Patting Myself on the Back

I did good last week.

After feeling like family medicine was a whole new world where I didn't speak the language, I'm finally getting my bearings. I still don't know the childhood vaccination schedule off by heart, I'm still not 100% sure when to recommend routine colonoscopy for colon cancer screening, and I'm still at a loss with most eye complaints and skin rashes... but I made a few good calls last week, so I'm going to brag. And I'm bragging here cause my significant other is tired of hearing about it.

Patient #1

A 43-year-old guy came into the office for abdominal pain. He had a long standing history of gallstones. When I came into the room, he was kneeling on the floor vomiting into a plastic bag. He was literally writhing in pain. A few questions and an abdominal exam later, I called over to the emergency room to tell them that I was sending over a guy with suspected renal colic (i.e. a kidney stone). My preceptor comes in and asks me why I didn't think it was gallstones, which he's known to suffer from. Easy... gallstones wouldn't make him jump through the roof if I tapped him on the back (costo-vertebral angle tenderness, to you med-folks).

Verdict from emerg? Renal colic. A stone big enough to require a trip to a larger centre for treatment. Score one for Dr. Couz.

Patient #2

A girl came in with a long standing sore throat. She's 11, and it had been going on since November. Mom (a nurse) was convinced that she had thrush, a fungal infection, as she had it a few times as a baby. I get her to describe the symptoms, and at one point her mother mentions the fact that she knew it was thrush when her tongue went white. I was intregued. I questioned further. Turned out her tongue was only white briefly, before the skin sloughed off and left her tongue strawberry red. Hmm. And yes, she admitted, now that you ask... she DID have a rash over her trunk sometime after the sore throat started.

Diagnosis? Strep throat and scarlet fever. I got complimented on the good pickup. Score two.

Patient #3

34-year-old guy, new to the practice, came in complaining of flu-like symptoms. The usual viral stuff-- dry cough, fatigue, aches and pains... sure sounded like the flu. But just to be safe, and since he was new and we had no information on him, he got the full workup-- CBC (rule out anemia), TSH and T4 (rule out hypothyroid), and even a monospot test to cover all the bases.

The verdict? Atypical lymphocytes, positive monospot. He had mono. My preceptor asked me what made me think to order the monospot. I wasn't even sure. It was just part of a full workup for fatigue. Either way, it made me look good. Or lucky. Whatever.

So I'm not saving the world, but I'm starting to feel like I might actually make a reasonably good family doctor in the next 17 months or so. It's nice to not feel completely incompetent for a change!