Dr's profileThe Adventures of the Fu...PhotosBlogListsMore  |  Tools Help |
|
February 09 Thursdays are ego gratification days!I love it when a day starts out badly, but gets better and better as the seconds tick by. Today started almost like any other, with the exception that traffic was horrible for my entire morning commute. A drive that usually takes me an hour lasted forty minutes longer, making me late for neurophysiology. But things got brighter.
I love Thursdays. Thursdays, if you remember, are Essentials of Clinical Medicine days, where we work with our "standardized test patients" preparing for all of our future clinic work. Last semester, we focused on communication skills, and learned how to take histories and perform physicals. This semester is a little different: now we are putting all of last semester's skills to work by doing focused exams, and working through differential diagnoses (contrary belief, doctors do not automatically know or assume a patient's condition... well, some might, but most do work their way through a series of possibilities before declaring the problem.) Last week's topic was chronic cough (my patient had gastroesophogeal refulx disease.) This week, the complaint was chest pain.
Chest pain can be caused by a variety of things: trauma, anxiety, pneumonia, pulmonary emboli, and the dreaded heart attack. Our task was to examine a "patient" who is complaining of chest pain, and through history taking and a physical exam, come up with a differential diagnosis to figure out the possible cause. My "patient" was a 65 year old white male who owns a ranch, and started having chest pains four days ago. I spoke with hiim at length about the pain: the severity, if it radiates, if anything he does makes it cease, it's frequency. We talked about his current medical conditions, his daily activities, and walked through symptoms of all the aforementioned conditions. I also performed a focused physical exam to rule out localized, reproducable pain, and decided that my patient is having an infarction - aka heart attack.
When time was called, my patient had two minutes to critique my performance and skills. While I did get "dinged" for forgetting to ask about his family, overall, he praised me so much that all I could do was sit there, beaming, and thanking him for his words. According to him (and who am I to argue?) I did an outstanding job - I made him feel that I really cared about him and what he had to say, and that he feels that I will be an outstanding physician. He actually asked me what year I was (I'm a n00b first year!), and told me that he would have no reservations calling "Dr Cara" if he had any issues. That just made my day!
After our patient encounters, we met in small groups with an actual physician to discuss our cases. Case presentation is where one science nerd talking in weird language to a group of other science nerds about the patients they are caring for. The follwing is my case presentation:
65 year old caucasian male presenting with a complaint of chest pain x4 days, worsening on exertion, rated 7 on scale of 1 to 10, some SOB, but pain subsides with rest. Pain started radiating to left upper extremity and neck last night. Denies fever, cough with sputum production, trauma, anxiety, diaphoresis. Patient is retired, but owns a ranch, is physically active, and partakes in heavy lifting and exertion. Hx of diabeties and HDL, both being controlled with diet and exercise. 1 1/2 pack/day smoker.
Patient is a 65 year old caucasian male, well nourished, fit, alert and orientated X3. Skin shows signs of anti-coagulation therapy. Vitals: BP 122/62, P 84, R 16. Denies pain on palpation of pectoral region. Lungs clear bi-laterlly, no abnormalities on lung percussion. Limbs show no signs of edema, pulses non-abnormal.
Diagnosis: possible MI. Ordr EKG, blood draw of troponin levels.
After presenting my case to our preceptor, he stated that I did a fantastic job getting the patient's history, and that he had a really good idea of what was going on just based on my observations. He also asked what year we were (we're n00bs, I tell ya!) He stated the patient most likely had a stable angina, and showed us how to evaluate an EKG for signs of a MI. It was very cool, and my ego just got bigger.
To top things off, we got back our results from that awful exam from Monday - you know, the one I whined and cried about and said i'd be happy if I got a 60% on it. Well, I did much, much better than that, and, for once, scored higher than the class mean! For once, I am above average! There's hope for me after all! Huzzah!!!!!
Comments (4)
TrackbacksThe trackback URL for this entry is: http://drcara.spaces.live.com/blog/cns!868FED0397653D16!1011.trak Weblogs that reference this entry
|
|
|
