This is how lame I am
by fiona
So we are supposed to do this project. There is no formal exam at the end of this, my rural primary care rotation, but instead we have a community project. This is supposedly something that we will have worked on for the entirety of our stay in ruraltown, USA, and should reflect our investigation into the complexities of rural medicine while at the same time actively contributing something to the community.
People in the past have studied domestic violence and come up with a resource guide for patients. They have surveyed patients about the use of complimentary and alternative medicine. I recently ran into a friend who honestly organized a focus group at the local high school to address the high rate of teen pregnancy in that county.
So what fabulous project am I doing? What contribution will I be offering to the community of Astoria, Oregon? Well, I'll tell you. It is honestly the lamest, incomprehensibly boring, pointless endeavour that this program has ever known. My project consists of me pulling patient charts in my clinic and analyzing a lot of stupid lab numbers to assess how well patients'diabetic follow up care complies to national recommendations. It is awful. I was in the clinic til 11 pm the other night flipping through charts and writing down numbers. It is embarassing. It makes me feel bad. I get a sinking feeling when I think about presenting this project to a panel and getting graded on it.
Why couldn't I have just made a brochure about resources for alcohol treatment? Or done an assessment of gun safety? Or investigated contraceptive availability for young people? Well, because those things take time and effort and foresight and are incompatible with the laziness and procrastination that seem to be the hallmark of my completely un-motivated life. Very very lame. Ugh.
Posted on November 12, 2005 | Comments (2)
This is how awesome I am
by fiona
Sometimes my preceptor likes to pull me into patients' rooms and say things like, "Take a listen to Ms. Larson's heart and tell me what you think" or "have a look at little Timmy's rash and give me the diagnosis." These sorts of questions usually result in me performing an akwardly long exam in front of everyone and then saying, sheepishly, "is there a murmur?" Luckily, I have gained a local reputation for being *bad at murmurs* so I never know whether she is trying to trick me into saying that I hear a heart murmur that isn't actually there. And when it is there, and I do hear it (which means that the patient's deaf grandma could probably hear it from across the room), I usually can't pick up on the subtleties. Like once I was all proud and said, "Dr. M, it sounds like a holosystolic murmur." And she was like, "Well, its more of a crescendo murmur. Did you hear the diastolic component?" And I was all, "uh, no." And then I listened again and still couldn't hear it.
But enough! I come here to tell a story of triumph!
The other day, she pulled me into a patient's room and told me that she had a congenital condition with some specific exam findings. I was to observe the physical exam and come up with a diagnosis. And I sat back and observed as she began to look in the ears of this very nice patient, who had something a little wrong with their posture and limb positioning. And as she moved to the eye exam, suddenly I saw it: a slight blue discoloration to her sclera (aka the whites of her eyes). "I know!" I gasped. "Osteogenesis imperfecta!" And I was right.
Osteogenesis imperfecta is a disease characterized by brittle bones that break easily and frequently, often leading to physical deformities and deafness. Kind of like Samuel L. Jackson's character in the movie Unbreakable. The hallmark of the condition, the thing that you learn in medical school, is that the whites of their eyes are blue. It was kind of exciting to actually see this disease.
It was a disease that once formed a very minor and very stupid sideplot on the only episode that I ever saw of a very awful circa-2004 medical drama called Medical Investigations. Also known in some circles as Poop Investigations. This inane sideplot involved a young novice investigator stealing the national stealth investigator helicopter and traveling thousands of miles to a hospital where the parents of a young girl were about to be acused of child abuse because the their daughter had multiple fractures... and turned out to have osteogenesis imperfecta. But apparently all of the multiple doctors taking care of this girl had never heard of the disease and it took a hot shot rebel medical investigator to solve the great mystery by saying: "take a look at her eyes - are they blue?" Why do I fixate so much on this show? Anyway, I am proof that a lowly medical student in a small family practice clinic in Astoria, OR can solve the same mystery within 30 seconds without calling in the national guard.
That is how awesome I am. I am also awesome because today I was able to correctly identify the first case of molluscum contagiosum that i have ever seen in another one of Dr. M's "come in here and look at little Suzy's rash" teaching moments. Awesome!
