Chuz out mang

At a time when many of my Esteemed Colleagues are having brain implosions from the tension and stress of having to prove that they are not idiots, I am floating in an ethereal world of bliss and happiness - it's like Nirvana but with cheese on toast and a gin and tonic. 

What is the secret of my success?  Simply this: I have so much on my plate that I can't even see the turd underneath the mashed potato.  So I'm just digging away with my fork saying yum yum yum, due to get a nasty surprise soon but carrying on regardless.

I'm moving house on Tuesday.  Actually, we've already started.  Yesterday my Smaller Half and I spent all day smashing our possessions into small pieces, tipping the debris into boxes, loading the boxes into our cars, driving up to town, unloading the boxes from the cars, tipping the boxes out onto the floor of our new house and gluing the pieces back together again into new and exciting combinations like some kind of domestic version of Voltron - Defender Of The Universe!

I hate moving so much that at the moment it completely dominates my every waking moment.  Intellectually I am aware that I have my Death Star Exams in a few weeks but it is having no emotional impact on me at all.  I'm not boasting about this - I think it's actually quite bad because it means that until the end of this week when we are finally mostly settled in to our new place, I am highly unlikely to actually do anything studywise.  Shrug.

The other thing I have on my plate is my fractious relationship with my supervisor.  After last week, when I emailed him and the university informing them that I was not prepared to have him supervise me any more due to his almost total lack of constructive criticism and fondness for asking "Have you stopped beating your wife"-style loaded questions, things have kind of died a whimpering death.

The university people were all very supportive of me, my supervisor sent me an lengthy email talking about a different issue entirely, and that's about it.  I went back to the clinic during the week and I was like the invisible man.  I saw a few patients, helped out a bit with a collapse and a chest pain, but none of the doctors or admin staff talked to me about what's going on.  My supervisor gave me a strained smile and waved across the waiting room at me.  So right now I don't now if my name is Mudd, if I have a new supervisor, or if the whole thing has been written off as me having a pre-exam mindfart that we should all awkwardly pretend never happened.  Shrug.

In the meantime, I'm going to spend today doing some study.  Eeeeexcept I just realized that all my textbooks are up in town, glued together in the shape of a giant marauding ant robot.  Bugger.

The OSCE is like a dose of clap

In a few weeks I'll be sitting our final OSCE (a practical exam).  There will be twenty stations, each of five minutes.  Because there are more than twenty people in my class, we're divided into in four groups: a morning and afternoon session each of which has two parallel "streams" running at the same time with the same stations.

Yesterday we got the email allocating us to our spot in this big chaotic event.  I am not pleased that I am in the "yellow" stream.  This immediately made me think of Whistler telling the Prince Of Wales that he was like a stream of bat's piss in the Monty Python sketch about Oscar Wilde.  That's not really the image I need to get me psyched up.

So I'm going to think of it as the gold stream.  When the rebels attacked the Death Star, did they have a yellow squadron?  No, they had a gold squadron.  Red, blue, gold, green.  Much better.

Actually, since I am listed first on the list of stations, I think of myself as Gold Leader.  A quick check on Wookiepedia shows that this makes me Jon "Dutch" Vander.

Which is nice, sure, but there are a few problems with it.  First, Gold Squadron was flying Y-wings, not X-wings.  Y-wings are pretty gumby starfighters if you want my opinion.  X-wings are where it's at.  The Y-wing is to the X-wing as C-3PO is to R2-D2.  And second, Dutch was shot down and killed by Darth Vader after he panicked during the trench run on the Death Star exhaust port.  Not a good omen for my OSCE outcome. Hopefully none of the OSCE stations will involve exhaust ports.

Still, at least I stood up for what is right and sacrificed myself to help defeat the Empire.  Maybe I'll get bonus empathy marks to make up for my lack of galactic competence.

Plummer-Vinson (Paterson-Brown-Kelly) syndrome

Dysphagia and ... ...
Screw it, I'd rather be a
Landscape gardener

Buerger's test

Elevate the leg
And observe it for pallor,
Dependent redness.

