patient encounters

Here is my official plan to change the world as we know it:

• I become a paramedic.
• If I encounter patients who cannot be saved, just as they’re about to die, I’ll look them dead (haha) in the eyes and slap ‘em real hard, right across the face.
• If ghosts are real, this will cause dozens of them to be personally upset with me. I mean, at the very least, they’ll want answers. I’ll be the most haunted person ever.
• This means I’ll have dozens of opportunities to record paranormal phenomenon.
• I’ll get my own show on the Travel Channel called GHOST SLAPPER, through which I’ll eventually get irrefutable scientific evidence that ghosts exist, making me the wealthiest and most respected paranormal researcher of all time.
• On my death bed, one of my interns will slap me real hard, to make sure I come back all pissed off and confused.
• I will be the first ghost to host a ghost hunting show (which is mega cool, come on, admit it).
• Eventually, the secret goes global, and everyone starts slapping their loved ones real hard as they die, because they believe it’s the best way for their spirit to remain here on Earth with them.
• After enough time, death slaps become commonplace. People have DNS (do not slap) instructions in their wills instead of or along with DNR (do not resuscitate) ones.
• HOWEVER, because everyone expects the death slaps, they no longer have the desired effect. Getting slapped is just a natural part of dying, now, but it accomplishes nothing.
• Like with all cultural junk, the origin eventually slips away, and the knowledge of WHY we slap the dying is esoteric at best.
• I, however, remember, and haunt hospitals for centuries, laughing because everybody’s gettin’ slapped in the face.
• Thank you for your time.

Things that can Destroy your Motivation

1. Not having goals. You can’t reach your goals if you don’t know what they are.

2. Choosing goals that don’t inspire you. You won’t be able to keep on going if the prize at the end doesn’t really matter to you.

3. Expecting immediate results. Anything worthwhile is a battle and a struggle. It takes times and effort to bring about a change.

4. Lack of support. We all need someone to believe in us and to be our cheerleader when we start to feel discouraged.

5. Not believing in yourself. As Henry Ford so wisely said: “Whether you think you can, or you think you can’t, you’re right.”

6. Feeling bored. Most success involves a lot of humdrum work, and repeatedly doing the same kind of stuff. But each day brings you closer to achieving what you want.

7. Inaction and laziness. You have to work the plan before the plan will work … and dreams are only dream till you turn your thoughts to actions. Also, it’s crucially important that you manage your time well, and you don’t get distracted or procrastinate.

8. Being around negative people. There are plenty of people who only see the flaws, and whose eyes are on the problems, and the absence of solutions. If you hang out with them, you will lose your zest and passion, and your positive outlook will soon be undermined.

9. Comparing yourself to others. We each are individuals, and we start from different places; we all face our challenges, and work at different rates. Remember “it’s your journey”. Be patient with yourself.

10. Encountering setbacks. No matter how great your plans, or your level of commitment, you’re bound to face some setbacks and encounter obstacles. That’s a normal part of growth – just keep going when life’s tough.

Good reminders

This morning I volunteered at a community health screening event. I was the only medical student helping out the faculty member, so I got to do a lot of HbA1c checks with the nifty machine.

One of the patients that I saw told me about how 7 months ago her physician diagnosed her with pre-diabetes. At the mention of Metformin during her appointment, the patient confided in me that she started crying. She could not believe that she was going to have to start taking medication for this disease. As the patient was about to have gastric bypass surgery, the physician conceded that they would wait to see what her numbers were after the surgery.

The patient and I discussed her story during the 5 minutes that it took for the machine to read her blood sample. She told me about this 16 week weight loss program she started and all about the different exercises she’s been doing. She noticed my School of Medicine t-shirt and asked if I was in the 6-year program. I told her yes, and she beamed with excitement and joy for me. I told her how I was studying for boards and have hit many obstacles during this time with my failing CBSE scores and the burnout of studying. We talked about how I rarely have time to see my family and she encouraged me that it would all be worth it in the end.

When her number popped up, I took the device in my hand and asked her to guess what it was. As her last reading was 6.5, she guessed 6. I said, “What if I told you it was 5.5?” The surprise and joy on her face was so heartwarming to see. Here was a woman who 7 months ago was told she would have to be on medication and decided, “Nope, not for me,” and started working towards a healthy lifestyle. 

I congratulated her and gave her a high-five. She thanked me and said, “I’ll be praying for you for your board exams. I know you can do it.”

And it was just a really great reminder why I’m doing what I’m doing.

Medical School—A Not-So-Quick Walkthrough

Hey humans! Aunt Scripty here. This post is a submission by Brittany, whose Tumblr handle I surprisingly don’t know. This post came through the Submissions Box. If you’re interested, I encourage people to submit articles to appear on the blog! [though it may behoove us both if you message me first, as I have a few posts in-progress and I don’t want us to duplicate efforts]

Anyway, give Brittany some props! This is an awesome post, and I’m CRAZY thankful she wrote in! And now, Brittany, take it away!

