Happy New Year!
WordPress sends a summary for the year to their authors, thought I’d share how this blog turned out to you all (you can scroll to the bottom for that). I’d like to take time to really thank you all, whether you’re a new or dedicated reader, your readership means a lot to me as I share and document my own experience. A year ago I was still in interview season, receiving my fair share of acceptances and rejections for medical school and I wasn’t yet accepted into the program I’m at now. Since medical school has started life started moving rather very quickly, at some points it was quicker than I would prefer. Neither the less, I am thankful for the opportunities already afforded to me thus far and those in my horizon.
To all my readers I only wish you the best for 2015. And while I hope 2015 went your way, always remember the words of the 14 Dalai Lama:
“Remember that sometimes not getting what you want is a wonderful stroke of luck.”
The WordPress.com stats helper monkeys prepared a 2014 annual report for this blog.
Here’s an excerpt:
The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 42,000 times in 2014. If it were a concert at Sydney Opera House, it would take about 16 sold-out performances for that many people to see it.
“But, for better or worse, in medical school you don’t have time to really “deal” with how you feel or else things would never get done.”
Yes, it’s finally over and I get a break from medical school. I have a few days off, though I trauma duty this Friday night on Black Friday (this is more of a treat for me than anything else). I wanted to update you on what’s going on, it started off rather short post and then expanded into a meandering account of my brief foray in medicine white a short white coat.
It’s only been about 3.5 months since medical school has started, but as many medstudents would admit, looking back it feels like a year has elapsed. In 3.5 months we’ve crammed a year or more worth of graduate education. But, the course that stands out the most to me was gross anatomy. Yes, the human body is interesting, it’s probably the best example of organized chaos leading to something good.
The poster child for medical experience is Gross Anatomy & Dissection. As a person, you change a lot after Gross Anatomy, it’s practically a rite of passage for almost all MD (and DO) candidates. I still remember the emotional experience we had the week before our first “cuts” into our donor. We were hesitant on the first day of dissection, that is to say no wanted to make the first “cut” into the person laying on a slab of lustrous aluminum table. You see, whatever excitement we had about the process was taken to another level when we learned more about the donors as we watched one speak on video about why she decided to donate her body. Seeing her, I couldn’t but help think how much I’d of enjoyed meeting her. After all, she seemed rather friendly, quick witted, and rather friendly. So, on the first day when we dissected, I couldn’t help but wonder what the woman lying in front of me was like. Did she have a sense of humor, did we like the same movies (Groundhog’s Day, or anything with Bill Murray), did she have good stories to tell? But, for better or worse, in medical school you don’t have time to really “deal” with how you feel or else things would never get done. Then 3.5 months later, we’ve done a lot more in dissection I’d ever imagined possible or feasible — I also have a lot of new funny-awkward, and likely for you, disturbing stories and sights. It’s an experience.
The biggest shock about medical school isn’t how hard it is — well I take that back, it feels like we’re in
mental medical school bootcamp. It’s a new experience for most people in medical school, how hard it is and what it takes just to get an “average” score. No matter the institution, compared to their peers in college, most people who made it into medical school probably were on the right side of the bell curve academically. In medical school, that changes rather quickly and at best you’re like everyone else. That can either be intimidating or motivating depending on how you choose to see it. Conceptually, the course work isn’t very difficult. Instead, it’s just that you’ll cover a ridiculous amount of material in even one day, and you’re responsible for a ridiculous amount of more (but ‘different’) information the next day and so forth. Unfortunately, understanding will often take a back seat until you’ve remembered a large heaping of information that you must have ready at a moments notice for regurgitation. Then, if you’re lucky it’ll somehow all become clear before the exams, typically though as fate would have it expect it to be after the exams. I don’t have any grand stories to tell you about how to make this process easier, it’ll get easier because you’ll grow accustomed to it because of the consequences of not.
