The 15 minute ride to the community mental health center is over soon. It’s a beautiful building, nestled between well manicured lawns. The clinic where I work looks nothing like this. Still, it’s a community mental health center. This is where I have been working for the past 6 months- I know this population. It makes me feel confident.
We meet our team leader, go through a smaller orientation, and are asked to wait in what appears to be a group room. There is a smaller room off to one side with food and drinks, labeled For Candidates! I make myself my third cup of coffee of the day. We all gather around the table, making small talk. Someone leaves for a walk, someone else catches a nap. There is no cellphone reception. An hour passes by.
Our team leader is back. He leads us down the hallway to meet the examiners. I am introduced to my examiners, one a generic handsome doctor type and the other an older swarthy looking gentleman with an inverted U shaped mouth. I follow the examiners into a clinic room.
The patient is already seated as we walk in. I take my seat at the desk. The examiners sit to one side, poker faces on. My patient is a middle aged woman, pleasant and eager to cooperate. I launch into my standard introduction, amended to include a brief line about the examiners. While talking, I draw lines on the writing pad, dividing it neatly into 8 blocks. I have done this thousands of times. This is easy.
History of Present Illness.
Past Psychiatric History.
Medical History.
Substance Abuse.
Family History.
Social History.
Mental Status Exam.
Assessment and Plan.
I let her talk freely for the first five minutes, barely interrupting, scribbling notes in the columns where they fit, sifting words into data now since there will be no time later. Never actually looking at the paper. She has the rhythm of someone who’s been in the system for a while, and knows what to say. So far so good.
Next, I start probing, leading with open ended questions, then following with more concise ones. At some point, I make a comment, trying to clarify her thoughts during a period of sickness. She turns to the examiners and says words that are pure exam joy- “She’s Good!” The examiners don’t blink. We carry on.
One of the examiners calls out the five minute warning. My patient, bless her, has given me enough information to fill in all my little boxes. We do a quick mental status exam and I thank her for her time. She smiles, wishes me good luck, and leaves.
My examiners don’t give me the usual couple of minutes to gather my thoughts. Dr. Inverted U hangs back while Dr. Handsome starts questioning me. I answer the questions as I would while discussing a case with colleagues- my case summary, differential diagnosis, plan. As we dig deeper, I realize I don’t have enough information on her current family situation. The examiners know this- Dr. Handsome asks me to hazard a guess. I do- he maintains his poker face, while Dr. U nods in the background. For the rest of the Q&A, I make sure to look at Dr. U- he keeps nodding.
And just like that, it’s over. We spill out of our clinic rooms, visibly more relaxed, grinning, suddenly hungry as we walk back to the bus. It turns out that the examiners are taking the same bus back to the hotel as the examinees. This dissuades most people from exam talk, and we spend the rest of the ride swapping restaurant reviews.
Once back in the car, I text my friend. We meet soon after, going out for dinner, treating ourselves to ice cream. Talking about our cases. Both of us agree that we might pass, but the three week wait is going to be hard.
As it happens, the results comes out in less than two weeks. I pass. So do my friends, new and old. Now we can get back to the actual practice of medicine as opposed to the stylized performance of the Oral board exam.
Sumpsimus 
Ah! Such a beautiful story. E-book!
I’ve got to work on a poker face.
It’s handy in many situations and
sometimes it’s only polite..
I wish I had known about that eight-block organization of notes back when I was a reporter. It would have made structuring an interview so much easier, especially when I was on a tight deadline or when the subject of the interview was in a hurry or reluctant to speak.
So congratulations! We never doubted you’d pass, but I am very impressed by your ability to examine a patient under such intense conditions. I probably would have been so nervous I’d forget everything (though you teach me that preparation is everything in such situations). Hail to our Purple!
specialbabies: I appreciate your input. My cousin is on SSD for epilepsy. She’s been on it all her life though and is around 40-41 now. I don’t understand it, but my SSA rep (when I initially filed) said that your age, education and work history count AGAINST you when filing for SSD. They certainly want you to pay into the system, but getting it back is another story, I guess. Perhaps you should get a lawyer. It seems like it would be very dangerous for someone in your condition to be driving. My cousin doesn’t drive and never has because of her condition. She’s on meds and doesn’t hardly have any seizures these days but still has her SSD. It seems the uneducated ones with no work experience get the rewards that we’ve worked so hard for all our lives. Not quite fair, but …. what can we do?