Now what...

beth came into the clinic today and saw my doctor to establish her as her primary care physician. Beth moved up to Oregon and didnt have a doc yet so i convinced her that dr.x would be a great fit for her. thats how much i like this doc. best part about the visit was i got to draw her blood to run some labs :)

my interest in primary care is growing less and less each day. i find myself day dreaming while the doctor is counseling a patient on diet and nutrition. im pretty sure i have ADD and im pretty sure i need to be entertained/thinking at all times of the day or else ill be bored. damnit, i started out being so excited about this rotation and now im back to square one.

1) OB/ GYN
2) Pediatrics
3) Family Practice


ob/gyn still in the lead. i still havent been able to beat the rush of delivering a baby or pulling one out of a uterus during surgery. so rad.


the most interesting things i saw this week were:
-a 28yo M with major depression and insomnia who drinks a gallon of vodka a week [stated by him]. he came in with his wife who seemed oddly ok with everything. they had obviously been through a lot together.
-a 51yo lady who was following up on her strep throat and upper resp infection. she was really sweet and i learned a lot about her and her case.

another one bites the dust

While my doctor was talking to a patient [who clearly had a personality disorder] about abdominal pain which has been investigated by several doctors but yet no cause found, i started to day dream and nearly fell asleep because i was so bored. i know this sounds heartless but i swear this lady was either drug seeking or had munchausen syndrome [faking illness for sympathy]. either way, i was pretending to take notes and this is what i wrote:

12:10pm Nov 1, 2011
I just decided at this moment that i don't want to go into family medicine. im pretty sure i want to work in a hospital setting. this sucks.

today a drug rep came in and took my lunch order for thai food. that was cool.

2 hours later another drug rep came in and took my starbucks order. that was pretty cool too.

i cant help but feel corrupted.

pure med student joy.

This week i got to see and do a lot of stuff. Heres a breakdown:

we had a patient come in with an ankle injury. after hearing the story and seeing it, we decided to send him up for ankle x rays [its actually 3 views] to rule out a fracture. it was swollen but didnt look too bad so the doctor and i didnt think it would come back with anything remarkable. we sent him upstairs to get them and 40 minutes later he came back down with the x rays in hand. the doctor told me to look at them and tell her what i saw and sure enough,  i found a fracture...a couple fractures actually. i was pretty proud of myself. to be fair, my sister could probably have found the fracture also considering how large it was so im not sure this is the biggest accomplishment of my career [no offense anna].

saw a 75yo lady who refused any kind of screening exams because whatever happens to her is natural selection and if she is meant to die, she will die. then at the end of the visit she said she wanted one test and that was for alzheimer's because if she finds out she has that then “she has plans.” [in 1997 Oregon enacted the Death with Dignity Act which allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose.... im pretty sure this is what she meant]. to each their own, i guess. 

a pretty depressing patient i had was a 30yo woman who was thrown off her horse last year and is still dealing with the effects. she hit her head and wasnt wearing a helmet so ended up with major brain damage. she has had two surgeries and though she is still totally functioning, she just isnt all there and was diagnosed with major depressive disorder [though almost all the patients i see are so thats not to rare]. the scary part was seeing how much her life changed in one instance and though i will still keep riding, i will make sure to NEVER be without a helmet when doing so.

last patient of the week was a woman who had chronic bilateral shoulder bursitis [basically inflammation of the joint]. she was a fun patient and both the doctor and i joked around with her during the visit. we decided to do steroid injections into her shoulder joints to temporarily relieve her pain and the doctor asked her if she wanted to do one or both of her shoulders. the patient said both if thats ok and i jokingly interjected and said “only if you let me do one of them.” then very suprisingly she answered “yeah sure why not.” i looked over at dr x and she said “see one, do one, teach one. ill do one shoulder and then you can do the other.” 

pure med student joy.

 so we drew up 2 syringes for each shoulder, one of lidocaine and one of a liquid steroid. we used a 1.5in needle and entered the shoulder joint. it was tricky because after putting in the needle and injecting the lidocaine, i had to unscrew the syringe to inject the steroid using the same needle and then take it out again to use another cc of lidocaine. my hands were steady and neither the doctor nor the patient could see how scared i was! i was nervous but pretended not to be which makes all the difference. after, the patient said it didnt hurt [which i am sure was a lie because thats a big freaking needle.] she told me it didnt hurt anymore than when the doctor did it so apparently, i did a good job. i love procedures!

oh yeah, and i watched the doc do a prostate exam on a 70yo man. that was not fun.

panic and confusion

Last couple days have been a med student’s dream. Tuesday morning we had 6 patients and then there was only 1 person scheduled for the afternoon and it was the last visit of the day so my doctor, being the awesome person she is, asked me at lunch “so, how do you feel about taking the rest of the day off. i mean, this is your elective and your new to portland so i think you should go do something fun.” Naturally, my first reaction was to think ‘is this a trick?’
 i responded with “well, i dont want to look like a slacker... are you sure?” She was sure.

 i left at 12:30 and spent the afternoon hiking. I also had Wednesday off per her usual schedule so really the last couple days have been pretty great.

