I just peeled myself off the couch to come update the blog. I was reading about metabolic alkalosis (when your blood becomes basic due to metabolic imbalance). It is already my third week of second semester and the academic work goes along as usual: lectures, reading, diagrams, note-cards, and trying to get enough sleep. The lecture-hours to organ-size ratio is extremely high right now. Kidneys do a LOT- those busy little beans! (Just checked, and the next unit is the lungs which only lasts 2 weeks for comparison.)
Last Wednesday I began my weekly hospital rotation for Physical Diagnosis II, and I felt the happiest that I’ve been in a long time. In fact, I had such a good time that waking up early and commuting 1.5 hours each way felt negligible. The first day was mainly an introduction, but I already fell in love with the doctors and hospital.
I can’t wait to see my first patient there tomorrow. I just gathered all my medical equipment in a small pile (I really need to get some kind of doctor bag). Tomorrow I’ll have lecture in the morning, then 2 hours to take a history and physical exam with a patient (who could be a child or an adult from almost any department).
The big change from anything I’ve done before is that I’ll be responsible for writing my own notes. Doctor’s notes are referred to as “the H&P” which stands for “History & Physical (Examination).” Not “H&PE!” That would be TOO obvious. Sorry, but abbreviations in doctor-world don’t make much sense to me yet!
We had a sample H&P due this past week. The assignment was based on a staged appointment with a standardized patient actor who had chest pressure. It took me about 3.5 hours to finish it! I can hardly imagine that eventually it should be possible to write my notes in 10 minutes or less. There’s going to be a steep learning curve (this along with everything else of course).
The main reason why it feels so hard is that I’m not used to the proper formula. Much like a lab report, an H&P is a scientific report that has sections for specific information. I’m learning that a good H&P will be as objective as possible . That means rather than using phrases like “normal,” “as expected,” or “acceptable,” I need to actually DESCRIBE what I did or observed.
I struggled with descriptive phrasing, and I’m sure someday I’ll be rolling on the floor laughing at what I wrote. ”Hears fingers rubbing in both ears.” ”Warm and dry, fingers pink.” ”Symmetric head, no wasting of facial muscles.” ”Tongue in midline.” Well, I have to start somewhere.
And tomorrow is the real start to seeing patients and performing focussed physical exams. I’m so excited! Oh yes, THIS is the reason I came to medical school; to be present with people. Now back to metabolic alkalosis…
Yeah for Liz! Good luck tomorrow.
So glad to hear how happy you are. Isn’t the beginning of the semester a gift? Have a wonderful time tomorrow!
I love your sense of humor Liz, even during an H&P write up!
ok liz, here’s a medical question for you. i went snowboarding 1 week ago, and i fell really hard on my ribs. so hard that i kind of screamed on impact and people looked around to see who the big wuss was. my ribs are still a little sore. the next day (and still) my ribs are itchy as hell. is the itchiness related to the crash or is it unrelated? also, cortizone cream doesn’t help.
if you can solve this one (or end up being right if i eventually go to the doc), i will send you a special san francisco treat.
Dae, I love questions like these- I don’t even need to be tempted with a treat! Although you know you shouldn’t rely on me without seeing your real doc of course. So, a 29 year old male complains of severe itching on ribs after a fall one week ago. If you were my patient, I’d want a better history and an exam: “Point to the place where you fell. Where do you feel sore? What does your skin look and feel like? Visible bruising? Redness? Anything make the itch better or worse, for example a hot shower, clothing, breathing? etc.” My differential diagnosis would be either #1 internal blood products or bone fragments from an internal injury are irritating your own inflammatory cells and the cortizone doesn’t penetrate deep enough to offer relief, #2 some type of neuropathy due to hitting a nerve. Sorry to hear about your fall- is it still itching now?
I take great care not to waste my facial muscles. When you see me tomorrow, do you think you could tell me if my head’s symmetrical or not? I’ve been wondering.