June 28, 2013

patience with the patient.

I've just finished week 4 of my first family medicine rotation. Only 2 weeks to go!

There really isn't much to say in terms of what all I've been doing and seeing... I'm still observing A LOT and still seeing a lot of diabetes, COPD, hypertension, back pain, etc. Kind of disappointed I haven't been able to do more, but such is life.

One thing that has been nagging at me is my attitude toward this rotation. One thing that I really looked forward to was being able to assess a patient's condition (by asking questions and performing a physical exam) and formulate my own assessment and plan. Although I already do that in my head, I was hoping for more opportunities to present my ideas to my preceptor (which I don't get to do often). I was also hoping to get "pimped" a lot on all the common things that I will see in primary care (pimping is when the preceptor asks tons of questions in a row and essentially makes you feel like an idiot). This also does not happen often. So I'm kind of bummed, but whatever.

Another thing that I really need to work on is patience. Now, I don't really show when I'm impatient, but I definitely feel it a lot. In particular, I am very quick to judge and become suspicious of patients who need pain meds. In my head, THEY ARE ALL DRUG SEEKERS. Or people that just complain all the time about everything. They come in with aches and pains all over. 
Do you have headaches? "Oh yes I get migraines all the time." 
Okay, well have you been feeling tired? "I can't seem to stay awake!"
Do you have any numbness or tingling in your legs? "Both of my feet are numb right now."
...Alright, well do you have any back pain? "I've had back pain since my slipped disk 10 years ago."
Suspicion, suspicion, suspicion.
But really they're just people with vague complaints that want some relief.

As a health care provider, it's so important to lay those prejudices, judgments, and suspicions aside and treat all patients with the respect and care that they deserve. It's our job. It's our job to take a person's vague complaint and turn it into a diagnosis. People really do have problems and they really do need our help. Some people really do need percocet and vicodin. Pain is real. Sometimes it really seems like people are faking because sometimes things don't quite line up as they should, but that's medicine. Patients are different and medicine is variable. It would be unacceptable to turn a patient away because of suspicion when they really do need our help. So, I'm working on that.

I'm also working on getting ready to go to ALASKA! Woo! I'm going to be in Juneau for a 5-week family medicine rotation. So pumped. Mountains, glaciers, hiking, kayaking, whales, exploring the beaches and downtown, working in the clinics, and so on. Alaska is going to be fantastic. The only downer is that I'm going to be alone a lot of the time. So, if anyone knows people in Juneau that will go exploring with me, call them up right now! I'm so desperate for a hiking buddy that I've even gone to the extremes of couchsurfing.com. No kidding. But companion or no companion, I'm sure I'll still have a great time.

Alright, well that's pretty much all I have to say for now! Thanks for being "patient" with another long post. I promise I'll try to keep it shorter next time!

June 20, 2013

3 weeks late...oops.

A little late, but I'm finally posting something!

So, I started my first clinical almost 3 weeks ago. I'm currently in Coshocton, Ohio for my family medicine rotation. If I could describe my experience in three words, they would be diabetes, hypertension, anxiety. Pretty much EVERYONE I see has at least one of these if not all. Oh and COPD. Everyone smokes! 

I'm currently at two clinics and following three preceptors. They are all very young and currently working their first real jobs. Two are medical doctors. One is particularly interested in internal medicine, and the other did a fellowship in sports medicine. Then I'm also following a nurse practitioner. It is interesting for me to see the differences in the way all three of these preceptors practice, even when they are all so young. Some are a lot more conservative in their management, while others are not.

Since this is my first rotation, I'm still mostly observing and trying to soak everything up. A lot of the appointments I see are to manage chronic conditions, so they consist of medication changes/refills, lab work follow-ups, and stuff like that. A lot of zoloft, a lot of percocet, a lot of insulin being prescribed on a daily basis. Many patients may walk out of the office with 3-4 new prescriptions in hand. It's insane. Every once and awhile I will get to go into a room myself and ask the patient questions and perform a quick exam. I've correctly diagnosed a few patients, so I'm pleased with that! But more often than not, I don't quite know what exactly is going on with the patient. Hence, the reason why the clinical year is a learning experience! I've also been able to assist in a few things, like knee injections, skin lesion removals, and I've even done a few pap smears on my own. Call me nerdy, but I love it all!

Most of what I have learned so far during this rotation is not necessarily medical knowledge, but rather practical knowledge that will help me be a better provider to the patients. Putting the patient first can be difficult at times because a lot of times you're just thinking about trying to fix the problem when you should be dealing with the patient as a whole. Every patient is different, so the listening part is really important. But it can be so hard though, because a lot of patients will literally talk your ears off! But I think forming that relationship is very important, especially in family medicine because you're managing chronic conditions, and essentially, a person's life.

When I'm not at the clinic, I'm studying, or trying really hard (or not so hard) to finish assignments and study. There was a point in time where I thought, "Oh, I'll have a ton of free time during clinicals to read books and what not!" NOT TRUE. Although I have spent a lot of time watching Grey's Anatomy. Oops.

Overall, this has been a good rotation. It started off slow, but has been getting better as time goes by. I'm just trying to make the most of the experience and get what I can out of it. I'm sure all of my rotations will have something different to offer that will be beneficial to my career :) Well, that's it for now! Props to you if you made it all the way to this point! I will try to write more often so they are not as long!