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kbinners last won the day on November 16 2018

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  1. Hi SocSci-PipeDream, I'm a Mac student, and I know there are people (not many, but still) in my class who had a cGPA similar to yours. There are more students who took the MCAT and only wrote the CARS section. (My roommate is one of the latter.) There are a good bunch of us who are your age or older. I was 26 when I applied. We have students in their 30s. There are also a few students that I know of living with chronic illnesses, some of whom are amazing, outspoken advocates. I think it's a great idea to write for CARS and give the application a try. For you, as well as for any student, it's a bit of a crap-shoot. For every single one of us, a big part of it comes down to luck. Your life experience and ECs will help you answer CASPER and interview questions with integrity and authority, and will probably help you stand out in the sea of med school gunners. On the other hand, your GPA is a bit of a handicap -- but not necessarily one you can't overcome. A lot of people end up applying and reapplying. If you don't get in this year, would you consider taking more courses to raise your GPA and/or give you some foundational science background? (The science background isn't essential, but it does help once you get here.) I forget what Mac's rules are about calculating GPA -- maybe have a look to see which courses they include in the cGPA calculation. Also double-check what your grades translate to on OMSAS, because they convert each school's numbers to standardize things and it changes everything a little bit (but for you a little may matter). I wish you all the best, Kathryn
  2. Hi premedcal, I still don't have my notes with me (most prolonged move everrr) but as far as I remember my CARS scores on the TPR FLs were consistently around 128-129. And I scored a 132 on the real exam. Good luck!!
  3. Hmm, I think my bio scores were similar on the practice and real tests, but I can't double-check because my notes are in a box in a truck moving across the country If I remember correctly, my practice bio scores ranged between about 126-130, and I scored a 128.
  4. Hi Click, Personally, I'd say the biology passages on the real test are really challenging. I assume that they know the majority of applicants are strong in biology, and so they make that section really difficult in order to see meaningful variation between students. I found the real exam more challenging than the TPR practice tests in terms of biology. And yes, I think I would say that the difficulty comes from complex passages and questions that expect a fairly high level of application and insight. (But maybe that's my perspective because I have limited biology training...? Perhaps those with more bio experience feel differently.) If you are finding TPR's passages challenging, keep working on them I found there was not a whole lot of physics on the test I wrote. There was some -- and I can't claim to have felt confident about my answers in that passage -- but not much, and not covering very many of the physics topics. My guess is it's kind of a crap-shoot, physics-wise: you're only going to get a small number of questions, so they can't cover all the possible topics, but you can't predict what will be included. This isn't a secret: you can see on the AAMC website what percentage each subject takes up of the test, and the physics percentage is low.
  5. How about this perspective? I'm sympathetic to this view. http://www.huffingtonpost.ca/dr-brenna-velker/physician-services-agreement_b_11174174.html
  6. Hi Ukmedstudent, Thanks for asking. It's obviously a complicated issue and I only have a tiny bit of (anecdotal) experience to bring to the table. That said, as a family member, I would ask that physicians remember that assisted death is now an intervention legally available to patients and they have the right to ask about it and to receive up-to-date information about how the process works and what choices are available to them. My main wish is for doctors to remember that the choice belongs to the patient. Only the patient can judge their own quality of life. I once received some very good advice: answer the first question first. If a patient comes in asking about assisted dying, tell them about assisted dying, how it works, and how you can help them. Once they have been able to access the information they want, they may be more willing to listen to other alternatives that may also be available to them, such as additional supports (home care, longterm care) or palliative care. I think a lot of doctors will have the initial reaction of shrinking from assisted dying as an option, and automatically trying to convince patients to try another other option. I suspect that will cause a lot of patients to feel unsupported or judged. That's not to say a doctor shouldn't help a patient look at other possibilities -- but the first thing has to be a willingness to support whatever they decide is right for their own body, and taking the time to listen to the patient's description of their life and reasons for their inquiry. Something I'd like to see is a real effort to avoid the duplication of inquiry into the patient's reasons for seeking an assisted death. Surely only one or maybe two professionals need interview the patient about the sensitive reasons they are seeking this intervention. My mom and I found that she was constantly having to justify her choices to many different people, and that process was exhausting for her. (The different people included, but were not limited to, over 6 PSWs, their four supervisors, a PT, two OTs, two palliative care specialists, a psychiatrist, a nurse practitioner, a family