James Brasic and Jack Goodman

00:07 I'm Jim raysik. I'm 73 years old. Today is Wednesday, April 28th. 2021. I'm in Baltimore, Maryland. I'm speaking to Jack Goodman, my friend.

00:24 My name is Jack Goodman. I'm 24 years old. Today is Wednesday, April 28th, 2021 and I'm speaking with James prasek. Who is my friend and Mentor. I'm recording this interview in my apartment in Hamden, Connecticut.

00:40 So Jim as someone who is about to finish their first year of medical school. I'll be at during a very strange year, with a pandemic and all I wanted to talk to you about what it was like for you when you were in medical school because I'm sure a lot has changed. I'd like to start if you're okay with it with the now ceremonious and usually photograph filled white coat ceremony.

01:12 Yeah, mine was supposed to be during orientation, but that got moved to do the pandemic and there was all this Pomp and Circumstance speeches and family. If they are in the area could come and everyone have their cameras out taking pictures and it was built up to be this huge. Welcome into the medical profession and now you are a medical student.

01:45 Wow.

01:46 Well, I'm glad that you did have that recognition and then you have a wife coats with your name.

01:55 Yep, that has my full name and has the school on it. It's that he was pins to put on it.

02:04 Wow, well, you know, I can remember that five decades ago. I did begin clinical work and I was told that I must use a white coat.

02:18 I was able to scrounge around. So I found some old quotes that other people hadn't used. But since I'm a little guy, they were way too big, I pull up my sleeves. I've always been like in a tent in the white coats, so it was

02:36 Am I embarrassing to to be in that situation and honestly, I

02:42 That's just how I have to have a white coat.

02:45 By the same token, I believe that you are.

02:53 You give a different introduction to patients. Ever call. When I was starting. I was told from the very first time. I see a patient, your name is Doctor basic from now on, you will always be back to basic. You are a doctor and though I was a second-year medical student. I had no experience with letting patient is different now, it's very strict. And if the other thing I noticed was, you said you started seeing patients in your second year. I've already started to see patients, under a mentor, who is a fully licensed physician, of course, but I was told, I am a medical student every time I must introduce myself as a medical student. I can say first-year medical student. I can say second-year medical student. When that eventually happens.

03:48 But after I take step one, I'm allowed to call myself a student doctor, but never should I ever introduce myself as a doctor or a physician?

04:02 That's a striking difference. Believe me and I can understand that patients are confused and actually nowadays. I even see badges that's a nurse or doctor or therapist in order to really

04:22 Emphasize to patients that the role that particular person plays. Yeah. Wow. I'm glad that your training as a first-year student. Then I can recall that I started seeing patients at the end of my second year.

04:40 You were given number Watchers. I was skipping like a 50-page hand out about what when do in a medical history and physical examination of the patient, but I never done this before so I thought well, I'll just go ahead and do everything and we were allowed I'd say we were told to make an appointment to see the patient name for 30-60 minutes in the evening.

05:12 In the allotted amount of time, so I went in to see a patient for 3 hours in the afternoon. I went back again three more hours and evening and then spent the night writing up the wrong report that I charge it.

05:26 Even though it wasn't mentioned by name, teacher did say that we must not have use patience. So I really miss understood the

05:38 The way in which to approach patients and I did have some guidance from teachers after they have been with Gary to go in with no experience at all with, loving patience for the first time and alone do an interview and examination. So are you

05:56 What are you doing with your patient? Let me tell you, it could not be more different.

06:04 Yeah, it sounds like you were just thrown right into the deep end. And and now starting in the first week of class. We have a clinical skills class and we are walked through how to do an interview by a physician in a small group and then walkthrough how to do specific, physical exams, and things like that. And we met for the first 10 weeks for, I think, six hours each week. And then on that 11th week, we were supposed to start seeing patients. But covid interrupted that. But his course continues through the rest of the year and all of next year. And I personally, I love it. It's great. I love my two physician preceptors. They they couldn't be more helpful and we get to our

07:04 With them each week and you can ask him any question you want. And even though I get hours upon hours of lecture, basic sciences and things like that. That is some of my most dense. The floor Physicians.

