IM, WK1: Ambulatory Medicine

Hey all!

It’s been a while since I’ve posted on here, but I believe it’s a great time to get back to writing! You will hear a lot more from me now that I’ve started my 3rd year and would like to document as much as I can during this phase of my career! I can’t believe I’m finally seeing my OWN patients (well kinda, lol, still have to report to the attending who then finalizes the assessment and plan). 

This week has been short because of Labor Day weekend, but man was it exciting. I’m starting my first rotation in Internal Medicine. I currently have 2 weeks of outpatient (and for those that know me, you know how much I love outpatient primary care LOL). I’ve been having a blast finally applying the knowledge I attempted to drill into my brain for the past two years to a real patient, an actual human being looking to me for comfort and answers. It is extremely daunting at first because in the back of my head I wasn’t sure if I was ready for this especially throwing me into a patients room on my first day with no knowledge about how the clinic works, no access to the electronic medical records, and an immense amount of doubt in myself and my capabilities. I couldn’t sleep properly 2 nights in a row because of the nerves… 

On the first day, my classmates and I went up to the chief resident to check-in and receive our assignments. We then proceeded to the clinic and [thankfully] ran into a few upperclassmen that gave us a quick rundown of the outpatient clinic and what to expect. This is one (of many) things I love about my school, regardless of where you are in your career, a fellow AUC student will ALWAYS have your back and help you, there is no competition or trying to outshine your colleagues. It’s a quality a lot the US med students we work with notice and admire. 

Upon reaching the clinic, we were fortunate enough that the attending allowed us to shadow the current students for a bit to get a feel of how the clinic works before we ventured out into the patient rooms on our own. This is where I quickly realized the difference in training between medical schools- it may have been a bit too evident on my facial expressions (oops). 

On the island, our ICM ( introduction to clinical medicine) curriculum emphasized the importance of patient-centered interviewing- let the patient tell you what’s going on. The attending straight up told me we have a 15-minute time limit to take a focused HPI and conduct a focused physical exam (doesn’t seem like a lot of time at first, but it’s more than enough). Shadowing the other students, I noticed that their training seemed to be very much doctor centered. Asking yes/no questions, not sitting down while taking the interview, and asking pertinent questions to complete the visit rather than hear the patient out. I’m not saying one method of interviewing is better than the other, but as someone who has been a patient before I’d prefer to be seen with a doctor that doesn’t seem to be rushed on time, but rather seems to genuinely care for my concerns and listen to me. Your body language can tell a patient a lot more than you think. Sitting there, it didn’t feel like we were able to get the entire story from that patient- and that bothered me. 

I’m also learning medicine isn’t perfect. Everyone seems to be overworked while providing the best care they possibly can. Being able to observe a lot of these factors put into perspective my goals for the next year and going forth into my career. I love the hospital I’m working at, being able to care for those coming from a lower SES to a higher SES. From native English speakers to those that need an interview conducted via a translator, and even providing care to inmates that have stories of their own. The diversity in care is unbelievable, and seeing all of these patients (regardless of their background, religion, and ethnicity) as just a human being that is vulnerable and counting on us, me, to listen to and tell their story to help them is a wonderful blessing. 

Due to the hospital social media policy and HIPAA, I won’t be sharing too many details, but I would love to share some memorable cases that I’ve seen this week. Especially for those of you still in basic sciences or about to start, I know I’ve always said to myself “the chances of me seeing this pathology are highly unlikely” but man did I prove myself wrong, and I hope this motivates you to learn that extra tidbit of information as well. 

Memorable Cases: 

  1. Chlamydia trachomatis
  2. Granulomatosis with polyangiitis
  3. Severe Iron-deficiency Anemia
    1. hammer down the differences in lab values between iron deficiency and anemia of chronic disease- huge pimping question from the attending 
  4. Helicobacter pylori 
  5. Chronic Kidney disease secondary to Diabetes Mellitus Type 2
  6. Osteoporosis 
  7. Varicose veins 
  8. GERD
    1. may have progressed to peptic ulcer disease :O
  9. non-compliant Hypothyroidism
    1. Goiter was evident and palpable

Keep striving for your dreams, you’re capable of achieving them. 

Sending you all good vibes, 

Preety 🙂

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