Myasthenia gravis

Eye muscle fatigue
Is often the first symptom -
Pyridostigmine.

Henoch–Schönlein purpura

Little red bumps, sore knees,
And a bad pain in the tum?
Monitor kidneys.

Hyperglycaemia

The patient must have
Much too much glycaemia -
So give them no more.

Hypoglycaemia

The patient must have
Not enough glycaemia -
Give glycaemia.

Concerning poems in the haiku form

The more keen-eyed of my readers will have noticed that I've been on a bit of haiku fling recently.  It's kind of my thing - I get caught up in an idea and have trouble moving on until I've wrung all the fun out of it and given it a few more squeezes just for good measure.  You may remember my similar binge of appalling Ernest Hemingway jokes about six months back.  Or my stuttering War On Innumeracy.  Or perhaps you've suppressed those memories.

Anyway, some of you are getting sick of my poems in haiku form.  Some of you like them.  And some of you are getting freaked out by them.  The first two responses are fair enough.  But please, please, do not respond by getting freaked out.  These poems in haiku form (dammit, that's getting tiresome to type, I'm just going to call them haikus from now on!) are not, as you may think, a representative sample of my medical knowledge.  They are the entirety of it.  Every time I learn something new, I write a haiku.  So if you come across something you don't know yet, just think of all the things you do know that I haven't written about yet.

I had a big start to my study binge.  I learned 4 or 5 new things that day.  Since then I've really slowed down.  But that's okay, medicine is not a race.  Not unless somebody is dying right in front of you, in which case it kind of is a race, except it's the winner who dies.  So why rush?

So I'll finish this post with a haiku about medical haikus just to be a little bit post-modern.

Medical haikus
Encapsulate my knowledge
In pithy verses.

(image swiped from savagechickens.com without permission but with much admiration)

Neostigmine

Quickly reverses
Neuromuscular blockers.
Give atropine too.

Hypoparathyroidism

Back pain, cataracts,
A tourniquet makes hand jump,
Tap the cheek for twitch.

Seven affirmations

As you may know, I live in interesting times.  Just had a bust-up with my supervisor, moving house next week, exams in a couple more weeks, baby due a couple of weeks after that.  By this time in December I will be a tiny wizened old man.

My Aged Mother was clearly concerned about me so she emailed me to remind me to recite my Seven Affirmations every morning to keep my spirits up.  I had to admit to her that not only do I not recite them, I do not actually have Seven Affirmations.

Sure, I have a morning recitation, but it goes like this:

1. Arrrgh, somebody get that cat off my face!
2. What's that godawful noise?  Snooze button!  Snooze button!
3. It's happening again!  Turn it off!
4. Oh my god, look at the time!  Get up!  Get up!
5. It's freezing in here!  Where are my ugg-boots?
6. I think my bladder is about to explode!  Run!
7. Maybe I'll cut back on coffee next week.

I don't those are the type of Affirmations that my Aged Mother wants me to make.  I think she wants me to leap out bed and say something like:

1. I am beautiful.
2. I am intelligent.
3. I am certified in the use of power tools.

and so on.  But (as is probably obvious from the paltry list above) I can't actually think of seven things that are positive (as opposed to not negative, such as "I am not anaemic").  I think the problem here is that I'm a medical student. Somebody is paid a rather large wage simply to tell me what a hopeless sack of shit I am.

Well, the joke's on them.  I am certified in the use of power tools.

Hyperparathyroidism

No get up and go?
Drink so much and pee a lot?
Find adenoma.

Haemochromatosis

Bronzed diabetic,
Arthritis and bad liver -
Treat bloody often.

Kawasaki disease

Red eyes, mouth, palms, soles?
IVIG will reduce
Ruined heart vessels!

PR, RR, BP for birth, infant, toddler, child.

One sixty, fifty,
Seventy at birth.  Fifteen,
ten less, fifteen more.

Red flags in paediatric heart murmurs

Loud diastolic
Harsh heart sounds when lying,
Aortic symptoms.

Kallman syndrome

My dog has no nose!
Oh really? How does he smell?
Simply terrible!

