Dr. Lickness gives me homework assignments. Yesterday it was a history lesson after I told him I would be heading to Boston for my next rotation and today some fun facts.
Todays homework assignment: why is everything in the OR including your scrubs blue or green?
The answer: Prior to the 1950's all OR attire was white, to symbolize cleanliness. The problem with this was that in a very brightly light OR with all white scrubs and linens, surgeons eyes would fatigue, resulting in eye strain. Therefore surgical attire was changed to light blue or green, to create a high contrast environment. The inside of the surgical field is varying shades of red. Blue and green which reside on the opposite side of the color wheel create contrast therefore decreasing the strain on surgeons eyes.
Wednesday, March 27, 2013
Tuesday, March 26, 2013
Moving on... Pediatrics, OBGYN and Pismo Beach
Life has been pretty crazy since last week.
As a parting gift from pediatrics one of the kiddos finally gave me a GI bug. It was minor and I avoided vomiting with some OTC meclizine but it knocked me out for most of the day Friday. I really enjoyed pediatrics, it is challenging in many ways that other areas of medicine are not. In school, we learned a very organized physical exam, typically from head to toe. However, in pediatrics there is no such thing as a head to toe exam. You simply examine the area the patient is presenting to you and work around that. For example, if you walk into a room to a baby that is sleeping, examine the abdomen, heart and lungs first (all the exams that you need the child to not be screaming for so you can hear through the stethoscope), then start moving the baby around and hope you can finish most or all of the exam before you have completely agitated them. Also most peds patients don't have the ability to tell you what they are feeling or do they have the intuition to understand why they maybe feeling the way they are, this can be challenging. As a practitioner when you are treating a child you are also treating their parents, in case you dont understand, that is TWO+ patients per visit. One of the greatest physical exam tools I learned in pediatrics, if a child will not open their mouth to allow you to see their throat, simply stick a tongue blade between their teeth, slowly push it towards their throat and gag them. The gag reflex is strong, if you gag someone they WILL ALWAYS open their mouth. Although I did not enjoy eliciting this in children, it is very effective.
Saturday I packed my belongings into my car and moved down to Pismo Beach. I arrived later in the afternoon just in time to see an amazing sunset. I went to bed early as I was still recovering from the GI stuff and needed to be well rested for the day of work I had ahead. I woke up early Sunday morning, found a local coffee shop near Shell Beach and started the long day of work. All of our assignments for school are currently submitted via mail and must be postmarked by their due date. I had three large assignments due Monday and I had been working on all of them but also procrastinating on all of them.
Yesterday I had my first day of OBGYN. I started the day with hospital orientation, walked into the office around 10:15, met the office staff and Dr. Lickness and off we went. We made three trips to the hospital yesterday in the hopes that twins would be born before 5:00 pm, after two trips to the hospital and two false calls the twin boys were born vaginally at 5:17 and 5:30 pm. It was a crazy and exciting first day!
Day two I saw another baby boy born via Cesarian section and two tubal ligations. My lunch was a sprite that I drank at 2:30 pm simply because the OR was running behind for the second tubal that was scheduled and Sprite was the only item available in the OR lounge.
Although seeing babies born is really exciting, my favorite part of the last two days is seeing a couples reaction the first time they get to hear their baby's heart beat or see their baby on ultrasound. The joy they feel fills the room and has brought me to near tears twice. Although I have been told that my empathy for others will be a challenge for me as a practitioner, I have yet to experience this "challenge" and I am so glad that I have been allowed to share these amazing moments with patients.
"Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around."
- Leo Buscaglia
As a parting gift from pediatrics one of the kiddos finally gave me a GI bug. It was minor and I avoided vomiting with some OTC meclizine but it knocked me out for most of the day Friday. I really enjoyed pediatrics, it is challenging in many ways that other areas of medicine are not. In school, we learned a very organized physical exam, typically from head to toe. However, in pediatrics there is no such thing as a head to toe exam. You simply examine the area the patient is presenting to you and work around that. For example, if you walk into a room to a baby that is sleeping, examine the abdomen, heart and lungs first (all the exams that you need the child to not be screaming for so you can hear through the stethoscope), then start moving the baby around and hope you can finish most or all of the exam before you have completely agitated them. Also most peds patients don't have the ability to tell you what they are feeling or do they have the intuition to understand why they maybe feeling the way they are, this can be challenging. As a practitioner when you are treating a child you are also treating their parents, in case you dont understand, that is TWO+ patients per visit. One of the greatest physical exam tools I learned in pediatrics, if a child will not open their mouth to allow you to see their throat, simply stick a tongue blade between their teeth, slowly push it towards their throat and gag them. The gag reflex is strong, if you gag someone they WILL ALWAYS open their mouth. Although I did not enjoy eliciting this in children, it is very effective.