The biggest shock isn’t the difficulty of medical school, after all there’s rays of sun in back of the clouds. Instead, it’s the level of responsibility and trust thrusted upon us. Before, as a premed in the hospital, the most that was expected and allowed of me as to perhaps fetch water and if I’m lucky bring a stool sample to a lab. As medical students, one classmate has already intubated someone under supervision, another has done CPR for 15-20 minutes until the patient was announced deceased. Besides trauma, many of us spend time with either inpatient or outpatient hospitals or clinics around Boston, I’m placed at a community hospital and clinic. I suppose my capstone experience for this “course” was when the doctor just gave me her new patient, said get “Get a health history, after that we’ll do a physical” and left the room leaving only me and the patient. You may wonder why, out of all the things I spoke of being trusted with a history is so important. Well, it’s often said that perhaps 2/3 of all medical diagnoses can be correctly deduced from a good “health history”. It’s an interesting experience, while having a conversation with a patient, you try to extract information that might be pertinent to their health. This often means you, underhandedly, lead the conversation into a direction where the mountains are rich with information. If someone comes in with back pain, you lead the conversation in a way that their history might give enough clues to both elucidate and eliminate possible causes. If you ask too many questions in a rapid fire fashion the patients won’t communicate with you, or might just eject you out of the room. For example, here’s a typical exchange with patients as I go in blindly without seeing their history:
As introducing myself, and asking a few probing questions
Me: do you have any health issues or diseases?
Me: sorry, maybe I’m mistaken but when I asked about medication you said you’re taking X medication?
Patient: yes, I have diabetes but I’m healthy.
Me: oh okay (writes down diabetes)
Often a patient will just misunderstand what I’m looking for, or in this last case perhaps misinterpret the difference between having your diseased being properly managed and being free of disease. There’s insider information in medicine, just like how there’s insider information your car mechanic knows because of their trade. There’s also two of my favorite typical exchanges:
Me: do you smoke?
Patient: smoke what….?
Patient: oh, NO.
Me: so, what do you smoke?
Protip: to those not in medicine, your doctor or the medical student working with you doesn’t care about what you decide to inhale, or stick into any orifice. We care about you and we care about your problems and health, but learning of your addiction to prostitutes or meth isn’t a black eye in our book, it’s simply part of the puzzle of trying to get patients healthier. Fortunately, most patients are rather frank with the drug and sexual history, making presenting and giving a differential diagnosis easier to my attending (thank you), as long as they tell the right stories and we ask the right questions. You’d also be surprised to learn that the most important part of the visit is likely the last few minutes:
Me: okay,..(recite history back to them), do you have any questions?
Then as I’m walking out the door
Patient: actually, there’s one more thing…
As a rule of thumb, patients postpone the most embarrassing questions for the end, i.e. genitals not in tip-top shape, or the real reason why they likely visited that day. So, during the history, if you can help get this information from them earlier you can both save time (after all there’s a waiting room full of patients waiting) and that person may even receive better treatment. Once you realize that you’re wearing a white coat and a stethoscope therefore most people trust you with it gets easier to just ask someone about their safe sex practices, depression issues, or the hue of their bloody poo. Red feces means the bleed is more distal, i.e. near the anus, whereas dark (tarry) colors infer an upper GI bleed. Red feces is typically more innocuous than darker stools, and therefore all of my follow up questions are different. If you had fresh red blood in you toilet, I’d try to ask questions to eliminate dehydration for example — but the trick is that I can’t use the word dehydration in my questioning otherwise the patient would likely just respond “No” because their definition of dehydration isn’t the same as the medical one. At first doing all of this is really hard, to keep track of things so that you can lead the conversation towards trying to obtain a differential diagnosis, but it’s fun and we’re all getting better at it and I’m sure we’ll continue to. I’ve heard amazing things about some my classmates as well, and we usually swap our horror stories or goofs.
Some days are less fun, for example being there as you watch a physician try to communicate that maybe the patient won’t be okay, that cancer has moved faster than expected. Interestingly, you’ll have to move room to room and patient to patient, while not bringing the weight from each patient with you.
Differential Diagnosis Training
You may have wondered I brought up “differential diagnosis” as a new responsibility. One thing we learned really quickly is that the peking order goes, from highest to lowest: attending, resident, medical students. But, while being at the bottom of the totem pole, it’s still a team, and you’re expected to contribute a quick witted input or two from time to time. No, you don’t need to try to diagnosis someone with Kuru, but you should be able to understand that the bladder cancer patients cancer has grown and is now likely impinging on the nerves in the ischioanal fossa based on what the patient has recently told you about pain while sitting. You should be able to understand how the patient’s refusal to take Vitamin D while still taking their prescribed dosage of calcium explains why they’ve gone from osteopenia to osteoporosis. We have a course on how to do this, we learn how to research on diseases and how to integrate so that we may differential diagnose, it’s not a set of skills you’re expected to walk into medical school with. In fact, our final exam, was similar to an episode of House (without the grumpiness) where we got a brief paragraph and lab results and tried to differential diagnose a mock patient, our tools being a white board and a few other medical students for brain storming.
