WILTIMS day #400 started early for me. I was the patient again as I had an echocardiogram done. We were rechecking a previous echo that had shown that my heart was pumping rather... half-heartedly. I still think it's always a good thing when doctors and other health care providers have to experience the system from the patient perspective. Just like everyone else, I had to put off this test for a week while waiting for my insurance to give prior authorization. I had to find a time that didn't conflict with my clerkship schedule. And I had to go back to work/school/hospital and await a call from my cardiologist to hear the results. (Everything's fine, btw)
Thursday was full of new experiences for me. First, I was interviewed by an anthropology PhD student about my experiences dealing with prediabetic patients. I'm still not sure how much help it is to have a medical student's opinion of things, but I was happy to help. The anthropologist manner of the woman was weird in the medical setting and reminded my of a class I took in undergrad on ethnomusicology where musicologists would roam the backroads of the country with a tape recorder in the hope of documenting isolated musicians. It felt like she treked through the wilds of our urban clinic to find my peculiar thoughts on medicine.
A couple hours later we walked over to the other half of our building to ask a podiatrist in the building for advice on what to do with a woman's broken toe. I love this part of medicine - the collaborative team. It's part of why I like hospitals and big medical groups like the one I'm rotating at more than little private practices. Everyone around you is an expert, so when one person wants/needs some help, it's readily available. It bothers me how little of this goes on in the relative isolation of a small private practice.
Finally, we saw a patient that reminded me that even our relatively poor population has it well-off compared to some. The man was homeless and dependant on alcohol. And yet, he was still more compliant than most of our patients with taking his blood pressure medication. It's hard counselling someone on eating a healthy diet when that person is not consistently eating. For this average-height ~50 year old man, I had to use the pediatric blood pressure cuff to get an accurate reading. He had yet to eat by 4pm that day, yet we knew he had already had a good amount of vodka. He wasn't drunk, per se, because alcohol barely affected him any more. He had recently cut back to a pint of vodka a day from half a gallon.
Friday, I was "invited" back to a remediation session to work on my admittedly lackluster timed notetaking skills. I was frustrated to have to be there (even though half of our class had to join me), but by the end of the day, I think it was good practice. It is amazing how little time 10 minutes is when you're trying to write-up a 15 minute encounter.
Thank you for reading through another 100 days of facts and musings! On to the big five-o-o!? Hmm that sounds more like the count dressed up as a ghost for Halloween... The big D!? Oh, wait, that came out wrong. Damn roman numerals!
WednesdayIL: Long QT syndrome can be diagnosed if the corrected QT interval (or QTc) is >450ish (depending on gender/age). The QT interval is the amount of time that passes on an EKG from the depolarisation to the repolarisation of the heart's ventricles with every beat. That time can be artificially lengthened or shortened depending on the patient's heart rate, so a correction is ideally applied before analysing the number. Long QT syndrome is usually asymptomatic, but can lead to sudden cardiac death when certain stressors or medications affect the patient.
ThursdayIL: Cream, ointment and lotion are not actually synonyms, but instead describe subtle differences between topical drug vehicles. Creams are mixtures of water and oil and are rapidly absorbed. Ointments are oil based and stay on the skin longer. Lotions are thinner and usually have an alcohol component, which makes them more likely to evaporate and dry out the skin.
FridayIL: For the USMLE Step 2 CS exam, you can use negative findings from one diagnosis to support the other two you list in the patient note. That way, if the standardized patient is a totally healthy person, you can still have appropriate physical exam findings by showing what you didn't see, that by being absent helps support one or more diagnoses over others.
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