A simple question

So what is the plural of haiku?  "I wrote a haiku.  I wrote many ..." what?

Haiku?  Maybe it's like giraffe or wildebeest to hunters.  "I shot a brace of giraffe today."
Haikus?  Perhaps, but it's not an English word, so do you still pluralize it like an English word?
Haiku's?  That doesn't seem right.  As far as I know the only place that apostrophes are correct for pluralization is for things like the 60's and 70's.

Perhaps someone could google it for me. I'm a busy man.  I have bridges to burn.

Pertussis

Paroxysmal cough,
So bad you thought you'd vomit.
Vaccine lasts five years.

Decelerations on CTG

Squeeze head for early,
And cord for variable.
Late? Think placenta.

Ring worm

Discoid skin lesion
With red ring? Rule out eczema,
Use Clotrimazole.

Otosclerosis

Conductive deafness
Early on, but then becomes
Sensorineural.

Cauda equina syndrome

Low back pain, wet pants,
Sensory change between thighs -
Call neurosurgeon!

Breast lump

Young?  Likely a cyst
Or fibroadenoma.
Still investigate.

Give me malaria or give me death!

Goya knew a thing or two about medical education.

This haiku thing is really catching on.  Today a psychiatrist started speaking to me in verse.

He was a pretty odd guy but I really enjoyed his company.  The conversation began by him asking me, "What's your claim to fame?"  I claimed to have no claim to fame but gave him the short version of my life story ("I'm spending 3rd year in Hometown, I used to be an engineer").  He sat staring down at his desk, deep in thought. 

"1940", he said.  And he wrote "1940" on his pad of paper.  "Was the year I was born".

"1949", he said, and again he wrote "1949" on his pad of paper, and he drew a box around it.  And then another box around "1940".  "Was the year I first thought to become a psychiatrist".  He would leave long pauses

in the middle of his sentences

so his speech sounded

quite poetic.

He continued to tell me his life story, accompanied by little illustrations of what he was talking about.  For example, when he was talking about the hypothalamic-pituitary-adrenal axis, he drew some little adrenal glands.  And when he used the phrase, "Following on from that", he would draw an arrow to a different part of the page and begin anew.  The whole page got filled up with a crazily complex flow diagram illustrating his professional life.

And much more!  For example, he asked me who won the first Nobel Prize related to psychiatry and I guessed that it was the guy who invented the frontal lobotomy, but he said it was much earlier than that.  Apparently it was given to a guy who was able to treat General Paralysis of the Insane, which was actually caused by cerebral syphilis, by deliberately giving people malaria.  The diagrams for that got a bit confusing, let me tell you.  We talked like that for more than 45 minutes because his first patient didn't turn up and he didn't realize that next patient was waiting already.

Anyway, the whole time there was this enormous blowfly careening drunkenly around the room, smacking into the light fittings and dipping distractingly in and out of our line of sight.  And that was when he spoke to me in haiku:

If we were at home
I would catch that fly and feed
It to my turtle.

It was really striking stuff.  So much so that at the end of the afternoon, after I'd seen him run through his list of patients and it was time to go to home, I thanked him for his time and said, "I hope you catch lots of flies for your turtle".  He let out a great bark of a laugh, like a seal, and waved me out the door.

I think I want to be a psychiatrist.

HELLP syndrome

Abdo band pain and
Hypertension?  Get coags,
Have the baby now!

Erythema infectiosum

Slapped cheeks and fever,
You're no longer infectious,
So no day off school.

Heart disease

You must be kidding!
I can't fit that much into
A simple haiku.

Measles

Fever, Koplik's spots.
Why aren't you vaccinated -
Gullible parents?

Acute post-streptococcal glomerulonephritis

Haematuria,
hypertension, oedema?
Supportive treatment.

Cluster headache

Alarm clock torture,
Angry eye, rhinorrhea.
Try Verapamil.

Thrombotic thrombocytopaenic purpura

Bruising and fever -
Haemolysis? Schistocytes?
Plasmapheresis!

