part physical treatment, part psychiatry

3 hours. i spent from 9am to 12pm with one patient. i came out with a whole new appreciation for psychologists, therapist, and psychiatrists. my appreciation stems from the thought "thank god" as in thank god they are around so that someone does their job cause i sure as hell am not going into that field. so far, i have dealt with patients that have chronic pain and im pretty sure 50% of them are attention seekers. or thats at least what it feels like. i know this sounds extremely insensitive but it is very mentally draining to speak to a patient for 2 hours and all they are doing is complaining of pain that is debilitating them. Noteworthy also is that most are on workmen's compensation even though they are sitting there smiling and laughing asking for their vicodin refill.

you may be wondering how this doctor makes a living spending so much time with patients. well, thats because she charges $350 for a new patient visit and anywhere from $150 to $300 for a return visit. Also, she is cash only meaning she takes payment from her patients right after treatment and then gives them a receipt so they can fight it out with their insurance companies [which do cover osteopathic treatment]. brilliant.

OMM [osteopathic manipulative medicine] also known as OMT [osteopathic manipulative treatment] rotation. Day 1. 
holy hell it is going to be a long 4 weeks.


i have nothing against OMM, im actually really excited to improve my palpation and rehabilitation skills. but damn am i spending waaaaay to much time with one patient and listening waaaaay to much spiritual babble along the way. most DOs that solely practice OMM will spend an hour with each patient. how did i get stuck at this clinic? at least im with 3 other students that i am good friends with


preface: learning OMM is what sets me apart from an MD. brief write up about it:
Physicians can have MD or DO after their names. This distinguishing acronym is an indicator of what type of medical degree they received. 

Both types of physicians are fully licensed and provide a full range of services from prescribing drugs to performing surgeries to using the latest medical tools and treatments. 

Many DOs offer a unique service called osteopathic manipulative treatment (OMT), a form of hands-on care which involves using the hands to diagnose, treat and prevent illness or injury. Using OMT, an osteopathic physician (DO) moves muscles and joints using techniques such as stretching, gentle pressure and resistance. 

OMT can help ease pain, promote healing and may increase mobility for those suffering from asthma, sinus disorders, carpal tunnel syndrome, migraines or menstrual pain. OMT can complement your treatment plan or even help deter need for prescriptive drugs or surgery. 

Every doctor is different but there are many more DOs that are holistic/naturopathic oriented than MDs. and apparently, i am working for the most unorthodox doctor. we spend about 2 hours with each patient. first, we chat about their chief complaint, get the HPI and then we spend around an hour treating them. think physical therapy, meets chiropractic, meets message therapist. really, there are some great techniques and i am really happy with how much i am learning but holy hell, 2 hours with one patient!? after an hour i feel like im gonna fall asleep from boredom. not to mention most people are those with chronic pain so as insensitive as it sounds, i get really jaded listening to people complain of their pain. 

everyone gets back pain, all of us have terrible posture and have very tight paraspinal muscles because of it which leads to a lot of uncomfortable sitting/ standing/ whatever. but not all of us complain constantly about it or need to pop 2 vicodin a day for it. granted, we [doctors] are the reason for drug addictions as we readily prescribe pain medication and then inadvertently create an addict, but when people demand drugs, how can you say no to them if they come to your office again and again asking for them saying nothing else helps? its unethical and malpractice to deprive them of medication that will stop their pain. but at what expense? 

anyways, i know im going to find this rotation challenging as i am much more fast paced and i am being forced to slow down and learn a lot of detail about each person i am working on. its emotionally draining to hear about every problem a person has and then be expected to start all over again and listen to more problems from your next patient. i barely have time to sit down and speak with friends and family for that long. i have never wanted to go into psychiatry and this rotation is a major wake up call for why i think that way. 

seriously, gonna be the longest month of my life. i would rather be working like a dog 12 hours a day in the hospital over this.

at least i get thanksgiving off...


and i dont have to work on fridays....

bye bye Portland

Week 4 of elective: Worked 3 days, had my normal wednesday off and then asked her for Friday off to start my road trip back to LA. She took me to lunch on Thursday and we said our goodbyes. I'll miss Portland, i'll miss her, i'll miss the free lunches and starbucks...won't really miss family practice.

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.