Monday, June 26, 2006

Fourth Year Focus

I feel that every year of medical school has a different focus. The goal of first year is simply to adjust to medical school and get used to memorizing huge volumes of new information. Second year, having had survived one year of med school, we were able to relax a bit more although the dark cloud of the boards was constantly looming overhead; even if school wasn't very demanding at a given time, you knew you should be devoting some time to boards studying. Third year you are thrust into the hospital, full of book knowledge, but absolutely clueless how to perform on the wards -- and pretty damn scared because of it.

Here I am now at the start of fourth year, wondering what my priorities are.

I am no longer scared of the hospital, as I have enough experience with clinical rotations to feel comfortable with patient care and the workings of the hospital. The motivation of before is also gone. With no more required rotations (which is what third year was filled with) the grading scale is now simply pass/fail -- no more honors, high pass, pass, or fail. This is a huge relief. Now there is no more struggle to out brown-nose the other medical students in order to appear more eager than them. This grading scale is also the reason why, when your resident tells you, "You can go home, or stay if you want to", you have no problem saying "see ya", instead of forcing out a "OK I'll stay".

With all that in mind, I realized the goal for this year really is not just to get by, but to prepare myself for internship. This is my chance to learn about true patient care, which, thus far, I have left to the responsibility of my interns and residents. Seeing how I'll be in that position in less than a year, I should start getting used to performing all these things myself.

And now with that in mind, I am more serious about fourth year. I am trying to learn the boring details of patient care that interns are typically responsible for, such as writing orders, learning medication dosages, following up abnormal lab values, etc. When a Mg returns at 1.8, I now know to write an order for Mg Oxide 400mg PO x 3, instead of running immediately to my resident. Hopefully this mindset will prepare me better for internship, and make the inevitable shock next year a little less overwhelming.

Friday, June 16, 2006

Standardized Patients

I just got through a monster afternoon dealing with a seemingly non-stop series of standardized patients -- actors trained to behave as patients and then interact with us as we practice various clinical skills (e.g. bedside manner, clinical reasoning, ability to take a good history and physical exam, etc.) Being required to make special efforts to teach their students good clinical skills, most medical schools now incorporate standardized patients into their curriculum.

But having performed dozens of encounters with standardized patients during the past few years, including today's exam that consisted of 8 back-to-back standardized patient encounters, I am officially sick of them.

It takes a lot of energy walking into each room putting on an extra fat grin, being extra verbose as you talk to the patient, and then remembering to perform every aspect of the physical exam (especially the ones you don't normally perform) on these people who are obviously tired. Furthermore, I treat them differently that I do my real patients, as I'm sure most people do. I seriously doubt there are students who take the time to inspect, palpate, percuss, and only then auscultate.

Although I'm sure the feeling is reciprocal. It must be hard putting on the same act 16 times a day for an entire month, complaining over and over to a new student how suddenly this morning they started having abdominal pain ... or how their poop has been discolored for awhile.

Tuesday, June 06, 2006

Latest Grand Rounds

Grand Rounds is up at the Medical Blog Network. The page is a little busy up top, but scroll down a little for the individual entries.

First Day in the CCU

Welcome to hell.

Today was the first day of my cardiology rotation, based entirely out of the cardiac care unit, which is an ICU only for heart patients. Patients with the most urgent or serious heart diseases come here and stay until they're stable enough to be transferred to the regular cardiology floor ... or until they die. (Or so I hear, that is; I have yet to witness a patient dying anywhere.)

I was also on call today and thus had to stick around until I admitted at least one patient. Used to long and uneventful hours of waiting while on call during other rotations, I was not looking forward to today's call. Lucky for me -- but not so much for our patients -- the events of the day were far from boring.

The first patient to usher in the day was my patient, a very young man with an acute MI -- heart attack. Not only had he just suffered a heart attack, but it was the second heart attack of his life. All my years of reading about nitrates and morphine and beta-blockers and interventional procedures were being put into play in front of me, and in overdrive. And this was for our most stable patient, too.

Some of our other patients we admitted -- ALL of which were acute MI's -- were a man who suffered an MI and whose condition went downhill fast (so much so that within a few minutes there were miles of wires and tubing leaving his body and connecting to life support machines and medicine drips), and another who had his MI while getting a CT scan for an entirely unrelated reason.

Quite an exciting day (at least for me, no my patients). Never before had I had an acute MI patient on a rotation, and now all of a sudden we were hit with five.

Happy 6/6/6, everyone.


On a related note, this is my first clinical rotation of 4th year in the hospital, so I got to sign my notes as MS4 today. Pretty exciting, although I first wrote MS3 and then had to cross it out.

Monday, June 05, 2006

Mealside Consult

Getting some lunch at the bagel place today, I stood in line behind one of the vascular surgeons who lectured us during my surgery rotation. His lecture topic, specifically, was on abdominal aortic aneurysms (AAA), which is when the aorta balloons out because of extra thin walls ... and, if you're very unlucky, ruptures. It's not very common, and it most often occurs in patients over 50 years old.

One of the symptoms of an AAA -- before it ruptures, of course -- is that if you press down on your abdomen you can feel the pulsating blood. And I've felt my abdomen pulsate in the past, mostly at the gym when I'm working out.

So back in line, I thought this was my chance to confront an AAA specialist and see what he thought. I politely introduced myself, let him know how his lecture has been weighing on my mind, and then asked about my problem (or is it my "problem"? See here.) Immediately he shot it down with a quick "of course you feel a pulsation, you should, since you're skinny".


He then let me know of some things to look for in the event it truly was an AAA, so you can be sure I'll be examing my abdomen in more detail tonight.

So much for that.

(However, I'll admit I was slightly relieved to hear what he said.)

Friday, June 02, 2006

Weird Habit

I have many weird habits, ask anyone that even slightly knows me. But if you ask me, none of them are weird ... in fact they are all done for a practical purpose.

One of these habits involves the bathroom here at the hospital and what I do as I enter one. Whenever I open the door to the bathroom -- and only those that are single-occupancy, not the ones that accomodate many people -- I open it slowly, very slowly. I do this just in case there is someone in there, so as to give them a chance to yell out in case they forgot to lock the door. As reasonable as it seems to me, people always give me a hard time about this, saying no one forgets to lock the bathroom door.

Well just a few days ago I went to the bathroom in clinic and started opening the door slowly ... and then heard something like a moan or a yell. Turns out a man was in there, and, that's right, he forgot to lock the door. I quickly apologized (or mumbled something) and shut the door.

And now I have no qualms about continuing this habit in the future. A 1 in 100 hit rate ain't bad!


Oops, a little late, but you can find the latest Grand Rounds up at KidneyNotes.