So, my first couple of months of medical school has had ups and downs, a lot of difficult times and exceptional ones. But, I enjoy the experience more than I’d ever imagine, because if anything my worst fear is abated: I’m never bored in medical school. As a classmate said today after we finishes our first semester, “I feel like a different person than when I started”.
I’ve been a little pre-occupied with studying, human dissection and medstudent tom-foolery. Starting tomorrow, my school has an exam block for MS1s (first year medical students). At my program, we have a traditional schedule, that is classes from 8 AM until the afternoon: Biochemistry & Molecular biology (and you thought you’d never talk about pKas again), Gross Anatomy (lab and written exams), Human Behavior in Medicine, and Public Health/Law. I have three tests this week, every other day, and the last test next Monday. Interestingly, as time marches on I’ll have less exams to take until Thanksgiving (Turkey Day) — I look forward to this idea.
There’s a lot on our plate as first year, lots of studying, lots of cramming. Though, cramming takes on a different meaning compared to undergrad: in undergrad cramming meant you studied 48 hours before the exam, in medschool cramming means you’ve always been studying and it’s still not enough so you need to really work your buns off as the test approaches to stuff every last bit of information into your brain you can before the exam. I’ve heard from my upperclass mates that this pattern abates, dropping off over time as you become more comfortable with the material and testing style. But for now, most of us are stressing out over the exam block coming up, some more than others. At my school, there are a lot of industrious medstudents who’ve fulfilled a masters/extension to place into my medical school wherein they have a lighter load because they don’t have retake classes they’ve already aced. These people worked for it, and their reward is a little less testing around this time — bravo. So, if you’re one of the people who decided to go this direction, be confident that you aren’t wasting your time once admitted if you set yourself up with the right program. A lot of us however didn’t go this route, so we need to have a full block and we cry ourselves to sleep internally every night as we try to keep everything together, know the minute details while hopefully still understanding the big picture.
So, how do I feel? Pretty freaked out to tell you the truth. But at the same time I’m elated to see that medical school is every bit as challenging as people made it out to be, because it means that hopefully by the end I’ll be a better person and perhaps (if I’m fortunate) a tad smarter. We have a pass/fail system at my school with no internal ranking, this is to help cut down on competition amongst ourselves, but internally I’m sure a lot of us still want to do well just to prove it to ourselves that we ‘belong’. I’m lucky though, my classmates are ultra supportive and we study together randomly all the time — in fact, I randomly crash study groups all the time.
This past Friday, I decided to take a study break and I visited the person who interviewed me. You see, she told me to visit her if I decided to attend the program after my interview. I laughed when she told me that, and said of course because I halfway figured I’d be rejected and she just didn’t want to ruin my day. So, I lived up to my word and paid a visit. We talked for about an hour and a half, she told me why she wanted me to be admitted and I told her how I felt about the interview day and her interview. She later showed me her lab where she helps head the amyloidosis research, where both PhDs and MDs work together on a translational research project. We viewed a slide of amyloid protein stained with a Congo Red dye. You’ve probably heard of amyloid protein before, and the first thing to come to your mind is probably Alzheimer’s, but the protein plaques can also aggregate in your visceral fat around your gut and heart (in the septum). You can diagnosis someone with amyloidosis by taking a sample of fat from the visceral region, using it to confirm images of a hypertrophied septum thus confirming amyloidosis — the day actually turns apple green under polarized light, it’s still debated why this happens exactly. It was awesome because I just learned all of this a few weeks prior, and I have a test on the subject (and many others) tomorrow morning, so that’s one question I probably won’t get wrong.
Eventually along the way you’ll find a secondary question asking you about how you deal with criticism. It’s an important question for innumerable reasons. The question for this essay is pretty much asking you, “Have you learned how to accept criticism and then do something constructive without having tantrum?” Medical students receive critiques to hone their skills prior to being flung into residency. Once there in their internship, they’ll be a lot more of it, most will be legit some unwarranted. Other physicians may criticize new interns, these new doctors find themselves bombarded by critiques that are no longer didactic exercises, but are now instead life and death lessons. Patients will berate you for being late, how could they know you were doing chest compression upstairs in room 215 for 20-minutes? But, without getting too far ahead of ourselves, let’s just remember that the medical school wants to see how you will handle criticism when they dish it out to you — there is also an undertone of show your maturity here please.
