Here's an inspirational article about improvement in ob/peds in Sierra Leone! http://www.nytimes.com/2011/07/18/world/africa/18sierra.html?pagewanted=2&_r=1 (thanks YW)
Saturday, July 23, 2011
Saturday, July 16, 2011
3rd year Summaries of Rotations
In general: I asked too many stupid questions - yes, there is such a thing. If it's a question where you can just look it up - then note it and look it up later. Better to ask questions that aren't easily looked up. Even better to look up something, and say, "I was reading this paper...and didn't understand..." Also figure out people's personalities. If they don't like questions, don't ask so many questions! - i can't seem to get this right.
Psychiatry: it was a very fascinating rotation. Got to see some things that most people would never ever see and probably never will see even if they're doing medicine just because everything's locked up. I've definitely had a change of mind about psych. I came in mostly skeptical about the "science behind it all" and the validity of using medication on all these seemingly personality related issues, but when you actually see these people, you know there's something else going on. And it's AMAZING what a big change the medicine makes, sometimes just in the course of a day! From the rambling, incoherent, suicidal lady who looks deathly distressed and disheveled to the joyful, upbeat lady who jokes with me and says I should go into psychiatry - all in 3 days.
Things that I could do: preround each morning, speak with patient's families, get previous hospital records (fax or ask awesome social workers for help), help put in orders, help put in discharge orders, help write up discharge dictation notes. For preround, it's good to look up labs, and flowsheet/psych notes from nurses (ask where they are under flowsheet). Note abnormal lab results. For call, good to go down to ER to take history (b/c can take a while for them to get up to the floor). Work with other med students on your team to present an article on certain days (maybe each week) - makes everyone happy.
Neurosurgery: Well, I had a resident who was very busy and walked really fast, so I often got lost, and didn't have much to do except listen. I think I could've done a better job listening during rounds because I knew stuff about my patient, but I just couldn't hear their question to answer them. Sighs. Well, know the patients, know their history, labs (results in compass and microbiology in clindesk), and imaging (ddx) in clindesk. Also know normal values for LP pressure (5-15), and basic important things like m/c cause of strokes, etc. Chief residents know their stuff - listen/watch them well. During operations, it's good to scrub in and watch from up close, even though you might not feel like you can do much (know how to tie knots! practice! - esp one-handed ones). During prep/post surgery, help anesthesia and help move the patient. Might need to watch well the first time, and then help out. Anesthesia's always willing to teach, so it's good to ask them if you can help. Also, you'd be surprised how much some of the tech's know - especially those monitoring that movement is still normal (Somatosensory evoked potentials). They can teach a lot! This one guy essentially gave me a play-by-play of this one surgery + other nifty info. Learn to speak succinctly on presentations of patients. Very big difference from the nice/friendly atmosphere of psychiatry. You have to be really alert/keen about what you can do. Never ask a surgeon about bleeding (ya...my mistake).
Neurology Inpatient: Well, enjoyed it enough that I'm not crossing it off my list of potentials. I definitely liked spending more time with patients and thinking more about each case. I find that I really enjoy thinking about things - maybe that points me towards medicine more than surgery? Who knows. A lot the cases were MS and seizures, but there were definitely a lot of cases where people got discharged, moved to another service, coded, or whatever...and we never really truly understood what they had. I think that might be a plus or a minus. The minus is that well, you don't always know what the patient has. But the plus is that it gives some purpose to the physician aside from just treating each individual patient. It's definitely a field that's constantly improving - kind of like psych. There are just still so much unknowns about the brain left to be discovered.
In terms of the team, I really enjoyed working with everyone. The attending was really friendly and greatly enjoyed teaching, and I was really fortunate to have an awesome chief resident who took the time take us aside and teach us for an hour. Even though the junior residents were really busy, it was still a pleasure to work with them, whether it was just helping them out with the gargangium amount of stuff they had to do, learning tidbits, or receiving advice on how to improve. It felt like me, being the slow and steady type of person, could fit in. Although I did get the criticism that I tended to focus on the details and forget about the big picture and plans/management for the patient. And since I'm a student, I should use the extra time I have to really work out the differential and consider all the angles/possibilities. It's true - by the time I get down to the assessment and plan, I just want to be done with it. One thing I regret not doing on this rotation was an LP. It's a shame, I probably ended up watching 7 or 8, but each time when I asked if I could try the LP, it was either a bad patient (too large), there were complications, I had lecture, or the resident needed to do it because he/she hadn't done it yet. Sighs. Hopefully I'll get to do one in the ER next rotation.
