Home Stretch for Cores!

So I am finally on the home stretch of my core rotations. For those of you who don’t know, every medical student has mandatory rotations that they have to do. They are 12 weeks of internal medicine, 12 weeks of surgery, and 6 weeks each of family medicine, pediatrics, psychiatry, and OB/GYN. After those are finished, we choose a variety of electives in the area(s) that we are planning to practice in. Some people choose to do some electives just for the learning experience because many specialties can be incorporated into primary care. For example, if you want to be an emergency medicine doctor, an elective in radiology might help you become more efficient at quickly interpreting X-rays and CT scans while in the ER. 

I am about halfway through my surgery rotation which is my last core. I must say, despite my reservations about being in such a large, unfamiliar city, I have had great learning experiences and have had the opportunity to see so much throughout my time in these rotations. Chicago is an amazing place to learn medicine!! I have had very eclectic experiences as each of the doctors I have worked with have been very different from one another, and they have each served different patient populations. 

 My OB rotation was in a very nice small hospital in the northwest suburbs of the city. Going into the rotation, I had a bit of a sour taste in my mouth because I didn’t have the greatest experience when I had my OB/Peds rotation in nursing school. I was also much younger then, and had seen far fewer gory situations than I have seen now and nearly hit the floor as I watched a vaginal delivery for the first time. I was pleasantly surprised to find out that it didn’t bother me at all this time around, and (although this is strange for me to admit) I actually had to keep myself from shedding an emotional tear with just about every delivery. It is so amazing what the human body goes through when giving birth and witnessing the immediate connection between a new mom, a new dad, and their new baby is absolutely amazing. During the rotation I got a really good mix of exposure to different things. Our time was divided up between office visits, labor and delivery, and surgery. In the office, we did routine check up and pap smears, DEXA scanning, prenatal care, and minor procedures like colposcopies and biopsies. I learned a lot about healthy pregnancies, and a ton about routine screening and prevention for women. I got to witness several deliveries as well, both vaginal and C-sections and also sat in for a couple of surgeries for gynecological cancers. The attending was awesome and genuinely wanted to make sure we were well versed in the field. He had high expectations of us and also made us do a presentation for the group each week.

My surgery rotation is with an orthopedic surgeon, so we are mostly dealing with musculoskeletal problems. I think it has been a great rotation that will be applicable in just about any field of practice. Hip pain, back pain, and knee pain have to be some of the most common reasons that people seek medical care. It has been great learning how to effectively assess someone and decide where the pain might be coming from. Again, the attending is really great and does lots of extra teaching for us. He has held workshops for us where we learned how to apply splints and casts, another where we worked on our suturing skills (using pigs feet) and he also has us do presentations. He really encourages us to bring him the difficult questions we stumble on as we are practicing for boards and works through the with us. He is amazing with his patients and a true joy to work with. I am learning so much “common knowledge” stuff that I think any doctor, regardless of the field they work in, should know. I would love to do some outreach medicine some day and the skills I am learning in this rotation will help me immensely with that! 

One of my favourite parts about getting to rotate with all of these different doctors is watching how each doctor approaches their patients. No doctor is perfect, but with each one I have found qualities that I admire and hope to incorporate into my own practice. Treating people is a true art form. It is not easy to connect with a stranger and quickly earn their trust and I have seen great examples of doing just that. Of course, I also see things that I would never do…but those things are just as much of a learning experience. It is like a fun journey where you pick up all of the great, positive things you see and put them in your pocket and simply leave the things that you don’t want to take with you. I am excited to start focusing in more on my big interests and to continue to work on becoming the great physician that I know I will soon be.

As always, thanks for reading and please feel free to contact me if you are a current student or hopeful soon-to-be student and you have questions!

XOXO

The books don't know these things!

Wooooh! It sure has been a long time since I have written a post. I have been really busy in clinical rotations and I have just had trouble finding time to sit down and get it done. I have been having such a great time and learning so much.

I recently finished up my internal medicine rotation. I had a totally awesome attending who was extremely knowledgeable and has a real passion for teaching. He travels to many, many different facilities - nursing homes, rehab facilities, hospitals, and outpatient offices. I will admit, at first I was a little disappointed that all of my time wasn’t going to be spent in the hospital, but I quickly changed my mind. Having the opportunity to see so many patients at so many facilities really provided a great learning experience. I saw some pretty rare cases and definitely developed my physical exam skills a lot. 

