Thursday, 24 May 2018

The Intern/Pathologist!



   He had missed the beginning of the Academic year, when all the internships and residency positions were matched, so he knew it wouldn't be easy.  He had arranged an internship abroad, but illness had forced cancellation.   Their meager savings weren't going to last very long.

    In those days in Dublin, teaching hospitals were smaller institutions, totally unlike the huge, impersonal institutions of today.   They inspired a fierce sense of loyalty and pride, and a feeling of competitive collegiality, that doesn't seem to exist today. That sense of loyalty extended as much to recent graduates as it did to professional forebears who had found fame and fortune in the medical texts, as well as consultants and teachers over the past couple of centuries.   So, it only stood to reason that he should start at the Meath Hospital, the breeding ground of such immortals as Stokes and Colles and Graves, many of whom had diseases or syndromes or clinical signs named after them.   This was the hospital he had done his undergraduate studies in so even though he  was out of sync with the clinical year he  was hopeful  that they would find a job for him.
            
     "We were on our way to Manchester, Connecticut, when my wife became ill and we had to turn back," he said to Dr. Pickles, the administrator.  "I know I've long missed the deadline for an internship, but I really need a job.  I can't afford to wait until the next selection date, which is more than four months away."
    "I'll do whatever I can," Pickles said sympathetically.  "All the regular internship positions are filled, but I'll try to find something for you.  Why do you look more familiar to me than most of your class?"

     Stan smiled uneasily, there had been one or two pranks in his student days that might have brought him to Dr. Pickles attention! "I guess you just saw me around."

     "Just give me a day or two.   Why not drop in on Wednesday, I'll probably have an answer for you by then.
 
     Stan  knew why he had looked familiar to him.   It was all about Dr Graves of international fame as the discoverer of thyrotoxicosis, also known as Graves Disease.  A bust of the Great Man decorated the main atrium of the Hospital, which was atop a broad flight of concrete steps.  Dean Eleftry, was an older medical student from Vancouver, BC, who had come to Dublin to study medicine.  He was a nice guy, who everyone liked to poke a little fun at because he was considerably older than the rest of students and also because he spent a lot of time polishing his little old Ford convertible.
      That night, a motley crew of students were heading back to the hospital after a good night at the local pub.  All three sheets to the wind, the older ones handling their booze a little better than the younger.

        "Let's do something with old Eleftry's car," Tom Snowdon said, in a loud self-assured English accent.  "I'm so fed up watching him polishing and nursing it, I think it's time we taught him a lesson."

        "Yes, maybe let the air out of his tyres," Pete Sangster responded.

         "For God's sake, don't be childish Sangster, can't you think of anything more original than that," Snowdon responded scornfully."

        The rest of the noisy group suddenly quietened down, wondering where this was going next.

        "Why don't we carry his stupid little car up the steps and deposit it in the main lobby of the hospital.  That would certainly create a little pandemonium in the morning." Snowdon said.

       Hoots of drunken approval emanated from the group.

       "We'll get into terrible trouble if we're caught," Stan said.

      "Don’t be such a funk," Sangster said contemptuously.

       The herd mentality was kindled and there was no stopping them now.                                          
     "Do you think we can lift it?" Sangster asked.

      "Let's give it a try," an anonymous voice suggested.

            As many pairs of hands that could squeeze around the little car tried to get a good grip on some lifting point and heaved.

            "It's as light as a feather," another responded.

            Twenty or so, able -bodied students lifted the car and slowly carried it up the twenty - eight concrete steps that opened onto the main lobby of the building.   Others held the large twin doors open, while the car was quietly placed in the centre of the lobby.

            "It looks wonderful there," drawled Ronny Snowden, "but it would look much better if we put that bust of Robert Graves behind the steering wheel."

            "Christ,"said Stan, "all hell will break loose."

            A contemptuous glance from Snowden, while  a couple of his followers struggled to get the bust into the front seat behind the steering wheel.

            "Let's put a scarf around his neck and a cap on his head, just to complete the picture," Snowden added.

            One of the more fashionable members of the group volunteered his scarf and rather racy hat which he carefully arranged to give the centuries deceased Graves a decidedly sporty appearance.   Even Stan had to admit that the effect was dramatic.  They stealthily withdrew to the students residence before releasing their whoops of apprehensive delight at their daring act.

