Okay, so life with the super-crazy-busy doc....
Has been...
Odd?
It isn't hard in the ways that I thought it would be hard. However, I am learning that I am incredibly sucky (yes, that is an official term) at writing prescriptions and hospital orders right now. Of course, some would say that I shouldn't be worried about it. They are probably true seeing how this is only my second day trying to write them.
But damn it!
I am supposed to know everything! Right...
I like being a hospitalist. I only do it right now for 2 hours of the day, but I really like it. The pace of working in a hospital (as compared to a clinic) is much faster. Problems are more acute and more interesting. I actually get to see people a few days in a row and see how they are progressing instead of just seeing them for 30 minutes or so and knowing that I won't see them again.
I got to help diagnose this woman who came in vomiting blood (Mallory-Weiss tear), look at a {DON'T click the next link if you are squeamish about gross looking feet} diabetic foot ulcer, and take care of a woman who tore her labral cartilage in her hip joint. Trust me, these things are so much better than what I had been seeing.
I also was told again that I am one of the "better" medical students. Bah. I still don't believe them. I always think that people are just being nice. One of my biggest fears is that I will become one of those doctors that patients like because I am nice (yes, that is right, I am NICE) and easy to get along with but they won't realize (and I won't realize) that I am actually a stupid doctor.
I mean, geez, at this point I can't even convince my bestest friend of 12 YEARS THAT SHE SHOULD REALLY GET A PRIMARY CARE DOCTOR WITH HER NEWLY ESTABLISHED HEALTH INSURANCE.
Whew.
Where did that come from?
Tuesday, July 29, 2008
Sunday, July 27, 2008
Slow on the uptake
Okay, so I am a bit slow on the uptake here. Mike has been telling me about this lecture for a few months now. If any of you have not watched this, you MUST do it. I am not kidding.
This talk with change your life. It is an hour and sixteen minutes of your time well used. Please watch and listen to it by giving it your entire attention. No multi-tasking. No putting on a podcast either, you need the visual.
Randy Pausch Last Lecture: Achieving Your Childhood Dreams
The professor just died two days ago.
This talk with change your life. It is an hour and sixteen minutes of your time well used. Please watch and listen to it by giving it your entire attention. No multi-tasking. No putting on a podcast either, you need the visual.
Randy Pausch Last Lecture: Achieving Your Childhood Dreams
The professor just died two days ago.
Trepidation
This next week may be interesting. I start with a different doctor in a different clinic and also add on some time in the local hospital. This doctor seems to be a bit more challenging (in that I-am-going-to-pimp-you-and-remind-you-of-the-med-student-that-you-are kind of way) and busy than the other physicians that I have been working with. I also have to drive about 30 minutes each way to the clinic and I am on call for the entire weekend next weekend.
Now, if anyone reading this is currently on his or her surgery rotation, they would be playing me the violin at this point. This schedule is nothing compared to what I will get when I am on my surgery rotation.
But.
I am not on that rotation yet, and so this is "bad" compared to what I have been going through.
I really just don't want to mess up and feel like an idiot. (Little voice inside my head: So why did you become a medical student again?)
Anyways, I will post as I get the chance. Hopefully it isn't too bad.
Oh, and in case you are interested, internal medicine as a specialty is still an option for me, but in no way would I do it in a small town. I am pretty sure that I would need to be a hospitalist. I am just not doing well with living in a small town and seeing "medication refill" patients most of the time. No kidding... A lot of the patients I have been seeing are in for a 4 month follow up appointment to make sure that they are doing okay on medications and that there are no new health problems. Don't get me wrong, these check ups are important for catching things that patients may not think of as important. Because of that, it is imperative that I like what I do and not get bored by it.
So yes, those visits are boring most of the time.
Now, if anyone reading this is currently on his or her surgery rotation, they would be playing me the violin at this point. This schedule is nothing compared to what I will get when I am on my surgery rotation.
But.
I am not on that rotation yet, and so this is "bad" compared to what I have been going through.
I really just don't want to mess up and feel like an idiot. (Little voice inside my head: So why did you become a medical student again?)
Anyways, I will post as I get the chance. Hopefully it isn't too bad.
Oh, and in case you are interested, internal medicine as a specialty is still an option for me, but in no way would I do it in a small town. I am pretty sure that I would need to be a hospitalist. I am just not doing well with living in a small town and seeing "medication refill" patients most of the time. No kidding... A lot of the patients I have been seeing are in for a 4 month follow up appointment to make sure that they are doing okay on medications and that there are no new health problems. Don't get me wrong, these check ups are important for catching things that patients may not think of as important. Because of that, it is imperative that I like what I do and not get bored by it.
So yes, those visits are boring most of the time.
Thursday, July 24, 2008
The specialists
For the past two days I have shadowed (followed around) two different specialists. The point of this is to expose me to areas that I wouldn't normally get to see unless I did an elective in it during 4th year. Yesterday, I spent my day split between a Hematologist-Oncologist and a Radiation-Oncologist.
A Hematologist/Oncologist is a doctor that specializes in blood and cancer diseases. The doctor I followed was awesome! She was good at listening to patients and explaining what they had. She was practiced and very adept at giving bad news and handling it when patients and their families cried. Yes, that is part of that job. Pros of the field: treatment changes a lot, there is always something to learn, docs practice is larger areas, you see some pretty cool (cool as in you don't want to be cool if you are a patient because that usually means bad) things. One "cool" thing that I saw was a breast cancer that had actually ulcerated out of the breast and was a 1.5x1.5 inch mass. Beneath her skin it was about 6 inches long and a few inches wide. The sad part was that this woman "wasn't all there in the head." She had actually thought that this growth was there because she had lifted her Christmas tree the wrong way. Can you imagine? She had an ulcerating mass that had completely destroyed her nipple and was bleeding, but she thought it was from lifting her Christmas tree the wrong way.... Another cool thing was an AML diagnosis. The patient came into the emergency room with a bad sinus infection and petechiae on his legs. Those were his only presenting symptoms! Crazy! Now, this doesn't mean that everyone who has this has AML, but it is crazy to think that those were the only things to pick up on. Cons: who wants to tell someone they will die in a few months or years, dealing with rightfully depressed people is hard, lots of drug reps. While I am not discounting this specialty fully, I doubt I will go into it.
