Happy Halloween!

October 31, 2012

It’s Halloween night.  I’m in the South side of Chicago…so trick-or-treating seems like a not-so-safe option.  I refuse to sit here and read psych stuff all night without doing something fun and recreational, so I thought I’d take all those interested through a day at the hospital in rotations.  Now last rotation, I was “off-site” which meant that I worked with a doctor affiliated with our main hospital but we didn’t see patients at our hospital–we were at his office which happened to be next to a different hospital.  This is dramatically different from doing an “on-site” rotation where you see all or most of your patients at the hospital and go to the main hospital on an almost-daily basis. Arrival time at the hospital varies with rotation.  There are some rotations where there are MANY patients and not so many students, so those kids have to show up wickedly early to pre-round on their patients.

What this involves is sitting down in front of a computer, printing out a census of the patients for which you’re responsible and then your team leader (a senior student) delegating out patients to all of the students on your team.  It varies–you can see anywhere between 0 patients (if you have more students than patients) to 7-8 patients if your attending has a large patient load and there’s only 4 or 5 students.  This takes place in the main student computer room.  There are 5 computers and often upwards of 20 students if there are multiple rotations meeting here, so you can see how the computers are often in very high demand.  Unfortunately, it’s not a quick process where you get your patients and then go on your merry way; you get students who want to collect ALL of their patient information from the computer (rather than the physical chart), so they’ll grab one of the computers and sit there for an hour.  Yes, frustrating, BUT on a level I do commiserate–depending on what time you’re pre-rounding, there can be a LOT of ancillary staff needing the chart and it’s more frustrating to be sitting somewhere with the chart and have someone come and angrily demand the chart and steal it and not bring it back.  But then you have those people who take the chart AND the computer and park it there and refuse to move.  ::sigh::

There are many kids who leave their personal belongings in this room also.  That doesn’t sound so safe to me…given that this room is off of a major patient hall and the door is not locked and there are no security cameras in the room.  There is, however, an alternative.  This is the locker room.  (There’s a male room and a female room) They’re down in the basement far away from the patients, BUT should you choose to use it, it’s a secure, lockable place to store your valuables where you don’t have to worry about their safety.

The other important thing that takes place during this time is seeing your patients.  It is of PARAMOUNT importance that you go talk to your patients and see how they’re doing.  Even if they’re in the ICU and can’t talk, you should go talk to their nurse and see how things went overnight.  This is your opportunity to cover the S and O portions of your daily inpatient SOAP note.  It’s possible that you can have an uncooperative patient–some of them will refuse to talk to you, some just refuse the physical exam, some won’t let you come into their room.  It’s fine you just smile, reassure them that it’s ok–they won’t get in trouble for saying no and apologize for disturbing them and leave them alone.  They don’t all have narcissistic personality disorder, they just feel bad and want to minimize the number of times they’re uncovered and prodded and questioned and have their privacy gently violated.

So once you pre-round on your patients, then you join the rest of your team for rounds.  This usually involves meeting with your attending or resident and presenting your patients.  You discuss why the patient is in the hospital, what has changed since you last discussed that patient, the results of any tests that might have been run on the patient.  Usually the doctor will ask you questions next–ask you to interpret the data, ask you questions related to conditions the patient might have, ask you differential diagnoses, ask you what OTHER tests you think should be performed, ask you what treatments you think should be administered, etc.  This is where the guessing game comes into place and shows how in-tune you are with your Doc–they have free reigns to ask you ANYTHING–depending on how well you’ve anticipated their questions or how prepared you are in terms of accumulating information about your patients determines how successful this encounter is.  If you don’t know what kind of information the Doc is going to ask and you don’t adquately prepare, the Doc makes you look stupid in front of the group or gets frustrated because he/she has to go look up the information themselves.  It’s not necessarily a bad thing unless you have a really overbearing doctor (because EVERYONE feels stupid at one time or another), but it does facilitate QUICK learning.  The other thing is that no matter how well you prepare, everyone can get caught by a random question every now and then.  I’m doing psych now and while you might think we spend our time sitting around talking about anti-psychotic drugs and DSM requirements for diagnoses (we do, actually spend quite a bit of time discussing these things), we got into a 20-minute discussion today about Metabolic Syndrome and what are the requirements to diagnose someone with it.  (This is where having a smart phone with internet access comes in REALLY handy…).  True, it’s something we covered in PD & ICM but when you’re focused on your patient and what they ate and what their sodium was yesterday, you can get caught off-guard and stumped on something as basic as metabolic syndrome.  As long as it’s not a daily occurrence for you, it’s fine–you just make sure you go home and read up about whatever subject you were deficient in your knowledge about and you move on.

After rounds with your Doc, it again depends on which rotation you’re on as to what you do next.  Some make their students wait around the hospital until a certain time so that they can take any new admissions or cases.  Some students go to clinic next and see patients.  Some have to wait around for afternoon rounds or lecture by their attending.  Some students go to surgery or procedures with their patients.  Some, like us, get to go home.

Psych and Trip to City

October 31, 2012

Ahoy, readers!  Hope that everyone’s ok now that Hurricane Sandy seems to have done most of her damage.  My heart goes out to everyone affected.  Was surprised to hear about the failed generators and subsequent evacuation of NYU hospital; after working in an ICU for a while, just the though of having to scramble to get all those sick, SICK patients on battery-backup for all of their necessary monitors and devices AND getting them out of a partially-flooded hospital with stairs, wow.  In Chicago, we haven’t felt many effects from the storm; the waves were crashing a bit higher than normal today on the lake shore and it has seemed windier than normal.

