Tuesday, April 24, 2007

FCM, Male Histo, Adrenals, Clinical Research Grand Rounds, and a First Pap Smear

Our FCM session today was about Medicare and Medicaid. It's incredibly boring, the rules are different in different states, and yet it's also incredibly important to learn about. Someone should come up with an entertaining cartoon book complete with mnemonics about health insurance like the ones they have for all of the science subjects. And by someone, I don't mean me!

We had two seminars today: one about male reproductive tract histology and one about the adrenal glands. What does one have to do with the other? Not much. I think the course directors just paired them this way because in females, the male hormones (androgens) are mainly produced in the adrenal glands.

The seminars were all kind of blah, and so was the Clinical Research Grand Rounds talk that I went to at lunchtime. (It was just about how the General Clinical Research Center operates, which is useful to know, but not the most exciting topic.) However, I had quite an interesting time in clinic today. My preceptor had to go to the hospital and make rounds. So I spent some time seeing patients with one of the IM residents. Then my preceptor came and got me, and we went to the hospital together. That was interesting too, except that we spent a lot of time searching for charts. I hadn't realized this, but CCF still uses paper charts for the hospital inpatients. In contrast, the outpatient clinic charts are completely computerized. In fact, outpatients' charts (complete with lab tests) can be released to the patients themselves on a website called My Chart. The patient logs in and can view all of their own info, make appointments, ask for prescriptions, etc. It's very cool. But the hospital hasn't gone computerized yet for inpatients.

After we saw several inpatients, we went back to the clinic to see another outpatient who had an appointment. This patient was here for a checkup, and it turned out that she needed a Pap smear. Now, keep in mind that we don't learn how to do Pap smears in school until next year. The three of us (me, my preceptor, and the patient) are all in the room together, and my preceptor says to me, "Do you want to do the Pap smear? You've done one of these before, right?"

Of course, I had not ever done any such thing. But I didn't want to say so in front of the patient and have her tell my preceptor to get this #*$#ing medical student away from her! So I said, "Yes, but only with your help. Would you walk me through it again?" My preceptor told me what to do step by step. I inserted the speculum, collected the cells, and removed the speculum. Then I inserted two fingers in the patient's vagina, palpated her cervix, and attempted to palpate her ovaries. Amazingly, her cervix felt just like the cadaver's cervix that I was palpating in anatomy lab yesterday, except that the patient's vaginal canal was plumper (she was pre-menopausal) and warmer (she was alive and she hadn't been in a refrigerator). We took a sample of the vaginal cells and looked at them under the microscope. The patient had a yeast infection, and I saw the yeast cells.

I've learned two very important lessons from this experience:

1) Yes, you should always take advantage of the opportunity to palpate the cadaver's cervix in anatomy lab. You never know when you'll need to do it on a living woman with no warning whatsoever. Plus, it's helpful to have paid attention in lab. That way, when your preceptor tells you to place the cell brush in the cervical os during the Pap smear, you know where the cervical os is. (It's the opening of the cervix.)

2) I wouldn't say that I am a particularly good liar in general. But evidently I can be a surprisingly convincing liar if I blurt the lie out before I have a chance to think about what I'm saying.

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