Radiation-Oncology - this field has the technology, but lacks the "doctory" feel. You hardly see patients. You memorize anatomy like no other. You get paid A TON. And the lifestyle is a piece of cake. Yes, that sounds awesome, but it isn't what I imagined myself doing. I will not be a radiologist, I like seeing patients too much to do that.
Today, I shadowed a gastroenterologist (otherwise known as a GI doctor). I saw a lot of butts today. Yeah, not my thing either. I like the fact that there were a lot of procedures, but I don't want to do those kinds of procedures. Also, the doctor kind of sucked with patients. He was rushed and didn't seem to listen to the patients. I am sure that the patients picked up on this because at some point, a patient began speaking with me more than him. He also seemed somewhat disgusted with the fact that he was seeing patients in this area. To give him the benefit of the doubt, this hospital is run pretty poorly. Organization and communication are really bad, I know this from seeing it myself and from hearing it from other docs that I meet.
Another thing about the GI doc today was his attitude toward me. Overall, it was nice and fair. There were a few times that he would ask me questions and be surprised that I knew the answer. I am not sure if he was surprised because usually third year medical students don't know the answer OR because I just didn't seem like the kind of student that would know the answer. I would like to think it was because of the first reason, but I wouldn't put it past him to "judge" me and it be the second reason. He also said that I didn't seem like a typical first rotation student, but again, because of what I saw him do with patients and because of his attitude, I don't know if I can believe him. Really, I would like to because that is a boost to my ego, but geez. Do I really want a doctor who is the type I DO NOT want to become (both in specialty and personality) to think that I am good at what I do? Maybe it doesn't matter and I am reading too much into it, but that is what I am thinking.
That GI doc also tried to give me lots of advice. Some of it I would listen to because I have heard it from other sources before, others I will take with a truck-load of salt. Good advice: pick a specialty that allows you to have the lifestyle you want; whether it is being crazy busy all of the time or wanting to have a family and be there for them. Truck-load of salt advice: do radiation-oncology because it gives you the money and the lifestyle.
Make that a semi-truck-load of salt.
A Hematologist/Oncologist is a doctor that specializes in blood and cancer diseases. The doctor I followed was awesome! She was good at listening to patients and explaining what they had. She was practiced and very adept at giving bad news and handling it when patients and their families cried. Yes, that is part of that job. Pros of the field: treatment changes a lot, there is always something to learn, docs practice is larger areas, you see some pretty cool (cool as in you don't want to be cool if you are a patient because that usually means bad) things. One "cool" thing that I saw was a breast cancer that had actually ulcerated out of the breast and was a 1.5x1.5 inch mass. Beneath her skin it was about 6 inches long and a few inches wide. The sad part was that this woman "wasn't all there in the head." She had actually thought that this growth was there because she had lifted her Christmas tree the wrong way. Can you imagine? She had an ulcerating mass that had completely destroyed her nipple and was bleeding, but she thought it was from lifting her Christmas tree the wrong way.... Another cool thing was an AML diagnosis. The patient came into the emergency room with a bad sinus infection and petechiae on his legs. Those were his only presenting symptoms! Crazy! Now, this doesn't mean that everyone who has this has AML, but it is crazy to think that those were the only things to pick up on. Cons: who wants to tell someone they will die in a few months or years, dealing with rightfully depressed people is hard, lots of drug reps. While I am not discounting this specialty fully, I doubt I will go into it.
Radiation-Oncology - this field has the technology, but lacks the "doctory" feel. You hardly see patients. You memorize anatomy like no other. You get paid A TON. And the lifestyle is a piece of cake. Yes, that sounds awesome, but it isn't what I imagined myself doing. I will not be a radiologist, I like seeing patients too much to do that.
Today, I shadowed a gastroenterologist (otherwise known as a GI doctor). I saw a lot of butts today. Yeah, not my thing either. I like the fact that there were a lot of procedures, but I don't want to do those kinds of procedures. Also, the doctor kind of sucked with patients. He was rushed and didn't seem to listen to the patients. I am sure that the patients picked up on this because at some point, a patient began speaking with me more than him. He also seemed somewhat disgusted with the fact that he was seeing patients in this area. To give him the benefit of the doubt, this hospital is run pretty poorly. Organization and communication are really bad, I know this from seeing it myself and from hearing it from other docs that I meet.
Another thing about the GI doc today was his attitude toward me. Overall, it was nice and fair. There were a few times that he would ask me questions and be surprised that I knew the answer. I am not sure if he was surprised because usually third year medical students don't know the answer OR because I just didn't seem like the kind of student that would know the answer. I would like to think it was because of the first reason, but I wouldn't put it past him to "judge" me and it be the second reason. He also said that I didn't seem like a typical first rotation student, but again, because of what I saw him do with patients and because of his attitude, I don't know if I can believe him. Really, I would like to because that is a boost to my ego, but geez. Do I really want a doctor who is the type I DO NOT want to become (both in specialty and personality) to think that I am good at what I do? Maybe it doesn't matter and I am reading too much into it, but that is what I am thinking.