Psych has been chugging right along.  Different from family med–new experience seeing in-patients and chasing attendings around the hospital, playing the hurry-up and wait game but it’s not unpleasant…I’d call it excitingly unpredictable.  Have learned to love my white coat.  No, I’m not big on the status thing (like other students, ahem) but being constantly in motion, moving from one unit to another, it’s VERY convenient having nice big pockets in which to carry your life–change for snacks, a book to read while you wait, notes on your patients, your phone to keep you connected to the world, pens, exam tools.  Life seems lighter when you don’t have to carry around a bookbag or even a purse.  Can’t believe we’re already 1/3 of the way through the rotation.

Some weeks are busier than others but on one of my less busy weeks, I decided to go adventuring uptown with friends.  Our efforts in searching for earmuffs (we didn’t find earmuffs…it got dark too soon):

 The Bus Ride can get a bit crowded…

“City Target”

Night-time view

Rotation 1: DONE!

October 22, 2012

Hi ya’ll.  Took a break to finish up the last couple weeks of family medicine selective strong.  For the elective rotations (or “Selective” (required elective) rotation, in the case of family medicine) 100% of your grade is determined by your preceptor’s evaluation of you, so I thought it would be good to read up and be on my best, most-prepared behavior.  Your preceptor is asked to give you a grade between 0-100 in the following categories:  Knowledge of Pathophysiology, Ability to form Differential diagnosis, Knowledge of Therapeutics, Data Gathering and Interviewing Skills, Chart Work, Treatment and Implementation, Rapport with Staff and Patients, Outside Reading, and Interest.  Um…so yeah: path, pharm, pd, and icm.  Make sure you pay attention, and obviously, that you keep up on your reading.  If you don’t read the textbooks, at least keep up on related journal articles.

Can’t believe family med’s over; feels like just yesterday I was sitting up in bed at 2am worrying that I would take the wrong bus and get lost on the way to hospital orientation.  Heh.  Now there are new kids in my place; SO many new MUA kids have come to Chicago and will start orientation tomorrow.  It’s nice to have so many familiar faces.  I think we’re quickly proving the rumors about Chicago to be untrue, which makes me very happy.

Speaking of untrue rumors, I must admit that I was too quick to dislike family medicine.  I was downright resentful at having to complete a required elective in it because I thought it would be boring and a waste of time.  Also, I think after reading all the statistics about it being the #1 practicing specialty of Caribbean grads, I programmed myself to hate it because I had somehow pictured it as the left-over scrap that remained after the US grads got to pick over all the cool specialties.  I was so wrong.  It wasn’t just the propaganda from the family medicine textbook that made me change my mind; there is a low-pressure atmosphere where you get to spend time with your patients and be more involved with their care and the impact it has on their lives.  Even in my short time in the rotation, I got the chance to follow-up on repeat patients and was surprised when they recognized me and then I, in turn, remembered details about them that made their care much more personalized.  You build-up a very personal, trusting relationship.  There are people decades older than you who come to you in times of desperate need for help and advice.  I’ve never felt more like an adult.  It made me realize why I wanted to get into this profession.  I will miss family med but look forward to the new and interesting challenges psych has to offer.

Breaks and Sushi

October 7, 2012

Have spent a lot of time at the homestead this past week, and will be spending more time here until Wednesday; clinic was cancelled one day last week and Monday of this coming week.  That means 4 days between clinic obligations, so lots of time to oneself.  What to do?

Reading is good.  Still haven’t felt the fire under my butt to start studying for Step 2 since the school requires you to complete 4 CORES before you’re elligible to take it, BUT have used the time to read up about family practice cases that I probably won’t get to see during this rotation.  It’s pretty lame reading with no assigned goals or problems or even cases that will be tested so I create little requirements for myself.  I broke the chapters down into quartets so that when I finish a quartet, I get to go watch an episode of internet tv or cook something or go work out.  I know, it’s silly but if I don’t, I find that I get distracted and end up getting NOTHING useful accomplished that day.

Went out with MUA rotation buddy after clinic the other day to a sushi place up in Hyde Park.  They have this great concept of all-you-can-eat a la carte.  You pay a flat rate and then fill out the sushi card and they bring you anything you like.  AWESOME!  Given that I don’t eat fish you’d think that I wouldn’t get that much out of it, but the crab and shrimp and veggie rolls were delish.  What a foreign concept, getting to enjoy sushi while being with school friends [from the island, where we didn’t have sushi…].  After we left, we took a long walk and passed this monument from the President’s first date by an ice cream shop.  How cute.Image

Ho Hum

October 2, 2012

Seems like yesterday I was complaining about the disorganization of orientation, and now all of a sudden I’m on my fourth week of my first rotation!  Yikes–over half-way done!  There’s not been a lot to comment about; clinic days are fun and challenging but then non-clinic days are pretty boring.  Between living on a next-to-nothing entertainment budget and still being really intimidated by leaving my nest and venturing out into not-so-secure Chicago, I don’t do much on my days off aside from go to the gym downstairs, catch up on internet TV, read and clean.  Sometimes I stop and think of how different it is from my life during the past two years and enjoy the contrast and the calmness.

This pretty much sums up the title: