Friday, July 07, 2006

More clinic

Today I had a very full day of clinic, going from 8:30 to 5:30. I saw about ten patients, for the most part I would go into the room and talk to them, then present to the doctor, and then we would go in together. I will describe some of the more interesting ones:

1) The doctor sent me into one room to talk to an elderly man on 4L O2. His wife and daughter were in the room with him. After I asked him what kind of lung problems he had, his daughter told me, “You don’t want to go there”. She and her father then proceeded to get into a five minute long argument over whether or not he had had lung cancer. It was kind of like watching a tennis match. She (and her mother to a much quieter degree) were trying to convince him that he had had cancer and that was why he got radiation, and that the doctors would not have given him radiation if he did not have cancer. He was arguing that the doctors didn’t know it was cancer, but rather gave him radiation because that is what doctors do when they don’t know what’s going on and want to cover their rears. I tried to steer the conversation a couple times by asking about specific bits of information they mentioned (eg. The man mentioned that he didn’t have to be on oxygen before the radiation, so I asked “Oh, so when was that?”) which worked for about ten seconds before they got back into it. Eventually I just waited for a millisecond break and quickly said that I had all the information I needed and that I would bring the doctor back. I left the room and found the doctor cracking up at the work station. Apparently he had been able to hear bits and pieces through the door. They were fun.

2) This patient wouldn’t have warranted a spot on my blog when I first saw her, but when her lab results came back that changed. She had a boatload of liver and kidney problems due to alcohol abuse, but had successfully quit alcohol and her lab results had shown improvement over the last few months. Her symptoms had improved considerably as well, making the doctor very satisfied with her progress. Then her labs came back and showed she had a hemoglobin level of 4.8. That is really, really, bad. At first the doctor didn’t believe it, so he had the lab run it again, but the same results came back. So he had to spend a large amount of time getting a blood transfusion arranged for her.

3) This patient was unusual in that he was a guy my age. I have never in my two years of shadowing physicians, and 2+ years work in the hospital seen a male patient my age. Since his chief complaint was bloody stool and he was young, the doctor decided it would be too awkward for the patient to have to talk to me alone, so we just went in together. Turns out we needn’t have worried, but I was a bit relieved all the same. I have no problem at all asking embarrassing and personal questions to people outside of my age range, but for some reason I feel very awkward when the patient is in my age range. Especially since this patient was also similar to me in education level as he will be starting grad school soon. There were several other similarities, but they would be considered identifying information so I won’t post them here. I would guess that most people would think it would be easier to talk to patients who are similar to oneself, but for me it is the total opposite. I think it is just confusing for me to figure out the proper relationship. For example, if I had met this person anywhere outside of the doctor’s office, he would be someone who would quite easily fit into my social circles, possibly even become one of my friends, so it is hard for me to be comfortable maintaing a professional relationship in which I am by definition in some degree “superior” (that doesn’t sound right, maybe "authoritative" is a better word). On the other hand, someone who is older than me, or even a female closer to my age, would not normally fit into my social circles, and therefore I have a much easier time being professional and somewhat “aloof” (again, not quite the word I’m looking for, but hopefully this makes some sense). He turned out to have hemorrhoids, which wasn’t a big surprise.

Other patients included a headache; neck pain; brain tumor; swimmer’s ear (I did the history and physical by myself); tinea cruris (aka jock itch--the poor kid had to show the rash to the doctor and me in front of his mother, sister, and brother); probable GERD (gastroesophageal reflux disease or heartburn) but with a possibly suspicious EKG; bronchitis; and a possible UTI, but since it was a youngish man (only 8/10,000 men get UTIs per year as opposed to 30% females over their life times) STD testing was necessary which consisted of a urethral swab which is exactly what it sounds like.


Blogger Just_Tiffany said...

I didn't understand most of it but I thought the part about the old man was really funny.....I'm so mean...

11:25 PM  

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