September 21, 2006

• Just like a real doctor

  Today was my first preceptorship visit. as a first year medical
  student, I learned the basics of taking a history and doing a physical
  exam-The different parts of each and the write up, what is included in
  each exam and techniques for doing it, all that jazz. At the end of the
  year, all the students took a full history and did a write up on a
  standardized patient. The standardized patient is an actor who knows
  what we should be doing and can correct us and give us feedback at the
  end of the exam given on campus in our practice clinical rooms

  M2
  year, not so much Each student is assigned to a random hospital,
  doctor, and specialty to shadow the physician for a certain number of
  visits. At each visit, we are expected to do a full workup of a patient
  including taking the history and physical and writing it up, and then
  present it to our preceptor for feedback and correction. Unlike first
  year, not only do the patients have actual things wrong with them, but
  they have no clue what we should be asking them or if what we are doing
  is correct. This means that I am back to the sink or swim immersion
  theory of learning. The department i was assigned to is ER, one of the
  fields i am potentially interested in going into.

  Met the doctor
  and some of the staff, got teased for not having my white coat buttoned
  up all the way, tying my tie sloppy, forgetting my stethoscope (the
  last one may have been just ribbing of the new guy, but i still felt
  guilty about that one) and then got to work. Followed the doctor
  (hereafter referred to as Dr. B) around to see some patients

  Dr
  B taught me that ER physicians have to be pessimistic detectives. ER
  has so many patients that the first concern when doing a history is to
  find out if they have anything life threatening- heart attack, stroke,
  hypoglycemic or hypertensive crisis, etc. and to try and rule those out
  first.

  One patient was anemic with a HGB of 8 (normal should be
  around 13) and vaginal bleeding and pain with a mass in the inguinal
  node. After looking at a chart for previous admits, Dr B suspected it
  was a flare up of previous cervical cancer, and did a pap smear and
  ordered a cbc

  Another patient had stomach pains and lower left
  quadrant tenderness. At this point Dr B asked me to start thinking of
  differentials looking at the chart before we had even seen the patient
  (AND I even came up with possible answers!-they were WRONG, but i had
  something ready which could have been right, so yay me)-i thought it
  could be due to appendicitis, or pancreatitis-it ended up being a
  probably case of food poisoning

  Yet another patient was a mother
  and fther who brought in their child to the er for crying. That’s it.
  crying. ER accepts everyone. The couple spoke very little english and
  while i had to struggle to remember vocab, i could understand what they
  were saying and translate it well enough that Dr. B did not have to
  call for a translator. BTW, orinar is the verb for to urinate-kinda
  puts a whole new spin on that enya song orinoco flow, doesn’t it?
  Anyway, this being their first child the parents were just concerned
  and overreacted to a normal baby reaction of crying, something i am
  sure i would have done in their place as well

  One patient was a
  frequent flier, meaning someone who often visits the ER. He was drunk
  with a BAC of 427 over 5 times the legal limit. His huge alcohol
  consumption had also led him to hypoglycemia with a level of 28 (normal
  is around 100 or so) Both of those things made him extremely hard to
  wake up, so the nurses and other docs tried different method like
  calling his name, doing a brachial pinch (painful stimulation) sternal
  rub (really painful), and waving ammonia under his nose (stinky, but
  not painful). None worked…this guy was out cold. He was lucky a
  family member found him passed out in time to get him to the ER, and
  sadly he will probably die one day when he is not found in time.

  After
  we received each chart, but before we met the patient, Dr B would ask
  me what things i thought the patient might have, and after meeting the
  patient, he would ask about what lab tests we should order. Basically
  he treated me like a first year resident, trying to pimp me out for
  anwers-to which i mentally reply “pimp away Dr B. See this street
  corner? see this vinyl miniskirt? want a date?”

  While i would
  rarely get the entire answer, i could usually figure out some, and he
  would then provide me with the rest. The times i was at a loss for info
  just make me that much more determined to study up and be more prepared
  for the next time i go in. It ought to be an interesting year

  -J

  • 12:26 am
  • 3 Comments