October 14, 2009

On the road again

So I have to say, hindsight being 20/10, I ended up enjoying my psych rotation a lot more then I expected. I'll readily admit my preconceptions of patients with mental illness were too skewed by popular culture; I think I was expecting more of a Hannibal Lecter flavor. A "What are the voices in your head telling you Mr. Williams?" "TO KILL YOU!!!" sort of thing. But, fortunately, I found my interactions with patients to be generally pretty interesting and much more pleasant on the whole (exempting one interview with a drunk patient with narcissistic personality disorder). Especially gotta love the schizophrenic patients. Such a sad disease, but a rich source of some purely AWESOME conversations.

Anyways, like it happens time and time again during third year, just when you get comfortable in a rotation, the dean's office picks you up and plops you down in another unfamiliar location. For me, for the next 5 weeks, into a low income family practice clinic on the southeast side. It's been a tough adjustment coming from a rotation where I was afforded a great deal of autonomy and input into patient care, namely because the physician I'm working with has somehow come under the assumption I have the IQ of a sheet of dry wall. Cue one interaction I had today in clinic:
*MedZag, presenting patient to attending while in patient room (I know, awkward.)*
MedZag: Ms. Rogers is here today complaining of persistent worsening of allergies of the past 8 months. She states her main symptoms have been rhinorrhea, nasal stuffiness and sneezing, sore throat, and some intermittent wheezing. No sinus pain or pressure, no cough, no shortness of breath. She tried a trial of Claritin for 2 week...
Attending: So what brings you in today Ms. Rogers?
*Physician and patient proceed to start talking and cover all pertinent points I was about to distill in my presentation*
*Attending begins physical exam*

Attending: Now, if you see here MedZag, if you look up her nose you can see fluid.
*biting tongue*
Attending: You can also see swelling. This is very characteristic of allergies.
MedZag: Hmmm, yes, interesting. I also noticed that when I performed a physical exam (not so subtle hint). I had some ideas of an assessment and plan, would you like me to continue?
Attending: Oh no, that's ok. We'll just give her some Allegra.

This is going to be an interesting 5 weeks.


sarah said...

the attending was probably in a hurry, plus it doesn't sound like a super high yield learning case! remember, gaining experience seeing/examining/formulating your assessment + plan is more important than getting to present to the attending! if you want feedback on presentations specifically, ask for it! but it doesn't have to be after every patient.

that said, i remember having the same sorts of frustrations back in my med student days. it's annoying when there are cases you know you CAN handle pretty much on your own but no one lets you do it! but someday you will look back on those responsibility-free days and sigh wistfully.

Anonymous said...

I think it's because you listed some findings, then your negatives, and then marginally important background info, so it kind of sounded like you were done listing the pertinent findings. That's probably what the doc thought.