ER: What do you know, I got to do an LP! That was really exciting. Even more exciting was that it was successful. ER was a load of fun. Being able to see all these different cases, and coming up with the most dangerous ddx was fun, but also sometimes made me a big skeptical. I mean, the lady with the fatigue and bilateral leg edema - do you really think that's a pericardial effusion when her heart/lungs sound fine? I suppose it's better to be safe than sorry. I also found that I LOVED seeing babies on ultrasound. Hm...maybe this means something? But then again, I also LOVED suturing. I could take forever. It reminds me of sewing and knitting - but flesh. Okay, that picture's getting gruesome. Anyhow, I can see myself doing ER. A lot of what they do seem like protocol than actual quick decision making, but I'm sure things are different in the more traumatic areas of the ER. We'll see, I'll probably need to do another shift next year, although I gotta say it does kind of bother me not knowing what happens to the patients (granted I could just look it up). I think I like more continuity. Maybe.
Pediatrics: I LOVE KIDS! They are just so adorable! I don't see how anyone can not like kids. Just walking through Children's Hospital gives me a warm fuzzy feeling. Maybe a part of me is still very much a kid, so I get drawn to the bright colors and the cool contraption of the rolly balls going up and down. Even being in heme/onc wasn't as sad as I had thought. The kids are just so resilient, and they are so bright compared to adults.
I've been a little more concerned about interacting with teenagers, but so far, they've been okay. They can be a little terse. I find I go into my little kid voice and sometimes continue to talk in that voice to the parents - oops.
I thought I was going to looooove babies, and well, yes I do. Just holding them in my arms and watching them sleep is like watching a little angel. I just want to cuddle them all day! But what made nursery difficult was having to work with the mothers and prepare them for motherhood - for which many were definitely NOT prepared. It's so sad sometimes. There are these innocent, perfect, beautiful babies, and you have to hand them over to who knows what kind of world is out there. Well, I guess that's life.
Lessons learned:
Psychiatry: it was a very fascinating rotation. Got to see some things that most people would never ever see and probably never will see even if they're doing medicine just because everything's locked up. I've definitely had a change of mind about psych. I came in mostly skeptical about the "science behind it all" and the validity of using medication on all these seemingly personality related issues, but when you actually see these people, you know there's something else going on. And it's AMAZING what a big change the medicine makes, sometimes just in the course of a day! From the rambling, incoherent, suicidal lady who looks deathly distressed and disheveled to the joyful, upbeat lady who jokes with me and says I should go into psychiatry - all in 3 days.
Things that I could do: preround each morning, speak with patient's families, get previous hospital records (fax or ask awesome social workers for help), help put in orders, help put in discharge orders, help write up discharge dictation notes. For preround, it's good to look up labs, and flowsheet/psych notes from nurses (ask where they are under flowsheet). Note abnormal lab results. For call, good to go down to ER to take history (b/c can take a while for them to get up to the floor). Work with other med students on your team to present an article on certain days (maybe each week) - makes everyone happy.
Neurosurgery: Well, I had a resident who was very busy and walked really fast, so I often got lost, and didn't have much to do except listen. I think I could've done a better job listening during rounds because I knew stuff about my patient, but I just couldn't hear their question to answer them. Sighs. Well, know the patients, know their history, labs (results in compass and microbiology in clindesk), and imaging (ddx) in clindesk. Also know normal values for LP pressure (5-15), and basic important things like m/c cause of strokes, etc. Chief residents know their stuff - listen/watch them well. During operations, it's good to scrub in and watch from up close, even though you might not feel like you can do much (know how to tie knots! practice! - esp one-handed ones). During prep/post surgery, help anesthesia and help move the patient. Might need to watch well the first time, and then help out. Anesthesia's always willing to teach, so it's good to ask them if you can help. Also, you'd be surprised how much some of the tech's know - especially those monitoring that movement is still normal (Somatosensory evoked potentials). They can teach a lot! This one guy essentially gave me a play-by-play of this one surgery + other nifty info. Learn to speak succinctly on presentations of patients. Very big difference from the nice/friendly atmosphere of psychiatry. You have to be really alert/keen about what you can do. Never ask a surgeon about bleeding (ya...my mistake).