If you’re not used to handling criticism, you should get used to it. I finally learned what criticism meant when I was just accepted as the co-principal investigator for a project. I turned in my research thesis for my senior project to my principal investigator. He gave it back a few weeks later, but for some reason he had changed all of the font to red. I was wrong, he meant the whole thing had to be scrapped. I faced more criticism during lab meetings where we had to present new or class electrophysiology research articles and our interpretation. After some time, you just learn how to take criticism and become better from it. If there’s room to criticize then there’s room for improvement.
During this essay you’ll try to do several things:
1. Show that you know how to take criticism, i.e. you don’t bite off people’s jugulars when they give you an honest critique.
2. Show that you understand that accepting criticism can be a learning experience — this can be true regardless of who’s “right or wrong”.
3. You can show that you have some real world experience, i.e. will the school also need to teach you “life skills” or do you already have some.
Tell us about a time where you’ve received unexpected feedback or critique. And, how did you react to the situation?
As an Institutional Review Board (IRB) [title redacted] my first and foremost goal is to ensure that research projects meet ethical and regulatory standards. However, principal investigators (PI) often have disparate concerns, namely the timely completion of their investigative study. In one particular protocol conducted by a well-established (PI) I found the protocol didn’t meet my interpretation of ethical compliance. In response, I received a deluge of emails noting my incompetence; it became apparent to me that my review didn’t sit well with my (PI) colleague. I’m not infallible, and there’s a lot of “grey areas” in law interpretations, so I launched an investigation into my own decision. I poured through ethical reference texts and case studies to establish an ethical precedent for my decision, after I proved my case I reported my findings to the IRB and PI. After the protocol was modified, the study was approved and I have a good working relationship with that same PI.
The hardest part of this entry was actually writing it in such a way that I could still be professional, and be certain to represent both sides of the argument. Also note that I decided to not defend some of the criticisms against me, and instead accept it and show how I grew from it.
So, how long exactly does it take for a person to get ready to move from one coast to another?
As I look around my room I see that I’ve packed and prepared absolutely nothing. Instead of packing I’m strategically procrastinating, not making my packing check-list, and instead choosing to: bake cheesecakes, write articles like this one, etc. Surprisingly, I’m not too caught up with the stress with the geographic transplant, somehow flying across the country just hoping you’ll get into medical school makes that one flight to revisit as a student a lot more bearable. In general, here’s my packing plan:
1. Get books to east coast somehow.
Probably, the most stressful part for is figuring out how to move my library of books. There’s several ways to accomplish this goal: toss em, ship em, leave them, or replace them electronically. I weep when books are destroyed, and it’s prohibitively expensive to ship these ‘bricks’. Thus, I decided to either box them up to store or to download digital copy’s of the books I already own. I’ve been rather successful at finding digital copies of my books at either Gutenberg.org or by enough sniffing around the web for PDFs. Though, bear in mind it’s easy to find copies of books when you read old books or stick to science and math — so, fortunately, I’m a boring person so it’s easy to find my books.
Book list that made the cut either with a digital copy or packed along:
1. Calculus Made Easy, Thomas (found digital replacement, but bringing original) — who doesn’t like a novel written on math from 100 years ago? I rather prefer the way math was explained before as opposed to now, so I prefer this book.
2. Age of Propaganda (digital replacement) — it’s a good book on both propaganda and advertisement, it was a mandatory read from an English course and I kept it. When applying to jobs, medical school, or residency it’s a good skill to know how to “sell yourself” and make your self “wanted” (although you’re probably not necessarily needed).
3. Medical Physiology Boron, Boulpaep (digital replacement) — this was the physiology book I had to refer to and present from during lab meetings, so I’m just familiar with the layout. My program will use another medical physiology text, but I will keep mine as well.
4. Communities of Discourse: The Rhetoric of Disciples, Schmidt, V. Kopple (soft cover)– tackles rhetoric from various angles. This is a great book if you want to find your favorite writer to emulate. This is another book I received in class that I couldn’t part with after purchasing.