Disclaimer: This applies to the American medical system only, and may be biased by the author’s experiences.  Also note that this is the process for becoming an MD, not a DO (both MDs and DOs are fully licensed physicians, but DOs have a stronger focus on the musculoskeletal system and their schooling is slightly different).

Disclaimer Part 2: I swear, this was SUPPOSED to be a brief post.  Oops.

The quick and dirty:

—4 years of undergrad

—4 years of medical school, 2 in the classroom and 2 clinical

—3-5 years of residency depending on what they specialize in.  Can be longer if they add subspecialties or fellowships.

The in-depth description:

Getting in (Premed student)

Acceptance to medical school is hard enough to start with.  There’s an estimate that 75% of applicants are qualified, but only 50% get in.  Your character doesn’t need to major in biology or pre-med, but there are pre-requisites: two semesters each of biology, chemistry, organic chemistry, calculus, and physics, plus a couple biology electives, and I think psych and statistics have been added on since I graduated, but don’t quote me on that.  That’s pretty much 2/3 of a science major right there, so you can see why a lot of people just end up with that.  During spring of junior year, they’ll take a giant standardized test called the MCAT that covers all of those topics and is notoriously difficult.

Along with the classroom work, they’ll have to get clinical experience—most commonly volunteering, shadowing, or working as a medical scribe, but you can get creative—and usually do a little research of some kind.  Med school is hard and being a doctor is harder; they want to know that you’ve got an idea of what you’re getting into.  If your character does all that right, they interview with medical schools during the fall of senior year, and hopefully get accepted!

Year 1 (MS1)

Your first year is classroom based.  You get daily lectures on very complicated medical topics, with relatively little patient interaction this year.  Schools will include more practical classes as well, including a cadaver dissection, pathology (where you train to look at cells and understand what a healthy vs. diseased one looks like; some schools are old school and have people still work with slides and microscopes, others like mine do it virtually), and standardized patient encounters (where they hire actors to come in and work with us so we can practice histories and physical exams and basically get a baseline on things like “what does a normal lung sounds like?”).

Patient interaction varies from school to school, but generally is pretty low.  You can shadow a certain specialty you’re interested in, volunteer in free clinics, join different clubs/interest groups, or do various electives that will focus on teaching certain aspects of patient care (nutrition, medical Spanish, global health, etc.), but you have to go look for them.  If I hadn’t done any of that, I would have seen maybe… two patients a month?  Most students will branch out with those other opportunities, though.

Year 2 (MS2)

Similar to MS1 in that you’re still on classroom duty, still not seeing many patients.  Typically you learn more sensitive physical exams this year (urological, gynecologic, breast, etc.), and you’re finished with the cadaver dissection, but things are otherwise the same.  At the end of your character’s MS2 year, they’ll take their first board exam, called STEP 1.  You can take it one time only unless you fail.  Low scores or a fail are really frowned on, and can limit the specialty your character goes into, so you can imagine the pressure.

Year 3 (MS3)

Yay!  Your character’s now ready to be let loose on the clinic/hospital!

Boo!  This year kicks. your. ass.

This year is all about making your character feel like an idiot putting what your character’s been studying for two years into action.  The schedule is broken up into rotations, which are periods of 4-8 weeks where students focus on a specific specialty each time.  These courses are: pediatrics, family medicine, psychiatry, ob/gyn, neurology (usually), emergency (sometimes), surgery, and internal medicine.  Difficulty varies by rotation, with surgery and ob/gyn being the worst (12 hour days with only one day off a week, max; surgery adds in occasional 24 hour shifts too, just to spice things up).  Occasionally you’ll land on a nice one, like psychiatry, with 10 hour days and free weekends.

On a more day-to-day level, third years are usually part of a small medical team that cares for a set of patients.  The team consists of an attending (fully licensed physician), residents (physicians who are training in their particular specialty), and medical students (MS3s and MS4s both).  MS3s will usually get a small subset of hospital patients they care for every day—take their histories, do their physical exams, list what you think they have, and suggest treatments/tests—but because you’re not licensed, you basically take all that to the attending/resident who hears you out and then says ‘yea’ or ‘nay.’  As the year progresses, hopefully you hear more ‘yeas’ and fewer ‘nays.’

At the end of this year/the beginning of 4th year, there’s another board exam called STEP 2.  Half is your typical multiple choice test, with a numeric score—much like STEP 1—while half is a pass/fail practical where you work with standardized patients.

Year 4 (MS4)

Hopefully by now your character has figured out what they want to specialize in.  I can go over specialties in another post if anyone’s curious, but the biggest ones are basically the same as the ones listed as core rotations during the MS3 year.  There’s a giant application/interview process that takes up the lion’s share of the summer/fall/winter for interviews with residency.  At the end of the process, everyone ranks the residencies they interviewed with from most to least favorite, and at the same time the residencies rank their interviewees from most to least.  The whole thing goes into a giant computer algorithm to give as many people as possible as high a choice as possible, and then on the same day of the year, at the same time, MS4s across the country take a deep breath and open envelopes saying where they ‘matched.’