I was truly astonished by some of the long term care facilities that we visited. At the nursing homes in Canada that I have worked at, the patients were quite stable. If they required more acute care, they would be transferred to the hospital. Here, it is a totally different set up. Many of these nursing homes handle patients on ventilators, patients receiving IV fluids and medications, and some even had dialysis units right in the building. Needless to say, not a day passed where there was a shortage of learning opportunities. One of my attending’s favorite sayings was “the books don’t know these things!”. He couldn’t be more right. I firmly believe that in order to be a great clinician, you really need to get out there and see as many patients in as many settings as you can. Books can give some great knowledge, but they certainly cannot make you a great clinician! 

The 12 weeks of internal medicine REALLY flew by. I find internal medicine to be so interesting. Each patient is a completely new mystery that needs to be unlocked and I really thrive on the challenge of figuring it all out. There is so much to know and I feel like it is an area that would be hard to ever truly master.

I have just finished my 2nd week of the pediatrics rotation. I must admit, this rotation has been quite refreshing. My entire medical career thus far has been (for the most part) caring for very sick, and mostly elderly people. This peds rotation is solely outpatient and the kids we see are, for the most part, not very sick. There are a lot of school physicals, sports physicals, weight management patients, and minor illnesses and injuries. The kids in the practice are delightful to work with and so well behaved! The population is almost exclusively hispanic. I’ve recently started to try to learn how to speak Spanish and there couldn’t be a better time to do it.

The attending is awesome. He expects a lot from and is quite hard on his students, but for me, that is a huge motivator. I love to be challenged and pushed to do better and this doctor is awesome at doing just that. He is really great at his job, makes a huge difference in his patient’s lives, and is incredibly thorough.

In Canada, at least where I am from, most kids don’t see a Pediatrician on a regular basis. For the most part, kids are cared for by Family Physicians and are only referred to Pediatricians if they have a serious or chronic disease. Here though, the Pediatrician assumes the role as the Primary Physician for many children. It is such a great and interesting role because you are dealing with young minds who are eager to look at you as a role model. I really think that you can make a lifelong difference in a child’s life by getting them starting out right with healthy lifestyle habits. Prevention is the main goal if you are a Pediatrician, and if you get through to kids while they are young they are more likely to hold onto those values as they grow older.

I suppose that is all there is to report for now, thanks so much for reading!
XOXO

The Challenges of Caring for People in Underserviced Areas

As a Canadian working for the first time in the US health system, and specifically in an area that serves primarily a low income African American population, it has been a huge eye opener to me. The experience so far has been extremely challenging, humbling, and at times heartbreaking. Currently, about 1 in 7 Americans live in poverty. It is no secret that those living in poverty are much more likely to suffer with health problems than those who do not. The internet is littered with articles and studies that prove this. So many people go without needed services. People either do not have insurance, or don’t really understand how to work with their insurance companies to ensure that they have their needs met. 

Let’s take the quintessential patient that is encountered in the clinic here (this isn’t any specific patient that I have seen, just a description of a typical situation).  A patient comes in at her wits end with her asthma. She has been suffering for so long. She is at the point now where it is difficult to leave the house because every time she does, she has an asthma attack. She lives in a rental unit that is old and that has mold and old carpets. These things are further contributing to her flares. She can’t afford to move into a new apartment.  In speaking with the patient more, you find out that she hasn’t been able to refill her prescription asthma medications for quite some time because they can not afford the co pay. Now she has been missing work, and is close to having to go on disability because her asthma attacks are so bad she can not do her job. You notice she hasn’t had a pap smear, a mammogram, or a colonoscopy in over a decade, but this is least of her worries because all that means for her is more money to pay that she doesn’t have. She has children at home and is often too unwell to care for them the way she wants to.

Doctors and medical students working with these people are faced with many challenges. It is so important to keep their situation in mind at all times. It is easy to catch yourself trying to teach a woman about providing nutritional foods for herself and her children without considering the fact that these nutritious foods are much more expensive than high calorie, nutrient depleted foods.

Here are some of the challenges that I have encountered during my 6 weeks here so far:

1. These patients often have unexpressed needs: either they do not recognize that they are missing something or they are too shy, too proud, or too scared to ask for help.
2. Community resources - there are several community resources available to help but many patients aren’t aware of what is out there to help them.
3. Patients often need an advocate - someone to push for them in order to get them the things they needs in order to take control over their own health and better contribute to society. Sometimes that means spending extra time talking to insurance companies to push for a required medication or treatment. Sometimes this means researching community services so that you can then tell your patients about them.
4. Patients often come in with the attitude that a physician or medical student couldn’t possibly relate to their situation. It is important to give these people your time and to allow them to explain.
5. Patients often have many many issues that need to be addressed in a single appointment. For some of them, visiting a physician is a substantial financial burden and it may be necessary to manage their medical conditions, counsel them on lifestyle choices, talk with them about any emotional issues they are facing, and help them navigate the health system all in a single visit. 
6. Patients are often lost to follow up. They seek medical care only when they absolutely have to but once they are feeling a bit better they may not be able to justify paying for a follow up appointment or to go and get the bloodwork done that you ordered for them. This is a problem because there is no continuity of care - these patients have a lot of chronic diseases that require regular monitoring. 

