Chanson Sans Paroles

Last Big Test ™

A few years before I belatedly completed my residency and passed the boards,  the American Board of Internal Medicine (whose acronym is awfully like the French for abyss) declared that the boards must be retaken every ten years. Most of my peers, then, having made a less circuitous path through training than I, escaped this requirement. So, for my youthful derelictions, there was an appropriate karmic outcome. I accept this. And I accept the notion that doctors should maintain a measurable level of competence. That does not make me any happier about having to take my second and last IM Board recertification test next Thursday. Nor does it make me feel a superabundance of warm-and-fuzzies toward the Abîme. 

The Abîme's testing system has gone through an amazing series of acronymic permutations, culminating in the current MOC and PIM. MOC simply reflects the goal of the exercise: Maintenance Of (board) Certification, a credential which is, more or less, de rigeur. In addition to The Big Test ™, one completes (as I have already done)  a series of little take-home, open-book tests, and, of course, the coup de grâce, one does a PIM. A Practice Improvement Module. A perky little acronym indeed, reminding one of the loathsome beverage POM and its cousin, Mr PIB. 

Again, I do see the point. One applies accepted quality measures to data concerning one's panel of patients, constructs a plan to improve ones performance,  and carries out said plan. There are about a dozen topics from which to chose, and one purely academic one for those docs who see no patients. 

Of course those of us who don't have panels of patients, who don't do primary care, are left dangling over the Abîme without much of a net. My pleas to be allowed to do the academic module fell (twice) on deaf ears. The Abîme  felt my pain, yes it did, and even admitted that, in the future, there would be PIMs for the likes of folks like me. But for now my only option was the dreaded  Self-Directed PIM, in which I would have to find my own applicable quality measure and take it from there.  

The blasted heath of PIM  is what will stretch out before me if I manage to traverse the Mountains of Doom of the Last Big Test ™.   

The last iteration of the recert exam was with pencil and paper at some high school; this week's has been subcontracted to an outfit that certifies everyone, from doctors to dogcatchers to hairdressers. It's a high security affair: two forms of ID, fingerprinting and/or palm scan, one's photo taken, and everything, including one's watch and wallet, confiscated. And it is, naturellement, computerized. What isn't, these days ? 

And, of course, where there is a test there will be a cheat, and the higher the stakes the more likely the mischief. At least we're not asked to take the exam naked after submitting to a cavity search. 

So think of me Thursday, sans watch and sans wallet, praying there won't be too many questions about renal tubular acidosis. This will likely be The Last Big (multiple choice) Test ™ of my life -- a life that has been rife with them -- as I plan to be long departed from the Halls of Asclepius by 2024, which would be my next tryst with  MOC/PIM or whatever next monster mutant emerges from the Abîme. 

It's a mildly harrowing milestone, all things considered, on my other, graver trek toward the real Abîme. 

Juggernaut

Backstage

Heart of the Matter

A Chalcedonian Moment

"These rituals," I thought, "are homely."

And yet, at the same time, they are numinous and mysterious.

A hypostatic union of the homely and the numinous ?

Of human and divine ?

The identity of relative and absolute ?

How Can You Even Ask ?

Impersona