In addition, with those pesky core rotations out of the way, the character has time to take electives that may or may not be applicable to their future specialty—me, I’m going for emergency medicine, so I’m doing several rotations in EM as well as EMS, but I’m also doing a two week course forensics because it sounds awesome.

Otherwise, 4th year is widely known as the ‘take a breath’ year.  People get married or have babies during this time, travel, and generally start to act like human beings again.  There’s space in your schedule that’s off—it’s generally intended for interviews or studying for STEP 2 if you’re taking it late, but people will use it for anything.

Residency

Not going to give too much detail about it, seeing as how your character is technically a doctor at this point, but residency is basically 3-5 years where your character trains in a specialty—yes, they’re physicians, but they don’t know everything about their particular field and need trained.  You’re in this weird limbo between student and employee; you make a salary (although a very low one considering the number of hours) and can prescribe medication, perform procedures, etc., but an attending is responsible for you, you still attend a weekly lecture, and you can’t practice independently.  To give you an idea of how hard these years are, they recently had to limit things like “don’t make residents work more than 36 hours in a row,” and “don’t put the doctor who graduated med school a month ago in charge of an entire floor of ICU patients for a night with no backup.”  Incredibly, some of the old-school attendings think said changes are a bad idea and will produce doctors who are “weak.”

Also, you thought your character was done with standardized tests?  You sweet summer child.  STEP 3 has to be finished before you can complete residency, and is usually done during intern year.  The good side of this is, you’re in a residency now, so as long as you pass, no one cares about the score.

Random notes:

—This is a sample timeline, following your ‘traditional’ student.  It’s becoming more and more common for people to take a couple of years off after undergrad and apply for medical school after that.  If you want a chance for your character to gain some non-medical life experience (travel, other skill sets, becoming a parent, etc.), this is a good chance for them to do it!

—I’ve been asked by a writer I know in RL how young someone could potentially become a doctor.  I think she wanted to put in a prodigy kind of person.  The problem with that is that medical schools don’t just look for smarts, they look for maturity—imagine having someone who looks like they can’t drink yet tell you you’ve got a terminal disease, and you can see why.  That said, there are a couple of accelerated programs, where I’ve seen people graduate undergrad a year early and go straight into medical school, or where they condense medical school into three whirlwind years because the person’s on track for a specific primary care residency.  So if most people graduate medical school at age 26-27, you could have someone out at 25 or maybe 24, but probably no younger.  And remember, they’ll still need residency training from there.

—Not gonna lie, medical school is incredibly difficult.  That said, I think the best students/doctors are the ones who maintain an outside interest or two, so don’t feel like your character can only have medical skills (*cough*Grey'sAnatomy*cough*) .  Give them a few side interests to maintain their spirit.

—I can give more detail about any and all of these if anyone asks; these are supposed to help you understand what your character has had to go through to be a doctor, not be a full detail spiel.  I can also do ‘day in the lifes’ if someone’s writing a med student character and wants an accurate description, but let’s be real: most people want to write the master, not the pupil.

10

If you’re transgender, there’s no such thing as a routine doctor’s appointment

The United States medical industry has slowly made health care for transgender people more accessible — including access to hormone treatments and gender confirmation surgery. But routine doctor’s visits continue to prove troublesome for trans patients, who regularly encounter doctors who are either wholly ignorant about trans health or as seen in one horrifying ER story, can’t look past gender identity.

duskdragon39  asked:

Also, in relation to the parasite story, (sorry for spamming you with asks) I can't help but imagine that when Dippet gets better he just leaves a note with his summoning circle and the message "call me if you need something" and the doctor and/or nurses just start freaking out b/c they just pulled a static worm out of Alcor the bloody Dreambender. Or not. I just have an overactive imagination. Loved the flock and their interactions in that story tho.

Hey, go ahead and spam. I love asks :D

And yeah, there was definitely a version of this story floating around in my brain where they realized what exactly it was they’d been operating on. As it is, I leave it up to you to imaginwe whether he leaves them knowing, or thinking he was just some random, weird preter.

Honestly, it’s probably the latter, if only because the video of the operation gets used as a case study for unusual situations for decades, maybe centuries into the future, and knowing there was an actual demon involved might make people reconsider its value for teaching.

He definitely does pay the hospital back though. He doesn’t like owing anyone anything.

Some late mornings feel like they belong in romantic stories, full of dramatic confessions, heartache and breath-taking conclusions. This is not one of those mornings; instead, it’s a halcyon thing set on the summer cusp. While the air is warm and humid, the rain softly pattering over rooftops still holds a certain chill. A film of water makes the world look clean, windows and cars shimmering in the sun peeking in and out from behind clouds, golden rays reflecting against puddles nested in the cracks of New York streets.

