I've gone from measuring baby bumps, and C-sections to sore throats, AOM's, and sports physicals.
Despite the barrage of ear infections and common colds, I've seen some pretty interesting cases in Peds. A young girl, according to her growth chart, has developed microcephaly as a result of an accident sustained as an infant. An adolescent presented with a classic case of mononucleosis. And I've heard quite a few murmurs as well.
I enjoy doing sports physicals, partly because I enjoy adolescents and I like talking to them. Some feel comfortable having an objective ear listen to them gripe and complain about the woes of life. Others prefer talking to people their own age. Most times, I can at least make them laugh or loosen up before heading out of the office. Overall, the most upsetting thing I'm seeing in this population is obesity. I've never really liked that word. Fat works just fine, and to me it more clearly defines the problem. What's more upsetting is parents are in denial. Anyone who is fat knows they are fat. I don't have to tell them that! The challenge is doing something about it, and this is where physicians and PA's can really step in and offer guidance.
I always like to share my personal struggle with weight with patients. They look at me and think I've been a size 4/6 all my life. Wrong! I tell them how I lost 20 lbs and how I've been keeping it off. I tell them about the importance of weight training, especially for girls. More importantly, I share with them the importance of proper nutrition. You won't believe how many people eat at McDonald's for breakfast, lunch, and dinner, and think that because they ordered a diet coke they are eating "pretty healthy." I haven't eaten at McDonald's for over 15 years, and I think that has a lot to do with my success.
Lifestyle changes can be challenging to make, but it can be done...and fast! I've seen it work in my own life, and this is something I wish to impart to all of my pediatric patients, and all of my future patients. Change is the only constant. Why not make all change POSITIVE!
Week 2 in Peds is shaping up to be a good one. I do find myself eager to get back into the OR. I really miss it. My general surgery rotation is 6 months away, so I'll have to be patient. That's all for now!
Saturday, July 30, 2011
Tuesday, July 19, 2011
Abraham Maslow
Don't know him? If you are preparing for a career in medicine, you should!
This topic deserved a post all its own. One of the greatest gifts given to me on this rotation is the Maslow hierarchy of needs. Needs...we all have them, and when left unfulfilled, they can wreak havoc on us in many ways. One of those ways is via health status.
When a 19 year-old girl with a flat affect, poor social skills due to molestation and abandonment issues, and a history of miscarriages comes into the office, and after delivering her daughter 10 months ago finds out that she is pregnant once again, think of Maslow.
When a 42 year-old woman who's in an abusive marriage comes in for irregular bleeding, think of Maslow.
When a 20 year-old homeless girl with a history of drug abuse, depression, endometriosis, absent parents, and abusive relationships refuses to be discharged from the hospital because she has nowhere else to go and likes Dilaudid, think Maslow!!
Practicing good medicine is treating the acute condition. Practicing great medicine is understanding the psychology behind the diagnosis. Often times I find myself wondering why patients do the things they do. Why do they take chances with their bodies. How is it possible for a young person to have such a long list of complaints. Why is she having another baby. The answer is Maslow. Understand that, and the picture becomes more clear. Medicine, whether you practice Psychology or not, is all about psychology. Talk to your patients and give them more than pills. Give them your ear. Let them know you are aware of the conditions they are in. Offer them assistance if you can. Refer them to counselors and psychologists. Most of all, let them be heard. If possible, work with them to fulfill whatever need that should be met. Do that, and the behavior begins to change. Do THAT, and the body can begin to heal itself.
Maslow's hierarchy of needs...look it up!
This topic deserved a post all its own. One of the greatest gifts given to me on this rotation is the Maslow hierarchy of needs. Needs...we all have them, and when left unfulfilled, they can wreak havoc on us in many ways. One of those ways is via health status.
When a 19 year-old girl with a flat affect, poor social skills due to molestation and abandonment issues, and a history of miscarriages comes into the office, and after delivering her daughter 10 months ago finds out that she is pregnant once again, think of Maslow.
