Last week saw me become comfortable with my new settings - too comfortable, it turned out. The first three days I was with my usual preceptor and I finally felt like I understood her routine and what she expects of me. But Thursday and Friday, that same doctor was out of office for a continuing medical education conference in the city. Conveniently (or so it might seem) the course director for all of Family Medicine at my school works on Thursdays at this same clinic. It wasn't until the night before that I realized how much of the recommended curriculum my preceptor was ignoring. I survived the day, but definitely didn't establish myself as the Hermione of my med school*.
On Friday, I rotated to another doctor at the clinic and had a great time. He is the doc that takes the most complicated (and interesting) cases. Besides the TIL below, I also got to draw the blood for one of our patient's lab work. This was my first successful blood draw! Strangely enough, drawing blood off an extremely hypertensive man is a bit easier than the obese, edematous, dehydrated pregnant women I was tasked to draw from during OBGYN. (Psych and Peds frowned upon us practicing on the patients...)
MondayIL: Double crush syndrome is an unexplained correlation that has been found between wrist and neck pain in patients with carpal tunnel. The hypothesized mechanism for the joint joint pain (see what I did there?) is that the nerve axons that travel all the way from the neck to the hand are damaged one one end and become more prone to damage on the other end.
TuesdayIL: An APRN may or may not be the same thing as an NP. My preceptor shares an office with a spectacular nurse practitioner (NP). In New York state, NPs are able to practice totally independently from MDs and DOs as long as they have doctors that they can refer patients to if a patient's problem goes beyond their expertise. I specify that this is the case in NY because laws and regulations regarding NPs, PAs, and Doctors of Nursing vary all over the country. Generally though, an advanced practice registered nurse (APRN) is a blanket term for any of four kinds of doctorate level healthcare workers who approach medicine from the perspective of nursing. They are: certified registered nurse anesthetists (CRNAs), certified nurse midwives (CNMs), clinical nurse specialists (CNSs), and nurse practitioners (NPs).
WednesdayIL: I know a lot of Spanish (but no Bengali). The one choice from my past that I have most consistently kicked myself for is not taking Spanish in high school (actually I really did love French and my awesome French teacher, but still... [kick]). The patients at this clinic are predominantly Spanish-speakers, so I do a lot of detective work as the doctor talks to them to figure out what's being said, but I all but never speak the language myself. Initially, I thought I knew only a tiny amount of Spanish and that I was getting a lot of information from gestures and context. But then my preceptor slipped into Bengali with a patient from her native Bangladesh. Suddenly I was totally in the dark. At first this seemed depressing but then I realized that this meant I'm not as inept at Spanish as I initially though.
ThursdayIL: Prurigo nodularis is a mysterious illness that causes itchy nodules to appear all over the body. We don't know what causes it, how to treat it, who gets it or how often.
FridayIL: HIV patients can present very diversely. On Friday I helped take care of some very different HIV+ patients. Patients who reliably take their medication and who are socioeconomically stable can do fantastically well. Even looking at their blood work, let alone their outward appearance, you'd never know that they have such a scary illness. Other patients look like they are on death's door, in part because they aren't compliant with their lifesaving medication, and in part because they have several other problems that are speeding them towards the grave (like active cocaine use!). With this second group of patients, you can see all sorts of weird, rare infections straight out of our seemingly esoteric exam questions.
*10 points from Gryffindor! :(
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