All done!

Today was my last day at my elective. I had a great experience...and it was nice to stay with my mom and visit her a bit more. These past few years haven't been easy for visiting family, but I take what I can. My fellow classmate 'Hiccups' reminded me of the "remember the feeling the day you got your acceptance letter" speech. I remember alright. Picture this: me, crying on my kitchen floor feeling so relieved that I didn't have to work at a job that I hated anymore and could do the thing I dreamt about doing. I called everyone I knew. No one answered because it was the middle of the day. I had to stew by myself until someone called me back an hour later!!!! But I was happy. That does feel like so long ago. Until today, when I realized why I am doing this.

As I was getting ready to leave my preceptors office this afternoon, his assistant gave me a piece of paper. My preceptor told me that this was sent to him by email and that he wanted to pass it along to me. It was from a patient I had seen the previous day who wanted to pass along a message to me. She said that I was "very professional yet warm and personable. My excellent manner with patients made her feel at ease" and she thought that this would help make me an excellent doctor. She went on to say that she wanted the clinic and me to know that I was doing a great job so far! I am not intending to toot my own horn, but I am sure that my classmates can agree that it is moments like this that mean the most to us. To know that we haven't tortured ourselves over the past few years for nothing. Or for the grades, or the praise from our instructors. Comments like that from patients keep us going...well, me at least.

I've been tagged!

Well, well, 'FIFE Me', I see we meet again. I accept your challenge. You wanted to know 5 things about me...here it is for all the world to see:

1) I am a rare find. I have type AB+ blood (2-3% of the population), I get an allergic reaction to the sun (3% of people), I taste metal with zopiclone sleeping pills (like the other 10% out there), and my aunt assures me that I will have at least twins if/when I have babies (1-2% of births).

2) On more than a few occasions, I have called in 'sick' (cough, cough) to work to stay home and finish a good book. The Harry Potter series made me particularly flu-ish. This was my pre-med school days of course when I actually had time to read for fun!

3) I feel like I am going to pass out if friends or family are bleeding or need needles. Once, my mom was giving herself a B12 shot and I had to sit down or risk falling over. Another time, my roommate had to take care of my boyfriends bleeding finger because I had my head between my knees. Contrast that with knee replacement surgery getting sprayed with all manner of bodily fluids and loving every minute of it. Go figure!

4) My all time favorite thing to do is curl up on the couch in the afternoon when the sun is shining in the window and having a nice nap!

5) I hope my past trampoline experience will prepare me for the in-floor trampoline I will be installing into my future house. Complete with open foam pit and padded walls and ceiling. Mustn't break bones.

Hiccups...your turn!

General Practice

It's nice being in a place with actual winter...instead of just a long, cold, rainy season (although I have to admit, this year is a bit of a blip). The weather has been beautiful where I am. It's colder than what I'm used to but I don't feel it because the sun is out and the sky is clear. Does wonders for the mood! But I digress...

My experience at the clinic so far has been great. I've seen about 20 patients a day on my own. I then confer with my preceptor who gives the A-OK and sees the patient briefly. And that's it! Not much to this whole doctor thing...could have done this years ago!!! Ya...as if!

This clinic is a little different than most. It has electronic medical records (which in itself isn't that different), but the docs don't get paid by fee-for-service. They are sort of salary based, not exactly, but I haven't yet had the time to talk with my preceptor more about that. The clinic also makes use out of nurses and nurse practitioners who triage calls and see the patients before the docs do. They take a brief history and vitals. Also, patients will see various teams (staffed by specially trained nurses) who do diabetes, nutrition, and chronic disease clinics for the patients where appropriate. They make periodic appointments with the teams who review their progress/regress and make appointments with the docs if necessary. The thought is to reduce the amount of time that docs have to spend with patients who have chronic diseases like diabetes and chronic heart disease because a large part of their management has to do with lifestyle modifications. There are also community health nurses who come and do immunizations for kids and newborn care as well as a travel clinic for those who travel and need immunizations/prophylaxis meds. Busy, comprehensive clinic!!!

On an individual basis, a patient makes a contract with the clinic that they won't use walk-in clinics or other GP offices before calling the clinic first. The clinic reserves 20-30% of it's appointments for 'emergent' patients (basically same-day apointments that don't require the emergency department) so patients won't need to use walk-ins. Patients are also required to come for annual physicals (male and female, regardless of age). The Canadian Guidelines for Disease Screening are used...the clinic even measures waist size and neck circumference! Men get DRE's and women get Pap's. And the docs ask about sexual as well as mental health. Depression screening and sexual dysfunction are routinely screened! I'm really impressed that the clinic takes the WHO's definition of HEALTH in account...physical, mental, and spiritual...or as me and my classmates would call it...bio/psycho/social!

But the most impressive thing that I have seen is that my preceptor asks "How are YOU doing?" to patients who really need it. A man whose wife has metastatic breast cancer and will die of it soon, a mother who has severe post-partum depression and thought of killing her baby, a woman who confessed that her husband was physically and sexually abusing her, a teen whose parents were in the middle of a divorce. These people really need someone who is compassionate and their doctor is that person for a brief moment. That's the part I like most about family practice.

Callie-Callie-Cone-Head!

At this moment, I'm at my mom's place in a different city for my elective. I'm doing 2 weeks of Family Practice at my mom's docs office. It's a fairly new clinic that is completely electronic, is multidisciplinary (ie makes good use of their nursing staff), and has their docs on a sort of salary. It's not fee-for-service, so there is no incentive to cram patients in all day long. We probably saw about 25ish patients all day, which is considerably more than what I've seen in other clinics. To top it off, my preceptor is a fantastic teacher...I think I'll learn lots of clinical pearls over the next 2 weeks.

