This week was nice and (relatively) laid back. There were some interesting cases, too! Granted, there were a lot of appointments for checkups/medication refills and upper respiratory infections, but we also saw a couple cases of mono and some other things. One patient was particularly interesting...her appointment slot just said she was there for medication refills, but once we were in there talking to her she started talking about how she'd been losing her balance over the past few months. Later, she mentioned that she'd been having some trouble holding lightweight objects (like a piece of paper) in her hands, because her grip "wasn't strong enough." On exam, she had a positive Romberg (balance test), ataxic gait, slightly weakened grip strength, and couldn't perform some of the cerebellar function tests. Needless to say, she got a referral to a neurologist. My preceptor and I both couldn't come up with a good idea behind why she was having these symptoms...we have a few ideas, but nothing seems to fit perfectly. I'm glad I'm here for another 8 weeks still so I'll be able to find out what happens!
And on Thursday, I got to hang out with a radiologist all day. I realize that most normal, non-medical people wouldn't think that's very exciting, but it was! Thursdays are my preceptor's days off, so he sent me out to this other town (90 miles away, or a "hop, skip, and a jump" to Montanans) to learn some radiology skills with the radiologist who reads all the X-rays and CTs from our facility and others. He was so nice and such a great teacher! I learned a lot, and I'm really excited to develop a skill set that most PA students probably don't have the opportunity to develop. Plus, it was nice to drive around Montana a little more. Even though the part of Montana that I'm in (north central) is pretty much flat, it's still beautiful. I'm hoping to explore a little more tomorrow!
Saturday, February 22, 2014
Sunday, February 16, 2014
Hello from Montana!
I'm so, so sorry I didn't post sooner! I was really busy getting settled in, and then the hours in the clinic this first week were pretty long and demanding, so by the time the day was over I just didn't have it in me to write anything.
So! Let me first explain the setup here. There is a nursing home facility with about 50 residents, a six-bed hospital, a two-bed ER, and a fully functioning clinic all located within the same building. The medical professionals in charge of this facility are one doctor, one PA, and one nurse practitioner. That means they do everything! They are simultaneously internists, pediatricians, gynecologists, ER providers, and long-term care providers. These three people are basically responsible for everything and everyone within a 90-mile radius, because that's how far it is to the nearest larger town. As the only student, this is an amazing opportunity!! Yes, I'm technically here for family practice and pediatrics rotations, but I'm also getting to brush off my ER skills and getting to learn some long-term management skills.
I'm mostly in the clinic, as are the providers. A typical day there lasts from 9 to 5ish, plus then finishing any lingering paperwork, and we see about 12-15 patients per day. I really like this patient load, because it gives you plenty of time to talk to patients and make sure you're really taking care of them well. So far, most visits have been for seasonal sicknesses - flu, sinusitis, bronchitis, etc. - and there are occasional checkups or follow-ups. I see a pretty good mixture of adults and kids, which is good - I have zero knowledge of how to interact with small kids in a medical setting! I think that will definitely be my biggest challenge while I'm here. It's an intricate dance of making sure the child feels comfortable around you so they let you do the exam, and also making sure the parents trust what you're doing and saying. Hopefully I'll be much better at it by the time I leave!
Most clinic visits aren't super exciting, but I have been able to do a fair number of procedure-type stuff in just the first week! I got to staple someone's head after they slipped on ice and fell and hit their head on stairs, and I got to suture a thumb that got sliced open by a carpet cutter at work. I've also done pelvic exams and Pap smears! Really, this rotation is kind of functioning as a review of most rotations I've had so far, plus adding the pediatric element. It's great!
Everyone here, patients and providers alike, is super nice and I think I'll really enjoy being here for the next two months or so. It's definitely a small community, though, and I can't really even go to the grocery store or the post office with that small degree of anonymity that you take for granted in suburban or urban life. Everywhere I go, people know that I'm not from there, and most times they even know that I'm the PA student at the clinic, because they heard one was coming and I don't look familiar! But that's okay, everyone is very welcoming and they seem happy to have me here. :)
So! Let me first explain the setup here. There is a nursing home facility with about 50 residents, a six-bed hospital, a two-bed ER, and a fully functioning clinic all located within the same building. The medical professionals in charge of this facility are one doctor, one PA, and one nurse practitioner. That means they do everything! They are simultaneously internists, pediatricians, gynecologists, ER providers, and long-term care providers. These three people are basically responsible for everything and everyone within a 90-mile radius, because that's how far it is to the nearest larger town. As the only student, this is an amazing opportunity!! Yes, I'm technically here for family practice and pediatrics rotations, but I'm also getting to brush off my ER skills and getting to learn some long-term management skills.