 

The clock is nearing the 10 a.m. mark, when Alec transfers the last pancake onto the already high-stacked, indulgent plate. There’s also freshly cut strawberries and maple syrup alongside a French press full of freshly brewed coffee. The muted music from the radio melts into his skin as Alec hums along to random notes, bare feet quiet on the kitchen floor, his hair mussed up and his face a home to dark stubble that he didn’t bother with shaving.

 

As Alec pours the bitter-sweet coffee into two mugs, there are steps near the door, then a warm hand at his lower back and even warmer lips pressed into his shoulder. A shiver runs through his skin, leaving behind goosebumps all the way down his arms and his bare chest; previous hours come back to mind, images hazy like half-developed polaroid pictures.

 

It was much earlier when they woke up, skin against skin, tangled in thin sheets and in each other, a want thrumming in their veins. There was no rush – at first kisses slow and wet and deep, kisses that lit fires along Alec’s spine and made Magnus hum with delight, kisses that left their mouths tingling and red. Then, hands pressed against hipbones and heavy breathing laced with laughter as Alec shifted himself into Magnus’ lap; it felt so good, to have Magnus so close, to have his arms around his waist as they moved together, a slow and steady trickle of heady pleasure rolling through their bodies.

Keep reading

asinine-genius  asked:

What's up doc? What was the most weirdest encounter with a patient you experienced?

Geez, I really don’t know which was the weirdest, but here are the nominees for Weirdest Encounter With A Patient:

  • That time when a patient claimed that my intern and I (who look nothing alike) were the same person using wigs to trick her. 
  • That time a patient threatened to punch me in the face.
  • The time when a patient told me she was planning to move across the country to stalk a C list rock star.
  • That time when my stroke patient’s answer to every question was “eggs”.
  • That time when I had to ask a patient if they had injected juice into their veins again.
Things that can Destroy your Motivation

1. Not having goals. You can’t reach your goals if you don’t know what they are.

2. Choosing goals that don’t inspire you. You won’t be able to keep on going if the prize at the end doesn’t really matter to you.

3. Expecting immediate results. Anything worthwhile is a battle and a struggle. It takes times and effort to bring about a change.

4. Lack of support. We all need someone to believe in us and to be our cheerleader when we start to feel discouraged.

5. Not believing in yourself. As Henry Ford so wisely said: “Whether you think you can, or you think you can’t, you’re right.”

6. Feeling bored. Most success involves a lot of humdrum work, and repeatedly doing the same kind of stuff. But each day brings you closer to achieving what you want.

7. Inaction and laziness. You have to work the plan before the plan will work … and dreams are only dream till you turn your thoughts to actions. Also, it’s crucially important that you manage your time well, and you don’t get distracted or procrastinate.

8. Being around negative people. There are plenty of people who only see the flaws, and whose eyes are on the problems, and the absence of solutions. If you hang out with them, you will lose your zest and passion, and your positive outlook will soon be undermined.

9. Comparing yourself to others. We each are individuals, and we start from different places; we all face our challenges, and work at different rates. Remember “it’s your journey”. Be patient with yourself.

10. Encountering setbacks. No matter how great your plans, or your level of commitment, you’re bound to face some setbacks and encounter obstacles. That’s a normal part of growth – just keep going when life’s tough.

Virtual humans help aspiring doctors learn empathy

For medical student Katie Goldrath, the first time delivering difficult health news came when she had to tell a young woman named Robin and her mom, Delmy, that Robin had leukemia.

As she broke the news, Goldrath was conscious of not only her words but also her body language: Was she leaning in, looking the patient in the eye and expressing empathy?

The conversation, though, was just for practice.

Keep reading

Doctor Strange x reader Imagine part 2

- Stephens POV -
I had no clue how someone as delicate managed to pull trough the damage that 6 bullets had done as they ripped trough her body. She was a miracle. And due to my skills or the luck that i refused to believe in she was still amongst the living.
There she was, laying on the hospital bed whose white sheets matched the paleness of skin. Her recovery was going well, she was going to be okay. Yet somehow she didnt seem like the usual patient that I’d encounter. I couldnt see her as just another success in my book. Something about her kept me up at night. She was indeed a miracle.

- Y/N’s POV -
I was woken up by a shadowy figure in my presence. I was in a state of confusion and cuelessness yet i strangely remained calm. Whatever the figure was it seemed strangely comforting, somehow warm and familiar. Then it all came back to me; the gunshots, pain, blood, hospital walls, voices and the coldness of the operation table. My heart started racing forcing my eyes to tear wide open. I was met by a piercing light which caused me emense pain. I le out a squeal and as i was adjusting to my awoken state the shadowy figure took up a much more human form. That was the first thing i saw after escaping death. Although it made me question my state for it seemed much more angelic than human. It was the man who put me back together. Doctor Strange himself. I must have been staring like a fool because he responded to my gaze with a lively chuckle.
“ Good morning Y/N. ”- he said with a smooth voice, sending shivers down my spine.

