I'm done now with all of the surgery subspecialty outpatient clinics. Since I'm going to be on the colorectal team, I had a half day of general surgery on Wednesday morning. I also had half days of urology, vascular surgery, and pediatric surgery. Most of the general surgery patients I saw were men who needed hernia repairs, really basic bread-and-butter stuff. My urology preceptor was a pediatric urologist, so I saw a bunch of kids with undescended testicles. Just in case any of you are new parents and worried, the testicle will usually come down in the first year or two of the kid's life without requiring surgery. Vascular surgery is really cool. The attending I worked with does 3D imaging of the patient's aorta and other vessels that have aneurysms. (Aneurysms are weaknesses in the blood vessel wall that lead to it expanding, kind of like a balloon. If they get too big, there is a danger that they could burst and quickly kill the patient.) Then he orders grafts that are made in Australia. It takes a few months for them to arrive since each graft is custom-made for that particular patient.
I have this weekend off and should be starting inpatient surgery on Monday. But I lucked out and got the day off for Labor Day since it's the first day for the two of us on this track. The other current surgery students who started the week before us did not get it off. (They are on a different track.) So needless to say, the two of us did not publicize this good fortune. It's not like I'm going to be spending the weekend doing anything fun anyway. We have 20 work-intensive surgery question prompts that we have to prepare for an oral exam at the end of the rotation, and that's what I'm going to spend this weekend doing. I know there won't be a lot of time to work on these prompts once things get going on Tuesday!
Friday, August 29, 2008
Tuesday, August 26, 2008
Outpatient Surgery and Orientation
This is my first week of surgery, and I have outpatient subspecialty clinics all week. Starting next week, I will be on inpatient surgery. The rationale for having this outpatient week is that I am supposed to try to scrub in for a surgery in each surgical subspecialty. So far I have done one half day each of orthopedic surgery, breast surgery, and ENT (ear/nose/throat, also called otolaryngology). I also had orientation this morning along with one other student who is starting surgery this week with me.
The ortho clinic was really cool, and the attending spent a lot of time teaching. He had a whole collection of replacement joints. Some were modern, and others were the kind that got used a few decades ago. We also looked at several x-rays, and he showed me what to look for to identify osteoarthritis. I'm not very good at reading x-rays, but even I could see the jagged edges of the cartilage in a patient with severe osteoarthritis. The breast clinic wasn't as exciting. I've already done several breast exams, so there wasn't much new. I did get to see some mammograms. It's hard to see the calcifications if you don't know what you're looking for. ENT was pretty cool, but it's also kind of disgusting. One of the patients had an in-office nose procedure, which I got to watch. Another had a sinus infection. We put a scope up his nose into the infected sinus, and when I looked through it, I could see all the green, infected mucus up there. Wow, that was gross. No wonder that patient was in pain!
The orientation was this morning. It wasn't all that exciting. First, we saw a video that I swear was made in the 1970s based on the clothing and hair styles. It was describing sterile technique and the importance of sterility in the operating room (OR). Then we got a tour of the ORs, and there are lots of them. There is also a stairway I didn't know about until today that leads from outside the ORs straight down to the cafeteria. That's a useful stairway to know about! Then we were given scrubs and lockers up in the ORs. Unfortunately, we have to share them with other people. Seeing the ORs again has gotten me excited for next week. I'm a bit nervous too, because surgery is so different than anything else I've done since I started med school. But I think this is going to be a very interesting month.
The ortho clinic was really cool, and the attending spent a lot of time teaching. He had a whole collection of replacement joints. Some were modern, and others were the kind that got used a few decades ago. We also looked at several x-rays, and he showed me what to look for to identify osteoarthritis. I'm not very good at reading x-rays, but even I could see the jagged edges of the cartilage in a patient with severe osteoarthritis. The breast clinic wasn't as exciting. I've already done several breast exams, so there wasn't much new. I did get to see some mammograms. It's hard to see the calcifications if you don't know what you're looking for. ENT was pretty cool, but it's also kind of disgusting. One of the patients had an in-office nose procedure, which I got to watch. Another had a sinus infection. We put a scope up his nose into the infected sinus, and when I looked through it, I could see all the green, infected mucus up there. Wow, that was gross. No wonder that patient was in pain!
