WILTYIMS #201: FCM and a comic

Today was a full day of FCM (Fundamentals of Clinical Medicine, the "how to be a doctor" class). We had a brief lecture on how to talk to difficult patients, for instance patients who you suspect of prescription drug abuse or who decide to pursue a treatment plan other than the one you recommend. The latter is often called "patient non-compliance" which has become a sort of dirty word due to the obviously negative connotation. The doctor and patient need to be a team and come to a joint decision on the best course of action for that individual based both on medical science and the personal or cultural considerations of the patient.

The rest of the morning we practiced these skills in small groups with standardized patients. Though the actors' stories are theoretically "standardized," it was interesting hearing from different groups about how uniquely each actor played their part. Some were defiant but willing to budge, others were argumentative and some sounded downright hostile. Our Step II clinical board exams after 3rd year will have similarly difficult patients, but thankfully the vast majority of real world patients will be much more willing to work with us to navigate treatment decisions.

Finally, the afternoon was taken up by our first preceptor session of the year. During each of our first two years we are assigned a local doctor to shadow and learn from for an afternoon every 3-4 weeks. This year I am learning in Mount Vernon, a city in Westchester County just over the county line from the Bronx. Last year I did pediatrics, so it's nice to mix it up and see adults this year.

This first visit was once again frustrating because we have yet to learn much of pathology, but it was already so much better that last year when we were truly useless. I enjoyed talking with patients and riddling through the doctors questions for me about topics I haven't covered in enough detail yet. Hopefully by the end of the year I will feel more comfortable before actually starting our clinical education in July.

TIL: Hypertension (high blood pressure) can come in several forms. One categorization is of whether the increase in pressure is seen in systole (heart contraction) or diastole (heart filling). The former is usually seen in older patients (>50yo) due to atherosclerosis (hardening) of the aorta from the accumulation of plaques. Each time the heart pumps blood out the aorta pushes back and these plaques make it less accommodating, thereby putting pressure on the heart to pump harder. Hypertension caused by other chronic conditions usually increases the diastolic pressure and these conditions are often seen at an earlier age.