Just trying to get a leg up!

Medical School is about trying to get a leg up on the competition. Each step of the way to become a Doctor, you must be better than someone to achieve the next step. Let me quickly sum up the steps to becoming a great doctor...

1. Be an member of the OAC (over achiever club)
2. Be willing at each and every moment to benefit from the failures of those around you (undergrad)
- in reality its not as bad as it sounds. In undergrad there are more people that want to get into medical school than there are spots in first year classes. To boil that down, only about 60% of your pre-med friends that actually apply to med school will get in. The rest will pick a better career to pursue with the knowledge you get in college in pre med.
3. Work hard, and at the very least work harder than at least 30% of your class, that way you will never end up in the bottom third of your class.
4. Be sure to renew your membership in the OAC
5. Understand that being a medical student in the hospitals is like being the new kid in high school again....ie, you are the butt of all jokes, and people think you don't your butt from head.
- most of the time its not that bad, i completely understand i don't know everything, and people above me will sometimes point out how much smarter and better they are than me, and for i just take my personality, check it at the door, suck it up and take it.
6. Don't take anything personally
7. Take constructive criticism, as constructive - Not personally
8. Be sure when criticism is personally to deal with it properly (there are going to be cases, when a comment is directed in a personal manner, if necessary these are the ones, that may require some added action)

ok, so now that we are all on the same level, let me share with you a story. I had a discussion with my attending about my progress, and how i was doing halfway through the rotation. He spoke to me as an equal and just told me exactly what I should do differently, some areas that are strong and what i need to work on. He also told me that I remind him of when he was a student and gave me some additional advice about how to approach other rotations.

After the short discussion, he told to go into room 2 and take my time, go through a complete physical. He also gave me a small warning, "she has a lot of pathology, and try to remember Ockham's razor, good luck!"

When he wished me good luck is when i started to wonder what kind of trap i am walking into. I decided not to worry, i know i have some skill when it comes to physical diagnosis. I trust my skills, and m knowledge and just knocked and entered the room. In the room is a nice older women sitting in a wheelchair, and another women sitting in a chair across from her. She didn't speak any English, and my Spanish is not that good, so luckily the daughter can translate.

I got through the HPI pretty quick with a little help, if only i had been a little more thorough the joke my have not been on me.
Starting on the physical,
-HEENT (head, eye, ear, nose, throat) all relatively normal. Moving onto chest, her lungs sounded like there was wet carpet inside, pathology.
-Heart, placed the stethoscope and heard a loud blowing sound, she has severe insufficiency from her aortic valve, pathology. She also has a prosthetic mitral valve, pathology.
- abdomen, relatively normal. PEG tube (feeding tube) in place but not infected.
now is when I became the butt of the joke. I was going to check peripheral pulses but couldn't find them. I thought that her legs felt a little funny, then i noticed both patients laughing and looking at me funny. Then she told me, which i also noticed...

She had no legs.

yep, sometimes the most obvious is not obvious, even when you are being observant and trying to pay attention to physical exam...you can miss something. But really, she has no legs, i have to admit i laughed a little too. Why? Because it was funny, i am doing a physical exam to pick up subtle changes to detect underlying pathology, and i miss the big obvious things...SHE HAS NO LEGS. She had bilateral below the knee amputation due to diabetes. So she has two prosthetic legs, she is able to walk around and be relatively independent.

She had some severe consequences of untreated diabetes, not to mention some problems due to her smoking. She had developed mild COPD, DVT's in legs and arms, PE and even had a stroke while on coumadin. She has been more compliant with her current medication/ treatment plan. So thankfully she is doing well and is in good spirits.

The Doc finally came in, laughing a little and wanted to know what i found, I said, she has no legs! and he said good, glad you noticed!


I still think its funny.

Also, my patient that i thought may have Dengue fever, does actually have Dengue fever. I was really excited about that...unfortunately there is a part of me that hopes his platelet count continues downward and that he develops hemorrhagic dengue (i know that sounds bad, but the curious med student sometimes wants patients to get worse so we can see more disease process.) But I am also glad his platelet numbers are climbing and he is getting better.

(hemorrhagic dengue has a 30% mortality, dengue fever has no treatment and is symptom based, making the patient comfortable and giving fluids)

other than that i feel i am seeing and learning a lot...between two hospitals and two offices every day i get in a lot of patient contact.

roughly 20 office patients/ day and so far we have followed 20 different patients in the hospital in my first 2 weeks, at one point we had 14 patients in the hospital at once, that was crazy since on my internal med rotation its just me, i have no team....i wish i did, so when i get 'pimped' and don't know the answer someone else can answer.