 When i got home, i spoke with a non-medical student friend [who is friends with a lot of med students] about this situation and his response was “it seems like every time one of you is asked to go home, your worried about going even though the doctor is practically pushing you out the door.” this is very true. So, just to clarify, if you ask any third year medical student what their reaction is when asked if they want to go home early the answer is always going to be no until you directly hear “yes its fine,go home” several times. You may think this question would cause a wave of excitment but really, it just provokes panic and confusion.You always have to balance how this newfound freedom will affect the rest of your rotation and of course, your evaluation. 9 times out of 10 the doctor really is just being nice and wants you to go home and relax because they know that med school sucks, but for some reason our thoughts are always geared toward several thoughts: 1) how is this going to make me look 2)how is this going to screw me over 3) will i look better than other students if i DONT go home. sad but true, we are a predictable bunch and we are scared shitless of admitting to a preceptor that we would rather be at home watching netflix than doing scutwork at the hospital/clinic. The cool part about this is that there are a few rotations that when asked if you want to go home, you actually don’t. and this my friends, is how we decide what kind of medicine to go into.

had an amazing weekend in seattle and went into work for 8am this morning. i was moving and thinking very slowly...so exhausted.


a drug rep brought in donuts. seriously, doctor's offices have the most unhealthy food of anywhere else i have worked. irony?

a married man came in to get an HIV test after having cheated on his wife with a woman who he hired to give him a massage. you cant make this stuff up.

family medicine, a form of psychiatry?

Today started out at 8am with me giving a pap smear to an OB/GYN... It was a crazy experience that I am not sure I will soon forget. The patient was a doctor [a DO] that was in for her yearly well woman's exam. We chatted with her for a while about OB and how she had her own practice and then after about 20 minutes Dr. X started to get into her medical concerns and did a breast exam. When that was over and we were about to do the pap smear she looked at me and said, "do you want to do it? i mean, would that be weird for you?" i laughed and said "no, would that be weird for you? if your ok with it im ok with it." So there i was, doing a pap on a women who was talking me through it/teaching me about it while another doctor stood behind me and gave me pointers. talk about being nervous. i def messed up a bit but what medical student wouldn't under that kind of pressure!

Another interesting part of my day was when a lesbian couple came in. one being pregnant and the other being our patient with back pain. the notable part about this patient was not the lesbian part [im not that politically incorrect] it was the fact that she is a chiropractor and we did OMM on her.... trying to adjust a chiropractor, thats pretty much what they do all day! we walked out and dr. X said "talk about intimidating, trying to adjust a chiropractor is pretty hard on the ego." we both laughed since both of us tried and neither of us were able to get any results in our attempt at lumbar HVLA.

in the afternoon we had a mom and daughter come in, each having their own separate appointment. First, we talked to the 18 year old daughter who had a history of severe cramps and the birth control we started her on were making her nauseous so we switched her to something else. I sat and listened to dr. X explain to our patient that she may have endometriosis and what that diagnosis meant. I worked in OB/GYN for 6 weels and never did i hear such a well formulated and easy to understand explanation of the disease. the more i listen to this doctor the more i admire her. she is SOOOO good at explaining things to patients but yet she doesn't make them feel stupid. she is great and i really hope i can be just as good at it as she is. she really is helping shape me into the doctor i want to be.

Then, we roomed the mom in the next room and had the daughter wait in the waiting room. The mom patient was in for a well women's exam and man was it an educational patient visit for me.
we started out the visit like we always do, chatting with them about how their lives are going and just getting a feel for their lifestyle. as conversation progressed, we slowly started to get into this woman's relationship with her daughter. it sounded like they had a healthy teenage daughter/mom relationship and that right now they were struggling with starting the conversation about the daughter's sexual activity. when we started to explore this area, we learned that this patient [the mom] had a lot of trouble talking to her daughter about self-respect and setting boundaries with men because when she was an adolescent her step-father sexually abused her along with his friends. because of this experience, she became very open sexually and for the rest of her adolescence whenever she liked a boy she would just have sex with him because that is the only way she she knew to be. so now with her daughter, she knows this is not the way to teach her how to be but she doesnt know how to express appropriate advice because it is so foreign to her.

being a doctor at this point in a visit is not about medical advice, it is about being a counselor/listener/advocate for your patient. we are the official 'secret keepers' and really, that alone is enough for some people. i think we helped this mother out extremely by giving her an open ear and also some advice on how to go about speaking with her son and daughter about their relationships and self- worth while also making the mother realize that she is a good person, a good mother, and more importantly, that she is doing a good job despite her insecurities and doubt.