Pericarditis

Friction rub, fever,
Sit forward to fix chest pain,
Diffuse STE.

Encopresis

Bad constipation,
Overflow incontinence.
Parachoc, star chart.

Pulmonary embolus

Virchow's triad, cough,
Sudden onset dyspnoea?
Warfarin for you!

Typical

Mobile phone rang yesterday while I was on another call.  No message left.
Mobile phone rang this morning soon after I struggled out of bed.
"Did you get the voicemail I left yesterday?"
"No."
"The room we were going to use for the videoconference here in Hometown is double booked.  You have to drive to Dustbowl."
"Okay".
Rushed to get ready, drove to Dustbowl.
Saw on videoconference that the camera was on in the room in Hometown.
"Hey Mr Videoconference-Guy, shut that one down, it's being used by other people".
Brrrrrrring!  Brrrrrrring!  It's my Esteemed Colleague calling.
"Hello?"
"Hi PTR, I'm in Hometown.  Can you get Mr Videoconference-Guy to turn the videoconference back on?"
"What? That room is double booked, what are you doing there?"
"Well, nobody told me so I came here.  And it turns out it wasn't double booked after all".
Wise Professor turns up at distal end of videoconference linkup.
"Hi guys, I've been roped into this at short notice and I don't really know what I'm supposed to be doing.  How do you normally run these things?"
"Well, this is the first time we've done it, so however you like really."
"Okay, how about I just run through the PowerPoint slides that I sent you?"
"Okay".

Emoticons

Did you know that <3 is like a little love heart if your tilt your head to the right?  I only realized it recently.  I've been tilting my head to the left because that's how you read the :) face.  I thought that <3 meant "boobs".  I could never understand why they would say things like: I <3 Bieber. 

I boobs Bieber???  What???

Antenatal class

We went to an antenatal class on the weekend.  It took the whole day, unlike the antinatal class where you are simply given a pamphlet on birth control.  I, in my typical medical student way, was expecting to be bored stupid because I am a professional smartarse.  My expectations were met in the first hour or so when the midwife running the class imparted such valuable knowledge as:

• the uterus is like a bag inside the mother that the baby grows in,
• you have to take off your pants to give birth,
• the placenta is a special organ made by the mother's body to provide nutrients to the baby.

When she said that last one I shot my hand up and said, "Actually all trophoblastic tissues are derived from the blastocyst and thus are distinct from maternal uterine parenchyma."  She thanked me for my wisdom and all the brickies, cooks, accountants and lawyers in the rest of the class gave me admiring glances and left the nicest sandwiches for me at lunch time.

But the day improved from there.  We were shown a movie about the stages of labour which I found quite useful because simple stuff like that is often not well described in books or lectures.  One of the annoying things about being a smartarsed med student is that people often assume that you know quite basic stuff about life that you somehow managed to miss along the way.  They'll happily bust your brains out of your ears with detailed descriptions of protein cleaving but will forget to mention the bit about having to take your pants off to have a baby only applying to the woman.  Knowing that will save me plenty of embarrassment when B-Day arrives.

Wants

My holiday in the Philippines was a great success.

One of my favourite parts of each day is when my Word Of The Day email arrives.  Each one has a feature word, the origin of the word, other words from that same origin, one or two examples, and, tucked away down the bottom of the message, an unrelated quote.  The quote is actually the best bit, in my humble opinion.  The feature words are often too obscure to be of use in daily life, although from time to time I do work them into a blob.

Today's quote was interesting:

To be without some of the things you want is an indispensable part of happiness. - Bertrand Russell, philosopher, mathematician, author, Nobel laureate (1872-1970)

Now "Plastic" Bertrand is a smart guy.  Nobel prize, philosophy, books, mathematics, and he was a dab hand at the old "pull my finger" joke too.  But in this case, he's talking bunkum.  The list of things that I want is short but I can guarantee you that if you generous readers would pool your resources and get them for me, I'd be happy as a clam.

So if any of you have the following things just lying around, please send them to me.

