Tuesday, April 08, 2008

Observed H & P

We had a really terrific pharm seminar on Friday about drugs for inflammatory bowel disease. The two pharmacists gave us some cases to work through and then went over them with us. Our POD/ARM seminar, on the other hand, was a disaster. I guess whoever was supposed to give the talk on diarrhea cancelled, because instead we wound up getting a talk by someone from the Innovations Center here at CCF. (They take care of patents for inventions made by people associated with the Cleveland Clinic.) What annoyed me the most about this talk was not that it was awful and had nothing to do with research. No, what really annoyed me is that the only reason I skipped the second look students' lunch and went to this talk at all is that Dean Franco asked me not to skip class when I told her about the schedule conflict. Once again, the faculty for the class didn't show up, and most of my classmates didn't, either. I think skipping it would have been completely justified, but I didn't feel right about leaving after I promised her that I would go. On a happier note, in the evening, one of my friends and I went for dinner at a Thai restaurant I had never been to before, and it was amazing. We are definitely going to go back.

This week seems to be a bit of a hodgepodge of different gastrointestinal (GI) problems. Yesterday we had a seminar on infections, and today we talked about diabetic neuropathy. You may not have known that the GI system has its own nervous system that functions semi-independently. This is one of those facts about the human body that I had no clue about before I began medical school, and that I find just fascinating.

My preceptor was back in clinic today, so I did my observed history and physical (H & P). It went really well. The patient was a very interesting woman who was involved in a variety of charities. I didn't do a Pap smear on her, but I did do a breast exam and instruct her about how to do them herself. I am amazed by how many women do not do breast self-exams. Whenever I ask them why, nearly all of them say that they know they should do self-exams, but that they have never been taught how to do them. This patient was no different. The good news is that patients seem to be getting the message about the importance of monthly breast self-exams. But of course, telling women to do these exams is not terribly helpful unless they also know when and how to do them! Instead of asking patients whether they do monthly self-exams, it is probably better to ask them if they know how to do monthly self-exams. Then if they say no, the provider can show them.

4 comments:

YS said...

I love tum yum soup :)

CCLCM Student said...

I don't think I've ever had tum yum soup, but I'll have to check for it on the menu the next time I go.

Carla said...

Just a question to consider re: monthly SBE- is there any evidence that monthly SBE saves lives?

CCLCM Student said...

Not alone. You need to combine monthly self breast exams with mammography and clinical breast exams to optimize detection of tumors. But considering that an alarmingly high number of women also don't go for yearly checkups or mammograms....