That GI doc also tried to give me lots of advice. Some of it I would listen to because I have heard it from other sources before, others I will take with a truck-load of salt. Good advice: pick a specialty that allows you to have the lifestyle you want; whether it is being crazy busy all of the time or wanting to have a family and be there for them. Truck-load of salt advice: do radiation-oncology because it gives you the money and the lifestyle.
Make that a semi-truck-load of salt.
Tuesday, July 22, 2008
The importance of the other one
It began
in high school.
"I hate you" were some of the first words
Only to be repeated back as if you were a mirror.
We moved on
One with an aspiring poison dart assassin to call her own
One with a somewhat colder mistress who spoke in bits, bytes, and GHz
Or was it MHz at that point?
I lost my assassin
You kept your mistress
One that I would learn to work around.
The winding and tortuous paths crossed
And we found each other in the murky soup of hormones and "indefinite groundings"
And almost lost each
Other to the Beastie Boys and their Girls.
But we made our paths stay together
You sacrificing your weekends to a town that held nothing for the both of us
Continually putting me and your family and friends ahead of your needs
O! Do I feel something serious beginning to develop?
Since then, there has been: 5 marriages, 3 divorces, 1 death, a variety of new and rotating siblings, 9 moves, 1 house, 2 dogs, 2 college degrees, and 4 cats.
You still have your same mistress
I have a new drug
One to rule them all.
That drug committed us both to a life that meant possible change
Every few years.
That drug made previously voiced goals a realization
Only for half of us.
The drug has ravished our lives
But has given us the solidarity to know that
Whatever life throws at us
Our paths are solid enough to laugh at the challenges.
It is mostly because of you
You pushed me when I could no longer pen down the 3 virtues that qualified me to gain entrance
It is your fault that I hold my schooling and goals to higher standards
You are to blame for the support that I get when I am in my fiery pit of ignorance
I hold you responsible for all of those times that my computer was miraculously fixed
And I wonder...
How many other people are as lucky as I am?
Not just lotto lucky, but four-leaf clover lucky!
I chuckle at those that have arguments about Christmas Ham vs. Christmas Turkey
And question why the vows were said
In the first place
Only to be broken at a later date.
Oh other one!
You (and your mistress) are one of the best things that has happened to me!
To those that can't see it, they must be blind
Or shrouded in pessimism.
Thank you for putting faith in my goals
Thank you for putting faith in me
Thank you for understanding
Thank you for putting up with Christmas time
Thank you for making super yummy shrimp
Thank you for re-arranging the bedroom for the eleventeenth time
Thank you for helping my family
Thank you for making family important
Thank you for loving me.
(Oh, and my stupid wireless access point is all fuggered up)
in high school.
"I hate you" were some of the first words
Only to be repeated back as if you were a mirror.
We moved on
One with an aspiring poison dart assassin to call her own
One with a somewhat colder mistress who spoke in bits, bytes, and GHz
Or was it MHz at that point?
I lost my assassin
You kept your mistress
One that I would learn to work around.
The winding and tortuous paths crossed
And we found each other in the murky soup of hormones and "indefinite groundings"
And almost lost each
Other to the Beastie Boys and their Girls.
But we made our paths stay together
You sacrificing your weekends to a town that held nothing for the both of us
Continually putting me and your family and friends ahead of your needs
O! Do I feel something serious beginning to develop?
Since then, there has been: 5 marriages, 3 divorces, 1 death, a variety of new and rotating siblings, 9 moves, 1 house, 2 dogs, 2 college degrees, and 4 cats.
You still have your same mistress
I have a new drug
One to rule them all.
That drug committed us both to a life that meant possible change
Every few years.
That drug made previously voiced goals a realization
Only for half of us.
The drug has ravished our lives
But has given us the solidarity to know that
Whatever life throws at us
Our paths are solid enough to laugh at the challenges.
It is mostly because of you
You pushed me when I could no longer pen down the 3 virtues that qualified me to gain entrance
It is your fault that I hold my schooling and goals to higher standards
You are to blame for the support that I get when I am in my fiery pit of ignorance
I hold you responsible for all of those times that my computer was miraculously fixed
And I wonder...
How many other people are as lucky as I am?
Not just lotto lucky, but four-leaf clover lucky!
I chuckle at those that have arguments about Christmas Ham vs. Christmas Turkey
And question why the vows were said
In the first place
Only to be broken at a later date.
Oh other one!
You (and your mistress) are one of the best things that has happened to me!
To those that can't see it, they must be blind
Or shrouded in pessimism.
Thank you for putting faith in my goals
Thank you for putting faith in me
Thank you for understanding
Thank you for putting up with Christmas time
Thank you for making super yummy shrimp
Thank you for re-arranging the bedroom for the eleventeenth time
Thank you for helping my family
Thank you for making family important
Thank you for loving me.
(Oh, and my stupid wireless access point is all fuggered up)
Slowing down
Is this really my third week in this rotation? It seems like it just started yesterday!
I feel like I haven't learned anything. The rational part of me knows this is not true. I have learned "loads" and I have "loads" yet to learn. However, I still feel useless. Well, honors useless. Yes, I really want honors in this rotation. I am just not sure how to get there. I start a presentation about a patient very strong, but then I hit a little snag and I feel like it all comes crashing down. I am burning in a fiery pit of my own ignorance. True, better ignorance than stupidity, but still.
I think that part of my problem is that I don't get a chance to work out my "brain" muscle outside of studying from books. At this stage, I am seeing a bunch of patients who are in for "follow up." What does this mean? It means that the new part of the care was established a while ago and the patient is in just to say how things are going. Most of the time, things are fine. What did I learn here? Nothing new.
