Posts tagged third year

Agree with above medical student’s assessment.

The satisfying addendum by attendings to a well written assessment and plan.

The Burning Flush of Confrontation

I stood there and did my best to explain what we felt was going on, our impression of the possible causes, and our investigations around them, some of which simply could not be done tonight.

The family was not satisfied. “We want answers. Now.” From there came the questions. “Why must it happen later? Why is this test being done? Why will you not take our complaints seriously?”

I reassured everyone that we were checking every avenue, that there was a method and reason behind the tests and explained as plainly and thoroughly as I could. More importantly, I tried to address their concerns up front and with honesty.

Nothing could appease my audience. I could feel the growing dissatisfaction in their tone, the tension that my presence brought to an obviously well meaning and concerned family.

However, standing there, the focus of every pair of eyes in the room, I began to feel the churning of my stomach, the pounding nudge in my chest, and the burning flush of my face. I had become an enemy in the room, an obstacle between the vocal family who wished to be heard and heard by none other but the doctor himself. It was time I excused myself.

I returned quickly to my attending and explained the situation: I had attempted my best to alleviate their anxiety and answer their questions but I had failed. I needed help.

When he arrived, even then the discussion presented challenges. It took a lot of work to come to an agreement and understanding.

The communication channel is open both ways. The solution to defusing a situation like this is always to make people feel that they have been acknowledged, that their concerns have been understood, that they are not an afterthought in this already complicated system of care. Even with that in mind, the discussion can be challenging. It really takes a lot of patience, perseverance, and thick skin to build up the rapport needed in difficult situations.

Perhaps with time and experience, I can find a way to finally manage this myself. For now: please do not shoot the messenger.

Were you ever involved in a confrontation? How did you deal with it?

The Gunner Song by the Harvard Medical School and Harvard School of Dental Medicine Class of 2016.

A well done parody video of “Thrift Shop” by Macklemore and Ryan Lewis. Bravo.

medicalschool

Why Physicians Need to Write

I would argue that one cannot be a good doctor without being able to communicate one’s thoughts, knowledge, opinions, and analyses in writing.

I write for many reasons. One of them is to reflect on my day, to debrief on the moments that my colleagues and seniors impart on me. Another reason I continue to write is to keep the passion of medicine alive.

It is no secret that most of us lose our ability to empathize in third year, a year where we are exposed to the real world of medicine for the first time. We are young and impressionable and bad habits can quickly form if one is not careful. Our passion for medicine, as it turns out, is a fragile and easily corruptible entity; I try not to lose sight of that.

I write for these two reasons and many more personal ones as well. Why do you write?

Invest in building your network. It will pay dividends in the future.
A specialist’s advice on building relationships with other doctors, community resources and services in a future practice.
The Satchel. Through thick and thin, my satchel has accompanied me through medical school. Initially, it strictly carried books and papers; now it is a repurposed bag for a clinical life. I talked briefly about what I usually carry with me in my first clinical pearl post. In response to Wayfaring MD’s post, I thought I would share what I actually bring with me. These are my standard issue items, with room for switching or adding more items as needed: Satchel Pocket evaluation forms: For clinical skills and procedures. Pocket Medicine: A compact book for diagnostics, investigations and laboratory values. Two clipboards: The first contains regular paper for note taking including pre-printed progress notes and other chart-related forms; the second contains preceptor documentations including more formal evaluation sheets, outcomes checklists as well as my weekly schedule. The notepad: Where I write and gather my patient information and keep the to-do list for the patients I am responsible for. Moleskin notebook: Where I keep rotation specific clinical pearls and other tips and tricks. Two pens: Always keep a back up pen. Always. Pen light: For the quick neurological screen. ID cards Three packs of lubricating jelly: Need to do a digital rectal exam or a bimanual exam? Gloves are everywhere but these are not. Access codes and contact list Juice box Two granola bars Pager: How I wish this could not be standard issue. Stethoscope: If I am not walking around with it around my neck, it goes back into the bag until its next calling. Other items that I will sometimes include are rotation specific pocketbooks, headphones, and my phone charger to name a few. To the medical readers, what do you carry with you? Tag your response with #what’s in your pocket.

The Satchel.

Through thick and thin, my satchel has accompanied me through medical school. Initially, it strictly carried books and papers; now it is a repurposed bag for a clinical life.

