What do you think?

Our clinical curriculum has focused on teaching us the skill of communicating with our patients, of making eye contact, reading body language and leaving space for the patient to talk. After practicing these things in the simulation center with standardized patients, I was feeling pretty comfortable stepping into my longitudinal clerkship placement with an ob/gyn. Then I realized that the real world doesn’t always work like the sim center – the real world requires using computers with electronic medical records. Of course this has MANY advantages... but one huge disadvantage is how computers change the way we communicate with patients.

Dr. R. is a great clinician. His patients trust him, confide in him, ask questions, raise concerns and talk to him honestly. Unfortunately, patients are talking to his back about 50% of the time while he reads ultrasound reports, updates the record, writes orders, electronically submits a prescription to the patient’s favorite pharmacy, or writes a note for the patient’s employer. Truthfully, I understand that it’s much more efficient to do the “paperwork” while sitting with the patient – but I’m frustrated that in exchange for saving time and being efficient, Dr. R. must compromise his communication and relationship building opportunities. There have been a few times when I have seen the patient’s body language or facial expression from where I stand and it has been clear that Dr. R. did not understand their question or did not recognize a patient’s hesitation or unease.

One of the main reasons for this situation is the set up of the exam rooms; the computer is on the counter and faces the wall. There has been talk about this problem being solved with tablet computers or iPads, and I hope this will be the case soon. The other factor is that Dr. R. likes to spend time with his patients in the exam room instead of splitting the patient’s scheduled time with time at his computer. One of Dr. R.’s colleagues doesn’t actually touch the computer while in the exam room with her patient. But she remains efficient by spending less time with her patients and stops at the workstation between patients to update the electronic medical record and sign orders.

It’s tough to say which option allows the most “face-time” with the patient. I would like my patient to know that I’m listening to them and to be able to talk face-to-face the entire time. I also want to be able to read my patient’s body language and observe their symptoms and signs of illness. This would likely inhibit me from using the computer to get the “paperwork” done efficiently and effectively, but would also require I leave the patient room before their appointment is over so that I can take care of the paperwork before seeing the next patient.

I'd really like to know what some readers think about this situation in their doctor's office. Does your doctor turn his or her back to you while typing on the computer? How does this make you feel? Would you rather your doctor use the computer while in the room with you so that you know the records are being updated with the correct information? What should I strive for as far as communicating with patients?

Match Day!

Thursday, March 17th was MATCH DAY! The balloon rainbow stretched two stories high and there were pots of gold coins with the secret to where the 4th years matched for residency at the end. At noon the class of 2011 opened their gold coins together and realized that they were finally going to be a surgeon, a pediatrician, or a radiation oncologist.

Even though I only know one 4th year student, it was honestly quite emotional seeing the happiness on the faces of the students, their spouses or parents, advisors, deans, lecturers and mentors. 3 years to go...

Chocolate Fat Tuesday

The most wonderful day of the year! (and I couldn't resist skipping school to get a taste at the 24th annual Chocolate Fat Tuesday!)

This is the Empire State Building. Made of chocolate. With a few thousand white Hershey's chocolate squares as windows. Now look at the top - a solid chocolate King Kong. And it's hard to see, but there is a mechanical airplane circling him.

My dad's creativity is amazing.

Matt and I jumped back in the car at 5pm on Monday, and made it to Olean by 10:30 -just in time to help Dad pull out all of his chocolate treasures: the chocolate train, candy jars, chocolate champagne, chocolate covered football, a 7 tier chocolate wedding cake, a giant copper bowl full of melted chocolate to dip strawberries and pineapples, a chocolate waterfall to send oreos and marshmallows through, a chocolate dolphin spouting chocolate sauce... and more chocolate cakes, pies, tortes and desserts you could ever sample.450 people enjoyed the feast of chocolate at The Old Library - I wonder how many then gave it up for Lent...













Well done Mom and Dad :)

Scranton

I got home from my trama shadowing shift at 7:30am and we jumped in the car and headed toward Scranton, PA for a wedding. Needless to say, I fell right asleep. But my wonderful husband woke me up an hour and a half later for a "pee break" and we were magically at my sister's house! We got to hang out with Bridget, Mike and Juliana for a few hours before hitting the road again.

No worries, I fell right back to sleep. Two hours later Matt surprised me with a visit to a dairy farm! Haha... he knows just how much I love ice cream :)

Finally we arrived in Scranton. The wedding was a blast - open bar, good food and great friends!