I don’t have a solution for this problem in the USA, but I do know that doctors can and should make a difference. No single person or doctor can turn this situation around overnight, but we need to celebrate small victories. Celebrate people. I truly believe that people, at their core, want what is best for themselves and want to do the right thing. They don’t want to be unhealthy, they don’t want to miss appointments and they don’t want to be without services and medications. People are in survival mode. Doctors should be doing everything in their power to make a difference to these people. Let them know that they are seen and heard, and that there are people out there that care about them. We can not write these people off. When you put faith into someone, they are more likely to put faith into themselves. 

BoardVitals...saving MY life in Family Med!

Hey Everyone!!

This post is specifically for other medical students. I've recently stumbled across a new resource called "BoardVitals" - they have question banks with questions that are specific to each rotation (even specialty/elective rotations)! I am currently using their Family Medicine question bank and am finding it really helpful in studying for the shelf exam. The Family Medicine qbank has over 1700 questions...they are very challenging and very helpful in practice too. They are reasonably priced compared to a lot of the other qbanks out there - $49 for one month, $59 for three months, or $69 for six months access. They also have one set fee that will give you access to all of the qbanks on their site.

For anyone interested, you can get $10 off of any qbank or qbank package on their site :)

https://www.boardvitals.com/users/6889d6/refer

Happy Studying!!

Family Medicine Rotation

The first couple of weeks of Family Medicine are wrapping up. Overall, I can say that I have had a pretty good experience so far and I have learned a lot in two weeks!

The family medicine program here at Jackson Park Hospital is a little different than a typical family medicine program. Jackson Park has a family medicine residency program, so there are about 20 residents completing their program here at the moment. Since they are the only residents at JPH, they do a lot more than you would think would be typical of a family doc. There is a clinic attached to the hospital, so they work there - in this aspect they do things that you think about when you think about family med - see patients for non urgent complaints, give vaccinations, health check ups, medication refills, health prevention screening, and refer patients to specialists, or to the ER if necessary. There are tons of other reasons people come to the clinic of course.

They also work throughout the hospital. They manage medical, surgical, and ICU patients. They essentially run the show here. Of course, there is an attending physician assigned to each patient who is admitted, and the attendings do rounds with the residents at least once a day to make sure everything is being done as it should.

The view from my apartment in Chicago!

As a student doing family medicine here, we also get to see and do things outside of the clinic as well. There are 1 or 2 students assigned to an attending, so the student doctor ratio is good. Unfortunately, it isn’t the same story for other rotations here - in internal medicine, for example, there are 10 or 12 students in a group with one attending. I am going to focus this post on the family medicine rotation, however.

There were about 10 of us starting our family medicine rotations here in January and we were split up amongst the family medicine attendings. In talking with the other students, it is clear that our experiences are all different - and that is largely dependent on which attending you are assigned to.

What I am assigned to do depends on what my attending is doing that day. Last week he was covering the clinic, so we worked there. We come to the hospital at 730 every morning and attend grand rounds with the residents. It is just a pretty informal meeting where there residents have to take turns doing lectures on various topics. When that is over, we review interesting cases that are in the hospital at the moment. We look at X-rays, CT scans, lab work and have a discussion about what is going on and what the plan should be for them going forward. I definitely learn a lot in these discussions. After rounds, we head to the clinic. The residents see the patients and report to the attending, so we each find a resident to stick with and follow them all day long. 

On Monday mornings and Thursday afternoons, my attending sees his own patients so we are with him. He has us go and see the patients first, then report to him, and then we go and see them together.

This week, our attending was on call on the ward. We came in for grand rounds at 730 as usual, then followed along for morning rounds on the ward. This is definitely where I have learned the most so far!  As we do rounds, we discuss what is going on, look at the patient’s EKGs, labs, and other imaging studies, and talk about a plan. Our attending drills us a lot during the rounds, asking us all sorts of questions. After rounds are done, we pair up with a resident and help them with admissions or whatever else they can use us for. 

During the rotation we have to do on call shifts. We have to come in at 730 as usual and then stay the whole day and the whole night, and then stay for grand rounds and floor rounds the next morning which lasts until around 11am, and then we get the rest of that day off.