            Stan awoke in the morning slightly hung-over and reflected on the previous nights action.  He got up as quickly as he could, anxious to see the damage.  He walked out into the courtyard.  About twenty maintenance workers were laying wooden planks in parallel tracks down the concrete steps.  The car, with Dean Eleftry sitting behind the wheel was purring gently, having just been driven through the twin doors and was now being secured by ropes attached to the front axle, so that it could be lowered slowly down the parallel planks to street level.  A large crowd stood in small groups at various vantage points around the courtyard.  Some laughing, some talking in hushed tones.  Dean was now anxiously supervising the maneuver to make sure his beloved car wasn't damaged.

     The next morning Stan was in the line-up that the students and interns were ordered to attend, when the perpetrators were exhorted to turn themselves in, so that the entire class wouldn't suffer the consequences for the desecration of the venerable and internationally respected [except by us!] Robert Graves.  Of course knowing that there's safety in numbers, no-one claimed responsibility and no-one remembered there ever being any consequences.  Steve hoped that was not why he was remembered by Dr Pickles.




   When he showed up at Dr Pickles office on monday morning he was greeted by a pleasant smile .

"I have good news for you, Smith," he said to Stan.  "Although all the regular internship positions have been filled, there's a vacancy in pathology, that normally would have be filled by a second year pathology resident, that we have been unable to fill, so we can offer that to you for four months and that will bring you into sync with the regular rotations. It will be quite a valuable experience as well as allowing you to earn some money "

            Stan was relieved to have a job, but a little apprehensive about his ability to do justice to a position normally occupied by a person with one or two years more experience than he had.

            "Thank you, sir, but do you think I'll be able to manage it satisfactorily?"

            "Oh don't worry about that.  You'll be working directly under the supervision of Dr. McMurray, and she'll give you all the supervision you'll need.  It will be a wonderful educational experience because there are no more senior residents between  you and your consultant.  You'll get the opportunity to do things that a junior rarely gets near."

            Monday at eight-thirty Stan arrived at Dr. McMurray's office, ready to start work.

            "Good morning," the pleasant -faced middle-aged secretary smiled at him.  Then, in a slightly remonstrative way, added, "Dr. McMurray is down in the morgue doing an autopsy.  She said that you're to go down there right away.  She starts at eight sharp, you know.  Don't worry  though, I'm sure she will take into consideration that it's just your first day."

            "Gee, I'm sorry, I thought we started at nine." Stan answered apologetically.

            "Just take the elevator at the end of the corridor down to the basement and turn left.  You'll see a big gray double door in front of you.  Walk right in."

            Stan followed the directions  and found himself facing the doors.  He turned the handle and walked in.   The smell of formaldehyde was overwhelming.  Standing at the operating table was a woman clad in operating room attire, a scalpel in her hand and so pregnant that she could barely reach the corpse.

            "I glad you could make it," she said irritably. "now get yourself gowned and gloved.  I need a hand."

            "I'm sorry, Doctor, I thought we started at nine.  I should have checked with you.  It won't happen again."

            As he slipped off his jacket and tie and secured the rubber apron that protected him from neck to ankle he felt like a butcher about to butcher a carcass.  He pulled on a green gown, tied it up at the back and stepped up to the mortuary slab.

            "Okay," said Dr. McMurray, "step up here and get another suture around the esophagus, above the one I've already secured, I can barely stretch that far, with this in front of me," she said pointing to her swollen belly.

            Stan leaned forward, still a little shaken from what, in those days was the rather bizarre picture of a very pregnant woman doing an autopsy.

            "Okay, cut right here, between the two sutures, then dissect away from the posterior thoracic and abdominal wall right down to the duodenum, and then cut between the lower two ligatures that I had secured earlier.  That way we can get the whole segment of bowel out, without spilling gastric content all over the peritoneal cavity.  Unless, of course, you puncture the bowel wall.  And, by the way, don't get a fright when Jim starts the saw going.  Jim, this is Dr. Smith," she added by way of introduction.

            Jim was the operating room orderly.  He nodded his head at Stan and smiled.

            "Ah, you'll get used to all this stuff quickly enough, doctor.  Just don't mind the noise."  He added this as he continued a transverse scalp incision and then pulled the apron of scalp forward to cover the face.