07:28 Yeah, it's invaluable. Really. I'm so glad you're getting that experience. And now have you started putting your hands on living patients.

07:37 Yes, I am in a primary care, practice a few towns over. And I work with a couple of positions there and they're very, very they have a quite a mix of patience and on patients, while we have a little bit more time, say on a on a physical, they'll let me do the physical exam or sometimes going before them and interview, the patient and then afterwards report back that I'm just trying to move things along a little bit quicker so that they can write some notes while I'm interviewing or whatever else they need to do.

08:21 But I've done General physical exams. I've given vaccines live vaccines. Yes. Yes. I was trained on how to give vaccines. And so I've given a handful now, which is really nice that that, that made me feel like I was a medical student there. A lot of things happening this year that

08:51 Made medical school. Not feel like medical school, but wearing a white coat and giving someone a vaccine that was

09:02 That would fit my mental image of medical students ready to go on to.

09:16 Working towards in Hospitals and Clinics in the coming years.

09:23 I sure hope so, and you're making contacts. Now with.

09:32 What supervisors mentors people with whom you can pursue your training in the coming months, and years? Yes, and they've all been very very helpful and said if I wanted to come in more frequently, I'm more than welcome to, which is, which is wonderful. It's

09:52 It feels like an innocence, that medicine is in a way, a family. Once you it's hard to get into it. The once you're there, everyone who has gone through medical school is just so happy to help you and try to help you succeed and I'm so glad to hear that. Now I my experience was being tested on life patient. So honestly, I have never been tested with

10:27 Actors, or even work with other students in I've always been

10:33 Working with my patients and even practicing skills. I've done that with life patient. So have you learned some skills with other students or with actors?

10:46 I've done it all. This fellow students, actors live patients it, some and anyone who can help you practice, you practice with.

11:01 My my classmates are a little bit more free than the availability of Life patients. So

11:09 But yeah, we know the way they teach us the exam, they have an actor there who has signed up and knows what they're getting into. And so we watch lectures, say the night before on how to do an abdominal exam. And then we'll go in the next day and depending on who your preceptor is my classmates, having a couple different ways. The preceptor might demonstrate that, you say, I'm on the actor and then you can give it a try or you can demonstrate it yourself and see what you did. Well and What needs fixed again, and a preceptor will definitely let you know.

11:57 Yeah, but you're getting plenty of experience and feedback. So that's, that's valuable. That's helping you to improve your skills and develop great. Wow.

12:12 I can recall that the spending experience for me was was challenging. I would go to a dark room for lecture. The lights will be turned off. I have to write down notes in the dark and then transcribe the notes and organize them, make up some flash cards, whatever, as best I could on my own. Then strive to learn that. You have your, what's your experience with the schedule?

12:41 Again, definitely a bit different. One thing that has stayed the same, as I'm still using flash cards, but now they're all in my computer and

12:56 What's really nice is a number of years ago, a group of medical students at I forget where exactly decided to make a deck of online flash cards available to all medical students. And so they put together a deck. I think it's down 37,000 flashcards and they just put it up on the internet and they said, hey, we cover everything. You need to know in your first two years of medical school. This is what we use. And if you want to use it, that would be great.

13:35 And so I download those. I can search their entire deck by keywords. So I pull out things that were covered in my lecture. I moved them over to mine flashcards and I review those but it's it's wonderful. It frees up a lot of time honestly.

13:58 Making the flashcards does take a little bit because of all the searching. But what's really nice is

14:07 It's programmed to only show you a flash card again when you're about to forget it because with each flashcard you do you'll say, I got it wrong. That was hard. That was okay. Or that was really easy. And so it'll space it out that way and that frees up time to do other things, which is great. You know, you could you can spend that time relaxing and that's how I'm seeing more patience and I spend that time doing research writing a paper and it's

14:47 It's great. I feel like I get to do more of the things I want to do in medical school. Thanks to all these things. Did you have time for any of that? I I honestly I cannot imagine trying to study off my notes and lectures. You can only see once

15:07 Well, you know that's that was my job. So I did know transcribe my notes and strive to learn the key points.

