As I have currently been completing one of my final surgery rotations — I think it’s time I introduce my audience to the real side of surgery, not what you see in Grey’s Anatomy, or House MD. Let me start by saying, this will be one of your most memorable experiences in your clinical years — it may be the only chance you will ever have to see a liver transplant, an open-heart surgery, a laparoscopic gastric bypass, or even a simple appendectomy.
If you want it to be, it can be an unbelievable experience, but it can also be quite intimidating. In the end, think of it as an opportunity to learn some basic concepts about surgery that will benefit you regardless of which field you chose to go into.
To start, there are four basic parts to any surgery: rounds, the operating room, clinic, and call.
This video made by some fellow medical students is clever and entertaining. Medical school can drive you crazy, but thankfully while working our way through the process, we can find ways to escape and claim our sanity back.
I’ve been rather busy with my Internal Medicine clerkship as of late, but I thought I’d write a post on the importance of a History & Physical Exam (H&PE) in medicine. There are several basic pieces of information that can be joined to establish the proper diagnosis by us.
- History (which must be accurate, skillfully elicited, carefully interpreted, and coherently expressed).
- Physical Examination (which should build on the existing information and provide clues for obtaining additional history).
- Ancillary data (routine and special studies, consultations, etc.).
- Observations of the course of the illness (usually less expensive and more rewarding than extensive excursions in the use of ancillary studies, e.g., lab).
Our basic thesis is that the vast majority of clinical problems should and can be resolved by the effective use of the H&PE. In most cases the history should be and is the most productive. You will find this conclusively and objectively demonstrated when dealing with patients about whom no history can be obtained.
To put it another way, the diagnosis should be clear based on the present illness and related points of the history most of the time. In fact, if the diagnosis is not apparent at the end of the history and the physical examination, there is little likelihood that such will emerge by the use of ancillary data/or special studies.
Laboratory studies should be viewed and used primarily to confirm a diagnosis rather than make one. Furthermore, experience has taught us that thoughtful observation of the patient and his or her illness can be the most effective tool of complex, particularly chronic, problems.
Preclinical training is called preclinical for a reason: it will form the knowledge base for your practice as a clinical student, resident, and attending. However, it’s not always presented in a way that’s clinically relevant. That is probably the reason for the move in some medical schools to do more case-based learning.
That being said, having a strong preclinical knowledge base will make your clinical life much easier: it often tells you the “why” of clinical practice. If you can remember why a practice is a certain way, you don’t have to memorize X, Y, and Z: diagnosis and treatment will just be based on your background knowledge. Just a caveat: people don’t always work the way we think their physiology is “supposed” to work, so this doesn’t always work, but it often does.
I get to work at the one that looks like it’s from a sci-fi movie! Starting from tomorrow, I’ll be rotating at Saints Mary & Elizabeth Medical Center in Chicago, IL.
I’m so excited, and a little anxious — that I just can’t wait.. We’ll see how it goes.
As I complete my rotations (clinical clerkship), I’ll be posting HIPAA friendly updates about my experiences as a Caribbean medical student at a major U.S. teaching hospital.
It’s 3 in the morning. You’re a third-year clerk, and you’re 21 hours into your on-call day on a busy internal medicine service. Suddenly, a page from the emergency department; “Mrs. J, a 78-year old woman with a history of heart disease, is coming in with what sounds like a CHF exacerbation, and it looks like it’s going to be a direct-to-medicine admit.” You kick into gear, grabbing your stethoscope and your iPhone, and head down.
Because you’re feeling lazy (or tired, or whatever: It’s 3am), you take the elevator intstead of the stairs, which affords you a couple moments to think. “Wait a minute,” you think. “I’ve never seen anyone with CHF before, and I know I’m going to get pimped like crazy on this by my evil resident, Dr. X. I should read up before I get down there, or else I’m going to look like I don’t know anything.”
So you hit the emergency stop, pry open the elevator doors, and crawl out, sprinting to the nearest computer, and pulling up your go-to source for easy-access medical information: Wikipedia.
I had a patient came in today saying, “Hey doc.. I got a leaky deaky, could you repair it so I can get freaky?!” — I chuckled to myself, and told the patient they had nothing to worry about.
Did you know, over 13 million people in America suffer from various forms of overactive bladder (OAB).
So what exactly is OAB? Basically the bladder muscle (the detrusor) is relaxed in a normal individual, but as we age, stress, and as life hits us — the muscle tends to tighten up and contract. These involuntary bladder muscle contractions during the bladder filling phase cause this increased urgency — as they cannot be suppressed by the patient. But, no need to worry — these days, OAB is treated relatively easily and pain free via the use of anticholinergic agents.
So far, my Family Medicine rotation has consisted of a lot of colds/flus, bronchitis, infections, diabetes, HTN, CHF, and basically pretty much everything else you can think of — and you know what? I’m loving it!
At a recent meeting I attended, a vigorous discussion broke out about what medical students, residents and attendings should wear, and more importantly what they should not wear. Interestingly, patients have been asked to weigh in on this discussion. What to wear is also on the mind of many current second year medical students who may find themselves trying to take study breaks from USMLE Step 1 to go buy clothes for the wards. I also remember doing this as a rising third year student and wondering what to get. Here are some tips from our Associate Dean of Student Advising and Professional Development, Dr. Shalini Reddy (@md2b_advisor).