Saturday I packed my belongings into my car and moved down to Pismo Beach. I arrived later in the afternoon just in time to see an amazing sunset. I went to bed early as I was still recovering from the GI stuff and needed to be well rested for the day of work I had ahead. I woke up early Sunday morning, found a local coffee shop near Shell Beach and started the long day of work. All of our assignments for school are currently submitted via mail and must be postmarked by their due date. I had three large assignments due Monday and I had been working on all of them but also procrastinating on all of them.
Yesterday I had my first day of OBGYN. I started the day with hospital orientation, walked into the office around 10:15, met the office staff and Dr. Lickness and off we went. We made three trips to the hospital yesterday in the hopes that twins would be born before 5:00 pm, after two trips to the hospital and two false calls the twin boys were born vaginally at 5:17 and 5:30 pm. It was a crazy and exciting first day!
Day two I saw another baby boy born via Cesarian section and two tubal ligations. My lunch was a sprite that I drank at 2:30 pm simply because the OR was running behind for the second tubal that was scheduled and Sprite was the only item available in the OR lounge.
Although seeing babies born is really exciting, my favorite part of the last two days is seeing a couples reaction the first time they get to hear their baby's heart beat or see their baby on ultrasound. The joy they feel fills the room and has brought me to near tears twice. Although I have been told that my empathy for others will be a challenge for me as a practitioner, I have yet to experience this "challenge" and I am so glad that I have been allowed to share these amazing moments with patients.
"Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around."
- Leo Buscaglia
Wednesday, March 13, 2013
Self defense
Last thursday night I traveled into San Francisco to go to a self defense class with Kat. I thought it would be smart to have some idea how to defend myself since I will be moving to a new city every six weeks for the next year. Although I am generally very aware of my surroundings, which is the key to prevention, I thought I would ease some of my anxiety (and my mothers) by taking a self defense class. The class was great, we practiced yelling STOP as loud as possible ( I was able to wake up my cheerleading yell after allowing it to sleep for about 10 years) and learned several maneuvers to use if ever attacked or in an uncomfortable situation.
Another form of self defense I will be learning throughout the clinical year is how to protect my heart while allowing myself to be available to emotionally support patients for the brief time I have with them. One of my professors described this as being like a teflon pan, having the ability to hold the space while with the patient but allowing the emotional aspect to slip off at the end of the day. In essence being able to leave work at work. I know this maybe a challenge for me as a provider because I am very empathetic but, I am hoping I can recognize the importance of my mental health, and that to best care for my patients I must be able to perfect this process.
This week I have been doing a lot of counseling with parents and their children regarding diet, exercise and weight. This is an aspect of being a practitioner I have come to realize I really enjoy. I feel like these parents hear me, at least for the ten minutes I am speaking to them. The real test comes at the follow up visit to determine if they have made the changes with their families to lose weight and gain health. Unfortunately, I will not be here in four weeks to determine if there has been any change.
I am seeing most patients on my own each day, Dr. Mahdavi then comes in the room to check over my work and add to anything that I might have missed. Although I have made several wrong diagnosis, I have made several right ones. Dr. Mahdavi is very positive and praises me for my efforts (right or wrong) and will quietly mark out my wrong diagnosis. He is a great teacher and I am so grateful for my time in this clinic!
Another form of self defense I will be learning throughout the clinical year is how to protect my heart while allowing myself to be available to emotionally support patients for the brief time I have with them. One of my professors described this as being like a teflon pan, having the ability to hold the space while with the patient but allowing the emotional aspect to slip off at the end of the day. In essence being able to leave work at work. I know this maybe a challenge for me as a provider because I am very empathetic but, I am hoping I can recognize the importance of my mental health, and that to best care for my patients I must be able to perfect this process.
This week I have been doing a lot of counseling with parents and their children regarding diet, exercise and weight. This is an aspect of being a practitioner I have come to realize I really enjoy. I feel like these parents hear me, at least for the ten minutes I am speaking to them. The real test comes at the follow up visit to determine if they have made the changes with their families to lose weight and gain health. Unfortunately, I will not be here in four weeks to determine if there has been any change.
I am seeing most patients on my own each day, Dr. Mahdavi then comes in the room to check over my work and add to anything that I might have missed. Although I have made several wrong diagnosis, I have made several right ones. Dr. Mahdavi is very positive and praises me for my efforts (right or wrong) and will quietly mark out my wrong diagnosis. He is a great teacher and I am so grateful for my time in this clinic!
Sunday, March 3, 2013
Paper
Today during my massage my therapist and I were discussing paper. I love paper. I love opening a book, it fulfills my sensations. The feel, the smell, the weight in my hands. It is one of my favorite things. (I should say that my love for paper is also a point of conflict for me because I also an environmentalist). I hadn't thought about my love for paper in a long time and enjoyed sharing this with Kim.