15:18 Even now some years ago when I was studying for the recertification exam and neurology I needed to

15:27 Developing a way to.

15:31 Can an overall picture of the

15:35 Of the oil field and I did find some review books that had some questions but even using those I developed my own flashcards on piece of paper with key points that I wanted to memorize and work on those. So I wrote those up and rode up, electronic notes that I used.

15:57 I share them with others since a few years old that they really need to be updated. But I did that all myself. So having this prepare for you is just a wonderful, wonderful resource. I'm so glad that that those guys were thoughtful enough that they put it together to share with others.

16:19 But that makes your that much easier, LOL, a lot easier and the

16:25 Wonderful thing that's happening. Now, these now their Physicians. I believe they made this, when they were medical students, opened it up to everyone, have a community of people that use the cards and if they have the time to give back, they will sign up to update it or make new cards.

16:51 Yeah, it's it's it's great. It's just a wonderful community of people helping helping each other out. Just have some, some experience with web making and the internet in order to put this together. You know, it sounds like, Wikipedia people, contribute to yeah. That's a wonderful now. It's very much like Wikipedia. Yeah. They have, they have a website. Now. I have a YouTube channel to walk you through how to do everything to use their

17:34 Flashcards effectively.

17:37 I want to make sure that everyone who wants to use, it can use it to its fullest potential and so paid, they walk you through every single step.

17:46 The only thing that's left for you to do is to actually do the flash card.

17:58 Oh my goodness. It is. It's such a dry exercise because I'm, I'm sitting at my desk, the laptop. In front of me. I have one hand on the spacebar, three fingers on the numbers. Tell the program, if I got it, right? And I'm sitting there for hours sometimes going through all of these.

18:25 Why sometimes all fall behind the little bit in adding cards to the deck and then I'll have to get through.

18:36 It's it's a slow process that first and for some reason, I don't know why I can't remember the blood supply to the greater curvature of the stomach and it just keeps coming back. And I can recall that that always has been it's been a challenge and I had, I had taken a review course for neurology and there was a practice exam, but that was given and I think it'd be a lot of. Of time. I got through about half of the questions.

19:18 So that gave me an indication that I need to go through items much more quickly when I have taken the time to exam which has but eventually did so that was something that I had to add up also and

19:35 I'm guessing that you're going to have time to zam's. Also.

19:40 Yes, I do have time to exams. My exams are some curious. Things are different from yours. I have two tests within each exam. One is a section written by my professors.

19:57 And so these are very tailored to our course work. So there are they try to integrate a variety of Social and economic.

20:08 Determinants of Health into our elections which aren't necessarily included in the National licensing exam questions. And so that's one section of our exam. We take that first and that's usually around 80 questions time. And then our second section is questions, hold from the national board of medical examiners, and that is also time.

20:38 But did you have exams like that, or was it all written by your professors?

20:46 That was the the only kind of exam that I had now. We were required to take the national board. So

20:54 I did that. And for that, I think we would go, those would be two days of time to exams, but was conducted by a different group of

21:05 Organizers that with entirely separate.

21:09 Well, I am but that can be a stumbling block. So it's fortunate that you're getting some experience with the national four type of questions so that you'll have some understanding what will be taking place when you take it for real.

21:24 Yeah, it's really nice. They have there's definitely a particular style that the national board of medical examiners likes to have and it's something to get used to a general exam questions or objective questions, and those types of questions are used.

21:54 I think everywhere. So it does require some experience getting those formats together. Keep in mind a negative or double- and consider the different the different different options. And also I think that it really requires the ability to read in between the lines. So the examiner really wants people to give a certain answer and

22:24 Does the options in such a way that it seems that a particular answer is the desired one?

22:38 Sorry, you're getting some exam taking experience or you're understanding, how to

22:45 How to read between the lines.

22:49 Yes. Yes. The tricky thing is.

22:56 In my first year, I only cover normal physiology.

23:02 And then in the second years were they added all of the pathology? And so it's

23:11 Kind of strange playing some of these questions sometimes because there may be a certain condition or disease in the questions, stand.

23:25 But perhaps we haven't covered it before, but if you are able, if you think about it, critically to piece together some information. Divine the answer.