            Meanwhile, Stan continued his dissection carefully, anxious to avoid the humiliation of perforating the bowel, let alone the miasmic odors that would follow.  The loud vibrations of the saw cutting through bone provided the background for the next half-hour, while Dr. McMurray carried on dissecting and supervising Stan at the same time.  Following the gross dissection, Dr. McMurray showed Stan how to section the removed organs and place the specimens in formalin for later histological microscopic examination.  They were all finished before noon.

            "Do we have another to do this afternoon ?" Stan asked.

            Dr. McMurray laughed.

            "We don't kill all our patents, you know.  I've assigned you to Tom Morgan, the chief laboratory technician.  A good pathologist has to be able to do and to supervise everything a technician can do."

            Stan thought it would be imprudent to mention that he had no interest in being a pathologist.
            Between autopsies, learning to do routine lab tests, clinicopathological conferences and the general house staff call he had not escaped, Stan kept busy.  He slept in the hospital only when he was on emergency call.   
            For some reason he could never figure out there was an extra small stipend for doing an autopsy and this make a big difference to a penniless intern in those days when an intern got nothing like a living wage.
             So when Dr. McCarthy went into labour a week later, he was more than willing to do the autopsies despite his lack of experience!  

Tuesday, 15 May 2018

O Cannabis - our new national Anthem.

   Canada's claim to fame in the 21st century may well be being the first pot producer on the New York Stock exchange.  Indeed, drug pushing may be one of the very few things we are exceptional  at, as Canada earned a "C" rating in global ranking as investment levels  slump, ranking 12th of 16 developed countries for innovation.    "Indeed" is a job placement agency headquartered in Austin, Texas. Looks  like Cannucks are employing them to recruit for our drug pushing industry,though you'd think that would be something we could do adequately ourselves!!   Read on!  RN/RPN 
O Cannabis Clinic - Scarborough, ON
Full-time, Part-time.Find similar jobs: RN Rpn jobs - O Cannabis Clinic jobs

HERE WE GROW AGAIN!

O Cannabis Clinic is a Nurse Practitioner led medical cannabis clinic. We are growing rapidly and require more RNs & RPNs to join our team!
The successful candidate will:
  • ‪‪Be excited to work in an emerging and evolving healthcare field
  • Be willing to work from home
  • Have a good quality computer (or be willing to get one)
  • Have strong internet connection and webcam
  • Accountable for own actions and decisions, comfortable making decisions within the scope of the position
  • ‪Be passionate about providing exceptional patient care
  • Excellent written documentation skills that are clear, thorough, concise accurate and timely
  • Be in good standing with the College of Nurses of Ontario
  • Have liability insurance
The successful candidates will receive training on company assessment policies, medical cannabis, and the current Health Canada Access to Cannabis for Medical Purposes Regulations (ACMPR), though prior knowledge is an asset.
Responsibilities include:
  • Screening patient charts to determine if patients have met the requirements to be eligible for a medical cannabis consultation
  • ‪Maintaining detailed EMR notes and records
  • Providing counseling and educational cannabinoid information to patients about medical cannabis
  • Performing consistent follow-up with patients
  • Helping with current research studies
Hours & Availability:
  • We have both FULL & PART time positions available now.
  • We have schedules available 7 days per week.
  • Daytime & Evening.
  • Our clinic is open 9am-9pm M-F; 12-5 Sat & Sun.
Job Types: Full-time, Part-time.

Ah well, perhaps some of the taxes that will be generated may be used to prop up our failing health care system as well as generating a whole new layer of bureaucrats!

Tuesday, 8 May 2018

Medical Malapropisms etc.

     Someone sent me the list below a few days ago.  Quite funny, but they pale in the face of medical malapropisms which can often be much funnier, for instance the patient in my early days of practice in Dublin, who informed me she had 'High - pretensions' or another who informed me her doctor told her she had 'Acute Vagina'!  God help the poor doctor who would be accused of saying that today, even though it be a medical malopropism. 
     Men, commonly mislabeled their prostate as their prostrate.
    Some other terms from my student and intern days in Dublin:
     Bilious - meaning naseated
     Grippe - meaning the 'flu'
     Fester - meaning pus forming or suppurating
     Chillblains - small cyanotic (blue-ish) inflamed areas on hands and feet due cooling and then rapid heating in front of the fire.  Were very common in all age groups in the winter.  In half a century of practice in Canada I have never seen one.  I had my last one when I boarded the Empress of England (Cunard Line) en route to Canada.
      Beeling - throbbing
      Nerves - meant anything from mild anxiety to major psychotic disorders.
      And of course 'Liverish', which has 93 synonyms!
      There were many others that I can't remember that I will try to recall.
      Equally quaint to my ears was when I first had a nauseated patient in Canada tell me that he felt as though he was "going to toss his cookies!"

