OPEX Reflections

Yesterday was my last day at OPEX (out patient clinical experience).

Yesterday I worked with Dr. X, a resident. We saw a wide variety of patients -- an 8yo boy with pink eye, a russian woman with migraines, a U.S. health service worker with an infected finger, and a mom wanting her 7 yo to be evaluated for ADD.

There were several things that struck me as we saw each patient--

1) It was so refreshing to see a child -- a talkative, friendly, outgoing 7yo boy at that. You don't realize you are missing anything working in a primary care adult clinic, but seeing that boy yesterday made the appeal of family practice care clear to me. You see a greater variety of patients. It was fun to take care of an enthusiastic little kid that talked about baseball, his best friend in school, and playing outside.

2) Cultural, communication, and social barriers. Our patient with migraines was an middle aged woman from Russia whose second language was English. My preceptor was also an immigrant whose second language was English. There were several times that I witnessed communication breakdown between them.

Dr. X -- "Was your head trrrobbing [throbbing]?"

Patient -- "What? No, I had a migraine."

Dr. X -- "you know? pulsating? what did it feel like?"

Patient -- "the pain was just on my right side"

Ai yi yi...and so it continued. The problem wasn't just the communication though. I really didn't like the way the interaction was going. Dr. X was acting very paternalistic and started lecturing her on how she shouldn't be taking ambien because it continues the insomnia cycle when she mentioned that she wasn't sure if she could take ambien and imitrex(migraine medication) together. Whenever she asked a question, he would continually interrupt her and say "now, listen to what I'm saying." Lastly, he kept touching her knee or her arm or hand when he was talking to her. Now...I like my personal space, and I know if I was that patient, I would have felt very uncomfortable about the doctor continually touching me while we are speaking. Ultimately, the doctor had the best intentions -- he wanted to educate the patient and help her get control of her migraines, but the approach was not for me.

3) The ADD epidemic. It is well known that ADD and ADHD are over diagnosed in children in the United States. It is no joke to put your kid on medication for life not to mention the psychological impact of "you have a disease that makes it harder for your to succeed" on the child. One of our patients was a mom bringing in her young daughter for ADD evaluation. She kept going on and on about how her kid refused to focus and how whenever she found something difficult she just quit or how she puts the wrong answers because she gets impatient with working out the problem. This child may very well have ADD, but I didn't like the way the mom was talking about her own child with the girl right there in the room. It just felt like she was being attacked and being told that something was wrong with her. It bothered me.

Looking back over the last year of OPEX experiences, I have learned so much. I can take a history and do a physical with ease now. I can come up with a differential diagnosis and a treatment plan for patients. I've seen the application of lecture material in real live patients over, and over, and over again. It has been a great experience and I am so glad that it is part of Emory's curriculum.

Untold Stories of the ER

As M2s, we get to apply for an elective for the next few months. I am in "Thrills and Spills" -- where you get exposure to the ER and learn new techniques such as intubation, IV placement, and suturing. Exciting!

I started shadowing this week -- first Grady (Blue zone) then Emory Midtown. Two very different experiences.

I LOVED my time at Grady. I was working with the residents, seeing patients, high energy (while simultaneously laid back?). It was great. At midtown, I was placed in the "red pod" which is assigned to the more intermediate cases -- abdominal pain, dizziness, etc... I was also working with an attending, which created a different environment.

Among all the craziness, the thing that struck me most was patient relationships. Both at Grady and Midtown, there were specific couples that just struck a cord within me.

At Grady, an 65yo woman was rolled into the ER because she was in pain and extremely hypotensive. IVs needed to be started on her immediately. Her husband was with her, and he was SO worried. As the ER attending was rapidly firing questions at him about his wife's medical history, he tried to answer the best as he could all the while shooting concerned glances over to his wife moaning in pain on the ER bed. As she screamed while the IVs were being placed, he had to leave the room-- I think it was too much for him. You could just see how much he loved her and how much he just wanted everything to be ok. His wife had a history of MS which even further showed his dedication and love to serve as a constant caregiver to a patient with a chronic condition.

At midtown, a 60yo woman came in for dizziness. Looking up her chart beforehand, I read her history -- "hepatitis C, liver cirrhosis, coagulopathies, double leg amputation after car accident in the 70s, severe dystonia." -- this lady again was a chronically ill patient. As I walked into the room to ask her about her dizziness, her husband was sitting there was well. He helped to answer questions that she couldn't -- filling in the details of her medical history. She was easily agitated and severely debilitated by her dystonia-- not an easy patient to care for, but again, you could tell how much her husband loved her, patiently staying by her side as her loyal caretaker.

Seeing these patients just reminded me of how much I love Ben and how it would break my heart to see him sick or in any kind of pain -- really giving insight into the patient's family perspective.