The orientation was this morning. It wasn't all that exciting. First, we saw a video that I swear was made in the 1970s based on the clothing and hair styles. It was describing sterile technique and the importance of sterility in the operating room (OR). Then we got a tour of the ORs, and there are lots of them. There is also a stairway I didn't know about until today that leads from outside the ORs straight down to the cafeteria. That's a useful stairway to know about! Then we were given scrubs and lockers up in the ORs. Unfortunately, we have to share them with other people. Seeing the ORs again has gotten me excited for next week. I'm a bit nervous too, because surgery is so different than anything else I've done since I started med school. But I think this is going to be a very interesting month.
Friday, August 22, 2008
End of Outpatient Medicine
We had another P/CP today on gastroesophageal reflux disease (GERD). It's a lot easier participating in these talks as part of the audience instead of one of the speakers, but it's a lot less fun. Basically, this was another surgical treatment versus medical treatment case. After the debate, we had a seminar on dysphagia (difficulty swallowing) and hematemesis (throwing up blood). It's not the most appetizing discussion to have right before lunch, but it was a pretty good seminar. In the afternoon, we had an FCM session on empathy. We were asked to read a couple of articles about doctors who had become patients and found themselves treated without much empathy. We also had to write a brief essay about an example we saw from our rotations where a doctor did not treat the patient with empathy. I wrote about the GI doctor I worked with last week who wouldn't stop to answer any of the patient's husband's questions.
I'm done now with outpatient medicine. Cards was a lot better than GI, but I still am glad that this rotation is over and ready to start something new. Monday I start surgery. I will have a week of outpatient clinics, then four weeks of inpatient surgery on the colorectal team. This is with the same surgeon who evaluated my P/CP debate last week. The word is that she loves to teach, and the med students get to do a lot on her service. I hope that's true!
I'm done now with outpatient medicine. Cards was a lot better than GI, but I still am glad that this rotation is over and ready to start something new. Monday I start surgery. I will have a week of outpatient clinics, then four weeks of inpatient surgery on the colorectal team. This is with the same surgeon who evaluated my P/CP debate last week. The word is that she loves to teach, and the med students get to do a lot on her service. I hope that's true!
Tuesday, August 19, 2008
Outpatient Medicine and Cards
This week is my last week of outpatient medicine. I still have general medicine clinic in the mornings, but now my afternoon specialty outpatient clinics are in cardiology. Many of the patients are here to follow up for pacemaker placements or MIs (heart attacks). But I had one patient whose cardiac problems were at least in part due to psychiatric problems. She told me that she measures her blood pressure every hour or two, at least a dozen times a day. She always brings her home cuff and the meds with her to work so she could take both all day long. She was worried because her pressure is always high, and she takes extra blood pressure meds whenever it's too high. The problem now is that sometimes she was getting dizzy and feeling like she might faint.
I wasn't quite sure what to do. Usually, we can't get patients with high blood pressure to take their blood pressures and meds consistently. This was the first time I had seen a patient who was massively overdoing the monitoring and taking too much medication! She had kept a thorough record of every reading from the past month, and not even one of her measurements was above normal (120/80). So I explained all of this to the attending, and then we went in to see the patient. The attending explained to her that she shouldn't take her blood pressure more than once or twice a day at most, because worrying so much about her blood pressure was probably making it higher. He also told her not to take more of the meds than had been prescribed. I could see that the patient was skeptical though. Now that I'm thinking about it, we should have probably referred her to psych, because she's obviously obsessive-compulsive enough that it's affecting her quality of life.