• Mazda MX5 hardtop.
• Twelve or so 25/28mm Persian cataphracts.
• A CD unscratcher.
• A barbecue.
• A fringed buckskin jacket like the one in that film with Jon Voigt that I haven't seen yet.
• A card marked "Get out of jail free (also good for exams)".
• A banjo and the inclination to practise.

Chip in now and put a smile on my dial.

Swept away

(From an interactive display in the National Museum, Edinburgh, which was trying to get children to think about how their lives would change if they were forced to leave their homes and move to somewhere new with almost nothing.)

Improvisation fail

Being typecast as Batman was ultimately damaging to my career.

You know, sometimes I sit back and think about this blog and it surprises me.  I can't believe you people come here and read this stuff.  Maybe you just look at it for the pictures...

Anyway, the other day I was sitting in with a GP who was running pretty late.  He got up to go and get the next patient and gave me a quick rundown on her problem list.  Somehow, probably because he was already so late, I got the impression that he wasn't going to get me to talk to her, plus I was very tired and was doing that thing where I clench my jaw so hard so avoid openly yawning that my teeth crumble into chalky dust inside my mouth, so I just tuned out and went to La-La Land while he was still speaking.  So the whole problem list sounded to me something like this: "So she's been out of hospital for three days and blah blah blah blah blah blah blah blah blah".

He left the room, came back in with the patient and then, to my horror, said to me, "Why don't you review Mrs Kafoops for me?"  I had no idea what to do.  He'd mentioned that she was garrulous, so I threw the dice and went generic.

PTR

So how have you been?

Mrs Kafoops

Oh pretty good thanks.

PTR

And how have your... symptoms... been?

Mrs Kafoops

Much better I suppose.  Yes.

PTR

Excellent.  Yes.  What sort of changes have you noticed?

Mrs Kafoops

Well I'm just better all over I think.

PTR

Good.  Good.  ... Good.  And how are you finding your treatment?

Mrs Kafoops

No problems at all.

PTR

Good.  Any side effects?  That you might not have been expecting or that you don't like?

Mrs Kafoops

No.

PTR

Gooooooood...  Goooooooood.  

It went on like for what seemed like hours but surely was only minutes.  It was agony - she was far from talkative and I still had no idea what was actually wrong with her.  Eventually I cracked and turned to the GP and said, "I'm not really sure where to go from here".  He must have been on to me because he just said, "What other questions might you want to ask someone with depression?"

Aha!

Empathy

I saw a patient today who kept making odd comments in response to my questions.  His wife ended up answering for him most of the time.  I assumed that he was just deaf, but as we left the room he said, "Goodnight!" in a cheery voice.  It was 10.30 in the morning.

So I said to the GP who was there, "Does he have a bit of dementia?"

"Oh yes", said the GP, "He's as nutty as a fruitcake".

Father Hood

For those of you who don't know me in Real Life (tm), we're pregnant!  Or, to put it in a less nauseating way, my Smaller Half is pregnant.

I'm not just making the obligatory morning sickness joke, by the way.  I actually feel physically ill when I hear people use the phrase "We're pregnant".  I want to grab them and shake them and scream at them.  Because are we really pregnant?  I know I'm certainly not.  My Smaller Half is pregnant.  I'm going to be a father.  But that's about as cooperative as it gets.  Pregnancy is not a collective state of being like getting married is.  Sure, I was briefly involved in the process for two minutes or so, but my physiology has returned to normal since then whereas hers - sheesh!

Mentally, emotionally, socially, sure - we're pregnant.  But saying that "we" are pregnant makes about as much sense to me as saying that "we" are going to have "our" prostate reamed out at some stage down the track.

I'm excited, of course.  A friend asked my Smaller Half yesterday what I was doing to prepare for fatherhood.  My Smaller Half said that she didn't think I was doing anything in particular.  But that's not really true.  I think this is something I've been preparing for all my life.

For example, I have developed an unearthly ability to synthesize awful puns combined with the fearlessness required to unleash them in the most inappropriate circumstances.  Plus I am pretty good at the old "pull my finger" gag.  Especially the gag part.

