Tuesday, April 29, 2008

Clinical Reasoning and Communication

Our communication class last week was about ending the doctor-patient relationship. It was insane. I was supposed to be a med student who had just finished my longitudinal clinic from first and second years, and I had to tell the patient that I was leaving to start my third year rotations. My actor was really over the top. He actually started crying with real tears when I told him that I'd be leaving! I wanted to laugh at the absurdity of it all, but I couldn't, because that would not be professional. Don't get me wrong. There are several patients whom I've seen multiple times, and we've built up some kind of relationship. But it's not like any of these people are going to throw a total hissy-fit like this guy did when I move on. Can we talk about dependence issues here? If this guy had been a real patient, I don't think I'd have worked nearly as hard to smooth things over. But when you're in a room with five people evaluating you, of course you have to see the whole thing through.

Friday was the last time we had to do one of those awful small group projects for ARM/POD. I was going out of town for the weekend, so I didn't even go to the presentation part. What a colossal waste these sessions have been. Even worse, what a missed opportunity to have made a series of small group sessions that could have been really interesting and useful. For example, it would have been great if the faculty had us actually go through the process of writing an NIH grant and taught us about different grant awards, how study sections work, etc.

We had another clinical reasoning session today. I had the same group and preceptor as last time, and it went about the same as before. First we each presented a patient and went through the differential as a group. Then we went over to the hospital to interview a real patient. This patient was a character. I'll just say that we heard about her sexual history in exquisite detail. And to think some people claim that you don't learn anything interesting in medical school!

Last week was our last week of GI (liver week), and now this week we have started with renal. Everything is going great. My PBL group still rocks. The renal seminars are as awesome this year as they were last year, interactive with lots of small group sessions. This week, we've been talking about glomeruli, which are the capillary beds that do the filtering in the kidneys. They're really beautiful. Here's a picture of one (the big thing in the middle). The smaller circular things surrounding the glomerulus are parts of the tubules of the nephrons, which are the urine concentrating units of the kidney.

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