I wasn't quite sure what to do. Usually, we can't get patients with high blood pressure to take their blood pressures and meds consistently. This was the first time I had seen a patient who was massively overdoing the monitoring and taking too much medication! She had kept a thorough record of every reading from the past month, and not even one of her measurements was above normal (120/80). So I explained all of this to the attending, and then we went in to see the patient. The attending explained to her that she shouldn't take her blood pressure more than once or twice a day at most, because worrying so much about her blood pressure was probably making it higher. He also told her not to take more of the meds than had been prescribed. I could see that the patient was skeptical though. Now that I'm thinking about it, we should have probably referred her to psych, because she's obviously obsessive-compulsive enough that it's affecting her quality of life.
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.
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.
Tuesday, August 12, 2008
Outpatient Medicine and GI
The bronch I was supposed to see yesterday wound up getting cancelled, which was disappointing for me--I'm sure my patient was relieved though. This week, I still have general medicine clinics in the mornings and specialty clinics in the afternoons. General medicine clinic has been very slow so far. For some reason, a lot of the patients are no-showing. On the bright side, it gives me a lot of time to write my patient notes and get my logs done during clinic, and that means I have my lunch hours free (and sometimes even get to go to lunch early!).
I have GI clinic in the afternoons this week. So far that has not been the greatest experience. Yesterday, my preceptor showed up to clinic an hour and a half late. I only got to see one of his patients because after a while I got tired of waiting for him and just went to see the patient on my own. He showed up when I was done with the interview and about to start the exam, and he took over from there. After that I pretty much just shadowed him all afternoon. It's a good thing I went and saw the patient when I did, because otherwise I probably wouldn't have gotten to do anything on my own. I was also annoyed because he kept me until 6 PM for no good reason. One of his patients was late and showed up at 4:45 PM. It was only supposed to be a 15 minute appointment, so we should have been done on time or at most been 15 or 20 minutes late. Instead, he spent 45 minutes with that patient and then made me stay an extra half hour afterward so that he could tell me about how stressful his job was. I am supposed to work with him again on Thursday. Wow, can't wait.
My GI preceptor today was a little better, but I still had a kind of strange experience. He sent me in to see a patient with one of the fellows. The fellow was really nice and well-intentioned. He was demonstrating how he does the complete abdominal exam for me. Considering that I got no teaching yesterday, I was very appreciative that he was making this effort. But he was basically ignoring the patient. After some time, the patient made a kind of funny noise, and the fellow asked her if anything was wrong. The patient said, "I feel like I'm some kind of guinea pig." The fellow started stammering that I am a med student, and he was showing me how to do the exam so that I could learn, etc. etc. I turned to the patient, who was a graduate student, and introduced myself. Then I asked her what she was studying. After we chatted for a few minutes, she was fine, and the fellow and I continued with the exam. When we came out of the room, he kind of laughed and shrugged about what had just happened.
I was pretty surprised he still didn't seem to realize that the patient just wanted us to include her in the conversation. I guess his med school didn't make him take any classes to learn how to communicate with patients. Maybe all those communication classes that we had to take over the last two years weren't so stupid and pointless after all!
I have GI clinic in the afternoons this week. So far that has not been the greatest experience. Yesterday, my preceptor showed up to clinic an hour and a half late. I only got to see one of his patients because after a while I got tired of waiting for him and just went to see the patient on my own. He showed up when I was done with the interview and about to start the exam, and he took over from there. After that I pretty much just shadowed him all afternoon. It's a good thing I went and saw the patient when I did, because otherwise I probably wouldn't have gotten to do anything on my own. I was also annoyed because he kept me until 6 PM for no good reason. One of his patients was late and showed up at 4:45 PM. It was only supposed to be a 15 minute appointment, so we should have been done on time or at most been 15 or 20 minutes late. Instead, he spent 45 minutes with that patient and then made me stay an extra half hour afterward so that he could tell me about how stressful his job was. I am supposed to work with him again on Thursday. Wow, can't wait.