Basics for the Wards: History and Physical (H&P)

For me at least, writing notes on patients was one of the hardest things to get the hang of once I started my clinical rotations.

When you first encounter a patient, you want to do a history and physical. This will be the most in-depth note you write. Most services have a template for use, especially if your site uses an EMR. Ideally, you will will ask the patient about literally everything when you’re doing an H&P and it will be a masterpiece of thorough-ness and answer any and all questions that could ever pop up. However, sometimes/most of the time depending on what service you are on, you have to do a focused H&P, which is what I’ve been doing a lot of lately. The format is generally the same, but some places/attendings have a preference for the order of presentation so be aware of that!

Whenever you talk to a patient, be sure to use the appropriate language without being condescending- I’ve had patients ask me what ‘nausea’ means. In med school you get accustomed to using fancy doctor words and then once you’re unleashed on the populace you have to remember how to talk to normal people. It’s harder than it sounds- I once was in a class where we had to try and explain an ectopic pregnancy to a standardized patient (aka actor) who was portraying a person with a 9th grade education level and it was incredibly frustrating.

Last, make sure you are looking at the patient and actively listening. Saying, “Mhmmm,” and “Ok,” will show to them that you are paying attention. Don’t get so wrapped up in what you think is happening based on pattern recognition that has been beaten into your brain that you ignore what the patient is trying to tell you. Oftentimes the diagnosis is in the history, and it’s your job to find it.

So! Here goes-

History of presenting illness (HPI): “What brings you in today?”

First and foremost, this is why they are at the hospital/doctor’s office! And this is where you can quote the patient- ex: “My back hurts,” or “Some guy shot me in the leg.” Then, get the details- like a reporter, answer who/what/when/where/why/how.

If pain is involved, it is important to know as much about it as possible. A common mnemonic is OPQTRST:
- Onset- when did it start, what was the patient doing when it started, was it sudden or gradual.
- Provocation/Palliation- what makes it better and what makes it worse.
- Quality- Ask the patient to describe the pain. Sometimes they won’t know how to describe it, in which case a good question is “Is it sharp or dull?” Other quality words include burning, tearing, throbbing, constant, intermittent.
- Region/Radiation- where is the pain, I usually ask them to point with one finger where it hurts worst and then use their hand to indicate the area that hurts. The ask if the the pain moves or has moved since it started (ex: appendicitis classically starts off as a dull diffuse abdominal pain and then progresses to the right lower quadrant as the inflammation gets worse).
- Severity: how bad does it hurt. This is a notoriously tricky and nuanced question. Be suspicious if a patient is asleep when you come in the room, or smiling and laughing but tells you their pain is 10/10.  Conversely, some people will downplay their pain (I had an old farmer who was in an accident that broke most of his ribs, his O2 saturation was in the crapper because it hurt too much for him to take deep breaths and he would not tell me how bad it hurt). If a woman has given birth, I ask her how bad is it compared to labor pain. For everyone else, I use one my old neurology attending’s scales: 'If 1 is no pain and a 10 is a hyena is ripping your arm off, how bad does it hurt on that scale’.
- Time - How long has it hurt, has this ever happened before, and if it has changed since it started or since the last time it happened.

Past Medical History (PMH): “Do you have any medical conditions?”

This is where I say, “Ok, now that we’ve talked about what brought you in today, I’m going to ask you some questions about your background.” Sometimes they say they have no medical problems, but their chart says they have diabetes and heptatitis or take Keppra. Then I have to ask leading questions like, “Do you have any problems with your blood sugar/blood pressure/cholesterol/insert organ system here.” Be sure to use the layman’s term for medical conditions: hypertension is high blood pressure, hyperlipidemia is high cholesterol. If they have a medical condition, ask how long they have had it. Sometimes patients will say “A long time,” or “I don’t know,” in which case I try to make a joke and say, “Well you know us scientists always want numbers, so can you guess how many years/months it’s been?” Usually they laugh and tell me a number.

Medications: “What medicines do you take?”

If possible, get the number of pills (ex: two water pills in the morning) and if you are really lucky, the dose. Prescribed and over the counter medicines fall in this area! Be sure to ask about vitamins and supplements. It doesn’t always have to be a medicine they take every day.

Past Surgical History (PSH): “Have you ever had surgery in your whole life?”

Like past medical history, this is pretty straighforward. Tonsillectomy counts! If possible get how old they were when the surgery took place, or what stage of life (ex: hernia repaired as an infant, appendectomy in high school) if they can’t remember exactly how old they were at the time.

Allergies: “Are you allergic to anything?”

People think they are allergic to something if they ate it/touched it and got a bump or a cough that one time. Spoiler: probably not an actual medical allergy. So, when you ask people if they are allergic to something, find out what happened when they were exposed to it. If they say “My throat swelled shut,” or “I got giant hives,” odds are it’s a real allergy. Be sure to include both environmental and medication allergies.