When a 42 year-old woman who's in an abusive marriage comes in for irregular bleeding, think of Maslow.
When a 20 year-old homeless girl with a history of drug abuse, depression, endometriosis, absent parents, and abusive relationships refuses to be discharged from the hospital because she has nowhere else to go and likes Dilaudid, think Maslow!!
Practicing good medicine is treating the acute condition. Practicing great medicine is understanding the psychology behind the diagnosis. Often times I find myself wondering why patients do the things they do. Why do they take chances with their bodies. How is it possible for a young person to have such a long list of complaints. Why is she having another baby. The answer is Maslow. Understand that, and the picture becomes more clear. Medicine, whether you practice Psychology or not, is all about psychology. Talk to your patients and give them more than pills. Give them your ear. Let them know you are aware of the conditions they are in. Offer them assistance if you can. Refer them to counselors and psychologists. Most of all, let them be heard. If possible, work with them to fulfill whatever need that should be met. Do that, and the behavior begins to change. Do THAT, and the body can begin to heal itself.
Maslow's hierarchy of needs...look it up!
Rotation #2: weeks 4 and 5
My 125th post!!
Hello readers. I'm sad to report that my time in Ob/GYN is coming to an end. Never in my imagination could I have conceived a more articulate, compassionate, intelligent preceptor. Never in my wildest dreams did I ever think that I could fall in love with this specialty. I am sad to see the end of the week draw closer and closer. I know I have lots left to learn and that the rotations I have left will be phenomenal. I just love this hospital, these people, and most of all, my preceptor.
Still, as much as I love this work I still don't see myself working in this specialty. Not at all. I could do GYN all day long, but the Ob side is not the most exciting to me. I do, however, enjoy the OR, and I now know that whatever specialty I do chose to work in, there must be a surgical component to it. Surgery is like music in a lot of ways. You prepare in advance by learning your lines (the procedure), and before stepping foot onto the stage (the OR suite) you must put on your costume (gown, gloves, mask, etc.). The stage is set and once the curtains rise (drapes) it's showtime! And it really feels that way to me. I love it! There is a fanfare associated with the OR. You either love it or you hate it.
I've learned a great deal about myself on this rotation. I've learned that babies aren't so bad after all. I've learned that Ob/GYN is so much more than pap smears and Ob office visits. I've learned that being aggressive in this field is a good thing! I've learned that this really is something I can do for the rest of my life. I love being in the hospital, and I love working with people...the good, the bad, and the just plain ugly! I've seen enough 15 year -old mothers to last me a lifetime. I've diagnosed enough Chlamydia and Trichomoniasis to last my entire career. But the relationships that develop between me and my patients...that never gets old. It means a lot to have been given this much responsibility. It means a lot to touch someone and change their life. It means even more when, serendipitously, a patient touches you and changes your life.
Good-bye Ob/GYN, hello Peds!
Hello readers. I'm sad to report that my time in Ob/GYN is coming to an end. Never in my imagination could I have conceived a more articulate, compassionate, intelligent preceptor. Never in my wildest dreams did I ever think that I could fall in love with this specialty. I am sad to see the end of the week draw closer and closer. I know I have lots left to learn and that the rotations I have left will be phenomenal. I just love this hospital, these people, and most of all, my preceptor.
Still, as much as I love this work I still don't see myself working in this specialty. Not at all. I could do GYN all day long, but the Ob side is not the most exciting to me. I do, however, enjoy the OR, and I now know that whatever specialty I do chose to work in, there must be a surgical component to it. Surgery is like music in a lot of ways. You prepare in advance by learning your lines (the procedure), and before stepping foot onto the stage (the OR suite) you must put on your costume (gown, gloves, mask, etc.). The stage is set and once the curtains rise (drapes) it's showtime! And it really feels that way to me. I love it! There is a fanfare associated with the OR. You either love it or you hate it.