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If you have any quaint or amusing examples, please send them to me.

Sunday, 29 April 2018

The Amazing Exploding Medjool Date!

     After fifty-five years of medical practice I thought I had seen everything. That was until I heard the amazing and almost unbelievable story of the exploding Medjool Date.
     The phone rang yesterday afternoon, it was my daughter. We talk most days, but yesterday she sounded a little anxious.
      "I have a really strange story to tell you Dad ," she said, "You won't believe it!"
"Try me,"I said.
     "I was eating some delicious dates that I had bought at Costco when all of a sudden, as I go bit into one, it exploded in my mouth!"
     "What?"
     "It exploded in my mouth and a huge cloud of what looked like black smoke came out of my mouth." she said. "For a moment I actually thought there was a fire in the condo".
     "Are you okay?" I asked.
    " I'm fine", she laughed, "though I'm still spitting up some black stuff."
I didn't find that quite so funny. I knew she would follow up on this. She's a nurse.
     "What's in the literature?" I asked.
I know my daughter. Mr. Google is a close friend of hers. If
there was information about this on the net, she would know about it before the professors of infectious diseases!
     "Better let Costco know," I said, not knowing anything about this weird phenomenon , "better let your Family Doc document this too."
     "Oh, in case there are any long term consequences?" she asked.

     "No, to get a refund," I laughedBut It was too late to deny my concern.
     "Yes, I will have to search the literature." I answered truthfully.. After all, what do I know?
     Well, I did search the literature.and lo and behold, I found all sorts of reference to occurrences of this phenomenon. Just ask Mr. Google and you'll get more than you bargained for! It appears that dates have a definite predilection for the climate they were born in. They like it hot and dry and just a small amount of moisture predisposes them to fungal infection. The incident described above is due to an infection with the fungus Aspergillus Niger which causes a disease called Black Mould on certain fruits and vegetables and is a common contaminant of foods. It rarely causes disease in humans unless they are immunocompromised or have certain other lung diseases, though I do remember seeing a few ear infections caused by it. The dramatic manner in which it presented itself as described here and elsewhere is alarming and pictures of the rotting core of the date compounds the horror the victims experience, despite reassurances of the benign outcome of the contact.
     I will be dissecting any dates I eat in the future to avoid the Black Mould!!

Wednesday, 25 April 2018

The Double Martini!

The Double Martini.
   When the last of my delicate martini glasses fragmented from stress fractures from excessive use since 1999, as my wife had often warned me it  might,( especially if I remained too lazy to wash them by hand) and insisted in putting them into the dishwasher, I had an acute anxiety attack.  Many folks think that an ordinary drinking glass will do equally well, but I  know otherwise.  The geometric design of that humble  and inexpensive glass gives it a unique elegance that is greatly enhanced by the two plump oval olives that gently traverse the inverted triangle.
   As I have often said to my closest and dearest, if God had not meant man to be happy he would never have invented the martini.  I think it promotes both health and happiness and I feel I have contributed to my chosen profession in some small way by, if not inventing, at least strongly promulgating the double martini.  So here I am at the age of 82 wondering whether it would be too bold, to recommend the TRIPLE!  I know of  course, there would be great danger in making such a recommendation to the dull and unsophisticated, but that is no reason that the intrepid and audacious among us should be deprived of such savoir- faire.
   I started my search for some new triangular glasses a few weeks ago and soon realized that there were two predominant models available.  The elegant cut glass expensive model, very fine thin glass, that give a delightful reverberating musical 'ping' when you flick it correctly.  (Long ago a friend of mine gave me one of these for a birthday present and I broke it in  the first week.  Mind you, in those days I didn't hold my liquor as well as I do now.) The real problem with this model is that it is rather delicate and requires hand washing, because it is too delicate to withstand the trauma of the dishwasher.   As I have no butler and would have to do the washing myself, I decided to forgo the aesthetics and settle for the working man's martini glass.   I had bought a few many years ago, in the Dollar Store and so I decided that was where I would start my search.  To my horror, I found that no Dollar Store that I visited had a martini glass, despite the fact that I was prepared to spend considerably more than a dollar for the glass.  Indeed, I would have been prepared to quintuple that amount without batting an eyelid!!   The solution to the problem was surprisingly simple, though I would never have thought of it in a month of Sundays! 
   My lovely bride had decided that we should donate some of our treasures to the 'Thrift Store', a chain of non-profit charitable stores who's profits are donated to worthy charities.  We visited the local one and after a moment we recognized that all the well made, delightful products of the craftsmanship of our youth was to be found in such stores.  Waterford cut glass, Royal Doulton China.   All the treasures of our parents and grandparents for sale for a pittance.  No one wants Lladro,Waterford, Bone china, silver candlesticks, they require too much care.   After all, these days people who are too busy  to look after their own children.  
So, as I browsed around, I shouldn't have been too surprised to find Martini glasses of very reasonable quality in two differed sizes, the large ones $2 and the smaller size $1.  I decided to splurge and take one of each size.
   As I checked out, the cashier said, "$2 please".
   "No," I said, "It's $3".
   "The big glasses are on sale, they are reduced to $1.  No one seems to want the big ones."
   "I do," I said as I handed over my $2.
  