There is definitely a lot that could be improved in this rotation too. Each day is kind of hit or miss, and a lot of that really depends on which resident you are paired up with. Some residents are GREAT. They are enthusiastic and are happy to have you with them. They teach you and quiz you and let you help them with procedures. Some let you do procedures if you are comfortable with it and they are there to guide you. Others are much less enthusiastic and will let you follow them but don’t really acknowledge that you are there, or they will direct you to an area to sit and they’ll say “I’ll come and get you if there is anything interesting”, and you mostly likely won’t see them again. I am sure that is pretty standard though and there are always people who are more willing to teach than others, this program just lacks some structure.

My other huge complaint is that the hospital just isn’t really set up for students. They don’t allow students to have access to the computer (most hospitals will assign each student their own login so their activity on the computers can be monitored) which makes it impossible to look up any information on the patients we are looking after. Because of this, we don’t get to do any documentation which is something I know is an important skill to develop. After doing a history and physical on a patient, it is almost like it never happened when it is not documented. On top of this, the unit is absolutely littered with students every day. It is not uncommon to see 40 or more students on the unit in any given morning which I think is a little excessive.

I have managed to book a few more rotations for when this one is finished. I will be doing my 6 week psychiatry rotation next, starting at the end of February as soon as this rotation is over. It will also be at this same hospital. After that, I will be heading to Virginia to do surgery for 12 weeks immediately followed by IM for 12 weeks. I am definitely looking forward to the move - I have several friends doing rotations in Virginia currently and they all having a great experience there.

Thank you all for following and I will post another update soon! 

XOXO Nicole

Next Stop....Family Medicine!!

Hey everyone! Happy New Year! I hope that everyone who is reading this had a great holiday season and have started 2016 off with a bang. I also want to thank everyone for the kind words of congratulations on passing my USMLE step one exam.

It has definitely been a whirlwind since taking the test! I just got back to Chicago about a week ago. I was thankful to spend some much needed time at home with my friends and family after spending so much time away. A lot has happened since my exam date so this is just an update post about what I’ve been doing and what I’m doing next!

Patrick and I celebrating New Years at his house in South Bend, IN

 The day after my exam, I went back to work at Bay Haven Nursing Home in Collingwood. I have worked there in the past and they were gracious enough to let me come back for the short time I was home. Unfortunately with being out of the country for so long, my RN license was not active so I worked in the role of a support worker. It was really a great experience and I am glad that I did it. It really took me back to my roots, where everything started for me. It was so nice to get back in there, get my hands dirty, and connect with people in a way that I missed so much. It showed me again how much the simple things in life really matter and how easy it can be to have a positive influence on someone’s day.

I also did some work at Georgian Downs in Innisfil - specifically at the racetrack. I was bartending and cooking there on weekends. I hadn’t done this kind of work since I graduated from the Practical Nursing program in 2009. It was actually a lot of fun and I met some very interesting people.

I had the opportunity to work with an amazing doctor in Midland as well. Dr. Anne Gannon was very receptive to my interest in shadowing her. She had me in for several sessions at her office. She allowed me to interact with patients and perform basic exams. I can not say enough great things about her! She is such a great mentor and role model for me. She is the epitome of the kind of physician I hope to be one day. She truly loves her job and cares about her patients. She remembers so many details about each person that comes into her office, takes the time to explain things about their health, and really allows and encourages them to take an active role in their overall wellbeing. I learned so much from her in a short period of time. Not only did I learn some superb examination skills, but she was a great example of the relationship I’d love to have with my patients one day. Simple things, such as providing her patients with a physical copy of their labs and diagnostic reports and going over them in detail allows people to take a proactive role in their own health. There were several occasions where patients brought in photographs of their family, or details of a recent vacation to share with her. She was just as enthusiastic about hearing what her patients had to share as they were to share it. I know her and I have developed a lasting relationship and I am so thankful for that.

My kooky family celebrating Christmas!

My time at home was certainly busy, but I loved being there and it helped with some of the disconnect and homesickness that I had been feeling. I am now back in Chicago and will be starting my Family Medicine rotation on Monday. I will be working with Dr. Okolo at Jackson Park Hospital. I don’t really know any details beyond that but I am sure I will find out much more on Monday. I am really excited about moving forward, and finally getting some hands on experience rather than sitting in classrooms all day long! That doesn’t mean the studying is done, I have already began preparing for the USMLE step 2 and I really hoping to take it without taking much (or any) time off from rotations. I will certainly post an update soon once I get going with Family Medicine!

Happy New Year again, and thanks for reading!

XOXO