Asthma Clinic

Yesterday was my first day of clinic! It was very laid back, and I didn’t get to do as much as I wanted to, but that should change as the month goes on. There weren’t any particularly interesting patients, mostly just follow-up for chronic problems. Most of the patients I would just watch in the room while the doctor talked to them, but a couple he had me go in and talk to first. I would like to be doing the initial history and physical by myself by next week, but I know it’s hard to do in an outpatient clinic that needs to stay on schedule. That is one of the things I dislike about outpatient, I feel like I am an inconvenience to the patients and doctor. At least in the hospital the patients don’t have anywhere else to be so students can spend more time with them. There was one little girl who had a rash, so I went and spoke to her and her mom and looked at the rash. I am considering that to be an H&P, albeit a focussed one. That afternoon I had to drive the half-hour to school, then go to two hours of lecture, one on abdominal pain which was quite good, and one on COPD (chronic obstructive pulmonary disease) which wasn’t as interesting, but was quite timely as I had asthma clinic this afternoon.

This morning I had to go to the VA hospital to get my password and training for their computer system, since all their patient charts and records are computerized. (Interesting tidbit I learned yesterday: apparently employees walking off with hospital scrubs is a huge problem, costly enough that my school’s main hospital is going to invest >$100K to buy a scrub dispensing machine that won’t give a person new scrubs until he returns the ones he checked out before. At the VA walking off campus in hospital scrubs is considered to be a federal offense, which presumably cuts down on scrubs’ disappearing.) Then I went to my school’s main hospital (wow is there a difference in even the appearance of private vs government-operated hospitals) for asthma clinic which I greatly enjoyed. Students are responsible for doing all of the patient interviewing and educating, and the physical exam, then they report to the incredibly energetic doctor and she goes to see the patient. Since they are going from paper charts to a new and apparently very frustrating computer system they only saw half the patients they normally do. I saw an asthmatic with very poorly controlled asthma despite her being on three or four medications, and I managed to classify her asthma correctly and come up with a fairly accurate assessment (she needed more drugs). The next time I go to asthma clinic, it will be a spanish speaking clinic.

They respiratory therapist did spirometry on all the students and the intern (the "kids" as the attending put it) to show us what it was like. Basically, you blow into a tube and then inhale, and a computer measures how much air you blow, and how quickly you blow it out. My FVC and FEV1 were 120% of their predicted values, which means that I have excellent lungs.

We scheduled our first Bible study (going through Daniel) for next week; the school then informed me that I have an OSCE (interviewing an actor pretending to be a patient) at the same time. I am very miffed. I did take advantage though of an opportunity presented by the course director to be a student reviewer for an internal medicine textbook. Normally I probably wouldn’t take the time to do that, but we’ve been promised to have our names published in the book’s next edition if we help review it. I, being a sucker for padding my curriculum vitae, could not pass that up. Oh, and helping improve the education of future students will be nice too.