I talked briefly about what I usually carry with me in my first clinical pearl post. In response to Wayfaring MD’s post, I thought I would share what I actually bring with me. These are my standard issue items, with room for switching or adding more items as needed:

  • Satchel
  • Pocket evaluation forms: For clinical skills and procedures.
  • Pocket Medicine: A compact book for diagnostics, investigations and laboratory values.
  • Two clipboards: The first contains regular paper for note taking including pre-printed progress notes and other chart-related forms; the second contains preceptor documentations including more formal evaluation sheets, outcomes checklists as well as my weekly schedule.
  • The notepad: Where I write and gather my patient information and keep the to-do list for the patients I am responsible for.
  • Moleskin notebook: Where I keep rotation specific clinical pearls and other tips and tricks.
  • Two pens: Always keep a back up pen. Always.
  • Pen light: For the quick neurological screen.
  • ID cards
  • Three packs of lubricating jelly: Need to do a digital rectal exam or a bimanual exam? Gloves are everywhere but these are not.
  • Access codes and contact list
  • Juice box
  • Two granola bars
  • Pager: How I wish this could not be standard issue.
  • Stethoscope: If I am not walking around with it around my neck, it goes back into the bag until its next calling.

Other items that I will sometimes include are rotation specific pocketbooks, headphones, and my phone charger to name a few.

To the medical readers, what do you carry with you? Tag your response with #what’s in your pocket.

Five Doctors Go Hunting

Five doctors - a general practitioner, a paediatrician, an internist, a surgeon, and a pathologist - decided to take a weekend trip and go duck hunting.

Soon after they were in their duck blind, a bird flew over and the general practitioner said, “I think that is a duck,” and so he took aim and slowly squeezed the trigger…but then he lowered his rifle and said, “I better get a second opinion.” “Back of the line,” said the group.

Another bird flew overhead and the paediatrician said, “I think this one is a duck too,” and he took aim…only to lower his rifle and say “but that duck might be a mother have baby ducks somewhere.” “Back of the line,” said the group.

A third bird flew overhead and the internist shouted, “That looked like a duck, etiologically classified as Animalia, Chordata, Aves, Anseriformes, Anatidae, based on the size, I am judging it to be a male, with an estimated weight of…” Before he could finish his thorough assessment or raise his rifle, the bird was gone. “We do not need to hear all that gibberish. Leave it to me,” said the surgeon.

Then a fourth bird flew overhead and the surgeon immediately raised his rifle and with no hesitation shot the bird out of the sky. He then turned to the pathologist standing next to him and said, “now go find out if that was a duck.”

Advanced Cardiovascular Life Support.

Fourth year is only three months away and part of the additional skills I need, besides renewing my CPR and First-Aid is to undergo ACLS training. 

This will begin in a few weeks’ time.

I’m a doctor, not a torpedo technician! Letting this morning’s psychiatry exam settle into the pit of my mind like a terrible repressed memory, my classmate and I went out for lunch. After an appetizing and relaxing meal, we scratched our heads as we wondered: “What are we going to do for the afternoon?” “What is good at the theatre?” I asked. His eyes widened as he came up with his hastily patched together plan à la Capt. Kirk. “Star Trek. First day. Matinée.” We checked the schedule and our watches: twenty minutes. We could make it.  And so, on a whim, we drove at warp speed to the theatre to catch the first available show. For two hours, we spaced-out and just watched as the science fiction tale unfolded before us. Unproductive? Sure. Time well-spent? Absolutely. 

I’m a doctor, not a torpedo technician!

Letting this morning’s psychiatry exam settle into the pit of my mind like a terrible repressed memory, my classmate and I went out for lunch. After an appetizing and relaxing meal, we scratched our heads as we wondered: “What are we going to do for the afternoon?”

“What is good at the theatre?” I asked. His eyes widened as he came up with his hastily patched together plan à la Capt. Kirk. “Star Trek. First day. Matinée.” We checked the schedule and our watches: twenty minutes. We could make it. 

And so, on a whim, we drove at warp speed to the theatre to catch the first available show. For two hours, we spaced-out and just watched as the science fiction tale unfolded before us. Unproductive? Sure. Time well-spent? Absolutely. 

Exam Tomorrow. Psychiatry has been a very nuanced rotation. We become so used to dealing with the objective and the tangible in our day to day practice that the abstract and intangible aspects of a patient’s health are often lost. However, if we dig deep enough, we often surprise ourselves with how many people struggle with psychiatric issues. It is definitely a weakness of mine and one that I will need to continue to improve in my later weeks in psychiatry. For the time being, the psychiatry exam will be my focus.

Exam Tomorrow.

Psychiatry has been a very nuanced rotation. We become so used to dealing with the objective and the tangible in our day to day practice that the abstract and intangible aspects of a patient’s health are often lost. However, if we dig deep enough, we often surprise ourselves with how many people struggle with psychiatric issues. It is definitely a weakness of mine and one that I will need to continue to improve in my later weeks in psychiatry.

For the time being, the psychiatry exam will be my focus.