[Interview] 5 days till the Big Day

I went to the Wine and Cheese social event organized by the Med Undergrad Society last weekend, and it was really a wonderful night (for various reasons :P). Social-wise, I got to know more med students and reconfirmed my finding that these people are the coolest kids in town. They are so dynamic, so unique, and all so enthusiastic about what they do... I want to be a part of this family.

A few interviewee friends of mine were there too, and one of them were quite nervous about her upcoming interview. She has it at the same timeslot as me.

I, on the other hand, was totally chilled. I could think of a few reasons for this too:

1. I've approached this application as a test run -- just to test the water and see how things work. My real med school application effort will come next year.

2. I'm never the type that gets nervous about exams and interviews; I was talking to another friend the other day, and I figured that my mentality is "do all I can do and see what happens".

3. My mind is just too damn occupied right now to worry about med interview. Is there anything more important than an imminent interview? *Surprised* Yes, yes there is.

Anyway, what have I done in the last little while and what will I do in the next 5 days, in terms of med school interview?

Last week, a friend of mine and I each organized a mock interview, hers at her apartment, and mine at some classrooms on campus. Counting the other practices, I've had 4 runs in total, and really, I think that's enough. If you haven't tried reading the question prompts and answering under time pressure, I strongly recommend you do so. Don't do it by yourself; best to find current med students or friends who are interviewing, but if that's not available, find other friends and family. Just ask them to sit there, keep time, and listen to you talk for 7 minutes.

I'm also reading some books on medical ethics, and I will probably read up on the rural medical issues. The book I am reading is called "Doing Right", by Philip C. Hebert.

Here I'd like to stress how previliged and thankful I feel about having an awesome supporting team of around 10 interviewing students. There is very little sense of competition among our group; we genuinely want each other to do well, giving the best feedback and suggestions we can give to each other. Also, I couldn't find that Doing Right book in bookstores and ordering it would take a month, so I sent out an email to this group for help. Within 24 hours, 3 people replied offering to lend me the book.

Anyway, in the next little while I'm just going to take it slow. Read the stuff I plan to read, do the school work I need to do, and on that fateful Sunday morning sleep in until 10am if I can, get a nice big brunch, take a walk around, shower, change, and drop the bomb.

[Interview] Mock MMI: tips I learned, and why I LOVE MED STUDENTS

Tonight, I met some 1st and 2nd year med students at 6:45, who organized a mock interview with 10 stations for 14 of us. It's now 11:30, and I just got back, being dropped off by a super awesome interviewer who stayed and talked to the very last anxious interviewee.

I'm so thrilled by this process and how much I learned, that I'm now typing this up fast -- still in my suit because I don't have time to take it off.

So, firstly, these are what I learned:

1. Avoid the law. Some situations are complicated with legal consequences, such as when your patient died, but the reviewing committee wants to see your empathetic response. How you feel for the patients, how you express your sincerity, how you approach the situation with warmth and honesty. Screw the hospital protocols; be the genuine, caring person that you are.

2. A big part about being a doctor is educating the patients. When the patients or your friends have some stuff that needs education, take that opportunity and tell them the correct information. Don't assume they are joking when they think STD stands for standard deviation.

3. Explore both sides of the argument when two conflicting sides exist. Even when you are clearly in favor of one side, if there is a dilemma, there has to be a strong argument for the other side as well. Explore that side of the situation and explain why you disagree with it.

4. Explain the thinking process; for questions that clearly does not have a right answer, the answer is not what's important, how you reach your answers is. Explain what's going through your mind, what values are being weighed on.

5. Explore all relevent areas of the question prompt. When the prompt asks for "what are the issues involved", think about who's involved, who's feelings are affected, what are the consequences of your decisions.

6. When the interviewer asks "do you have anything to add", don't take that as an invitation to babble on. If you reached your optimal, stay there and don't distract the interviewer with repetition.

7. Talk in an appropriate tone for the station. Some stations are more creative and fun, while some are more serious and heavy.

8. When a procedure fails, be mindful of the well being of the entire team: the nurses, the anaesthetist, everyone involved.

9. Read up on the Canadian Medical Association Journal for information on rural doctor shortage: rural doctors are actually getting paid more, but still there is a serious shortage, so the financial incentive is obviously not effective on its own.

10. When wearing a suit jacket, the last button should be undone.

[Interview] Practice MMI: Placebo Effects

Placebo (Ethical Decision Making)

Dr Cheung recommends homeopathic medicines to his patients. There is no scientific evidence or widely accepted theory to suggest that homeopathic medicines work, and Dr Cheung doesn't believe them to. He recommends homeopathic medicine to people with mild and non-specific symptoms such as fatigue, headaches and muscle aches, because he believes that it will do no harm, but will give them reassurance.

Consider the ethical problems that Dr Cheung's behaviour might pose. Discuss these issues with the interviewer.

* * * 

Outline: 

- ethics in informing the patient

- placebo effect as reassurance is trickery and undermines physician-patient trust

- using useless drugs may make the patients feel treated, and they do not have to follow other measures to improve their non-specific symptoms

* * *

Response:

Although the goal of doctors is to improve the well-being of the patients, physically, mentally, and emotionally, I believe that using placebo effects to trick patients into a false sense of safety and reassurance is unethical. It may be true that placebo effects sometimes are real; the mechanism of psychology affecting physiology is poorly understood, but not unheard of. And sometimes the patients may even demand the drugs that they believe are useful.

Despite that, I will explain two reasons why using placebo effect may be unethical, and propose a better approach to dealing with these patients.

First, using the psychological effect of placebo to sooth the patients is at best a well-intended lie. It puts the patient's trust for this doctor and even the entire medical system at jeopardy, since the patient may find out that the drug he or she was prescribed has no effect to improve his or her conditions. 

Second, even if the patient does not find out the ineffectiveness of the prescribed drug, providing him or her with this false sense of security may undermine other efforts to improve his or her health. For example, if the patient is reassured by the placebo for fatigue, he or she might ignore the suggestion to quit smoking, which may actually be the root cause of his or her fatigue.

In the situation when the cause of the patients' symptoms are ambiguous, the physician should be honest and open about the ineffectiveness of placebo, and suggest treatments that are actually beneficial for the health of the patients. These may not even need to be pharmaceutical; for non-specific symptoms that do not have medical treatments for, suggestions for a healthy life style such as regular exercise, a balanced diet, and adequate rest would be more beneficial for the patients.