Trauma Shadowing

When I googled "trauma" this was the first image that came up. I'm pretty sure it's not real, but it is funny.

Last Friday night I was at the hospital from 7pm - 7am doing "trauma shadowing." The Emergency Medicine Interest Group arranged for two first year students to follow around the second year resident for a 12 hour night shift to start learning what trauma, surgery and emergency medicine are all about. We carried a beeper all night and in addition to going to see the post-surgical patients the resident was taking care of (to remove tubes, draw blood or prescribe pain killers), we met down in the trauma bay whenever someone was on their way to the hospital in an ambulance.

First of all, it is really hard to stay up all night. Thankfully the "sleeping rooms" have very comfortable beds (but no pillows), personal bathrooms, and allow for naps between traumas.

Our first case was a "chest stabbing" that the other student and I decided to demote to a "chest poking." The man was "minding his own business" ("one of the most dangerous things to do in Baltimore," in the words of one of his nurses) and didn't know who or what stabbed him. After a chest x-ray and CT scan he got 3 staples to hold the wound together and was released.

The second case was a man who tried to commit suicide and had a very deep rope burn around his neck. He had a history of psychiatric disorders and came in to the emergency room on his own actually. A CT scan showed no soft tissue damage and the blood vessels in his neck were not torn. I believe he was taken to another area of the hospital after it was determined he would be ok.

Our final patient was brought in around 2:30am (the bars close at 2am) after he got in a bar fight. He was in rough shape and the attending physician wanted to get a CT scan to make sure he didn't have any head or brain injuries. Unfortunately, an hour later the we still had no scan to look at because the man kept climbing out of the CT machine. He was NOT happy to be in the hospital (which he referred to as the bar several times, while asking for his boys) and did not want an IV in his arm (which he ripped out twice).

Overall, it was interesting to see the approach to taking care of a patient with possible trauma. Lots of people were completing many tasks - and I was able to identify who was doing what and why they were doing it. Getting a history, age, drug and alcohol use, and allergies. Hooking up the finger pulse oximeter and blood pressure cuff to monitor vital signs. Understanding when to get a chest x-ray and CT scan. Then as the situation gets under control, people start to thin out and the patient is given the care and support necessary for his specific situation. Which makes sense :)

Borrowing from others

I've come across several interesting articles or stories lately. Some were emailed to me, some showed up on my Facebook News Feed. I hope people don't mind that I use their links for this post.

The article Girls and Boys Together in The Opinion Pages of The New York Times discusses "the first report on the status of American women since the one Eleanor Roosevelt prepared for John F. Kennedy." Here is the link to the report: Women in America: Indicators of Social and Economic Well- Being

One of my favorite teachers sent me this link, pointing out that although not everyone likes Jon Stewart, it's nice to see him defending teachers: Jon Stewart Critiques Wisconsin's 'Class Warfare' in The Huffington Post

And finally: Cut Teach for America funding and we'll be closer to flunking the future in the Opinions section of The Washington Post. Don't get me started.

We've learned

I'm terrible at consistent blogging.

Other than that, we've learned almost 100 different bugs (bacteria, viruses, fungi, protozoa that infect the human body) and more than 50 drugs (antibiotics, antivirals, antifungals....) to treat those infections.

If you have a UTI, it's either E. coli, E. coli or E. coli. If you have a fever and you are a returned traveler, it's malaria until further testing is done. If your infant eats natural honey or home canned fruits or veggies, they are at risk for botulism. (This is because the spore of the bacteria is found in nature, accidentally put into the honey jars and ingested.. The still developing immune system of the baby can't deal with it like adult immune systems can.)

Last night 4 of us went across town to the other med school to participate in their Family Medicine Interest Group Procedures Night. We don't have a Family Medicine department, which is strange, so the awesome group across town includes us in their activities. I learned how to put on splints and casts and draw blood. We practiced on each other. :) I was all ready to break out my plaster of Paris, rip up some newspaper strips and dip them in the paper mache goop, and practice my pinata making skills from 3rd grade... but you should know, as I learned last night, this is not at all how you make a cast. Instead, you use this nifty foam/mesh product that hardens as it is exposed to air. It comes like an ace bandage and after positioning the joint and bones, you just start wrapping. Ok, it's a little more complicated than that, but I assure you, there are no liquid glues involved.

They say the third time's a charm... and that's about how my technique drawing blood went. :( I felt so very bad for my partner, but she assured me that skilled professionals have trouble finding her veins. She found my vein on the first try... and we both decided that was because I'm so white my skin in see though.

To Do: Get outside into the sun.