I have also learned reams of tiresome trivia about old wars, grammar, etymology and science.  And I can draw almost anything (except horses, which always end up looking like dogs).  As a handyman I am appropriately unskilled yet enthusiastic, being happy to tie things up with tape or wire and then forget about them.  I told my Smaller Half the other day that I was thinking of buying a jigsaw (no, not the puzzle, the tool) because that way I could cut things out and assemble the pieces into useful things should the need arise.  She was really impressed.  I own a paintbrush and I once painted a chair red.

I am great at making up bedtime stories and hardly any of them are terrifying enough to induce nightmares.  I can catch spiders inside a glass.  I can use a lawnmower.  I can cook food well enough to be able to extract grudging compliments with a few simple ploys. 

I can clean flat surfaces like benchtops, floors, and windows.  I am the designated Person In Charge Of Cleaning Up Cat Poop And Vomit, even from carpet.  I can sing.  I can dance.  I can hide behind chairs and pop out saying "RAAAARHHH!" so it's scary enough to make you laugh but not so scary that you wet your pants (except for that one time).

My hairline is receding and I have the odd grey hair in my eyebrows, which lends me a certain air of maturity to offset the sprightliness of my childish and petulant behaviour.  Like all good fathers, I am patient.  And like most fathers, when I snap, I carry on like an idiot and make a fool of myself.  Exhibition A: this whole blog.

So yeah - I've been preparing.  I'll be a champ.  It's got me thinking about nominating myself for Australian Father Of The Year.  Just look at the chumps who've won it in the past.  John Howard.  Mark Taylor.  Steve Waugh.  Ken Done.  Dr Karl.  Malcolm Fraser.  John Kerr.  Robert Menzies.  None of them could have done a decent "pull my finger" if their life depended on it.  Well, maybe Malcolm Fraser could.

Send me the bill

PTR
Mmm, this bolognaise is very tomatoey!

Smaller Half
Did you use two cans?

PTR
No, beef.

Enraging

I don't often write a blob just for one person but this is an exception.  In the last couple of months I've noticed that the little-used check-boxes at the bottom of each blob that allow you to choose between "engaging", "enraging" and "absurd" is being consistently checked as "enraging".  Just once for each blob, usually within a day of me posting.  My assumption is that it is a single reader doing this rather than an emergent behaviour of the interwebs as a whole.

Here are the questions I would like to ask that strangely devoted reader:
Are you really enraged?  If so, why do you keep coming back?  Do you like feeling angry?  Or is it your way of marking the blob so that you know you've read it because you have some kind of memory deficit?  If that's the case, how do you remember what your method is?  And why not just bookmark your favourite post and read it anew each day?  Or are you trying to inspire your fellow readers to vote more often?  Or is it perhaps your way of giving me a little wave so I know that you've visited even though I don't know who you are?

I know you're out there, enraged man, in the dark so utter,
For when I put my blobs online I hear you gasp and splutter.

OSCE stations for the real world

Having recently undergone trial-by-OSCE, it concerns me that the stations were extremely unrealistic.  Oh sure - they may well be very similar to the stations we'll get at the end of the year.  But they bear absolutely no similarity to the tasks that medical students are required to undertake every day and thus they are a poor measure of medical student core competencies.  Here are some model stations I've come up with to make the OSCE fairer.

Obstetrics and Gynaecology
Student Instructions
You are in a pre-natal clinic doing routine checkups.  You haven't seen a birth all year and realize that this is your last chance to get on board.  Please convince the patient that they should boot the student midwife off the list and let you assist with the birth instead.

Standardized Patient Briefing
Do not agree to let the student be present at your birth even if they cry and beg.  It is important that you mention the following counter-arguments provided to you by the midwifery student:

1. The doctor always misses the birth anyway then swans in with a muffin saying, "How are things going in here, ladies?"
2. On the off chance the doctor doesn't miss the birth, he/she will want to do an unnecessary caesarian.
3. Oh, and doctors are always pressuring you to agree to drugs that will give your baby autism.

As the student leaves the station, let him/her know that you would have agreed if he/she was more experienced.