I must emphasize, however, that those interactions are not losses at all. I get the chance to interact with patients and build on my communication skills with patients. General communication I have always had down pat. But paying attention to the little nuances that the people around you have is the golden ticket. That is one of the differences between good doctors and awesome doctors.
Gosh darn it though! I want to learn something new in the clinic! I am tired of learning all of the time through books.
The other problem is that I don't get a lot of time to interview a patient, digest the information and formulate a plan, and then present it to the attending. I would like a bit more time to figure out what is wrong with the patient before I have to present the info to the attending. However, I don't get that luxury in an outpatient setting. Patient appointments are set to 15 minutes each. That doesn't give me a lot of time. In the inpatient setting, I will get more time because I won't have as many patients (and I will be on call all night with "nothing" to do but study my patient and sleep).
Oh, and I start the "intense" part of this rotation next week. That means lots of hours and not as much down time. Should be interesting!
I feel like I haven't learned anything. The rational part of me knows this is not true. I have learned "loads" and I have "loads" yet to learn. However, I still feel useless. Well, honors useless. Yes, I really want honors in this rotation. I am just not sure how to get there. I start a presentation about a patient very strong, but then I hit a little snag and I feel like it all comes crashing down. I am burning in a fiery pit of my own ignorance. True, better ignorance than stupidity, but still.
I think that part of my problem is that I don't get a chance to work out my "brain" muscle outside of studying from books. At this stage, I am seeing a bunch of patients who are in for "follow up." What does this mean? It means that the new part of the care was established a while ago and the patient is in just to say how things are going. Most of the time, things are fine. What did I learn here? Nothing new.
I must emphasize, however, that those interactions are not losses at all. I get the chance to interact with patients and build on my communication skills with patients. General communication I have always had down pat. But paying attention to the little nuances that the people around you have is the golden ticket. That is one of the differences between good doctors and awesome doctors.
Gosh darn it though! I want to learn something new in the clinic! I am tired of learning all of the time through books.
The other problem is that I don't get a lot of time to interview a patient, digest the information and formulate a plan, and then present it to the attending. I would like a bit more time to figure out what is wrong with the patient before I have to present the info to the attending. However, I don't get that luxury in an outpatient setting. Patient appointments are set to 15 minutes each. That doesn't give me a lot of time. In the inpatient setting, I will get more time because I won't have as many patients (and I will be on call all night with "nothing" to do but study my patient and sleep).
Oh, and I start the "intense" part of this rotation next week. That means lots of hours and not as much down time. Should be interesting!
Thursday, July 17, 2008
A small percentage, a big problem (oh, and good news)
One of the most frustrating things in medicine are the tests that come back showing that a symptom can be one of two things. The first "thing" may be "sucky" but it won't kill you. The second "thing" is both "sucky" and can kill you. Hmmmm. There are diseases and situations in medicine that come up that are horrible to miss in a patient. An obvious example would be missing a heart attack in someone who shows up to the emergency room with chest pain. My example from today? A woman had sudden onset pleuritic chest pain, shortness of breath, and coughing. Later, she developed hemoptysis.
The two things at the top of my differential are: pneumonia (sucky) and pulmonary embolism (sucky and can kill you).
So, we order a chest xray. And what comes back? A pattern that could either be pneumonia or a pulmonary embolism. Sheesh. And, may I reiterate, missing a pulmonary embolism would be very ungood. The problem here is that the chance of pneumonia is MUCH higher than a pulmonary embolism. Statistically, this woman has a higher probability of having pneumonia. But since I can't rule out a pulmonary embolism, her higher probability isn't doing much for her right now.
I'll let you know what happens. The tests come back tomorrow.
Good news from me? I did pretty well on my USMLE Step 1. Not stellar, as in I won't get into plastic surgery (lucky for me I don't want to do face lifts all of the time). However, the score is pretty competitive. I wanted a 230.... But I got a 229. So close damn it! But, I am still happy with the score. Of course, a freaking 260 would have been awesome, but you know, not many people ever are able to score that high.
In case you are curious, below is a graph of fourth year students from 2007 who matched (matching just means that the students were placed into that specialty) into different fields and what their Step 1 scores were. The numbers on the graph represent the median score of those who matched into that specialty. The bars represent the two middle quartiles. The two extreme quartiles were excluded from the graph. (yes, the graph looks like crap... Click here for the link to the original .pdf that has the info. This graph is Chart 10 on page 11. Or, you can just click on the chart in this post and it will open in a new window as a bigger picture.)
I know that I DO NOT want to do plastic surgery, otolaryngology (anyone who knows me will know that this would be the LAST field I would EVER do), dermatology, radiation oncology, or radiology. I don't need to worry about those high scores... I am somewhat interested in orthopedic surgery, so that could be in the running.
Anywhoo, I should go off to slumberland.
The two things at the top of my differential are: pneumonia (sucky) and pulmonary embolism (sucky and can kill you).
So, we order a chest xray. And what comes back? A pattern that could either be pneumonia or a pulmonary embolism. Sheesh. And, may I reiterate, missing a pulmonary embolism would be very ungood. The problem here is that the chance of pneumonia is MUCH higher than a pulmonary embolism. Statistically, this woman has a higher probability of having pneumonia. But since I can't rule out a pulmonary embolism, her higher probability isn't doing much for her right now.
I'll let you know what happens. The tests come back tomorrow.
Good news from me? I did pretty well on my USMLE Step 1. Not stellar, as in I won't get into plastic surgery (lucky for me I don't want to do face lifts all of the time). However, the score is pretty competitive. I wanted a 230.... But I got a 229. So close damn it! But, I am still happy with the score. Of course, a freaking 260 would have been awesome, but you know, not many people ever are able to score that high.