23:39 What's that? Was that what you went through? Did you have?

23:46 The first year is all normal body. Works are rotations in Fauquier. What electives?

24:04 And I did not strive to learn each subject matter. But, you know, even even in retrospect. I find that studying for exams. There are advances that have been made in normal development, genetics.

24:22 And I need to learn those right now, even though

24:26 You know, I haven't learned it before, so.

24:29 I tell myself to keep an open mind and to be

24:35 Where of developments cuz they can all be useful. And I recognize

24:43 How much?

24:46 I'm sure that you know, I probably don't have your understanding of genetics and I've learned some over the years. I've been so many advances that it's highly specialized that really would be. You're going to be in a position where you have a

25:06 Sound basic knowledge in the near future and slice when continually studies there is a drop-off.

25:15 I fear that's reason for taking the continuing courses, continuing education, continuing.

25:24 Yet some of the fields are just moving at Breakneck speeds like genetics or hematology and oncology. I get a variety of the journal sent to me because I get their membership for free because I'm student.

25:44 Each month. Some of them come by weekly. I think you see some new thing on the cover, a huge Discovery in this small condition that doesn't affect many people, but it's huge. And then there's also this new drug came out that new truck came out. It all God crazy names.

26:08 Things are moving so quickly. It's, it's terrifying. Sometimes to know that eventually I suppose I have to keep on top of all of that.

26:21 Yeah. Yeah, and we we need to be aware of our limitations. So

26:28 So I would be cautious about.

26:33 Making any statement that could be interpreted as being specific.

26:38 Guidance for particular patient special situations where I really haven't seen interview. Examine patients, and develop the practice.

26:51 Since I haven't interviewed or examined you and I'm not familiar with your

26:55 Detailed history. I cannot speak about you in particular, but I can make some general comments. So I'm, I'm really cautious and especially

27:07 When I would be working with patients, if there's a very I'm not familiar, I'm contempt and I certainly would want to refer a person to

27:17 Somebody who could was an expert in that field in a pack possible for us to be expert in everything. So I must be aware my limitation.

27:30 Definitely. That's also very nice phrase to hold onto not familiar with everything that's going on with you. But I'll make some general statements definitely going to be helpful when I could come even more requests from friends and family about some advice. And right now, I can tell them guys. I'm in my first year of medical school. I do not know.

27:59 Yes, yes. Yes. Yes. Yes. Yes. Well, since I have some articles, buy some topics, I have been contacted by some people and I have

28:11 Really?

28:13 Strive to guide, people, sometimes giving people general information. Although not specific about their individual also suggested ways that they can.

28:25 Seek additional treatment, for example, National Institutes of Health has evaluations and they can do a valuations for people provide transportation. There are a number of resources around the world.

28:40 Yeah.

28:42 Where are my limitations?

28:47 I do strive to help people.

28:52 Yeah, do you like it when someone reaches out to you about an article that you've written?

29:00 Well, I do, and I try to help people as much as I can. So sometimes people just ask for a particular copy, something. There are some people who have had particular problems and probably, that's the reason why they contact me because they have seen other people and they haven't been. They haven't had problems resolved. So I have

29:30 In this limited way tempted to provide some suggestions to people.

29:38 How to?

29:41 Deal with purchase further situations, future situations problem for me, come up all. So I can just sit. There are some resources like in the age that are available to everyone, no cost.

29:59 And I am trying to suggest two people ways that they can, they can seek out then, if some people have problems.

30:11 And those are areas that that I'm working on it. I just paid it. You're going to be working with me on some of these issues also in the future.

30:21 Yeah, so that's really interesting that.

30:28 Some people are are reaching out to chew. It sounds like they are the people or the family of people with these conditions that you research. Is it more questions or responses from

30:49 People who have a personal connection rather than professional colleagues, or is it a? Is it a mixture? Or some colleagues have contacted me? I can think that the ones. Yes, use that I'd say our most pressing are the the the patients themselves people who have particular condition.

31:12 I have.

31:15 I've written articles about tardive dyskinesia and adverse effect of some.

