Monday, August 15, 2011

Le Circ

I've performed (under close supervision) two circumcisions.  One was on an 8-day-old; another on a 16-day-old.  It's a crazy, crazy thing to do.  After administering anesthesia, removing adhesions, installing the correct Gomco clamp, you just do the damned thing.  Generally, the babies tolerate it pretty well without very much agitation.  One of them slept through it.

On another note, I'm giving up calamari for a while.

Saturday, August 13, 2011

On Being a Part of It, In Good Times and Bad

Another week has flown the coup.  I am having an amazing time in my Family Practice rotation.  Part of it stems from the fact that I'm working with preceptors who are near my age and who love to teach.  They're great at encouraging me to be a part of their day and to help them with patients.  It makes a huge difference, believe me. One of my docs does a lot of pediatrics and women's health care, which is pretty interesting.  In all, I've been seeing a lot of good cases, meeting interesting patients, and getting better at the art of being a physician.

The Bad
It's interesting to be in the room, to work with someone, and to be privy to such personal information.  I've heard things that spouses might not hear from their loved one.  I'm trusted to inspect areas of concern on a body that few will ever be given permission to examine.  There are few things better than to be there when you know the solution for a malady, when you're able to offer comfort, solace, a remedy.  Antithesis to the joy is being the bearer of bad news, the worst news.

I spoke with a preceptor about how he'd discovered what was likely lung cancer in a patient who'd had a non-remitting cough for some time.  The patient had to be begged to get a chest X-ray.  Being in the room while the doctor delivered the news was, to say the least, humbling and crushing.

Last week, I was helping with an OB exam.  We got the bedside ultrasound and doppler and were going to do a check for a patient complaining of bleeding and abdominal pain.  We saw the fetus but no heart flutter.  We couldn't find fetal heart tones with the doppler.  Standing there in the darkened room, watching the woman's face strain with the comprehension of the images on the monitor was absolutely crushing.  I can still see her bathed in the light of the LCD panel, eyes widened with fear, tears welling.  It was an awful, awful silence.  At times, I don't know if my heart is large enough for medicine.

The Good
Mostly, though, I get to deal with sick people that can be helped and who's understanding of their body is, let's say, unique.  A couple of days ago, I met with an obese gent who told the female nurse that he had an eye problem that wouldn't clear up.  (It's likely allergies.) When I met with him, he confessed that, although he was too embarrassed to tell her, he was here for a rash on his penis that wouldn't go away.

He'd been to see someone about it before and, when they recommended treatment and another circumcision, immediately considered them a quack.  He was convinced that a salty discharge from was drying the skin on his penis.  Also, he also was certain that his penis was shrinking.  I explained that his recent weight gain likely changed his perception of his penis but it was doubtful that it was going anywhere.  The physical exam showed that he had a infection that likely stemmed from a hygiene problem worsened by extra penile skin.  Another circumcision that completed the job would probably remove the bacterial breeding ground and prevent it from recurring.  As it stands though, treatment with topical and oral anti-fungal meds will likely do the trick for him.  Weight loss will do wonders for his ego ... and ruler.

Monday, August 01, 2011

On Free Lunch and Ethical Comprimise

On my last rotation, drug reps would provide lunch for the office in exchange for a little face time with the doc to discuss their products and garner feedback from the prescribing physicians.  As I was essentially glued to his hip, I attended these lunches also.  The more experienced reps seemed to have an easy-going relationship with the doc: they'd known one another for a long time, they'd talk about the drug, and, thankfully, would intersperse normal conversation.  For many of these, it was informative and beneficial.  Here's new information about a drug, here's a new combination with a synergistic drug, here's some news about pricing or insurance coverage that will help your patients, and ask for information about how the physician prescribes it.  Also, they'd stock the sample shelves.  So, it's a good way to get information.  As a student, it was a great way to learn a little more pharmacology involved in family practice and save some cash on lunch.

Occasionally, however, I'd meet a rep that really made me feel icky, that reminded me of a caricature of a used car salesman.  On one particular day, a slick dressed gent who wasn't particularly humble was pitching his wares and doing his best to sell his drug.  He was trying so damned hard that, at one point, he actually says "Boom!!!  Take that, high blood pressure!" about his drug's ability to lower pressure.

I sat there amazed but thankful for the best catchphrase I'd hear in quite some time.  Personally, I'd love to see it in some ad campaigns.