Wednesday, August 25, 2010

Need direction draft 1

I need to write a personal statement for residency applications. One thing medical school self-selects is for good standardized test takers (multiple choice) at the detriment to the essayist as is essential in undergraduate (and high school) academia. I am out of touch as a writer and need to get my act into gear to pump out a effective personal statement. My current concept is a personal statement is very much like a blog entry (or at least a well edited and hyperfocused blog entry). So below is a first attempt.

Several glaring errors about this draft... I am growing more and more convinced I want to do a combined psych/family or a psych only or a psych heavy family residency. This essay is focused on primary care aka FP. (partially because the patient in the vignette in the intro didn't need additional psychiatric care but rather a good FP). maybe future attempts should include several vignettes that emphasize why you need combined training? The other weakness in this essay is that it's focus is too "soap box" and falls short of capturing any of the personal part of a personal statement. Starting for me is always a major hurdle so even if my final is fundamentally different or unrecognizable from this draft... at least the ball is rolling.
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Today, as I walked into see my patient, an 82 year old gentleman with chronic low back pain and a history of falls being managed by a pain specialist on methadone, I noticed a keratinized patch on the crown of his head that appeared consistent with bowen’s disease, a variant of squamous cell carcinoma. Asking my pain management preceptor about this finding he matter-of-factly announced he would have to see his primary care physician and that our focus was specifically the chronic low back pain. We need pain specialists to conduct the management of polypharmacy and chronic refractory pain, we need dermatologist and dermatopathologists to ID and treat skin cancers. The vastness of medicine and the pathologies of the human condition appropriately lead to a medical hierarchy dictated by chief complaint specific or organ specific experts to micromanage a patient’s symptomatology. However there is an immeasurable loss in the practice of medicine when you lose sight of the patient while looking for the disease; if you cannot see the forest because of the trees- you have failed. I have learned that good medicine is both patient-centered and interdisciplinary. No one physician can be expected to single handedly treat every medical condition but every doctor should be expected to treat the patient first, the disease, imaging, and diagnostic results later. As a family physician you are the best person to partner with patients and families to navigate and integrate the health care system. In the operating room the surgeon was once described as the captain of the ship an unquestionable and especially if someone you love is under the knife…an infallible director. That perspective does not mesh with today’s medical practice. Patients have the right to determine the type and extent of medical interventions they require, they are the captains. A physician then becomes the navigator, the GPS of healthcare guiding patients with preventative healthcare and appropriate management of chronic diseases and as needed redirecting patients who have made wrong turns or missed the highway exit. This is no small feat but it is essential and requires skills of collaboration (with colleagues and patients), a foundation of knowledge (life-long learning), and compassion. Family medicine is my calling because my strengths are in expertly managing patient care in all stages of life. This requires a substantial breadth of medical knowledge but success is at least equally based on the doctor’s adeptness in facilitating communication between patient and caregivers, consulting physicians, and addressing psychosocial and compliance concerns. It is in the tailoring of medicine to the patient that the art of medicine is performed. No disease is the same regardless if the etiology or treatment algorithm is unchanged because every patient’s perception and interaction with their pathology is unique. I am looking for a residency training facility that will not only establish the medical knowledge required to be a leader in the medical standard of care but also to be at my peak performance at practicing the art of medicine and the care of patients.


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because I am writing really long posts today here's a link about personal statements i stole from some medical school (university of Alabama) via google. http://main.uab.edu/uasom/2/show.asp?durki=23485

• ERAS allows personal statements up to 28,000 characters (8 pages); however, personal statements greater than 3,500 characters (one page) may be ignored or viewed unfavorably.
• Multiple personal statements can be written to allow for program-specific submissions.
• Draft the personal statement in a word processing software (i.e, Microsoft Word) to give yourself an opportunity to edit and use tools like spell check. Cut and paste your final copy into ERAS.
• After you have pasted your personal statement into ERAS, but before you assign it to any programs, print a copy to make certain the conversion did not create any spacing or character problems.
• The final version should be no larger than one page in 11 or 12 point font. However, it should fill at least ¾ of the page or it may appear that you do not have much to say.
• Your personal statement must be grammatically perfect.
• Do not overuse the pronoun "I." Avoid "bragging." Do not use superlatives (very, really).
• Rely on several people to give critical reviews.
• Do not simply rehash your Curriculum Vitae in paragraph form.
• Use this as an opportunity to display your personality, not your accomplishments.
• It should be unique, and interesting. Imagine having to read 400 personal statements that all say "I have wanted to be a doctor ever since I saw a doctor treat...."
• The first paragraph must both grab the reader's attention and compel them to read more or clearly state why you want to match into the specific field.
• If your first paragraph does not clearly state why you want to match in the specific field, the last paragraph should.
• Consider using stories to highlight your strongest points. Rather than claim to be a good listener, tell a story about a resident who praised your listening skills. Readers remember stories much longer than they remember facts and statements.
• Include details in your story to give them life.
• This may be a good place to address any areas of concern in your record. If you want to do this, be careful not to sound defensive or victimized.
• Do not beg and plead.
• Do not flatter.
• If you cannot decide where to start, look at the answers you wrote on your MSPE Student Information Sheet. Which of those things do you want to make certain the program knows about you?
• Make sure that every sentence adds to your overall message.
• Stay away from the draft for at least a week between revisions.
• Ask several colleagues to proof for content.
• Ask several skilled people to proof for grammar.

1 comment:

Unknown said...

Hi Peter.

I like your point of view. I wish more of my doctors have it. It can be very confusing to have a "specialized" condition because there are no guidelines to tell you who to see. the only person left to put it all together is the patient.

I am to see my pcp for the excema (dry skin patches) but i remember my onc saying not to use cortisone creams.This what doc use to treat it. Will my pcp know not to give it to me? Am I responsible for knowing not to take it? I don't even know why I'm not to take it. Docs don't tell you these things.

I am left juggling because all these docs have their own territory. I should be their territory. Me, all of me. Not just my cancer, just my asthma, just my sore back. If I can't breath I want my pcp to wonder if I have mets to the lungs, not just give me a new inhaler. I want my onc to look at my skin and say, try using hand cream, don't use cortisone, if it isn't better go see your pcp but no cortisone.

My friend Tom many years ago had high blood pressure. His pcp said, it isn't really high, it's stable, your healthy. let's leave it alone.

Tom has second degree heart block, gets a pacer and cardio says wait, we have to treat your bp, take this medicine. It makes Tom sick and dizzy. Cardio says take it anyway you'll get used to it. you need THIS drug.

Tom's friend (me) says, there are a gazillion meds for high BP, try a different one. Tom goes to pcp who sticks with him until the find a med that he can live with and keeps hhis bp in check.( I think they tried 3 or 4) Tom shouldn't have to doctor shop to get what he needs.

Your old guy with the bad back deserved to have a doctor, at the very least, say "that area of skin looks very suspicious for skin cancer. Have you had it looked at? You need to see your pcp. Let me refer you to a dermatologist" But that didn't happen. Your preceptor didn't look at the whole person, just his little bit of territory.

You know, if each state in the "Colonies" had only fought for themselves and not as a whole we might still be British.