Tuesday, January 30, 2007

FCM, Nerve Histology, and Clinic

Our FCM class today was about bioethics, and it was one of the better FCM sessions we've had. First we met in our small groups for about 45 minutes to discuss bioethics, and then we had a group lecture. I thought that the best insight from today's reading was that bioethics is really about not only how we treat individuals, but also what kind of a society we want to be in general. The faculty leader asked us if we thought bioethics was even necessary or important, and I guess I answered, "obviously!" kind of strongly, because he actually laughed that I take the importance of bioethics for granted. He said a lot of people don't. I learned another amazingly awesome thing this morning that has absolutely nothing to do with FCM: it turns out that this same faculty leader is related to Robert Boyle, the chemist who came up with Boyle's Law for gases. How cool is that?

The nerve histology seminars (there were two short ones back to back instead of one two hour long one) were pretty good. Our seminar leader did a really great thing and annotated her slides. This makes them actually useful to us for studying. I printed them out and plan to go over them again later when I have some time.

I had clinic this afternoon, and it was quite an interesting experience. We were finishing up with the neuro exams. You know how I told you that practicing these physical diagnosis exams on standardized patients is nothing like performing them on real patients? Ok, so today, I was trying to get this one patient to have a patellar tendon reflex. That's the stereotypical one that doctors do where they hit the patient's knee with the little reflex hammer and the patient kicks their leg. I tried it last week with the standardized patient, and I also spent some time practicing it on myself. No problems there. But today one of my patients was so obese that I couldn't even find the patella (kneecap), let alone the patellar tendon. You have to understand that on most people, the patella is pretty easy to find. Feel your own knee, and you can easily find your kneecap. The patellar tendon is right below the bone. But I couldn't find the patella on this patient to save my life. There was just too much fat covering it. So finally I took the reflex hammer and kind of hit where I thought the tendon should be. Not much happened. But the patient claimed to have felt it, so I decided to call it a positive patellar tendon reflex and move on.

Luckily my preceptor was understanding about it. We calculated the patient's body mass index (BMI), which measures whether your weight is appropriate for your height. A normal person's BMI is between 19-24. Someone who is slightly overweight will have a BMI from 25-29, and a BMI over 30 means that the person is obese. This patient's BMI was above 60.

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