5. The Feynman Lectures on Physics , Feynman, Leighton, Sands (digital) — this book covers everything from physics, to quantum physics using vector calculus. I recently picked up volume I, but returned it after realizing I should just wait till I settle in to get all III volumes. I’ve now read all of volume I and have made it through most of II, and have dabbled into III. I won’t be wining in bets with Hawkings any time soon though.
6. Ion Channels of Excitable Membranes, Hille (found digital copy, but probably bringing hardcover anyways) — this was the field and research that helped me get into medical school. But, really it’s more symbolic than anything, it was a mandatory read assigned to my by my old PI. It reminds me of those days.
7. The Human Brain Coloring Book, Diamond, Scheibel, Elson (soft cover copy only) — so, I bought this book during Neuroscience for undergrad but never actually colored in it. But, I did read the information, that’s actually all I needed at that time as I would draw out the brain structure. This time however, I’ll use it for anatomy in medical school as this coloring book series is popular.
I have another 60+ books (all science related), but the rest of them will get left behind in Sharpie marked boxes at my parents house. I made it a point to keep my undergraduate books, occasionally I like to read through them to see how far I’ve come or how much I’ve forgotten (something to justify all that money I spent on my education).
Clothes to pack
This is the easiest part. I live in California, we have four seasons: hot, really hot, kinda hot, and not that hot today. In Boston there will be spring, summer, autumn and winter. Therefore, my clothes from California are likely only useful for between a 1/3 or 1/2 of the year at best. So, most of my clothes can be left behind. The bulk of my clothes will be donated, undergarments with questionable structural deficits (holed-up knickers) will be tossed. I only need to worry about enough clothes to last a month or two, the rest has to be purchased while I’m out there (winter wear etc). I’m very sentimental with my blankets and my towels (I never got over the blanket phase?), so I’m bringing some items I’m already familiar with for comfort.
The laptop obviously goes, not because it’s a good laptop, but just because of the data and programs on it — as you may imagine I’ll also be bringing my portable hard-drive (Library of Alexandria) as well. I’ll also be bringing my set of speakers (non passive speakers), and my favorite guitar.
That’s actually just about it. I like starting from scratch, it doesn’t bother me to move around. Californians move around the state a lot, it’s rare for us to grow up in one neighborhood or one domicile, we’re known to even move around during elementary school — not that kids want to. So, I’m accustomed to losing everything and starting over from scratch, it’s practically “spring cleaning” for me.
Hm, it seems that be writing this article I’ve accomplished one of my goals, writing a check-list. I procrastinated my way into success.
We are all full of weakness and errors; let us mutually pardon each other our follies – it is the first law of nature — Voltaire
During the secondary applications, there is a good likely hood that you’ll eventually hit a question that asks for your to explain your weaknesses — some questions may even have you elaborate more, some less. As premeds we’re hyper vigilant when it comes to addressing our weaknesses. The worst thing you can do on this essay is to wall yourself up, become defensive, and start playing “cat and mouse” on this question. When interviewed, this is a question interviews like to toss in, so the better you know this question the better you’ll be during it. In fact, there’s seldom a job interview that I’ve had that also didn’t ask this question (at least a job that preferred a degree).
On the other hand you may indeed be perfect, good luck explaining that to your interviews who likely can easily give you a running list of their “weaknesses”.
Here was my strategy in answering the question:
1. Present weakness (feint)
The first step to many problems is to first acknowledge you have one. (see step 3). In my example it’s my “self doubt” about past decisions.
2. Rationalize/humanize, but don’t minimize weakness (parry into step 3)
Use an explanation to explain what your weakness is in context, then project how this could be a ‘problem’ later. Pretty much, in this phase I was beating my reviewer to the punch by acknowledging my issues, then being realistic about how that is a weakness in their context as well. After that, I used that to transition into the next step, step 3. In my case I tried to reason with physicians who probably were just as neurotic as I was about things, so it wasn’t a hard argument to bridge rumination and self destruction.
3. Propose solution/plan of action for your weakness (Parry into a gentle counter attack ‘riposte’)
Up until this point, I was on the defensive as a writer, but at the conclusion I moved towards the offensive, I decided to address how I’d overcome my problem: becoming more systematic, learning how to trust and delegate better (more trust in the process less restless nights in theory). This helped turn my weakness into more of an, “Aha!”, moment then a guilty admission. The key here is to really give the “how will you solve” this problem prompt real consideration.