In case you are curious, below is a graph of fourth year students from 2007 who matched (matching just means that the students were placed into that specialty) into different fields and what their Step 1 scores were. The numbers on the graph represent the median score of those who matched into that specialty. The bars represent the two middle quartiles. The two extreme quartiles were excluded from the graph. (yes, the graph looks like crap... Click here for the link to the original .pdf that has the info. This graph is Chart 10 on page 11. Or, you can just click on the chart in this post and it will open in a new window as a bigger picture.)
I know that I DO NOT want to do plastic surgery, otolaryngology (anyone who knows me will know that this would be the LAST field I would EVER do), dermatology, radiation oncology, or radiology. I don't need to worry about those high scores... I am somewhat interested in orthopedic surgery, so that could be in the running.
Anywhoo, I should go off to slumberland.
Tuesday, July 15, 2008
Nothing too new...
Today was another day. Not boring by any means, but just another day. I burned off two warts from a guy's arm (purposely). Exciting, yes. I know you are jealous! :D
Something that I have noticed today (more so than any other time) is the weirdness and sometimes frank offensiveness of medical terms. A common occurrence in my teaching here is talking about the patient, in front of the patient, but not actually talking to the patient. This happens only because the attending is trying to teach me something. This isn't the offensive part; the patient is warned that this is going to happen and invited to ask any questions that they would like. The offensive part is when the attending asks me to name a finding on a person. Here are some of the things that I have named/pointed out that I am sure caused some discomfort or at least wonder in the patient: buffalo hump, Cushingoid facies, moon facies, male-pattern balding (on a female), meaty appearance (of the genital area of a female with a yeast infection), and a few others...
I always hesitate when I have to answer these questions. I hesitate because I know that the answers might bother the patients. My concern for the patient then turns into my attending thinking that I don't know the answer because of my hesitation. Sheesh. They have been in the practice for so long that they just don't remember when things are weird. I hope I never get to that point. However, since I have seen many good doctors get to that point, it means that I have to shoot for being a great/excellent/awesome/super/cool/brilliant doctor.
No pressure.
Something that I have noticed today (more so than any other time) is the weirdness and sometimes frank offensiveness of medical terms. A common occurrence in my teaching here is talking about the patient, in front of the patient, but not actually talking to the patient. This happens only because the attending is trying to teach me something. This isn't the offensive part; the patient is warned that this is going to happen and invited to ask any questions that they would like. The offensive part is when the attending asks me to name a finding on a person. Here are some of the things that I have named/pointed out that I am sure caused some discomfort or at least wonder in the patient: buffalo hump, Cushingoid facies, moon facies, male-pattern balding (on a female), meaty appearance (of the genital area of a female with a yeast infection), and a few others...
I always hesitate when I have to answer these questions. I hesitate because I know that the answers might bother the patients. My concern for the patient then turns into my attending thinking that I don't know the answer because of my hesitation. Sheesh. They have been in the practice for so long that they just don't remember when things are weird. I hope I never get to that point. However, since I have seen many good doctors get to that point, it means that I have to shoot for being a great/excellent/awesome/super/cool/brilliant doctor.
No pressure.
Monday, July 14, 2008
The depressing side of medicine...
Sorry for the brief hiatus... No medicine on the weekend means that I have more time to spend with Mike and I don't really blog. :)
So, today. Hm. The beginning of the day was okay. I am still learning medicine (go figure) and am still really frustrated that I don't know everything (go figure). I did have a typical small town clinic experience today. Just about right when my attending and I were going to go to lunch (literally) the nurse comes back to tell us that a guy just walked into the clinic with chest pain and wanted to know if the doctor could see him (instead of taking the drive to the ER which is a ways away). Le sigh. Of course, we saw the guy. He wasn't having a heart attack, but it looks like he MIGHT have had a heart attack a long time ago that he didn't know about. So the attending and I used that to try and scare him into quitting smoking. :) Yes, scare tactics are used everywhere, especially in medicine. How many people are going to respond to, "You should really quit, it will harm your health?"
The depressing part of the day was after clinic was done with. I did a home visit with the doctor to a woman who will probably die in about a week. If that isn't bad enough... Her story is super sad. About 1.5 months ago, she showed up to the clinic because of shoulder pain. The attending sent her to get an MRI and it showed that she tore her rotator cuff. When the orthopedic surgeon went to operate, he found the cause of the tear. A bone tumor that had grown into the rotator cuff. (The person reading the MRI had missed the tumor, but that is a different story and a detail that doesn't really matter) After the surgery, the patient came back to the attending with lower back and hip pain. Guess what? She had tumors in her spine and hip. She got an xray. It showed a tumor in her lungs (probably small cell lung cancer -- if you were to pick lung cancers, you would not want this one.... survival is measured in months). This patient had an even worse prognosis because of all the places that the cancer traveled to (officially called "metastasis" of the tumor). She was walking just fine until about 2 weeks ago when she fell and broke her leg (due to a tumor in her leg). So, she is now bed ridden and will really probably die within a week.
This is sad. The only nice thing about this story is that for some reason this woman had setup her "health affairs" ahead of time. Even before she had shoulder pain. So, it made caring for her a lot easier. Her power of attorney was picked out... She had told her power of attorney general things that she would want. And the family was very supportive. It just makes me wonder why all families don't have their sh*t together like that. It is like our own mortality is a taboo subject. We all know we are going to die at some point, so why not try and make it easier for yourself and for those that will need to take care of you.
I think that some people believe that as soon as they sign a medical durable power of attorney (or just a power of attorney) form, they are handing over their control to someone else and admitting that they are going to die soon. That isn't the case! It is there for those instances that you can't predict and that you wouldn't be able to plan for (yes, I just used a double negative).
Argh!
So enough about death... I need to go study.