31:21 Drugs that has multiple manifestations at the number of people have contacted me because they have

31:30 Movements that haven't that may have resulted from some medications are treatments that they've received and have resolved. And

31:41 Unfortunately.

31:44 There isn't a Magic Bullet are all for this condition. So it's it's a heterogeneous condition, your many causes and there isn't a single or treatments out. Some people continue to have problems and

32:02 I mean just a week or so ago. I was contacted by a physician on the west coast who saw a patient, who I've been speaking to for the past 10 years. Probably.

32:14 I did speak with her as best. I caught in my limited way. Might. I have never personally interviewed or examined this person. So I really don't do details of her history and I did speak with this colleague to

32:31 Convey, the experience that I had.

32:34 Are there are unfortunately some people who continue to have problems despite the available treatments that we seek better intervention.

32:50 Yeah, that's that's really interesting. I've been thinking.

32:54 I said about that recently, how

32:59 People are taking a much more active role in their Healthcare and it's wonderful that you're when they reach out to your able, to refer them to these great resources. Help them out. And because it's, it's such a confusing.

33:18 Filled with all these twists and turns. But at the same time, there is just so much information out there, famously. WebMD for people just start typing things in there. Like, I've got it and then they come to you, I have to see, this is what I need. Yeah. Yeah. Well, sometimes people have contacted me and even

33:50 I don't know. Some weeks ago. I had got a message. I was sleeping and this was one of the of this messenger and you know, something that I just started using, I very little experience with it, but a woman sent me a message because her mother was in the hospital and it have a an adverse event and was

34:17 Was not doing well. And apparently the

34:22 Woman had been advised, that there's nothing they can do for her and she was calling contact me as a neurologist to ask for advice. She's in different city, but I was able to look up the

34:37 The American Academy of Neurology. I found that there was a medical student actually in that City who was an expert in or who was specialized in neurologic emergencies. And I advised her to contact that person. I suggested to her. That this is something that is uncertain may be worthwhile for you to have your mother to have an examination in person. I somebody has to wear with this to provide a second opinion. Of course, it's not something that I can do a thousand miles away and it with my cell phone, so I had to strive to help people.

35:15 Have you been? You've been asked for advice from your family also?

35:21 I have been asked for advice from my family. I've received a number of questions from my parents and most of them I am able to defer and say you have a doctor that you can do that. But some of them are also. So easy to to answer like I received a number of questions about nutrition from my family. What to eat.

36:01 And how to exercise to be as healthy as possible, and

36:08 There's, there's an incredible amount of misinformation out there and a lot of people have gut feeling that they have, and then they want and it's challenging to change. My dad's my love a couple of things.

36:37 Yeah, she had some.

36:40 Ideas that you needed to exercise for some large number of hours every day for real with no rest in between dad. What are you doing?

36:54 You need to recover. Need to rest.

37:00 So, that makes sense to me. Yes. Yeah, but you know, it's

37:09 It's nice that, you know, they're trying to ask me questions all already and although that they're treating me a little bit ahead of where I am. It's nice to know that they think highly of me in that way.

37:28 Yeah, it's it feels nice. But at the same time, sometimes I have to just say one guy, but you're actually the first medical practitioner in your family.

37:46 Yes, I am. I am in actually, I'm the first person on my dad's side to go to college, to get any sort of higher education.

37:58 Yeah, he's he's very happy about that. Very happy about that.

38:05 What about you? Were there? A lot of healthcare practitioners family, but I would like to also point out that I'm proud of you. I'm so glad that you have gone.

38:25 To medical school and that you're proceeding with your career, and I'm really delighted to

38:32 To continue to work with you at that. It certainly isn't what I planned when we met, but we've been able to maintain our friendship online and we're planning to continue to develop in the future.

38:49 Thank you. I really appreciate that. He's been absolutely wonderful, being your friend and I it's crazy to think how we just met at us parents meeting waiting in line for the shuttle and it was my neon green shorts. That made me spend so much.

39:13 All right. Well, that's another story check. So there are some other projects that you and I shall develop.

39:23 Definitely, definitely.

39:32 Well, I really been having you that we were able to find we speak today. No, we have talked about doing this.