I’ve been looking forward to starting this rotation because I think pediatric and congenital heart diseases are super interesting… and I like listening for murmurs. Today I got exactly what I was hoping for (mostly); truly amazing and awesome patients and their families, some really interesting cardiac pathology, plenty of echocardiograms, and lots and lots of murmurs. I wasn’t sure how my time during this rotation would be divided, but today was completely outpatient (despite being in the hospital) clinic work. To be honest I expected it to be 100% inpatient, but I’m glad its going to be a bit of everything. Having this rotation right after a very primary care heavy month I have several observations, but I think I’ll save that for after I have a few more specialty clinic days under my belt.
Also I think this commute just may kill me.
It feels good to be told you’re wanted. It’s validating to hear from the residents that I wasn’t the only one who thought I fit in. Whether or not it’s truly genuine is another story, but I like to believe it was. At this point I feel like I’ve beat to death talking about how much I felt like this kind of practice and these kinds of people align with my philosophies and values in medicine, so I just want to express my gratitude to everyone I worked with these past weeks. Even if I don’t end up back here, I’m glad to know there are doctors out there doing much of the work that I aspire to.
It’s kinda hard to believe I was spent 12ish hours a day 5 days a week for 4 weeks in this clinic (as of tomorrow), and was pretty much actively doing something the entire time. Surprisingly I don’t feel super burnt out and I think a big part of that is variety of things I get to see. Certainly there were days where I would be thankful for breaks and breathers throughout the day, but I’m a bit sad this rotation is coming to an end. I feel like I could very easily see myself as a resident here (should I be so lucky), but that’s all still a bit aways to see if MedPeds is even the path I want to go down. This isn’t the first time I’ve been a bit sad to leave rotation, but it may be the one where I felt the most validated and understood.
All that said I am also pretty excited to start pediatric cardiology next week. I love CHLA and I can’t want to be traipsing through her beautiful colorful halls once more.
I’m really starting to feel like this is where I belong. A lot of the residents and I have shared interests or if not interests similar perspectives on different things, especially with respect to medicine and patient care. Again it’s hard to tell if its actually getting along, or they are just super nice and easy going people at baseline. It’s weird ’cause I keep thinking about all the future med students who are going to go through the clinic after me getting kinda jealous wondering if they will be liked better than me. All silly stuff, but I can’t help it. In any case it’s too late now for me to try to change anybody’s mind for the better, just gotta keep pushing forward.
Today was a much-needed slow day. There was a lot of no-shows in the morning and a lot of babies in the afternoon. Of course it’s not great when there are no-shows because that means someone is missing care. One of the patient who I did see was from juvenile hall which was interesting. I’m not sure what I was expecting when I met her, but she just seemed like a pretty normal, pleasant kid with some additional psychosocial aspects. I’ve been really enjoying the continuity and the transitional care aspect of this rotation. Also we should not restrict trans-healthcare or gender affirming care to adolescents. I agree extensive conversations should be had with patients and family. But there is a lot of good data to support that having access to these kinds of services is safe and saves lives.
Today I saw a newborn for the third time this rotation. I did his initial newborn visit, his weight and bili check a couple days later, and then now his 2 week check-up. It’s cool getting a chance to experience a small taste of continuity in the span of a 4 week rotation. As I’m rounding out my final week, I’m feeling even more a part of the team. I don’t always propose the right stuff or feel confident about it, but I’m not as afraid to make suggestions as far as what I think we need to do for the patient.
I also did a phone visit today; only my second of the rotation. I feel like I’m so awkward over the phone. Not sure if it’s because I suddenly just become more self-conscious of my voice and choice of words, causing me to stumble over myself or what, but I definitely need to work on that.
Talking to patients about the decisions of other doctors is kinda challenges. On the one hand you want to make your patient feel heard and be sympathetic to their concerns that their health may have been mismanaged. On the other hand, I want to believe that most, if not all doctors are trying to do what’s best for their patients, at least given what information they have. Plus, I can’t confidently speak about an encounter I wasn’t involved in.
That said, I think we can always do a better job of listening to our patient. I can do more to take a second to check ourselves when we are having a long day to make sure our mental state isn’t affecting our medical decision making.
Today we send a patient to the emergency department. The patient had been dealing with ongoing abdominal pain for the past 5 months, hoping around to different hospitals essentially being told to walk it off. When they finally get a proper work-up and appropriate treatment, the pain didn’t get better. They came to clinic today and were understandably frustrated. After talking to them about what was going on and then talking to my resident and attending, we decided the patient had to be sent to the hospital. We almost didn’t see them today because they were running late and had difficulty finding parking.
It was a long one. I honestly don’t know how actual doctors keep up with the notes. It’s necessarily an arduous process, but it takes a while especially since patients are constantly coming in before I get a chance to finish. My dad describes it being like that I Love Lucy episode when Lucy and Ethel are working in chocolate factory they have to wrap the chocolates, but they keep coming faster and faster and the more behind they get the harder it becomes to catch up.
Efficient note writing will probably come with time, as well as efficient patient interviews. Now that I think about it, interviews is probably the thing I need to work on more. I am constantly giving patient’s space to talk about every concern that they have. While that probably can fly as a student, when I’m practicing I need to be more mindful of how much time I’m spending which each patient.
This morning I went with one of the attendings and one of the residents to Homeboy Industries for what they call “Baby Talk.” It’s a once-a-month small group meeting where parents can come ask the pediatricians questions about childcare and parenting (first of all if you haven’t heard about Homeboy definitely check out the link above, they do amazing work). It was a pretty good turn out and there was a lot of good conversation about potty training, “corrective behavior,” diet, etc. The group was filled with lovely people and it was a lot of fun.
Afterwards we went to a Homeboy-associated teen/ young adult center where we were supposed to just be around to have 1-on-1 conversations with the youths regarding pretty much anything. We only had one biter, but she had a lot of great questions regarding the effects of mood on health. I was super impressed with there insight and vulnerability.
The rest of the day was all just clinic, which was pretty standard, but I definitely felt a bit charged up from the morning. I think medical school and graduate medical education in general needs to incorporate more community outreach into the base curriculum. Not only is it educational for student and can have positive impacts on the community, but it’s also a wellness exercise. For me having the sense of connection to my community is super motivating.
This morning was more no-shows than I’ve had the entire rotation, and it wasn’t even raining. Because of that I got to spend a little more time with the patients that did show up which is always kinda nice. I always feel bad when clinic is busy and I kind of have to cut patients off while their talking or kindly re-direct the conversation to things that are more immediately pertinent to their health (though I truly believe it is all important). It’s always a tough balance because they don’t necessarily see how busy the clinic is, and so when we ~gently~ interrupt them it probably can often come off as a bit rude.
I also got to spend more time just talking to the residents and hearing all the “hot gos” as the young people say regarding the future of the residency programs and some, let’s call… interdepartmental perspectives.