Tuesday, April 24, 2012

Quite a long day...

...but it was well worth it!! We had a LOT (and by a lot, I mean almost thirty) of patients today. I'm almost done with family, so my attending doesn't seem to have much objection to me seeing many of the patients alone, and doing a lot of the work and writing before she gets there. Obviously this hinges on the patients being ok with that, and they know upfront if they want to wait for the doctor they can, and occasionally patients do request that I not come in the room. I am ok with that, because it gives me a chance to over the paperwork and charts that the doctor has me do, and then present to her. I usually get this done in the morning as I try to arrive at least 30 minutes before the patients. The doctor does not, but she's the doctor and I'm the student. (Sidenote, as I write this, the Cubs just won in extra innings against the Cardinals. The game was in extra innings when I got home, and the fans at Wrigley were making it impossible for me to avoid turning the game on, I could hear them that well, it was awesome!! In three minutes the stadium will be completely empty.) I don't even want to think about long it would take her to get through an equal patient load if she didn't have a student there. Anyway, today's said paperwork was a  MOUNTAIN. I think my doctor is a procrastinator at heart (I am not...fill the in the blanks) and like most procrastinators does beautifully when there are mountains of things that must be done RIGHT THIS MINUTE. I have not yet acquired appreciation for this art form. I see a pile of papers and want to whittle away at it categorically and succinctly. Anyway, long story short (too late) we were at the clinic until 2030, and then went to the hospital to do a newborn check. That was really cool! This baby was Babinski-ing all over the place. It was awesome. Then, because it was 935 at this point, the doctor pretty much insisted on driving me home. My apartment and her house are pretty much at diagonal corners of Chicago. It was very nice of her to offer!!!

Monday, April 23, 2012

I love working with pediatric patients. I can make them laugh and pretty much work well with them...but I want to know which one of the little brats gave me a runny nose and sore throat!

Monday, April 16, 2012

Accomplished so far...

I have done a lot of the things the same since I have begun my family rotation, so I guess it's time to document some of them.

My goal of this week is to make my SOAP notes more detailed, concise, and linear. That almost sounds like opposing objectives, doesn't it? In a nutshell, this is what a SOAP note is:
S: Subjective -- why the patient is there, what they're feeling, how long, and anything that could impact their current condition.
O: Objective -- what you, the examining physician/student find. Every doctor likes this done differently, which can be a bit frustrating.
A: Assessment: The diagnoses
P: Plan -- what is going to be done about A.

Filling these things out can either be easy--in many cases the patient will give you so much impertinent information you have to start figuring out what is and is not relevant--or maddeningly difficult. SOAP notes for patients coming in requesting refills for medications they have been on for years are more an exercise of necessity than usefulness, and are usually quite short. 

Complicating the matter slightly is the fact that at the current clinic about 1/3 of the patients are Spanish speakers. While it works in their favor that I understand much more Spanish than I am currently capable of speaking back, it takes an extra minute or so because I cannot write as they are speaking. However, those are often some of my better notes because I have to get their full story before I even think about writing. Invariably, I get about 75-80% of the story because either I didn't quite understand one thing they were saying, and/or they were holding out on me and waited to save the full story for the REAL doctor, not the tall güero in the white coat who speaks really muddled Spanish. The Spanish-speaking nurses have given my Spanish a good mark in that it "isn't güero Spanish, it's pretty good," I do not have a definitive type of Spanish. The neighborhood my clinic is in has a great deal of Mexicans in it. Until now I have almost zero exposure to Mexican Spanish other than music. My Spanish teacher in high school was a Costa Rican who forever left me with a bad taste of the "ll" as a "y" pronunciation. I traveled to Costa Rica. When I lived on the island I was in Puerto Rico at least a dozen times. I lived in Miami, surrounded by Cubans, more Borricuas, Ecuadorians, Venezuelans, and Colombians -- and very few Mexicans. Not too long ago I traveled to Argentina, and found that their pronunciation of the "ll" (like "shuh") rolls of my tongue the easiest of all the "ll" pronunciations--and there are quite a few--so I tend to use that one. So, having said all of that I must sound like a Spanish mutt to a native speaker.

After three ever-improving attempts, today I nailed (wow, um, ok, perhaps a less-than-appropriate term) a pelvic exam. I found the cervix on the first try with the speculum, and the patient didn't scream in pain -- obviously I did something right!! (It should be noted that during none of my executions of a pelvic exam has the patient screamed...) Side note: anyone who ever makes jokes about gynecologists getting their kicks from doing pelvic exams has obviously never seen someone in a white room, draped in an oh-so-sexy gown fashioned from the latest and most luxurious brand of paper, with her feet in stirrups. There cannot be anything sexy about that in my mind, and if you do, then you probably have a few other creepy fantasies I'd rather not know about. So to those of you who make those jokes...those of us in the know think you're either an idiot, or a pervert. It's a vagina. Women have them, they serve more non-sexual functions than sexual, and most women aren't really keen on you seeing it, much less touching it. Grow up and stop being so creepy.

So here would be the appropriate place, I presume, to post some of the more interesting things (I think) I've seen and learned:
A liver that could be palpated almost at the left hip
TMP/SMX is an alternative to azithromycin for sinusitis
Mexicans think pinworms cause tooth grinding
Saw a patient that had had a left lung removed -- yet there were still breath sounds
Hip click in a newborn
Clonidine and concerta for ADHD
A patient with vitiligo...everywhere
Mycobacterium avia intracelulare
Removed staples
Observation of injection in the tympanic membrane and tonsils
Tonsiliths -- and I watched them being removed. Basically it involves taking a cotton swab and poking it into the tonsil just so...it's gag-inducing just to watch
TMJ Syndrome
The fact that one cannot be allergic to iodine, only it's biochemical ligand 
A patient with a removed coccyx
Diagnosed a patient as carrying the HLA-B27 gene for ankylosing spondilytis (this one I must pat myself on the back for, as I suggested the doctor look for it!!!!)