I'm mostly in the clinic, as are the providers. A typical day there lasts from 9 to 5ish, plus then finishing any lingering paperwork, and we see about 12-15 patients per day. I really like this patient load, because it gives you plenty of time to talk to patients and make sure you're really taking care of them well. So far, most visits have been for seasonal sicknesses - flu, sinusitis, bronchitis, etc. - and there are occasional checkups or follow-ups. I see a pretty good mixture of adults and kids, which is good - I have zero knowledge of how to interact with small kids in a medical setting! I think that will definitely be my biggest challenge while I'm here. It's an intricate dance of making sure the child feels comfortable around you so they let you do the exam, and also making sure the parents trust what you're doing and saying. Hopefully I'll be much better at it by the time I leave!
Most clinic visits aren't super exciting, but I have been able to do a fair number of procedure-type stuff in just the first week! I got to staple someone's head after they slipped on ice and fell and hit their head on stairs, and I got to suture a thumb that got sliced open by a carpet cutter at work. I've also done pelvic exams and Pap smears! Really, this rotation is kind of functioning as a review of most rotations I've had so far, plus adding the pediatric element. It's great!
Everyone here, patients and providers alike, is super nice and I think I'll really enjoy being here for the next two months or so. It's definitely a small community, though, and I can't really even go to the grocery store or the post office with that small degree of anonymity that you take for granted in suburban or urban life. Everywhere I go, people know that I'm not from there, and most times they even know that I'm the PA student at the clinic, because they heard one was coming and I don't look familiar! But that's okay, everyone is very welcoming and they seem happy to have me here. :)
Sunday, February 9, 2014
Made it to Montana!
I'm all settled in and ready for my combination family practice and pediatrics rotations! The town I'm in is pretty small, and I haven't had much of a chance to explore yet, but I don't think there's much to it. So far I've only gotten a tour of the clinic and hospital, and I've been to the grocery store. The town seems nice, and the people are really friendly! I met a bunch of people on my tour today, even though it's the weekend, and they all seemed really welcoming. I'm excited to start tomorrow! I'll be sure to post an update about my first day. :)
Tuesday, January 28, 2014
Still in IM...
I'm still doing my internal medicine rotation, and just wanted to check in quickly! I'm not loving the rotation, mostly because I'm pretty frustrated with the lack of care most patients actually receive, and I don't want to rant about it too much in case anyone from my school (or the doctor's office) could happen to find my blog somehow. But, essentially: the office I'm at sees a high volume of patients each day, and that means that the doctor spends about 2-3 minutes with each patient, and really glosses over some things that (in my opinion) should be given more consideration. So! It's up to the students to really talk to the patient and advocate for what they think the patients need, but the doctor can choose to ignore some really glaring things.
I'm honestly pretty disappointed in this rotation. As my preceptor's head nurse said to me today, "This is the rotation where you learn what not to do." My preceptor is a personable guy and pretty friendly, and his patients like him because of this, but they're really not receiving in-depth, quality care. I'm hoping my next rotations in Montana will be different!
I'm honestly pretty disappointed in this rotation. As my preceptor's head nurse said to me today, "This is the rotation where you learn what not to do." My preceptor is a personable guy and pretty friendly, and his patients like him because of this, but they're really not receiving in-depth, quality care. I'm hoping my next rotations in Montana will be different!
Monday, January 13, 2014
A great day in IM!
This rotation is great. Not only are the hours incredibly sparse (this whole week, I will only be there for about 23 hours...), but my preceptor is really nice and a great teacher, and the patients are (mostly) nice and come in for relatively easy appointments. I think my favorite part, though, is just taking a few minutes to talk to people and help them beyond just refilling their medications.
Today, for example, we had a new patient come in who hadn't been to a doctor in over six years, because he "never felt bad." So, when I was asking him the typical questions that you ask a new patient, I inquired about his diet and found that it was awful (fast food, highly processed foods, no fruits/vegetables, lots of carbs, sugary drinks all day every day). He thought he was doing pretty well, and told me he never even thinks about eating more healthily. So...kindly and patiently, I suggested adding more fruits and vegetables in, and also suggested drinking something like a V8 Fusion that tastes pretty good but offers some of the benefits of fruits and vegetables. He said he hates fruits/veggies, so that sounded like a good option, and he was definitely excited to try it. Also, he was already trying to quit smoking, so I encouraged him with that and gave him some tips. We also set up a couple of referrals for problems that would require a specialist. It just felt really good to listen to the problems this patient was presenting with and help him to come up with a plan of action that he was really, truly going to follow. I felt good leaving that room because I knew that a person who had previously hated doctors and was only coming in for an acute complaint had been converted and would start getting preventive screenings and care. So, I was pretty proud of myself!
The rest of our patients today were pretty uneventful. This rotation is pretty relaxed, and we get free food a lot. Even though it's not as exciting as, say, the ER or surgery, I could see myself working in an office setting like this!
