Friday, February 19, 2010


First of all, it seems like I've jumped on the bandwagon with It's kind of nifty, so ask me any question you want! You can do so anonymously. Go ahead, amuse me. :-P

Anyway, Janus is the Roman god of gates, doorways, beginnings and endings. Janus is depicted as a person with 2 heads facing in opposite directions. The month of January carries his namesake. Sometimes I feel like my interests are kind of like that, facing in opposite directions.

A couple days ago I was talking with some fellow classmates about . . . something, I forget what. But at some point I mentioned the 1000 Genomes Project and how my former lab was super-excited about it. The thought of this project is pretty mind-blowing as well as its ramifications. To sequence the genomes of at least 1000 individuals in 3 years, and then to have all that data to analyze, is super-exciting indeed!

My former lab was a cancer genetics epidemiology (particularly colorectal cancer), and they were hoping to participate in a multi-center, multi-national consortium in analyzing the results of the 1000 Genomes Project for cancer genetics. Each center has its own role - Seattle, other parts of the US, London, Toronto, etc. The PI joked that we would "outsource" the genotyping to a 3rd-world lab, such as Toronto, lol. Anyway, just discussing genetics again, and epidemiology, and the implications for the future of medicine and clinical practice really got me going.

Today I shadowed my mentor again (still required to shadow 2 more times before the end of the semester). For the last 2 patients I saw, he told me to go take the medical history and physical exam. What a way to throw me into it all, as I've no training in dealing with peds patients other than watching him work.

The first of the 2 patients came in with earache. Simple enough, right? Well, apparently I forgot to ask all sorts of questions, lol . . . as well as do the physical exam, because I didn't know I was supposed to nor have I been formally shown how. When I "finished" and went to go get him, he told me a nice pearl of wisdom:
"You should have a good idea of what the diagnosis is by the end of the history and exam. If you have no idea, go do it again."
I was much better with the 2nd patient, who I saw immediately afterwards. It was a kid who had a cough for the last week or so. Simple enough, right? I did the history (pretty bland and straight-forward there) and the physical exam which included: looking in the ears and throat, and listening to lung and heart sounds. Apparently I forgot to palpate (feel) the submandibular glands for swelling, the spleen for mono (you should never be able to feel the spleen in a healthy person), and the liver. Ah well, I got most of it. Next time I'll remember. :-)

So primary care isn't particularly simple (and anyone who thinks it is should be slapped). There are always so many things to remember! At least I'm just an M1 and get a TON of slack in all this, lol. I'm rather annoyed that the vast majority of my M1 education has ignored children's health and women's health (except for gynecological issues). I mean, I don't even know how to properly listen to heart sounds in kids and women (have to work around the breasts somehow)!

Anyway, where was I getting with all this? Oh yeah, that I still like my MPH stuff as well as clinical MD stuff. I suppose I'm kinda bi in this respect, lol. Hence Janus. I'll be talking with my med school's MPH director next Thursday about maybe finishing my MPH here. There's no MD/MPH program here, annoyingly. :-/

I'd like to welcome a new person to the blogosphere, Edward of Pardon my Schadenfreude. Please go over and give him a warm welcome!!

Also, I'd like to plug Biki's collab blog, You Could Have It So Much Better. I know I gave a plug for this blog a while back; there have been collab blogs before but none of them really took off, so I hope this one does! If you have a general question about . . . anything(?), send her an email and someone will hopefully write a post about it. Chances are, if you have some general question, a lot of other bloggers out there probably do as well. It's "general" for a reason, lol.

Lastly (I swear I've edited this post several times already, grrr), you may have noticed that I reorganized the blogs I follow on the sidebar. I've sorted blogs by world region/continent (the US is broken down into several regions, due to the fact that the majority of the blogs I read are from the US).


naturgesetz said...

I guess your experience with examining those patients shows why it's a good thing you have to go through med school before you begin your own practice.

Anonymous said...

Anon MD here:

In peds, think of your patients the same way you would if you were a vet examining an animal (no, I'm not trying to demean the patient, just that one can't assume the patient will say anything helpful--though as they get older, they can contribute more info, until they get to puberty, at which time, don't believe anything the parents tell you). Basically, you have to depend on the parents. That's life.

Ron said...


primary care. i'm on my primary care rotation right now and it's been just a few weeks, we've been trying to polish up on our consulting skills and starting on management planning.

but yeah primary care isn't all that easy... there's a ton to remember. i just bought a textbook (Murtagh's General Practice) -- it's Australia -- and it's a big book :P

I'm M3 (5 year med program here) and i'm sure I'll still be getting a ton of slack once i start in the clinics and hospital.. my next rotation will be general medicine, the next half of this semester.

quite excited but daunting at the same time.

take care.

Aek said...

naturgesetz: Hehe, yup.

Anon MD: Well, the kids I was allowed to work up were pre-teens/early teens, so it's all good. But you give even little kids too little credit (excluding babies and toddlers)! At least the medical history a worried parent gives you is really complete - no stone unturned, lol.

Ron: Yeah, I know right?! But it sounds busy and interesting nonetheless, hehe.