So, today. Hm. The beginning of the day was okay. I am still learning medicine (go figure) and am still really frustrated that I don't know everything (go figure). I did have a typical small town clinic experience today. Just about right when my attending and I were going to go to lunch (literally) the nurse comes back to tell us that a guy just walked into the clinic with chest pain and wanted to know if the doctor could see him (instead of taking the drive to the ER which is a ways away). Le sigh. Of course, we saw the guy. He wasn't having a heart attack, but it looks like he MIGHT have had a heart attack a long time ago that he didn't know about. So the attending and I used that to try and scare him into quitting smoking. :) Yes, scare tactics are used everywhere, especially in medicine. How many people are going to respond to, "You should really quit, it will harm your health?"
The depressing part of the day was after clinic was done with. I did a home visit with the doctor to a woman who will probably die in about a week. If that isn't bad enough... Her story is super sad. About 1.5 months ago, she showed up to the clinic because of shoulder pain. The attending sent her to get an MRI and it showed that she tore her rotator cuff. When the orthopedic surgeon went to operate, he found the cause of the tear. A bone tumor that had grown into the rotator cuff. (The person reading the MRI had missed the tumor, but that is a different story and a detail that doesn't really matter) After the surgery, the patient came back to the attending with lower back and hip pain. Guess what? She had tumors in her spine and hip. She got an xray. It showed a tumor in her lungs (probably small cell lung cancer -- if you were to pick lung cancers, you would not want this one.... survival is measured in months). This patient had an even worse prognosis because of all the places that the cancer traveled to (officially called "metastasis" of the tumor). She was walking just fine until about 2 weeks ago when she fell and broke her leg (due to a tumor in her leg). So, she is now bed ridden and will really probably die within a week.
This is sad. The only nice thing about this story is that for some reason this woman had setup her "health affairs" ahead of time. Even before she had shoulder pain. So, it made caring for her a lot easier. Her power of attorney was picked out... She had told her power of attorney general things that she would want. And the family was very supportive. It just makes me wonder why all families don't have their sh*t together like that. It is like our own mortality is a taboo subject. We all know we are going to die at some point, so why not try and make it easier for yourself and for those that will need to take care of you.
I think that some people believe that as soon as they sign a medical durable power of attorney (or just a power of attorney) form, they are handing over their control to someone else and admitting that they are going to die soon. That isn't the case! It is there for those instances that you can't predict and that you wouldn't be able to plan for (yes, I just used a double negative).
Argh!
So enough about death... I need to go study.
Thursday, July 10, 2008
Finally!
I have been put in my place!
I never knew I would be so excited about being knocked down.
It wasn't really all that bad anyways. So, basically what happened is that I started being pimped more by both the really important doctor and the regular doctor that I have been following. This doesn't really bother me because I am expecting pimping. However, this pimping resulted in me feeling two different things. One, stupidity (inadequacy as well). I feel like I should know these answers! And sometimes, I do know the answers but I don't say them because I don't think I am write, and yeah, I end up being correct. Two, more confidence. What?!? Yes, more confidence. They think that I have stuff down enough to even want to ask me about these diseases and processes.
I definitely showed my frustration with being pimped and not knowing the answer. I shouldn't have let it show though... We were in patients' rooms, which is normally how these things work. The doctor that I follow even asked me if I was frustrated with it later... I had to tell him that I was frustrated with myself because I didn't know the answer. For some reason, my brain seems to think that I should know all of the answers already, even though it is only my 4th day into the clerkship.
The nice part about today is that I got some cool feedback from both of them saying that they think I am definitely above average. :-0 Yay! I will take that for now... I am not yet honors level, but if I keep improving I might get there.
I never knew I would be so excited about being knocked down.
It wasn't really all that bad anyways. So, basically what happened is that I started being pimped more by both the really important doctor and the regular doctor that I have been following. This doesn't really bother me because I am expecting pimping. However, this pimping resulted in me feeling two different things. One, stupidity (inadequacy as well). I feel like I should know these answers! And sometimes, I do know the answers but I don't say them because I don't think I am write, and yeah, I end up being correct. Two, more confidence. What?!? Yes, more confidence. They think that I have stuff down enough to even want to ask me about these diseases and processes.
I definitely showed my frustration with being pimped and not knowing the answer. I shouldn't have let it show though... We were in patients' rooms, which is normally how these things work. The doctor that I follow even asked me if I was frustrated with it later... I had to tell him that I was frustrated with myself because I didn't know the answer. For some reason, my brain seems to think that I should know all of the answers already, even though it is only my 4th day into the clerkship.
The nice part about today is that I got some cool feedback from both of them saying that they think I am definitely above average. :-0 Yay! I will take that for now... I am not yet honors level, but if I keep improving I might get there.
Wednesday, July 9, 2008
Now I am a bit nervous
So.... Today went well, again. Seriously! I need something to go wrong (not horribly, just enough though) so that I can learn it really well. Or maybe I just think I need something to go wrong because that is just how I think things should happen. Who knows.
Today, another procedure! I helped remove skin tags from a woman's neck. Yes, all of these procedures aren't glamorous or super cool to write home about, but I keep doing them. The part that I like the most is that I am not as nervous doing them as I thought I would be. They tell me to help or do something, and I do it. I really do think that my lack of anxiety is due to their abundance of confidence in me. When I did my RUOP over summer, it felt like although Dr. Oley wanted me there, he didn't have confidence in any skills that I could have had or may have developed. In turn, that made me doubt what I could and could not do.