On another note, my mom and I had to take her cat Callie to the vet yesterday...poor thing. Turns out she had an anal abscess (mmmmmm!) and needed surgery to drain it! She noticed something was wrong with the cat when she was letting me pet her and wasn't running away! So, she went for surgery today and is now walking around my mom's place with one of those friggin stupid cone-head things. She's feeling much better by the way...although she looks ridiculous!

Well, I have to look up the Ddx of primary testicular failure right now...saw a case of possible Kleinfelter's this afternoon. Cool for me, not for him.

Random thoughts

It's been a bit since I've blogged, so there's a few things I'd like to talk about:
1) Dermatology. It's boring. Here's the bread-and-butter:
-psoriasis- combo of creams, shampoos, and UVB light therapy
-atopic dermatitis a.k.a eczema- hydrocortisone cream
-warts- burn them off with liquid nitrogen
-seborrheic keratosis ("age spots")- cosmetic concern only (so no treatment)
-actinic keratosis- very small chance of transformation to skin cancer, so burn them off
-basal cell carcinoma- benign, burn them off
-actinic lentigo a.k.a sun spots a.k.a liver spots- laser can reduce their appearance, harmless
-various types of nevi aka moles- concerning to the patient, but harmless
-melanoma- dangerous malignant skin cancer that can look like moles (see above)
Everything else is weird and unusual and only dermatologists need to know them.

2) Our changing climate
Obviously our winter weather pattern is due to the fact that we keep pumping out pollution that warms our atmosphere, causing the city I live in to have 14 hurricane-force storms, power outages, boil water advisories, a bout of flooding, and 2 severe snow storms that dumped a total of 85cm. These have left our poor city and famous city park in shambles! Have I mentioned that this has only been in the last 2 months? Did I also mention that usually at this time of year, our average temperature is between 5-10 degrees, our average snowfall for the whole winter is 0mm, and the crocuses are usually starting to bud? Meanwhile the other side of the country (that normally fits into the class of "quintesential Canadian Winter") stole our weather???? They think they're so smug with their golfing and their fleece vests without jackets! They should be ashamed of themselves!

3) I have started introducing myself to patients as a student doctor because I am annoyed. I can't say how many time's I've had this conversation with a patient:
Me- I Mr/Mrs/Ms So-and-So. I am Me and I am a medical student. I hope you don't mind if I talk to you before Dr.Such-and-Such comes in to see you?
Patient- Oh, that's not a problem at all! So, you're in medical school are you...well, good for you! So what kind of nurse do you want to be?

Many patients make this assumption that because I am female, medical school must mean that I will become a nurse. If I wanted to be a nurse, I would be in NURSING school, not medical school. My male counterparts don't run into this problem. Old Boys' Club rearing it's ugly head.

Well, I think that's all I have att he moment. I think I can find something else to bitch at though!!!!

Birth Announcement

One of my high school friends and her husband had a baby on December 28, 2006. Baby Loren was 6lbs 11oz and has since been under the 'bili-lights' but otherwise healthy! The new mom is trying to figure out how to sleep and take care of the baby at the same time...I suggested a nanny. Probably the easy way out, but I'm all about easy living at this point in my life.

She said something that rang true and that I will try to encourage my future pateients to do...she said "I should have spent the 9 months reading about how to adjust to a new baby rather that reading about the pregnancy and birth...that part was easy!" Good advice, D!!!

Windows of the soul

They say that eyes are the windows into the soul. I wouldn't really know. Here's my week in Ophthamology:
Monday- STAT holiday, no school
Tuesday- orientation (for which no instructors showed up for), morning clinic in a neuro-ophthamology clinic (mostly MS patients), afternoon clinic cancelled
Wednesday-outpatient clinic in the morning working with residents, afternoon in surgery watching 4 cataract replacements and a lid lift (eye surgery is pretty cool but gives me the heebie-geebies!!!)
Thursday- sleep in, exam at 11am, afternoon spent in another clinic with an awesome teacher
Friday- all cancelled

I'm at home blogging, working on a paper some of my classmates and I are writing, and preparing to have friends over for drinks later this evening. Since I am looking towards family practice as a future career option, I really hope none of my patients have eye problems. I really don't think the 3 days of training I will have received in ophthamology will be enough...do you? I thought 5 days was pushing it, but come on!!!!

Here's a conversation I envision having in the future:
Patient: Doc, I'm having some trouble with my eyes
Me: What kind of trouble is that?
Patient: I can't see, everything's all blurry.
Me: Ah, crap. You better get them taken out then. They're no use to you now.

Wonder how that will go over?

Happy New Year

OK...so my withdrawal from Luxor wasn't as bad as I thought it was. Although, I did have to download a free copy, but that was just to show my friend the game. I only played 2/3s of it! 8 more sleeps until I can play it again...

I had one of the best New Years I've had in ages, probably ever! New Years is one of those mushy holidays only meant for slutty singles and couples. Everyone else pretty much hates it, unless they have the time and money to take off and do something cool. Otherwise, you're stuck in a bar or some house party with snuggly couples who are kissy kissy and who make me puke at this time of year. I'm not bitter, really I'm not.

But this New Years was different! I spent it at my good friends house (she happens to be married to a great guy) and I invited a classmate of mine. There was also another couple who brought their 10 month old baby boy, who pretty much slept the whole time. We had great appies and wine. We made boulibaisse and had a fantastic salad and more great wine. We played games like Cranium and Skatergories and stayed up until ~4am- only because the booze ran out! There was no awkward PDAs (public displays of affection, for those of you who don't know the cool-kids lingo) and lots of laughing! Happy New Year is right! Breaky the the next day was great and I spent New Years Day relaxing and preparing for the week...ophthomology here I come!