Jokes made by Dr. S:
How do you hide medical information from an orthopod?
----publish it!
How do you hide patient information from an orthopod?
----put it in the chart!
Booya!
Thursday, September 18, 2008
Tuesday, September 16, 2008
Bonding
This morning was clinic day with Dr. S. I was pretty excited about it because Dr. S told me that we would have at least one HIV positive kid, and not to sound morbid, but I was looking forward to it, because I find HIV fascinating and I've not met a known HIV kiddo before and I wanted to learn about how they were diagnosed and what their prognosis was like, etc.
18 year old R was our first patient. I walked into the room and there sat a healthy appearing cute kid. Cute enough that I would let my daughter date him. He was polite, and answered all my questions. He was diagnosed with HIV as a small child---it was passed on perinatally meaning while his mom was pregnant. He is currently on four medications to suppress his virus*---some of which he has to take twice or three times per day adding up to at least 9 pills per day. His viral load has been undetectable for several years. Meaning he is doing great. So great that Dr. S has wanted to change his meds so that he only needs to take 2 pills per day. But R has been reluctant to do so because he is doing so well and he is worried about going downhill once he changes his meds. Pretty amazing for an 18 year old. Most 18 year olds can't even remember to brush their teeth or put on deodorant.
When Dr. S walked into the room R jumped off the table and gave him the biggest hug. I didn't start crying (that would have been my usual reaction) but I felt this over whelming joy --- like Dr. S and R had this amazing bond and all I could do was to hope that some day I would have the same bond with my patients. After their inital hellos, R opened up and told Dr. S that he was smoking 6 cigarettes per day and pot about 2 times per week. I was impressed with his honesty but sad he was headed down that road. So Dr. S and I gave him a talking to, where I suggested running instead of getting high because it is a "natural high."
And alcohol and rock n' roll will send you to hell!! Sigh..... kids probably think I live in the 1950s.
* in talking with the mom and the kiddo---I realized they knew more about antivirals and HIV therapy than I probably ever will.
18 year old R was our first patient. I walked into the room and there sat a healthy appearing cute kid. Cute enough that I would let my daughter date him. He was polite, and answered all my questions. He was diagnosed with HIV as a small child---it was passed on perinatally meaning while his mom was pregnant. He is currently on four medications to suppress his virus*---some of which he has to take twice or three times per day adding up to at least 9 pills per day. His viral load has been undetectable for several years. Meaning he is doing great. So great that Dr. S has wanted to change his meds so that he only needs to take 2 pills per day. But R has been reluctant to do so because he is doing so well and he is worried about going downhill once he changes his meds. Pretty amazing for an 18 year old. Most 18 year olds can't even remember to brush their teeth or put on deodorant.
When Dr. S walked into the room R jumped off the table and gave him the biggest hug. I didn't start crying (that would have been my usual reaction) but I felt this over whelming joy --- like Dr. S and R had this amazing bond and all I could do was to hope that some day I would have the same bond with my patients. After their inital hellos, R opened up and told Dr. S that he was smoking 6 cigarettes per day and pot about 2 times per week. I was impressed with his honesty but sad he was headed down that road. So Dr. S and I gave him a talking to, where I suggested running instead of getting high because it is a "natural high."
And alcohol and rock n' roll will send you to hell!! Sigh..... kids probably think I live in the 1950s.
* in talking with the mom and the kiddo---I realized they knew more about antivirals and HIV therapy than I probably ever will.
Tuesday, September 9, 2008
Data Collector
I've been working my butt off in Peds Infectious Disease. We cover two hospitals, plus there is clinic so basically we're constantly picking up new cases and finishing up others. We've got some sick kiddos recently: a Rocky Mountain Spotted Fever, lots of osteomyelitis, Leptospirosis, bacteremia sepsis, and today I diagnosed malaria!
But part of the hardest part of this rotation is getting my thoughts together in order to get the assessment and plan ready to present. I am good at getting the information--I can ask the important questions, and I can pick up abnormal findings on the physical exam. I can also get the vital signs and the lab values off the computer. After that I am supposed wrap it up with a simple one line sentence and explain my thought process for what I think it is. This is where I falter. While I was on ED I could get it together, but on Peds ID, I am usually so confused and have a billion things running in my mind that it sounds like blllllaaahhh.
Lucky, my attending sort of expects this. He believes our teaching was geared at making us great Data Collectors and looking back over 3rd year I actually completely agree. For example, on surgery I would wake up early to "round" which really just means I would make sure to find out if anything bad happened to my patient while I slept. If that was a no---did they eat? did they have a temperature? did they get out of bed? how was the pain? after I collected that info and their vitals and labs (which we rarely ordered anyway) I would just recommend that they eat, get out of bed and make sure their pain was controlled. Done and done. On OB it very similar only I'd mention something if they wanted any form of birth control. On psych I never rounded. On medicine we were told by the ED what they had, and we just consulted various services so I'd make recommendations on that and I'd look up journal articles to learn.
