Tuesday, February 27, 2007

FCM, Gastric Function, NMS Feedback, and Clinic

Today's FCM session was pretty interesting. Dean Franco, who is a psychiatrist, was the one running it. She had us watch a brief documentary about a mentally ill man who died in prison from neglect. Then we broke into our small groups to discuss the stigma against the mentally ill. A lot of them wind up going to prison, so our conversation tended to focus a lot on that aspect. At the end, we all got back together as a large group. A psych resident talked to us some more about problems with the mentally ill accessing care. All in all, this was a pretty good FCM session. Not that I expected any less from Dean Franco.

Our gastric function seminar unfortunately wasn't nearly as good. The seminar leader had us break up into small groups. Each group had a poster with a picture from the Boron physiology textbook. We were supposed to come up with a small presentation for the rest of the class. My group was doing hormonal regulation of acid secretion, which is a pretty complex topic. There were seven of us, and it wound up being hectic. At the end, when each group was presenting, it was really hard to see the posters. I was sitting near the front and had trouble seeing them, so I am sure the people in the back were definitely not able to see them. It's too bad, because this format might have worked if they had broken the class up into two or three groups first. But as a whole class, it was two hours of futility. I didn't learn much at all.

After seminar, I went to the NMS block feedback meeting. I had been asked a few weeks ago to give comments to the NMS block coordinators. They ask eight students to do this after every block; I did it last fall for summer block too. We had several suggestions, including adding more time for neuro, using a different book for the bone part, and studying cartilage before bone like they did last year. Hopefully some of those changes will be instituted for next year's class. They give us lunch at these meetings, but of course I didn't eat it. I am still not totally back to normal, actually, so I have been eating kind of bland things.

I had to leave the meeting a few minutes early because I had clinic this afternoon. It was a long day, because my preceptor wasn't working with residents. So I saw all four of my patients plus some of hers. It was kind of snowy, and I thought some of my patients might not show up, but they all did. I was doing the GI exam on them and screening them for alcohol use. I didn't find any problem drinkers who needed counseling, but I did find out about some interesting practices from one very religious patient. She told me that she didn't drink, and when I asked her why not (we're supposed to do this in case they are former alcoholics), she said it was for religious reasons. But then as we kept talking, it turns out that she takes these colon cleansing regimens (basically a laxative) while fasting. Apparently this is a very popular thing to do among some religious Christian groups. But it's actually pretty dangerous since it can lead to people dying of dehydration. My preceptor told the patient unequivocably that she could not do both things together in what I thought was a pretty respectful and nonjudgmental way. All in all, it was a really good learning experience for me.

The only other exciting thing to happen is that I had a patient with a hiatal hernia, which we have been learning about this week. Basically, there is hole in the diaphragm for your esophagus to pass down into your abdomen. (That's the hiatus.) In some people, the hole gets too big, and their stomach can actually start coming up through the hiatus into the chest. I don't know if that's what the patient had exactly, but that's the most common type of hiatal hernia.

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