The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Wednesday, February 01, 2006

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!

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8 Comments:

Anonymous Kudra said...

good calls, couz... you know you're going to kick ass at this...

12:02 PM

 
Anonymous Anonymous said...

nice pick ups.

How do you think the FRCP ER people respond to CCFP EM's training side by side and in some cases becoming staff in the tertiary care ER's. You've been on both sides of the fence. If I was an FRCP I think it might tick me off to see some CCFP grad waltz in, get their EM and waltz out effectively as an attending. Do you think this is a barrier to effective training in the ER for a CCFP. I'm going through carms at the moment. I've fully intended to do 2+1 from the beginning and I've always wondered if there was any tension between the FRCPs and the CCFP em. I was recently warned of this by someone and wondered what your take on it is. Not like it would stop me from doing 2+1, but just wondered what other people thought.

Ram
UWO Meds

7:19 PM

 
Anonymous Anonymous said...

wow, I forgot about 10 question marks in that commentary

7:22 PM

 
Blogger Couz said...

Hi Ram!

For the most part, there is surprisingly little tension. My FRCP friends joked that if I stayed in my current centre I'd be their attending when they were seniors, but it's not said with any malice.

Honestly, the five year program is great if you have interest in research, academia or administration, or if you have your heart set on practicing in tertiary care centres forever and want to make yourself the most competitive candidate possible... but otherwise, it's not worth the extra two years. It's also true that the FRCP's are a little more confident when they first start practicing, but they'll also be the first to admit that within a couple of years the difference disappears.

Come to think of it, the only derogatory comment I ever heard about CCFP(EM)'s was from a surgery resident who was convinced that the FRCP residents gave him better consults (i.e. did more of the workup before consulting, and consulted less bullshit)... but who would ever take the word of a surgery resident for anything? ;-)

If you have any questions, drop me a line at labrat_27 at hotmail dot com.

8:03 PM

 
Anonymous Melissa said...

Hey there Doc in-training!!

I love reading about the different cases that you've seen recently. I'm a Medical Lab Technologist and I think you deserve more than a pat on the back.....You deserve a drink. Good job gir!!I'm a relatively new tech(in the field 2 years now), and I understand the whole " in the trenches" world!!

Keep blogging about your different medical cases & don't let any of the 'know-it-all's' out there burst your bubble!!

Bored?Check out my space:
http://spaces.msn.com/melissas61/

I've linked ya!
Mel
:)

12:32 AM

 
Anonymous Anonymous said...

Interesting blog...but please spell PRESCRIPTION properly.

9:29 PM

 
Blogger MustangSally said...

Way to go! I bet that's a great feeling.

I had no idea scarlet fever was even diagnosed anymore until Nov. 2004 when I found myself with the very same diagnosis. Let me be the first to tell you it's no fun.

8:54 PM

 
Anonymous natural mosquito repellent said...

Good work!

4:36 AM

 

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