My GI preceptor today was a little better, but I still had a kind of strange experience. He sent me in to see a patient with one of the fellows. The fellow was really nice and well-intentioned. He was demonstrating how he does the complete abdominal exam for me. Considering that I got no teaching yesterday, I was very appreciative that he was making this effort. But he was basically ignoring the patient. After some time, the patient made a kind of funny noise, and the fellow asked her if anything was wrong. The patient said, "I feel like I'm some kind of guinea pig." The fellow started stammering that I am a med student, and he was showing me how to do the exam so that I could learn, etc. etc. I turned to the patient, who was a graduate student, and introduced myself. Then I asked her what she was studying. After we chatted for a few minutes, she was fine, and the fellow and I continued with the exam. When we came out of the room, he kind of laughed and shrugged about what had just happened.
I was pretty surprised he still didn't seem to realize that the patient just wanted us to include her in the conversation. I guess his med school didn't make him take any classes to learn how to communicate with patients. Maybe all those communication classes that we had to take over the last two years weren't so stupid and pointless after all!
Friday, August 08, 2008
One Quarter Done with Block One
I am officially 1/4 of the way done with this entire block as of today. It was a good week up until today. I spent the mornings in general IM clinic, which is pretty much like the longitudinal clinics we did last year. The main difference is that this year there is a lot more focus on differentials and treatment instead of physical diagnosis skills. I spent all of the afternoons in the pulm clinics and that was really cool. After two days of lung transplant clinic, I had one day of asthma clinic and then a patient yesterday who was just really cool and interesting. He needs a bronchoscopy on Monday morning, so I am going to go for that. The patient himself asked if I could come, which was a real compliment as far as I am concerned.
Today we had classes in the morning and then our first Block Assessment Team (BAT) meetings in the afternoon. The lecture was on wound healing and it was ok. It was nice not having class in the afternoon, but those BAT meetings are pretty ridiculous. We had to come up with a learning plan based on our evals so far by Wednesday, which seems like a sensible requirement. We were also required to fill out evals on the preceptors and on the rotations we've completed so far, which seems reasonable enough as well. Of course, the stupid eval system locked all of us out and there was a whole to-do for us to get the evals done by noon yesterday like we were supposed to. But in the end, I got them all done in time by working on them during clinic yesterday morning.
Next, some mysterious combination of the order we filled out the evals, where our last name falls in the alphabet, and the alignment of Venus with Mars was used to generate an order for when each of us would meet with the BAT. This order was guarded like Fort Knox and only revealed to us on the morning of the BAT meetings (this morning). The order was also changed at least two or three times during the course of the morning, thus making it impossible to plan anything for the entire afternoon. So basically, what we did all this afternoon is hang around in the library complaining about how stupid this system was while awaiting our turns to meet with the BAT.
The BAT has one family med doc, one internal med doc, and one surgeon on it, although my team's surgeon was in the OR and couldn't come. When you go in to meet with them, they have copies of your evals and your learning plan. The meeting lasts about five minutes, most of which is spent chatting about nothing in particular. Then they told me that it seems like everything is going well so far, and keep up the good work. I went out and told the next student it was his turn, and that was it. So much for my afternoon off.
Today we had classes in the morning and then our first Block Assessment Team (BAT) meetings in the afternoon. The lecture was on wound healing and it was ok. It was nice not having class in the afternoon, but those BAT meetings are pretty ridiculous. We had to come up with a learning plan based on our evals so far by Wednesday, which seems like a sensible requirement. We were also required to fill out evals on the preceptors and on the rotations we've completed so far, which seems reasonable enough as well. Of course, the stupid eval system locked all of us out and there was a whole to-do for us to get the evals done by noon yesterday like we were supposed to. But in the end, I got them all done in time by working on them during clinic yesterday morning.
