July 20, 2007

• Clerking my way back to you babe

  While I have not finished the spain postings yet (and given my track record of pic posting, who knows when i will) I figured that those of you in the non medical fields might be curious as to what exactly I am doing with my third year of medical training.

  Quick background: medical students do two years of classroom work (known as pre-clinical), then take a really freaking hard 8-hour test (known as “The Boards” or “Step One”, to which i will recieve my scores this week…eep!). Then we spend our next two years working in the hospital in different specialties, seeing which ones we like, which we don’t, and trying to get exposure to that which is actually medicine, all in time to finally choose what kind of doctor we want to be by 4th year. So when you ask your med school friends, this question and they look at you blankly, that is why…most of us will have no clue til we have had some exposure.

  I am currently in the 3rd week of my medical rotation, but let me back up a bit to before my first day. I’ve reviewed how to talk to and get information from a patient (called “taking a history”) and examining a patient (called “examining a patient”).  I wake up early (”early” still means about 6am, ha!), shower, get dressed, and walk over to my hospital where I’ll spend the next 2 months.

  I meet my team, which consists of a an attending, 2 senior residents, 4 junior residents (called interns), and myself. My team is awesome and happy to have the opportunities to interact with and teach me as a medical student, and also quite forgiving of the fact that i really do know nothing at this point. Other students teams may not be the same, but in this particular gamble, i came up sevens. So how does my knowledge measure up? After 2 years, nay a lifetime of preparing myself for this, what happens when i am actually transplanted into the hospitals as a doc to be?

  You’re really, I mean really, just thrown in there. You finish second year taking your boards, and you think you’ve got medicine down pat. You know what every drug does and what it treats, you know how every disease process works. And then you get into clinics, and you’re immediately humbled. You know nothing. There are new acronyms, strange new drug names, new locations, new computer systems, and new people. But to everyone else, it’s totally normal. You’re already playing catch-up. Not to mention a lot of what you studied you may have already forgotten just from sheer information overload

  You don’t want to seem like an idiot, but you’re also excited and inquisitive. But you don’t want to be annoying, either. Your team isn’t just your team, it’s also people that are evaluating you, and trying to feel you out to see what kind of a team member you’re going to be. So you ask questions about things you’ve never ever heard of, and take notes to try to look up the rest later. You learn to mutter questions quietly and secretly to nurses and your interns, who will probably help you out (and aren’t really evaluating you as critically): they just finished medical school 3 weeks ago, so it’s easiest for them to remember where you’re at.

  Real medicine is very different from ideal medicine. You’re supposed to give everyone a full check-up, look in their eyes, ears, and nose, and feel for their thyroid, but who has time for that? And different specialties want different things. Medical residents are obsessed with every minor detail and the corresponding train of chain reactions that led to it. Stomach hurting? when did it start? how long did it lasst? what were you doing when it started? stopped? anything make it better or worse? has this happened before? what did you do for it then? how would you classify the pain. Are you taking any drugs for it? Which ones? I am sure that i i were to check back through the history books, all the great interrogators from the spanish inquistion up to the folks at guantanamo had some basic medical training, because you learn to pull info out of people they didnt even realize they knew.

  Feeling stupid makes you learn quickly, which is one reason I’m usually not too distraught when I get an answer wrong: I know it’ll be locked into my head from that point on. At the same time, “don’t get sick in July” is just way too true. Your doctors won’t be as quick to get a diagnosis, and your sutures won’t be as straight. Everyone’s supervised by multiple people, but July is usually especially hectic. You get a flood of new medical students, newly-graduated doctors, new residents, and new official attendings. Everyone’s trying to figure everything out, and it can be difficult.

  So what is a typical day for me? I wake up head to the hospital and pre-round on my patients by 8am. Checking how they did during the night, if anything changed, and all that jazz. I usually have about 2-3 patients to follow up on and write my notes. Then comes morning conference, where the different teams gather and a couple cases (interesting patient stories, or perhaps just routine adminssions) are presented to the chiefs of medicine and discussion ensues about what was done or should be, or teaching points. After that, we go round on the floors, visiting each patient our team is responsible for, and presenting the case to the attending, who will then go in and spend about 5 minutes with the patient, teaching us and checking up on the exam. This is followed by noon conference, where some topic is presented on, and sometimes we are provided lunch by drug reps. More on that another post. Then i might have a lecture again at 1, or if not, i just go see all my patients again, finish writing up my notes and orders and get home, where i go to the gym, study, eat dinner, and turn in by around 10pm

  I’m incredibly exhausted, but incredibly happy. I’ve really started to get the hang of this whole clerkships thing (so far, at least), and it’s been a really amazing experience to see many of our patients go from the ER to the wards to being discharged.

  So there is the intro..more thoughts to come later

  -J

  • 12:18 pm
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