Posted on November 9, 2005 | Comments (3)
No, I can't see a movie tonight. I'm saving up for a mouth guard.
by fiona
I went to the dentist the other day. I had some constant tooth/jaw pain that I was convinced was caused by an untreated cavity turned dental abscess that would necessarily result in one or more root canals. Possibly a partial jaw amputation. To my great relief, there was no abscess and no impending face-altering surgery. Instead, the dentist theorized, the source of my aching pain was caused by chronic teeth clenching and grinding at night. Long story short, I might need a mouth guard. The mouth guard recommended by my dentist costs $650.
I repeat, THE MOUTH GUARD COSTS SIX HUNDRED AND FIFTY DOLLARS.
This, obviously, brings to mind several pertinent questions:
1. How could it possibly cost this much money?
2. Is it made of solid gold?
3. Does it prevent cancer?
4. Will it allow me to communicate telepathically or become invisible?
If not, I demand to know why they think I should pay that much money.
Naturally, my insurance won't cover a cent of it. My first instinct is to invest in a sports mouth gaurd instead. One of those bulky ones that comes solely in black or fluorescent yellow and can be purchased for $9.99 at Rite-Aid. That'll show 'em. Take that, capitalistic dental patriarchy! Your oppressive expensive mouth guard ways will be defeated by the blinding light of justice emitted by my fluorescent yellow soccer guard!
Just in case, though, my family should be warned not to expect any Christmas presents this year. They will have to content themselves with the knowedge of my improved dental health. Again.
Posted on November 5, 2005 | Comments (11)
Taking the plunge
by fiona
Looking back on myself three years ago, when I first started out on this grand *adventure,* I realize how much things have changed. I remember being a first year medical student at my clinical preceptorship, charged with the assignment of "go see what's going on with Mr. Johnson." I would stand nervously outside Mr. Johnson's door and carefully pluck his chart from its plastic wall holder (this had to be done as delicately as possible so Mr. Johnson wouldn't be tipped off by the tell-tale paper rustling as to the presence of someone standing nervously outside his door). I would flip through his chart, trying to glean some sort of helpful information from reams of unintelligible documentation. Maybe the chart would tell me what was going on with Mr. Johnson. It rarely did. It was undecipherable to me. Then I would spend the remainder of my few minutes of akward-hallway-standing trying to plan out an appropriate opening line, practicing in my head what it would be like to actually knock on the door, open it, and be standing face to face with Mr. Johnson himself, who may or may not be half-naked. Then, after jotting down some notes of the questions I wanted to ask him (word for word, of course) and convincing myself to not think about what he would think about me, I would raise my hand up slowly and knock. Every single time I saw a patient it was like this, like taking a plunge from an uncomfortable height into very cold water. I had to mentally prepare. I had to hold my breath. I had to be ready to flounder around in the water for a while, and possibly drown in my own insecurity.
And now. Now! Now it is so much easier! I see multiple patients a day. I knock on their doors, I introduce myself, I ask them personal questions, I look in their ears, I ask them to take their shirts off, I palpate their breasts. (Not on every single patient, of course.) Its so refreshing not to be filled with nervousness, not to agonize over what on earth I will possibly say when I open that door. I just open it.
And its weird - most of the time it just works out.
But there's still a group of people with whom a little of that pre-knock nervousness returns. The mid-to-late-twenties male patient. Guys my own age. They are scary! They pose a problem for me for several reasons: 1) they might feel uncomfortable talking to me, 2) they might question my right to be there, 3) what if they are cute?, 4)what if they misconstrue my naturally comfortable, easy-going bedside manner as flirting? 5) if a young, healthy guy is seeing a doctor, its usually because they have a very private, embarassing problem that, after months or years of stalling, they have finally convinced themselves to be seen for. Granted, most of this is likely in my head, and its nothing that a little professionalism couldn't overcome... but seriously. I feel akward.
Such a situation nearly presented itself today, but fortunately my preceptor took a look at his age and said, "28 year-old here for a physical? There's gotta be something going on. Why don't you sit this one out." And there was something going on. Going on "down there". And if I had gone in there, with my confident hand-shake and comfortable questioning, she is convinced that he never would have told me.
Just goes to show.
Posted on November 2, 2005 | Comments (7)