Tuesday, September 25, 2007

Seminars, FCM, and Clinic

We had two seminars today on the endocrine control of bone metabolism. It was mostly review from last year, but these seminars weren't too bad. Our FCM session afterward was about medical malpractice. We went over a case where a patient sued a doctor over a delayed diagnosis of lung cancer. The doctor possibly did drop the ball a bit. It wasn't an open-and-shut case though, because the patient skipped several appointments, so he majorly contributed to the delay himself. It was based on a real case, and the jury ultimately decided in favor of the physician.

Today was a long day for me because I had clinic. It was a pretty interesting clinic day. The first patient I had was ridiculously rude. When I introduced myself and went to shake his hand, he just left me hanging there and didn't take it. OK....so I took him over to the scale to weigh him, and he ordered me to put down fresh paper towels so that he didn't have to step directly on the scale. OK....then we went into the room, and I was taking his blood pressure after getting his history. He said to me, "Is this your first day in clinic? Because you're obviously not very experienced." At that point, I decided that we were both sufficiently turned off by one another that any further physical exam would be pointless, so I told him that I would get my preceptor for him and left the room.

This is the first time I have ever had a patient behave like this toward me. When I talked to one of the nurses about it, she assured me that the patient was just like that, he would have treated her the exact same way, it wasn't me, and I shouldn't take it personally. I didn't take it too personally actually, but I viscerally disliked this patient to the point that I think it would have been difficult for me to care for him properly if I were his physician. I think that I managed to hide my feelings well enough that he didn't know what a jerk I thought he was. But it definitely got me to start thinking about what physicians should do when they really dislike a patient and the patient seems to dislike them as well.

My next patient was completely the opposite of the first one. She was really friendly and seemed to enjoy talking to me. She was also very nice about letting me examine her. In fact, at the end of her visit, this patient was assuring me that she was going to schedule her next appointment on a Tuesday afternoon so that she could see me again. Well, I may not be able to please everyone, but at least I can please someone!

I was finished seeing all four of my patients by 4:00, so I wrote up a SOAP note and a journal entry. These are two new requirements for clinic this year. SOAP stands for Subjective, Objective, Assessment, Plan. It is the general outline of how physicians write up reports to go in the patients' charts. Subjective is the patient's story. Objective is what I found during my exam. Assessment is what I think is wrong with the patient. Plan is what treatment I am suggesting. We are also expected to list the patients' medications and look up their uses and whether any can interact with one another. It's pretty time-consuming, but I can see that this is going to help me learn my pharm cold by the end of this year. The journal entry is a research question that I come up with from one of the cases I've seen. There are about a dozen different subject areas that we can research and write about. I did mine on behavioral medicine (psych) because I was interested in whether emotional stress could be causing or at least worsening one of my patient's problems. It turns out that it can.


Anonymous said...

I read "How Doctors Think" this summer by Jerome Groopman. He addresses the issue of not having good chemistry with your doctor (he wrote the book primarily as a reference for patients but, as a fellow med student, I think it is a great read for people in medicine as well). You probably don't have time now, but you should check it out during one of your breaks. I've loved reading your blog by the way!!

CCLCM Student said...

I read that book last spring actually, and I agree with you. One of my classmates borrowed it a few months ago and I can't remember who has it now....