12 months of clinical rotations has swept by in the blink of an eye, and here I am, approximately 8 weeks away from taking the biggest exam of my life so far (my first licensing exam). It's a somewhat nostalgic time, and thus a good time for reflection. A few more lessons I've picked up along the way:
Lesson 1:
A lot of times, attendings say words that I try to avoid. For instance: the word titrate. Do most people understand what titrate means? I mean, even I have only dull memories of the word from my chemistry classes in high school. I've heard attendings and residents often tell a patient that we'll start them on a low dosage of a particular medication, then titrate the dose as we see how the patient responds. I suppose this isn't such a bad usage, since it's the physician side that does the titration. But sometimes they'll tell patients to "titrate" the dosage of over the counter medications, based on their response, and I always have to wonder if patients understand what they're telling them to do. It's interesting what words we do and don't use in various situations, and sobering to think how important words are in a field like this.
Lesson 2:
Neurology is kind of boring to me. Maybe that's because I don't understand the basics well enough, or maybe that's because it really is boring to me. Whatever the cause, I know for sure that it's not the field for me.
Lesson 3:
On a related note, I often felt, on neurology, that if we didn't know the exact reason a patient presented with particular symptoms, we'd chalk it up to a psychogenic etiology--which means that their brain, for some reason, believed that they were weak, or felt tingly and numb, or couldn't walk, or whatever, and so they experienced those symptoms--but there was no physical abnormality causing them. I had SO many patients who we concluded had psychogenic causes for their neurological symptoms, that now I'll always wonder if a person's neurological problems are psychogenic.
Lesson 4:
Contrary to what I believed at the beginning of this year, shelf exams really do get easier to perform on and study for as you take more and more. This is great news. The key, at least for me, was to repeatedly do practice questions until I got them all right...then rinse and repeat.
Lesson 5:
It's amazing how often you'll hear interesting stories from your patients, especially when you're treating outpatients. Almost every day when I was on family medicine, I'd meet a patient or two who had had interesting life experiences, had cool goals for the future, or were interesting in various other ways.
Lesson 6:
A year's worth of clinical rotations definitely teaches you a thing or two. It's amazing how much my confidence has grown, along with my knowledge base. This is a good thing.
Lesson 7:
Shingles comes in many shapes and sizes. So does mono.
Lesson 8:
I still have a lot to learn in terms of handling patients, especially those I would call "difficult." I was impressed by my family medicine attending's ability to entertain even the wackiest of patient requests without missing a beat. And she did it all while maintaining the patients' respect and trust. Hopefully this is a skill I'll gain with time and experience.
Lesson 9:
It's surprising how many people are vehemently opposed to the flu shot. It's also surprising how many people think that the flu shot "injects the flu into you" (not quite), a belief that implies they don't realize that most other vaccines also inject the disease-causing entity into you. For the record: the flu vaccine, and the majority of other vaccines, inject a dead virus, or an inert part of a bacterium, into you. The point is to teach your body to react against the disease-causing entity, without giving you the disease itself. However, since your body is supposed to launch a counter attack (which is what you're experiencing when you feel "sick:" fever kills bugs and helps the body fight infection better; runny noses are meant to flush out bugs living inside your nose, and so on), you often do end up feeling a bit sick after getting a vaccine, any vaccine. It sounds like more people get sick after getting the flu vaccine than after getting other vaccines, but that's probably because more people get the flu vaccine, more often, than any other vaccine. Basically, my point is that if I had to choose between getting sick after getting the flu shot, but never truly getting the flu, and actually getting the flu--I'd choose the shot every time. You should too. Just saying.
Lesson 10:
Time flies. I've said it before, and I'll say it again. Forgive me for the repetition. But these 12 months flashed by in an instant, and I'm sure the next 18 will do the same. At that point, I'll just be Dr. n00b.
Lesson 1:
A lot of times, attendings say words that I try to avoid. For instance: the word titrate. Do most people understand what titrate means? I mean, even I have only dull memories of the word from my chemistry classes in high school. I've heard attendings and residents often tell a patient that we'll start them on a low dosage of a particular medication, then titrate the dose as we see how the patient responds. I suppose this isn't such a bad usage, since it's the physician side that does the titration. But sometimes they'll tell patients to "titrate" the dosage of over the counter medications, based on their response, and I always have to wonder if patients understand what they're telling them to do. It's interesting what words we do and don't use in various situations, and sobering to think how important words are in a field like this.
Lesson 2:
Neurology is kind of boring to me. Maybe that's because I don't understand the basics well enough, or maybe that's because it really is boring to me. Whatever the cause, I know for sure that it's not the field for me.
Lesson 3:
On a related note, I often felt, on neurology, that if we didn't know the exact reason a patient presented with particular symptoms, we'd chalk it up to a psychogenic etiology--which means that their brain, for some reason, believed that they were weak, or felt tingly and numb, or couldn't walk, or whatever, and so they experienced those symptoms--but there was no physical abnormality causing them. I had SO many patients who we concluded had psychogenic causes for their neurological symptoms, that now I'll always wonder if a person's neurological problems are psychogenic.
Lesson 4:
Contrary to what I believed at the beginning of this year, shelf exams really do get easier to perform on and study for as you take more and more. This is great news. The key, at least for me, was to repeatedly do practice questions until I got them all right...then rinse and repeat.
Lesson 5:
It's amazing how often you'll hear interesting stories from your patients, especially when you're treating outpatients. Almost every day when I was on family medicine, I'd meet a patient or two who had had interesting life experiences, had cool goals for the future, or were interesting in various other ways.
Lesson 6:
A year's worth of clinical rotations definitely teaches you a thing or two. It's amazing how much my confidence has grown, along with my knowledge base. This is a good thing.
Lesson 7:
Shingles comes in many shapes and sizes. So does mono.
Lesson 8:
I still have a lot to learn in terms of handling patients, especially those I would call "difficult." I was impressed by my family medicine attending's ability to entertain even the wackiest of patient requests without missing a beat. And she did it all while maintaining the patients' respect and trust. Hopefully this is a skill I'll gain with time and experience.
Lesson 9:
It's surprising how many people are vehemently opposed to the flu shot. It's also surprising how many people think that the flu shot "injects the flu into you" (not quite), a belief that implies they don't realize that most other vaccines also inject the disease-causing entity into you. For the record: the flu vaccine, and the majority of other vaccines, inject a dead virus, or an inert part of a bacterium, into you. The point is to teach your body to react against the disease-causing entity, without giving you the disease itself. However, since your body is supposed to launch a counter attack (which is what you're experiencing when you feel "sick:" fever kills bugs and helps the body fight infection better; runny noses are meant to flush out bugs living inside your nose, and so on), you often do end up feeling a bit sick after getting a vaccine, any vaccine. It sounds like more people get sick after getting the flu vaccine than after getting other vaccines, but that's probably because more people get the flu vaccine, more often, than any other vaccine. Basically, my point is that if I had to choose between getting sick after getting the flu shot, but never truly getting the flu, and actually getting the flu--I'd choose the shot every time. You should too. Just saying.
Lesson 10:
Time flies. I've said it before, and I'll say it again. Forgive me for the repetition. But these 12 months flashed by in an instant, and I'm sure the next 18 will do the same. At that point, I'll just be Dr. n00b.
