This rotation was a logistics nightmare. First, we were supposed to have rotations each day from 6 am – 6 pm (with rotations every 3-6 hours, depending on the rotation). But they decided this year to mix it up and start at different times. So while the student starting on Emergency started at 4:30 am, we on the Blue Team started at 8 am. Then, the team was divided between UVA physicians and students and EVMS physicians and students, which made it difficult to fairly distribute the patients. Then, we started with the EKG machine in our area, and so we were being crowded out by the patients waiting for an EKG.
But, it was still a good experience, I just wish it had been better logistically.
I started out the morning doing EKGs. Nothing special, really, just placing the leads and making sure the tracing looked halfway decent before I sent the patient on their way. The most difficult was on a morbidly obese patient; no matter how hard we tried, we couldn't get artifact out of the tracing. I'm not sure if it was the machine that we were using, the environment we were in, or just the fact that the patient was so large. But, we got a halfway decent tracing and sent the patient on their way as well.
Unfortunately, I got stuck doing EKGs for the first 2 hours or so of my (4 hour) rotation. That kinda sucked, but again, it was the logistics of it all. I think a nursing student would've gotten more out of doing EKGs, because they weren't doing much of anything in Gen Med anyway. But I digress...
The first patient I actually saw was a relatively healthy woman who just wanted a checkup. She complained of some heel pain, but otherwise didn't have any complaints. Most of my task with her was to go through various screening questions, such as safety (Do you wear a seatbelt in the car? Do you wear a helmet when riding a bicycle or motorcycle?), breast cancer (Have you noticed any lumps or changes in your breast? Any discharge? Any skin changes? Has your partner noticed any changes?), cervical cancer (Do you have any abnormal discharge? Any pain or bleeding with intercourse? Last menstrual cycle?), and thyroid (Do you have any changes in your hair, skin or nails? Do you have a sensitivity to heat or cold?)
I'm not comfortable doing physical exams yet, mostly because I hardly ever know what I'm looking for, so I literally only interviewed this patient before going out and presenting her to one of the physicians (the one I presented to was actually a resident, not an attending). Naturally, I forgot several questions, but it's all about practice, right?
Upon returning, the resident went through the basic steps of the physical exam. Based on the history (long standing heel pain, worse when standing up or after standing for an extended period of time), she suspected plantar fasciitis, and demonstrated it by pressing her thumb into the arch of the foot. The poor patient jumped out of the chair with pain. We didn't prescribe any medications, only recommended heel cups and ice/NSAIDs for the pain, and counseled her that it might take up to 18 months for the pain to go away. We also recommended a series of calf stretches to help loosen the Achilles tendon. Hopefully, some combination of that will make her feel better.
My next patient came in looking for an orthopedics consult due to wrist pain. The pain started a few months ago while she was working around the house. It started right at her wrist, and radiated out to her thumb. Nothing seemed to make it better or worse. Upon physical exam, she didn't have severe tenderness upon palpating the anatomical snuffbox, she didn't feel pain when the inside of her wrist was tapped (so likely not carpal tunnel) and no other maneuvers that we (that is, me and the fourth year) did seemed to elicit the worse pain. Nothing else on her physical exam seemed abnormal.
We go out and I present, and the first thing the attending asks (or so it seems) is if we did Finklestein's test. She proceeds to enter the room and do the maneuver, which causes the patient to wince in pain. Diagnosis: DeQuervain's tenosynovitis.
What makes this patient most interesting is that the attending was actually happy to give her to me, because the musculoskeletal system is one I've already done. Clearly I learned a lot there.
One of the patients we saw had an incidental finding of a low O2 sat... somewhere in the low 90's. I was asked to listen to the lungs, and didn't hear anything terribly abnormal. But... I've listened to like three people's lungs. The only normal ones were my own. My sister has asthma, and I've heard her wheezing a little bit. The other person I listened to was a standardized patient, and I couldn't hear any breath sounds at all, despite the fact that he was breathing perfectly normally. So, not so good with that skill yet. Add to the fact that we had a large fan blowing over our heads, and it was pretty impossible for me to hear anything through my stethoscope. The attending said she heard coarseness, I listened again and thought I heard something a little off on the right side, she listened again and heard it on the left side, and maybe a little on the right...
I'm not sure we ever managed to get that mystery sorted out.
All in all, I wish I had been able to see more patients, had longer time on the unit (some people got to do two gen med rotations; I got one and it was cut in half), and been able to remember more from class. I guess it'll all come with some more repetition... right?