doctor, a social worker, and a representative from the ALS society.) The system needs to be coordinated better. Someone needs to step up and make sure that coordination happens for any given patient -- in our case, sometimes the nurse practitioner took on that job, sometimes a home care supervisor, sometimes the case coordinator, but all of them were able to work to ensure less reduplication when they set out to do so. I really feel that there are a lot of parallels between the new legislation on assisted dying and the initial legalization of abortion. Both are interventions that have a major, and irreversible, impact on the patient. In both cases, the patient needs to be supported and empowered in their decision-making, because they are facing a very difficult choice. Women seeking an abortion used to have to justify their decision in front of a panel of experts, and could be denied access. They were faced with stigma and judgement and pushed to consider other alternatives. I believe that women today face much less judgement and pressure from their doctors regarding abortion. Physicians (on the whole) recognize that the patient has a difficult decision to make and that each option has its consequences and benefits for her. I hope that care providers will begin to change their reticence regarding assisted dying into an attitude more similar to that regarding abortion -- that it is an intervention that is therapeutic in the right circumstances, and that those circumstances are best determined by an informed and empowered patient. I hope that begins to address your question. Feel free to ask for clarification or let me know if there was something you wondered about that I didn't think to discuss.
  7. Hi Wasteman, I'd love to know more about how basic income might be implemented. In so many ways I think it's a crucial policy. Fighting to stay on welfare often becomes a full time job itself, as recipients have to stay on top of bureaucrats who constantly challenge or arbitrarily cut off all or part of their income. The stress of insecurity, not to mention low incomes and lack of affordable housing, takes real tolls on people's health and ability to thrive. A basic income COULD stop the constant interrogation and threatening of people on social assistance and the bureaucracy required to maintain it, which would be excellent. But I have questions about what it would really look like. What amount would people get? Would it be enough to live on, or would those without additional income still have to apply for a top-up to survive, duplicating the existing bureaucratic model? Would people with disabilities get more, for example, or would the Mincome be enough for them to live on? What impact will it have on wages? If everyone gets a given amount per year from the government, will private employers start to pay workers that amount less? In that case, Mincome could become a government subsidy for private capital, which seems counterproductive. Basically, I don't know enough about the program being proposed to be able to evaluate it. I am, however, super keen to see what happens with the pilot project that the Ontario government has been whispering about it. It's really exciting to hear the idea being discussed seriously by political players in a number of provinces and at multiple levels of government. I hope it continues to show promise as it moves forward. Another forum user posted this link ages ago, but it talks about some of the ways that doctors in Canada can help patients outside the scope of traditional medical practice: http://tedxtalks.ted...elp-Me-Prescrib There are a lot of great initiatives out and about that address some some of the failings of our health and care system as seek to create a better system, on a micro level, with a view to scaling up. A few books I've read that include good examples of innovations that help health systems serve people more effectively include Michael Rachlis' Prescription for Excellence, Atul Gawande's Being Mortal and Paul Farmer's Pathologies of Power. There's also lots of critical analysis and ideas for solutions on Brian Goldman's White Coat Black Art, and a CBC program called Keeping Canada Alive includes some programs that are pushing boundaries in Canada this year. Essentially, I think doctors have the opportunity to listen to the people in their community regarding the biggest challenges to their health, come up with models that might serve those people better (in more or less 'traditional' ways) and use their (comparatively high level) of influence to build better systems. On a small and immediate level it might be 'prescribing income' in the form of a social assistance diet allowance, as described in the TED talk; on a medium level it might be establishing a local program or pilot project (harm reduction program, network of doctors who actively seek out patients not receiving care, innovative clinic); on a high level it might be national or international advocacy and policy-forming (mincome, First Nations rights, generic drugs, etc). Regarding my mom's statement that her diagnosis improved her quality of life in some ways: she meant that when she was undiagnosed she was living on welfare ($600/month) in a rooming house, which meant she didn't have enough money to get through the month, she felt stressed and unsafe in her place of residence, and she was socially isolated (you can't go out for coffee if you don't have the money for it, and you can't invite someone over to visit; after diagnosis she was moved to disability funding ($1200/month when you include diet and transit allowances) and could afford to move to a better place, and eat better. She always preferred to keep her illness private when possible, so she didn't mean that she got more sympathy after diagnosis.