Social history (SH): “Tell me about yourself.”

Patients are people too. They put their pants on one leg at a time just like you. Getting some background information on your patients is really important. Good things to include are:
- Vices - tobacco (what, how much, how long, have you thought about quitting), alcohol (what, how much, when, CAGE questionnaire if indicated), illicit drugs (I always say, “Now, I don’t care what you do and I won’t tell anyone, but if you do anything I need to know about it so that I can give you the best health care possible.”), sex (with who recently, protection)
- Living situation- where do they live, and with whom. If a patient is homeless or lives alone, this is good information to have for post discharge planning.
- School/Work- how far did they go in school, and what do they do for a living. If anything, this is helpful for directing your interactions and post discharge planning. In most cases, I’m going to talk and plan differently for a homeless patient with a 5th grade education vs a factory worker with a GED vs a teacher with a masters degree.

Family History (FH): “What medical conditions does your family members have?”

The big ones to ask about (especially in the South) are diabetes, hypertension, hyperlipidemia, asthma/COPD, and cancer. Ask if their parents and siblings are alive, and if not when they died and of what cause.

Vital signs/lab work

Not so much for when you are talking to patients, but when you are writing your note be sure to include their vitals (blood pressure, heart rate, respiratory rate, O2 sats, temperature) and any labwork (CBC, CMP, LFTs, etc).

Review of systems (ROS): “I’m going to ask you a bunch of yes or no questions, now.”

Most H&P templates have literally 150 things for every organ system on the ROS, and if you can go through all that, swell. For a focused H&P, you usually won’t have time. Now, it’s important to be clear that you are asking about recent/current symptoms, not 'have you ever had’ symptoms, because otherwise you will be there all day- most people have, at some point in their life, had nose bleeds and sore throats and diarrhea. You are concerned about the present illness.

I usually start with the head and work my way down:
- Head: headache, vision changes, loss of balance
- Neck: difficulty swallowing
- Lungs: shortness of breath, cough
- Heart: chest pain, racing heart
- Abdomen: nausea/vomiting, belly pain, diarrhea, constipation
- Genitourinary: problems peeing, any weird stuff with vagina/penis
- Extremities: able to move all limbs, get around
- Skin: any rashes/bumps/moles

Physical exam

I know we are all trained to do a very thorough physical exam that takes an hour. Sadly, that is just not practical in most cases. It’s important to know all the physical exam steps so you can tailor your exam to presenting problem. For example, if the patient is having horrible abdominal pain, it’s likely not as crucial to check all 12 cranial nerves.

Everyone is taught the order of the physical exam a little different. I also like to do this head to toe because it helps me not miss things. Figure out what works best for you and do it every time.

Assessment/Plan

This is for your H&P note. Now, every attending will like notes to be a certain way, find out before you start writing them. Someday you’ll be able to write your notes however you want, but for now you are subject to the whims of whatever doctor is supervising you. Start your assessment with a summary of everything above, mostly why the patient is there, and the relevant details from the history, vitals/labs, review of systems, and physical exam. (ex: 29 year old gentleman with a 4 day history of vomiting and watery diarrhea who recently went camping in Mexico. He is febrile and tachycardic but denies headache and chest pain, he has dry mucous membranes, and diffuse abdominal tenderness to deep palpation). Then go into your plan. Sometimes it is helpful to list your plan out by problem (ex: dehydration- IV fluids, vomiting - IV zofran, etc), but some attendings don’t like that.

Tagged

Tagged by: @hollyashton

Rules: Tag 15 people at the end of this challenge.

  • Five things you’ll find in my bag:
    • One ever handy planner
    • My pencil case containing my pens and markers
    • My pencil case containing my colored pencils
    • My large and disappointingly heavy notebook
    • Emergency girl supplies in a Purse
  • Five things you’ll find in my bedroom:
    • Closet
    • Study table
    • Study materials 
    • My dogs
    • My rats
  • Five things I’ve always wanted to do:
    • Do extreme sports
    • Learn how to drive a motorcycle
    • Work in a hospital in Hawaii… or maybe in Europe
    • Have a house near the beach
    • Jog. Like literally go jogging every morning. XD
  • Five things that make me happy:
    • talking to my friends
    • making onigiri
    • making desert from bananas and strawberries
    • going to patient encounters and talking to patients
    • discussing diagnoses with our mentors
  • Five things on my to-do list:
    • finish my annual medical exam
    • update my playlist
    • tidy up my study area
    • bathe my dogs
    • exercise XD

well, that was kinda fun. AND eye opening. XD

Tagging: @shazrystyles @everythingchoices @mermaidwarriorqueen @fromthecastlesintheair @larosecontent-official @romandoodlez @jakemckenzieappreciationlife @londoner20 @orionakatsukis @illegallyblonde2 @kara-choices @aleister-rourke-is-a-tsundere @ohmymaxwell @ohmysnarkydrake @justhedeepsea

Enjoy!!!

