Today was great! It started out a little rocky, but got much better.
This morning, I got to the clinic around 7:45 since the clinic starts at 8. I walk in, only to find out that apparently my preceptor doesn't start until 1pm on Mondays - something she neglected to tell me when we were talking before I got here. But, a very nice nurse gave me a quick tour of the clinic, and then I just went back to the apartment I'm staying in and caught up on some things for school and did some reading, which was nice! So I just had a nice, relaxing morning to myself.
The clinic is really interesting. It's federally funded, so most patients who go there don't have any insurance at all, not even Medicare. They use a sliding fee scale to determine how much each patient pays. I think it works like this: whatever percentage of the poverty line a patient's income is, that's the percentage of the cost they pay. So, if someone makes 20% of the poverty line per year, they only pay 20% of their costs. The clinic gets a subsidy from the government, but it's not enough to cover all the costs - the clinic operates in the red most years, according my preceptor. I'm no economist, but I'm not really sure how that continues to work year after year. I guess it does, though, which is good for the people that need healthcare around here. Every patient I saw today was so nice, and so appreciative of the care they were getting. Most of them might come to a doctor once a year because that's all they can afford, and most of them like coming to the clinic I'm at because my preceptor does a lot of smaller procedures right in the office, which saves the money of having to go see a specialist.
Speaking of smaller procedures, today I did 10 injections (even though I was only there for about four hours). I did eight injections in a woman's neck for chronic neck pain, one in a woman's elbow for inflammation from holding too many heavy grandbabies for too long, and one in a man's shoulder who has a rotator cuff tear but can't take off work to let it heal (at his manual labor-intensive job) so he needed a quick fix. I also saw other patients who were just in for medication adjustments, and got to see them by myself before the doctor came in. My preceptor is really great because she just lets me do things and doesn't seem to question my ability to do it, which is definitely a confidence booster. I think I'll be able to learn a lot here!
Monday, August 26, 2013
Sunday, August 25, 2013
Round three!
Well, I have arrived in Kentucky for my third rotation! Sorry for the lack of updates, I've been pretty busy with traveling and getting everything together.
My surgery rotation ended on a good note! My preceptor gave me a good evaluation, and my last patient with her was a mole excision - she let me do a punch biopsy all on my own! It was really cool. I got to numb the skin up, do the punch, and then glue the little circular hole together so the patient would have a more linear scar. It was a good way to end that rotation! Then, I flew from Kansas to home in New Jersey, then relaxed with family during our summer week off. Yesterday, I drove out to Pittsburgh, and today, I completed the journey to Kentucky - whew!
The area I'm in is extremely rural, even more so than the town I was at in Maine. It even seems more remote than Kansas, because at least in Kansas things are more flat, so you can see other buildings. Here, it's mountain after mountain with just the occasional building. The "downtown" section of where I am looks more like a ghost town, with empty storefronts and boarded windows. On the outskirts, there are a few bigger stores, but not anything major: one (small) grocery store, a couple gas station convenience stores, a Rite-Aid, and some family-owned auto repair businesses. Oh, and the clinic! It looks huge compared to most other buildings here, but it's still pretty small. I start tomorrow, and I'll be working with the one doctor that works there. There are also three nurse practitioners at the clinic. The hours are long (8am-7pm every day, except hours end at 5pm on Friday), so I'm pretty sure they don't all work every day.
I'll probably post something tomorrow about how my first day went, but I'm expecting it to mostly be shadowing, which is fine with me. This rotation is in family practice, and since my last two rotations were pretty specific (women's health and general surgery), I feel like I need serious refreshing on the rest of the body! There will definitely be lots of studying happening this week. :)
My surgery rotation ended on a good note! My preceptor gave me a good evaluation, and my last patient with her was a mole excision - she let me do a punch biopsy all on my own! It was really cool. I got to numb the skin up, do the punch, and then glue the little circular hole together so the patient would have a more linear scar. It was a good way to end that rotation! Then, I flew from Kansas to home in New Jersey, then relaxed with family during our summer week off. Yesterday, I drove out to Pittsburgh, and today, I completed the journey to Kentucky - whew!
The area I'm in is extremely rural, even more so than the town I was at in Maine. It even seems more remote than Kansas, because at least in Kansas things are more flat, so you can see other buildings. Here, it's mountain after mountain with just the occasional building. The "downtown" section of where I am looks more like a ghost town, with empty storefronts and boarded windows. On the outskirts, there are a few bigger stores, but not anything major: one (small) grocery store, a couple gas station convenience stores, a Rite-Aid, and some family-owned auto repair businesses. Oh, and the clinic! It looks huge compared to most other buildings here, but it's still pretty small. I start tomorrow, and I'll be working with the one doctor that works there. There are also three nurse practitioners at the clinic. The hours are long (8am-7pm every day, except hours end at 5pm on Friday), so I'm pretty sure they don't all work every day.
