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!!