Side Effects May Include....

While attending medical school, you may experience:

1) Insomnia

2) Narcolepsy (exacerbated by professors who are only capable of reading slides in a monotone voice)

3) Caffeine-induced anxiety attacks

4) A drastic increase in your use of profanity (at least in your mental dialogue; may be exacerbated by pending exams)

5) Mental hangovers aka the emotional and intellectual inability to give approximately 0 f**ks the day following exams

6) Chronic single-ness (and an inability to find anyone worth dating whose idea of a relationship doesn’t involve hooking up on a first date)

7) The appearance of speaking in tongues, especially when around non-medical family and friends

8) Rarely, students have reported weird and sudden bouts of euphoria, typically following an aha! moment, a fulfilling clinical encounter with patients, or otherwise being reminded of why you put yourself through this utter torment in the first place

Asperger’s Syndrome vs Autism

At various times in my life, I’ve been diagnosed with both these conditions. I currently identify with “Autism/Autistic” more than “Asperger’s/Aspie”, but reading about history has made me reconsider this.

Points in favour of identifying as autistic:

  • Autism is seen as a united spectrum condition. I can stand in solidarity with other autistic people.
  • As I have a degree of passing privilege, I can maybe present a “positive” view of autism that will benefit others indirectly.
  • I can more credibly advocate for the needs of other autistic people if I have the same label
  • It’s shorter, easier to pronounce, and better understood

However, the lives and approaches of Leo Kanner and Hans Asperger have led me to think that Asperger deserves more academic credit for autism’s discovery and his ideas about it.

  • Asperger was the first person to apply the “autism” name to the condition, although it was being used to refer to other (defunct) conditions previously. Kanner published first, but Asperger had been writing about it for years.
  • Kanner believed autism was a very narrow condition, turning away the vast majority of patients he encountered. Asperger quickly realised that it was a spectrum (this is the opposite of what I had come to believe - see below for explanation)
  • Asperger approached the condition from a “special education” perspective, aiming to help autistic individuals achieve their full potential by placing them in friendly environments that met their needs. Kanner approached autism from a psychiatric viewpoint, considering autistic children to be broken (although he tentatively revised this view when some of his patients grew up to be highly successful). He strongly supported the “refrigerator mother” theory, and treatments he proposed included aversive ABA and institutionalisation.
  • Kanner suppressed Asperger’s research; he was certainly aware of it, and was a German speaker, but he dismissed it out of hand, fearing that it would undermine his legacy. This is why “Asperger’s syndrome” is seen as a narrow condition - it fills the gap left by Kanner.
  • When the Nazis took over Austria, Asperger openly preached neurodiversity. Although thousands of autistic people were killed, he managed to save a few dozen (from across the spectrum) at considerable personal risk. 
  • However, it should be noted that Asperger recommended that at least one child be murdered to unburden her family, and sat on a panel (of seven) which recommended a further 35 “uneducable” children be murdered.

Correction: this post originally did not properly represent Asperger’s wartime actions with regards to murder of disabled children. Consequently, it was significantly more positive. I know longer feel confident recommending Asperger as more than a good scientist.

amnesia - part one

title : amnesia (PG)

type : chaptered

character : Jinyoung

plot : you save him but when he comes to, he can’t remember a single thing.

A/N : Okay, here’s the Jinyoung chaptered fic! I actually wanted to write another one, but i didn’t really have a feel for that so i ended up switching to this plot instead. I honestly don’t even know what AU this is, saving AU? Amnesia AU? If you have any idea, please let me know because whatever I can think of sounds weird when i put an ‘au’ at the back……. Also, do tell me if you like this or not! c:

part two | part three | part four | part five | part six | part seven | part eight 

Keep reading

“You have a patient with agoraphobia here for a diabetes followup in 12. He’s a bit nervous.”
I hadn’t ever encountered a patient with agoraphobia, so i wasn’t totally sure what to expect. In this case, a bit nervous was a bit of an understatement. I walked into the room to find a young man and his wife. He was wearing sunglasses and looking at the ground and rocking back and forth in his seat.
I walked in and introduced myself and asked if it would be ok for me to talk with him before the resident comes in. He agreed and I sat down in the chair opposite him.
“I can see that it had been really difficult for you to come here. Is there anything I can do to help put you at ease?” He said no.
We talked. He told me about his diabetes treatment and how his symptoms have improved since he was first seen two months ago. He told me about the changes he’s made to his diet and the challenges he’s faced. Food is a coping mechanism for him that helps him manage his anxiety and fear. He told me about a rash that had been bothering him for months, that has been interfering with his life, including his ability to have sex. I was surprised to hear him open up so much, given how visibly uncomfortable he was when I first walked in.
He calmed down as we talked. I listened and asked a few questions. When I got up to leave to go present to the resident he thanked me.
“You helped me feel safe here.”
My heart, I wanted to give him a hug. He’s this big tough looking guy and it seemed so odd that I could do anything to make him feel safe. But it’s easily my proudest moment of the day. Afterall, in medicine we see people at their most vulnerable. What are we doing if not making them feel safe?

mirandamnit  asked:

Hi! I have a character who is about the age of 16 and in reasonable health. He is shot in the shoulder with an arrow and it goes through the space between his scapula and clavicle. How would this affect his mobility once healed? Thank you!