Next, some mysterious combination of the order we filled out the evals, where our last name falls in the alphabet, and the alignment of Venus with Mars was used to generate an order for when each of us would meet with the BAT. This order was guarded like Fort Knox and only revealed to us on the morning of the BAT meetings (this morning). The order was also changed at least two or three times during the course of the morning, thus making it impossible to plan anything for the entire afternoon. So basically, what we did all this afternoon is hang around in the library complaining about how stupid this system was while awaiting our turns to meet with the BAT.
The BAT has one family med doc, one internal med doc, and one surgeon on it, although my team's surgeon was in the OR and couldn't come. When you go in to meet with them, they have copies of your evals and your learning plan. The meeting lasts about five minutes, most of which is spent chatting about nothing in particular. Then they told me that it seems like everything is going well so far, and keep up the good work. I went out and told the next student it was his turn, and that was it. So much for my afternoon off.
Tuesday, August 05, 2008
Outpatient Medicine and Pulmonology
For the next three weeks, I will be doing general outpatient medicine in the mornings, and then specialty clinics in the afternoons. The general medicine clinics are exactly like the longitudinal clinics that I was doing for the past two years on Tuesday afternoons. In fact, I even spent yesterday morning in the exact same clinic that I worked in first and second years (though not with the same preceptor, because my old preceptor is now out at one of the suburban satellite centers). The general medicine clinics seem downright slow after the hectic bustle of the family medicine clinics. I am only seeing two, maybe three patients each half day, and I never have trouble finishing my notes or logs before lunch. To be fair though, the IM department cuts back the schedule so that the preceptors have more time to teach us, and the patients tend to be older and have more complex problems compared to the typical family medicine patients.
My specialty clinics for this week are all with pulmonologists. These are lung specialists. It's a really cool and interesting specialty. I spent the past two afternoons working with people who evaluate patients for lung transplants. Most of the patients have chronic obstructive pulmonary disease (emphysema) due to having smoked for a few dozen pack-years. (A pack-year is equivalent to 365 packs of cigarettes, or one pack of cigarettes per day for a year. So someone who smokes two packs per day is actually accruing TWO pack-years in a year.) There are a lot of factors that go into deciding whether to list someone for a lung transplant. First of all, the patient has to be sick enough to need a new lung (or pair of lungs), but not too sick to perform the surgery. Second, there are many psychosocial factors that come into play. If the patient is still smoking or doesn't have enough psychiatric or social stability to comply with the demanding anti-rejection regimen that they will need to take for the rest of their life, they won't be eligible for the transplant.
I learned several interesting things from the past two days. One is that the Cleveland Clinic performs the second largest number of lung transplants in the country. (Interestingly, the preceptor wasn't sure who performs the most!) Another is that Cleveland Clinic operates on much sicker patients than most other centers do. For example, one of the restrictions for lung transplants is age, but some of the patients who have received lungs here are older than the upper limit. The last thing I took away from these past two days is a strong reminder of the importance of talking to patients who smoke about quitting in the general medicine clinics. The COPD patients have to have a really awful quality of life by the time they are sick enough to merit being listed for a transplant. They're in wheelchairs and have to be on oxygen all the time. They can barely speak one sentence without getting short of breath. And all of this suffering is for what, exactly? It is sickening to see teenagers or young adults smoking and know that in a few decades, they could end up in this exact same pulmonology office with a life-threatening illness that is entirely preventable.
My specialty clinics for this week are all with pulmonologists. These are lung specialists. It's a really cool and interesting specialty. I spent the past two afternoons working with people who evaluate patients for lung transplants. Most of the patients have chronic obstructive pulmonary disease (emphysema) due to having smoked for a few dozen pack-years. (A pack-year is equivalent to 365 packs of cigarettes, or one pack of cigarettes per day for a year. So someone who smokes two packs per day is actually accruing TWO pack-years in a year.) There are a lot of factors that go into deciding whether to list someone for a lung transplant. First of all, the patient has to be sick enough to need a new lung (or pair of lungs), but not too sick to perform the surgery. Second, there are many psychosocial factors that come into play. If the patient is still smoking or doesn't have enough psychiatric or social stability to comply with the demanding anti-rejection regimen that they will need to take for the rest of their life, they won't be eligible for the transplant.
