Wednesday, October 18, 2006

Back in the hospital: ER shadowing

School is great so far, but the general basic biology review that comprises our first term is a bit slow and lacking in clinical experience.

Things will brighten up when I get my stethoscope / otoscope / opthalmascope next Tuesday. Also that day, I start my first of four experiences in a family physician's office, which is going to add an exciting element to my medical education.

The doctor I'll be shadowing seems pretty cool, and excited to have us, which is nice. He sent me an e-mail that got me really excited. Part of that e-mail:

In my office, you will be doing more than just talking. I expect you to do limited physical examinations under my supervision. So yes, bring all your instruments. You will also have a chance to do some minor procedures, like giving shots or taking out sutures. In another word, you have to work. Flu shot season is coming up. Hopefully you will be an expert in giving shots by the time you leave.

I hope you will have a good experience and at the same time, have some fun. Books can be very boring.

That's all you need to tell a med student to get them very excited. As well, his practice is about 60% Chinese, "so polish up your Cantonese." And, I don't have to wear a tie. Nice.

Though I'm required to get that experience, I'm still trying to get some more exposure to the specialties I'm most interested in right now, namely, OR and ER. I finally have had enough of trying to smother my itch for clinical exposure and signed up to shadow an ER doc for a couple hours yesterday. Our school has a comprehensive online list of about 100-150 local docs in all sorts of specialties who are happy to have med students to shadow them, so I looked one up, and yesterday found myself wandering towards the big city hospital a short walk away.

I haven't been orientated to that hospital, or any hospital here for that matter, so I wandered in through the paramedic ER entrance, put on my short lab coat in a hallway and wandered over to meet the doc.

The doc I was following looks EXACTLY like a younger, shorter, blond Greg Kinnear. I kept doing double takes all night. He was great to shadow; it was pretty busy and he also had a R1 (first-year resident) and a MSIII (third-year medical student) following him around, but he was happy to have me there.

It's only the second ER I've ever shadowed in, too, so it was neat comparing the two places. This big city hospital had all sorts of neat stuff: a very belligerent HIV+ homeless individual who got drunk on rubbing alcohol and bumped his head and subsequently cussed out the doctor at full volume when the doc tried to get info about his HIV condition; a lady with alpha-1 antitrypsin, sepsis, lung transplant (alpha1 is one of the few conditions we've actually learned something about so far); a 50-year-old Fijian gentleman who had recently had a SEXTUPLE bypass (never heard of that before)!

It was also my first experience with actual teaching-hospital-attending-doc pimping, something I had only heard about to date in the medical blogosphere. The doc asked me a few medical questions, which I wasn't expecting. Fortunately, one of the ones he asked me (why do we give thiamine when we give glucose?) was something I learned this week in class. He seemed almost surprised that I knew the answer.

I enjoyed seeing what the MSIII does, as well. It'll be exciting to finally be on the floors and doing medicine and interviewing patients and doing procedures. He did a great job of presenting cases to the attending; I wonder how some of the people in my class will end up when it comes time for them to coherently present cases. At this point, at least, they don't seem nearly as confident...or he was.

[Formerly the first half of a longer post; second half can be found at the post Post-ER-Shadowing Advice]


Anonymous said...

You have a little ways to go in learning how to handle attendings! :D Never let on that you are leaving the scene (clinic, hospital, inpatient consult, whatever) to do anything other than study. You don't have to lie, just don't be explicit about the fun activities you have planned. Otherwise they get the impression that you have too much free time, or are not interested in the subject, or don't do any studying on your own.

Most students get a lot better at clinical functions throughout the years, and especially during the first two weeks of third year; some of my classmates, on the other hand, I'm still wondering about.

Isn't that the best feeling ever, when you know the answer to something the attending didn't expect at all?

Enjoy the flu shots. Believe it or not, in my third year family med rotation, the office nurses were so uptight, I had to have a minor showdown with three different attendings before they ordered the nurse manager to let me give flu shots. . .

Tiny Shrink said...

It's great that you're getting some clinical experience in your first year. I did a few weekends at a homeless clinic during first and second year, and as a result I was much more comfortable seeing patients and presenting to attendings than many of my classmates. Knowing what to say around attendings is kind of an art form, and needless to say, my med school class is much like yours; many of my classmates are still struggling with this concept, 4 months into 3rd year. (I may be, too, to be honest). Good luck with med school!