nANIMOv

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.

The trouble of having generally nice and pleasant residents and attendings is it can be hard to tell whether or not you are meeting their expectations or performing up to their standards. I’m constantly questioning whether or not I’m performing at or below where I should be. Even when I directly ask for feedback I sometimes feel like they are pulling punches to preserve my feelings (I know if I was in their position I probably would be inclined to do so [because it’s also easier to say everything is fine and not have to full “work up” so to speak the root of the problem]). Also that could just be my brain psyching myself out.

Anyways, was another varied day in the clinic. I find that I spend a lot of time with the patients I see which is part of what makes it a generally pleasant experience. I can see how, if you are strapped for time/ have a lot of patients to see, the burnout can set in because you don’t get to spend the time you feel you need to properly address patients’ concerns. Definitely something I should here more about from the residents.

The kinda cool part about doing a rotation working with a lot of residents is I get to see the different stages of medical expertise and a lot of different styles. It’s like observing the different evolutions of a Pokemon; each evolution with its own abilities and special techniques. Today we had pretty much all of the evolutions present in clinic, with maybe the except a of a 3rd year, but we had 1, 2, 4, chief, and attending.

It was a shorter day today because we were supposed to have didactics in the afternoon, but they got canceled. I also think about how interesting it is that as medical student we basically just run around getting to do stuff that people get paid to do.

One of the big pieces of advise you always hear when trying to figure out what specialty you want to go into or what residency to apply to is “see what the residents are like.” And all the residents, and even the attendings I’ve worked with so far I vibe with. It’s refreshing to be around people who make it part of their job to be genuinely interested in patients’ lives outside of the clinic/ hospital. Not to say other specialties don’t care, just often times they aren’t as interested because it’s not pertinent to their role/ objective.

Today I got to tell a patient she was pregnant (she was hoping to be). I got to work with some babies and diagnose some rashes. Did some motivational interviewing and worked up some chest pain (clinically). I still need to work on being a bit more thorough/ systematic in my history taking. I just sometimes just get caught up in the conversation, or I ask things a bit spur of the moment so I rush, or I don’t want to fatigue the patient. We will adjust.

Again a lot of things I missed from primary care that popped up again today. I like talking about lifestyle and I do feel like a have an approach that many patients have responded well to (at least in the moment). I also did a HEADSS assessment (basically a very thorough social history) with a 12-year-old (usually at this age this is the first appointment where we ask their parent to step outside the room) which is something I enjoy and feel like I am good at. Throughout the day I also got good feedback from the residents and attendings, as well as from patients.

Still learning a lot and definitely have pick up a lot of good technique from my seniors, but overall its been a super good learning environment. The days also feel like they go by quickly and aren’t arduous.

We still in the honeymoon phase of the rotation though, we’ll see where I’m at by week 3.