So, I just had a test on how to use all of this stuff:
- one reflex hammer
- one 128 Hz C note tuning fork
- one 512 Hz C note tuning fork
- one Littmann Cardiology III stethoscope
- in the bag, there’s an ophthalmoscope and an otoscope that also check the nose should you change speculums
- in reality, with the exception of the stethoscope and the reflex hammer, and perhaps a tuning fork I expect most things to be found in patient rooms so I don’t haul this stuff around
Next year, or rather towards the end of my 3rd year as a medical student, I’ll take STEP 2 of my board certification. You’re expected to know how to use the stuff in the above picture and show off your clinical prowess in other ways. My school year ends in less than 3 month! It’s hard to believe that in less than 3 months I’ll be heading towards the 3/4th point of finishing medical school — I pick my 3rd year rotations (including elective rotations) in a few weeks. It seemed to have taken so long to have gotten here, and yet it seems to be flying by a lot quicker than expected.
Anyways, with all that aside, to prepare for the 3rd year we performed a 250-point physical on a standardized patient. Over winter break I had illustrious dreams of practicing the physical, way before the deadline I contemplated, perfecting my craft. This didn’t happen. But, at least temporarily, I did lose the bags under my eyes. This was a small life-cycle victory for myself. I was able to practice, just the day before the exam, once with a classmate and multiple times with my partner — it’s a time consuming process, I still owe her dinners till this day to make up for it. Mike, my standardized patient was also a great person to examine. Likely well into his mid to late 50’s, Mike was well built (likely more muscular than I, not that I’m all that impressive of a norm) and a talkative native of Boston; accent included. I invited him to talk the whole time, though there are times where quiet is necessary, I find examining patients while they talk to be a lot more natural than probing them and reaching into their nether regions in stone-cold silence. Mike told me he’s into sports, so we spoke about sports while I give him a physical from head to toe (literally). The most difficult part of the exam was that I actually don’t watch or care about sports, with the exception of the Olympics (oddly enough, I haven’t missed any for the last 12 years). I grew up in a sports loving family, if you didn’t play sports you were considered weird, I played: baseball, basketball, football, and even golf. I fell out of love with watching sports a long time ago, just quitting cold turkey. But, I know the buzz word things to talk about in sports conversation. Though, somehow, sometime later we got into a conversation about our mutual love for the smell of Christmas trees. Yes, specifically the smell, how else to test cranial nerve I?
After the exam, while emphasizing my lack of knowledge, I told him ‘off the record’ that one of his arteries was bounding more than I would like. I asked him if anyone had ever told him something like that before, he said in fact they had. The finding could have been benign, but after we spoke he agreed it’d be best if he’d go ahead and check it out. He asked for a mole check, did the basic ABCDE, and seemed like just a normal mole — apparently, others he asked were also in agreement. Besides some typical features found with aging, he was perfectly healthy except for a slightly non-malignant high blood pressure that he was concerned about because he’s historically 120/80. He cared about his health, I could appreciate that. We spoke more about that, I asked him more about his substance use, in this case coffee that he remembered drinking (2-3 cups a day). We agreed that at his next visit he’d skip the coffee and then see if he’s back to normal, then take things from their with his doctor.
It’s funny, when I started the exam, I had heard that this is just a dry-run: you just have to speed through the 250-point checklist like they’re a car at Jiffy-Lube. Instead, I was met by a man, a patient who actually was both teaching me and hoping to get a medical benefit from the examination. And for me, that felt a lot more natural: me trying to give him a benefit. I’ll try to remember that as I practice my skills with patients in the coming days.
Today, we just finished our Rheumatology unit, I enjoyed it more than I expected. It was challenging, but a fair unit. During that unit, I went back to refresh myself on medical microbiology (Sketchy Medical, First Aid and UWorld questions). Some days I’m scheduled at a local community health center, we’re farmed out to a lot of places but I was fortunate to pull one that’s easy to get to. We’re now required to have one clinic day where we see patients, where we perform a battery of histories and physical examinations. I’m looking forward to returning to clinic, it does take some time out of my study schedule but it helps to remind me of why I want to do this in the first place. Though, I prefer being in a more intensive setting, so I’m also schedule to hop onto cardiology wards this coming week the day after the health center. As such, I decided to start reviewing cardiology again in my board studying schedule this weekend. Given that I’ve rounded with this attending before, my PI (he’s an Atrial Fibrillation (AF) specialist), I’ll review the basics before I show up: drugs (their indications and side effects in regards to), certain high yield risk analysis scores like the CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk, ECGs, murmurs, etc. With the cardiology team, it’s quite large, and there’s a lot that needs to get done so I don’t expect to be called on or present. But, I feel I should at least put in the effort to understand the answer that my seniors are being politely pimped about; it does seem at least common courtesy. Knowing stuff helps me pretend I know what’s going on, it’s an important strategy.
Tuesday, we start Renal Medicine. Should be a tough course, though it’s pretty much just a down hill slide from here as long as I keep on schedule. Thus, I’m looking forward to it and the patients and experiences I’ll incidentally meet along the way.