Surgery
Student Instructions
You are in clinic with Dr Bastard, a surgeon.  He instructs you to examine the patient's Ossicles of Zeno and give him your top ten differential diagnoses and the associated aetiologies.

Standardized Patient Briefing
The student will attempt to examine your Ossicles of Zeno whilst being glared at by Dr Bastard. Ensure that you ask the student the following questions as he does so:

1. Is it true that they don't teach anatomy any more?
2. If that's the case then where is my spleen?
3. No, I'm sure the left is where the liver is.  My cousin has his liver removed when he was five, how long can you live without a liver?
4. So you want to be just like Dr Bastard do you?

General Practice
Student Instructions
It is lunchtime.  You have been consulting with your supervisor all morning and feel that you are finally getting the hang of this stuff.  Enter the staff lunch room and converse with your supervisor.

Supervisor Briefing
The student will attempt to interact with you as if you are human.  Behave capriciously and imperiously.  Ensure that the following points are covered in your conversation:

• Ask them where they have been all morning.
• Introduce them to someone that you know they have met before.  Get the student's name wrong.  Be incredulous if they correct you.
• Ask the student a question about themselves then start talking to someone else while they are answering you.
• Reminisce fondly about previous students who were much more engaged, competent and intelligent.
• Criticise the university and its terrible teaching and newfangled course that has resulted in such a poor student being sent to work with you.
• Announce that a drug rep is turning up soon and throw the student out.

Paediatrics
Student Instructions
Please give the child in this room an injection.

Standardized Patient Briefing
Your child is to receive an injection.  Please follow these steps:

• Instill fear in your child by getting very tense and promising them a huge reward afterward if they don't scream.
• Instill distrust in your child by promising them that it won't hurt at all.
• Overdress your child in multiple layers so that getting access to even a single limb is impossible without a struggle.
• Wait until the child has spotted the needle and has started screaming before raising your concerns about the possible side-effects of the injection.
• Restrain your struggling child until the needle is almost touching their skin.  Then release your child suddenly, allowing them to flail around wildly and maximise the chance of the student stabbing themselves with the needle.

Medicine
Student Instructions
You have been sent to buy lunch for a senior consultant.  You were told to go to "Jack's Cafe down the road to the right" and buy a tandoori chicken, avocado and edam sandwich on white bread, and a large soy macchiato.  You have discovered that Jack's Cafe has been closed for six years.  There was only one other cafe within a reasonable distance and it didn't have much to choose from.  You have returned with a bacon, pumpkin and cottage cheese flatbread wrap and a small latte.  Enter the room and give the consultant her lunch.

Consultant Briefing
Ensure that you raise the following issues with the student when he/she returns with your lunch:

• They have been gone a long time and missed seeing lots of interesting signs in patients.
• This is not the sandwich you wanted.
• This is not the coffee you wanted.
• Jack's Cafe was there last week.
• This is not the sandwich you wanted.

Do not offer to reimburse the student for the cost of your lunch.  If they do ask for money you should remind them that this is not the sandwich you wanted.  If they still persist, point out to them that the university doesn't pay them very much for the teaching you provide.

Psychiatry
Student Instructions
Please observe the following conversation between doctor and patient for five minutes.  At the end of this time you will asked to diagnose each of them with a mental illness and/or personality disorder.

Examiner Marking Sheet
Bonus marks if the student also diagnoses themselves with depression.

Power

Reginald Machiavelli, my old high school principal, used to say that it was better to be feared than to be loved.  Clearly you, Gentle Reader, disagree.  You thought it was better to be overlooked than loved, better to be loved than feared or respected, better to be feared or respected than admired, and better to be admired than to be scorned.  Good luck with that.  People are going to think you're nuts.

Since the most popular response was that it is better to be overlooked, I declare the winner of this poll to be the most overlooked choice.  Thus it is clearly best to be scorned.  And if you think what I'm doing is unconstitutional - tough.  I've got a friend with two angry rabbits who thinks otherwise:

Flopsy and Mopsy are VERY disappointed...