nANIMOv

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.

It’s the start of my 3rd week. At the beginning of this rotation I was feeling comfortable being back in the clinic setting and seeing patients on my own. The the health maintenance stuff is coming back to me (while some of it is ingrained into my soul through Anki). I’m also getting more confident with proposing my plan to the attending without getting initial input from my resident, even if its wrong. What’s nice about learning in an outpatient setting, is each day its a new patient and a new chance to make smaller iterative changes to your style, but with a brand new patient.

It’s times like today that make you just want to give up. After my disappointing and embarrassing performance on my practicals yesterday, when I was getting ready to leave at 5:30 AM this morning, I got locked out of my car. And it’s not cause I locked my keys in or anything, my car sometimes does this thing where if I only open the trunk while the car is locked and then close the trunk without unlocking the rest of the car, it has what is the equivalent of a car seizure. It becomes completely unresponsive to the remote, and won’t even open to the physical key, supposedly due to an electrical or software issue. It just like bad things one after the other.

Anyways despite the delays I still managed to make it to clinic before any of the residents. After seeing patients, regaining some perspective, and spending some time in clinic things did get better. I also got to see my person at the end of the day which never fails to make me feel like the luckiest guy around.

I still got a long way to go. Clinic has been going ok today, but I had my kinda big practical exam in the afternoon. I felt good about of a lot of this, but there were a couple cases that I felt like I butchered and what’s worse is that it was confirmed at a “feedback” session at the end of it all. If those were real patients, at least one of them would have probably died.

What I will say is that this are the kind of environment that I think are great for learning, and it’s a bit of a shame that we don’t utilize this more as a regular teaching method and reserve it for evaluations. I feel like I learn best in an environment where I can make mistakes with emotional consequences. Practice questions allow you to make mistakes and learn from them, but there is no emotional consequence. With these fake patients, even though I know it’s not real, I am making a social and emotional connection which (1) better simulates my actual clinical decision making and (2) makes mistakes feel more devastating and memorable.

I’m not sure if its a sign or if its just in my head, but I’ve notice a bunch, like 4/9th to 1/2 of the Med/ Peds residents have Android phones. Are these my people??? Jokes aside (but I was also serious) I was very much looking forward to clinic this morning. I was supposed to be working the adolescent transitional care clinic which sees a lot of high-risk or at-risk adolescents and young adults with chronic medical conditions and/ or in foster care or with ACES. Unfortunately, because of the nature of the population there is a high no-show rate, which was the case today. It’s sad to think about how often times the people who have the greatest healthcare needs are often the people with the most limited access (for one reason or another). Being in a position to meet people where they are at and bring them the care that they need despite whatever their personal circumstance or situation may be that is limiting their access is one of the big things I am looking for in my future career.

I wonder how I’ll ever manage once I’m practicing on my own in the future. Even just averaging seeing 3 patients in the morning and 3 patients in the afternoon I don’t leave clinic until around 6 PM. Even if I make my notes and my time spent with the patients more focused and concise, it’s hard to imagine doing more than double the amount of work in the same amount of time or less. I guess it’s just one of those things I’ll have to figure again. But as I’ve mentioned, at this point the work doesn’t feel super arduous. I probably would get burned at the stake if I said this to any of my classmates, but I kind of like writing notes (though doesn’t necessarily correlate with being good at it). I like reflecting on the encounter and then trying to imagine what would be most helpful for my future self or the next person trying to read the note.

I can really see my self working, at least part time, in this environment with this population. And the more and more residents and attendings I meet, the more it feel like the right place for me.