Tuesday, December 11, 2007

Rants of a Crank

Our PBL case this week is about premature ovarian failure, and it's an interesting one so far. We had two seminars yesterday, one on deficiencies of adrenal enzymes and one on menopause, to go with it. The menopause seminar speaker has written a book on the topic, and she gave free copies to anyone who wanted one. Her powerpoint slides were disgustingly pink, the presentation made annoying little cutesy noises every time she changed slides, and her talk was half science and half soap box. But it's amazing how getting a free book can make all of these sins of powerpoint presentations forgivable.

In the evening, CCLCM was co-sponsoring an event at the Maltz Museum so that all the Case medical students could see the Deadly Medicine exhibit for free. It's the same exhibit that I went to a few months ago, only this time we didn't get to go to Mrs. Lerner's house afterward. Someone cancelled at the last minute, so there was an extra ticket, and I was able to go back to see the parts that I didn't make it to last time. I didn't stay too long though because I still had to do some more work on my paper for my MS class.

This morning, we had seminars on osteoporosis and thyroid pathology, and then for FCM we had a "field trip" to the art museum. I had been asked to participate in the NMS block evaluation session, scheduled for today at lunch. But I couldn't do it, because I had to videotape myself interviewing a patient in clinic. This is a ridiculous new requirement that all the first and second years have to do this year, where we check out a video camera, print out a consent form, and take them both to clinic to video an interview with a real patient. I wouldn't have minded as much if I could have scheduled the day myself, but the school decided to make me do it today, which is about the worst day they could have picked all block for me. They had also scheduled me to have a clinical correlation today, so I had to go see someone in administration to get it straightened out. I dare say that I'm a pretty decent multi-tasker, but even so, I readily confess that I'm not so good that I can be in two different clinics at the same time.

The actual patient interview taping went ok once I got everything set up. As it turns out, my first patient consented to be interviewed on tape, and he was some kind of video camera whiz, so he even set it all up for me. It was good that I did the videotaping early in the afternoon, because as usual we were double booked from 3-5 PM, and all four of those patients showed up today.

I was completely puzzled by one of my patients. She wanted to get pregnant but couldn't, so she was interested in infertility treatments. She said she'd been trying to get pregnant for several years. That definitely fits the definition of infertility, which is an inability to conceive after one year or more of trying. I asked her about the regularity of her menstrual cycles and age of menarche. Both were normal and she hadn't noticed any changes in her menstrual cycles. Did she take birth control? No. Was she using condoms? No, she was having regular, unprotected intercourse. Did she have a medical condition that could interfere with her fertility? None that either of us could think of. How about her husband? He didn't have any known infertility problems. At a complete loss, I started going through her medications on the computer, and what do you know, she had been getting intramuscular injections of Depo Provera for the past few years. At that point, I excused myself from the room and went to get my preceptor. I suppose I could have just told her myself. But I figure this is one of those things where it's better for the patient to hear it from the physician and not some second year medical student!

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