Of course, I didnt let go of all responsibilities since break has started. Last week before I left for London, I volunteered for the third [or fourth, cant remember] time at the Montclair clinic. I had two patients, a Spanish speaking 45yo Male and a 44yo Female. The man was the first time i encountered a patient who did not understand English at all. I worked my way through it as best as possible. I led him to exam room one and with a smile on my face the entire time (it was the only way i knew to break the tension) I took his blood pressure, pulse, temperature, respiratory rate, height and weight. After doing his vitals, the only thing I could manage to say was 'dalor?' as I pointed to his eye [it looked a lil red and droopy...dalor means pain]. He said no....thats it. After an awkward pause and another smile, I told him [in english which he obviously couldnt understand] that I would be right back. I then got the Clinic Coordinator [our saving grace at the clinic...she helps us with everything] to interpret for me. Through her, we asked him a few questions and it was all I needed because he was just there for a BP check and medication refills for HTN and Diabetes.
After this patient I had a 44 year old lady who could speak English and suddenly I felt 20x more confident in myself. It seemed like a no brainer since i could ask her any question i wanted [retrospectively, having this spanish speaking patient was pretty good for my learning curve]. She was here for HTN medication refills but also because she wanted to switch her anti-depression medication. She was just put on them at her last visit 2 months ago and since then she was having major side affects of 'shaking' and 'trembling.' I asked her a ton of questions about her symptoms and didnt do any physical exam cause I didnt really think it through and didnt think it was needed. I went back to the resident and presented the cause and it became pretty clear that I did not do enough. He asked if I did any physical tests and educated me on why a neuro exam would be very important. So, I went back to the patient and did a full neuro exam to rule out any other causes. I did reflexes, muscle strength testing and sensation testing...all were intact and within normal limits. After going back and giving my pertinent negative findings to the resident, we went to see the patient together and ended up switching her medication.
Retrospectively, I really should have known to do the neuro exam and present this to the resident in the first place. We just learned about this a couple months ago and it should have been in the back of my mind when I was listening to the patient. I felt pretty stupid for having forgotten it. Its hard to see a patient, learn all their symptoms and really critically think while i am in front of them. Its hard enough trying to pretend and look semi-competent while in the exam room... its another to actually BE competent. So, I took this experience as a valuable one and next time, I will slow myself down a bit and not feel bad about thinking things through and making the patient wait while i study their chart and my notes. After all, thats what doctors are supposed to do, right?
On that note, I am also VERY happy I have been volunteering at the clinic because if I am already learning and becoming more comfortable with patients and charting, I wont make these basic mistakes when I start rotations. Then ill just look like a rockstar!
Anyways, it was a very long night at the clinic and we didnt get out until 10:30pm [we start at 5pm.] We had a resident that was pretty slow but he was also valuable as he spent a lot of time teaching us about the patients and also giving us pointers while writing our SOAP notes [the exam documentation complete with Assessment and Plan for treatment]. Sadly, its this kind of stuff that makes me dislike medicine. We spend about 20 minutes with the patients but then at least an hour on their chart. granted, charting will go much quicker and smoother when we are more experienced but for now, everything I am about to write gets scrutinized in my head a couple times before it actually get puts on paper. This is a legal document and I have to make sure everything is complete and accurate. Well... that and the resident and clinic coordinator have to sign off on our charts and i dont want to look/sound like a complete idiot. I havent been doing this for long but I should have some ideas of how to do this, it has been a year after all!
Every shift after our last patient appointment at 7:30pm, we all finish up our patients documentation [SOAP notes] and give them to the resident and then to the clinic coordinator to sign off. It has become a competition each shift to see who can write their chart without getting 'called back' from her to correct something.
I didnt get called back at this shift, she said my charts looked great and were done very well :)
A small triumph but a triumph nonetheless.
be back in a month when i return from Africa, will have lots of medical stuff to write about then!