I learned several interesting things from the past two days. One is that the Cleveland Clinic performs the second largest number of lung transplants in the country. (Interestingly, the preceptor wasn't sure who performs the most!) Another is that Cleveland Clinic operates on much sicker patients than most other centers do. For example, one of the restrictions for lung transplants is age, but some of the patients who have received lungs here are older than the upper limit. The last thing I took away from these past two days is a strong reminder of the importance of talking to patients who smoke about quitting in the general medicine clinics. The COPD patients have to have a really awful quality of life by the time they are sick enough to merit being listed for a transplant. They're in wheelchairs and have to be on oxygen all the time. They can barely speak one sentence without getting short of breath. And all of this suffering is for what, exactly? It is sickening to see teenagers or young adults smoking and know that in a few decades, they could end up in this exact same pulmonology office with a life-threatening illness that is entirely preventable.
Sunday, August 03, 2008
Tips for Doing Well in the Family Medicine Rotation
Here are my tips for doing well in Family Medicine.
1) Be enthusiastic. This is good advice for every rotation actually, but especially in the outpatient clinic. You might feel like you have no intention of going into family medicine (which I don't), but that doesn't mean you can't learn something from the experience or that it isn't important.
2) Read about your patients. Even though your contacts with most of the patients will be short-term (just one visit) because the rotation is so short, you should still read up on the patients and learn more about their diseases. Discuss what you read with your preceptors.
3) Be on time. This should be an obvious thing, so don't be "that student". You'll be fine if you always keep in mind that it is ok for you to wait half an hour for the attending to show up, but the opposite is not true! ;-)
4) Keep up with your logs. You should write your H & Ps and fill out your logs every day (every half day if possible). Yeah, it sucks spending your lunch hour writing logs and H & Ps. But you see so many patients in the family medicine clinic (I'd usually see about 8 per day on average) that there is just no possible way that you will remember what you saw or did if you don't write the notes as quickly as possible. Plus, if you get all of the notes done while you're in clinic, you won't have to write them at home.
5) Read a family medicine book. The book that was suggested for this rotation wasn't very helpful, in my opinion. It's too long to possibly get through during a three week rotation. Get Case Files: Family Medicine instead and read it cover to cover. That's definitely doable in three weeks.
6) Submit EVERY log for assessment. Some preceptors won't write you an eval. If you submit every log, you will have no problem getting enough evals for the rotation. Just be sure to batch them each half day so that the preceptor isn't getting like four different eval requests per day.
7) Any time a preceptor asks, "Hey, would you like to do....?" always say yes. Stay the extra half hour, do the extra Pap smear, interview the extra patient. The more interest you show in learning, the more willing the preceptor will be to teach you something interesting.
8) Be nice to the nurses and MAs. Yes, they have been in medicine way longer than you have. Yes, they do know more about clinical stuff than you do. Yes, they will talk about you behind your back if you're an arrogant idiot. I was hearing stories about previous med students who are long done with their residencies by now....assuming that they made it through the rest of their third years!
9) Work your way into the rooms one baby step at a time. Sometimes you may run into patients who don't want to see a med student. What you should do is ask them if you can just talk to them for a couple of minutes to get their meds or find out why they came in today. You can even point out that it will speed things up since you can put their info into the computer for the doctor. Once they have been talking to you for a while and you have had a chance to build up some rapport, you can then ask them to let you listen to their heart and lungs. While they're on the exam table, you can throw in an HEENT exam or an abdominal exam if appropriate. This strategy worked for me every single time. I never had a patient refuse to let me talk to them "just for a couple of minutes," and I never walked out of the room without doing a focused physical exam. The key is that you need to project an attitude of confidence and humility at the same time.
