Archive for August, 2007

The Telephone Game

I never realized who absolutely critical communication is in the medical world.  PAtient charts are one way for all the folks involved in a patient’s care to communicate, but recording takes time and sometimes notes are not as thorough or legible as one would like.  Then there is the EMR (electronic medical record) that sometimes has more information than you want and you have to sift through the plethora.

Lastly, there is verbal communication.  This is the part that troubles me.  Doctors have very good memories.  That is how they managed to make it through medical school.  However, as they get more experienced and more busy, they tend to have selective memories, brushing off that which seems insignificant and emphasizing that which is imminent, but may not be directly relevant.  I get frustrated because on one side where the doctors SAY they appreciate me as a students because I ask silly, naive questions about a patient that may be important and I do extensive research into a patient’s history.  However, I get brushed off and bulldozed whenever I bring these questions or findings up in conversation.  OR they take what I’ve told them and run with it when I was simply asking about it, not thinking it was important and then they blow it out of proportion!  Maybe it is important, but I talk to then about it out of the context in which it was found and if they had found the SAME information in the SAME place, but because of their experience, would they have treated that information differently?

I abhor the neglect of patients in the medical world.

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Depends what you mean by “success”

This is a topic that puzzled me from day one in medical school.  Although I now understand the thrill a little bit more, it is a troubling oxymoron.

The topic I am speaking of is academic/student success versus patient success.  My fellow classmates used to talk about “cool” cases they saw in the emergency room or a lecturer would present an “interesting” case study.  While these cases were fascinating to me, I was troubled by the enthusiasm medical students showed regarding a dissecting aortic aneurysm or subacute subdural bleed presenting as acute mental status change.  These cases were actual people in extreme distress.

Over the last couple of weeks I’ve seen some amazing pathology: primary cholangiocarcinoma with hemobilia, peripheral blood smear of chronic lymphocytic leukemia w/ schistocytes, nucleated RBCs and lymphoblasts, and today meningoencephalitis with severe mental status changes.  All this “fascinating” pathology has with it an associated human and all the humiliations hospitals bring: foley catheters, stupid little johnny’s, having to squeeze into a small MRI machine, IV lines and audiences during a physical exam.

The issue for me is that I actually have moments of joy/excitement when I put clinical presentation and pathology together to make a coherent picture.  It’s even more exciting when I remember learning about these subjects in a far-removed lecture hall.  Now I’m seeing it, in the flesh with all the complications and obligations: keeping the family informed enough, but not terrified, getting consults, lab results, writing up the H&P and admission orders.  The burdens of real-life readily extinguish the delight I felt, but it was there nonetheless.  I feel a twinge of guilt, but I also feel a twinge of relief because there is some excitement within me regarding medicine.  Enough excitement to help carry me through when I mourn the lack of Osteopathy in patient care.

Although it is rather ironic that Dr. Still lost 3 children to meningitis and today I saw my first acute case…

Isolations

Here’s the female “response” to the male hip hop isolations/popping!  😛

Comfortable Fit

Today I learned an incredible amount working with one patient AND I watched an endoscopy!  I made phone calls, confirmed a surgical appointment,  changed medications and wrote an excellent progress report if I do say so myself.  It is my 5th day on my Internal Medicine rotation and I already like a doctor.  Taking care of other people suits me.  When I have to take of other people, my self care falls in line.  I’m jogging in the morning, eating healthy foods (veggies and stuff), talking to friends on the phone or through email and now it is time for me to go to sleep!  😛

We’ll see how chipper I am after being on-call tomorrow night…

Lost in the Cracks

Wow.  It is no wonder that so many people get hurt at hospitals!   There are too many people taking care of them during short segments of time.

I have enjoyed my self-directed studies because my patient(s) may have a certain condition (chronic renal failure) and then I find myself falling down the rabbit hole of information: What does the BUN and Cr mean again?  What drugs will make it worse?  What are the sxs of ESRD?

Sorry about the abbreviations and acronyms.  My life is an acronym to make it more efficient.

Play the game

I survived my first week of my 3rd year rotations.  I was able to touch base with some of the DO residents, which was marvelous, even though they complained most of the time.  One more week of MD residents and I’ll have a couple of DO’s to work with for 4 weeks.

I did some gentle OMT on a patient I’ve been following.  It was exhilirating and terrifying to come up with my own diagnosis and treatment plan, then ask for permission to do it.  Not sure how much of a change I made, but the patient felt more relaxed after I was done.  I was proud to have jumped without any help.

Otherwise, my 2nd day, night on-call and 3rd half day of rotations consisted of me being stuck regarding what I was supposed to do, what I actually did, what I had to write in the chart and what I could tell the patient.  It was absolute chaos.  And I get to do more TOMORROW!  Yeah.  At least Tues I can go to Augusta for student didactics and OMT with C (Dr. P) from 3-5pm, not to mention exchange notes with the other students about how their rotations are going.  K (my roommate) has already helped deliver 4 babies and found a mentor who took her under her wing; buying food for her, guiding her studies and inviting her over for dinner last night.  Yeah, I’m jealous.

Empty

A beautiful Sunday afternoon and I find myself driving, searching for the rain and the clouds and the darkness.  I want to be covered, enclosed.  I want to disappear.  My center is hollow and my chest wall is caving in.  I drove in a circle, found where the rain had been, but never felt a drop of the rain.  It even rained at my house while I was gone.

Holy Overwhelming

Not only was it my first day learning about a world I don’t belong in, butI also managed to start my period today too.  Lovely.  Want some cramps with that stress?

And I miss DO’s.  I’m in the Maine-Dartmouth Family Practice Residency program (as a student), so most of the MD’s I work with are from Dartmouth.  Great folks, just not Osteopaths.  Even if DO’s don’t do manipulation, at least they know what it is and would be able to discuss it with me.  My residents didn’t have a problem with me doing an Osteopathic Structural Exam, but they had no way to help me.  This feeling is striking to the core of my dilemma.  I don’t mind learning the medicine, but I want to learn it WITH the osteopathic perspective.  Anything Osteopathic that I do has to be all self-initiated (like most of my education from here on out), but it will also only be appreciated by me.  And what if I try to bring up the possibility that somatic dysfunction could be exacerbate the patient’s condition?  There’s no one to tell me (knowledgable) that I’m full of shit or that I’m right on.  And who’s going to show me how to go about treating the dysfunction and what to consider?

I feel so alone.

Orientation complete

Well, the general orientation in Augusta is complete.  Tomorrow I head up to Waterville and begin working with people I don’t know, doing tasks I haven’t done and learning what I haven’t been taught.  Thursday I’m going to be on-call!   I’m already tired.  I guess I’m going to have to get used to this feeling and be able to function regardless.

What did I get myself in to?

1st day: Orientation

First day was a success.  We received binders with all the sentinel articles related to the topics of our rotations and the recommended textbook, keys, folders with more papers, pagers and free lunch.  I can’t believe I have a pager.  And I’m one of two students on the internal medicine rotation, which is the only rotation that really uses pagers.   I’m psyched to be on IM first because it is the big gunner, running at 12 weeks compared to all the other rotations of 6 weeks.  It sounds intense, overwhelming and I will probably cry a lot, BUT it sounds like it will prepare me well for all my other rotations!

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