Agraphia Medical Tragicomedy



As I mentioned previously, I'm studying for the boards right now.  Just for fun, I pulled out my old study notes from Step I of the USMLE, all the way back in medical school.

It's really fascinating to look back at how far I've come.  My notes are covered in lists and lists of drugs, side effects, and mnemonics; stuff that once took massive amounts of mental energy to memorize. Now, much of it is either intimately familiar or gone completely.

What I find really interesting about these notes is that they don't have any weight to them.  Skimming through them now, my attention is drawn to specific diseases that occur more frequently than others, medicines that are safer and therefore more commonly used, and anatomic locations of significance.  7 years ago I went through and learned them all without much understanding of why.  Now it's all I care about.

Metformin, for example, is the most widely prescribed medication in the world for diabetes.  It shows up only once in my 15 pages of notes, listed in the middle of 6 other diabetic drugs, with the word "lactic" written cryptically next to it.  I did an entire lecture on metformin-induced lactic acidosis during my toxicology rotation last year... but for the boards, all I knew was that single word association.

That said, much of the information is simply gone.  I haven't thought twice about embryology since that test.  Sure, I know what drugs to avoid during pregancy, when to avoid teratogenic radiation, and what to do for premature labor, but the basic science behind the "why" has long been pushed out of the way for more clinically useful data.

Looking back through these pages is kind of like a stroll down memory lane - the study room in the medical school library, the grueling hours, the fast-food burritos scarfed down for lunch breaks.  I can't say I really miss it...

...but in a way?  I do.

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  1. Let’s be honest here and not try to pretend that we’ve stopped eating fast food burritos…. well, maybe not Taco Bell, maybe we’ve graduated to that fancy and hip Mexican joint down the road. Hell, I eat more burritos now if anything, as I know that if I pick it up on the way to work and then forget about it, leaving it sit in my bag for 8 hours until I finally get a half way calm moment to scarf it down, odds are, its still going to be pretty damn delicious, even if it’s cold. Or maybe it’s just me.

  2. I was just recently accepted to medical school. I currently work in an ED as a scribe where most of the attendings are constantly bitching about the patient protection and affordable care act (Obamacare), even to the point of telling me not to go into medicine.

    I was a non-traditional applicant who spent a few years teaching high school English (aimlessly wandering) until I finally got around to applying. I’ve wanted to be a doctor since I was a kid, so they haven’t dissuaded me. However, I am curious how medicine will change as a result of the act, particularly emergency medicine.


    • You know, I don’t understand why ER docs are upset about this at all. Normally we see a huge proportion of uninsured patients who will not pay their bills – the ACA is going to ensure that everyone we see, we can charge for. Even if taxes are raised on the wealthy, I still think our revenue stream stands to gain from this.

      Also, I think it’s the humanitarian right thing to do – but from a strictly monetary argument I believe EM has a lot to gain here. Perhaps I’m wrong.

  3. So, I’m studying for Step 1 right now and I’ll admit it’s a bit comforting that (hopefully) the precise details of the coagulation cascade won’t prevent me from being a good doctor. Love your stories about EM — thinking about going into it myself so please keep the stories coming and thanks for taking the time to share your experiences!

  4. I really enjoyed reading your blog! My boyfriend is currently studying for his fellowship in emergency medicine (unfortunately he failed his first one :( partially because i was distracting him maybe???) so it was interesting to read what you go through… :)

    Im trying to be supportive… How do you deal with all the and study? Im simply amazed by the work you guys do!

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