Day 722
On my way to morning report today, my friend tells me some horror stories about the surgical rotation a lot of my classmates just went through. Apparently, it’s the only rotation where the atmosphere is highly “malignant”. Morning report reminds me a lot of CPS in 2nd year. Attendings, residents, and med students sit around as one resident presents a current case to everyone for teaching purposes. An attending asks the resident questions and writes on a white board. Then, all the attendings ask everyone questions about what is important in the case. The senior resident knows almost everything. The younger residents know a decent amount. The med students, like myself, stay pretty quiet. Papers are cited, differentials are kicked around, labs are proposed. Then, everyone from my team goes on rounds. An attending, three residents, myself, and an undergraduate who’s shadowing. The attending speaks with authority to patients. He is very decisive. Sure of himself. Not cocky but confident. When the patient hears from him, it is the conclusion of a long string of examinations by residents and med school students. He delivers the final diagnosis. And suddenly all parts of a typical patient’s hospital experience come together for me. I realize that over the past two days I’ve been privy to what exactly goes on during those gaps of time when someone sits in their bed watching TV and eating lackluster food. At a teaching hospital, as your jello is sliding through your esophagus, residents and medical students are pouring over your history, labs, and scans again and again trying to get a complete picture for what is going on with you. While you keep being woken up by nurses who want to draw your blood, attendings are trying to understand that picture before they even meet you. I think this is what makes being treated at a teaching hospital so great. Quality control. While it may be a pain being given the same routine physical exam five separate times, you’ve gotta take some comfort in the fact that if there is something that the med student misses, the residents will pick it up and if there’s something they miss, the attending will find it. That chain works in reverse as well occasionally. It creates a web where very little slips through the holes. So you see, it’s probably better to be treated by a team than a single knowledgeable yet fallible human being.
Did I mention how awesome the residents are? Because they’re fantastic people really. I’m enjoying spending time with them. They nearly always know what they’re doing and they also have sympathy for med students since they recently were one themselves. I did a neuro exam on a patient today by myself. The physical exam went pretty well but I stupidly forgot to take even a mediocre history of present illness which I feel like is equivalent to forgetting how to put your clothes on in the morning. So I gave my all too forgiving resident a “naked” and sparse patient presentation while she sweetly corrected me.
Later I was told to administer a MOCA test to the same patient. It consists of simple writing, logic, and memory exercises to asses cognitive function. The patient did poorly and I was somewhat concerned until I reported my findings to the residents who postulated that he was probably faking things a bit. Looking at all the facts of the case, it’s probably true. But I still felt bad for the guy. He recently separated from his wife and became essentially homeless.
I feel like at this point I can bond with patients pretty well and I have a decent competency for the physical exam, my history taking could get a lot better and I need to tighten the screws on everything. Tomorrow I have to perform a neuro exam on a patient in front of the attending. Let’s all pray I don’t screw this one up too badly.