I had kind of a cool experience today... I was listening to this older gentleman's lungs (and by older, I mean 94) and I was pretty sure that I heard crackles at the base of both of his lungs. When I presented this information to the doctor I was with today, she listened to his lungs and said that she didn't hear any crackles. I then listened again with her stethoscope and pointed her to the exact place that I heard the crackles. She then agreed with me! That was soooo awesome! I am in no way bragging, but it is just nice to know that I wasn't imagining the crackles. :)
So, why am I nervous? I have to see patients with head of the UWMC General Internal Medicine Department. And, of course, they aren't just "normal" patients... Apparently, the clinic saves the really "complicated" patients for this guy. Great. Oh, and I am the only med school student here at this point, so I get all of his attention. Is that good? I will let you know later!
I am learning so much already. I am not sure how I can keep cramming all of this information into my head! I have 11.5 more weeks of this rotation!
Today, another procedure! I helped remove skin tags from a woman's neck. Yes, all of these procedures aren't glamorous or super cool to write home about, but I keep doing them. The part that I like the most is that I am not as nervous doing them as I thought I would be. They tell me to help or do something, and I do it. I really do think that my lack of anxiety is due to their abundance of confidence in me. When I did my RUOP over summer, it felt like although Dr. Oley wanted me there, he didn't have confidence in any skills that I could have had or may have developed. In turn, that made me doubt what I could and could not do.
I had kind of a cool experience today... I was listening to this older gentleman's lungs (and by older, I mean 94) and I was pretty sure that I heard crackles at the base of both of his lungs. When I presented this information to the doctor I was with today, she listened to his lungs and said that she didn't hear any crackles. I then listened again with her stethoscope and pointed her to the exact place that I heard the crackles. She then agreed with me! That was soooo awesome! I am in no way bragging, but it is just nice to know that I wasn't imagining the crackles. :)
So, why am I nervous? I have to see patients with head of the UWMC General Internal Medicine Department. And, of course, they aren't just "normal" patients... Apparently, the clinic saves the really "complicated" patients for this guy. Great. Oh, and I am the only med school student here at this point, so I get all of his attention. Is that good? I will let you know later!
I am learning so much already. I am not sure how I can keep cramming all of this information into my head! I have 11.5 more weeks of this rotation!
Tuesday, July 8, 2008
Another day, another procedure
Today was pretty cool, again.
I am just waiting for this bubble to burst. I mean, I need to really mess up soon, don't I?
I got to do/help with two procedures. In the first, I did sutures on a person's finger. The last time I did sutures was about 1.5 years ago on a dead pig's foot. It is amazing how similar this guy's skin was to a dead pig's... Not exactly sure what that means, but there you have it. The sutures weren't the best, but there were only two and it was on his finger. Also, this guy didn't really mind what was going on. He apparently has had over 700 stitches throughout his lifetime. It was a good first suture patient. :)
The second procedure was to help remove a little skin tag from the inside of a woman's nose. I injected the lidocaine solution to numb up the area and then the doctor removed the skin tag. That was an odd location.
I also got to see my first patient that had a new problem that was quite possibly very serious. It seems like he was in the beginning of congestive heart failure. Unfortunately, I will not be a part of any final diagnosis this guy has because it will be made by a cardiologist. It was disturbing to me to realize what this patient probably has and what his course might be like. It is not disturbing to me because of the physical course of the disease, it is disturbing because I actually had the knowledge to be able to make the possible diagnosis.
One of the other highlights of today was a patient who thanked me for my caring attitude. She also said that she "knew" I was going to be a good doctor because I actually was listening to her. She told me not to lose that art (active listening) and that she wished me good luck in the remainder of my schooling. I really wished that I could fold her up and stash her away in my pocket for the day sometime in the future where I make a mistake and wonder what the heck I was doing.
I am still continually being amazed at how much I learned over the past two years. What keeps happening is that I feel like I won't know a diagnosis or the name of a certain feature, but when I am told what it is, the information is dredged up out of the recesses of my mind and dusted off. It turns out that I have been exposed to (in at least a verbal manner) many of my daily encounters. I didn't remember them, however, because I didn't have an experience to tie the name to (like a patient encounter). Now that I am seeing patients, the names are sticking soooo much better!
I am just waiting for this bubble to burst. I mean, I need to really mess up soon, don't I?
I got to do/help with two procedures. In the first, I did sutures on a person's finger. The last time I did sutures was about 1.5 years ago on a dead pig's foot. It is amazing how similar this guy's skin was to a dead pig's... Not exactly sure what that means, but there you have it. The sutures weren't the best, but there were only two and it was on his finger. Also, this guy didn't really mind what was going on. He apparently has had over 700 stitches throughout his lifetime. It was a good first suture patient. :)
The second procedure was to help remove a little skin tag from the inside of a woman's nose. I injected the lidocaine solution to numb up the area and then the doctor removed the skin tag. That was an odd location.
I also got to see my first patient that had a new problem that was quite possibly very serious. It seems like he was in the beginning of congestive heart failure. Unfortunately, I will not be a part of any final diagnosis this guy has because it will be made by a cardiologist. It was disturbing to me to realize what this patient probably has and what his course might be like. It is not disturbing to me because of the physical course of the disease, it is disturbing because I actually had the knowledge to be able to make the possible diagnosis.
One of the other highlights of today was a patient who thanked me for my caring attitude. She also said that she "knew" I was going to be a good doctor because I actually was listening to her. She told me not to lose that art (active listening) and that she wished me good luck in the remainder of my schooling. I really wished that I could fold her up and stash her away in my pocket for the day sometime in the future where I make a mistake and wonder what the heck I was doing.
I am still continually being amazed at how much I learned over the past two years. What keeps happening is that I feel like I won't know a diagnosis or the name of a certain feature, but when I am told what it is, the information is dredged up out of the recesses of my mind and dusted off. It turns out that I have been exposed to (in at least a verbal manner) many of my daily encounters. I didn't remember them, however, because I didn't have an experience to tie the name to (like a patient encounter). Now that I am seeing patients, the names are sticking soooo much better!