Saturday, 21 April 2018

Medical musings.

  After finding it impossible to shake the blog addiction, I decided to use this site as a note pad to incubate my new blog which will be commencing in a few months.   Most of the scribbles here will have little to do with Medicalmanes, but feel free to peep in and see what's cooking, if you so desire.  For the present this is just the incubator for whatever will ultimately evolve and to keep me scribbling.

An amusing incident (but not for my sister!).
    A couple of weeks ago, my sister was at a community affair in the province where I spent the large part of my professional life practicing.  She was approached by a neurosurgeon who had been a colleague and something of a friend years ago.
   "Sorry to hear of Stan's passing away," he said .
   My poor sister almost passed away.  As she related the story, after the panic attack subsided and she realized I could hardly have passed on without her having heard about it, she informed him that I was alive and well.  He was somewhat embarrassed to hear this!
   What had transpired was this.  This man had worked with a colleague and me in putting together a neurosciences program for Family Medicine residents and we had worked together as a threesome for a considerable period of time.  Unfortunately, the other Family Doc, Mike Spooner had recently passed away and the neurosurgeon had thought it was me.
    I instructed my sister that the next time she saw this  man she was to inform  him, in the  immortal words of Mark Twain, "rumours of my death have been greatly exaggerated!".

    I recently had an echocardiogram (an ultrasound of the heart).  The echocardiography technician was a middle-aged Chinese gentleman and it was soon  apparent in the course of our conversation that he was very knowledgeable regarding cardiology and medicine in general.   I commented on this and he replied, "I was a specialist in cardiology in China, but couldn't get a license to practice in Canada."
   "Surely," said I,"you could have studied and passed your specialty exams in Canada?"
"I did," he said, "but while I was trying to get a residency position in Cardiology, a research fellowship came up in the States and I made the mistake of taking it.  It turned out to last for a few years and  when I came back to Canada, I was told there was no way I could  get a residency spot although I had passed the Fellowship exams.  I was eligible for  such a spot before I  went to the U.S. but I  was told the situation had changed and I was  no longer eligible.  I was able to get licensed as a electrocardiography technician and have been doing that ever since.   I still think about going back to China and practicing cardiology."
   I have had some experience in organizing health care in rural  Saskatchewan.   There are places in  Canada where they would sell their souls to have the services of a cardiologist, so if this man's qualifications are in order, it is difficult to understand why there isn't a position available for him.
But of course it facilitates the rationing of  health care by just not having the service available.

Thursday, 15 March 2018

Medical School. Who should be in and who should be out? Are we makng the right choices?

