Family Med Hospital Week: OSCEs and Bad Students

This morning the family medicine students had their OSCEs. That was bad news for Andie when we told her yesterday (b/c we had lots of patients to see), so she told us to see two patients in the morning before going to the OSCE and two patients after we return. I fulfilled my end and saw two patients before driving to school for the OSCE. Let me just say, I hate OSCEs because I suck at patient interviews. I always forget to do something crucial. My first standardized patient even told me where I messed up at the end of the interview: i.e. I forgot to ask him the severity of his pain, I palpated the abdomen before auscultating, and I didn't ask how long his symptoms lasted. Oops. The other two fared slightly better (by the third one I was determined not to make more errors than I had to), but after it was over I still wanted to kick myself. I forgot to shake hands with my first two patients. I spoke softly b/c my throat still felt raw (but much better compared to the last two days). I forgot to do OMM. The list ran on and on. *sigh* And I'm supposed to watch this with Dr. RR and have him critique me? One thing he can't accuse me of not doing is auscultating under the patient's clothes; I kept that in mind during the whole OSCE.

I drove back to PMC in time to find a frazzled Andie jotting down lab values for one of my patients (the one with suspected brain mets). I took over so she could see her own patients and did everything Dr. T told me to do to my patient: palpate lymph nodes, do a fundoscopic exam (I failed; he had glaucoma and I couldn't see a thing), have him draw a clock (to make sure he had no right parietal lesions), and...a DRE. I thought I felt a nodule but wasn't sure; got to have Dr. T follow-up after me. Fortunately my patient was a good sport about it; both of my male patients are friendly and don't mind me poking at them. I don't think he has prostate cancer though; he said his prostate exams were normal in the past, and according to St. Francis's Guide to Inpatient Medicine, prostate cancer rarely, if ever, metastasizes to the brain (hehe, guess I did learn something from that assigned chapter) By the time I finished seeing all my patients it was 11:30 a.m. so I went to get lunch. On the way I saw Dr. T eating in the doctor's lounge as the door was closing, so I was glad that he was at least in the hospital.

There were actually plantains for lunch, so I was happy to get a few as part of a $3.99 special (one entree, two sides). At lunch, Andie was pissed at Mani (who fortunately was nowhere to be found); he had not written a single note all morning and she had to see 3 of his patients for him (on top of the 3 or 4 that were already assigned to her) this morning. Granted, I don't know the guy too well, but in the hospital setting, not pulling your own weight is just wrong. Andie was relieved when I told her I'd spotted Dr. T in the doctor's lounge, and we began rounding on patients shortly before noon. This day was very unlike the others; there was almost no waiting around for Dr. T. Andie let us all write orders for our patients and even call other physicians' offices for consultations (normally the resident's job but he's off taking USMLE III so it's our job now). Funnily enough, I ran into the oncologist I called for a consult on my brain lesion patient shortly after he paged Dr. T, and he told me that because my patient's CT/Abd/Pelvic scans were clean, he needs a neurosurgeon, not an oncologist. I was all too glad to relay that to Dr. T in person (he gets way too many phone calls), and Andie was gratified to know that she was right to want a neurosurg consult (Dr. T had originally said it wasn't necessary yet)

We ended up rounding on most of our patients by 3:00 pm, and one patient's room was full of homemade get-well cards from his 1st grade students =) He came to PMC for the flu, but now he's possibly descending into ARDS because his O2 sats are horrible and he needs a Bipap to maintain his airway. When we had a break, Mani went to dictate on one of his patients and we told him to meet us on the 7th floor later. We didn't see him again until about 30-45 minutes later on the 5th floor; he never called us after finishing the dictation to see where we were. I asked why he didn't call Andie, and he said it was b/c she seemed busy and didn't want to bug her. That's BS. I've called Andie for more insignificant things ("Did you leave your sweatshirt on 4? Where are you?"), and she always answered her phone. Andie was more annoyed by why it took him so long to do a dictation (it shouldn't take more than 10 minutes). "He needs to start pulling his s*** around here or he'll fail medicine," she said. She did report him to Dr. T, who said he'd speak with Mani afterwards. *sigh* For his sake, I hope he gets his act together.

(And for those of you reading this who happen to be friends with Mani, please do not rat my blog out to him. Only selected people are supposed to know this blog exists, and if I hear that classmates that I do not want to read this blog are reading it, I won't hesitate to delete it. I don't have to share my hospital experiences; I do it because I feel we can all learn from other people's actions and mistakes. And in this case, I already revealed the names of the people doing hospital week with me, so it's a little late for anonymity. So please, please keep this to yourselves)

I had a doctor's appointment at 4:00 pm and asked Dr. T around 3:40 if I could leave, but at first he didn't seem thrilled (Andrew already left at 2:00 for a doctor's appointment also). "We can't have two doctor's appointments in the same day," he said, asking how long I knew about my appointment. "Since yesterday," I said, and he replied, "Even though you knew you'd be on service with me all week?" Andie commented that originally I was going to ask him to check my throat but things got too busy (that woman's a lifesaver), but in the end Dr. T said I could go. Whew. For those of you who don't know, the Student Clinic is now at the new building since the professor who runs it now also runs the Radiology clinic there. As a result, the new exam room is large and cushy with wooden floors, and the waiting room looks like something in an executive's office. Awesomeness =P The doctor who saw me is one of the family docs (young blond guy with glasses) He examined my throat and said it still looked red, and while the strep test came back negative (thanks to 2 days worth of amoxicillin), he was still going to treat me for strep because my description of sore throat, fever, and bleeding/exudate-filled tonsils clinched the diagnosis. I told him the strength of amoxicillin my dad was taking so that he could write the exact same thing, because since I started on it, I should finish it the same way. Not to mention I need to return the number of pills I took from my dad back to him so he can finish his meds =P