Saturday, September 19, 2009

The (Student) Doctors are In

So this morning I was scheduled to volunteer at a free clinic for the uninsured. It was a great experience, to say the least. I'm going to bullet-point some things before I really get into it all:

1. Electronic medical records (EMRs) rock!
2. Charting sucks and is a huge (but oh so vital) time sink.
3. You forget a ton of things you really shouldn't during a patient interview.
4. The M2s barely know more than M1s at this stage in the game.
5. M3s and M4s somehow gain the ability to do physical exams lightning-quick.
6. Med students have better handwriting than doctors.
7. Patients are very very patient. Very.

Alright, now to flesh things out a bit more. I woke up before 7am (ick) so I could get to the free clinic by 7:30am. We see the first patient at 8am but patients have been waiting there since like, before 6am. o_O All the patients are currently uninsured, many just recently uninsured. The managers (current M2s) gave us a quick and dirty run-down on how things work, leaving us M1s scratching our heads and going "Wtf, how do we do this?!" It's all good - every M1 was paired with an M2. The M3s and M4s came in later with the volunteering doctors.

So the EMR rocks because it's such a nicer way to organize things. And it's really cool to be able to pull up a patient's old files quickly. On paper things get to be really messy, as I write all over the place in the margins in such a way that only I know the order of the things I wrote. But charting sucked up a ridiculous amount of our time (mainly because I don't know how to chart and was basically allowed myself to be dictated by the M2 who took the patient history with me).

During the patient interview, despite currently taking an interviewing course and have already interviewed a standardized patient, there was just so much that we could/should hit with each patient that I just kept forgetting things to ask here and there. Thankfully the M2 who was with me asked follow-up questions to mine to get a clearer picture of the patient's health. With my second patient, I kept forgetting to ask age-relevant questions about colon cancer, prostate cancer, and diabetes. Things that I should have known to ask from having taken so much cancer genetics. *Sigh* It's all good, the doctors and the M3 kept complimenting us on our collection of the patient history considering it was my first time. ^_^

We were required to have our stethoscopes with us, though we M1s haven't learned how to use them yet. They were more decorations around our necks. However, my M2 showed me how to listen for heart rhythms and lung sounds, as he just learned how. For my 2nd patient (I only had 2 patients in the whole 4-5 hours I was there) the M3 did a lightning quick physical exam. He looked like he was just poking and massaging the patient super-fast; it was pretty cool actually. The M3 was also really on top of his game, asking all sorts of questions and knowing all sorts of knowledge. I suspect our knowledge expands nigh-exponentially towards the end of our M2 year. The M3 was also burping out shorthands left and right, and I didn't even know half of the stuff he dictated to me.

I'm pretty convinced that med students have better handwriting than doctors. I wrote a prescription script for my 1st patient (w00t!), of course the doctor had to sign off on it. I made sure my script was legible. I suspect doctors get their bad handwriting not from med school, but in residency. Charting really does take a long time (still haven't figured out how doctors see so many patients a day; 15-minute time slots are NOT enough). I'm thus not surprised handwriting deteriorates to chicken scratch.

The patients we saw were very very patient. Triple emphasis on patient. My first patient had been waiting about 1.5 hours before being seen by me (and the M2). And by the time we were done with him, about 2-3 hours had gone by. The doctor who I presented to was so excited with this patient and used him as a "teachable moment." It was really neat, and I think the patient had a sense of humor not to be irritated after waiting so long. Also, our 1st patient was 66-years-old and should be eligible for Medicare (which would mean there was no reason why he should be seeing us). But he kept getting denied for some reason (stupid little reasons, silly government, ugh). The doctor wasn't happy about that, and ordered us to find the patient Medicare info and to help him get coverage. o_O

So yeah, that was my morning. My first real foray into clinical medicine. Saw 2 patients, wrote a prescription, did a ton of charting, dressed a huge sebaceous cyst (not doing dermatology I think), and learned more than a few things.

Hey everyone, Courage from A Beautiful Addiction is back to blogging! Head over to his blog and welcome him back!! :D


Mike said...

That's sooooo cool getting all that hands on experience!!! And first prescription sounds pretty crazy!!! You feel official!

Dave83201 said...

A good bedside manor is important. So many doctors I come in contact with (and I've seen my share) make little to no effort developing a rapport with their patients.

My main doctor is very nice, and very cute, so the kind of bedside manor I'm looking for in him is not of the medical kind. LOL.

Anonymous said...

This is indeed cool. It's a great beginning. And the satisfaction grows a lot when you see someone who was for all intents and purposes dead when they came in walk out of the hospital under their own power holding the hand of their little boy or girl.

It's really a great feeling.

Jason Carwin said...

Good post. Sounds like it was exciting even if you only had a few patients for the whole time slot.

Ty said...

good to hear that you had a good time man

i guess that as you progess then your writing will detieorate then lol

sounds like that is one reason why i'm lucky to live in Oz (never wait longer than 15 min and medicare is available for everyone no matter the age)

Peace :)

Anonymous said...

Oooo, a sebaceous cyst! Awesome! If I ever went in to medicine the field I would pick would definitely be dermatology. Skin health, skin infections, skin problems...all very cool (in a creepy disturbing sort of way).

flixthecat85 said...

congrats on writing your first prescription! what was it for? (just curious, i'm also a M1 and feel like i wouldn't be able to write a prescription for much at this point haha, unless y'all just learn much more than us)

Aek said...

Mike, Jason: Thanks. :)

Dave83201: Yes, bedside manner is very important. But it's very difficult to establish rapport when you feel the 15 minute slot ticking. o_O

Ty: I certainly hope my writing doesn't deteriorate! How's the system work in Oz?

James: Ick, no thanks. :P

fixthecat85: I wrote a prescription for Cephalexin, an antibiotic. The doctor wanted to prescribe Keflex, but that wasn't on the formularies we had to go off of. So the M2 and I looked up its generic name and discovered it was Cephalexin. We don't learn pharmacology until the 2nd semester of our M2 year, so I was basically just "following doctor's orders." The doctor gave me a "template" script to base my prescription off of, so yeah, I knew nothing. :P

Anonymous said...

Template is:

Drug name Units
Number of tablets
"Sig:" instructions for taking the drug