  8. Thank you, Bambi. I hope you are right. One of the things this experience has taught me is that it can be really hard to be actively compassionate, even with the best of intentions. Caregiving is really hard. Despite having tried like heck, I have lots of regrets, especially about my ability to give the level of emotional energy that I wished I could always give... Something to continue to strive for.
  9. Hi Click, Glad to hear that your scores are going up In general I did find the TPR FLs similar in style to the real test. I found the CARS section on the real test to be easier than the TPR sections. I might say that the psych/soc section felt more like a vocabulary test in the real test (seemed to involve less application, more definitions, and more terms I didn't know) than I was used to with TPR. I found the science sections quite similar to the TPR sections. Content always varies, of course, but I think TPR and the real test have the same approach (in all sections): both tend to emphasize reading and application more than straight memorization. Last year, people's scores tended to higher on the real test than on TPR tests (I'd say about an average of 10 points higher in total, based on data people shared on the forums). Good luck!
  10. Hi Canucks, I don't think I could have completed even close to 13 FLs myself, but everyone's different. I also didn't have the money for a course. I am sure they include lots of help in addition to the tests themselves. It probably doesn't make sense to get the whole course just for the practice tests, but there are probably a number of reasons to sign up for one. They're not really my style though and I din't have the funds I meant that I found the Kaplan materials too detailed and inefficient. I really liked the EK books, and the TPR tests, as you note, were invaluable. I didn't use the TPR study materials much (just a little for psych/soc vocabulary review) so I can't speak to them. You are right: those are all the materials I used to prep for psych and soc. I didn't really use the Kaplan ones though, for the reasons noted above.
  11. What do you know -- I joined ON July 11th. So I guess I'm not off the hook.
  12. Hey Ploughboy, I think my main question is: what were the membership hoping for with this agreement that they didn't get? I understand that people seem to want the right to binding arbitration, but the OMA is still pursuing a charter challenge to achieve that and agreeing to this deal doesn't get in the way of that. So that seems moot. (Plus, I hate to say it, but binding arbitration really isn't such hot shakes. For people who already don't trust the government or the OMA to represent them, why would they trust a wildcard arbitrator?) Did they want a reversal of the cuts of two years back? Do they want a promise that whatever physician expenses are, they will be covered? (Sorry to be ignorant, but is that the system we had until recently, eg no budget or cap on physician services?) Do they want more specifics on how fee schedules may be altered? What specific parts of the agreement are doctors unhappy with (and why)? The thing I hear the most about is the lack of binding arbitration (but see 1st point above) Someone above mentioned a lack of longterm stability (beyond 4 years)... but would anyone really want to sign off on an agreement that claimed to be a binding contract for say 10 years? Wouldn't both sides potentially want to revisit the issue ahead of that? A few people have suggested waiting for a non-liberal government... I'm sorry, are you suggesting that a conservative government is going to be more generous towards health care spending...?? I have serious doubts on that front. This seems like a week argument for a 'no' vote. PARO mentioned concerns about "implementing any restrictive or discriminatory measures on new doctors once they are training in the Canadian medical system". What are they alluding to? Where is this in the agreement? If you can fill me in on any of these points, I'd be grateful
  13. Hi again Wasteman I made my decision to apply to medicine before my mom was diagnosed. I don't intend to specialize in palliative or geriatrics or anything, but I am aiming for family medicine so I would expect it to be part of what I'd do. In general I'd like to help amplify patient voices & experiences if I can. When my mom was diagnosed I had just moved across the country with my partner. My mom had seen some terrible things happen between sick family members and caregivers, and she insisted that I continue to pursue my goals even though she was sick. It took me while to come to understand this. In the book Cartwheels that I mentioned above, Amy Doolittle talks about her daughter's achievements as she is growing up -- and it helped me finally understand that being able to watch me continue to pursue my goals was worth the sacrifice to the help available to her. I have to say, the day I got my MCAT scores was one of the happiest days we shared in the last year. Interview invites were also something exciting and hopeful we were able to celebrate together. In the end, I also came to understand how hard it is to be a caregiver, the strange things that it does to a relationship, even a close and loving one, and why she wished to avoid those changes as much as possible. I am lucky to have a great dad, but my parents spilt up when I was 4 and I have no siblings, so I grew up alternating between it being just me and dad at one house, and just me and mom at the other. One of