Neurology Inpatient: Well, enjoyed it enough that I'm not crossing it off my list of potentials. I definitely liked spending more time with patients and thinking more about each case. I find that I really enjoy thinking about things - maybe that points me towards medicine more than surgery? Who knows. A lot the cases were MS and seizures, but there were definitely a lot of cases where people got discharged, moved to another service, coded, or whatever...and we never really truly understood what they had. I think that might be a plus or a minus. The minus is that well, you don't always know what the patient has. But the plus is that it gives some purpose to the physician aside from just treating each individual patient. It's definitely a field that's constantly improving - kind of like psych. There are just still so much unknowns about the brain left to be discovered.
In terms of the team, I really enjoyed working with everyone. The attending was really friendly and greatly enjoyed teaching, and I was really fortunate to have an awesome chief resident who took the time take us aside and teach us for an hour. Even though the junior residents were really busy, it was still a pleasure to work with them, whether it was just helping them out with the gargangium amount of stuff they had to do, learning tidbits, or receiving advice on how to improve. It felt like me, being the slow and steady type of person, could fit in. Although I did get the criticism that I tended to focus on the details and forget about the big picture and plans/management for the patient. And since I'm a student, I should use the extra time I have to really work out the differential and consider all the angles/possibilities. It's true - by the time I get down to the assessment and plan, I just want to be done with it. One thing I regret not doing on this rotation was an LP. It's a shame, I probably ended up watching 7 or 8, but each time when I asked if I could try the LP, it was either a bad patient (too large), there were complications, I had lecture, or the resident needed to do it because he/she hadn't done it yet. Sighs. Hopefully I'll get to do one in the ER next rotation.
ER: What do you know, I got to do an LP! That was really exciting. Even more exciting was that it was successful. ER was a load of fun. Being able to see all these different cases, and coming up with the most dangerous ddx was fun, but also sometimes made me a big skeptical. I mean, the lady with the fatigue and bilateral leg edema - do you really think that's a pericardial effusion when her heart/lungs sound fine? I suppose it's better to be safe than sorry. I also found that I LOVED seeing babies on ultrasound. Hm...maybe this means something? But then again, I also LOVED suturing. I could take forever. It reminds me of sewing and knitting - but flesh. Okay, that picture's getting gruesome. Anyhow, I can see myself doing ER. A lot of what they do seem like protocol than actual quick decision making, but I'm sure things are different in the more traumatic areas of the ER. We'll see, I'll probably need to do another shift next year, although I gotta say it does kind of bother me not knowing what happens to the patients (granted I could just look it up). I think I like more continuity. Maybe.
Pediatrics: I LOVE KIDS! They are just so adorable! I don't see how anyone can not like kids. Just walking through Children's Hospital gives me a warm fuzzy feeling. Maybe a part of me is still very much a kid, so I get drawn to the bright colors and the cool contraption of the rolly balls going up and down. Even being in heme/onc wasn't as sad as I had thought. The kids are just so resilient, and they are so bright compared to adults.
I've been a little more concerned about interacting with teenagers, but so far, they've been okay. They can be a little terse. I find I go into my little kid voice and sometimes continue to talk in that voice to the parents - oops.
I thought I was going to looooove babies, and well, yes I do. Just holding them in my arms and watching them sleep is like watching a little angel. I just want to cuddle them all day! But what made nursery difficult was having to work with the mothers and prepare them for motherhood - for which many were definitely NOT prepared. It's so sad sometimes. There are these innocent, perfect, beautiful babies, and you have to hand them over to who knows what kind of world is out there. Well, I guess that's life.
Lessons learned:
- Don't throw/erase things unless I'm SURE they aren't needed - backup is good.
- Don't put bad things in the differential because OB is very tense about litigations
- No disclosures! - talk to residents first.
- Write a lot, talk little
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