The hospital that Dr. Mahdavi's office is in went live with their new EHR (electronic health records) system on friday, therefore the hospital will have NO more paper charts. Tuesday I attended a lunch time talk that served to answer questions and address fears or frustrations. There was a physician who was particularly agitated because he wouldn't be able to dictate all of his notes and would be responsible for typing progress notes into the system. Most of his agitation was stirred because he is unable to type, or has never had training in typing. Upon further thought I realized I will be entering the medical field at a time of great transition for many practices and hospitals. Although I have been around computers my entire life and have had exposure to three different EHR systems to date, EHR is very scary to some medical providers because they have never used a computer. I wonder if they will achieve the same level of efficacy they had with paper charts or will they end their careers being frustrated with the new system they were required to conform to.
Some statistics from HealthIT.gov
The hospital that Dr. Mahdavi's office is in went live with their new EHR (electronic health records) system on friday, therefore the hospital will have NO more paper charts. Tuesday I attended a lunch time talk that served to answer questions and address fears or frustrations. There was a physician who was particularly agitated because he wouldn't be able to dictate all of his notes and would be responsible for typing progress notes into the system. Most of his agitation was stirred because he is unable to type, or has never had training in typing. Upon further thought I realized I will be entering the medical field at a time of great transition for many practices and hospitals. Although I have been around computers my entire life and have had exposure to three different EHR systems to date, EHR is very scary to some medical providers because they have never used a computer. I wonder if they will achieve the same level of efficacy they had with paper charts or will they end their careers being frustrated with the new system they were required to conform to.
Some statistics from HealthIT.gov
- 79% of providers report that with an EHR, their practice functions more efficiently
- 82% report that sending prescriptions electronically (e-prescribing) saves time
- 68% of providers see their EHR as an asset with recruiting physicians
- 75% receive lab results faster
- 70% report enhances in data confidentiality
So, although this process maybe scary, it seems there is a lot of data available that supports the change. In addition, it is required that all medical records be electronic in the US by 2014.
Friday, March 1, 2013
Week Three
This has been quite a week. Last weekend I moved out of my apartment, most of my belongings are being housed in a storage unit in Benicia and I have moved in with a family in Brentwood. My morning commute was 25 miles and is now less than 10. Although I feel settled I still have a lot of stuff to sort through and organize for storage. Tonight I am headed to SF to eat crab and make smores, a much needed break with friends. I realized that I am trying to have as much friend time as possible while I am local because in three weeks I will be moving south to San Luis Obispo.
It is hard to believe that I am half way through my first rotation. I am starting to see well child checks on my own and continuing to observe episodic visits. I am continuing to learn so much. Yesterday while doing laundry at the laundry mat I was brushing up on anemias and realized I still remember quite a bit, however a lot of it seemed brand new (we learned this 1/2012), and this is the reason I will have a year of clinical rotations, to cement the information I learned during the didactic year.
Yesterday we saw a kiddo who was 6 and was diagnosed with avascular necrosis of the femoral head (the hip joint). The diagnosis was made early in the disease progression, in an effort to save the head of the bone from needing replacement now, the child will have to be non-weight bearing on crutches for 4-6 weeks. I can't imagine having a 6 year old who is not allowed to run and play for 6 weeks, sounds like a form of torture for parents, and believe me this kid had some energy. I was speaking with Dr. Mahdavi after the family had left and asked if he would consider sending the family to a session with an occupational therapist to find activities the family/child can do during this time of restriction. Dr. Mahdavi said it was a great idea and called the father immediately.
And I will leave you with another quote, simply because my dreams are coming true...
"All our dreams can come true - if we have the courage to pursue them."
-Walt Disney
It is hard to believe that I am half way through my first rotation. I am starting to see well child checks on my own and continuing to observe episodic visits. I am continuing to learn so much. Yesterday while doing laundry at the laundry mat I was brushing up on anemias and realized I still remember quite a bit, however a lot of it seemed brand new (we learned this 1/2012), and this is the reason I will have a year of clinical rotations, to cement the information I learned during the didactic year.
Yesterday we saw a kiddo who was 6 and was diagnosed with avascular necrosis of the femoral head (the hip joint). The diagnosis was made early in the disease progression, in an effort to save the head of the bone from needing replacement now, the child will have to be non-weight bearing on crutches for 4-6 weeks. I can't imagine having a 6 year old who is not allowed to run and play for 6 weeks, sounds like a form of torture for parents, and believe me this kid had some energy. I was speaking with Dr. Mahdavi after the family had left and asked if he would consider sending the family to a session with an occupational therapist to find activities the family/child can do during this time of restriction. Dr. Mahdavi said it was a great idea and called the father immediately.
And I will leave you with another quote, simply because my dreams are coming true...
"All our dreams can come true - if we have the courage to pursue them."
-Walt Disney
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