Today, for example, we had a new patient come in who hadn't been to a doctor in over six years, because he "never felt bad." So, when I was asking him the typical questions that you ask a new patient, I inquired about his diet and found that it was awful (fast food, highly processed foods, no fruits/vegetables, lots of carbs, sugary drinks all day every day). He thought he was doing pretty well, and told me he never even thinks about eating more healthily. So...kindly and patiently, I suggested adding more fruits and vegetables in, and also suggested drinking something like a V8 Fusion that tastes pretty good but offers some of the benefits of fruits and vegetables. He said he hates fruits/veggies, so that sounded like a good option, and he was definitely excited to try it. Also, he was already trying to quit smoking, so I encouraged him with that and gave him some tips. We also set up a couple of referrals for problems that would require a specialist. It just felt really good to listen to the problems this patient was presenting with and help him to come up with a plan of action that he was really, truly going to follow. I felt good leaving that room because I knew that a person who had previously hated doctors and was only coming in for an acute complaint had been converted and would start getting preventive screenings and care. So, I was pretty proud of myself!
The rest of our patients today were pretty uneventful. This rotation is pretty relaxed, and we get free food a lot. Even though it's not as exciting as, say, the ER or surgery, I could see myself working in an office setting like this!
Monday, January 6, 2014
First day of internal medicine!
My first day at this rotation went much better than anticipated! I fell right back into the groove and did totally fine at talking to patients. It definitely helped that my preceptor is incredibly laid-back and funny. He's not pretentious or uptight at all, and he seems to treat students like people and not idiots, which is refreshing (even if I still feel like an idiot at times and still, obviously, have a lot to learn!).
He gives us a lot of autonomy, which is both awesome and terrifying. We (me and the two other students) bring patients back, take their vitals, and see them on our own. Then we jot down a brief SOAP note on the back of their intake sheet, and give it to the doctor (or present it briefly if we have time! He moves fast!). Then, he goes in to see them for about one minute, and basically just chats. Most patients are there for their three-month follow-up visits just for medication refills, but I did do one annual physical today. Then, he uses our opinion and our note to dictate the actual note! Seriously, I heard him doing one of mine and it was essentially exactly what I had written down. Even though it's scary to think that I'm essentially having the last word in terms of how a person is doing, it's also good because it makes you actually assume responsibility for the patients, instead of just relying on the fact that someone with more experience is going to go right in after you and double-check. So, it's closer to real life, and I like that.
Oh, and the content of the visits is very similar to family practice - medication refills and urgent care-type stuff like colds, joint or back pain, etc. Nothing I can't handle. :)
He gives us a lot of autonomy, which is both awesome and terrifying. We (me and the two other students) bring patients back, take their vitals, and see them on our own. Then we jot down a brief SOAP note on the back of their intake sheet, and give it to the doctor (or present it briefly if we have time! He moves fast!). Then, he goes in to see them for about one minute, and basically just chats. Most patients are there for their three-month follow-up visits just for medication refills, but I did do one annual physical today. Then, he uses our opinion and our note to dictate the actual note! Seriously, I heard him doing one of mine and it was essentially exactly what I had written down. Even though it's scary to think that I'm essentially having the last word in terms of how a person is doing, it's also good because it makes you actually assume responsibility for the patients, instead of just relying on the fact that someone with more experience is going to go right in after you and double-check. So, it's closer to real life, and I like that.
Oh, and the content of the visits is very similar to family practice - medication refills and urgent care-type stuff like colds, joint or back pain, etc. Nothing I can't handle. :)
Sunday, January 5, 2014
Back at it!
Well, after an amazing and much-needed winter break at home with family, I am back in Pittsburgh and ready for my sixth rotation - internal medicine. If I'm being honest, my heart's just not in it right now - I'd rather still be hanging out at home for a few more weeks! I'm hoping that getting back in the routine tomorrow will help.
This rotation should be relatively relaxing compared to my last couple rotations - this whole spring semester, in fact, is going to be much more laid back than the fall, just because of which rotations I have coming up. Internal medicine is really just general practice, but specifically for adults. So, it will be a lot of high blood pressure, high cholesterol, and diabetes, and managing all the medications that come with those. Personally, it's not fascinating to me, but my preceptor is supposed to be really nice and relaxed, so at least the rotation itself will be fun.
I'll actually only be at my rotation for the afternoon tomorrow, but I'll try to post an update about the first day anyway! Here's hoping it's either more exciting than I think it will be, or that my attitude changes with a good night's sleep. :)
This rotation should be relatively relaxing compared to my last couple rotations - this whole spring semester, in fact, is going to be much more laid back than the fall, just because of which rotations I have coming up. Internal medicine is really just general practice, but specifically for adults. So, it will be a lot of high blood pressure, high cholesterol, and diabetes, and managing all the medications that come with those. Personally, it's not fascinating to me, but my preceptor is supposed to be really nice and relaxed, so at least the rotation itself will be fun.
I'll actually only be at my rotation for the afternoon tomorrow, but I'll try to post an update about the first day anyway! Here's hoping it's either more exciting than I think it will be, or that my attitude changes with a good night's sleep. :)
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