OMM: Nonexistent punctuality

One thing I'll never get used to on these rotations is how far preceptors can fall behind schedule. With Dr. P, he scheduled 15 or 30 minute slots with each patient and did his best to see each one on time. Inevitably, there' d be overlap if a patient (or their spouse) had a lot of medical (or psych) issues to discuss and work with, but by the end of the day, we saw anywhere from 25-35 patients and were rarely more than one hour behind. Today, with Dr. KB, the last patient didn't leave until 6:30, and her scheduled appointment was around 4:20. The difference: Dr. KB sees only about 18-20 patients a day and schedules 20 minutes with each, but with the work she does (manip, hormone therapy, general family practice), it's very easy to fall behind. After seeing one patient together, I went to the manip room and spent 45 minutes treating a guy for back pain, and when I left to find her afterwards, she was still with the same patient...for a lab follow-up. This patient, however, was a sad case; she had interstitial pneumonitis and her lungs were infested with Aspergillus and Pseudomonas, but because her WBCs are too low due to chemo (what they use to treat pneumonitis), she can't fight off the infections. It's sad. Another time, Dr. KB spent about 20 minutes chatting with a patient (a nurse) about bio-identical hormone therapy (her specialty) and how she wants to educate others on that. A good goal, to be sure, but I couldn't help but think that while she was talking, others were waiting.

As far as manip goes, I'm still hesitant to use HVLA (and Dr. KB knows it; she has me pegged as the "muscle energy/indirect technique" type), but I'm getting better at it. With one tall guy today, I cracked his thoracics simply by pushing down on his back while he lay prone (a trick Miguel taught me when we were OMM partners) rather then use the Kirksville crunch. I've also gotten better and diagnosing the sacrum, but don't ask me to pop any OAs anytime soon. Everyone has their own way of doing the OA, so I'm a bit confused as to what's best for me. The bad news: no manip cases at all tomorrow. =/ Oh well. I'll just learn more about holistic medicine.