      When I decided I wanted to become a doctor, life was a lot simpler.  First one had to pass the entrance examination to University.  If one couldn't manage that, that was the end of the  story.  As far as I can  recall one was permitted three tries and if one failed three times, that was the end.   You weren't getting into University at all, let alone into Medical  School.  No-one thought, in those days that everyone should go to university.   No one considered that it was unfair discrimination or racism that all potential candidates were not accepted.  In fact, it was widely recognized that an applicant required a certain initiative and level of competence to be a suitable candidate for a university education.  In those distant days, applicants or their families had to pay their fees, so even the candidates did not want to waste their time and money entering a program that they were likely to fail.  This tended to weed out those who were not likely to ultimately gain a degree that would be an asset to their success  in later life.
      Getting into medical school in those days did not mean you were going to come out a physician.  If one failed to meet the standard one might easily be thrown out!  There were other standards that had to be met, as well as mastering the core content of knowledge.   There were standards of professionalism demanded of a prospective physician.  If the academic faculty. the professors and the Dean of Medicine felt a candidate did not meet the required standards, unless the situation was remediable that candidate  would not allowed to continue the program.  Although the years have clouded my memory, I believe about twenty per cent of the class I started with in Medical School  fell by the wayside.   Any appeal would be dealt with in-house and if it failed, no lawyer would have been sufficiently presumptive to assume that he knew better than a committee of  professional peers whether a candidate was fit to become a physician or not.
     Things are quite different today, when short of criminal activity, no  matter how inadequately a candidate performs he/she is almost certain come out of the program with an MD degree.  The martinets of Academe dare not face the legal teams that will appear on their door-step to challenge their decisions.   As you may have already read in a previous blog, a failed resident is currently trying to establish a suit against Western University, (until recently the University of Western Ontario) for failing to pass the specialty fellowship examination.  Should he succeed the nature of medical education in Canada, and perhaps elsewhere, will be radically changed.   Since it is almost impossible to fail a candidate, the admission process is critical, because once admitted, short of illegal or immoral behaviour, almost everyone who gets into med school will come out as a qualified physician.  The old joke, Q. "what do  they call the person who graduates at the bottom of his medical school class?" A." Doctor!" isn't so funny anymore.
     The Universities, the licensing bodies, the doctor's union (the Canadian Medical Association) and virtually all of the medical associations are intimidated by the prospects of litigation, or falling foul of government and its legion of administridiots. There remains a method in addition to marks, to attempt to ensure that the quality of prospective physicians and other health care workers meet an acceptable standard.  That is by the selection requirements to get into medical school and even that is a target of the bureaucrats.   So, let us at least make it as relevant as possible.
     Not  all schools require a personal interview and other requirements, such as letters of reference and letters from the candidates vary considerably from school to school.  Aside from marks, some of the qualities are extremely difficult to assess even in a carefully planned interview and almost impossible without one.
    The academic knowledge component is the most easily examined and tends to be the most  emphasized, perhaps because it is so well documented and available.    While undeniably important, it is often over-emphasized. In many areas of medical  practice there are very important skills that are unrelated to high marks.  For many years I have maintained that a B+ student with the right qualities can make an A+ practitioner.
     The value of the interview is that it gives skilled interviewers an opportunity to observe the general  presentation of the candidate and his/her attitudes, aptitudes and aspirations.   Admission interviews are very labour intensive.   They require training of the interviewers and tie up four people per interview, and I suspect for that reason in many institutions much of this sort of information is gathered by references, letters or essays written by the candidate and/or referees.  Unfortunately, these are often more indicative of the candidates ability to hit on the 'right' formula and sometimes templates are easily recognizable in the letters submitted.
     In the interview, the demeanor and general presentation of the candidate tells a lot.  Anxiety is normal and we spent some time in making the applicant as comfortable as possible.  Some candidates were obviously well rounded, had broad interests in what is going on in the world and showed comprehension appropriate to their age and experience.  Some were totally lacking in general knowledge.   Some had never read a book. Some had a realistic idea of what it might be like to be a physician and had talked to a doctor or nurse or someone at their local hospital.  Some had aspirations and ambitions to do something in health care, like be a family  doctor or a pediatrician or a 'research' doctor.   Some had no such aspirations and one fellow answered my question re an important achievement with, "I'd like to get around the golf course in par."        
    There were four interviewers and while that may have been a bit  overwhelming, it made the procedure very fair, as each interviewer graded the candidate separately and only after the interview did we compare scores.   If ALL of the interviewers were not very close in their assessment, the candidate got another interview.   That did not happen very often. 
    I continue to believe that the interview is an important part, perhaps the most important part of selecting prospective physicians, who will deliver the best possible care to the population.   I hope it will not be abandoned in favour of easier but less valuable methods of selecting the future generation of physicians. 
   
If you have any opinions on this, share them with me!!