Wednesday, April 11, 2012

Fun fact of the day...

If you drop an open box of orzo on the floor...it will go everywhere...EVERYWHERE

Saturday, April 7, 2012

Head --> Wall

Because my school has students doing clinicals all over the country, many students use a Facebook group to to inquire "What's a good rotation for Peds" or "Would anybody like to swap X for Y on Date Q." Such things I think are useful, until I see questions like "What are the hours like?" or "Are the hours long?" Who.cares. Show up, do your assignment, get your work done, and GO. You're in medical school for cryin' out loud...didn't you know when you signed up for this insanity that the hours would be long? Ugh, some of my colleagues. But today's takes the cake. It went something like this:
I'm starting Rotation Whatever at Hospital Wherever on Day Whenever and I just realized I forgot to go there and get my drug test because I've been busy with my elective. Does anyone know how quickly their occupational health dept schedules you and gets you the results? I don't want to get kicked off the rotation. I'm pissed Brand University didn't remind me!
What are you five???? You're going to be a bloody doctor and you need reminding about something as simple as making an appointment to pee in a cup? REMINDING implies that you have already been told. Act like you are at least in your twenties for the love of pick-a-diety. Try using the "reminder" feature that nearly every cell phone and email feature has. Or if it's too difficult...write it down in your own datebook!! It's not the school's job to baby you!!

...another classmate on the short but real list of "People I will never refer patients to."

Thursday, April 5, 2012

Nutty Day

Today I actually got to do it a fair bit because we were running behind from pretty much the outset (blasted walk-ins!). Pretty much all the straightforward stuff the Doctor let me handle pretty much on my own, and then she'd come behind me and make sure I covered all the bases. 

One thing I am enjoying about this doctor is the fact that in many cases she is already treating me as a colleague (albeit it's obvious she's the teacher, and I am the student). There have been cases where she is legitimately asking my opinion about a medication or the case of a small boy whose foreskin was incredibly tight. It takes me aback to a degree that a mere peon in the health system is to be consulted. She asked me to accompany her on house calls as well, which is pretty cool.

Monday, April 2, 2012

We got done relatively early at the clinic today, so I treated myself to some tacos and whatnot from a taqueria just down the street (the clinic is in an area with a large Mexican population). Just as I sit down on the bus to head back home: No lie,  heard by yours truly today: "My boyfriend wants me to have another baby with him. He keep saying 'I want to put my babies in you.' and I'm like can I finish high school first? And he keeps saying,
'What, you're almost done and you gotta carry it nine months."
Do I laugh or cry????

First week

My first week has gone pretty well so far, all things considered.

Monday: Didn't have a clue what to expect. I was hoping that there would be at least another student, someone for me to suffer through inadequacy with, alas no. It is just me in Family for the next six weeks. Me and the same doctor. Thankfully, my clinical knowledge seems to be intact, as does most of my "book learnin." Where I had to make quick improvements was remembering how to interview patients--it's been almost a year since I've interacted with patients. After a few awkward moments I'm starting to get my wits about me again. The most frustrating part is trying to get the office and doctor's individual procedures and idiosyncrasies down. That's going to be a continual test until I get to impose the same torture on medical students and residents in the somewhat distant future, so I'd best make peace with that now. I'm pleased that my Spanish still credible, though I could improve a great deal. I'm hoping it will. I can understand much better than I speak, but by listening to the doctor speak (with an accent much worse than mine, I gleefully add, despite a far superior vocabulary)I am remembering and learning appropriate phrases and responses. Maybe if I get desperate I'll watch Univision, but frankly I would rather watch Barney and Friends...

Tuesday: Much the same as Monday. I feel I did a much better job of presenting patients to the doctor than I did the day prior. That was an area of improvement that was suggested. I didn't leave the office until 8 because the good doctor and I were backed up with paperwork.

House calls. I didn't know that doctors still did this, but apparently, given our aging Boomers, this is a growing, and soon to be--no pun intended--booming business. The day before the doctor asked me if I would like to accompany her on her house calls. Not wanting to miss an opportunity I said that I absolutely would. What time should I be where? So, I ended up meeting her at her house (which is almost exactly on the exact opposite and diagonal side of the city from me, joy) at around 8 in the morning, and off we went. We saw 10 patients, which was a lot considering very few of them actually lived close together. Many of the patients were poor and elderly, and only one just made me outright uncomfortable and sad. Her home was in an apartment complex that didn't even have locks from the inside, yet they did from the outside. So basically you're house is safe if you're not in it??? Anyway, her apartment was FILTHY disgusting. I wouldn't let a dog live there much less a human being. There was dirt everywhere. Candy, the wrappers, and half-eaten food on all the horizontal surfaces. I shudder to think what the bathroom would look like, but I couldn't bring myself to go in there. A little girl was walking around barefoot, and I don't think any of them had taken a bath in at least a week. Just squalor.  You do not have to be rich or even have a paycheque to be clean. Water is pretty much free...and soap costs less than that bag of candy. A classic case of does their economic status lead them to accept living like that, or does the fact that they obviously have very low standards lead them to accept the minimal things that come along. One house absolutely reeked of cigarettes, but the people there were clean, and actually seemed to care about themselves, even if they are old, poor, and ill--and perhaps crazy.

Same as Monday and Tuesday

Gave my first pelvic exam. Much easier than on those stupid plastic models we had in school. Will not make any jokes!!!