I'll probably post something tomorrow about how my first day went, but I'm expecting it to mostly be shadowing, which is fine with me. This rotation is in family practice, and since my last two rotations were pretty specific (women's health and general surgery), I feel like I need serious refreshing on the rest of the body! There will definitely be lots of studying happening this week. :)
Tuesday, August 6, 2013
A much delayed update
Sorry for the lack of recent updates! I've been busy with assignments for school, along with studying for and taking exams. Plus, my rotation hasn't been overly exciting recently. I mean, I still get to see and do really cool things, but it's a lot of the same kind of things over and over again, and therefore not really worth blogging about. But, I did see some cool surgeries yesterday!
The first one I saw was an arteriovenous fistula creation. That basically means that the surgeon takes an artery and a vein, and sews them together. They're used for patients who need to get dialysis because the vein becomes strengthened as a result of the fistula creation, and this makes for a better site to stick people for repeated dialysis treatments. Needless to say, the surgery was all very small cutting and sewing, but luckily I was allowed to sit right across from my preceptor and watch the whole thing, and also hold instruments and generally be helpful during the procedure. And after the surgery is done, the patient has what's called a "thrill" that you can feel under the skin. It's basically like a more diffuse pulse that kind of feels like what a cat purring sounds like, if that makes any sense. This particular fistula was so successful that you could feel the thrill right after everything was all sewed up. It was awesome!
The other surgery I saw yesterday that was new and exciting for me was a laparoscopic Nissen fundoplication. This surgery is used for patients with serious chronic acid reflux, and basically acts by wrapping the top of the stomach around the base of the esophagus to help prevent the backflow of acid from the stomach into the esophagus that causes the reflux symptoms (heartburn). The surgery isn't too complicated technically, but because of the area it's in, it can be a stressful procedure for the surgeons (the area where they're working is very close to the heart and lungs, among other things).
Something I really like about this rotation is that there are no other students here. That means I get all the attention from not only my preceptor, but the other doctors in her practice, too. I also get to scrub in on almost every case, and I get to suture nearly every case I'm scrubbed in on (that means I'm getting really good at suturing, which is an important skill for a PA!). According to some of my classmates that are also doing surgery rotations right now, that's pretty rare. If I was in a city, or a location with a nearby medical school or PA program, I would have to share all of these resources with not only other PA students, but med students too. I really like having it all to myself so I can learn the most! I have about a week left here, and I'm definitely going to make the most of it. :)
The first one I saw was an arteriovenous fistula creation. That basically means that the surgeon takes an artery and a vein, and sews them together. They're used for patients who need to get dialysis because the vein becomes strengthened as a result of the fistula creation, and this makes for a better site to stick people for repeated dialysis treatments. Needless to say, the surgery was all very small cutting and sewing, but luckily I was allowed to sit right across from my preceptor and watch the whole thing, and also hold instruments and generally be helpful during the procedure. And after the surgery is done, the patient has what's called a "thrill" that you can feel under the skin. It's basically like a more diffuse pulse that kind of feels like what a cat purring sounds like, if that makes any sense. This particular fistula was so successful that you could feel the thrill right after everything was all sewed up. It was awesome!
The other surgery I saw yesterday that was new and exciting for me was a laparoscopic Nissen fundoplication. This surgery is used for patients with serious chronic acid reflux, and basically acts by wrapping the top of the stomach around the base of the esophagus to help prevent the backflow of acid from the stomach into the esophagus that causes the reflux symptoms (heartburn). The surgery isn't too complicated technically, but because of the area it's in, it can be a stressful procedure for the surgeons (the area where they're working is very close to the heart and lungs, among other things).
Something I really like about this rotation is that there are no other students here. That means I get all the attention from not only my preceptor, but the other doctors in her practice, too. I also get to scrub in on almost every case, and I get to suture nearly every case I'm scrubbed in on (that means I'm getting really good at suturing, which is an important skill for a PA!). According to some of my classmates that are also doing surgery rotations right now, that's pretty rare. If I was in a city, or a location with a nearby medical school or PA program, I would have to share all of these resources with not only other PA students, but med students too. I really like having it all to myself so I can learn the most! I have about a week left here, and I'm definitely going to make the most of it. :)
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