Posts tagged practice

The Zebra

“Tom, come take a look at this,” the attending beckons excitedly. I get up from the charting station and walk over to his computer.

A CT scan fills his screen with a very large, obvious abnormality. “This is one of the biggest I have seen in my career,” he says. The patient had developed not only a large mass but a rare one, causing all sorts of systemic anomalies. Given the extent, it would be inoperable.

As we proceed to the patient’s room, the doctor explains the clinical presentation of mass effect on the body. His eyes are wide and flicker with a fiery excitement. He can barely control the rate of his words as he gushes about the various pieces of the unique clinical puzzle in front of him.

“Are you excited?” he asks after he finishes. I reply that it is “interesting,” much to his displeasure. “How could you not be excited? You might not see this ever again in your life.”

But all I could think about was how this mass, this zebra on a CT scan would soon bring our patient to their untimely death.

Within, I watched the attending as he spoke to the patient and their family about the situation. He explained things with such professionalism, clarity and assurance that I could see no better way it could have gone.

Yet it continued to disturb me, his excitement in it all.

Joseph Addison, a poet said: “Everything that is new or uncommon raises a pleasure in the imagination, because it fills the soul with an agreeable surprise, gratifies its curiosity, and gives it an idea of which it was not before possessed.”

For my attending, who may have seen thousands upon thousands of patients with very similar presentations, this zebra case must have stirred up a renewed sense of adventure, a break from an otherwise regular routine of patients.

Perhaps, it is that hot flush of novelty, that infectious high of our peers that perpetuate our own behaviour.

Too often our fascinations show outwardly as our primary intent. In the process, we forget that the patient has a name, has a right to be treated with dignity, has an illness that still needs to be treated. In the process, we forget that the condition does not define the patient any more than he defines the condition.

It is a strange situation we find ourselves in, to be excited and captivated by our morbid curiosity; on some level, we must in order to learn and improve as clinicians; at the end of the day however, it must come at the expense of someone else’s health. For that, I must always consider the fine line that separates respectful and disrespectful learning.

“Pretty neat findings, eh?” He nudges me. I take a look back at the patient’s room. I watch as the family huddle in an emotional embrace as they come to terms with our news.

“Yeah. It is really interesting,” I mutter bleakly.

i just started med school and it is so unbelievable that i am qualified to start learning how to do physical exams and volunteering as a 'student doctor' and taking bp and asking history... how long did it take you to feel like you were qualified to do true medical things? — Asked by 25andnotpregnant

I do not think I will ever shake that feeling of being a student doctor. The learning never stops. For the basic clinical skills like doing physicals and taking vitals, I became more comfortable with practice and repetition. Now, I am at a point where I am comfortable enough to be thorough, put some of the pieces together, and figure out a basic differential based on the findings. For many other advanced skills that I have not had much exposure to, I still feel as lost as I did when I first learned the basic skills. To feel truly qualified is going to take more practice and experience. 

Digital Smarts - A Common Sense Primer for Interns from Bryan Vartabedian MD and Joey Spinner MD

This is a short video on being smart about our own digital footprints within the healthcare setting. The risks and challenges of social media is one that I am constantly trying to manage. While I have many checks and balances in place for myself, I am always on edge about what goes up on this blog.

Let this video be another reminder to be ever vigilant.

Surgical Rehearsal Platform by Surgical Theater.

This is an interesting product for surgery. The idea is to give surgeons and trainees a chance to rehearse the finer points of an operation using the patient’s actual anatomical data rather than a generic template. Typically, there are practice modules that are available for computerized surgical systems to work through an operation but this aims to give surgeons a trial run before ever making a cut on the patient.

Late Night Suturing.
A group of us came together tonight to practice some suturing techniques before our assessment later in the week. We came loaded: a box of suture kits, a set of sterile fields, and the requisite pigs’ feet from the local butcher shop. This was our chance to figure out the kinks before being put on the spot. Here I practice the very commonly done vertical mattress suture, with mixed results. 

Late Night Suturing.

A group of us came together tonight to practice some suturing techniques before our assessment later in the week. We came loaded: a box of suture kits, a set of sterile fields, and the requisite pigs’ feet from the local butcher shop. This was our chance to figure out the kinks before being put on the spot. Here I practice the very commonly done vertical mattress suture, with mixed results. 

Casting Clinic.
Slip on cotton sleeve. Wrap soft padding. Apply plaster. Sixteen of us worked with an orthopedist practicing casting on each other. As we took turns building our crude creations layer by layer, the doctor gave us pointers and words of encouragement.
Here is my friend’s work of art wrapped snugly around my arm.

Casting Clinic.

Slip on cotton sleeve. Wrap soft padding. Apply plaster. Sixteen of us worked with an orthopedist practicing casting on each other. As we took turns building our crude creations layer by layer, the doctor gave us pointers and words of encouragement.

Here is my friend’s work of art wrapped snugly around my arm.

He's an expert

  • Doctor: Alright, so the next patient is in for their vitamin B12 shot. We should be in and out in no time.
  • Me: Sounds good.
  • Doctor: Have you given any injections before with your last preceptor?
  • Me: Only a handful. I did not get to do a flu vaccine clinic.
  • Doctor: Hm. Okay, well that's alright. We'll try to get you some more practice.
  • Enter the room
  • Doctor: Good to see you again VR. This is Tom, he's a medical student. He'll be giving you your shot today. He's an expert so you're in good hands. Tom, go ahead and get set up.
  • Patient: Really? That's wonderful!
  • Me: *Heart races as all eyes fall on me.*
Hi, I am a student at UCSB and majoring in biology. I was wondering what is your opinion towards registered nurses? I decided awhile ago to become a registered nurse after undergrad than a doctor about a year ago not due to lacking grades or motivation, but because I feel being a nurse is more of an intimate job with the patient than a doctor. I always felt doctors were those persons who wrote up the prescription medicine, while nurses actually take their time to overlook and take care of you. — Asked by Anonymous

My significant other is in nursing actually and I think it is a great profession, one that I have a lot of respect for. It can be easy to overlook or to forget the sort of care that is being managed and provided by nurses. There are a lot of things that nurses do for patients that doctors might never get an opportunity to see and fully appreciate. Likewise, the reverse is also true. I think that each profession has a unique scope of practice, an area of expertise in the care of the patient, and oversimplifying either would be a misrepresentation of the respective disciplines and the years of training each one undergoes.

Preparing for the Abdominal Exam.
Tomorrow there will be a clinical skills session focusing on the abdominal exam. With a lot more details covered since last semester, it is probably a good idea to brush up on the subject. Here is my homework for the day.

Preparing for the Abdominal Exam.

Tomorrow there will be a clinical skills session focusing on the abdominal exam. With a lot more details covered since last semester, it is probably a good idea to brush up on the subject. Here is my homework for the day.