Hi there! So let’s look at this from an anatomical point of view. This is the spine, thorax, scapulae and clavicles, as seen from behind:

(source)

Now let’s work the clavicle into the equation, and just for fun, let’s add some muscles:

So the injury you describe is basically going in medial (toward the middle) to the shoulder blade and coming out…. I’m guessing inferiorly (below) the clavicle? Somewhere near the 1st and 2nd ribs?

I just need you to know that anatomically, between those things, there is a lung. Lungs do not like being shot through with arrows. It is not a thing they line up to do when they sneak off to go dancing at the Respira Club.

Another thing to be concerned about is that just underneath the clavicle runs the subclavian artery, which is a Big Scary Bleeder when it’s cut. There’s also a big loop of the aorta up there, as shown below:

So now that we’ve covered the “penetrating trauma in the chest is BAD™ ” basics, let’s talk about the ACTUAL QUESTION, which was mobility.

In a way, your character is deeply lucky. While the back is extremely muscular, especially in a  fit individual with any form of upper body strength, your character is actually pretty lucky.

See, when bullets go through an object, they leave behind a wave called cavitation. They basically cause a hole, that then collapses. What’s below is a substance called ballistics gel, and what’s going through it is a handgun:

Originally posted by tacticalnorwegian

Err, a bullet from a handgun:

Originally posted by ughpsh

See how it mushrooms out, and then collapses? Gunshot wounds cause damage both from the bullet and from the cavitation. There’s damage when the muscle and organs expand; there’s damage when they snap back into place, and there’s extreme damage where the bullet has actually made a hole.

I can’t get the video to load on Tumblr, but there’s video here of an arrow entering ballistics gel here: https://zippy.gfycat.com/TinyCalculatingFlatcoatretriever.webm

My point is this. There’s definitely still cavitation with the arrow, but it’s nowhere near as severe as the damage that can be done by a bullet. Why? The arrow is heavier, but the bullet is much much faster, and since Kinetic Energy = Mass x (velocity ^2), the speed matters A LOT MORE than the mass.

What I’m trying to say here is this: She’s better off getting shot with an arrow than a bullet. The damage may be smaller, more contained, less overall-destructive.

I’ve never encountered a patient whose long term outcome hinged on an arrow wound in the chest, so I’m making a Somewhat Educateed Guess and saying that, as long as the arrow missed the bones and their lung healed from the lung trauma, they should have pretty solid mobility, especially if they were good and kept their arm in a sling while it healed.

Best of luck :)

xoxo, Aunt Scripty

disclaimer    

Medicine-related book recommendations

I’ve compiled a list of my favourites medical books. Some are very factual but others are semi-autobiographical and tell real life stories of patients.

Thinking fast and slow
By Daniel Kahneman
Have only just begun reading this book but have already been highlighting like mad. Unbelievably interesting. Also this guy won a Nobel prize so you know he knows what he’s talking about…

On The Move
By Oliver Sacks
His autobiography. So interesting to read, but I probably enjoyed it so much as I have read a lot of his other books, which I also definitely recommend reading. Favourites are: Awakenings, Musicophilia, The Man Who Mistook His Wife For A Hat, Hallucinations. These books mainly focus on stories of particular patients he encountered and their conditions are explained in detail. On The Move includes tonnes of stories about how he wrote these books which I loved.

Incognito
By David Eagleman
Written in a really accessible way (I read it with no problems understanding when I was about 15). Tells us a lot about the unconscious mind and some cool related stories.
(He has another book called Sum which is hypothetical short stories about the afterlife… Quite odd but very cleverly written)

Do No Harm
By Henry Marsh
Very popular in the UK at the moment. Pretty much an autobiography of his life as a brain surgeon. Quite harrowing to read at times, especially if you’re considering surgery as a career.

Phantoms in the brain
By V.S. Ramachandran
Amazing neuroscientist explains all sorts of things related to the brain, including his work on phantom limbs and synaesthesia. I also highly recommend his other book, The Tell Tale Brain. There’s some overlap but definitely worth reading, and rereading, both!

Complications
By Atul Gawande
I didn’t think this was as great as everyone said it was (probably because I read it directly after I had read Oliver Sacks who is a better writer, in my opinion), but nevertheless an excellent read. Tells us the complications (no shit) in medicine, including stories of chronic pain and persistent nausea.

Taking The Medicine
Druin Burch
A pretty factual book about the history of medicine and basically showing how crap doctors and medicine can be (compared with doing nothing at all). A nice overview of how far we’ve come, but also how similar mistakes could be repeated.