FCM, Acid-Base Seminar, and Clinic

FCM this morning was more or less anti-climactic. We were each given a ten minute time slot when we were supposed to meet individually with our small group preceptors to get feedback. That's what we thought, anyway. I figured they'd talk to us about our participation and maybe comment on the essays, which were due yesterday. Instead, my preceptor asked each of us what we thought should be done to improve the course. I suggested continuing to have the small group meetings first before the lectures to prevent speakers from talking too long, and allowing people to choose which volunteer project they wanted to work on instead of assigning us to them. The preceptor agreed that those were reasonable changes to make and wrote them down. We'll see how things go starting in January, I guess.

The acid-base seminar was a problem solving session, and it went pretty well. There were five problems that we worked on as a group. We already covered acid-base chemistry a month ago during the respiratory block, but it makes a lot more sense now that we've gotten some background in renal physiology. You can't really talk about compensation for acid-base problems if you don't understand how the kidneys contribute to the body's acid-base balance. For those of you who are going through this next year, don't feel bad if you don't get all of the acid-base stuff the first time through, because it will all come together a lot better the second time.

I had clinic this afternoon, and I saw two patients. We didn't learn any new physical diagnosis skills, but we were supposed to take family histories. Ok, for those of you who are pre-meds, let me tell you right now that working with standardized patients is NOTHING like working with real patients. You will go on your medical school interviews and your second looks, and they will tell you how seeing standardized patients will prepare you for seeing real patients, but I'm telling you that it won't. It's like the difference between imagining in your mind about what it would be like to ask someone out versus doing it for real. You don't have any control over the outcome of these things when you do them for real. When I did the practice family history last week, it went like clockwork. The actress went through her pretend family members smoothly and efficiently. In contrast, with real patients, things are not nearly as efficient, and there is always some kind of unseen minefield waiting for you to step right into it.

In this case, I was going through the rather extended family history of a very nice but overly talkative older lady. She was telling me all about her multitude of family members. I was really having to work hard to keep her focused on the task at hand and not let her digress too much into stories from half a century ago. Then, with no warning, she tells me that one of her family members was murdered when she was a child and promptly bursts into tears. This is totally NOT part of the script, and nothing in our books explains how to deal with bawling patients whose family members have been murdered. I offered her a tissue along with my condolences and asked if she'd like to discontinue the interview, but she said she was fine with finishing. The one good thing was that she wasn't as talkative after this, and we were able to get through the rest of her family members relatively quickly. As it was, I spent about 45 minutes with her, and my preceptor was kind of annoyed with me about that. My second patient was much more reserved and did not have any murdered family members that she told me about. So we got through her family history in about 10 minutes, and I somewhat redeemed myself.