How are you feeling today?
(c) What brings you in today?
(d) You seem quiet. I can wait allllll day, for my time is not precious.
(e) You seem depressed, would you like to talk about it?
(f) I'd like to have a shrink look at you, crazy lady.

Thusly, without further ado...

Zac's 10 Golden Rules of Doctordom (or, How To Rock The Boards).

1) NEVER REFER. My own personal favorite. Even if your patient has a brain tumor and you are a pediatrician with no neurosurgical background, on an SBS-type question, you should never call for a consult (see Turfing).
2) Don't be an asshole. Answer choices with "don't be so sensitive", "you'd have to be inbred to be concerned about that", and "You have cancer... now suck it up and deal" are always - here's a shocker - wrong.
3) Never treat disease; that's what real doctors do. These are SBS questions, not medical ones. The answer with a legitimate treatment (prescribing anything or draining abscesses) is guaranteed to somehow ignore the patient's feelings, insult them, or be the wrong drug. Trust me. A patient is rushed into an ER with a gaping, spurting chest wound, but always ask them if they're upset about it first.
4) Don't break HIPAA. Kick families out of rooms while the patient is minutes away from death so you can ask if they've pooped in the last 12 hours... it's privileged medical information and the most important thing is not to break confidentiality.
5) Never assume. It makes an ass out of u and me, but it also means that "you seem upset" is literally the worst thing you can say to your patient. Assuming depression because of the 15 vicodin overdose, the cuts on the wrist, and the mascara streaks means trusting your instincts - which incidentally is also the quickest way to get an SBS question wrong on the USMLE.
6) Do it yourself. If you need to perform a procedure, never ask the family to hold the patient's hand. Get a nurse or a janitor to do it - they get paid. In fact, never ask a patient to do anything. Ever. It's always your responsibility.
7) Don't be racist... openly. There's this wierd love-hate relationship between SBS, race, and sex. Black males are in the highest-risk category for high blood pressure, so you need to screen for it- but you should never admit to racial profiling.
8) Guarantees are only good in big business. Saying "I promise the treatment will work", "There's no way you've got herpes", and "You'll never win the lottery" is the quickest way to be dead wrong. Probably a legitimate rule.
9) You always fucked it up. Nice going, champ. Always admit your mistakes, because if something went wrong in the question stem, the correct response will always start with "my bad", "I'm sorry", or "Ssss..... didn't mean to cut off your leg".
10) Never express an opinion. After all the training you've been though, the sleepless nights, and the constant threat of malpractice- isn't it nice to know that what you think is unimportant? When the patient asks if you think they should take the antibiotic you just prescribed for their strep throat, your answer should always be "I have no idea".

And there you have it! We can now quickly apply Rule #2 to answer choices (a),(c), and (d) ( (c) is "too abrupt"), Rule #5 to answer (e), and Rule #1 to answer choice (f). This leaves us with "Hi, I'm Dr. Zac, how are you feeling today", which probably seemed like the right thing to do in the first place.

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  1. shit! i thought it was c……i am going to fail….

  2. ‘SBS’ is also Shaken Baby Syndrome. FYI

  3. haha I JUST had this question in my Kaplan Qbank today—not one or two days after reading this post here.

    It was a weird Déjà vu moment…and amazingly I got it right (even though I couldn’t remember WHERE I had seen the stem before!)