Friday, August 15, 2008

Surviving GI and Point/Counterpoint

This has been a rough week. Wednesday afternoon, things started out well. I had a preceptor who seemed to really like teaching. He spent a lot of time with me going over the differential and treatment for my patient's disease. But then when we went into the room to talk to the patient, the doc started talking at her about treatment options and didn't bother answering any questions or explaining anything. She sat stolidly and said nothing, while her anxious husband looked at me and pantomimed what he thought the doctor was saying. I tried to pantomime back, but it was an awkward and embarrassing experience. After the doc and I left the room, he told me not to bother submitting an eval, because he wasn't going to fill it out anyway. Of course that annoyed me, but I felt a lot worse about what had happened in the exam room. When the doc dismissed me for the day, I left by a side entrance because I just didn't feel like I could face the patient and her husband.

As bad as that experience was, yesterday took the prize. It turns out that the doc I was supposed to work with had cancelled clinic for the day, but no one had bothered to tell me. While I was hanging out once again in the hallway, I struck up a conversation with a patient and his wife. This happened because I had gotten my white coat caught on the door as I was going out of the administrator's office, and this patient started laughing at me. I thanked him and offered to do an encore. The next thing I knew, I was sitting with him and his wife in the hallway, and the patient was telling me all about his GI issues. I figured since I had gotten his whole history anyway, I might as well get some credit for it. So I asked him who his doctor was, got his doc's permission to see him officially, and went on from there. That doc was really awesome. He went out of his way to make the patient feel comfortable, and he spent time teaching me as well.

Today we didn't have morning report because we had a surgery/medicine debate (called Point/Counterpoint or P/CP) about the best treatment for ulcerative colitis (UC). UC is an inflammatory bowel disease similar to Crohn's disease, but it mainly affects the colon. There were four of us who participated. We were given a patient scenario and then assigned to take sides. Two people discussed the basic science behind the medicine and surgery options, and the other two debated the actual treatment options. I was assigned to advocate for surgery to remove the patient's colon. Apparently most people in the past have debated with powerpoints, but I didn't want to do that. What kind of passion can you show with your audience staring at a powerpoint? So I decided to do my presentation with just a page of notes to jog my memory. The surgeon who was in charge of the debate snapped at us when she heard that my partner and I hadn't made powerpoints. But when I got up there, I really did my best to make the pro-surgery case. Out of the corner of my eye, I could see the surgeon furiously scribbling notes the whole time I was talking. When I was done, she didn't say a word to me. She just told the medicine people to come up there to present. That was how I knew she thought I had done a good job.

After P/CP, this same surgeon gave us a seminar on anal diseases. Some of the more interesting things I learned were that sitting too long on the toilet increases the chance of getting a rectal prolapse, and that hemorrhoids are only painful if they're external. That has to do with the nerve supply to the anus, which is different than the nerve supply to the rectum. I also learned that everyone has hemorrhoids, because hemorrhoids are just veins that drain the anus and rectum. The last thing I learned is kind of the stuff of nightmares, and that is about the existence of anal fissures. Wow, talk about a disease I hope I never see, let alone experience....

My last class today was POD, aka ARM. This class is incredibly painful. Picture this: it's Friday afternoon, you're exhausted from the whole week, and now you have to sit through a three hour seminar on how to write abstracts for scientific papers. The worst part was when they broke us up into groups, and we had to write an abstract on a project that we basically knew nothing about. All in all, it was the perfect rotten ending for a generally bad week.


Sean M. Hobson said...

Great detail in this post. I almost felt as if I were a bystander observing your day.

I really enjoyed the part about how you chose not to use powerpoint slides to prove your pro-surgery case. Passion will always overwhelm pictures; and it seems as if your presentation was good enough to overwhelm the female doctor's original low expectations :)

I suppose in medical school you learn the interesting and the interesting-but-id rather not think about that stuff- as well. I googled anal fissures and found that women giving childbirth, and infants suffering from constipation are most susceptible to it. Judging from the image you provided, it indeed looks painful.

As always, enjoying the eventful days of CCLM students :)

CCLCM Student said...

Patients with Crohn's disease can get anal fissures as well. My understanding is that yes, they are exquisitely painful.

This colorectal surgeon who evaluated my presentation and taught the class is my surgery attending, so I will get to learn much more about anal fissures and all the rest. Stay tuned!