I've learned a great deal about myself on this rotation. I've learned that babies aren't so bad after all. I've learned that Ob/GYN is so much more than pap smears and Ob office visits. I've learned that being aggressive in this field is a good thing! I've learned that this really is something I can do for the rest of my life. I love being in the hospital, and I love working with people...the good, the bad, and the just plain ugly! I've seen enough 15 year -old mothers to last me a lifetime. I've diagnosed enough Chlamydia and Trichomoniasis to last my entire career. But the relationships that develop between me and my patients...that never gets old. It means a lot to have been given this much responsibility. It means a lot to touch someone and change their life. It means even more when, serendipitously, a patient touches you and changes your life.
Good-bye Ob/GYN, hello Peds!
Wednesday, July 6, 2011
Rotation 2: weeks 2 and 3
Sorry for the delay. Time is flying!
Two days into week three and I'm still having a blast. What am I seeing/doing??
vaginal deliveries and C-sections (my subcuticular stitches are looking nice these days)
OB office visits and follow ups
invasive cervical CA
dyspareunia and palpable pelvic masses
incompetent cervix
annual exams and Pap smears
lots and lots of GC/Trich/Chlamydia
ovarian cysts
suction D and C
endometriosis
adenomyosis
leiomyomas
hysterectomies
The list goes on and on. I remember seeing a middle aged woman who had a seven month history of painful sex. Her past medical history was significant, but she had no pertinent family history. On physical exam her abdomen was quite tender. I felt what I thought were small masses in her lowe quadrants. Because she had a partial hysterectomy, I skipped the speculum exam and went straight to the bimanual, and again, another mass measuring about 2 cm was felt at 6 o'clock. I suggested a workup to my preceptor and he agreed! It will be interesting to see what the scans show.
I find myself getting upset when I think of this rotation coming to an end. I'm in love with my preceptor and I'm doing much more than I thought I would be. This rotation has shown me just how much I enjoy surgery...and just how much I enjoy the clinic! I don't think I would enjoy OR work exclusively. The clinic allows you to practice medicine; to get to know your patients and to really put your education to use. I enjoy the process of eliciting a history, performing an exam, and coming up with a diagnosis. I also love using my hands! That's where my fondness of the OR comes in. I enjoy procedure work, and certainly one can do lots of it in the clinic. However, the parade that is the OR is an experience like no other. I look forward to seeing what specialty I find myself in this time next year!
Two days into week three and I'm still having a blast. What am I seeing/doing??
vaginal deliveries and C-sections (my subcuticular stitches are looking nice these days)
OB office visits and follow ups
invasive cervical CA
dyspareunia and palpable pelvic masses
incompetent cervix
annual exams and Pap smears
lots and lots of GC/Trich/Chlamydia
ovarian cysts
suction D and C
endometriosis
adenomyosis
leiomyomas
hysterectomies
The list goes on and on. I remember seeing a middle aged woman who had a seven month history of painful sex. Her past medical history was significant, but she had no pertinent family history. On physical exam her abdomen was quite tender. I felt what I thought were small masses in her lowe quadrants. Because she had a partial hysterectomy, I skipped the speculum exam and went straight to the bimanual, and again, another mass measuring about 2 cm was felt at 6 o'clock. I suggested a workup to my preceptor and he agreed! It will be interesting to see what the scans show.
I find myself getting upset when I think of this rotation coming to an end. I'm in love with my preceptor and I'm doing much more than I thought I would be. This rotation has shown me just how much I enjoy surgery...and just how much I enjoy the clinic! I don't think I would enjoy OR work exclusively. The clinic allows you to practice medicine; to get to know your patients and to really put your education to use. I enjoy the process of eliciting a history, performing an exam, and coming up with a diagnosis. I also love using my hands! That's where my fondness of the OR comes in. I enjoy procedure work, and certainly one can do lots of it in the clinic. However, the parade that is the OR is an experience like no other. I look forward to seeing what specialty I find myself in this time next year!
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