And the golden rule — don’t BS ( unless you believe the BS too, but that’s some type of Inception type concept that we don’t have time to cover).
What is your weakness?
I feel one of my largest flaws is my tendency to ruminate on my past decisions. As a future doctor I could imagine myself always wondering if I could have provided a better outcome for a patient: if I just had noticed a symptom sooner, prescribed medicines more or less aggressively, if I made the correct ethical choice, and wondering constantly if there was a better way to perform my duty. This year I have strove to empirically record my observations using an online journal; it has allowed for me reduce circular worries. Later, I could assuage my concerns with meticulous chart recording and recording case studies. I should also learn how to better develop trust and delegate to others, this would help reduce a lot of stress. These skills would transfer into medicine as I better learn to foster team work with other allied professionals. While I believe self-criticism is necessary, and should be invited, nonconstructive self-doubt helps no one.
As you may have imagined, to reflect on things is healthy but to ruefully regret is not a good thing. You may have also imagined that this trait would have made me more anxious during application season, at the beginning this was indeed true. However, during that time I grew to appreciate a new philosophy about my time and how much I would worry about things.
Along the way through your secondary applications you’ll hit a “Project to the Future” question in some incantation. This was one of my favorite prompts to reply to, it hopefully it will be for you as well. I know it sounds like I speak blasphemy to even imply applying to medical school can be fun, but honestly there is are some satisfying parts to the process. This prompt happens to be one of them. If you put this prompt into context, up until now you were just a premed scrabbling across the prerequisite and MCAT mind field. For a lot of applicants, this is the first time you’ll have a moment to realize that you’re actually applying to medical school (bravo you!). Now, this question should get you thinking, “Just what am I going to be up to in 10 years?”. It’s a fun question, imagine yourself with your white coat freshly pressed to get the vomit out, but it’s okay because you’re a doctor!
Also, don’t worry too much about i you’ll change your mind about your specialty; most people change their mind anyways. Though, you do want to have a tone of keeping and open mind or being flexible while driven. Make sure to check the school’s website for more specific information like how their institution can fit into your projection.
For the things I tried to catch in this entry were:
1) Involve the school and their abilities into my projection. There’s a cat and mouse game of BS between some applicants and admissions. My advice: don’t play the game, find legitimate reasons why going to that specific program is a plus. Don’t go into detail about the school, you’ll have another essay prompt to do that; instead just remember the school and you are intertwined after acceptance.
2) Show what you know about medicine here. I decided to project the imagery of me becoming a doctor. I suppose the only thing you have to worry about is that your 10 year or future projection makes temporal sense.
3) Remember that you’re selling yourself here as well, so remember that you need to sound like you’ll be an asset to medicine later. This doesn’t mean you need to cure Amyloid Lateral Sclerosis or cancer (though I hope you do), you should acknowledge the little victories in a physicians life — and I do mean little victories.
4) Remember that you will be asked this again during the interview, and maybe even expected to elaborate on several points. Interviewers who have access to your entries and their notes to them tend to ask really good follow up questions, at least that was my experience. During the interview, if your secondary was genuine then that can be pretty out-right fun; if you pulled it out of the ether then it’s down-right miserable.
As a future alumnus of Cookie Monster Medical University I see my medical career being devoted to serving the local and national community. As a Awesome-ologist attending I would help promote positive patient health outcomes by collaborating with a team of medical professional. Although I loathe the disease, I would enjoy the long term relationships I could develop with patients, allowing me to holistically treat the individual. My undergraduate research experienced combined with new experiences during medical school would prepare me for interpreting new research to be used with my patients. I would stay involved in the local community, working with other physicians and health professionals to encourage preventative screening of cooties for the under-served population of Honeybunville, empowering individuals through knowledge. At the same time I’d support and mentor residents and medical students, passing on the lessons given to by my predecessors. I have a strong belief in the link between research and medicine so I would like to get involved in clinical trials, as drugs studied at the bench are later medicines to be dispensed by a physician.
Note, in case you’re curious I did notice, “promote positive patient”, that is “P.P.P”. I sort of had contempt for the fact that I had to use those words in lieu of saying “I like to help people”, so I decided to make it almost acronym like to make both I and the reader feel better about the cliche term — I live on the edge. =D