Sunday, July 7, 2013

Rotations

I started third-year clinical rotations this month. First thing I noticed was that it is so much more fun that sitting in a classroom or studying all day.

I started off in a family practice clinic of 4 doctors and I wasn't quite sure what to expect my first day. For close to two years I have heard of institutionalized hazing - abuse built into the system for those trying to learn how to be a doctor. The first day I feared getting yelled out, told to stay out of the way, criticized for how little I knew, and getting my clothes sneered at for being under-starched. Those are the stories that people tell. What they don't tell is how wonderful the doctors and nurses are, how funny and respectful the patients are, how nice the staff members are, and how helpful everyone is.

I rotate between three doctors and when one of them discovered that I wouldn't be with him that first day he looked a little disappointed - just enough to make me feel like it was important to him that I was there. From where I stand, I decrease the productivity of these busy people to whom time is money and a third-year student takes time away from seeing patients by having to explain what is going on, or giving the student time to examine the patient, and formulate a diagnosis and plan. I don't know if or how much the school might reimburse the doctors I am working with for lost productivity, but the ones I am working with currently have been wonderful to work with.

My first day I expected to be thrown into the lion's mouth and expected to do everything all on my own. Instead my preceptor told me to "stay close, and try to get a feel of the pace around here. I bet you are so overwhelmed right now that you can't even function, so let's go slow, get you comfortable, and you can start seeing patients when you are ready." Before the end of the first day I was ready.

On the second day the doctor was with wanted to move a bit faster and said, "I want you to go see our next patient. I'm not going to tell you anything about her, but I want to know what you think."

I go it and my extensive two year training did not even begin to prepare me for what followed.


"So, what brings you in today?"

"I am here for an excision biopsy to remove some basal cell carcinoma."

"Oh."

I was never told that some patients might actually know what is going on. Everything I'd ever done indicated that the patient is in the dark, has one complaint and my job is to find out what that one thing is. Additionally, the situations we were trained on either wound up needing antibiotics or reassurance. I had absolutely no idea where to go from there or what my preceptor wanted me to learn so I turned to my extensive knowledge of basal cell carcinoma gleaned from having just barely finished 12 hour study-days in preparation for Step 1 of the boards just a week before.

"Have you ever been exposed to arsenic?"

"Not that I know of."

"Do you get sunburned often?"

"I did when I was younger, but I try to avoid the sun now."

At that point, a histopathology picture showed up uninvited in my mind and that's when things started to get awkward. Peripheral pallisading, myxoid stroma, artefactual clefting. None of that would be useful to talk to the patient about. She had probably never seen a histopathology picture. After a few quiet seconds I excused myself and went back to my preceptor. All she had to say was, "Good! I'm glad that you learned it's a basal cell carcinoma. Let's go take it out."

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