10) Even if you hate family medicine, look at the bright side. It's only a few weeks, and there are no weekends or calls. You're totally going to miss this rotation once you start slaving away 80 hours per week on one of the inpatient services!
1) Be enthusiastic. This is good advice for every rotation actually, but especially in the outpatient clinic. You might feel like you have no intention of going into family medicine (which I don't), but that doesn't mean you can't learn something from the experience or that it isn't important.
2) Read about your patients. Even though your contacts with most of the patients will be short-term (just one visit) because the rotation is so short, you should still read up on the patients and learn more about their diseases. Discuss what you read with your preceptors.
3) Be on time. This should be an obvious thing, so don't be "that student". You'll be fine if you always keep in mind that it is ok for you to wait half an hour for the attending to show up, but the opposite is not true! ;-)
4) Keep up with your logs. You should write your H & Ps and fill out your logs every day (every half day if possible). Yeah, it sucks spending your lunch hour writing logs and H & Ps. But you see so many patients in the family medicine clinic (I'd usually see about 8 per day on average) that there is just no possible way that you will remember what you saw or did if you don't write the notes as quickly as possible. Plus, if you get all of the notes done while you're in clinic, you won't have to write them at home.
5) Read a family medicine book. The book that was suggested for this rotation wasn't very helpful, in my opinion. It's too long to possibly get through during a three week rotation. Get Case Files: Family Medicine instead and read it cover to cover. That's definitely doable in three weeks.
6) Submit EVERY log for assessment. Some preceptors won't write you an eval. If you submit every log, you will have no problem getting enough evals for the rotation. Just be sure to batch them each half day so that the preceptor isn't getting like four different eval requests per day.
7) Any time a preceptor asks, "Hey, would you like to do....?" always say yes. Stay the extra half hour, do the extra Pap smear, interview the extra patient. The more interest you show in learning, the more willing the preceptor will be to teach you something interesting.
8) Be nice to the nurses and MAs. Yes, they have been in medicine way longer than you have. Yes, they do know more about clinical stuff than you do. Yes, they will talk about you behind your back if you're an arrogant idiot. I was hearing stories about previous med students who are long done with their residencies by now....assuming that they made it through the rest of their third years!
9) Work your way into the rooms one baby step at a time. Sometimes you may run into patients who don't want to see a med student. What you should do is ask them if you can just talk to them for a couple of minutes to get their meds or find out why they came in today. You can even point out that it will speed things up since you can put their info into the computer for the doctor. Once they have been talking to you for a while and you have had a chance to build up some rapport, you can then ask them to let you listen to their heart and lungs. While they're on the exam table, you can throw in an HEENT exam or an abdominal exam if appropriate. This strategy worked for me every single time. I never had a patient refuse to let me talk to them "just for a couple of minutes," and I never walked out of the room without doing a focused physical exam. The key is that you need to project an attitude of confidence and humility at the same time.
10) Even if you hate family medicine, look at the bright side. It's only a few weeks, and there are no weekends or calls. You're totally going to miss this rotation once you start slaving away 80 hours per week on one of the inpatient services!
Friday, August 01, 2008
First Presentation
I did my first presentation today, and it went well. We wound up discussing the patient's psychosocial issues and how they could be contributing to her problems with headaches. It's interesting that so many people have these nonspecific complaints (headaches, stomach aches, muscle and joint aches). They go to multiple doctors and no one can figure out what is wrong with them. Maybe they have some random degenerative changes on an x-ray that are related to their pain, and maybe those changes are just coincidental. It's tough to know. But regardless, there are a lot of depressed, anxious, and stressed people out there, and it's important to ask people about their moods and stress levels. You cannot be in good physical health if you are not also in good psychological health.
Subscribe to:
Posts (Atom)
Posts
