Wednesday, May 2, 2018

Oral Boards

Disclaimer. This was what I wrote the day before my boards in early January. One of the most traumatizing times in my life. We are posting a bunch of blogs we didn’t get posted. So sorry for the confusion. Welcome to our life!! The last 3 months have flown by. 

Oral boards

Describe your practice setting.  

I am a solo practitioner practicing in a rural hospital in Africa.  We have a 100 bed hospital with 3 physicians, myself, an ED trained physician, and an FP trained general surgeon.  We serve a region of a million people and have referrals from the surrounding areas. I am available 24/7 as I live on the hospital compound.  Our electricity is run with a generator, and I have minimal diagnostic equipment, no pathology, no specialists to refer to, and no NICU.

There.  That’s my shpeal.   I’m trying to keep it short and simple.  I’m trying to keep the two worlds separate.  For the boards, all they care about is how I will practice in america.  Will I be safe?  Do I know the standard of care?  

I have come back to America for 2 months to study for these dang oral boards, and it has come down to one day now.  I have left my family.  I have left my work.  I have done numerous mock orals.  I felt sort of ready last week (I had some awesome mockers who were very motivational).  I knew the answers.  I felt ok.  

Last night I had a mock that didn’t go so well.  There was a lot that I didn’t know on office.  Today I had a mock where the examiner wasn’t sure what to do with my list.  I feel like he was very hung up on the idea that my practice was so different.  It definitely did not make me more confident.  

In the past I have overcome this by separating my two worlds.  When the examiners ask a general question, I answer like I was in america practicing.  If they ask about a specific patient, then I explain why I did what I did while in Chad.  

But several people recently have encouraged me to “be myself.”  Show them who you are and where you practice.  I have always separated the two worlds.  In Chad for instance, a baby hardly ever lives less than 1500 grams or around 31 weeks.  In America the cut-off for viability can go down to even 23 weeks now.  There are these HUGE differences.  When I even stop to think about it, I get emotional.  It’s not fair.  It’s NOT normal the way I do what I do.  But it’s all I have in Chad.

Rant.  I don’t have diagnostic lab work like potasium, sodium, serum-Hcg, TSH, Prolactin, FSH, Estradiol, Testosterone, 17 OHP, ovarian tumor markers, urinary cultures, endometrial biopsies, pap smears.  I don’t even have X-ray at my hospital, let alone CT or MRI.  I don’t have ovulation predictor kits to see when my patients on Clomid are ovulating.  I don’t have pathology to evaluate the surgical specimens that I take out.  I don’t have blood cultures.  I don’t have mid-urethral slings.  My light on my cystoscope has been out for a long time.  I have NO aneuploidy screening.  I can’t even trust my RPR because I don’t have a confirmatory syphilis test, so why would I even order it since malaria causes false positives?  My prenatal care is crap.  Nobody gets the 28 week fasting blood glucose that I recommend.  In a postpartum hemorrhage, I stop the bleeding and replace blood.  Period.  I don’t have platelets or a coagulation profile like fibrinogen, PT, PTT.  Hmm…white as a ghost even though you are black…?, yes I think I’ll give blood.  

I don’t have so much.  I have no one to refer to.  I have no chemo or radiation.  IN THE COUNTRY.  I am a bad doctor.  According to my case list.  

BUT.  I am doing the best that I can.  And I just need to get the words out to show them that I am a good doctor.  I am a safe doctor.  And I am in no way trying to be a cowboy.

When I combine the worlds, it’s challenging.  It makes all of the death and sadness that I bottle up in Chad more real.  It makes it more unfair.  Somehow if I keep things separate, it’s easier.  That’s what I do in Chad….and this is what I would do in America.  Separate.  Much easier.  But to apply my standards of care in America to my case list in Chad is emotionally draining.  The world is an unfair place.  

I essentially have to answer two things in one answer.  In America I would do this, but in Chad I did this because of XYZ.  

Certainly God is leading.  I know He is.  I just have to rely on His providence.  He always provides whether I pass the test or not.  But I know He wants me to do my best. 

I am literally emotionally drained.  It didn’t help that I attract drama and realised that I lost my photo ID (maybe at the airport 2 weeks ago) today.  My test is tomorrow.  Michael (brother-in-law) has graciously flown to DC overnight to bring back my passport in the morning so that I will have a photo ID for the test.