the things I've heard people say about what happens when someone is given a serious diagnosis is 'Oh it's amazing what happens -- all these people rally around, and they bring you all kinds of food...' I'd like to note that this doesn't happen for everyone. My mom was very much on her own from when she was diagnosed until I moved to be with her, which was about 2 years after her diagnosis (with the exception of 10-day visits throughout that period, and one 4-month stretch I spent with her). This was really hard for me to accept. It was what my mom seemed to want, in a lot of ways. She was fiercely independent. That said, she really could have used more help. I tried to figure out a way for her to move to BC with us, where the weather is warmer (no snow) and would allow her to get around more easily as she got sicker, and where we could be with her while still doing classes as she wanted -- but even the social worker I talked to basically said 'Well, I wish you luck with that'. It turns out Canada has a systemic problem with inter-provincial moves for sick people. My mom, having been diagnosed with a progressive debilitating disease, was living on disability and in subsidized housing. I was told by the social worker, and found out myself as I tried to make it happen, that it's almost impossible to move someone on social assistance across the country (unless you have an independent source of wealth) because of the waitlists and eligibility requirements for subsidized housing and lack of affordable housing in general. Old and sick people are often on social assistance of one form -- disability, old age pension, welfare -- and so often what happens is that their employed children have to quit work and move provinces in order to care for them, because it's just not possible for the sick person to move without losing their income. The years leading up to my mom's diagnosis were already really hard for her. The great recession caused the business she worked for to fold, and she bounced between contract work and EI for years before finally ending up on welfare. Just months before her diagnosis she had been forced to move to a cheaper place -- in which most of the renters were also on social assistance -- and that was a truly heart-breaking experience. No one deserves to live with the amount of stress, insecurity, and chaos of living in those conditions. After her diagnosis, but before she had been approved for disability assistance (welfare in Ontario is about $600/month; disability up to $1200 if you include the transit allowance and special diet allowance; makes a big difference; allowed her to move, for example), my mom told one of the professionals at the ALS clinic 'To be honest, at this point the poverty is much worse than the disease'. For a number of months, even years, the terminal diagnosis actually improved her quality of life. If you want to know more about how this could have happened, or why I wasn't able to help her more, you can ask me. I know I ask myself all the time. There have been a lot of hard choices over the years. But I'll leave it here for now. Thank you for your kind words. You never know what you'll be able to do until you have to. There has been a lot of heartbreak, it's true. When I first learned about the diagnosis I think I went into shock. My teeth were chattering. But then you have to figure out how to live -- and with diseases like ALS, as they like to remind you, the timeline is massively uncertain. Some people get months, some people get ten years. It adds difficulty to choices like where to live, when/whether/how much to work, etc.
  14. Thanks, Lifeisawesome. It was a damn difficult time. Just to clarify -- while the last couple of years have truly been difficult, the hardest parts were watching my mom lose more and more of her abilities, fearing that she would pursue an early death in secret, fearing complications from an unassisted attempt at death, wrestling with the homecare system and jumping through hoops to bring the care team on side, and, obviously, losing my mom --- not being the one to help my mom apply for assistance with her death. (You probably understood this; I just felt I needed to make it explicit.) For some family members, accepting that their loved one wants to die earlier than they might absolutely have to is the hardest part. I know that. However, personally I always understood the fact that my mom wanted some measure of control over her death, and wanted to be able to get out on her own terms before she got to the point of feeling helpless. It's very understandable to me, and I think to many doctors, that patients with degenerative diseases greatly fear the loss of control and autonomy that those conditions come with. If there's one thing I'm proud of about the way I was able to care for my mom it's that I always understood and supported her choice to seek 'an early exit' (which is not to say that was easy to do). Here's something I'd like more people to consider: limiting eligibility to physician-assisted dying does not really limit patients' ability to die 'early'. It does force those who are committed to living life on their own terms to pursue much more desperate options. Those who can afford it spend in the range of $35000 to go to Switzerland, and are unable to say real goodbyes to family and friends because of the need to keep the reason for their flight a secret for fear of the law (it seems possible that Canadian law could stop them at the airport). Those with connections are