Saturday, November 25, 2006

Days off

Nothing particularly exciting happened at my various pediatric clinics this week (though I did find an ear infection in a kid who came in for something totally different!). This rotation has been like a vacation—less than forty hours a week of being in clinic/lecture, weekends off, and a four day weekend for Thanksgiving—but I am ready for it to be over. I am discovering that there is such a thing as too much free time. I’ve tried to use a lot of the time to study, but since there is no stress this month I have very little motivation to study pediatrics—I have started going through some step 2 questions though. Tuesday I’ll start pediatric inpatient which should be quite a bit busier. I am missing the OR a bit.

Since I spent yesterday lying around doing nothing productive I decided to go to the Saturday Free Clinic this morning. It is much better as a third year than as a second. Usually it works by the M1 getting the patient and measuring vitals, then the M2 interviewing the patient, then the M3/M4 going and filling in any gaps and doing the physical, and coming up with a plan. Then the attending looks over everything, sees the patient, and signs the notes. Today, however, there were a lot of M3s, so I saw two patients by myself. The first patient, though, was reported to me by an M1 and M2. It was a young lady who wanted an annual pap smear and STD check, so there wasn’t much history to get. I basically just listened to her heart and lungs, then deferred the rest to an M3 who just finished OB/GYN. There weren’t any other M1/M2 teams in need of an M3 so I went ahead and got my own patient, a 35 year old man with type 2 diabetes and hypertension. He weighed 332 lbs, but had lost 40 pounds over the last two months with diet and exercise. I congratulated him and told him to keep it up. His blood pressure was still high though, so I told him we’d probably increase the dose. His hemoglobin A1c, a measure of long-term blood sugar control, was 9.2 (high). I reported to the attending, and he agreed with me as to increasing the blood pressure meds. He didn’t want to start diabetes meds though, since the patient was doing so well at losing weight.

The next patient was a man with rectal pain off and on for several years (he was diagnosed with hemorrhoids 7 years ago) worsening over the last two months. He described large, visible masses, but when we looked the attending could not detect any hemorrhoids. The man had been trying a lot of ointments and hot baths without success. From the patient’s description I thought he would need surgery—our exam was not really consistent with that, but we went ahead and referred him to a general surgeon for a second opinion anyway. Since this is a free clinic, the doctor who oversees it will have to approve the request.

This was the first time I have had any significant contact with the M1 class—I could not believe how young some of them looked. What’s scary is that I’m the same age most of them are—if I look that young I can definitely understand some of the comments I have gotten from patients!

4 Comments:

Anonymous Alice said...

The first and second years do look remarkably young. (College students look like little kids to me now.) The thing is, I remember back at the beginning when I was a first year, looking at the third years, and thinking, They look so much older than my class. I'm hoping now that the difference is just increasing seriousness, nothing more; it's only been three years, right? :) I bet by a year from now, you won't be getting many comments about your age.

4:55 PM  
Blogger Chris Emlyn said...

I think seriousness/confidence has something to do with it, but I was recently told by one of my own classmates (after he looked at my ID badge, photo taken my first year) that medical school has aged me...

3:39 PM  
Blogger Just_Tiffany said...

I can't wait to see you at christmas. I drew your name. any suggesstions?

10:15 AM  
Blogger Chris Emlyn said...

I will have to think about it. Who did I draw? Just 3 more weeks!

9:36 AM  

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