Tuesday, November 20, 2007

Spiritual Madness

Today was one of those crazy days where I think back on it later and kind of just shake my head. We had not one, not two, but THREE seminars this morning about prostate and testicular pathology. They were one after another, each with its own reading. All of them were great seminars, but three in a row was just a little over the top.

Then there was FCM. They had this guy from pastoral care come to give us a seminar. He was supposed to be talking about spirituality and how it affects decision-making in medicine. Instead, he wound up getting into a fight with about half the students in my class and half the preceptors too, because he was saying things like that ministers are the only people with proper training to help patients spiritually. That really got the doctors' dander up. He was also asking ridiculous questions like how we thought the case patient felt when she was having sex at the age of 11. Ok, first of all, this case patient is a composite, not a real person. Second of all, it's not like she was there and we could ask her! How the heck would we know what an imaginary person felt while having sex twenty years ago? The whole exchange was very hostile, and the FCM faculty wound up emailing the entire class this afternoon to apologize for the speaker's behavior. We didn't learn much, but at least for once I can say that an FCM session was exciting!

I had clinic in the afternoon. When I got there, it turned out that my preceptor was on vacation all this week and no one had told me. The nurses said I could go home, but I didn't want to have to make up the clinic. So I wound up working with one of the residents and his preceptor instead. He had a patient who needed a neuro exam, and he let me do it. At long last, I pretty much have the cranial nerve exam down, and no one has to prompt me because I forgot to examine CN 11 or something.

There is a pharmacist in our clinic who meets with patients, and I went into a room with her resident on one patient also. That was really interesting because I had no idea what the pharmacists did in the clinic. It turns out that they counsel patients with tough cases who take lots of meds. This particular patient was a diabetic who was completely noncompliant and was also hypertensive, obese, and dyslipidemic. The most interesting part to me was how different the focus was. The pharmacists really don't get much into the disease symptoms or mechanisms at all. After the resident presented to the senior, they were debating for 15 minutes about which type of insulin was best for this patient, and so I got a review of all the different long and short-acting insulins. When they were done, the pharmacist asked me what I thought we should do. I said, "Tell the patient to drink diet soda instead of regular soda." All the insulin in the world is not going to help a patient who drinks a six pack of sugar water every day!

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