sometimes able to procure lethal drugs, but anyone who helps them faces 14 years in jail and so these people must act earlier than they would if eligible for assistance and they must act entirely alone. Those without either have the option to stop eating and drinking, which believe it or not is relatively common, or they invent their own ways out. One woman with ALS, Amy Doolittle, wrote a book called Cartwheels about her experience. It ends with a note from her mother explaining that Amy ended her life by smothering herself in the plastic material in which she stored her wedding dress. A doctor, Michael Miller, allowed his own death to be filmed (Dying Wish) when he chose to stop eating and drinking in order to avoid the end stages of cancer. Kim Teske, profiled in the Globe and Mail, also chose to stop eating and drinking to escape from Huntington's. These are just a few examples you can read about. A hospice worker told me that over his years there he'd seen everything from overdoses to patients secreting guns into the facility to end their own lives (this is in Canada, for the record). Regardless of the assisted dying law, patients have the option to end their lives. But the process is so much more difficult for everyone involved. My mom looked at all these options. Before the law changed in February 2016, my mom's plan was to stop eating and drinking. Apparently it's not as bad as it sounds. (But it sounds damn terrible, right?) Supposedly, if a person really doesn't drink anything, their body produces sufficient endorphins to provide effective pain relief. We were lucky that she was supported in this plan by her nurse practitioner and supervising doctor, the homecare provider, and the palliative care team (these were all public employees, not people we hired). We were told that times from the stoppage of eating to death vary wildly depending on the person's circumstances -- in extreme cases the time could be as short as three days or as long as six weeks (note these are very extreme cases). And yet people are choosing this option over the much more prolonged suffering promised by the disease they suffer from. This is the main alternative for people who want, but do not qualify for, assisted death. Really, the whole 'injection at home' option wasn't even at the top of my mom's end-of-life wishlist. She really would have liked the ability to choose her own time and place -- out by a lake, ideally. If a patient has to die decades before their time, why can't we help them plan an exit in a beautiful place they love? (Isn't that, in a way, the least we can do for a terminal patient?) That would have been option number one, followed by an at-home assisted death, followed by the stop-eating route, etc. It's just an image to keep in mind for those of us who may find ourselves voting to determine the CMA's position on whether patients could be allowed to self-administer lethal drugs (in a place of their choice) or whether they require a physician to administer (for example). Thanks for reading. Kathryn
  15. Hi everyone, I've been thinking about starting this thread for a while. I'm doing it because assisted dying is so newly legal and there are therefore few of us with firsthand knowledge of what it means to patients and families. It's very new, and therefore I think a lot of physicians are afraid of it. If it's an issue that you think you may find yourself involved in, I'd like to offer you my perspective, as merely one person affected. My mom had ALS, which means that under the current assisted-dying law she would probably not have qualified for an assisted death. ALS is considered a chronic condition and it's often difficult to tell when a patient is nearing death because the progression varies wildly from person to person -- this is why it is unlikely that my mom would have been eligible under the current law, even though over 90% of ALS sufferers die within 2-5 years of diagnosis (making it, pretty clearly, a terminal condition). However, between February 6th and June 6th of 2016 there was a legislation vacuum and it was possible for patients to apply for an individual exemption to the previous assisted dying legislation. This is the application I was helping my mother with. It was a lot more involved than applications would be under the current law, at least for those who qualify -- at least I certainly hope so. We started putting together the application in February, and had not yet completed it by April, when my mom passed away in her sleep; depending on the day, I think of this as a blessing or as a tragedy. Notably, my mom was unable to secure the care she sought with the time she had. Therefore I obviously cannot speak to the moment of assisted death itself. What I offer is the experience of a family member who supported a patient's choice to seek an assisted death, the other options that were considered, the impact of legalities and wait-times on patient and caregiver, ethical and emotional challenges, etc. My goal is to keep this intro short, but to give you the opportunity to ask me any questions you might be wondering about regarding patient/family experience and assisted dying. I hope that -- just maybe -- I might be able to encourage more proto-physicians to engage with these questions and to aid your ability to discuss this option with patients and families as it becomes increasingly relevant. I hope a few of you are interested. I hope I can tell you something of use. Kathryn
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