Monday, July 7, 2008
My first day...
...wasn't all that bad!
But, I don't want to get ahead of myself. I went pretty slowly, I only saw 5 patients. Some of the patients that I saw didn't have anything wrong with them, so talking with them and updating their records was a bit easy.
I did get to help in a procedure though! I helped remove someone's in-grown toenail. Yes, you may laugh, but I finally got to do something. :)
This is definitely a different experience from my RUOP. At my RUOP, if a patient didn't want to see me, I didn't get to see them. In this situation, I am introduced as the person that is going to talk with the patient first, without question. Of course, the patient is never seen by only me at this stage. So the only thing that the patient has to endure is telling their story about 1.5x.
I am also getting things right at this site. Of course, not everything, but there were a few times that I was able to answer a question that the doctor didn't think I would know. That gave me the warm and fuzzy feeling.
I also am realizing where I falter in confidence. There were 2 times today that I had the correct diagnosis, but I didn't think that it would be it (only because I was questioning myself). And, it turned out, I was correct. So frustrating! I guess that I am so worried that I will be labeled as arrogant and egotistical that I am pushed into the other direction of seeming like I am just not sure of myself and that I have to make apologies for everything that I do.
I should work on that.
My favorite patient of the day was actually my first patient. He came in with his wife because he fell asleep while driving and they were trying to figure out why (It is slightly more complicated than that but I can't really go into the details, of course). When he was informed that he was my first patient as a 3rd year medical student, he genuinely seemed interested in how I was doing and he was happy to be a part of my education. Are you kidding? I am about to put him through questioning twice, be all nervous in front of him, and give him an awkward physical exam but yet he was still happy to be a part of it all.
I LOVE working with patients! This is why I went into medical school. After the hell, otherwise known as second year, that I went through, I am reminded what I signed up for. I only hope that I don't lose that excitement.
But, I don't want to get ahead of myself. I went pretty slowly, I only saw 5 patients. Some of the patients that I saw didn't have anything wrong with them, so talking with them and updating their records was a bit easy.
I did get to help in a procedure though! I helped remove someone's in-grown toenail. Yes, you may laugh, but I finally got to do something. :)
This is definitely a different experience from my RUOP. At my RUOP, if a patient didn't want to see me, I didn't get to see them. In this situation, I am introduced as the person that is going to talk with the patient first, without question. Of course, the patient is never seen by only me at this stage. So the only thing that the patient has to endure is telling their story about 1.5x.
I am also getting things right at this site. Of course, not everything, but there were a few times that I was able to answer a question that the doctor didn't think I would know. That gave me the warm and fuzzy feeling.
I also am realizing where I falter in confidence. There were 2 times today that I had the correct diagnosis, but I didn't think that it would be it (only because I was questioning myself). And, it turned out, I was correct. So frustrating! I guess that I am so worried that I will be labeled as arrogant and egotistical that I am pushed into the other direction of seeming like I am just not sure of myself and that I have to make apologies for everything that I do.
I should work on that.
My favorite patient of the day was actually my first patient. He came in with his wife because he fell asleep while driving and they were trying to figure out why (It is slightly more complicated than that but I can't really go into the details, of course). When he was informed that he was my first patient as a 3rd year medical student, he genuinely seemed interested in how I was doing and he was happy to be a part of my education. Are you kidding? I am about to put him through questioning twice, be all nervous in front of him, and give him an awkward physical exam but yet he was still happy to be a part of it all.
I LOVE working with patients! This is why I went into medical school. After the hell, otherwise known as second year, that I went through, I am reminded what I signed up for. I only hope that I don't lose that excitement.
Sunday, July 6, 2008
The beginning of the adventure...
So. I am here. I am in Montesano, WA about 1 block from the local correctional facility. A sign?
Nothing much has happened since I arrived (shocking, I know). I am nervous, excited, sad that I am not at home, hoping that I do well, hoping that I at least "don't suck," and wondering why I feel so incredibly unprepared when all I have done for the past two years is be in class.
Would you like a tour of the house I am in? You would?! Awww, shucks. I just happened to have taken pictures.
Yea.... I was going to put the photos in this blog and write captions, but then what would I do with my Flickr account? :)
A more substantial and interesting post will probably be made tomorrow.
Nothing much has happened since I arrived (shocking, I know). I am nervous, excited, sad that I am not at home, hoping that I do well, hoping that I at least "don't suck," and wondering why I feel so incredibly unprepared when all I have done for the past two years is be in class.
Would you like a tour of the house I am in? You would?! Awww, shucks. I just happened to have taken pictures.
Yea.... I was going to put the photos in this blog and write captions, but then what would I do with my Flickr account? :)
A more substantial and interesting post will probably be made tomorrow.
I leave today
Let me start by saying that this won't be updated all that much.
There. I set the bar incredibly low.
Whew.
I have grandiose ideas of how often I will update this blog, but you know, life gets in the way sometimes. That life will actually be the whole point of this blog (I see a vicious circle coming on).
I want to use this blog to keep my friends and family updated on how my third year of medical school goes. I will not be able to call or email all of you as often as I would like, so this is a token offering.
There. I set the bar incredibly low.
Whew.
I have grandiose ideas of how often I will update this blog, but you know, life gets in the way sometimes. That life will actually be the whole point of this blog (I see a vicious circle coming on).
I want to use this blog to keep my friends and family updated on how my third year of medical school goes. I will not be able to call or email all of you as often as I would like, so this is a token offering.
Subscribe to:
Posts (Atom)