So it seems like I really didn't have any creative thought of my own when it came to summing up the patients---I was medical student, the Data Collector.
But part of the hardest part of this rotation is getting my thoughts together in order to get the assessment and plan ready to present. I am good at getting the information--I can ask the important questions, and I can pick up abnormal findings on the physical exam. I can also get the vital signs and the lab values off the computer. After that I am supposed wrap it up with a simple one line sentence and explain my thought process for what I think it is. This is where I falter. While I was on ED I could get it together, but on Peds ID, I am usually so confused and have a billion things running in my mind that it sounds like blllllaaahhh.
Lucky, my attending sort of expects this. He believes our teaching was geared at making us great Data Collectors and looking back over 3rd year I actually completely agree. For example, on surgery I would wake up early to "round" which really just means I would make sure to find out if anything bad happened to my patient while I slept. If that was a no---did they eat? did they have a temperature? did they get out of bed? how was the pain? after I collected that info and their vitals and labs (which we rarely ordered anyway) I would just recommend that they eat, get out of bed and make sure their pain was controlled. Done and done. On OB it very similar only I'd mention something if they wanted any form of birth control. On psych I never rounded. On medicine we were told by the ED what they had, and we just consulted various services so I'd make recommendations on that and I'd look up journal articles to learn.
So it seems like I really didn't have any creative thought of my own when it came to summing up the patients---I was medical student, the Data Collector.
Thursday, September 4, 2008
off it went
www.cartoonstock.com/lowres/jkn0020l.jpgI submitted my application for residency last night (AGHHH!!) and I am freaking out (AGHHH!!). I tried drinking a beer after submitting, but in all honesty---it didn't help. So I might go towards heavy drugs---like chocolate.....
I wasn't going to submit until next week (I'm still waiting for a couple of letters of rec) but after talking to the Peds Residency Director---it changed my whole outlook. It was a simple run in---we both happened to grab our lunch at the same time. He is super friendly so he asked me how I was doing and what rotation I'm on, etc etc. Just plesant chat until we hit the elevator. Thats when he asked if I submitted yet. I said, I was working up the courage. Thats when he mentioned that he already had 250 applicants. 250!!! The option to apply was only open for 30 hours at that point and he already had 250?!!?! So I went home and stared at my computer until I finally hit enter. And off it went.
So I've checked my email about 30 times today in hopes to have an interview request. But no such luck. The worst part is you can look up who has downloaded your application. Several have downloaded it. Still no interview requests. AGHHHHH
I wasn't going to submit until next week (I'm still waiting for a couple of letters of rec) but after talking to the Peds Residency Director---it changed my whole outlook. It was a simple run in---we both happened to grab our lunch at the same time. He is super friendly so he asked me how I was doing and what rotation I'm on, etc etc. Just plesant chat until we hit the elevator. Thats when he asked if I submitted yet. I said, I was working up the courage. Thats when he mentioned that he already had 250 applicants. 250!!! The option to apply was only open for 30 hours at that point and he already had 250?!!?! So I went home and stared at my computer until I finally hit enter. And off it went.
So I've checked my email about 30 times today in hopes to have an interview request. But no such luck. The worst part is you can look up who has downloaded your application. Several have downloaded it. Still no interview requests. AGHHHHH
Tuesday, September 2, 2008
Having a kid is just like owning a pet.....
http://www.cartoonstock.com/lowres/amc0336l.jpgMy first patient on Peds Infectious Disease (Peds ID) was supposed to be a kiddo who lives in the near-by bigger city. I find it absolutely amazing that the neighboring city which has about 4 million more people does not have a single Peds ID doc. Instead they have to come here or the docs from my city, go up there. Well aparently this kid doesn't even have a doc to begin with---he's been seeing a veterinarian.
He got diagnosed with MRSA---the strongest bug there is out there! Its a resistant strain of staphylococcus (a bacteria) which will definitely need some big gun antibiotics. But instead of going to a doc for this diagnosis, his family took him to a vet. Aparently, it only costs $17 per day for the kid to stay at the barn shelter. Which I guess compaired to hospital bills ---this is a fabulous deal. Why did he go to a vet in the first place? no idea. What kind of MRSA does he have? no idea. Why do I not have the vital information on this kid? Because he was a no show in clinic today.
He got diagnosed with MRSA---the strongest bug there is out there! Its a resistant strain of staphylococcus (a bacteria) which will definitely need some big gun antibiotics. But instead of going to a doc for this diagnosis, his family took him to a vet. Aparently, it only costs $17 per day for the kid to stay at the barn shelter. Which I guess compaired to hospital bills ---this is a fabulous deal. Why did he go to a vet in the first place? no idea. What kind of MRSA does he have? no idea. Why do I not have the vital information on this kid? Because he was a no show in clinic today.
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